Minnesota Legislature
SF 4410
2nd Unofficial Engrossment - 92nd Legislature (2021 - 2022) Posted on 05/04/2022 09:28pm
4.2 4.3
4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 6.1 6.2 6.3 6.4 6.5
6.6
6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15
6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25
6.26 6.27 6.28 6.29 6.30 6.31 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 8.33 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13
9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18
10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 11.1 11.2 11.3 11.4 11.5 11.6 11.7
11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29
11.30 11.31 11.32 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 13.1 13.2 13.3
13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21
13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24
14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 15.32 15.33 15.34 15.35 15.36 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 16.33 16.34 16.35 16.36 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14
17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9
19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18
20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8
21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 21.33 21.34 21.35 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19
22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31
23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17
24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 27.32
28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22
29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30
31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 32.33 32.34 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11
33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29
35.30 35.31 35.32 35.33 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19
36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 36.33 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31
37.32 37.33 37.34 37.35 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10
38.11
38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19
39.20
39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 40.33 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 43.1 43.2 43.3 43.4 43.5
43.6
43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 44.1 44.2 44.3 44.4 44.5 44.6 44.7
44.8
44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19
44.20
44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33
46.1 46.2 46.3 46.4 46.5
46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30
47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 48.1 48.2 48.3 48.4 48.5 48.6 48.7
48.8 48.9 48.10 48.11 48.12
48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29
49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27
49.28 49.29 49.30 49.31 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17
51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10
52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19
55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12
56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23
56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20
57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 57.33 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9
58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31
59.1 59.2 59.3 59.4 59.5
59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31 60.32 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 64.1 64.2 64.3
64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23
67.24 67.25 67.26 67.27 67.28 67.29 67.30 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24
68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 68.33 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10
69.11 69.12 69.13 69.14 69.15
69.16 69.17 69.18 69.19 69.20 69.21
69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26
70.27 70.28 70.29 70.30
71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9
71.10 71.11 71.12 71.13
71.14 71.15 71.16 71.17 71.18 71.19
71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22
72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 73.33 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17
74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25
74.26 74.27 74.28 74.29 74.30 74.31 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32
76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9
76.10 76.11 76.12 76.13 76.14
76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22
76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30
77.1 77.2 77.3 77.4 77.5 77.6 77.7
77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15
77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 78.1 78.2 78.3 78.4 78.5 78.6 78.7
78.8 78.9 78.10 78.11 78.12 78.13
78.14 78.15 78.16 78.17 78.18 78.19
78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11
79.12 79.13 79.14 79.15 79.16 79.17
79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 80.1 80.2 80.3 80.4 80.5
80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23
80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24
81.25 81.26 81.27 81.28 81.29
82.1 82.2 82.3 82.4 82.5 82.6
82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14
82.15 82.16 82.17 82.18 82.19 82.20
82.21 82.22 82.23 82.24 82.25 82.26
82.27 82.28 82.29 82.30 82.31 83.1 83.2
83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 83.32 83.33 83.34 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15
85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 86.1 86.2 86.3
86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17
86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 87.1 87.2
87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17
87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29
88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 88.32 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 89.33 89.34 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 90.32 90.33 90.34 91.1 91.2 91.3
91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13
91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11
92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 93.1 93.2 93.3 93.4 93.5
93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11
95.12 95.13 95.14 95.15 95.16 95.17 95.18
95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23
96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13
97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22
97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 98.1 98.2
98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12
98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23
99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12
101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 102.33 102.34 103.1 103.2 103.3 103.4
103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 103.32 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12
104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27
105.1 105.2
105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18
106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14
107.15 107.16 107.17 107.18
107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27
109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 109.33 109.34 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 110.34 111.1 111.2
111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25
111.26 111.27 111.28 111.29 111.30 111.31 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21
112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10
113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 114.33 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 119.1 119.2 119.3 119.4 119.5
119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10
120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9
121.10
121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 122.1 122.2 122.3 122.4 122.5 122.6
122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16
122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8
123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21
123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10
124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20
124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20
125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30
126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 129.1 129.2 129.3 129.4 129.5 129.6
129.7
129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23
131.24
131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13
132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27
132.28
133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18
134.19
134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15
135.16
135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11
136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13
137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23
137.24 137.25 137.26 137.27
137.28 137.29 137.30 137.31 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26
138.27 138.28 138.29 138.30 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12
139.13 139.14 139.15 139.16 139.17
139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21
140.22 140.23 140.24 140.25 140.26 140.27 140.28
141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23
141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13
142.14 142.15 142.16 142.17 142.18
142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17
143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22
144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 144.33 145.1 145.2 145.3 145.4
145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24
145.25 145.26 145.27 145.28 145.29 145.30 145.31
146.1 146.2
146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13
146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29
147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15
147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16
149.17 149.18 149.19
149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14
150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 151.1 151.2 151.3 151.4 151.5 151.6
151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 152.1 152.2
152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29
153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12
154.13 154.14 154.15 154.16
154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 155.1 155.2 155.3
155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15
155.16 155.17 155.18 155.19 155.20
155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29
156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10
156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 157.1 157.2 157.3 157.4
157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 158.1 158.2 158.3 158.4 158.5
158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31
159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25
159.26 159.27 159.28 159.29 159.30 159.31 159.32 159.33 160.1 160.2 160.3 160.4
160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18
160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26
160.27 160.28 160.29 160.30 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19
161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30
162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14
162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20
163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 164.1 164.2
164.3 164.4 164.5 164.6 164.7
164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27
165.28 165.29 165.30 165.31 165.32 165.33 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 166.33 166.34 167.1 167.2 167.3 167.4 167.5 167.6 167.7
167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24
169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 170.32 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10
171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10
172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22
172.23 172.24 172.25 172.26 172.27 172.28 172.29 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9
174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10
176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19
176.20 176.21 176.22 176.23 176.24 176.25
176.26 176.27
177.1 177.2
177.3 177.4 177.5 177.6 177.7 177.8 177.9
177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13
179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13
180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16
181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23
183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 185.34 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20
186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22
187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30
189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12
189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20
189.21
189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24
193.25
193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26
194.27 194.28 194.29 194.30 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27
195.28
196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 197.1 197.2 197.3
197.4 197.5 197.6
197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17
197.18
197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 198.33 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10
199.11 199.12 199.13 199.14 199.15
199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8
200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24
200.25 200.26 200.27
200.28 200.29 200.30 200.31 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21
202.22 202.23 202.24
202.25 202.26 202.27 202.28 202.29 202.30 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 204.33 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 205.33 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19
207.20
207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13
208.14
208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29
209.1 209.2 209.3 209.4 209.5 209.6 209.7
209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26
209.27
209.28 209.29 209.30 209.31 209.32 210.1 210.2 210.3
210.4 210.5 210.6
210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 210.32 210.33 210.34 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 212.34 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 215.33 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14
216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13
218.14 218.15 218.16
218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19
220.20 220.21 220.22
220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12
223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 224.33 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13
225.14
225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17
226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 228.1 228.2
228.3
228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30
228.31
229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9
229.10
229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30
230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20
230.21
230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14
231.15
231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21
232.22
232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 232.32 232.33 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 233.33 233.34 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22
234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32 235.1 235.2 235.3 235.4 235.5 235.6 235.7
235.8 235.9 235.10 235.11 235.12 235.13 235.14
235.15 235.16 235.17 235.18 235.19 235.20
235.21 235.22 235.23 235.24
235.25 235.26 235.27 235.28 235.29 235.30
236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9
236.10 236.11 236.12 236.13 236.14 236.15
236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26
236.27 236.28 236.29 236.30 236.31 236.32
237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 237.33 237.34 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11
238.12 238.13 238.14 238.15 238.16 238.17 238.18
238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 240.33 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 242.33 242.34 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 243.32 243.33 243.34 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 245.33 245.34 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 246.34 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 247.34 247.35 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29
248.30 248.31 248.32 248.33 248.34 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31
250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26
250.27 250.28 250.29 250.30 250.31 250.32 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21
252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 252.33 252.34
253.1
253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25
253.26
253.27 253.28 253.29 253.30 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9
254.10
254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 254.32 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8
255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 256.1 256.2 256.3 256.4 256.5 256.6
256.7 256.8
256.9
256.10 256.11
256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 257.1 257.2
257.3 257.4 257.5 257.6 257.7 257.8
257.9
257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15
258.16
258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11
259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16
260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 260.33 260.34 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 261.33 261.34 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 262.33 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30
263.31
264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11
266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22
266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21
269.22
269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32
270.1 270.2 270.3 270.4 270.5
270.6 270.7
270.8 270.9 270.10 270.11 270.12 270.13
270.14 270.15
270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11
271.12 271.13
271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26
271.27 271.28
271.29 271.30 271.31 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10
272.11 272.12
272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25
272.26 272.27
272.28 272.29 272.30 272.31 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14
273.15 273.16
273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 275.1 275.2 275.3 275.4 275.5 275.6 275.7
275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 275.32 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22
276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 276.32
277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 278.1 278.2 278.3 278.4
278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28
278.29 278.30 278.31 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13
279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23
279.24 279.25 279.26 279.27 280.1 280.2 280.3 280.4
280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13
280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24
280.25 280.26 280.27 280.28 280.29 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9
281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 283.33
284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 285.1 285.2
285.3
285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 286.32 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 287.33 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31
288.32
289.1 289.2
289.3 289.4
289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23
289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 290.33 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13
291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8
292.9
292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 298.33 298.34 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24
299.25 299.26 299.27 299.28 299.29 299.30 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25
300.26 300.27 300.28 300.29 300.30 300.31 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10
302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14
303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 303.33 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16
304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27
304.28 304.29 304.30 304.31 304.32 304.33 305.1 305.2 305.3 305.4
305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22
305.23 305.24 305.25 305.26 305.27 305.28 305.29 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9
306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24
306.25 306.26 306.27 306.28 306.29 306.30 306.31 307.1 307.2 307.3 307.4 307.5
307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27
308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30
310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 311.1 311.2
311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 312.1 312.2
312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 313.1 313.2
313.3 313.4 313.5 313.6 313.7
313.8 313.9 313.10 313.11
313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26
314.27 314.28 314.29 314.30 314.31 315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17
315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 316.1 316.2 316.3 316.4 316.5 316.6
316.7 316.8 316.9 316.10
316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25
317.26 317.27 317.28 317.29 317.30 318.1 318.2 318.3 318.4 318.5 318.6 318.7
318.8 318.9 318.10 318.11 318.12
318.13 318.14
318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13
319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32
321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2
322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 323.1 323.2
323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18
324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10
326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9
327.10 327.11 327.12 327.13 327.14 327.15
327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28
327.29 327.30 327.31 328.1 328.2
328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16
328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 329.1 329.2 329.3 329.4 329.5
329.6 329.7
329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 330.1 330.2
330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27
331.28 331.29
331.30 331.31 331.32 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 333.1 333.2
333.3
333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24
334.25
334.26 334.27 334.28 334.29 334.30 334.31 334.32 335.1 335.2 335.3 335.4 335.5 335.6
335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 335.33 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31
338.1 338.2 338.3 338.4 338.5
338.6
338.7 338.8 338.9 338.10 338.11 338.12 338.13
338.14
338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9
339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 340.33 340.34 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 341.34 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20
343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 343.32 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 344.33 344.34 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 345.33 345.34 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32 346.33 346.34 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30
348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14
348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18
349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 354.32 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 355.32 355.33 355.34 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 358.33 359.1 359.2 359.3 359.4 359.5
359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 360.33 360.34 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 361.32 361.33 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25
362.26 362.27 362.28 362.29 362.30 362.31 362.32 362.33 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 363.32 363.33 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25
364.26 364.27 364.28 364.29 364.30 364.31 364.32 364.33 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9
366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17
366.18 366.19
366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16
367.17 367.18
367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 367.31 367.32 367.33 368.1 368.2
368.3 368.4
368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12
368.13 368.14
368.15 368.16 368.17 368.18 368.19 368.20
368.21 368.22
368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 369.1 369.2
369.3 369.4
369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31
370.1 370.2
370.3 370.4 370.5 370.6 370.7
370.8
370.9 370.10 370.11 370.12 370.13
370.14
370.15 370.16
370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30
371.31 371.32 371.33
372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29
372.30 372.31 372.32
373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 373.32 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25
375.26 375.27 375.28 375.29 375.30
376.1 376.2 376.3
376.4 376.5 376.6 376.7 376.8
376.9 376.10 376.11
376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27
376.28 376.29 376.30
377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12
377.13 377.14 377.15
377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24
377.25 377.26 377.27
377.28 377.29 377.30 377.31 377.32 377.33 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 379.31 379.32 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30 380.31 380.32 380.33 380.34 381.1 381.2 381.3 381.4 381.5
381.6 381.7 381.8
381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 381.33 381.34 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 382.33 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 383.32 383.33 383.34 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 384.33 384.34 384.35 385.1 385.2 385.3 385.4 385.5 385.6
385.7
385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29
385.30
386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9
386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18
386.19 386.20 386.21 386.22 386.23 386.24
386.25 386.26 386.27
386.28 386.29 386.30 386.31 386.32 387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 388.1 388.2
388.3 388.4 388.5
388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26
389.27 389.28 389.29
390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23
390.24 390.25 390.26
390.27 390.28 390.29 390.30 390.31 390.32 391.1 391.2 391.3
391.4 391.5 391.6
391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27
392.28 392.29 392.30
393.1 393.2 393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 393.31 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8
395.9 395.10 395.11
395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29
396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11
396.12 396.13 396.14
396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17
399.18 399.19 399.20
399.21 399.22 399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 399.31 399.32 399.33 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21
400.22 400.23 400.24
400.25 400.26 400.27 400.28 400.29 400.30 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 402.33 402.34 403.1 403.2
403.3 403.4 403.5 403.6 403.7 403.8
403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26
404.27 404.28 404.29 404.30 404.31 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 405.31 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26
406.27 406.28 406.29
407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 407.32 407.33 407.34 407.35 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 409.31 409.32 409.33 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 410.33 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 411.31 411.32 411.33 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20
412.21 412.22 412.23 412.24 412.25 412.26 412.27 412.28 412.29 412.30 412.31 412.32 412.33 413.1 413.2 413.3 413.4 413.5 413.6 413.7
413.8 413.9 413.10
413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26
414.27 414.28 414.29 414.30 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 415.32 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15
416.16 416.17 416.18
416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32 416.33 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26
418.27 418.28 418.29 418.30 418.31 418.32 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9
421.10 421.11 421.12 421.13 421.14 421.15
421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 422.1 422.2 422.3
422.4 422.5 422.6 422.7
422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25
422.26 422.27 422.28
423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8
423.9
423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10
424.11 424.12 424.13 424.14
424.15 424.16 424.17 424.18
424.19 424.20
424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18
425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14
428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 428.31 428.32 428.33 428.34 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 429.31 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26
430.27 430.28 430.29 430.30 430.31 430.32 430.33 431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8 431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 431.33 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 432.32 432.33 432.34 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25
433.26 433.27 433.28 433.29 433.30 433.31 433.32 434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22
434.23 434.24 434.25
434.26 434.27 434.28 434.29 434.30 434.31 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12
435.13 435.14 435.15
435.16 435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26
435.27 435.28 435.29
436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27
436.28 436.29 436.30
437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28
438.29 438.30 438.31
439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26
439.27 439.28 439.29
440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21
441.22 441.23 441.24
441.25 441.26 441.27 441.28 441.29 441.30 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 442.31
443.1 443.2 443.3
443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17
443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31
444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28
444.29 444.30 444.31
445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31
447.1 447.2 447.3
447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25
448.26 448.27 448.28
449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 450.1 450.2 450.3 450.4 450.5
450.6 450.7 450.8
450.9 450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27
450.28 450.29 450.30
451.1 451.2 451.3 451.4 451.5 451.6 451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28 451.29 451.30 451.31 452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29
453.1 453.2 453.3
453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22
453.23 453.24 453.25
453.26 453.27 453.28 453.29 454.1 454.2 454.3 454.4 454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28 454.29 454.30 454.31 454.32 454.33 454.34 454.35 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28
455.29 455.30 455.31 455.32 455.33 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8
456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16 456.17 456.18 456.19 456.20 456.21
456.22 456.23 456.24
456.25 456.26 456.27 456.28 456.29 456.30 456.31 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26
457.27 457.28 457.29
458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 458.32 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 459.32 459.33 460.1 460.2 460.3
460.4 460.5 460.6
460.7 460.8 460.9 460.10 460.11 460.12 460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18
461.19 461.20 461.21
461.22 461.23 461.24 461.25 461.26
461.27
461.28 461.29 461.30 462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 462.28 462.29 462.30 462.31 463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14 463.15 463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19
465.20
465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 466.1 466.2 466.3 466.4 466.5 466.6 466.7 466.8 466.9 466.10 466.11 466.12
466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28 466.29 466.30 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24 467.25
467.26 467.27 467.28 467.29 467.30 467.31 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26 468.27 468.28 468.29 468.30 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 469.30 469.31 469.32 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24 471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 472.1 472.2 472.3
472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31
473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9
473.10 473.11 473.12 473.13 473.14 473.15 473.16
473.17 473.18 473.19
473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30
474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9
474.10 474.11
474.12 474.13 474.14 474.15 474.16 474.17 474.18
474.19
474.20 474.21 474.22 474.23 474.24
474.25
474.26 474.27 474.28 474.29 474.30 474.31 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 475.32 475.33 475.34 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24
476.25
476.26 476.27 476.28 476.29 476.30 476.31 476.32 476.33 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11
477.12
477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 477.31 477.32 477.33
478.1
478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14
479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24
479.25 479.26 479.27 479.28 479.29 479.30 479.31 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8
480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 480.33 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31 481.32 481.33 481.34
482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 483.1 483.2 483.3 483.4 483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22
483.23 483.24 483.25 483.26 483.27 483.28 483.29 483.30 483.31 484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8
484.9
484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25 485.26 485.27 485.28 485.29 485.30 485.31 485.32 485.33 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10
486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 486.31 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12
487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23 487.24 487.25 487.26 487.27 487.28 487.29 487.30 487.31 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13
488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 488.30 488.31 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13
489.14
489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26 489.27 489.28 489.29 489.30 489.31 489.32 489.33 490.1 490.2 490.3 490.4 490.5 490.6
490.7 490.8 490.9 490.10 490.11 490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25 490.26
490.27 490.28 490.29 490.30 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28 491.29 491.30 491.31 491.32 491.33 492.1 492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13 492.14
492.15 492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27 493.28 493.29 493.30 493.31 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26
494.27 494.28 494.29 494.30 494.31 494.32 495.1 495.2 495.3 495.4
495.5
495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22 495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8 496.9 496.10 496.11
496.12
496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30 497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12
497.13
497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 497.33 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11
498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 499.1 499.2
499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 499.32 499.33 500.1 500.2 500.3 500.4 500.5 500.6 500.7
500.8
500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18
500.19
500.20 500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 500.30 500.31 500.32 501.1 501.2 501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16 501.17 501.18 501.19
501.20
501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28 501.29 501.30 501.31
501.32
502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8
502.9
502.10 502.11 502.12 502.13 502.14 502.15 502.16
502.17
502.18 502.19 502.20 502.21
502.22
502.23 502.24 502.25 502.26
502.27
503.1 503.2 503.3 503.4 503.5 503.6
503.7
503.8 503.9 503.10
503.11
503.12 503.13 503.14 503.15 503.16
503.17
503.18 503.19 503.20 503.21 503.22 503.23
503.24 503.25 503.26
503.27
504.1 504.2 504.3 504.4 504.5
504.6
504.7 504.8 504.9 504.10 504.11
504.12
504.13 504.14 504.15 504.16 504.17 504.18
504.19
504.20 504.21 504.22 504.23 504.24 504.25
504.26
504.27 504.28 504.29 504.30 505.1 505.2 505.3 505.4
505.5
505.6 505.7 505.8 505.9 505.10 505.11
505.12
505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20 505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 505.32 506.1 506.2 506.3 506.4 506.5 506.6
506.7
506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27 506.28 506.29 506.30 506.31 506.32 506.33 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13 507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27
507.28
507.29 507.30 507.31 507.32 507.33 508.1 508.2 508.3 508.4 508.5 508.6
508.7 508.8 508.9 508.10 508.11 508.12
508.13
508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 508.32 509.1 509.2 509.3 509.4 509.5 509.6 509.7 509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20 509.21 509.22 509.23 509.24 509.25 509.26 509.27 509.28 509.29
509.30
510.1 510.2 510.3 510.4 510.5 510.6 510.7 510.8 510.9 510.10 510.11
510.12
510.13 510.14 510.15 510.16 510.17 510.18 510.19 510.20 510.21 510.22 510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30 510.31 510.32 511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15 511.16 511.17 511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26 511.27 511.28 511.29 511.30 511.31 511.32 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10 512.11 512.12 512.13 512.14 512.15 512.16 512.17 512.18 512.19 512.20 512.21 512.22 512.23 512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 512.32 513.1 513.2 513.3 513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25 513.26
513.27
513.28 513.29 513.30 513.31 514.1 514.2
514.3
514.4 514.5 514.6 514.7 514.8
514.9
514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 514.31 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25
515.26
515.27 515.28 515.29 515.30
515.31
516.1 516.2 516.3 516.4 516.5
516.6
516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14 516.15 516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24 516.25 516.26 516.27 516.28 516.29 516.30 517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11
517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22
517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 517.31 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16 518.17 518.18 518.19 518.20 518.21 518.22 518.23 518.24 518.25 518.26 518.27 518.28 518.29 518.30 518.31 519.1 519.2 519.3 519.4 519.5 519.6 519.7 519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30 519.31 520.1 520.2 520.3 520.4 520.5 520.6 520.7 520.8 520.9 520.10 520.11 520.12 520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20 520.21 520.22 520.23 520.24 520.25 520.26 520.27 520.28 520.29 520.30 520.31 521.1 521.2 521.3
521.4 521.5 521.6
521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16 521.17 521.18 521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28 521.29 521.30 521.31 522.1 522.2 522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10 522.11 522.12 522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24 522.25 522.26 522.27 522.28 522.29 522.30 522.31 522.32 522.33 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12
523.13 523.14 523.15 523.16 523.17 523.18 523.19 523.20 523.21 523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 523.30 523.31 523.32 524.1 524.2 524.3 524.4 524.5 524.6 524.7 524.8 524.9 524.10 524.11 524.12 524.13 524.14 524.15 524.16 524.17 524.18 524.19 524.20 524.21 524.22 524.23 524.24 524.25 524.26 524.27 524.28 524.29 524.30 524.31 525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8 525.9 525.10 525.11 525.12 525.13
525.14 525.15 525.16 525.17 525.18 525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29
525.30 525.31 525.32 526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11 526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31 526.32 526.33 526.34 526.35 527.1 527.2 527.3 527.4 527.5 527.6 527.7 527.8 527.9 527.10 527.11 527.12 527.13 527.14 527.15 527.16 527.17
527.18 527.19 527.20 527.21 527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29 527.30 527.31 527.32 528.1 528.2 528.3 528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22 528.23 528.24 528.25 528.26 528.27 528.28 528.29 528.30 528.31 528.32 528.33 529.1 529.2 529.3 529.4 529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12 529.13 529.14 529.15 529.16 529.17 529.18 529.19 529.20 529.21 529.22 529.23 529.24 529.25 529.26 529.27 529.28 529.29 529.30 529.31 529.32 529.33 530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16 530.17 530.18 530.19 530.20 530.21 530.22 530.23 530.24 530.25 530.26 530.27 530.28 530.29
530.30 530.31 530.32 531.1 531.2 531.3 531.4 531.5
531.6
531.7 531.8 531.9 531.10 531.11 531.12 531.13 531.14 531.15 531.16 531.17 531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 531.29 531.30 531.31 531.32 531.33 531.34 532.1 532.2 532.3 532.4 532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12 532.13 532.14 532.15 532.16
532.17 532.18 532.19 532.20 532.21 532.22
532.23 532.24 532.25 532.26 532.27 532.28 532.29 532.30 532.31 532.32 532.33 533.1 533.2 533.3 533.4 533.5 533.6 533.7 533.8 533.9 533.10 533.11 533.12 533.13 533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21 533.22 533.23 533.24 533.25 533.26 533.27 533.28 533.29 533.30 533.31 533.32 533.33 534.1 534.2 534.3
534.4 534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14
534.15 534.16 534.17 534.18 534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28 534.29 534.30 535.1 535.2 535.3 535.4 535.5
535.6 535.7 535.8
535.9 535.10 535.11 535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19 535.20 535.21 535.22 535.23 535.24 535.25 535.26 535.27 535.28 535.29 535.30 535.31 535.32 536.1 536.2 536.3 536.4 536.5 536.6 536.7 536.8 536.9 536.10 536.11 536.12 536.13 536.14 536.15 536.16 536.17 536.18 536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26 536.27 536.28 536.29 536.30 536.31 537.1 537.2 537.3 537.4 537.5 537.6 537.7 537.8 537.9 537.10 537.11 537.12 537.13 537.14 537.15 537.16 537.17
537.18 537.19 537.20
537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 537.32 537.33 538.1 538.2
538.3 538.4 538.5
538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19 538.20 538.21 538.22 538.23
538.24 538.25 538.26
538.27 538.28 538.29 538.30 538.31 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18 539.19 539.20 539.21 539.22 539.23 539.24 539.25 539.26 539.27 539.28 539.29 539.30 539.31 539.32 539.33 540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12
540.13 540.14 540.15
540.16 540.17 540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 540.29 540.30 540.31 541.1 541.2 541.3 541.4 541.5 541.6 541.7
541.8 541.9 541.10
541.11 541.12 541.13 541.14 541.15 541.16
541.17 541.18 541.19
541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29 541.30 541.31 542.1 542.2 542.3 542.4 542.5 542.6 542.7 542.8 542.9 542.10 542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 542.30 542.31 543.1 543.2 543.3 543.4 543.5
543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22
543.23 543.24 543.25 543.26 543.27 543.28 543.29 543.30 543.31 544.1 544.2 544.3 544.4 544.5 544.6 544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18 544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27 544.28 544.29 544.30 544.31 545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8 545.9 545.10 545.11 545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 545.29 545.30 545.31 546.1 546.2 546.3
546.4 546.5 546.6 546.7 546.8 546.9 546.10 546.11 546.12 546.13 546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26 546.27 546.28 546.29 546.30 546.31 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13 547.14 547.15 547.16 547.17 547.18 547.19 547.20 547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 547.30 547.31 547.32 548.1 548.2 548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17
548.18 548.19 548.20
548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 549.1 549.2 549.3 549.4 549.5 549.6 549.7 549.8 549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16 549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25
549.26 549.27 549.28 549.29 549.30 550.1 550.2 550.3 550.4 550.5 550.6 550.7 550.8 550.9 550.10 550.11 550.12 550.13 550.14 550.15 550.16 550.17 550.18 550.19 550.20 550.21
550.22 550.23 550.24 550.25 550.26
550.27 550.28 550.29 550.30 550.31 550.32 550.33 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15 551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29
551.30 551.31 551.32 551.33 551.34 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19 552.20 552.21 552.22 552.23 552.24 552.25 552.26 552.27 552.28 552.29 552.30 552.31 552.32 553.1 553.2
553.3 553.4 553.5 553.6 553.7 553.8 553.9 553.10 553.11 553.12 553.13 553.14 553.15 553.16 553.17 553.18 553.19 553.20 553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 553.31 553.32 553.33 553.34 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16 554.17 554.18 554.19 554.20 554.21 554.22 554.23 554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 554.32 554.33 554.34 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14
555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24 555.25 555.26 555.27 555.28 555.29 555.30 555.31 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14
556.15 556.16 556.17 556.18 556.19 556.20 556.21 556.22 556.23 556.24 556.25
556.26 556.27 556.28 556.29 556.30 556.31 556.32 557.1 557.2 557.3 557.4 557.5 557.6 557.7 557.8 557.9 557.10 557.11 557.12
557.13 557.14 557.15 557.16 557.17 557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25
558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15
558.16 558.17 558.18
558.19 558.20 558.21
558.22 558.23 558.24 558.25 558.26 558.27
559.1 559.2 559.3 559.4 559.5 559.6 559.7 559.8
559.9 559.10 559.11 559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20
559.21 559.22 559.23 559.24 559.25 559.26 559.27 559.28 559.29 559.30 559.31
560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9
560.10 560.11
560.12 560.13 560.14 560.15 560.16 560.17 560.18 560.19 560.20 560.21 560.22 560.23 560.24 560.25 560.26 560.27 560.28 560.29 560.30 561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15 561.16 561.17 561.18 561.19 561.20 561.21
561.22
561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31
562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8 562.9 562.10 562.11 562.12 562.13 562.14 562.15 562.16 562.17 562.18
562.19 562.20 562.21 562.22 562.23
562.24 562.25 562.26 562.27 562.28 562.29 562.30 562.31 562.32 563.1 563.2 563.3 563.4 563.5 563.6
563.7 563.8 563.9 563.10 563.11 563.12 563.13 563.14 563.15 563.16 563.17 563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26 563.27 563.28 563.29 563.30 564.1 564.2
564.3 564.4 564.5
564.6
564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19 564.20 564.21 564.22 564.23
564.24 564.25 564.26 564.27 564.28 564.29 564.30 564.31 564.32 565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12
565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22
565.23 565.24 565.25 565.26 565.27 565.28 565.29 565.30 565.31 565.32 565.33 566.1 566.2
566.3 566.4 566.5 566.6 566.7 566.8 566.9
566.10 566.11 566.12 566.13 566.14 566.15 566.16 566.17
566.18 566.19 566.20 566.21
566.22 566.23 566.24 566.25
566.26 566.27 566.28 566.29 566.30
567.1 567.2 567.3 567.4
567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21 567.22 567.23 567.24 567.25 567.26 567.27
567.28 567.29 567.30 567.31 568.1 568.2 568.3 568.4 568.5 568.6 568.7 568.8 568.9
568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26
568.27 568.28 568.29 568.30 568.31 568.32 569.1 569.2 569.3 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16 569.17 569.18 569.19 569.20 569.21 569.22 569.23 569.24 569.25 569.26 569.27 569.28 569.29 569.30 569.31 569.32 569.33
570.1 570.2 570.3 570.4 570.5 570.6 570.7 570.8 570.9 570.10 570.11 570.12 570.13 570.14 570.15
570.16 570.17 570.18 570.19 570.20 570.21 570.22 570.23 570.24 570.25 570.26 570.27 570.28 570.29
570.30 570.31 570.32 570.33 571.1 571.2 571.3
571.4 571.5 571.6 571.7 571.8 571.9 571.10 571.11 571.12 571.13 571.14 571.15 571.16 571.17 571.18 571.19 571.20 571.21 571.22 571.23
571.24 571.25 571.26 571.27 571.28 571.29 571.30 571.31 571.32
572.1 572.2 572.3 572.4 572.5 572.6 572.7
572.8 572.9 572.10 572.11 572.12 572.13 572.14
572.15 572.16 572.17 572.18 572.19 572.20 572.21 572.22 572.23 572.24 572.25 572.26 572.27 572.28 572.29 572.30 572.31 573.1 573.2 573.3 573.4 573.5 573.6 573.7 573.8 573.9 573.10 573.11 573.12 573.13 573.14 573.15 573.16 573.17 573.18 573.19 573.20 573.21 573.22 573.23 573.24 573.25 573.26 573.27 573.28 573.29 573.30 573.31 573.32 574.1 574.2 574.3 574.4 574.5 574.6 574.7 574.8 574.9 574.10
574.11 574.12 574.13 574.14 574.15 574.16 574.17 574.18 574.19 574.20 574.21 574.22
574.23 574.24 574.25
574.26 574.27
574.28 574.29 574.30 574.31 575.1 575.2 575.3 575.4 575.5 575.6 575.7 575.8 575.9 575.10 575.11 575.12 575.13 575.14 575.15
575.16 575.17 575.18 575.19 575.20 575.21 575.22 575.23 575.24 575.25 575.26 575.27 575.28 575.29 575.30 575.31 575.32 575.33 575.34 575.35 576.1 576.2 576.3 576.4 576.5 576.6
576.7 576.8 576.9 576.10 576.11 576.12 576.13 576.14 576.15 576.16 576.17 576.18 576.19 576.20 576.21 576.22 576.23 576.24 576.25 576.26 576.27 576.28 576.29 576.30 576.31 576.32 577.1 577.2 577.3 577.4 577.5 577.6 577.7 577.8 577.9 577.10
577.11 577.12 577.13 577.14 577.15 577.16 577.17 577.18 577.19 577.20 577.21 577.22 577.23 577.24 577.25 577.26 577.27 577.28 577.29 577.30 577.31 577.32 578.1 578.2 578.3 578.4 578.5 578.6 578.7 578.8 578.9 578.10 578.11 578.12 578.13 578.14 578.15 578.16 578.17 578.18
578.19 578.20 578.21 578.22 578.23 578.24 578.25 578.26 578.27 578.28 578.29 578.30 578.31 578.32 578.33 579.1 579.2 579.3 579.4 579.5 579.6 579.7 579.8 579.9 579.10 579.11 579.12 579.13 579.14 579.15 579.16 579.17 579.18 579.19 579.20 579.21 579.22 579.23 579.24 579.25 579.26 579.27 579.28 579.29 579.30 579.31 579.32 580.1 580.2 580.3 580.4 580.5 580.6 580.7 580.8 580.9 580.10 580.11 580.12 580.13 580.14 580.15 580.16 580.17 580.18 580.19
580.20 580.21 580.22 580.23 580.24 580.25 580.26 580.27 580.28 580.29 580.30 581.1 581.2 581.3 581.4 581.5 581.6 581.7 581.8 581.9 581.10 581.11 581.12 581.13 581.14 581.15 581.16 581.17 581.18 581.19 581.20 581.21 581.22 581.23 581.24 581.25 581.26 581.27 581.28 581.29 581.30 581.31 581.32 582.1 582.2 582.3 582.4 582.5 582.6 582.7 582.8 582.9 582.10 582.11 582.12 582.13 582.14 582.15 582.16 582.17 582.18 582.19 582.20 582.21 582.22 582.23 582.24 582.25 582.26 582.27 582.28 582.29 582.30 582.31 582.32 582.33
583.1 583.2 583.3 583.4 583.5 583.6 583.7 583.8 583.9 583.10 583.11 583.12 583.13 583.14 583.15 583.16 583.17 583.18 583.19 583.20 583.21 583.22 583.23 583.24
583.25 583.26 583.27 583.28 583.29 583.30 583.31 583.32
584.1 584.2 584.3 584.4 584.5 584.6 584.7 584.8 584.9 584.10 584.11 584.12 584.13 584.14 584.15 584.16 584.17 584.18 584.19 584.20 584.21 584.22 584.23 584.24 584.25 584.26 584.27 584.28 584.29 584.30 584.31 584.32 584.33 584.34 585.1 585.2 585.3 585.4 585.5 585.6 585.7
585.8 585.9 585.10 585.11 585.12 585.13 585.14 585.15 585.16 585.17 585.18 585.19 585.20 585.21 585.22 585.23 585.24 585.25 585.26 585.27 585.28 585.29 585.30 585.31 585.32 586.1 586.2 586.3 586.4 586.5 586.6 586.7 586.8 586.9 586.10 586.11 586.12 586.13 586.14 586.15 586.16 586.17 586.18 586.19 586.20 586.21 586.22 586.23 586.24 586.25 586.26 586.27 586.28 586.29 586.30 586.31 586.32 586.33 587.1 587.2 587.3 587.4 587.5 587.6 587.7 587.8 587.9 587.10 587.11 587.12 587.13 587.14 587.15 587.16 587.17 587.18 587.19 587.20 587.21 587.22 587.23 587.24
587.25
587.26 587.27 587.28 587.29 587.30 587.31 587.32 588.1 588.2 588.3 588.4 588.5 588.6 588.7 588.8 588.9 588.10 588.11 588.12 588.13 588.14 588.15 588.16 588.17 588.18 588.19 588.20 588.21 588.22 588.23 588.24 588.25 588.26
588.27
588.28 588.29 588.30 589.1 589.2 589.3
589.4
589.5 589.6 589.7 589.8 589.9 589.10
589.11
589.12 589.13 589.14 589.15 589.16 589.17 589.18 589.19 589.20 589.21 589.22 589.23 589.24 589.25 589.26 589.27
589.28
590.1 590.2 590.3 590.4 590.5 590.6 590.7 590.8 590.9 590.10 590.11 590.12
590.13
590.14 590.15 590.16 590.17 590.18 590.19 590.20 590.21 590.22 590.23 590.24
590.25
590.26 590.27 590.28 590.29 590.30 591.1 591.2
591.3
591.4 591.5 591.6 591.7 591.8 591.9 591.10 591.11 591.12 591.13 591.14 591.15 591.16 591.17 591.18 591.19
591.20
591.21 591.22 591.23 591.24 591.25 591.26
591.27
592.1 592.2 592.3 592.4 592.5 592.6 592.7 592.8 592.9 592.10 592.11 592.12 592.13 592.14 592.15 592.16 592.17 592.18 592.19 592.20 592.21 592.22 592.23 592.24 592.25 592.26 592.27 592.28 592.29 592.30 592.31 592.32 592.33 592.34 593.1 593.2 593.3 593.4 593.5 593.6 593.7 593.8 593.9 593.10 593.11 593.12 593.13 593.14 593.15 593.16 593.17 593.18 593.19 593.20 593.21 593.22 593.23 593.24 593.25 593.26 593.27 593.28 593.29 593.30 593.31 593.32 593.33 593.34 594.1 594.2 594.3 594.4 594.5 594.6 594.7 594.8 594.9 594.10 594.11 594.12 594.13 594.14 594.15 594.16 594.17 594.18 594.19 594.20 594.21 594.22 594.23 594.24 594.25 594.26 594.27 594.28
594.29
595.1 595.2 595.3 595.4 595.5 595.6 595.7 595.8 595.9 595.10 595.11 595.12 595.13 595.14 595.15 595.16 595.17 595.18 595.19 595.20 595.21 595.22 595.23 595.24 595.25 595.26 595.27 595.28 596.1 596.2 596.3 596.4 596.5 596.6 596.7 596.8 596.9 596.10 596.11 596.12 596.13 596.14 596.15 596.16 596.17 596.18 596.19 596.20 596.21 596.22 596.23 596.24 596.25 596.26 596.27 596.28 596.29 597.1 597.2
597.3
597.4 597.5 597.6 597.7 597.8 597.9 597.10 597.11 597.12 597.13 597.14 597.15
597.16
597.17 597.18 597.19 597.20 597.21 597.22 597.23 597.24 597.25 597.26 597.27 597.28 597.29 598.1 598.2 598.3 598.4 598.5 598.6 598.7 598.8 598.9 598.10 598.11 598.12 598.13 598.14 598.15 598.16 598.17 598.18 598.19 598.20 598.21 598.22 598.23 598.24 598.25 598.26 598.27 598.28 598.29 598.30 599.1 599.2 599.3 599.4 599.5 599.6 599.7 599.8 599.9 599.10 599.11 599.12 599.13 599.14 599.15 599.16 599.17 599.18 599.19 599.20 599.21 599.22 599.23 599.24 599.25 599.26 599.27 599.28 599.29 599.30 600.1 600.2 600.3 600.4 600.5 600.6 600.7 600.8 600.9 600.10 600.11 600.12 600.13 600.14 600.15 600.16 600.17 600.18 600.19 600.20 600.21 600.22 600.23 600.24 600.25 600.26 600.27 600.28 600.29 600.30 601.1 601.2 601.3 601.4 601.5 601.6 601.7 601.8 601.9 601.10 601.11 601.12 601.13 601.14 601.15 601.16 601.17 601.18 601.19
601.20
601.21 601.22 601.23 601.24 601.25 601.26 601.27 601.28 601.29
602.1 602.2 602.3
602.4 602.5 602.6
602.7 602.8 602.9 602.10 602.11 602.12 602.13 602.14 602.15 602.16
602.17 602.18
602.19
602.20 602.21
602.22 602.23 602.24 602.25 602.26 602.27 602.28 602.29 603.1 603.2 603.3 603.4 603.5 603.6 603.7 603.8 603.9 603.10 603.11 603.12 603.13 603.14 603.15 603.16 603.17 603.18 603.19 603.20 603.21 603.22 603.23 603.24 603.25 603.26 603.27 603.28 603.29 603.30 603.31 603.32 604.1 604.2 604.3 604.4 604.5 604.6 604.7 604.8 604.9 604.10 604.11 604.12 604.13 604.14 604.15 604.16 604.17 604.18 604.19 604.20 604.21 604.22 604.23 604.24 604.25 604.26 604.27 604.28 604.29 604.30 604.31 604.32 604.33 605.1 605.2 605.3 605.4 605.5 605.6 605.7 605.8 605.9 605.10 605.11 605.12 605.13 605.14 605.15 605.16 605.17 605.18 605.19 605.20 605.21 605.22 605.23 605.24 605.25 605.26 605.27 605.28 605.29 605.30 605.31 605.32 605.33 606.1 606.2 606.3 606.4 606.5 606.6 606.7 606.8 606.9 606.10 606.11 606.12 606.13 606.14 606.15 606.16 606.17 606.18 606.19 606.20 606.21 606.22 606.23 606.24 606.25 606.26 606.27 606.28 606.29 606.30 607.1 607.2 607.3 607.4 607.5 607.6 607.7 607.8 607.9 607.10 607.11 607.12 607.13 607.14 607.15
607.16 607.17 607.18 607.19 607.20 607.21 607.22 607.23 607.24 607.25 607.26 607.27 607.28 607.29 607.30 607.31 607.32 607.33 608.1 608.2 608.3 608.4 608.5 608.6 608.7 608.8 608.9 608.10
608.11 608.12 608.13 608.14 608.15 608.16
608.17 608.18 608.19 608.20 608.21 608.22 608.23 608.24 608.25 608.26 608.27 608.28
608.29 608.30 608.31 608.32 609.1 609.2 609.3 609.4
609.5 609.6 609.7 609.8 609.9 609.10 609.11 609.12 609.13 609.14 609.15 609.16 609.17 609.18 609.19 609.20 609.21 609.22 609.23 609.24 609.25 609.26 609.27 609.28 609.29 609.30
610.1 610.2 610.3 610.4 610.5 610.6 610.7 610.8 610.9 610.10 610.11 610.12 610.13 610.14
610.15 610.16 610.17 610.18 610.19 610.20 610.21 610.22 610.23 610.24 610.25 610.26 610.27 610.28 610.29 610.30 610.31 610.32 610.33 611.1 611.2 611.3 611.4 611.5 611.6 611.7 611.8 611.9 611.10 611.11 611.12 611.13 611.14 611.15 611.16 611.17 611.18 611.19 611.20 611.21 611.22 611.23 611.24 611.25 611.26 611.27 611.28 611.29 611.30 611.31 611.32 611.33 611.34 612.1 612.2 612.3 612.4 612.5 612.6 612.7 612.8 612.9 612.10 612.11 612.12 612.13 612.14 612.15 612.16 612.17 612.18 612.19 612.20 612.21 612.22 612.23 612.24 612.25 612.26 612.27 612.28 612.29 612.30 612.31 612.32 613.1 613.2 613.3 613.4 613.5 613.6 613.7 613.8 613.9 613.10 613.11 613.12 613.13 613.14 613.15 613.16 613.17 613.18 613.19 613.20 613.21 613.22 613.23 613.24 613.25 613.26 613.27 613.28 613.29 613.30 613.31 613.32
614.1 614.2 614.3 614.4 614.5 614.6 614.7 614.8 614.9 614.10
614.11 614.12 614.13 614.14 614.15 614.16 614.17 614.18 614.19 614.20 614.21 614.22 614.23 614.24 614.25 614.26 614.27 614.28 614.29 614.30 614.31 614.32 614.33 615.1 615.2 615.3 615.4 615.5 615.6 615.7 615.8 615.9 615.10 615.11 615.12 615.13 615.14 615.15 615.16 615.17 615.18 615.19 615.20 615.21 615.22 615.23 615.24 615.25 615.26 615.27 615.28 615.29 615.30 615.31 615.32 615.33
616.1 616.2 616.3 616.4 616.5 616.6 616.7 616.8 616.9 616.10 616.11 616.12 616.13 616.14 616.15 616.16 616.17 616.18 616.19 616.20 616.21 616.22 616.23 616.24 616.25 616.26 616.27 616.28 616.29 616.30 616.31 617.1 617.2 617.3 617.4 617.5 617.6 617.7 617.8 617.9 617.10 617.11 617.12 617.13 617.14 617.15 617.16 617.17 617.18 617.19 617.20 617.21 617.22 617.23 617.24 617.25 617.26 617.27 617.28 617.29 617.30 617.31 617.32 617.33 617.34 618.1 618.2 618.3 618.4 618.5 618.6 618.7 618.8 618.9 618.10 618.11 618.12 618.13 618.14 618.15 618.16 618.17 618.18 618.19 618.20 618.21 618.22 618.23 618.24 618.25 618.26 618.27 618.28 618.29 618.30 618.31 618.32 619.1 619.2 619.3 619.4 619.5 619.6 619.7 619.8 619.9 619.10 619.11 619.12 619.13 619.14 619.15 619.16 619.17 619.18 619.19 619.20 619.21 619.22 619.23 619.24 619.25 619.26 619.27 619.28 619.29 619.30 619.31 619.32
620.1 620.2 620.3 620.4 620.5 620.6 620.7 620.8 620.9 620.10 620.11 620.12 620.13 620.14 620.15 620.16 620.17 620.18 620.19 620.20 620.21 620.22 620.23 620.24 620.25 620.26 620.27 620.28 620.29 620.30 620.31 620.32 620.33 621.1 621.2 621.3 621.4 621.5 621.6 621.7 621.8 621.9 621.10 621.11 621.12 621.13 621.14 621.15 621.16 621.17 621.18 621.19 621.20 621.21 621.22 621.23 621.24 621.25 621.26 621.27 621.28 621.29 621.30 621.31 621.32 621.33 622.1 622.2 622.3 622.4 622.5 622.6 622.7 622.8
622.9 622.10 622.11 622.12 622.13 622.14 622.15 622.16 622.17 622.18 622.19 622.20 622.21 622.22 622.23 622.24 622.25 622.26 622.27 622.28 622.29 622.30 622.31 622.32 622.33 622.34 623.1 623.2 623.3 623.4 623.5 623.6 623.7
623.8 623.9 623.10 623.11 623.12 623.13 623.14 623.15 623.16 623.17 623.18 623.19 623.20 623.21 623.22 623.23 623.24 623.25 623.26 623.27 623.28 623.29 623.30 623.31 623.32 624.1 624.2 624.3 624.4 624.5 624.6 624.7 624.8 624.9 624.10 624.11 624.12 624.13 624.14 624.15 624.16 624.17 624.18 624.19 624.20 624.21 624.22 624.23 624.24 624.25 624.26 624.27 624.28 624.29 624.30 624.31 625.1 625.2 625.3 625.4 625.5 625.6 625.7 625.8 625.9 625.10 625.11 625.12
625.13 625.14 625.15 625.16 625.17 625.18 625.19 625.20 625.21 625.22 625.23 625.24 625.25 625.26 625.27 625.28 625.29 625.30 626.1 626.2 626.3 626.4 626.5 626.6 626.7 626.8 626.9 626.10 626.11 626.12 626.13 626.14 626.15 626.16 626.17 626.18 626.19 626.20 626.21 626.22 626.23 626.24 626.25 626.26 626.27 626.28 626.29 626.30 626.31 626.32 626.33 627.1 627.2 627.3 627.4 627.5 627.6 627.7 627.8 627.9 627.10 627.11 627.12 627.13 627.14 627.15 627.16 627.17 627.18 627.19 627.20 627.21
627.22 627.23 627.24 627.25 627.26 627.27 627.28 627.29 627.30 627.31 627.32 627.33 628.1 628.2 628.3 628.4 628.5 628.6 628.7 628.8 628.9 628.10 628.11 628.12 628.13 628.14 628.15 628.16 628.17 628.18 628.19 628.20 628.21 628.22 628.23 628.24 628.25 628.26 628.27 628.28 628.29 628.30 628.31 629.1 629.2 629.3 629.4 629.5 629.6 629.7 629.8 629.9 629.10 629.11 629.12 629.13 629.14 629.15 629.16 629.17 629.18 629.19 629.20 629.21 629.22 629.23 629.24 629.25 629.26 629.27 629.28 629.29 629.30 629.31 629.32 629.33 629.34 630.1 630.2 630.3 630.4 630.5 630.6 630.7 630.8 630.9 630.10 630.11 630.12 630.13 630.14 630.15 630.16 630.17 630.18 630.19 630.20 630.21 630.22 630.23 630.24 630.25 630.26 630.27 630.28 630.29 630.30 630.31 630.32 631.1 631.2 631.3 631.4 631.5 631.6 631.7 631.8 631.9 631.10 631.11 631.12 631.13 631.14 631.15 631.16 631.17 631.18 631.19 631.20 631.21 631.22 631.23 631.24 631.25 631.26 631.27 631.28 631.29 631.30 631.31 632.1 632.2 632.3 632.4 632.5 632.6 632.7 632.8 632.9 632.10 632.11 632.12 632.13 632.14 632.15 632.16 632.17 632.18 632.19 632.20 632.21 632.22 632.23 632.24 632.25 632.26 632.27 632.28 632.29 632.30 632.31 632.32 632.33
633.1 633.2 633.3 633.4 633.5 633.6 633.7 633.8 633.9 633.10 633.11 633.12 633.13 633.14 633.15 633.16 633.17 633.18 633.19 633.20 633.21 633.22 633.23 633.24 633.25 633.26 633.27 633.28 633.29 633.30 634.1 634.2 634.3 634.4 634.5 634.6 634.7 634.8 634.9 634.10 634.11 634.12 634.13 634.14 634.15 634.16 634.17 634.18 634.19 634.20 634.21 634.22 634.23 634.24 634.25 634.26 634.27 634.28 634.29 634.30 634.31 634.32 634.33
635.1 635.2 635.3 635.4 635.5 635.6 635.7 635.8 635.9 635.10 635.11 635.12 635.13 635.14 635.15 635.16 635.17 635.18 635.19 635.20 635.21 635.22 635.23 635.24 635.25 635.26 635.27 635.28 635.29 635.30 635.31 635.32 635.33 636.1 636.2 636.3 636.4 636.5 636.6 636.7 636.8 636.9 636.10 636.11 636.12 636.13 636.14 636.15 636.16 636.17 636.18 636.19 636.20 636.21 636.22 636.23 636.24 636.25 636.26 636.27 636.28 636.29 636.30 636.31 636.32 636.33 637.1 637.2 637.3 637.4 637.5 637.6 637.7 637.8 637.9 637.10 637.11 637.12 637.13 637.14 637.15 637.16 637.17 637.18 637.19 637.20 637.21 637.22 637.23 637.24 637.25 637.26 637.27 637.28 637.29 637.30 637.31 637.32 637.33 638.1 638.2 638.3 638.4 638.5 638.6 638.7 638.8 638.9 638.10 638.11 638.12 638.13 638.14 638.15 638.16 638.17 638.18 638.19 638.20 638.21 638.22 638.23 638.24 638.25 638.26 638.27 638.28 638.29 638.30 638.31 639.1 639.2 639.3 639.4 639.5 639.6 639.7 639.8 639.9 639.10 639.11 639.12 639.13 639.14 639.15 639.16 639.17 639.18 639.19 639.20 639.21 639.22 639.23 639.24 639.25 639.26 639.27 639.28 639.29 639.30 639.31 639.32 639.33 640.1 640.2 640.3 640.4 640.5 640.6 640.7 640.8 640.9 640.10 640.11 640.12 640.13 640.14 640.15 640.16 640.17 640.18 640.19 640.20 640.21 640.22 640.23 640.24 640.25 640.26 640.27 640.28 640.29 640.30 640.31 640.32 640.33 641.1 641.2 641.3 641.4 641.5 641.6 641.7 641.8 641.9 641.10 641.11 641.12 641.13 641.14 641.15 641.16 641.17 641.18 641.19 641.20 641.21 641.22 641.23 641.24 641.25 641.26 641.27 641.28 641.29 641.30 641.31
642.1 642.2 642.3 642.4 642.5 642.6 642.7 642.8 642.9 642.10 642.11 642.12 642.13 642.14 642.15 642.16 642.17
642.18 642.19 642.20 642.21 642.22 642.23 642.24 642.25 642.26 642.27 642.28 642.29 642.30 642.31 642.32 642.33 643.1 643.2 643.3 643.4 643.5 643.6 643.7 643.8 643.9 643.10 643.11 643.12 643.13 643.14 643.15 643.16 643.17 643.18 643.19 643.20 643.21 643.22 643.23 643.24 643.25 643.26 643.27 643.28 643.29 643.30 644.1 644.2 644.3 644.4 644.5 644.6 644.7 644.8 644.9 644.10 644.11 644.12 644.13 644.14 644.15 644.16 644.17 644.18 644.19 644.20 644.21 644.22
644.23 644.24 644.25 644.26 644.27 644.28 644.29 644.30 644.31 645.1 645.2 645.3 645.4 645.5
645.6 645.7 645.8 645.9 645.10 645.11 645.12 645.13 645.14 645.15 645.16 645.17 645.18 645.19 645.20 645.21
645.22 645.23 645.24 645.25 645.26 645.27 645.28 645.29 645.30 645.31 645.32 646.1 646.2 646.3 646.4 646.5 646.6 646.7 646.8 646.9 646.10 646.11 646.12 646.13 646.14 646.15 646.16 646.17 646.18 646.19 646.20 646.21 646.22 646.23 646.24 646.25 646.26 646.27 646.28 646.29 646.30 646.31 646.32 646.33 647.1 647.2 647.3 647.4 647.5 647.6 647.7 647.8 647.9 647.10 647.11 647.12 647.13 647.14 647.15 647.16 647.17 647.18 647.19 647.20 647.21 647.22 647.23 647.24 647.25 647.26 647.27 647.28 647.29 647.30 647.31 647.32 647.33 648.1 648.2 648.3 648.4 648.5
648.6 648.7 648.8 648.9 648.10 648.11 648.12 648.13 648.14 648.15 648.16 648.17 648.18 648.19 648.20 648.21 648.22 648.23
648.24 648.25 648.26 648.27 648.28 648.29 648.30 648.31 648.32 649.1 649.2
649.3 649.4 649.5 649.6 649.7 649.8 649.9 649.10 649.11 649.12 649.13 649.14 649.15 649.16 649.17 649.18 649.19 649.20 649.21 649.22 649.23 649.24 649.25 649.26 649.27 649.28 649.29 649.30 649.31
650.1 650.2 650.3 650.4 650.5 650.6 650.7 650.8 650.9 650.10 650.11 650.12
650.13 650.14 650.15 650.16 650.17 650.18 650.19
650.20 650.21 650.22 650.23 650.24 650.25 650.26 650.27 650.28 650.29 650.30 650.31 650.32 651.1 651.2 651.3 651.4 651.5 651.6 651.7 651.8 651.9 651.10 651.11 651.12 651.13 651.14 651.15 651.16 651.17 651.18 651.19 651.20 651.21 651.22 651.23 651.24 651.25
651.26 651.27 651.28 651.29 651.30 651.31 651.32 651.33 652.1 652.2 652.3 652.4 652.5 652.6 652.7 652.8 652.9 652.10 652.11 652.12 652.13 652.14 652.15
652.16 652.17 652.18 652.19 652.20 652.21 652.22 652.23 652.24 652.25 652.26 652.27 652.28 652.29 652.30 652.31 652.32 652.33 653.1 653.2 653.3 653.4 653.5 653.6 653.7 653.8 653.9 653.10 653.11 653.12 653.13 653.14 653.15 653.16 653.17 653.18 653.19 653.20 653.21 653.22 653.23 653.24 653.25 653.26 653.27 653.28 653.29 654.1 654.2 654.3 654.4 654.5 654.6 654.7 654.8 654.9 654.10 654.11 654.12 654.13 654.14 654.15 654.16 654.17 654.18 654.19 654.20 654.21 654.22 654.23 654.24
654.25 654.26 654.27 654.28 654.29 654.30 654.31 654.32 655.1 655.2 655.3 655.4 655.5 655.6 655.7 655.8 655.9 655.10 655.11 655.12 655.13
655.14 655.15 655.16 655.17 655.18 655.19 655.20 655.21 655.22 655.23 655.24 655.25 655.26 655.27 655.28 655.29 655.30 655.31 655.32 655.33 656.1 656.2 656.3 656.4 656.5 656.6 656.7 656.8 656.9 656.10 656.11 656.12 656.13 656.14 656.15 656.16 656.17 656.18 656.19 656.20 656.21 656.22 656.23 656.24 656.25 656.26 656.27 656.28 656.29 656.30 656.31 656.32 657.1 657.2 657.3 657.4 657.5 657.6 657.7 657.8 657.9 657.10 657.11 657.12 657.13 657.14 657.15 657.16 657.17 657.18 657.19 657.20 657.21 657.22 657.23 657.24 657.25 657.26 657.27 657.28 657.29 657.30 657.31 657.32 657.33 657.34 657.35 658.1 658.2 658.3 658.4 658.5 658.6 658.7 658.8 658.9 658.10 658.11 658.12 658.13 658.14 658.15 658.16 658.17 658.18 658.19 658.20 658.21 658.22 658.23 658.24 658.25 658.26 658.27 658.28 658.29 658.30 658.31 658.32 659.1 659.2 659.3 659.4 659.5 659.6 659.7 659.8
659.9 659.10 659.11 659.12 659.13 659.14 659.15 659.16 659.17 659.18 659.19 659.20 659.21 659.22 659.23 659.24 659.25 659.26 659.27 659.28 659.29 659.30 659.31 659.32 659.33 659.34 660.1 660.2 660.3 660.4 660.5 660.6 660.7 660.8 660.9 660.10 660.11 660.12 660.13 660.14 660.15 660.16 660.17 660.18 660.19 660.20 660.21 660.22 660.23 660.24 660.25 660.26 660.27 660.28 660.29 660.30 660.31 660.32 660.33 660.34 660.35 661.1 661.2 661.3 661.4 661.5 661.6 661.7 661.8 661.9 661.10 661.11 661.12 661.13 661.14 661.15 661.16 661.17 661.18 661.19 661.20 661.21 661.22 661.23 661.24 661.25 661.26 661.27 661.28 661.29 661.30 661.31 661.32 661.33 661.34 662.1 662.2 662.3 662.4 662.5 662.6 662.7 662.8 662.9 662.10 662.11 662.12 662.13
662.14 662.15 662.16 662.17 662.18 662.19 662.20 662.21 662.22 662.23 662.24 662.25 662.26 662.27 662.28 662.29 662.30 662.31 662.32 662.33 662.34 663.1 663.2 663.3 663.4 663.5 663.6 663.7 663.8 663.9 663.10 663.11 663.12 663.13 663.14 663.15 663.16 663.17 663.18 663.19 663.20 663.21 663.22 663.23 663.24 663.25 663.26 663.27 663.28 663.29 663.30 663.31 663.32 663.33 664.1 664.2 664.3 664.4 664.5 664.6 664.7 664.8 664.9 664.10 664.11 664.12 664.13 664.14
664.15 664.16 664.17 664.18 664.19 664.20 664.21 664.22 664.23 664.24 664.25 664.26 664.27 664.28 664.29 664.30 664.31 665.1 665.2 665.3 665.4 665.5 665.6 665.7 665.8 665.9 665.10 665.11 665.12 665.13 665.14 665.15
665.16 665.17 665.18 665.19 665.20 665.21 665.22 665.23 665.24 665.25 665.26 665.27 665.28 665.29 665.30 665.31 666.1 666.2 666.3 666.4 666.5 666.6 666.7 666.8 666.9 666.10 666.11 666.12 666.13 666.14 666.15 666.16 666.17 666.18 666.19 666.20 666.21 666.22 666.23 666.24 666.25 666.26 666.27 666.28 666.29 666.30 667.1 667.2 667.3 667.4 667.5 667.6 667.7 667.8 667.9 667.10 667.11 667.12 667.13 667.14 667.15 667.16 667.17 667.18 667.19 667.20 667.21 667.22 667.23 667.24 667.25 667.26 667.27 667.28 667.29 667.30 667.31 667.32 668.1 668.2 668.3 668.4 668.5 668.6 668.7 668.8 668.9 668.10 668.11 668.12 668.13 668.14 668.15 668.16 668.17 668.18 668.19 668.20 668.21 668.22 668.23 668.24 668.25 668.26 668.27 668.28 668.29 668.30
668.31 668.32 668.33 669.1 669.2 669.3 669.4
669.5 669.6 669.7 669.8 669.9 669.10 669.11 669.12 669.13 669.14
669.15 669.16 669.17 669.18 669.19 669.20 669.21 669.22 669.23 669.24 669.25 669.26 669.27 669.28 669.29 669.30 669.31 670.1 670.2 670.3 670.4 670.5 670.6 670.7 670.8 670.9 670.10 670.11 670.12 670.13 670.14 670.15 670.16 670.17 670.18 670.19 670.20 670.21 670.22 670.23 670.24 670.25 670.26 670.27 670.28 670.29 670.30 670.31 670.32 670.33 671.1 671.2 671.3 671.4 671.5 671.6 671.7
671.8 671.9 671.10 671.11 671.12
671.13 671.14 671.15 671.16 671.17 671.18 671.19 671.20 671.21 671.22 671.23 671.24 671.25 671.26 671.27 671.28 671.29 671.30 672.1 672.2 672.3 672.4 672.5 672.6 672.7 672.8 672.9 672.10 672.11 672.12 672.13 672.14 672.15 672.16 672.17 672.18 672.19 672.20 672.21 672.22 672.23 672.24 672.25 672.26 672.27 672.28 672.29 672.30 672.31 672.32 673.1 673.2 673.3 673.4 673.5 673.6 673.7 673.8 673.9 673.10 673.11 673.12 673.13 673.14 673.15 673.16 673.17 673.18 673.19 673.20
673.21 673.22
673.23 673.24 673.25 673.26 673.27 673.28 673.29 673.30 673.31 673.32 674.1 674.2 674.3 674.4 674.5 674.6 674.7 674.8 674.9 674.10 674.11 674.12 674.13 674.14 674.15 674.16 674.17 674.18 674.19 674.20
674.21 674.22 674.23 674.24 674.25 674.26 674.27 674.28 674.29 674.30 674.31 674.32 674.33 674.34 675.1 675.2 675.3 675.4 675.5 675.6 675.7 675.8 675.9 675.10 675.11 675.12 675.13 675.14 675.15 675.16 675.17 675.18 675.19 675.20 675.21 675.22 675.23 675.24 675.25 675.26 675.27
675.28 675.29 675.30 675.31 675.32 675.33 675.34 676.1 676.2 676.3 676.4 676.5 676.6 676.7 676.8 676.9 676.10 676.11 676.12 676.13 676.14 676.15 676.16 676.17 676.18 676.19 676.20 676.21 676.22 676.23 676.24 676.25 676.26 676.27 676.28 676.29 676.30 676.31 676.32 676.33 676.34 677.1 677.2 677.3 677.4 677.5 677.6 677.7 677.8 677.9 677.10 677.11 677.12 677.13 677.14 677.15 677.16 677.17 677.18 677.19 677.20 677.21 677.22 677.23 677.24 677.25 677.26 677.27 677.28 677.29 677.30
678.1 678.2 678.3 678.4 678.5 678.6 678.7 678.8 678.9 678.10 678.11 678.12 678.13 678.14 678.15 678.16 678.17 678.18 678.19 678.20 678.21 678.22 678.23 678.24 678.25 678.26 678.27 678.28 678.29 678.30 678.31
679.1 679.2 679.3 679.4 679.5 679.6 679.7 679.8 679.9 679.10 679.11 679.12 679.13 679.14 679.15 679.16 679.17 679.18 679.19 679.20 679.21 679.22 679.23 679.24 679.25 679.26 679.27 679.28 679.29 679.30 679.31 679.32 679.33 679.34 680.1 680.2 680.3 680.4 680.5 680.6 680.7 680.8 680.9 680.10 680.11 680.12 680.13 680.14 680.15 680.16 680.17 680.18 680.19 680.20 680.21 680.22 680.23 680.24 680.25 680.26 680.27 680.28 680.29 680.30 680.31 680.32 680.33 681.1 681.2 681.3 681.4 681.5 681.6 681.7 681.8
681.9 681.10 681.11 681.12 681.13 681.14 681.15 681.16 681.17 681.18 681.19 681.20 681.21 681.22 681.23 681.24 681.25 681.26
681.27 681.28 681.29 681.30 681.31 681.32 681.33 682.1 682.2 682.3
682.4 682.5 682.6 682.7 682.8 682.9 682.10 682.11 682.12 682.13 682.14
682.15 682.16 682.17 682.18 682.19 682.20 682.21 682.22 682.23 682.24 682.25 682.26 682.27 682.28 682.29 682.30 682.31 683.1 683.2 683.3 683.4 683.5 683.6 683.7 683.8 683.9 683.10 683.11
683.12 683.13 683.14 683.15 683.16 683.17 683.18 683.19 683.20 683.21 683.22 683.23 683.24 683.25
683.26 683.27 683.28 683.29 683.30 683.31 683.32
684.1 684.2 684.3 684.4 684.5 684.6 684.7 684.8 684.9 684.10 684.11
684.12 684.13 684.14 684.15 684.16 684.17 684.18 684.19 684.20 684.21 684.22 684.23 684.24 684.25 684.26 684.27 684.28 684.29 684.30 685.1 685.2 685.3 685.4 685.5 685.6
685.7 685.8 685.9 685.10 685.11 685.12 685.13 685.14
685.15 685.16 685.17 685.18 685.19 685.20 685.21 685.22 685.23 685.24
685.25 685.26 685.27 685.28 685.29 685.30 685.31 686.1 686.2 686.3 686.4 686.5 686.6 686.7 686.8 686.9 686.10 686.11 686.12 686.13 686.14 686.15 686.16 686.17 686.18 686.19 686.20
686.21 686.22 686.23 686.24 686.25 686.26 686.27
686.28 686.29 686.30 686.31 687.1 687.2 687.3 687.4 687.5 687.6 687.7 687.8 687.9 687.10 687.11 687.12 687.13 687.14 687.15 687.16 687.17 687.18 687.19 687.20 687.21 687.22 687.23 687.24 687.25 687.26
687.27 687.28 687.29 687.30 687.31 687.32
688.1 688.2 688.3 688.4 688.5 688.6 688.7
688.8 688.9 688.10 688.11 688.12
688.13 688.14 688.15 688.16 688.17 688.18 688.19 688.20 688.21 688.22 688.23 688.24 688.25 688.26 688.27 688.28 688.29 688.30 688.31 689.1 689.2 689.3 689.4 689.5 689.6 689.7 689.8 689.9 689.10
689.11 689.12 689.13 689.14 689.15 689.16 689.17 689.18 689.19 689.20 689.21 689.22 689.23 689.24 689.25 689.26 689.27 689.28 689.29 689.30 689.31 689.32 690.1 690.2 690.3 690.4
690.5 690.6 690.7 690.8 690.9 690.10 690.11 690.12 690.13 690.14 690.15 690.16 690.17 690.18 690.19 690.20 690.21 690.22 690.23 690.24 690.25 690.26 690.27 690.28 690.29 690.30 690.31 691.1 691.2 691.3 691.4 691.5 691.6 691.7 691.8 691.9 691.10 691.11 691.12 691.13 691.14 691.15 691.16 691.17 691.18 691.19
691.20 691.21
691.22 691.23 691.24 691.25 691.26 691.27 691.28 691.29 691.30 691.31 692.1 692.2 692.3 692.4 692.5 692.6 692.7 692.8 692.9 692.10 692.11 692.12 692.13 692.14 692.15 692.16 692.17 692.18 692.19 692.20
692.21 692.22 692.23 692.24 692.25 692.26 692.27 692.28 692.29 692.30 692.31 693.1 693.2 693.3 693.4 693.5 693.6 693.7 693.8 693.9 693.10 693.11 693.12 693.13 693.14 693.15 693.16 693.17 693.18 693.19 693.20 693.21 693.22 693.23 693.24 693.25 693.26 693.27 693.28
694.1 694.2 694.3 694.4 694.5 694.6 694.7 694.8 694.9 694.10 694.11 694.12 694.13 694.14 694.15 694.16 694.17 694.18 694.19 694.20 694.21 694.22 694.23 694.24 694.25 694.26 694.27 694.28 694.29 694.30 694.31 694.32 695.1 695.2 695.3 695.4 695.5 695.6 695.7 695.8 695.9 695.10 695.11 695.12 695.13 695.14 695.15 695.16 695.17 695.18 695.19 695.20 695.21 695.22 695.23 695.24 695.25 695.26 695.27 695.28 695.29 695.30 695.31 695.32 695.33
696.1 696.2 696.3 696.4 696.5 696.6 696.7 696.8 696.9 696.10 696.11 696.12 696.13 696.14
696.15 696.16
696.17 696.18
696.19 696.20 696.21 696.22 696.23 696.24 696.25 696.26 696.27 696.28 696.29 696.30 696.31 696.32 697.1 697.2 697.3 697.4 697.5
697.6 697.7 697.8 697.9 697.10 697.11 697.12 697.13 697.14 697.15 697.16 697.17 697.18 697.19 697.20 697.21 697.22 697.23 697.24 697.25 697.26 697.27 697.28
697.29
698.1 698.2 698.3 698.4
698.5
698.6 698.7 698.8 698.9 698.10 698.11 698.12
698.13 698.14 698.15 698.16 698.17 698.18 698.19
698.20
698.21 698.22 698.23 698.24 698.25 698.26 698.27 698.28 698.29 698.30
698.31
699.1 699.2 699.3 699.4 699.5 699.6 699.7 699.8 699.9 699.10 699.11 699.12 699.13 699.14 699.15 699.16 699.17 699.18 699.19 699.20 699.21 699.22 699.23
699.24 699.25 699.26 699.27 699.28 699.29 699.30 699.31 699.32 699.33 700.1 700.2 700.3 700.4 700.5 700.6 700.7 700.8 700.9 700.10 700.11 700.12 700.13 700.14
700.15 700.16 700.17 700.18 700.19 700.20 700.21 700.22 700.23 700.24 700.25 700.26 700.27 700.28 700.29 700.30 701.1
701.2
701.3 701.4 701.5 701.6 701.7 701.8 701.9 701.10 701.11 701.12 701.13 701.14 701.15 701.16 701.17 701.18 701.19 701.20 701.21 701.22 701.23 701.24 701.25 701.26 701.27 701.28 701.29 701.30 701.31 701.32 702.1 702.2 702.3 702.4 702.5 702.6 702.7 702.8
702.9 702.10 702.11 702.12
702.13
702.14 702.15 702.16 702.17 702.18 702.19 702.20 702.21 702.22 702.23 702.24
702.25
702.26 702.27 702.28 702.29 702.30 702.31 703.1 703.2 703.3 703.4 703.5 703.6 703.7 703.8 703.9 703.10 703.11
703.12
703.13 703.14 703.15 703.16 703.17 703.18 703.19 703.20 703.21 703.22 703.23
703.24 703.25 703.26 703.27
703.28
703.29 703.30 704.1 704.2 704.3 704.4
704.5
704.6 704.7 704.8 704.9 704.10 704.11 704.12 704.13 704.14 704.15 704.16 704.17 704.18 704.19 704.20 704.21 704.22 704.23 704.24 704.25 704.26
704.27
704.28 704.29 704.30 705.1 705.2 705.3 705.4 705.5 705.6 705.7 705.8 705.9 705.10 705.11 705.12 705.13 705.14 705.15 705.16 705.17 705.18 705.19 705.20 705.21 705.22 705.23 705.24
705.25
705.26 705.27 705.28 705.29 705.30 705.31 706.1 706.2 706.3 706.4 706.5 706.6 706.7 706.8 706.9 706.10 706.11 706.12 706.13
706.14 706.15
706.16 706.17 706.18 706.19 706.20 706.21
706.22
706.23 706.24 706.25 706.26 706.27 706.28
706.29
707.1 707.2 707.3 707.4 707.5 707.6 707.7 707.8 707.9 707.10 707.11 707.12 707.13 707.14 707.15 707.16 707.17 707.18 707.19 707.20 707.21
707.22
707.23 707.24 707.25 707.26 707.27 707.28 707.29 707.30
707.31
708.1 708.2 708.3 708.4 708.5 708.6 708.7 708.8 708.9 708.10 708.11 708.12 708.13 708.14 708.15 708.16 708.17 708.18 708.19 708.20 708.21 708.22
708.23
708.24 708.25 708.26 708.27
708.28
709.1 709.2 709.3 709.4 709.5 709.6 709.7 709.8 709.9 709.10 709.11 709.12 709.13 709.14 709.15 709.16 709.17 709.18 709.19 709.20 709.21 709.22 709.23
709.24
709.25 709.26 709.27 709.28 709.29 709.30 710.1
710.2
710.3 710.4 710.5 710.6 710.7 710.8 710.9 710.10 710.11 710.12 710.13 710.14 710.15 710.16 710.17 710.18 710.19 710.20 710.21 710.22 710.23 710.24 710.25 710.26 710.27 710.28 710.29 711.1 711.2 711.3 711.4 711.5 711.6 711.7 711.8 711.9 711.10 711.11 711.12 711.13 711.14 711.15 711.16 711.17
711.18 711.19
711.20 711.21 711.22 711.23 711.24
711.25
711.26 711.27 711.28 711.29 711.30
712.1
712.2 712.3 712.4 712.5 712.6 712.7 712.8 712.9 712.10 712.11
712.12
712.13 712.14 712.15 712.16 712.17 712.18 712.19 712.20 712.21 712.22 712.23 712.24 712.25 712.26 712.27 712.28 712.29 712.30 712.31 713.1 713.2 713.3 713.4 713.5 713.6 713.7 713.8 713.9 713.10 713.11 713.12 713.13 713.14 713.15 713.16 713.17 713.18 713.19 713.20 713.21 713.22 713.23 713.24 713.25 713.26 713.27 713.28 713.29 713.30 714.1 714.2 714.3 714.4 714.5 714.6
714.7 714.8
714.9 714.10 714.11 714.12 714.13 714.14 714.15 714.16
714.17
714.18 714.19 714.20 714.21 714.22 714.23 714.24 714.25 714.26 714.27 714.28 714.29 714.30 715.1 715.2 715.3 715.4
715.5
715.6 715.7 715.8 715.9 715.10 715.11 715.12 715.13 715.14 715.15 715.16 715.17
715.18
715.19 715.20 715.21 715.22 715.23 715.24 715.25 715.26 715.27 715.28 715.29 715.30 716.1 716.2 716.3
716.4
716.5 716.6 716.7 716.8 716.9 716.10 716.11 716.12 716.13 716.14
716.15
716.16 716.17 716.18 716.19 716.20 716.21 716.22 716.23 716.24 716.25 716.26 716.27 716.28 716.29 716.30 716.31 717.1 717.2 717.3 717.4 717.5 717.6 717.7 717.8 717.9 717.10
717.11
717.12 717.13 717.14 717.15 717.16 717.17 717.18 717.19 717.20 717.21 717.22 717.23 717.24 717.25 717.26 717.27 717.28 717.29 717.30 717.31 717.32 717.33 718.1 718.2 718.3 718.4 718.5 718.6 718.7 718.8 718.9 718.10 718.11
718.12 718.13 718.14 718.15 718.16 718.17 718.18 718.19 718.20 718.21 718.22 718.23 718.24 718.25 718.26 718.27 718.28 718.29 718.30 718.31 719.1 719.2 719.3 719.4 719.5 719.6 719.7 719.8 719.9 719.10 719.11 719.12 719.13 719.14 719.15 719.16 719.17 719.18 719.19 719.20 719.21 719.22 719.23 719.24 719.25 719.26 719.27 719.28 719.29 719.30 719.31 720.1 720.2 720.3 720.4 720.5 720.6 720.7 720.8
720.9 720.10 720.11 720.12 720.13 720.14 720.15 720.16 720.17 720.18 720.19 720.20 720.21 720.22 720.23 720.24 720.25 720.26 720.27 720.28 720.29 720.30
720.31 720.32
721.1 721.2 721.3 721.4 721.5 721.6
721.7 721.8 721.9 721.10
721.11 721.12
721.13 721.14 721.15 721.16 721.17 721.18 721.19 721.20 721.21 721.22 721.23 721.24 721.25 721.26 721.27 721.28 721.29 721.30 721.31 722.1 722.2 722.3 722.4 722.5 722.6 722.7 722.8 722.9 722.10 722.11 722.12 722.13 722.14 722.15 722.16 722.17 722.18 722.19 722.20 722.21 722.22 722.23 722.24 722.25 722.26 722.27 722.28 722.29 722.30 722.31 722.32 722.33 723.1 723.2 723.3 723.4
723.5 723.6 723.7 723.8 723.9 723.10 723.11 723.12 723.13 723.14 723.15 723.16 723.17 723.18 723.19 723.20 723.21 723.22 723.23 723.24 723.25
723.26 723.27 723.28 723.29 723.30 723.31 723.32 724.1 724.2 724.3 724.4 724.5 724.6 724.7 724.8 724.9 724.10 724.11 724.12 724.13 724.14 724.15 724.16 724.17 724.18 724.19 724.20 724.21 724.22 724.23 724.24 724.25 724.26 724.27 724.28 724.29 724.30 724.31 724.32 724.33 724.34 725.1 725.2 725.3 725.4 725.5 725.6 725.7 725.8 725.9 725.10 725.11 725.12 725.13 725.14 725.15 725.16 725.17 725.18 725.19 725.20 725.21 725.22 725.23 725.24 725.25 725.26 725.27 725.28 725.29 725.30 725.31 725.32 725.33 726.1 726.2 726.3 726.4 726.5 726.6 726.7 726.8 726.9
726.10 726.11 726.12
726.13 726.14
726.15 726.16 726.17 726.18 726.19
726.20 726.21 726.22 726.23 726.24 726.25 726.26 726.27 726.28 726.29 726.30 726.31
727.1 727.2 727.3 727.4 727.5 727.6 727.7 727.8 727.9 727.10 727.11 727.12
727.13 727.14 727.15 727.16 727.17 727.18 727.19 727.20 727.21 727.22 727.23 727.24 727.25 727.26 727.27 727.28 727.29 727.30
728.1 728.2 728.3 728.4 728.5 728.6 728.7 728.8 728.9 728.10
728.11 728.12 728.13 728.14 728.15 728.16 728.17 728.18 728.19 728.20
728.21 728.22 728.23 728.24 728.25 728.26
728.27 728.28 728.29 729.1 729.2 729.3
729.4 729.5 729.6 729.7 729.8 729.9 729.10 729.11 729.12 729.13 729.14 729.15 729.16 729.17 729.18 729.19 729.20 729.21 729.22 729.23 729.24 729.25 729.26 729.27 729.28 729.29 729.30 729.31 730.1 730.2 730.3 730.4
730.5
730.6 730.7
730.8 730.9 730.10 730.11 730.12 730.13 730.14 730.15 730.16 730.17 730.18 730.19 730.20 730.21 730.22 730.23 730.24 730.25 730.26 730.27 730.28 730.29 730.30 731.1 731.2 731.3 731.4 731.5 731.6 731.7 731.8 731.9 731.10 731.11 731.12 731.13 731.14 731.15 731.16 731.17
731.18
731.19 731.20 731.21 731.22 731.23 731.24 731.25 731.26 731.27 731.28 731.29 731.30 732.1 732.2 732.3 732.4 732.5 732.6 732.7 732.8 732.9 732.10 732.11 732.12 732.13 732.14 732.15 732.16 732.17 732.18 732.19 732.20 732.21 732.22 732.23 732.24 732.25 732.26 732.27 732.28 732.29
732.30
732.31 732.32 732.33 732.34 733.1 733.2 733.3 733.4 733.5 733.6 733.7 733.8 733.9 733.10 733.11 733.12 733.13 733.14 733.15 733.16 733.17 733.18 733.19 733.20 733.21 733.22 733.23 733.24 733.25 733.26 733.27 733.28 733.29 733.30 733.31 733.32 733.33 733.34 733.35 733.36 734.1 734.2 734.3 734.4 734.5 734.6 734.7 734.8 734.9 734.10 734.11 734.12 734.13 734.14 734.15 734.16 734.17 734.18 734.19 734.20 734.21 734.22
734.23 734.24 734.25 734.26 734.27 734.28 734.29 734.30 734.31 734.32 735.1 735.2 735.3 735.4 735.5 735.6 735.7 735.8 735.9 735.10 735.11 735.12 735.13 735.14 735.15 735.16 735.17 735.18 735.19 735.20 735.21 735.22 735.23 735.24 735.25 735.26 735.27 735.28 735.29 735.30 735.31 735.32 735.33 735.34 736.1 736.2 736.3 736.4 736.5 736.6 736.7 736.8 736.9 736.10 736.11 736.12 736.13 736.14 736.15 736.16 736.17 736.18 736.19 736.20 736.21 736.22 736.23 736.24 736.25 736.26 736.27 736.28 736.29 736.30 736.31 736.32 736.33 737.1 737.2 737.3 737.4 737.5 737.6 737.7 737.8 737.9 737.10 737.11 737.12 737.13 737.14
737.15 737.16 737.17 737.18 737.19 737.20 737.21 737.22 737.23 737.24 737.25 737.26 737.27 737.28 737.29 737.30 737.31 737.32 737.33 738.1 738.2 738.3 738.4 738.5 738.6 738.7 738.8 738.9 738.10 738.11 738.12 738.13 738.14 738.15 738.16 738.17 738.18 738.19 738.20 738.21 738.22 738.23 738.24 738.25 738.26 738.27 738.28 738.29 738.30 738.31 738.32 739.1 739.2 739.3 739.4 739.5 739.6 739.7 739.8 739.9 739.10 739.11 739.12 739.13 739.14 739.15 739.16 739.17 739.18 739.19 739.20 739.21 739.22 739.23 739.24 739.25 739.26 739.27 739.28 739.29 739.30 739.31 739.32 740.1 740.2 740.3 740.4 740.5
740.6
740.7 740.8 740.9 740.10 740.11 740.12 740.13 740.14 740.15 740.16 740.17 740.18 740.19 740.20 740.21 740.22 740.23 740.24 740.25 740.26 740.27 740.28 740.29 740.30 740.31 740.32 740.33 741.1 741.2 741.3 741.4 741.5 741.6 741.7 741.8 741.9 741.10 741.11 741.12 741.13 741.14 741.15 741.16 741.17 741.18 741.19 741.20 741.21 741.22 741.23 741.24 741.25 741.26 741.27 741.28 741.29
741.30
742.1 742.2 742.3 742.4 742.5 742.6 742.7 742.8 742.9 742.10 742.11 742.12 742.13 742.14 742.15 742.16 742.17 742.18 742.19 742.20 742.21 742.22 742.23 742.24 742.25 742.26 742.27 742.28 742.29 742.30 742.31 742.32 742.33 743.1 743.2 743.3 743.4 743.5 743.6 743.7 743.8 743.9 743.10 743.11 743.12 743.13 743.14 743.15 743.16 743.17 743.18 743.19 743.20 743.21
743.22
743.23 743.24 743.25 743.26 743.27 743.28 743.29 743.30 743.31 743.32 744.1 744.2 744.3 744.4 744.5 744.6 744.7 744.8 744.9 744.10 744.11 744.12 744.13 744.14 744.15 744.16 744.17 744.18 744.19 744.20 744.21 744.22 744.23 744.24 744.25 744.26 744.27 744.28 744.29 744.30 745.1 745.2 745.3 745.4
745.5
745.6 745.7 745.8 745.9 745.10 745.11 745.12 745.13 745.14 745.15 745.16 745.17 745.18 745.19 745.20 745.21 745.22 745.23 745.24 745.25 745.26 745.27 745.28 745.29 745.30 746.1 746.2 746.3 746.4 746.5 746.6 746.7 746.8 746.9 746.10 746.11 746.12 746.13 746.14 746.15 746.16 746.17 746.18 746.19 746.20 746.21 746.22 746.23 746.24 746.25 746.26 746.27 746.28 746.29 746.30 746.31 747.1 747.2 747.3 747.4 747.5 747.6 747.7 747.8 747.9 747.10 747.11 747.12 747.13
747.14 747.15 747.16 747.17 747.18 747.19 747.20 747.21 747.22 747.23 747.24 747.25
747.26
747.27 747.28 747.29 747.30 748.1 748.2 748.3 748.4 748.5 748.6 748.7 748.8 748.9 748.10 748.11 748.12 748.13 748.14 748.15 748.16 748.17 748.18 748.19 748.20 748.21 748.22 748.23 748.24 748.25 748.26 748.27 748.28 748.29 748.30 748.31 748.32
749.1
749.2 749.3 749.4 749.5
749.6
749.7 749.8 749.9 749.10 749.11 749.12 749.13 749.14 749.15 749.16 749.17 749.18 749.19 749.20 749.21 749.22 749.23 749.24 749.25 749.26 749.27 749.28 749.29 750.1 750.2
750.3
750.4 750.5 750.6 750.7 750.8 750.9
750.10
750.11 750.12 750.13 750.14 750.15 750.16 750.17 750.18 750.19 750.20 750.21 750.22 750.23 750.24 750.25 750.26 750.27
750.28
751.1 751.2 751.3 751.4 751.5 751.6 751.7 751.8 751.9 751.10 751.11 751.12 751.13 751.14 751.15 751.16 751.17 751.18 751.19 751.20 751.21 751.22 751.23 751.24 751.25 751.26 751.27 751.28 751.29 751.30
751.31
752.1 752.2 752.3 752.4 752.5 752.6 752.7 752.8 752.9 752.10 752.11 752.12 752.13 752.14 752.15 752.16 752.17 752.18 752.19 752.20 752.21 752.22 752.23 752.24 752.25 752.26 752.27 752.28 752.29 752.30 752.31 753.1 753.2 753.3 753.4 753.5 753.6 753.7 753.8 753.9 753.10 753.11 753.12 753.13 753.14 753.15 753.16
753.17
753.18 753.19 753.20 753.21 753.22 753.23 753.24 753.25 753.26 753.27 753.28 753.29 753.30 753.31 754.1 754.2 754.3 754.4 754.5
754.6
754.7 754.8 754.9 754.10 754.11 754.12 754.13 754.14 754.15 754.16 754.17 754.18
754.19
754.20 754.21 754.22 754.23 754.24 754.25 754.26 754.27
754.28
754.29 754.30 754.31 755.1 755.2 755.3 755.4 755.5 755.6 755.7 755.8 755.9 755.10 755.11 755.12 755.13 755.14 755.15 755.16 755.17 755.18 755.19 755.20 755.21 755.22 755.23 755.24 755.25 755.26 755.27 755.28 755.29 755.30 755.31 755.32 756.1 756.2 756.3 756.4
756.5
756.6 756.7 756.8 756.9 756.10 756.11 756.12 756.13 756.14 756.15 756.16 756.17 756.18 756.19 756.20 756.21 756.22 756.23 756.24 756.25 756.26 756.27 756.28
756.29
757.1 757.2 757.3 757.4 757.5 757.6 757.7 757.8 757.9 757.10 757.11 757.12 757.13 757.14 757.15 757.16 757.17 757.18 757.19 757.20 757.21 757.22
757.23
757.24 757.25 757.26 757.27 757.28 757.29 757.30 757.31 757.32
758.1
758.2 758.3 758.4 758.5 758.6 758.7 758.8 758.9 758.10 758.11 758.12 758.13
758.14 758.15 758.16 758.17 758.18 758.19 758.20 758.21 758.22
758.23
758.24 758.25 758.26 758.27 758.28 758.29 758.30 758.31 758.32 759.1 759.2
759.3
759.4 759.5 759.6 759.7 759.8 759.9 759.10 759.11 759.12 759.13 759.14 759.15 759.16 759.17 759.18 759.19 759.20 759.21 759.22 759.23
759.24
759.25 759.26 759.27 759.28
759.29
760.1 760.2
760.3 760.4 760.5 760.6 760.7 760.8 760.9 760.10 760.11 760.12 760.13 760.14 760.15 760.16 760.17 760.18 760.19 760.20 760.21 760.22 760.23 760.24 760.25 760.26 760.27 760.28 760.29 760.30 760.31 761.1 761.2 761.3
761.4
761.5 761.6 761.7 761.8 761.9 761.10 761.11 761.12 761.13 761.14 761.15 761.16 761.17 761.18 761.19 761.20 761.21 761.22 761.23 761.24 761.25 761.26 761.27 761.28 761.29 761.30 761.31 761.32 761.33 762.1 762.2 762.3 762.4 762.5 762.6 762.7 762.8 762.9 762.10 762.11 762.12 762.13 762.14 762.15 762.16 762.17 762.18 762.19 762.20 762.21 762.22 762.23 762.24 762.25 762.26 762.27 762.28 762.29 762.30 762.31
762.32
763.1 763.2 763.3 763.4 763.5 763.6 763.7 763.8 763.9 763.10 763.11 763.12 763.13 763.14 763.15 763.16 763.17 763.18 763.19 763.20 763.21 763.22 763.23 763.24 763.25 763.26 763.27 763.28 763.29 763.30 763.31 763.32 763.33 763.34
764.1
764.2 764.3 764.4 764.5 764.6 764.7 764.8 764.9 764.10 764.11 764.12 764.13 764.14 764.15 764.16
764.17
764.18 764.19 764.20 764.21 764.22 764.23 764.24 764.25 764.26 764.27 764.28 764.29 764.30 764.31 764.32 765.1 765.2 765.3 765.4
765.5
765.6 765.7 765.8 765.9 765.10 765.11 765.12 765.13 765.14 765.15 765.16 765.17 765.18 765.19 765.20 765.21 765.22 765.23 765.24 765.25 765.26 765.27 765.28 765.29 765.30 765.31 765.32 765.33 766.1 766.2 766.3 766.4 766.5 766.6 766.7 766.8 766.9 766.10 766.11 766.12 766.13 766.14 766.15 766.16
766.17
766.18 766.19 766.20 766.21 766.22 766.23 766.24 766.25 766.26 766.27 766.28 766.29 766.30 766.31 766.32 767.1 767.2 767.3 767.4 767.5 767.6 767.7 767.8 767.9 767.10 767.11 767.12 767.13 767.14 767.15
767.16
767.17 767.18 767.19 767.20 767.21 767.22 767.23 767.24 767.25 767.26 767.27 767.28 767.29 767.30 767.31 767.32 768.1 768.2 768.3 768.4 768.5 768.6
768.7
768.8 768.9 768.10 768.11 768.12 768.13 768.14 768.15 768.16 768.17 768.18 768.19 768.20 768.21 768.22 768.23 768.24 768.25 768.26 768.27 768.28 768.29 768.30 768.31 768.32 769.1 769.2 769.3 769.4 769.5 769.6 769.7 769.8 769.9 769.10 769.11 769.12 769.13 769.14 769.15 769.16 769.17 769.18 769.19 769.20 769.21 769.22 769.23 769.24 769.25 769.26 769.27 769.28 769.29 769.30 769.31 769.32 769.33 769.34 770.1 770.2 770.3 770.4 770.5 770.6 770.7 770.8 770.9 770.10 770.11 770.12 770.13 770.14 770.15 770.16 770.17 770.18 770.19 770.20 770.21 770.22 770.23 770.24 770.25 770.26 770.27 770.28 770.29 770.30 770.31 770.32 771.1 771.2 771.3
771.4
771.5 771.6 771.7 771.8 771.9 771.10 771.11 771.12 771.13 771.14 771.15 771.16 771.17 771.18
771.19
771.20 771.21 771.22 771.23 771.24 771.25 771.26 771.27 771.28 771.29 771.30 771.31
771.32
772.1 772.2
772.3 772.4 772.5 772.6 772.7 772.8 772.9 772.10 772.11
772.12
772.13 772.14 772.15 772.16 772.17 772.18 772.19 772.20 772.21
772.22
772.23 772.24 772.25 772.26 772.27 772.28 772.29 772.30 772.31 772.32 773.1 773.2 773.3 773.4 773.5 773.6 773.7 773.8 773.9 773.10 773.11 773.12 773.13 773.14 773.15 773.16 773.17
773.18
773.19 773.20 773.21 773.22 773.23 773.24 773.25 773.26 773.27 773.28 773.29 773.30 773.31 773.32 773.33 774.1 774.2 774.3 774.4 774.5 774.6 774.7 774.8 774.9 774.10 774.11
774.12
774.13 774.14 774.15 774.16 774.17 774.18 774.19 774.20 774.21 774.22 774.23 774.24 774.25 774.26 774.27 774.28 774.29 774.30 774.31 775.1 775.2 775.3 775.4 775.5 775.6 775.7 775.8 775.9 775.10 775.11 775.12 775.13 775.14 775.15 775.16 775.17 775.18 775.19 775.20 775.21 775.22 775.23 775.24 775.25 775.26 775.27 775.28 775.29 775.30 775.31 775.32 776.1 776.2 776.3 776.4 776.5
776.6 776.7 776.8 776.9 776.10 776.11 776.12 776.13 776.14 776.15 776.16 776.17 776.18 776.19 776.20 776.21 776.22 776.23 776.24 776.25 776.26 776.27 776.28 776.29 776.30 776.31
777.1 777.2 777.3
777.4
777.5 777.6 777.7 777.8 777.9 777.10 777.11
777.12 777.13 777.14 777.15 777.16 777.17 777.18 777.19 777.20 777.21 777.22 777.23 777.24 777.25 777.26 777.27 777.28 777.29 777.30 777.31
778.1 778.2 778.3 778.4 778.5 778.6 778.7 778.8 778.9 778.10 778.11 778.12
778.13 778.14 778.15 778.16 778.17 778.18 778.19 778.20 778.21 778.22 778.23
778.24 778.25 778.26 778.27 778.28
779.1 779.2 779.3 779.4 779.5 779.6 779.7 779.8 779.9 779.10 779.11 779.12 779.13 779.14 779.15 779.16 779.17 779.18 779.19 779.20 779.21 779.22 779.23 779.24 779.25 779.26 779.27 779.28 779.29 780.1 780.2 780.3 780.4 780.5
780.6 780.7 780.8 780.9 780.10 780.11 780.12 780.13 780.14 780.15 780.16 780.17 780.18 780.19 780.20 780.21
780.22 780.23 780.24 780.25 780.26 780.27 780.28 780.29 780.30 781.1 781.2 781.3 781.4 781.5 781.6 781.7 781.8 781.9 781.10 781.11 781.12
781.13 781.14 781.15 781.16 781.17 781.18 781.19 781.20 781.21 781.22 781.23 781.24 781.25 781.26 781.27 781.28 781.29 781.30 781.31 781.32 781.33 782.1 782.2 782.3 782.4 782.5
782.6 782.7 782.8
782.9 782.10
782.11 782.12 782.13 782.14 782.15 782.16
782.17 782.18 782.19 782.20 782.21 782.22 782.23 782.24 782.25 782.26 782.27 782.28 782.29 782.30 782.31 783.1 783.2 783.3 783.4 783.5 783.6 783.7 783.8 783.9 783.10 783.11 783.12 783.13 783.14 783.15 783.16 783.17 783.18 783.19 783.20 783.21 783.22 783.23 783.24 783.25 783.26 783.27 783.28 783.29 783.30 783.31 784.1 784.2 784.3 784.4 784.5 784.6 784.7 784.8 784.9 784.10 784.11 784.12 784.13 784.14 784.15 784.16 784.17 784.18 784.19 784.20 784.21 784.22 784.23 784.24 784.25 784.26 784.27 784.28 784.29 784.30 784.31 784.32 784.33 785.1 785.2 785.3 785.4 785.5 785.6 785.7 785.8 785.9 785.10 785.11 785.12 785.13 785.14 785.15 785.16 785.17 785.18 785.19 785.20 785.21 785.22 785.23 785.24 785.25 785.26 785.27 785.28 785.29 785.30 785.31 785.32 786.1 786.2
786.3 786.4 786.5 786.6 786.7 786.8 786.9 786.10 786.11 786.12 786.13 786.14 786.15 786.16 786.17 786.18 786.19 786.20 786.21 786.22 786.23 786.24 786.25
786.26 786.27 786.28 786.29 786.30 787.1 787.2 787.3 787.4
787.5 787.6 787.7 787.8 787.9 787.10 787.11 787.12 787.13 787.14 787.15 787.16 787.17 787.18 787.19 787.20 787.21
787.22 787.23 787.24 787.25 787.26 787.27 787.28 787.29 787.30 787.31 788.1 788.2 788.3 788.4 788.5 788.6 788.7 788.8
788.9 788.10 788.11 788.12 788.13 788.14 788.15 788.16 788.17 788.18 788.19 788.20 788.21 788.22 788.23 788.24 788.25 788.26 788.27 788.28 788.29 788.30 788.31 788.32 789.1 789.2 789.3 789.4
789.5 789.6 789.7 789.8 789.9 789.10 789.11 789.12 789.13 789.14 789.15 789.16 789.17 789.18 789.19 789.20 789.21 789.22 789.23 789.24 789.25 789.26 789.27 789.28 789.29 789.30 789.31 790.1 790.2 790.3 790.4 790.5 790.6 790.7 790.8 790.9 790.10
790.11 790.12 790.13 790.14 790.15 790.16 790.17 790.18 790.19 790.20 790.21 790.22 790.23 790.24 790.25 790.26 790.27 790.28 790.29 790.30 790.31 791.1 791.2 791.3
791.4 791.5 791.6 791.7 791.8 791.9 791.10 791.11 791.12 791.13 791.14 791.15 791.16 791.17 791.18 791.19 791.20 791.21 791.22 791.23 791.24 791.25
791.26 791.27
791.28 791.29 791.30 791.31 792.1 792.2 792.3 792.4 792.5 792.6 792.7 792.8 792.9 792.10 792.11 792.12 792.13 792.14 792.15 792.16 792.17 792.18 792.19 792.20 792.21 792.22 792.23 792.24 792.25 792.26 792.27 792.28 793.1 793.2 793.3 793.4 793.5 793.6 793.7 793.8 793.9 793.10 793.11 793.12 793.13 793.14 793.15 793.16 793.17 793.18 793.19 793.20 793.21 793.22 793.23 793.24 793.25 793.26 793.27 794.1 794.2 794.3 794.4 794.5 794.6 794.7 794.8 794.9 794.10 794.11 794.12 794.13 794.14 794.15 794.16 794.17 794.18 794.19 794.20 794.21 794.22 794.23 794.24 794.25 794.26 794.27 794.28 794.29 795.1 795.2 795.3 795.4 795.5 795.6 795.7 795.8 795.9 795.10 795.11 795.12 795.13 795.14 795.15 795.16 795.17 795.18 795.19 795.20 795.21 795.22 795.23 795.24 795.25 795.26 795.27 795.28 795.29 795.30 796.1 796.2 796.3 796.4 796.5 796.6 796.7 796.8 796.9 796.10 796.11 796.12 796.13 796.14 796.15 796.16 796.17 796.18 796.19 796.20 796.21 796.22 796.23 796.24 796.25 796.26 796.27 796.28 797.1 797.2 797.3 797.4 797.5 797.6 797.7 797.8 797.9 797.10 797.11 797.12 797.13 797.14 797.15 797.16 797.17 797.18 797.19 797.20 797.21 797.22 797.23 797.24 797.25 797.26 797.27 798.1 798.2 798.3 798.4 798.5 798.6 798.7 798.8 798.9 798.10 798.11 798.12 798.13 798.14 798.15 798.16 798.17 798.18 798.19 798.20 798.21 798.22 798.23 798.24 798.25 798.26 798.27 799.1 799.2 799.3 799.4 799.5 799.6 799.7 799.8 799.9 799.10 799.11 799.12 799.13 799.14 799.15 799.16 799.17 799.18 799.19 799.20 799.21 799.22 799.23 799.24 799.25 799.26 799.27 799.28 799.29 799.30 800.1 800.2 800.3 800.4 800.5 800.6 800.7 800.8 800.9 800.10 800.11 800.12 800.13 800.14 800.15 800.16 800.17 800.18 800.19 800.20 800.21 800.22 800.23 800.24 800.25 800.26 800.27 800.28 801.1 801.2 801.3 801.4 801.5 801.6 801.7 801.8 801.9 801.10 801.11 801.12 801.13 801.14 801.15 801.16 801.17 801.18 801.19 801.20 801.21 801.22 801.23 801.24 801.25 801.26 801.27 801.28 802.1 802.2 802.3 802.4 802.5 802.6 802.7 802.8 802.9 802.10 802.11 802.12 802.13 802.14 802.15 802.16 802.17 802.18 802.19 802.20 802.21 802.22 802.23 802.24 802.25 802.26 802.27 802.28 802.29 802.30 802.31 803.1 803.2 803.3 803.4 803.5 803.6 803.7 803.8 803.9 803.10 803.11 803.12 803.13 803.14 803.15 803.16 803.17 803.18 803.19 803.20 803.21 803.22 803.23 803.24 803.25 803.26 803.27 803.28 803.29 803.30 803.31 803.32 803.33 804.1 804.2 804.3 804.4 804.5 804.6 804.7 804.8 804.9 804.10 804.11 804.12 804.13 804.14 804.15 804.16 804.17 804.18 804.19 804.20 804.21 804.22 804.23 804.24 804.25 804.26 804.27 804.28 804.29 804.30 805.1 805.2 805.3 805.4 805.5 805.6 805.7 805.8 805.9 805.10 805.11 805.12 805.13 805.14 805.15 805.16 805.17 805.18 805.19 805.20 805.21 805.22 805.23 805.24 805.25 805.26 805.27 805.28 805.29 805.30 806.1 806.2 806.3 806.4 806.5 806.6 806.7 806.8 806.9 806.10 806.11 806.12 806.13 806.14 806.15 806.16 806.17 806.18 806.19 806.20 806.21 806.22 806.23 806.24 806.25 806.26
806.27 806.28
806.29 806.30 807.1 807.2 807.3 807.4 807.5 807.6 807.7 807.8 807.9 807.10 807.11 807.12 807.13 807.14 807.15 807.16 807.17 807.18 807.19 807.20 807.21 807.22 807.23 807.24 807.25 807.26 807.27 807.28 808.1 808.2 808.3 808.4 808.5 808.6 808.7 808.8 808.9 808.10 808.11 808.12 808.13 808.14 808.15 808.16 808.17 808.18 808.19 808.20 808.21 808.22 808.23 808.24 808.25 808.26 808.27 808.28 808.29 808.30 809.1 809.2 809.3 809.4 809.5 809.6 809.7 809.8 809.9 809.10 809.11 809.12 809.13 809.14 809.15 809.16 809.17 809.18 809.19 809.20 809.21 809.22 809.23 809.24 809.25 809.26 809.27 810.1 810.2 810.3 810.4 810.5 810.6 810.7 810.8 810.9 810.10 810.11 810.12 810.13 810.14 810.15 810.16 810.17 810.18 810.19 810.20 810.21 810.22 810.23 810.24 810.25 810.26 810.27 810.28
810.29 810.30
811.1 811.2 811.3 811.4
811.5 811.6 811.7 811.8
811.9 811.10 811.11 811.12 811.13 811.14 811.15 811.16 811.17 811.18 811.19 811.20 811.21 811.22
811.23 811.24 811.25 811.26 811.27 811.28 811.29 811.30 812.1 812.2
812.3 812.4 812.5 812.6 812.7 812.8 812.9 812.10 812.11 812.12 812.13 812.14 812.15 812.16 812.17 812.18 812.19 812.20 812.21 812.22 812.23 812.24 812.25 812.26 812.27 812.28 812.29 812.30 812.31 813.1 813.2 813.3 813.4 813.5 813.6 813.7 813.8 813.9 813.10 813.11 813.12 813.13 813.14 813.15 813.16 813.17 813.18 813.19 813.20 813.21 813.22
813.23 813.24 813.25 813.26 813.27 813.28 813.29 813.30 814.1 814.2 814.3 814.4 814.5 814.6 814.7 814.8 814.9 814.10 814.11 814.12 814.13 814.14 814.15 814.16 814.17 814.18 814.19 814.20 814.21 814.22 814.23 814.24 814.25 814.26 814.27 814.28 814.29 814.30 815.1 815.2 815.3 815.4 815.5 815.6 815.7 815.8 815.9 815.10 815.11 815.12 815.13 815.14 815.15 815.16 815.17 815.18 815.19 815.20 815.21 815.22 815.23 815.24 815.25 815.26 815.27 815.28 815.29 815.30 815.31 815.32 816.1 816.2 816.3 816.4 816.5 816.6 816.7 816.8 816.9
816.10 816.11 816.12 816.13 816.14 816.15 816.16 816.17 816.18 816.19
816.20 816.21 816.22 816.23 816.24
816.25 816.26
816.27 816.28 816.29 816.30 816.31 816.32 817.1 817.2 817.3 817.4 817.5 817.6 817.7
817.8 817.9 817.10 817.11 817.12 817.13 817.14 817.15 817.16 817.17 817.18 817.19 817.20 817.21 817.22 817.23 817.24 817.25 817.26 817.27 817.28 817.29 817.30 817.31 817.32 817.33 818.1 818.2 818.3 818.4 818.5
818.6
818.7 818.8 818.9 818.10 818.11 818.12 818.13 818.14 818.15 818.16 818.17 818.18 818.19 818.20 818.21 818.22 818.23 818.24 818.25 818.26 818.27 818.28 818.29 818.30 818.31 818.32 818.33 819.1 819.2 819.3 819.4 819.5 819.6 819.7 819.8 819.9 819.10 819.11 819.12 819.13 819.14 819.15 819.16 819.17 819.18 819.19 819.20 819.21 819.22 819.23 819.24 819.25 819.26 819.27 819.28 819.29 819.30 819.31 819.32 820.1 820.2 820.3
820.4
820.5 820.6 820.7 820.8 820.9 820.10 820.11 820.12 820.13 820.14 820.15 820.16 820.17 820.18 820.19 820.20 820.21 820.22 820.23 820.24 820.25 820.26 820.27 820.28 820.29 820.30 820.31 820.32
820.33
821.1 821.2 821.3 821.4 821.5 821.6 821.7 821.8 821.9 821.10 821.11 821.12 821.13 821.14 821.15 821.16 821.17 821.18 821.19 821.20 821.21 821.22 821.23 821.24 821.25 821.26 821.27 821.28 821.29 821.30 821.31 821.32 821.33 821.34 821.35 821.36 822.1 822.2 822.3 822.4 822.5
822.6
822.7 822.8 822.9 822.10 822.11 822.12 822.13 822.14 822.15 822.16 822.17 822.18 822.19
822.20
822.21 822.22 822.23 822.24 822.25 822.26 822.27 822.28 822.29 822.30
823.1
823.2 823.3 823.4 823.5 823.6 823.7 823.8 823.9 823.10 823.11 823.12 823.13 823.14 823.15 823.16 823.17 823.18 823.19 823.20 823.21 823.22
823.23
823.24 823.25 823.26 823.27 823.28 823.29 823.30 823.31 824.1 824.2 824.3 824.4
824.5
824.6 824.7 824.8 824.9 824.10 824.11 824.12 824.13 824.14 824.15 824.16 824.17 824.18 824.19
824.20
824.21 824.22 824.23 824.24 824.25 824.26 824.27 824.28 824.29 824.30
825.1
825.2 825.3 825.4 825.5 825.6 825.7 825.8 825.9 825.10 825.11 825.12 825.13 825.14 825.15 825.16
825.17
825.18 825.19
825.20 825.21 825.22 825.23 825.24 825.25 825.26 825.27 825.28 825.29 825.30 825.31 826.1 826.2 826.3 826.4
826.5 826.6 826.7 826.8 826.9 826.10 826.11 826.12 826.13 826.14 826.15 826.16 826.17 826.18 826.19 826.20 826.21 826.22 826.23 826.24 826.25 826.26 826.27 826.28 826.29 826.30 826.31 826.32 827.1 827.2 827.3 827.4 827.5 827.6 827.7 827.8 827.9 827.10 827.11 827.12 827.13 827.14 827.15 827.16 827.17 827.18 827.19 827.20 827.21 827.22 827.23 827.24 827.25 827.26 827.27 827.28 827.29 827.30 827.31 827.32 827.33 827.34 828.1 828.2 828.3 828.4 828.5 828.6 828.7 828.8 828.9 828.10 828.11 828.12 828.13 828.14 828.15 828.16 828.17 828.18 828.19 828.20 828.21 828.22 828.23 828.24 828.25 828.26 828.27 828.28 828.29 828.30 828.31 828.32 828.33 828.34 829.1 829.2 829.3 829.4 829.5 829.6 829.7 829.8 829.9 829.10 829.11 829.12 829.13 829.14 829.15 829.16 829.17 829.18 829.19 829.20 829.21 829.22 829.23 829.24 829.25 829.26 829.27 829.28 829.29 829.30 829.31 829.32 829.33 829.34 829.35 830.1 830.2 830.3 830.4 830.5 830.6 830.7 830.8 830.9 830.10 830.11 830.12 830.13 830.14 830.15 830.16 830.17 830.18 830.19 830.20 830.21 830.22 830.23 830.24 830.25 830.26 830.27 830.28 830.29 830.30 830.31 831.1 831.2 831.3 831.4 831.5 831.6 831.7 831.8 831.9 831.10 831.11 831.12 831.13 831.14 831.15 831.16 831.17 831.18 831.19 831.20 831.21 831.22 831.23 831.24 831.25 831.26 831.27 831.28 831.29 831.30 831.31 831.32 831.33 831.34 832.1 832.2 832.3 832.4 832.5 832.6 832.7 832.8 832.9 832.10 832.11 832.12 832.13 832.14 832.15 832.16 832.17 832.18 832.19 832.20 832.21 832.22 832.23 832.24 832.25 832.26 832.27 832.28 832.29 833.1 833.2 833.3 833.4 833.5 833.6 833.7 833.8 833.9 833.10 833.11 833.12 833.13 833.14 833.15 833.16 833.17 833.18 833.19 833.20 833.21 833.22 833.23 833.24 833.25 833.26 833.27 833.28 833.29 833.30 833.31 833.32 833.33 833.34 833.35 834.1 834.2 834.3 834.4 834.5 834.6 834.7 834.8 834.9 834.10 834.11 834.12 834.13 834.14 834.15 834.16 834.17 834.18 834.19 834.20 834.21 834.22 834.23 834.24 834.25 834.26 834.27 834.28 834.29 834.30 834.31 834.32 834.33 835.1 835.2 835.3 835.4 835.5 835.6 835.7 835.8 835.9 835.10 835.11 835.12 835.13 835.14 835.15 835.16 835.17 835.18 835.19 835.20 835.21 835.22 835.23 835.24 835.25 835.26 835.27 835.28 835.29 835.30 835.31 835.32 835.33 835.34 835.35 836.1 836.2 836.3 836.4 836.5 836.6 836.7 836.8 836.9 836.10 836.11 836.12 836.13 836.14 836.15 836.16 836.17 836.18 836.19 836.20 836.21 836.22 836.23 836.24 836.25 836.26 836.27 836.28 836.29 836.30 836.31 836.32 836.33 836.34 837.1 837.2 837.3 837.4 837.5 837.6 837.7 837.8 837.9 837.10 837.11 837.12 837.13 837.14 837.15 837.16 837.17 837.18 837.19 837.20 837.21 837.22 837.23 837.24 837.25 837.26 837.27 837.28 837.29 837.30 837.31 837.32 837.33 837.34 837.35 838.1 838.2 838.3 838.4 838.5 838.6 838.7 838.8 838.9 838.10 838.11 838.12 838.13 838.14 838.15 838.16 838.17 838.18 838.19 838.20 838.21 838.22 838.23 838.24 838.25 838.26 838.27 838.28 838.29 838.30 838.31 838.32 838.33 838.34 838.35 838.36 839.1 839.2 839.3 839.4 839.5 839.6 839.7 839.8 839.9 839.10 839.11 839.12 839.13 839.14 839.15 839.16 839.17 839.18 839.19 839.20 839.21 839.22 839.23 839.24 839.25 839.26 839.27 839.28 839.29 839.30 839.31 839.32 839.33 839.34 839.35 840.1 840.2 840.3 840.4 840.5 840.6 840.7 840.8 840.9 840.10 840.11 840.12 840.13 840.14 840.15 840.16 840.17 840.18 840.19 840.20 840.21 840.22 840.23 840.24 840.25 840.26 840.27 840.28 840.29 840.30 840.31 840.32 840.33 840.34 841.1 841.2 841.3 841.4 841.5 841.6 841.7 841.8 841.9 841.10 841.11 841.12 841.13 841.14 841.15 841.16 841.17 841.18 841.19 841.20 841.21 841.22 841.23 841.24 841.25 841.26 841.27 841.28 841.29 841.30 841.31 841.32 841.33 842.1 842.2 842.3 842.4 842.5 842.6 842.7 842.8 842.9 842.10 842.11 842.12 842.13 842.14 842.15 842.16 842.17 842.18 842.19 842.20 842.21 842.22 842.23 842.24 842.25 842.26 842.27 842.28 842.29 842.30 842.31 842.32 842.33 843.1 843.2 843.3 843.4 843.5 843.6 843.7 843.8 843.9 843.10 843.11 843.12 843.13 843.14 843.15 843.16 843.17 843.18 843.19 843.20 843.21 843.22 843.23 843.24 843.25 843.26 843.27 843.28 843.29 843.30 843.31 843.32 843.33 844.1 844.2 844.3 844.4 844.5 844.6 844.7 844.8 844.9 844.10 844.11 844.12 844.13 844.14 844.15 844.16 844.17 844.18 844.19 844.20 844.21 844.22 844.23 844.24 844.25 844.26 844.27 844.28 844.29 844.30 844.31 844.32 844.33 844.34 845.1 845.2 845.3 845.4 845.5 845.6 845.7 845.8 845.9 845.10 845.11 845.12 845.13 845.14 845.15 845.16 845.17 845.18 845.19 845.20 845.21 845.22 845.23 845.24 845.25 845.26 845.27 845.28 845.29 845.30 845.31 845.32 845.33 845.34 846.1 846.2 846.3 846.4 846.5 846.6 846.7 846.8 846.9 846.10 846.11 846.12 846.13 846.14 846.15 846.16 846.17 846.18 846.19 846.20 846.21 846.22 846.23 846.24 846.25 846.26 846.27 846.28 846.29 846.30 846.31 846.32 846.33 846.34 846.35 847.1 847.2 847.3 847.4 847.5 847.6 847.7 847.8 847.9 847.10 847.11 847.12 847.13 847.14 847.15 847.16 847.17 847.18 847.19 847.20 847.21 847.22 847.23 847.24 847.25 847.26 847.27 847.28 847.29 847.30 847.31 847.32 847.33 847.34 847.35 847.36 848.1 848.2 848.3 848.4 848.5 848.6 848.7 848.8 848.9 848.10 848.11 848.12 848.13 848.14 848.15 848.16 848.17 848.18 848.19 848.20 848.21 848.22 848.23 848.24 848.25 848.26 848.27 848.28 848.29 848.30 848.31 848.32 848.33 848.34 849.1 849.2 849.3 849.4 849.5 849.6 849.7 849.8 849.9 849.10 849.11 849.12 849.13 849.14 849.15 849.16 849.17 849.18 849.19 849.20 849.21 849.22 849.23 849.24 849.25 849.26 849.27 849.28 849.29 849.30 849.31 849.32 849.33 849.34 850.1 850.2 850.3 850.4 850.5 850.6 850.7 850.8 850.9 850.10 850.11 850.12 850.13 850.14 850.15 850.16 850.17 850.18 850.19 850.20 850.21 850.22 850.23 850.24 850.25 850.26 850.27 850.28 850.29 850.30 850.31 850.32 850.33 850.34 850.35 851.1 851.2 851.3 851.4 851.5 851.6 851.7 851.8 851.9 851.10 851.11 851.12 851.13 851.14 851.15 851.16 851.17 851.18 851.19 851.20 851.21 851.22 851.23 851.24 851.25 851.26 851.27 851.28 851.29 851.30 851.31 851.32 851.33 851.34 851.35 852.1 852.2 852.3 852.4 852.5 852.6 852.7 852.8 852.9 852.10 852.11 852.12 852.13 852.14 852.15 852.16 852.17 852.18 852.19 852.20 852.21 852.22 852.23 852.24 852.25 852.26 852.27 852.28 852.29 852.30 852.31 852.32 852.33 852.34 852.35 853.1 853.2 853.3 853.4 853.5 853.6 853.7 853.8 853.9 853.10 853.11 853.12 853.13 853.14 853.15 853.16 853.17 853.18 853.19 853.20 853.21 853.22 853.23 853.24 853.25 853.26 853.27 853.28 853.29 853.30 853.31 853.32 853.33 853.34 853.35 854.1 854.2 854.3 854.4 854.5 854.6 854.7 854.8 854.9 854.10 854.11 854.12 854.13 854.14 854.15 854.16 854.17 854.18 854.19 854.20
854.21 854.22 854.23 854.24 854.25 854.26 854.27 854.28 854.29 854.30 854.31 854.32 854.33 854.34 855.1 855.2 855.3 855.4 855.5 855.6 855.7 855.8 855.9 855.10 855.11 855.12 855.13 855.14 855.15 855.16 855.17 855.18 855.19 855.20 855.21 855.22 855.23 855.24 855.25 855.26 855.27 855.28 855.29 855.30 855.31 855.32 855.33 855.34 855.35 856.1 856.2 856.3 856.4 856.5 856.6 856.7 856.8 856.9 856.10 856.11 856.12 856.13 856.14 856.15 856.16 856.17 856.18 856.19 856.20 856.21 856.22 856.23 856.24 856.25 856.26 856.27 856.28 856.29 856.30 856.31 856.32 856.33 856.34 856.35 857.1 857.2 857.3 857.4 857.5 857.6 857.7 857.8 857.9 857.10 857.11 857.12 857.13 857.14 857.15 857.16 857.17 857.18 857.19 857.20 857.21 857.22 857.23 857.24 857.25 857.26 857.27 857.28 857.29 857.30 857.31 857.32 857.33 857.34 857.35 858.1 858.2 858.3 858.4 858.5 858.6 858.7 858.8 858.9 858.10 858.11 858.12 858.13 858.14 858.15 858.16 858.17 858.18 858.19 858.20 858.21 858.22 858.23 858.24 858.25 858.26 858.27 858.28 858.29 858.30 858.31 858.32 858.33 858.34 858.35 859.1 859.2 859.3 859.4 859.5 859.6 859.7 859.8 859.9 859.10 859.11 859.12 859.13 859.14 859.15 859.16 859.17 859.18 859.19 859.20 859.21 859.22 859.23 859.24 859.25 859.26 859.27 859.28 859.29 859.30 859.31 859.32 859.33 859.34 860.1 860.2 860.3 860.4 860.5 860.6 860.7 860.8 860.9 860.10 860.11 860.12 860.13 860.14 860.15 860.16 860.17 860.18 860.19 860.20 860.21 860.22 860.23 860.24 860.25 860.26 860.27 860.28 860.29 860.30 860.31 860.32 860.33 860.34 860.35 861.1 861.2 861.3 861.4 861.5 861.6 861.7 861.8 861.9 861.10 861.11 861.12 861.13 861.14 861.15 861.16 861.17 861.18 861.19 861.20 861.21 861.22 861.23 861.24 861.25 861.26 861.27 861.28 861.29 861.30 861.31 861.32 861.33 861.34 861.35 862.1 862.2 862.3 862.4 862.5 862.6 862.7 862.8 862.9 862.10 862.11 862.12 862.13 862.14 862.15 862.16 862.17 862.18 862.19 862.20 862.21 862.22 862.23 862.24 862.25 862.26 862.27 862.28 862.29 862.30 862.31 862.32 862.33 862.34 863.1 863.2 863.3 863.4 863.5 863.6 863.7 863.8 863.9 863.10 863.11 863.12 863.13 863.14 863.15 863.16 863.17 863.18 863.19 863.20 863.21 863.22 863.23 863.24 863.25 863.26 863.27 863.28 863.29 863.30 863.31 863.32 863.33 863.34 864.1 864.2 864.3 864.4 864.5 864.6 864.7 864.8 864.9 864.10 864.11 864.12 864.13 864.14 864.15 864.16 864.17 864.18 864.19 864.20 864.21 864.22 864.23 864.24 864.25 864.26 864.27 864.28 864.29 864.30 864.31 864.32 864.33 864.34 864.35 865.1 865.2 865.3 865.4 865.5 865.6 865.7 865.8 865.9 865.10 865.11 865.12 865.13 865.14 865.15 865.16 865.17 865.18 865.19 865.20 865.21 865.22 865.23 865.24 865.25 865.26 865.27 865.28 865.29 865.30 865.31 865.32 865.33 865.34 866.1 866.2 866.3 866.4 866.5 866.6 866.7 866.8 866.9 866.10 866.11 866.12 866.13 866.14 866.15 866.16 866.17 866.18 866.19 866.20 866.21 866.22 866.23 866.24 866.25 866.26 866.27 866.28 866.29 866.30 866.31 866.32 866.33 866.34 866.35 867.1 867.2 867.3 867.4 867.5 867.6 867.7 867.8 867.9 867.10 867.11 867.12 867.13 867.14 867.15 867.16 867.17 867.18 867.19 867.20 867.21 867.22 867.23 867.24 867.25 867.26 867.27 867.28 867.29 867.30 867.31 867.32 867.33 867.34 867.35 868.1 868.2 868.3 868.4 868.5 868.6 868.7 868.8 868.9 868.10 868.11 868.12 868.13 868.14 868.15 868.16 868.17 868.18 868.19 868.20 868.21 868.22 868.23 868.24 868.25 868.26 868.27 868.28 868.29 868.30 868.31 868.32 868.33 868.34 868.35 869.1 869.2 869.3 869.4 869.5 869.6 869.7 869.8 869.9 869.10 869.11 869.12 869.13 869.14 869.15 869.16 869.17 869.18 869.19 869.20 869.21 869.22 869.23 869.24 869.25
869.26 869.27 869.28 869.29 869.30 869.31 869.32 869.33 869.34 870.1 870.2 870.3 870.4 870.5 870.6 870.7 870.8 870.9 870.10 870.11 870.12 870.13
870.14
870.15 870.16 870.17 870.18 870.19 870.20 870.21 870.22 870.23
870.24 870.25 870.26
870.27 870.28 870.29 870.30 870.31 870.32 870.33 870.34
871.1 871.2 871.3 871.4 871.5 871.6 871.7 871.8 871.9
871.10 871.11 871.12 871.13 871.14 871.15 871.16 871.17 871.18 871.19 871.20 871.21 871.22 871.23 871.24 871.25 871.26 871.27 871.28 871.29
871.30 871.31 871.32 871.33 871.34 871.35 872.1 872.2 872.3 872.4
872.5 872.6 872.7 872.8 872.9 872.10 872.11 872.12 872.13
872.14 872.15 872.16 872.17 872.18 872.19 872.20 872.21 872.22
872.23 872.24 872.25 872.26 872.27 872.28 872.29 872.30 872.31
872.32 872.33 873.1 873.2 873.3 873.4 873.5 873.6 873.7 873.8 873.9 873.10 873.11 873.12 873.13 873.14 873.15 873.16 873.17 873.18 873.19 873.20 873.21 873.22 873.23 873.24 873.25 873.26 873.27 873.28
873.29 873.30 873.31 873.32 873.33 873.34 873.35 873.36 874.1 874.2 874.3 874.4 874.5 874.6 874.7 874.8 874.9 874.10 874.11 874.12 874.13 874.14 874.15 874.16 874.17 874.18 874.19 874.20 874.21
874.22 874.23 874.24 874.25 874.26 874.27 874.28 874.29 874.30 874.31 874.32 874.33 874.34 874.35 875.1 875.2 875.3 875.4 875.5 875.6 875.7 875.8 875.9 875.10 875.11 875.12 875.13 875.14 875.15 875.16 875.17 875.18 875.19 875.20 875.21 875.22 875.23 875.24 875.25 875.26 875.27 875.28 875.29 875.30 875.31 875.32 875.33
876.1 876.2 876.3 876.4 876.5 876.6
876.7 876.8 876.9
876.10 876.11 876.12
876.13 876.14
A bill for an act
relating to state government; modifying provisions governing the Department of
Health, health care, health-related licensing boards, prescription drugs, health
insurance, community supports, behavioral health, continuing care for older adults,
child and vulnerable adult protection, economic assistance, direct care and
treatment, preventing homelessness, human services licensing and operations,
opioid litigation settlements, and child care assistance; making forecast adjustments;
providing for fees; providing civil penalties; requiring reports; appropriating money;
amending Minnesota Statutes 2020, sections 34A.01, subdivision 4; 62A.02,
subdivision 1; 62A.25, subdivision 2; 62A.28, subdivision 2; 62A.30, by adding
a subdivision; 62J.2930, subdivision 3; 62J.84, as amended; 62N.25, subdivision
5; 62Q.021, by adding a subdivision; 62Q.1055; 62Q.47; 62Q.55, subdivision 5;
62Q.556; 62Q.56, subdivision 2; 62Q.73, subdivision 7; 62U.04, subdivision 11,
by adding a subdivision; 62U.10, subdivision 7; 119B.011, subdivisions 2, 5, 13,
15; 119B.025, subdivision 4; 119B.19, subdivision 7; 137.68; 144.1201,
subdivisions 2, 4; 144.122; 144.1501, subdivisions 4, 5; 144.1503; 144.1505;
144.1911, subdivision 4; 144.292, subdivision 6; 144.383; 144.497; 144.554;
144.565, subdivision 4; 144.586, by adding a subdivision; 144.6502, subdivision
1; 144.651, by adding a subdivision; 144.69; 144.7055; 144.9501, subdivisions 9,
26a, 26b; 144.9505, subdivisions 1, 1h; 144A.01; 144A.03, subdivision 1; 144A.04,
subdivisions 4, 6; 144A.06; 144A.4799, subdivisions 1, 3; 144A.75, subdivision
12; 144G.08, by adding a subdivision; 144G.15; 144G.17; 144G.19, by adding a
subdivision; 144G.20, subdivisions 1, 4, 5, 8, 9, 12, 15; 144G.30, subdivision 5;
144G.31, subdivisions 4, 8; 144G.41, subdivisions 7, 8; 144G.42, subdivision 10;
144G.50, subdivision 2; 144G.52, subdivisions 2, 8, 9; 144G.53; 144G.55,
subdivisions 1, 3; 144G.56, subdivisions 3, 5; 144G.57, subdivisions 1, 3, 5;
144G.70, subdivisions 2, 4; 144G.80, subdivision 2; 144G.90, subdivision 1, by
adding a subdivision; 144G.91, subdivisions 13, 21; 144G.92, subdivision 1;
144G.93; 144G.95; 145.4716, by adding a subdivision; 145.56, by adding
subdivisions; 145.924; 145A.131, subdivisions 1, 5; 145A.14, by adding a
subdivision; 146B.04, subdivision 1; 148B.33, by adding a subdivision; 148E.100,
subdivision 3; 148E.105, subdivision 3; 148E.106, subdivision 3; 148E.110,
subdivision 7; 149A.01, subdivisions 2, 3; 149A.02, subdivision 13a, by adding
subdivisions; 149A.03; 149A.09; 149A.11; 149A.60; 149A.61, subdivisions 4, 5;
149A.62; 149A.63; 149A.65, subdivision 2; 149A.70, subdivisions 3, 4, 5, 7;
149A.90, subdivisions 2, 4, 5; 149A.94, subdivision 1; 150A.06, subdivisions 1c,
2c, 6, by adding a subdivision; 150A.09; 150A.091, subdivisions 2, 5, 8, 9, by
adding subdivisions; 151.01, subdivisions 23, 27, by adding subdivisions; 151.071,
subdivisions 1, 2; 151.37, by adding a subdivision; 151.555, as amended; 151.72,
subdivisions 1, 2, 3, 4, 6, by adding a subdivision; 152.01, subdivision 23; 152.02,
subdivisions 2, 3; 152.11, by adding a subdivision; 152.12, by adding a subdivision;
152.125; 152.22, subdivision 8, by adding subdivisions; 152.25, subdivision 1, by
adding a subdivision; 152.29, subdivisions 3a, 4, by adding a subdivision; 152.30;
152.32; 152.33, subdivision 1; 152.35; 152.36; 153.16, subdivision 1; 169A.70,
subdivisions 3, 4; 177.27, subdivisions 4, 7; 242.19, subdivision 2; 245.462,
subdivision 4; 245.4882, by adding subdivisions; 245.4889, by adding a
subdivision; 245.713, subdivision 2; 245A.02, subdivision 5a; 245A.04, subdivision
4, by adding a subdivision; 245A.07, subdivisions 2a, 3; 245A.14, subdivision 14;
245A.1435; 245A.1443; 245A.146, subdivision 3; 245A.16, subdivision 1;
245D.10, subdivision 3a; 245D.12; 245F.03; 245F.15, subdivision 1; 245F.16,
subdivision 1; 245G.01, subdivisions 4, 17; 245G.05, subdivision 2; 245G.06,
subdivision 3, by adding subdivisions; 245G.08, subdivision 5; 245G.09,
subdivision 3; 245G.11, subdivisions 1, 10; 245G.13, subdivision 1; 245G.20;
245G.22, subdivisions 2, 7, 15; 245H.05; 245H.08, by adding a subdivision;
253B.18, subdivision 6; 254A.19, subdivisions 1, 3, by adding subdivisions;
254B.01, subdivision 5, by adding subdivisions; 254B.03, subdivisions 1, 4, 5;
254B.04, subdivision 2a, by adding subdivisions; 256.01, by adding subdivisions;
256.042, subdivisions 1, 2, 5; 256.043, subdivision 1, by adding a subdivision;
256.045, subdivision 3; 256.969, by adding a subdivision; 256B.021, subdivision
4; 256B.055, subdivisions 2, 17; 256B.056, subdivisions 3, 3b, 3c, 4, 7, 11;
256B.0595, subdivision 1; 256B.0625, subdivisions 13f, 17a, 18h, 22, 28b, 64, by
adding subdivisions; 256B.0631, as amended; 256B.0651, subdivisions 1, 2;
256B.0652, subdivision 11; 256B.0653, subdivision 6; 256B.0659, subdivisions
1, 12, 19, 24; 256B.0757, subdivision 5; 256B.0913, subdivisions 4, 5; 256B.092,
by adding a subdivision; 256B.0941, subdivision 3, by adding subdivisions;
256B.0946, subdivision 7; 256B.0949, subdivision 15; 256B.49, by adding a
subdivision; 256B.4911, by adding a subdivision; 256B.4914, subdivisions 8, as
amended, 9, as amended; 256B.69, subdivisions 4, 5c, 28, 36; 256B.692,
subdivision 1; 256B.6925, subdivisions 1, 2; 256B.6928, subdivision 3; 256B.76,
subdivision 1; 256B.77, subdivision 13; 256B.85, by adding a subdivision; 256D.03,
by adding a subdivision; 256D.0515; 256D.0516, subdivision 2; 256D.06,
subdivisions 1, 2, 5; 256D.09, subdivision 2a; 256E.33, subdivisions 1, 2; 256E.36,
subdivision 1; 256I.03, subdivisions 7, 13; 256I.04, subdivision 3; 256I.06,
subdivision 6; 256I.09; 256J.08, subdivisions 71, 79; 256J.21, subdivision 4;
256J.33, subdivision 2; 256J.37, subdivisions 3, 3a; 256J.95, subdivision 19;
256K.26, subdivisions 2, 6, 7; 256K.45, subdivision 3, by adding a subdivision;
256L.03, subdivision 5; 256L.04, subdivisions 1c, 7a, by adding a subdivision;
256L.12, subdivision 8; 256P.01, by adding a subdivision; 256P.04, subdivision
11; 256P.07, subdivisions 1, 2, 3, 4, 6, 7, by adding subdivisions; 256Q.06, by
adding a subdivision; 256R.02, subdivisions 4, 17, 18, 19, 22, 29, 42a, 48a, by
adding subdivisions; 256R.07, subdivisions 1, 2, 3; 256R.08, subdivision 1;
256R.09, subdivisions 2, 5; 256R.13, subdivision 4; 256R.16, subdivision 1;
256R.17, subdivision 3; 256R.26, subdivision 1; 256R.261, subdivision 13;
256R.37; 256R.39; 256S.15, subdivision 2; 256S.16; 256S.18, subdivision 1, by
adding a subdivision; 256S.19, subdivision 3; 256S.211, by adding subdivisions;
256S.212; 256S.213; 256S.214; 256S.215; 260.012; 260.761, subdivision 2;
260B.157, subdivisions 1, 3; 260B.331, subdivision 1; 260C.001, subdivision 3;
260C.007, subdivision 27; 260C.151, subdivision 6; 260C.152, subdivision 5;
260C.175, subdivision 2; 260C.176, subdivision 2; 260C.178, subdivision 1;
260C.181, subdivision 2; 260C.193, subdivision 3; 260C.201, subdivisions 1, 2;
260C.202; 260C.203; 260C.204; 260C.221; 260C.331, subdivision 1; 260C.451,
subdivision 8, by adding subdivisions; 260C.513; 260C.607, subdivisions 2, 5;
260C.613, subdivisions 1, 5; 260E.01; 260E.02, subdivision 1; 260E.03, by adding
subdivisions; 260E.14, subdivisions 2, 5; 260E.17, subdivision 1; 260E.18; 260E.20,
subdivision 1; 260E.22, subdivision 2; 260E.24, subdivisions 2, 7; 260E.33,
subdivision 1; 260E.34; 260E.35, subdivision 6; 268.19, subdivision 1; 299A.299,
subdivision 1; 518A.43, subdivision 1; 626.557, subdivisions 4, 9, 9b, 9c, 9d, 10,
10b, 12b; 626.5571, subdivisions 1, 2; 626.5572, subdivisions 2, 4, 17; Minnesota
Statutes 2021 Supplement, sections 16A.151, subdivision 2; 62A.673, subdivision
2; 62J.497, subdivisions 1, 3; 62J.84, subdivisions 6, 9; 119B.03, subdivision 4a;
119B.13, subdivision 1; 144.0724, subdivision 4; 144.1481, subdivision 1;
144.1501, subdivisions 1, 2, 3; 144.551, subdivision 1; 144.9501, subdivision 17;
148B.5301, subdivision 2; 148F.11, subdivision 1; 151.066, subdivision 3; 151.335;
151.72, subdivision 5; 152.27, subdivision 2; 152.29, subdivisions 1, 3; 245.467,
subdivisions 2, 3; 245.4871, subdivision 21; 245.4876, subdivisions 2, 3; 245.4885,
subdivision 1; 245.4889, subdivision 1; 245.735, subdivision 3; 245A.03,
subdivision 7; 245A.043, subdivision 3; 245A.14, subdivision 4; 245I.02,
subdivisions 19, 36; 245I.03, subdivision 9; 245I.04, subdivision 4; 245I.05,
subdivision 3; 245I.08, subdivision 4; 245I.09, subdivision 2; 245I.10, subdivisions
2, 6; 245I.20, subdivision 5; 245I.23, subdivision 22, by adding a subdivision;
254A.03, subdivision 3; 254A.19, subdivision 4; 254B.03, subdivision 2; 254B.04,
subdivision 1; 254B.05, subdivisions 1a, 4, 5; 256.01, subdivision 42; 256.042,
subdivision 4; 256.043, subdivisions 3, 4; 256B.0371, subdivision 4; 256B.04,
subdivision 14; 256B.0622, subdivision 2; 256B.0625, subdivisions 3b, 5m, 9, as
amended, 13, 17, 30, 31; 256B.0671, subdivision 6; 256B.0759, subdivision 4;
256B.0911, subdivision 3a; 256B.0946, subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947,
subdivisions 2, 3, 5, 6; 256B.0949, subdivisions 2, 13; 256B.85, subdivisions 7,
8; 256B.851, subdivision 5; 256I.06, subdivision 8; 256J.21, subdivision 3; 256J.33,
subdivision 1; 256L.03, subdivision 2; 256L.07, subdivision 1; 256L.15, subdivision
2; 256P.01, subdivision 6a; 256P.04, subdivisions 4, 8; 256P.06, subdivision 3;
256S.21; 256S.2101, subdivision 2, by adding a subdivision; 260C.007, subdivision
14; 260C.157, subdivision 3; 260C.212, subdivisions 1, 2; 260C.605, subdivision
1; 260C.607, subdivision 6; 260E.03, subdivision 22; 260E.20, subdivision 2;
363A.50; Laws 2009, chapter 79, article 13, section 3, subdivision 10, as amended;
Laws 2015, chapter 71, article 14, section 2, subdivision 5, as amended; Laws
2019, chapter 63, article 3, section 1, as amended; Laws 2020, First Special Session
chapter 7, section 1, subdivisions 1, as amended, 5, as amended; Laws 2021, First
Special Session chapter 2, article 1, section 4, subdivision 2; Laws 2021, First
Special Session chapter 7, article 1, section 36; article 3, section 44; article 14,
section 21, subdivision 4; article 16, sections 2, subdivisions 29, 31, 33; 12; article
17, sections 1, subdivision 2; 3; 6; 10; 11; 12; 14, subdivision 3; 17, subdivision
3; 19; Laws 2021, First Special Session chapter 8, article 6, section 1, subdivision
7; Laws 2022, chapter 33, section 1, subdivisions 5a, 9a; Laws 2022, chapter 40,
section 7; proposing coding for new law in Minnesota Statutes, chapters 3; 62A;
62J; 62Q; 62W; 115; 119B; 144; 144A; 145; 149A; 152; 181; 245; 245A; 256B;
256E; 256P; repealing Minnesota Statutes 2020, sections 119B.03, subdivision 4;
150A.091, subdivisions 3, 15, 17; 169A.70, subdivision 6; 245A.03, subdivision
5; 245F.15, subdivision 2; 245G.11, subdivision 2; 245G.22, subdivision 19;
246.0136; 252.025, subdivision 7; 252.035; 254A.02, subdivision 8a; 254A.04;
254A.16, subdivision 6; 254A.19, subdivisions 1a, 2; 254B.04, subdivisions 2b,
2c; 254B.041, subdivision 2; 254B.14, subdivisions 1, 2, 3, 4, 6; 256B.057,
subdivision 7; 256B.063; 256B.69, subdivision 20; 256D.055; 256J.08, subdivisions
10, 61, 62, 81, 83; 256J.30, subdivisions 5, 7; 256J.33, subdivisions 3, 5; 256J.34,
subdivisions 1, 2, 3, 4; 256J.37, subdivision 10; 256R.08, subdivision 2; 256R.49;
256S.19, subdivision 4; 501C.0408, subdivision 4; 501C.1206; Minnesota Statutes
2021 Supplement, sections 144G.07, subdivision 6; 254A.19, subdivision 5;
254B.14, subdivision 5; 256J.08, subdivision 53; 256J.30, subdivision 8; 256J.33,
subdivision 4; Minnesota Rules, parts 2960.0460, subpart 2; 9530.6565, subpart
2; 9530.7000, subparts 1, 2, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 17a, 19, 20, 21;
9530.7005; 9530.7010; 9530.7012; 9530.7015, subparts 1, 2a, 4, 5, 6; 9530.7020,
subparts 1, 1a, 2; 9530.7021; 9530.7022, subpart 1; 9530.7025; 9530.7030, subpart
1; 9555.6255.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
DEPARTMENT OF HEALTH FINANCE
Section 1.
new text begin
[62J.811] PROVIDER BALANCE BILLING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Requirements. new text end
new text begin
(a) Each health provider and health facility shall comply
with Division BB, Title I of the Consolidated Appropriations Act, 2021, also known as the
"No Surprises Act," including any federal regulations adopted under that act, to the extent
that it imposes requirements that apply in this state but are not required under the laws of
this state. This section does not require compliance with any provision of the No Surprises
Act before January 1, 2022.
new text end
new text begin
(b) For the purposes of this section, "provider" or "facility" means any health care
provider or facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that
is subject to relevant provisions of the No Surprises Act.
new text end
new text begin Subd. 2. new text end
new text begin Compliance and investigations. new text end
new text begin
(a) The commissioner of health shall, to the
extent practicable, seek the cooperation of health care providers and facilities in obtaining
compliance with this section.
new text end
new text begin
(b) A person who believes a health care provider or facility has not complied with the
requirements of the No Surprises Act or this section may file a complaint with the
commissioner of health. Complaints filed under this section must be filed in writing, either
on paper or electronically. The commissioner may prescribe additional procedures for the
filing of complaints.
new text end
new text begin
(c) The commissioner may also conduct compliance reviews to determine whether health
care providers and facilities are complying with this section.
new text end
new text begin
(d) The commissioner shall investigate complaints filed under this section. The
commissioner may prioritize complaint investigations, compliance reviews, and the collection
of any possible civil monetary penalties under paragraph (g), clause (2), based on factors
such as repeat complaints or violations, the seriousness of the complaint or violation, and
other factors as determined by the commissioner.
new text end
new text begin
(e) The commissioner shall inform the health care provider or facility of the complaint
or findings of a compliance review and shall provide an opportunity for the health care
provider or facility to submit information the health care provider or facility considers
relevant to further review and investigation of the complaint or the findings of the compliance
review. The health care provider or facility must submit any such information to the
commissioner within 30 days of receipt of notification of a complaint or compliance review
under this section.
new text end
new text begin
(f) If, after reviewing any information described in paragraph (e) and the results of any
investigation, the commissioner determines that the provider or facility has not violated this
section, the commissioner shall notify the provider or facility as well as any relevant
complainant.
new text end
new text begin
(g) If, after reviewing any information described in paragraph (e) and the results of any
investigation, the commissioner determines that the provider or facility is in violation of
this section, the commissioner shall notify the provider or facility and take the following
steps:
new text end
new text begin
(1) in cases of noncompliance with this section, the commissioner shall first attempt to
achieve compliance through successful remediation on the part of the noncompliant provider
or facility including completion of a corrective action plan or other agreement; and
new text end
new text begin
(2) if, after taking the action in clause (1) compliance has not been achieved, the
commissioner of health shall notify the provider or facility that the provider or facility is in
violation of this section and that the commissioner is imposing a civil monetary penalty. If
the commissioner determines that more than one health care provider or facility was
responsible for a violation, the commissioner may impose a civil money penalty against
each health care provider or facility. The amount of a civil money penalty shall be up to
$100 for each violation, but shall not exceed $25,000 for identical violations during a
calendar year; and
new text end
new text begin
(3) no civil money penalty shall be imposed under this section for violations that occur
prior to January 1, 2023. Warnings must be issued and any compliance issues must be
referred to the federal government for enforcement pursuant to the federal No Surprises Act
or other applicable federal laws and regulations.
new text end
new text begin
(h) A health care provider or facility may contest whether the finding of facts constitute
a violation of this section according to the contested case proceeding in sections 14.57 to
14.62, subject to appeal according to sections 14.63 to 14.68.
new text end
new text begin
(i) When steps in paragraphs (b) to (h) have been completed as needed, the commissioner
shall notify the health care provider or facility and, if the matter arose from a complaint,
the complainant regarding the disposition of complaint or compliance review.
new text end
new text begin
(j) Civil money penalties imposed and collected under this subdivision shall be deposited
into the general fund and are appropriated to the commissioner of health for the purposes
of this section, including the provision of compliance reviews and technical assistance.
new text end
new text begin
(k) Any compliance and investigative action taken by the department under this section
shall only include potential violations that occur on or after the effective date of this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2020, section 62Q.021, is amended by adding a subdivision to
read:
new text begin Subd. 3. new text end
new text begin Compliance with 2021 federal law. new text end
new text begin
Each health plan company, health provider,
and health facility shall comply with Division BB, Title I of the Consolidated Appropriations
Act, 2021, also known as the "No Surprises Act," including any federal regulations adopted
under that act, to the extent that it imposes requirements that apply in this state but are not
required under the laws of this state. This section does not require compliance with any
provision of the No Surprises Act before the effective date provided for that provision in
the Consolidated Appropriations Act. The commissioner shall enforce this subdivision.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62Q.55, subdivision 5, is amended to read:
Subd. 5.
Coverage restrictions or limitations.
If emergency services are provided by
a nonparticipating provider, with or without prior authorization, the health plan company
shall not impose coverage restrictions or limitations that are more restrictive than apply to
emergency services received from a participating provider. Cost-sharing requirements that
apply to emergency services received out-of-network must be the same as the cost-sharing
requirements that apply to services received in-networknew text begin and shall count toward the in-network
deductible. All coverage and charges for emergency services must comply with all
requirements of Division BB, Title I of the Consolidated Appropriations Act, 2021, including
any federal regulations adopted under that actnew text end .
Sec. 4.
Minnesota Statutes 2020, section 62Q.556, is amended to read:
62Q.556 deleted text begin UNAUTHORIZED PROVIDER SERVICESdeleted text end new text begin CONSUMER
PROTECTIONS AGAINST BALANCE BILLINGnew text end .
Subdivision 1.
deleted text begin Unauthorized provider servicesdeleted text end new text begin Nonparticipating provider balance
billing prohibitionnew text end .
(a) Except as provided in paragraph deleted text begin (c)deleted text end new text begin (b)new text end , deleted text begin unauthorized provider
services occurdeleted text end new text begin balance billing is prohibitednew text end when an enrollee receives services:
(1) from a nonparticipating provider at a participating hospital or ambulatory surgical
center, deleted text begin when the services are rendered:deleted text end new text begin as described by Division BB, Title I of the
Consolidated Appropriations Act, 2021, including any federal regulations adopted under
that act;
new text end
deleted text begin
(i) due to the unavailability of a participating provider;
deleted text end
deleted text begin
(ii) by a nonparticipating provider without the enrollee's knowledge; or
deleted text end
deleted text begin
(iii) due to the need for unforeseen services arising at the time the services are being
rendered; or
deleted text end
(2) from a participating provider that sends a specimen taken from the enrollee in the
participating provider's practice setting to a nonparticipating laboratory, pathologist, or other
medical testing facilitydeleted text begin .deleted text end new text begin ; or
new text end
deleted text begin
(b) Unauthorized provider services do not include emergency services as defined in
section 62Q.55, subdivision 3.
deleted text end
new text begin
(3) from a nonparticipating provider or facility providing emergency services as defined
in section 62Q.55, subdivision 3, and other services as described in the requirements of
Division BB, Title I of the Consolidated Appropriations Act, 2021, including any federal
regulations adopted under that act.
new text end
deleted text begin (c)deleted text end new text begin (b)new text end The services described in paragraph (a), deleted text begin clausedeleted text end new text begin clauses (1) andnew text end (2), new text begin as defined in
Division BB, Title I of the Consolidated Appropriations Act, 2021, and any federal
regulations adopted under that act, new text end are deleted text begin not unauthorized provider servicesdeleted text end new text begin subject to balance
billingnew text end if the enrollee gives deleted text begin advance writtendeleted text end new text begin informednew text end consent deleted text begin to thedeleted text end new text begin prior to receiving
services from the nonparticipatingnew text end provider acknowledging that the use of a provider, or
the services to be rendered, may result in costs not covered by the health plan.new text begin The informed
consent must comply with all requirements of Division BB, Title I of the Consolidated
Appropriations Act, 2021, including any federal regulations adopted under that act.
new text end
Subd. 2.
deleted text begin Prohibitiondeleted text end new text begin Cost-sharing requirements and independent dispute
resolutionnew text end .
(a) An enrollee's financial responsibility for the deleted text begin unauthorizeddeleted text end new text begin nonparticipatingnew text end
provider services new text begin described in subdivision 1, paragraph (a), new text end shall be the same cost-sharing
requirements, including co-payments, deductibles, coinsurance, coverage restrictions, and
coverage limitations, as those applicable to services received by the enrollee from a
participating provider. A health plan company must apply any enrollee cost sharing
requirements, including co-payments, deductibles, and coinsurance, for unauthorized provider
services to the enrollee's annual out-of-pocket limit to the same extent payments to a
participating provider would be applied.
(b) A health plan company deleted text begin must attempt to negotiate the reimbursement, less any
applicable enrollee cost sharing under paragraph (a), for the unauthorized provider services
with the nonparticipating provider. If a health plan company's and nonparticipating provider's
attempts to negotiate reimbursement for the health care services do not result in a resolution,
the health plan company or provider may elect to refer the matter for binding arbitration,
chosen in accordance with paragraph (c). A nondisclosure agreement must be executed by
both parties prior to engaging an arbitrator in accordance with this section. The cost of
arbitration must be shared equally between the partiesdeleted text end new text begin and nonparticipating provider shall
initiate open negotiations of disputed amounts. If there is no agreement, either party may
initiate the federal independent dispute resolution process pursuant to Division BB, Title I
of the Consolidated Appropriations Act, 2021, including any federal regulations adopted
under that actnew text end .
deleted text begin
(c) The commissioner of health, in consultation with the commissioner of the Bureau
of Mediation Services, must develop a list of professionals qualified in arbitration, for the
purpose of resolving disputes between a health plan company and nonparticipating provider
arising from the payment for unauthorized provider services. The commissioner of health
shall publish the list on the Department of Health website, and update the list as appropriate.
deleted text end
deleted text begin
(d) The arbitrator must consider relevant information, including the health plan company's
payments to other nonparticipating providers for the same services, the circumstances and
complexity of the particular case, and the usual and customary rate for the service based on
information available in a database in a national, independent, not-for-profit corporation,
and similar fees received by the provider for the same services from other health plans in
which the provider is nonparticipating, in reaching a decision.
deleted text end
new text begin Subd. 3. new text end
new text begin Annual data reporting. new text end
new text begin
(a) Beginning April 1, 2023, a health plan company
must report annually to the commissioner:
new text end
new text begin
(1) the total number of claims and total billed and paid amount for nonparticipating
provider services, by service and provider type, submitted to the health plan in the prior
calendar year; and
new text end
new text begin
(2) the total number of enrollee complaints received regarding the rights and protections
established by Division BB, Title I of the Consolidated Appropriations Act, 2021, including
any federal regulations adopted under that act, in the prior calendar year.
new text end
new text begin
(b) The commissioners of commerce and health may develop the form and manner for
health plan companies to comply with paragraph (a).
new text end
new text begin Subd. 4. new text end
new text begin Enforcement. new text end
new text begin
(a) Any provider or facility, including a health care provider or
facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that is subject
to relevant provisions of the No Surprises Act is subject to the requirements of this section.
new text end
new text begin
(b) The commissioner of commerce or health may enforce this section.
new text end
new text begin
(c) If the commissioner of health has cause to believe that any hospital or facility licensed
under chapter 144 has violated this section, the commissioner may investigate, examine,
and otherwise enforce this section pursuant to chapter 144 or may refer the potential violation
to the relevant licensing board with regulatory authority over the provider.
new text end
new text begin
(d) If a health-related licensing board has cause to believe that a provider has violated
this section, it may further investigate and enforce the provisions of this section pursuant
to chapter 214.
new text end
Sec. 5.
Minnesota Statutes 2020, section 62Q.56, subdivision 2, is amended to read:
Subd. 2.
Change in health plans.
(a) If an enrollee is subject to a change in health plans,
the enrollee's new health plan company must provide, upon request, authorization to receive
services that are otherwise covered under the terms of the new health plan through the
enrollee's current provider:
(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one
or more of the following conditions:
(i) an acute condition;
(ii) a life-threatening mental or physical illness;
(iii) pregnancy deleted text begin beyond the first trimester of pregnancydeleted text end ;
(iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided that the disability has lasted or can be expected to last for at least
one year, or can be expected to result in death; or
(v) a disabling or chronic condition that is in an acute phase; or
(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
lifetime of 180 days or less.
For all requests for authorization under this paragraph, the health plan company must grant
the request for authorization unless the enrollee does not meet the criteria provided in this
paragraph.
(b) The health plan company shall prepare a written plan that provides a process for
coverage determinations regarding continuity of care of up to 120 days for new enrollees
who request continuity of care with their former provider, if the new enrollee:
(1) is receiving culturally appropriate services and the health plan company does not
have a provider in its preferred provider network with special expertise in the delivery of
those culturally appropriate services within the time and distance requirements of section
62D.124, subdivision 1; or
(2) does not speak English and the health plan company does not have a provider in its
preferred provider network who can communicate with the enrollee, either directly or through
an interpreter, within the time and distance requirements of section 62D.124, subdivision
1.
The written plan must explain the criteria that will be used to determine whether a need for
continuity of care exists and how it will be provided.
(c) This subdivision applies only to group coverage and continuation and conversion
coverage, and applies only to changes in health plans made by the employer.
Sec. 6.
Minnesota Statutes 2020, section 62Q.73, subdivision 7, is amended to read:
Subd. 7.
Standards of review.
(a) For an external review of any issue in an adverse
determination that does not require a medical necessity determination, the external review
must be based on whether the adverse determination was in compliance with the enrollee's
health benefit plannew text begin and any applicable state and federal lawnew text end .
(b) For an external review of any issue in an adverse determination by a health plan
company licensed under chapter 62D that requires a medical necessity determination, the
external review must determine whether the adverse determination was consistent with the
definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
(c) For an external review of any issue in an adverse determination by a health plan
company, other than a health plan company licensed under chapter 62D, that requires a
medical necessity determination, the external review must determine whether the adverse
determination was consistent with the definition of medically necessary care in section
62Q.53, subdivision 2.
(d) For an external review of an adverse determination involving experimental or
investigational treatment, the external review entity must base its decision on all documents
submitted by the health plan company and enrollee, including medical records, the attending
physician, advanced practice registered nurse, or health care professional's recommendation,
consulting reports from health care professionals, the terms of coverage, federal Food and
Drug Administration approval, and medical or scientific evidence or evidence-based
standards.
Sec. 7.
Minnesota Statutes 2020, section 62U.04, is amended by adding a subdivision to
read:
new text begin Subd. 5b. new text end
new text begin Non-claims-based payments. new text end
new text begin
(a) Beginning in 2024, all health plan companies
and third-party administrators shall submit to a private entity designated by the commissioner
of health all non-claims-based payments made to health care providers. The data shall be
submitted in a form, manner, and frequency specified by the commissioner. Non-claims-based
payments are payments to health care providers designed to pay for value of health care
services over volume of health care services and include alternative payment models or
incentives, payments for infrastructure expenditures or investments, and payments for
workforce expenditures or investments. Non-claims-based payments submitted under this
subdivision must, to the extent possible, be attributed to a health care provider in the same
manner in which claims-based data are attributed to a health care provider and, where
appropriate, must be combined with data collected under subdivisions 4 and 5 in analyses
of health care spending.
new text end
new text begin
(b) Data collected under this subdivision are nonpublic data as defined in section 13.02.
Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary
data prepared under this subdivision may be derived from nonpublic data. The commissioner
shall establish procedures and safeguards to protect the integrity and confidentiality of any
data maintained by the commissioner.
new text end
new text begin
(c) The commissioner shall consult with health plan companies, hospitals, and health
care providers in developing the data reported under this subdivision and standardized
reporting forms.
new text end
Sec. 8.
Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 deleted text begin anddeleted text end new text begin ,new text end 5new text begin , and 5bnew text end for the
following purposes:
(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patients, payers, or providers;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
deleted text begin
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
Sec. 9.
Minnesota Statutes 2020, section 62U.10, subdivision 7, is amended to read:
Subd. 7.
Outcomes reporting; savings determination.
(a) deleted text begin Beginning November 1,
2016, anddeleted text end Each November 1 deleted text begin thereafterdeleted text end , the commissioner of health shall determine the
actual total private and public health care and long-term care spending for Minnesota
residents related to each health indicator projected in subdivision 6 for the most recent
calendar year available. The commissioner shall determine the difference between the
projected and actual spending for each health indicator and for each year, and determine
the savings attributable to changes in these health indicators. The assumptions and research
methods used to calculate actual spending must be determined to be appropriate by an
independent actuarial consultant. If the actual spending is less than the projected spending,
the commissioner, in consultation with the commissioners of human services and management
and budget, shall use the proportion of spending for state-administered health care programs
to total private and public health care spending for each health indicator for the calendar
year two years before the current calendar year to determine the percentage of the calculated
aggregate savings amount accruing to state-administered health care programs.
(b) The commissioner may use the data submitted under section 62U.04, subdivisions
4 deleted text begin anddeleted text end new text begin ,new text end 5, new text begin and 5b, new text end to complete the activities required under this section, but may only report
publicly on regional data aggregated to granularity of 25,000 lives or greater for this purpose.
Sec. 10.
new text begin
[115.7411] ADVISORY COUNCIL ON WATER SUPPLY SYSTEMS AND
WASTEWATER TREATMENT FACILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose; membership. new text end
new text begin
The advisory council on water supply systems
and wastewater treatment facilities shall advise the commissioners of health and the Pollution
Control Agency regarding classification of water supply systems and wastewater treatment
facilities, qualifications and competency evaluation of water supply system operators and
wastewater treatment facility operators, and additional laws, rules, and procedures that may
be desirable for regulating the operation of water supply systems and of wastewater treatment
facilities. The advisory council is composed of 11 voting members, of whom:
new text end
new text begin
(1) one member must be from the Department of Health, Division of Environmental
Health, appointed by the commissioner of health;
new text end
new text begin
(2) one member must be from the Pollution Control Agency, appointed by the
commissioner of the Pollution Control Agency;
new text end
new text begin
(3) three members must be certified water supply system operators, appointed by the
commissioner of health, one of whom must represent a nonmunicipal community or
nontransient noncommunity water supply system;
new text end
new text begin
(4) three members must be certified wastewater treatment facility operators, appointed
by the commissioner of the Pollution Control Agency;
new text end
new text begin
(5) one member must be a representative from an organization representing municipalities,
appointed by the commissioner of health with the concurrence of the commissioner of the
Pollution Control Agency; and
new text end
new text begin
(6) two members must be members of the public who are not associated with water
supply systems or wastewater treatment facilities. One must be appointed by the
commissioner of health and the other by the commissioner of the Pollution Control Agency.
Consideration should be given to one of these members being a representative of academia
knowledgeable in water or wastewater matters.
new text end
new text begin Subd. 2. new text end
new text begin Geographic representation. new text end
new text begin
At least one of the water supply system operators
and at least one of the wastewater treatment facility operators must be from outside the
seven-county metropolitan area, and one wastewater treatment facility operator must be
from the Metropolitan Council.
new text end
new text begin Subd. 3. new text end
new text begin Terms; compensation. new text end
new text begin
The terms of the appointed members and the
compensation and removal of all members are governed by section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Officers. new text end
new text begin
When new members are appointed to the council, a chair must be
elected at the next council meeting. The Department of Health representative shall serve as
secretary of the council.
new text end
Sec. 11.
Minnesota Statutes 2020, section 144.122, is amended to read:
144.122 LICENSE, PERMIT, AND SURVEY FEES.
(a) The state commissioner of health, by rule, may prescribe procedures and fees for
filing with the commissioner as prescribed by statute and for the issuance of original and
renewal permits, licenses, registrations, and certifications issued under authority of the
commissioner. The expiration dates of the various licenses, permits, registrations, and
certifications as prescribed by the rules shall be plainly marked thereon. Fees may include
application and examination fees and a penalty fee for renewal applications submitted after
the expiration date of the previously issued permit, license, registration, and certification.
The commissioner may also prescribe, by rule, reduced fees for permits, licenses,
registrations, and certifications when the application therefor is submitted during the last
three months of the permit, license, registration, or certification period. Fees proposed to
be prescribed in the rules shall be first approved by the Department of Management and
Budget. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be
in an amount so that the total fees collected by the commissioner will, where practical,
approximate the cost to the commissioner in administering the program. All fees collected
shall be deposited in the state treasury and credited to the state government special revenue
fund unless otherwise specifically appropriated by law for specific purposes.
(b) The commissioner may charge a fee for voluntary certification of medical laboratories
and environmental laboratories, and for environmental and medical laboratory services
provided by the department, without complying with paragraph (a) or chapter 14. Fees
charged for environment and medical laboratory services provided by the department must
be approximately equal to the costs of providing the services.
(c) The commissioner may develop a schedule of fees for diagnostic evaluations
conducted at clinics held by the services for children with disabilities program. All receipts
generated by the program are annually appropriated to the commissioner for use in the
maternal and child health program.
(d) The commissioner shall set license fees for hospitals and nursing homes that are not
boarding care homes at the following levels:
| Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and American Osteopathic Association (AOA) hospitals |
$7,655 plus $16 per bed |
| Non-JCAHO and non-AOA hospitals |
$5,280 plus $250 per bed |
| Nursing home |
$183 plus $91 per bed until June 30, 2018. $183 plus $100 per bed between July 1, 2018, and June 30, 2020. $183 plus $105 per bed beginning July 1, 2020. |
The commissioner shall set license fees for outpatient surgical centers, boarding care
homes, supervised living facilities, assisted living facilities, and assisted living facilities
with dementia care at the following levels:
| Outpatient surgical centers |
$3,712 |
| Boarding care homes |
$183 plus $91 per bed |
| Supervised living facilities |
$183 plus $91 per bed. |
| Assisted living facilities with dementia care |
$3,000 plus $100 per resident. |
| Assisted living facilities |
$2,000 plus $75 per resident. |
Fees collected under this paragraph are nonrefundable. The fees are nonrefundable even if
received before July 1, 2017, for licenses or registrations being issued effective July 1, 2017,
or later.
(e) Unless prohibited by federal law, the commissioner of health shall charge applicants
the following fees to cover the cost of any initial certification surveys required to determine
a provider's eligibility to participate in the Medicare or Medicaid program:
| Prospective payment surveys for hospitals |
$ |
900 |
| Swing bed surveys for nursing homes |
$ |
1,200 |
| Psychiatric hospitals |
$ |
1,400 |
| Rural health facilities |
$ |
1,100 |
| Portable x-ray providers |
$ |
500 |
| Home health agencies |
$ |
1,800 |
| Outpatient therapy agencies |
$ |
800 |
| End stage renal dialysis providers |
$ |
2,100 |
| Independent therapists |
$ |
800 |
| Comprehensive rehabilitation outpatient facilities |
$ |
1,200 |
| Hospice providers |
$ |
1,700 |
| Ambulatory surgical providers |
$ |
1,800 |
| Hospitals |
$ |
4,200 |
| Other provider categories or additional resurveys required to complete initial certification |
Actual surveyor costs: average surveyor cost x number of hours for the survey process. |
|
These fees shall be submitted at the time of the application for federal certification and
shall not be refunded. All fees collected after the date that the imposition of fees is not
prohibited by federal law shall be deposited in the state treasury and credited to the state
government special revenue fund.
(f) Notwithstanding section 16A.1283, the commissioner may adjust the fees assessed
on assisted living facilities and assisted living facilities with dementia care under paragraph
(d), in a revenue-neutral manner in accordance with the requirements of this paragraph:
(1) a facility seeking to renew a license shall pay a renewal fee in an amount that is up
to ten percent lower than the applicable fee in paragraph (d) if residents who receive home
and community-based waiver services under chapter 256S and section 256B.49 comprise
more than 50 percent of the facility's capacity in the calendar year prior to the year in which
the renewal application is submitted; and
(2) a facility seeking to renew a license shall pay a renewal fee in an amount that is up
to ten percent higher than the applicable fee in paragraph (d) if residents who receive home
and community-based waiver services under chapter 256S and section 256B.49 comprise
less than 50 percent of the facility's capacity during the calendar year prior to the year in
which the renewal application is submitted.
The commissioner may annually adjust the percentages in clauses (1) and (2), to ensure this
paragraph is implemented in a revenue-neutral manner. The commissioner shall develop a
method for determining capacity thresholds in this paragraph in consultation with the
commissioner of human services and must coordinate the administration of this paragraph
with the commissioner of human services for purposes of verification.
new text begin
(g) The commissioner shall charge hospitals an annual licensing base fee of $1,150 per
hospital, plus an additional $15 per licensed bed/bassinet fee. Revenue shall be deposited
to the state government special revenue fund and credited toward trauma hospital designations
under sections 144.605 and 144.6071.
new text end
Sec. 12.
Minnesota Statutes 2021 Supplement, section 144.1501, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following definitions
apply.
new text begin
(b) "Acupuncture practitioner" means an individual licensed to practice acupuncture
under chapter 147B.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end "Advanced dental therapist" means an individual who is licensed as a dental
therapist under section 150A.06, and who is certified as an advanced dental therapist under
section 150A.106.
new text begin
(d) "Advanced practice provider" means a nurse practitioner, nurse-midwife, nurse
anesthetist, clinical nurse specialist, or physician assistant.
new text end
deleted text begin (c)deleted text end new text begin (e)new text end "Alcohol and drug counselor" means an individual who is licensed as an alcohol
and drug counselor under chapter 148F.
deleted text begin (d)deleted text end new text begin (f)new text end "Dental therapist" means an individual who is licensed as a dental therapist under
section 150A.06.
deleted text begin (e)deleted text end new text begin (g)new text end "Dentist" means an individual who is licensed to practice dentistry.
deleted text begin (f)deleted text end new text begin (h)new text end "Designated rural area" means a statutory and home rule charter city or township
that is outside the seven-county metropolitan area as defined in section 473.121, subdivision
2, excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud.
deleted text begin (g)deleted text end new text begin (i)new text end "Emergency circumstances" means those conditions that make it impossible for
the participant to fulfill the service commitment, including death, total and permanent
disability, or temporary disability lasting more than two years.
deleted text begin (h)deleted text end new text begin (j)new text end "Mental health professional" means an individual providing clinical services in
the treatment of mental illness who is qualified in at least one of the ways specified in section
245.462, subdivision 18.
deleted text begin (i)deleted text end new text begin (k)new text end "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin
(j) "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse anesthetist,
advanced clinical nurse specialist, or physician assistant.
deleted text end
deleted text begin (k)deleted text end new text begin (l)new text end "Nurse" means an individual who has completed training and received all licensing
or certification necessary to perform duties as a licensed practical nurse or registered nurse.
deleted text begin (l)deleted text end new text begin (m)new text end "Nurse-midwife" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse-midwives.
deleted text begin (m)deleted text end new text begin (n)new text end "Nurse practitioner" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse practitioners.
deleted text begin (n)deleted text end new text begin (o)new text end "Pharmacist" means an individual with a valid license issued under chapter 151.
deleted text begin (o)deleted text end new text begin (p)new text end "Physician" means an individual who is licensed to practice medicine in the areas
of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (p)deleted text end new text begin (q)new text end "Physician assistant" means a person licensed under chapter 147A.
new text begin
(r) "Public health employee" means an individual working in a local, Tribal, or state
public health department.
new text end
deleted text begin (q)deleted text end new text begin (s)new text end "Public health nurse" means a registered nurse licensed in Minnesota who has
obtained a registration certificate as a public health nurse from the Board of Nursing in
accordance with Minnesota Rules, chapter 6316.
deleted text begin (r)deleted text end new text begin (t)new text end "Qualified educational loan" means a government, commercial, or foundation loan
for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.
new text begin
(u) "Underserved patient population" means patients who are state public program
enrollees or patients receiving sliding fee schedule discounts through a formal sliding fee
schedule meeting the standards established by the United States Department of Health and
Human Services under Code of Federal Regulations, title 42, section 51c.303.
new text end
deleted text begin (s)deleted text end new text begin (v)new text end "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.
Sec. 13.
Minnesota Statutes 2021 Supplement, section 144.1501, subdivision 2, is amended
to read:
Subd. 2.
Creation of account.
(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:
(1) for medical residents, mental health professionals, and alcohol and drug counselors
agreeing to practice in designated rural areas ornew text begin innew text end underserved urban communitiesnew text begin , agreeing
to provide at least 25 percent of the provider's yearly patient encounters to patients in an
underserved patient population,new text end or specializing in the area of pediatric psychiatry;
(2) for deleted text begin midlevel practitionersdeleted text end new text begin advanced practice providersnew text end agreeing to practice in
designated rural areas or to teach at least 12 credit hours, or 720 hours per year in the nursing
field in a postsecondary program at the undergraduate level or the equivalent at the graduate
level;
(3) for nurses who agree to practice in a Minnesota nursing home; an intermediate care
facility for persons with developmental disability; a hospital if the hospital owns and operates
a Minnesota nursing home and a minimum of 50 percent of the hours worked by the nurse
is in the nursing home; a housing with services establishment as defined in section 144D.01,
subdivision 4; new text begin a school district or charter school; new text end or for a home care provider as defined in
section 144A.43, subdivision 4; or agree to teach at least 12 credit hours, or 720 hours per
year in the nursing field in a postsecondary program at the undergraduate level or the
equivalent at the graduate level;
(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;
(5) for pharmacists, advanced dental therapists, dental therapists, new text begin acupuncture
practitioners, new text end and public health nurses who agree to practice in designated rural areas; deleted text begin and
deleted text end
(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to deleted text begin state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section 51, chapter 303.deleted text end new text begin patients in an underserved patient population;
new text end
new text begin
(7) for mental health professionals agreeing to provide up to 768 hours per year of clinical
supervision in their designated field; and
new text end
new text begin
(8) for public health employees serving in a local, Tribal, or state public health department
in an area of high need as determined by the commissioner.
new text end
(b) Appropriations made to the account do not cancel and are available until expended,
except that at the end of each biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing commitments shall cancel to the
fund.
Sec. 14.
Minnesota Statutes 2021 Supplement, section 144.1501, subdivision 3, is amended
to read:
Subd. 3.
Eligibility.
(a) To be eligible to participate in the loan forgiveness program, an
individual must:
(1) be a medical or dental resident; a licensed pharmacist; or be enrolled in a training or
education program to become a dentist, dental therapist, advanced dental therapist, mental
health professional, alcohol and drug counselor, pharmacist, new text begin public health employee, new text end public
health nurse, deleted text begin midlevel practitionerdeleted text end new text begin advanced practice providernew text end , new text begin acupuncture practitioner,
new text end registered nurse, or a licensed practical nurse. The commissioner may also consider
applications submitted by graduates in eligible professions who are licensed and in practice;
and
(2) submit an application to the commissioner of health.
(b) new text begin Except as provided in paragraph (c), new text end an applicant selected to participate must sign a
contract to agree to serve a minimum three-year full-time service obligation according to
subdivision 2, which shall begin no later than March 31 following completion of required
training, with the exception of a nurse, who must agree to serve a minimum two-year
full-time service obligation according to subdivision 2, which shall begin no later than
March 31 following completion of required training.
new text begin
(c) An applicant selected to participate who is a public health employee is eligible for
loan forgiveness within three years after completion of required training. An applicant
selected to participate who is a nurse and who agrees to teach according to subdivision 2,
paragraph (a), clause (3), must sign a contract to agree to teach for a minimum of two years.
new text end
Sec. 15.
Minnesota Statutes 2020, section 144.1501, subdivision 4, is amended to read:
Subd. 4.
Loan forgiveness.
new text begin (a) new text end The commissioner of health may select applicants each
year for participation in the loan forgiveness program, within the limits of available funding.
In considering applicationsnew text begin from applicants who are mental health professionals, the
commissioner shall give preference to applicants who work in rural or culturally specific
organizations. In considering applications from all other applicantsnew text end , the commissioner shall
give preference to applicants who document diverse cultural competencies. new text begin Except as
provided in paragraph (b), new text end the commissioner shall distribute available funds for loan
forgiveness proportionally among the eligible professions according to the vacancy rate for
each profession in the required geographic area, facility type, teaching area, patient group,
or specialty type specified in subdivision 2. The commissioner shall allocate funds for
physician loan forgiveness so that 75 percent of the funds available are used for rural
physician loan forgiveness and 25 percent of the funds available are used for underserved
urban communitiesnew text begin , physicians agreeing to provide at least 25 percent of the physician's
yearly patient encounters to patients in an underserved patient population,new text end and pediatric
psychiatry loan forgiveness. If the commissioner does not receive enough qualified applicants
each year to use the entire allocation of funds for any eligible profession, the remaining
funds may be allocated proportionally among the other eligible professions according to
the vacancy rate for each profession in the required geographic area, patient group, or facility
type specified in subdivision 2. Applicants are responsible for securing their own qualified
educational loans. The commissioner shall select participants based on their suitability for
practice serving the required geographic area or facility type specified in subdivision 2, as
indicated by experience or training. The commissioner shall give preference to applicants
closest to completing their training. new text begin Except as specified in paragraph (c), new text end for each year that
a participant meets the service obligation required under subdivision 3, up to a maximum
of four years, the commissioner shall make annual disbursements directly to the participant
equivalent to 15 percent of the average educational debt for indebted graduates in their
profession in the year closest to the applicant's selection for which information is available,
not to exceed the balance of the participant's qualifying educational loans. Before receiving
loan repayment disbursements and as requested, the participant must complete and return
to the commissioner a confirmation of practice form provided by the commissioner verifying
that the participant is practicing as required under subdivisions 2 and 3. The participant
must provide the commissioner with verification that the full amount of loan repayment
disbursement received by the participant has been applied toward the designated loans.
After each disbursement, verification must be received by the commissioner and approved
before the next loan repayment disbursement is made. Participants who move their practice
remain eligible for loan repayment as long as they practice as required under subdivision
2.
new text begin
(b) The commissioner shall distribute available funds for loan forgiveness for public
health employees according to areas of high need as determined by the commissioner.
new text end
new text begin
(c) For each year that a participant who is a nurse and who has agreed to teach according
to subdivision 2 meets the teaching obligation required in subdivision 3, the commissioner
shall make annual disbursements directly to the participant equivalent to 15 percent of the
average annual educational debt for indebted graduates in the nursing profession in the year
closest to the participant's selection for which information is available, not to exceed the
balance of the participant's qualifying educational loans.
new text end
Sec. 16.
Minnesota Statutes 2020, section 144.1501, subdivision 5, is amended to read:
Subd. 5.
Penalty for nonfulfillment.
If a participant does not fulfill the required
minimum commitment of service according to subdivision 3, the commissioner of health
shall collect from the participant the total amount paid to the participant under the loan
forgiveness program plus interest at a rate established according to section 270C.40. The
commissioner shall deposit the money collected in deleted text begin the health care access fund to be credited
to the health professional education loan forgiveness program account established in
subdivision 2deleted text end new text begin an account in the special revenue fundnew text end . new text begin The balance of the account does not
expire and is appropriated to the commissioner of health for health professional education
loan forgiveness awards under this section. new text end The commissioner shall allow waivers of all or
part of the money owed the commissioner as a result of a nonfulfillment penalty if emergency
circumstances prevented fulfillment of the minimum service commitment.
Sec. 17.
new text begin
[144.1504] HOSPITAL NURSING LOAN FORGIVENESS PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
(a) For purposes of this section, the following definitions
apply.
new text end
new text begin
(b) "Nurse" means an individual who is licensed as a registered nurse and who is
providing direct patient care in a nonprofit hospital.
new text end
new text begin
(c) "PSLF program" means the federal Public Student Loan Forgiveness program
established under Code of Federal Regulations, title 34, section 685.21.
new text end
new text begin Subd. 2. new text end
new text begin Eligibility. new text end
new text begin
(a) To be eligible to participate in the hospital nursing loan
forgiveness program, a nurse must be:
new text end
new text begin
(1) enrolled in the PSLF program;
new text end
new text begin
(2) employed full time as a registered nurse by a nonprofit hospital that is an eligible
employer under the PSLF program; and
new text end
new text begin
(3) providing direct care to patients at the nonprofit hospital.
new text end
new text begin
(b) An applicant for loan forgiveness must submit to the commissioner of health:
new text end
new text begin
(1) a completed application on forms provided by the commissioner;
new text end
new text begin
(2) proof that the applicant is enrolled in the PSLF program; and
new text end
new text begin
(3) confirmation that the applicant is employed full time as a registered nurse by a
nonprofit hospital and is providing direct patient care.
new text end
new text begin
(c) The applicant selected to participate must sign a contract to agree to continue to
provide direct patient care as a registered nurse at a nonprofit hospital for the repayment
period of the participant's eligible loan under the PSLF program.
new text end
new text begin Subd. 3. new text end
new text begin Loan forgiveness. new text end
new text begin
(a) The commissioner of health shall select applicants each
year for participation in the hospital nursing loan forgiveness program, within limits of
available funding. Applicants are responsible for applying for and maintaining eligibility
for the PSLF program.
new text end
new text begin
(b) For each year that a participant meets the eligibility requirements described in
subdivision 2, the commissioner shall make an annual disbursement directly to the participant
in an amount equal to the minimum loan payments required to be paid by the participant
under the participant's repayment plan under the PSLF program for the previous loan year.
Before receiving the annual loan repayment disbursement, the participant must complete
and return to the commissioner a confirmation of practice form provided by the
commissioner, verifying that the participant continues to meet the eligibility requirements
under subdivision 2.
new text end
new text begin
(c) The participant must provide the commissioner with verification that the full amount
of loan repayment disbursement received by the participant has been applied toward the
loan for which forgiveness is sought under the PSLF program.
new text end
new text begin Subd. 4. new text end
new text begin Penalty for nonfulfillment. new text end
new text begin
If a participant does not fulfill the required
minimum commitment of service as required under subdivision 2, or the secretary of
education determines that the participant does not meet eligibility requirements for the PSLF
program, the commissioner shall collect from the participant the total amount paid to the
participant under the hospital nursing loan forgiveness program plus interest at a rate
established according to section 270C.40. The commissioner shall deposit the money
collected in the health care access fund to be credited to the health professional education
loan forgiveness program account established in section 144.1501, subdivision 2. The
commissioner shall allow waivers of all or part of the money owed to the commissioner as
a result of a nonfulfillment penalty if emergency circumstances prevent fulfillment of the
service commitment or if the PSLF program is discontinued before the participant's service
commitment is fulfilled.
new text end
Sec. 18.
Minnesota Statutes 2020, section 144.1505, is amended to read:
144.1505 HEALTH PROFESSIONALS CLINICAL TRAINING EXPANSION
new text begin AND RURAL AND UNDERSERVED CLINICAL ROTATIONS new text end GRANT deleted text begin PROGRAMdeleted text end new text begin
PROGRAMSnew text end .
Subdivision 1.
Definitions.
For purposes of this section, the following definitions apply:
(1) "eligible advanced practice registered nurse program" means a program that is located
in Minnesota and is currently accredited as a master's, doctoral, or postgraduate level
advanced practice registered nurse program by the Commission on Collegiate Nursing
Education or by the Accreditation Commission for Education in Nursing, or is a candidate
for accreditation;
new text begin
(2) "eligible dental program" means a dental residency training program that is located
in Minnesota and is currently accredited by the accrediting body or is a candidate for
accreditation;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end "eligible dental therapy program" means a dental therapy education program or
advanced dental therapy education program that is located in Minnesota and is either:
(i) approved by the Board of Dentistry; or
(ii) currently accredited by the Commission on Dental Accreditation;
deleted text begin (3)deleted text end new text begin (4)new text end "eligible mental health professional program" means a program that is located
in Minnesota and is listed as a mental health professional program by the appropriate
accrediting body for clinical social work, psychology, marriage and family therapy, or
licensed professional clinical counseling, or is a candidate for accreditation;
deleted text begin (4)deleted text end new text begin (5)new text end "eligible pharmacy program" means a program that is located in Minnesota and
is currently accredited as a doctor of pharmacy program by the Accreditation Council on
Pharmacy Education;
deleted text begin (5)deleted text end new text begin (6)new text end "eligible physician assistant program" means a program that is located in
Minnesota and is currently accredited as a physician assistant program by the Accreditation
Review Commission on Education for the Physician Assistant, or is a candidate for
accreditation;
new text begin
(7) "eligible physician program" means a physician residency training program that is
located in Minnesota and is currently accredited by the accrediting body or is a candidate
for accreditation;
new text end
deleted text begin (6)deleted text end new text begin (8)new text end "mental health professional" means an individual providing clinical services in
the treatment of mental illness who meets one of the qualifications under section 245.462,
subdivision 18; and
deleted text begin (7)deleted text end new text begin (9)new text end "project" means a project to establish or expand clinical training for physician
assistants, advanced practice registered nurses, pharmacists, new text begin physicians, dentists, new text end dental
therapists, advanced dental therapists, or mental health professionals in Minnesota.
Subd. 2.
new text begin Health professionals clinical training expansion grant new text end program.
(a) The
commissioner of health shall award health professional training site grants to eligible
physician assistant, advanced practice registered nurse, pharmacy, dental therapy, and mental
health professional programs to plan and implement expanded clinical training. A planning
grant shall not exceed $75,000, and a training grant shall not exceed $150,000 for the first
year, $100,000 for the second year, and $50,000 for the third year per program.
(b) Funds may be used for:
(1) establishing or expanding clinical training for physician assistants, advanced practice
registered nurses, pharmacists, dental therapists, advanced dental therapists, and mental
health professionals in Minnesota;
(2) recruitment, training, and retention of students and faculty;
(3) connecting students with appropriate clinical training sites, internships, practicums,
or externship activities;
(4) travel and lodging for students;
(5) faculty, student, and preceptor salaries, incentives, or other financial support;
(6) development and implementation of cultural competency training;
(7) evaluations;
(8) training site improvements, fees, equipment, and supplies required to establish,
maintain, or expand a physician assistant, advanced practice registered nurse, pharmacy,
dental therapy, or mental health professional training program; and
(9) supporting clinical education in which trainees are part of a primary care team model.
new text begin Subd. 2a. new text end
new text begin
Health professional rural and underserved clinical rotations grant
program.
new text end
new text begin
(a) The commissioner of health shall award health professional training site grants
to eligible physician, physician assistant, advanced practice registered nurse, pharmacy,
dentistry, dental therapy, and mental health professional programs to augment existing
clinical training programs by adding rural and underserved rotations or clinical training
experiences, such as credential or certificate rural tracks or other specialized training. For
physician and dentist training, the expanded training must include rotations in primary care
settings such as community clinics, hospitals, health maintenance organizations, or practices
in rural communities.
new text end
new text begin
(b) Funds may be used for:
new text end
new text begin
(1) establishing or expanding rotations and clinical trainings;
new text end
new text begin
(2) recruitment, training, and retention of students and faculty;
new text end
new text begin
(3) connecting students with appropriate clinical training sites, internships, practicums,
or externship activities;
new text end
new text begin
(4) travel and lodging for students;
new text end
new text begin
(5) faculty, student, and preceptor salaries, incentives, or other financial support;
new text end
new text begin
(6) development and implementation of cultural competency training;
new text end
new text begin
(7) evaluations;
new text end
new text begin
(8) training site improvements, fees, equipment, and supplies required to establish,
maintain, or expand training programs; and
new text end
new text begin
(9) supporting clinical education in which trainees are part of a primary care team model.
new text end
Subd. 3.
Applications.
Eligible physician assistant, advanced practice registered nurse,
pharmacy, dental therapy, deleted text begin anddeleted text end mental health professionalnew text begin , physician, and dentalnew text end programs
seeking a grant shall apply to the commissioner. Applications must include a description
of the number of additional students who will be trained using grant funds; attestation that
funding will be used to support an increase in the number of clinical training slots; a
description of the problem that the proposed project will address; a description of the project,
including all costs associated with the project, sources of funds for the project, detailed uses
of all funds for the project, and the results expected; and a plan to maintain or operate any
component included in the project after the grant period. The applicant must describe
achievable objectives, a timetable, and roles and capabilities of responsible individuals in
the organization.new text begin Applicants applying under subdivision 2a must also include information
about the length of training and training site settings, the geographic locations of rural sites,
and rural populations expected to be served.
new text end
Subd. 4.
Consideration of applications.
The commissioner shall review each application
to determine whether or not the application is complete and whether the program and the
project are eligible for a grant. In evaluating applications, the commissioner shall score each
application based on factors including, but not limited to, the applicant's clarity and
thoroughness in describing the project and the problems to be addressed, the extent to which
the applicant has demonstrated that the applicant has made adequate provisions to ensure
proper and efficient operation of the training program once the grant project is completed,
the extent to which the proposed project is consistent with the goal of increasing access to
primary care and mental health services for rural and underserved urban communities, the
extent to which the proposed project incorporates team-based primary care, and project
costs and use of funds.
Subd. 5.
Program oversight.
The commissioner shall determine the amount of a grant
to be given to an eligible program based on the relative score of each eligible program's
applicationnew text begin and rural locations if applicable under subdivision 2bnew text end , other relevant factors
discussed during the review, and the funds available to the commissioner. Appropriations
made to the program do not cancel and are available until expended. During the grant period,
the commissioner may require and collect from programs receiving grants any information
necessary to evaluate the program.
Sec. 19.
new text begin
[144.1507] PRIMARY CARE RURAL RESIDENCY TRAINING GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Eligible program" means a program that meets the following criteria:
new text end
new text begin
(1) is located in Minnesota;
new text end
new text begin
(2) trains medical residents in the specialties of family medicine, general internal
medicine, general pediatrics, psychiatry, geriatrics, or general surgery; and
new text end
new text begin
(3) is accredited by the Accreditation Council for Graduate Medical Education or presents
a credible plan to obtain accreditation.
new text end
new text begin
(c) "Rural residency training program" means a residency program that utilizes local
clinics and community hospitals and that provides an initial year of training in an existing
accredited residency program in Minnesota. The subsequent years of the residency program
are based in rural communities with specialty rotations in nearby regional medical centers.
new text end
new text begin
(d) "Eligible project" means a project to establish and maintain a rural residency training
program.
new text end
new text begin Subd. 2. new text end
new text begin Rural residency training program. new text end
new text begin
(a) The commissioner of health shall
award rural residency training program grants to eligible programs to plan and implement
rural residency training programs. A rural residency training program grant shall not exceed
$250,000 per resident per year for the first year of planning and development, and $225,000
for each of the following years.
new text end
new text begin
(b) Funds may be spent to cover the costs of:
new text end
new text begin
(1) planning related to establishing an accredited rural residency training program;
new text end
new text begin
(2) obtaining accreditation by the Accreditation Council for Graduate Medical Education
or another national body that accredits rural residency training programs;
new text end
new text begin
(3) establishing new rural residency training programs;
new text end
new text begin
(4) recruitment, training, and retention of new residents and faculty;
new text end
new text begin
(5) travel and lodging for new residents;
new text end
new text begin
(6) faculty, new resident, and preceptor salaries related to a new rural residency training
program;
new text end
new text begin
(7) training site improvements, fees, equipment, and supplies required for a new rural
residency training program; and
new text end
new text begin
(8) supporting clinical education in which trainees are part of a primary care team model.
new text end
new text begin Subd. 3. new text end
new text begin Applications for rural residency training program grants. new text end
new text begin
(a) Eligible
programs seeking a grant shall apply to the commissioner. Applications must include: (1)
the number of new primary care rural residency training program slots planned, under
development, or under contract; (2) a description of the training program, including the
location of the established residency program and rural training sites; (3) a description of
the project, including all costs associated with the project; (4) all sources of funds for the
project; (5) detailed uses of all funds for the project; (6) the results expected; and (7) a plan
to seek federal funding for graduate medical education for the site if eligible.
new text end
new text begin
(b) The applicant must describe achievable objectives, a timetable, and the roles and
capabilities of responsible individuals in the organization.
new text end
new text begin Subd. 4. new text end
new text begin Consideration of grant applications. new text end
new text begin
The commissioner shall review each
application to determine if the residency program application is complete, if the proposed
rural residency program and residency slots are eligible for a grant, and if the program is
eligible for federal graduate medical education funding, and when funding becomes available.
The commissioner shall award grants to support training programs in family medicine,
general internal medicine, general pediatrics, psychiatry, geriatrics, and general surgery.
new text end
new text begin Subd. 5. new text end
new text begin Program oversight. new text end
new text begin
During the grant period, the commissioner may require
and collect from grantees any information necessary to evaluate the program. Appropriations
made to the program do not cancel and are available until expended.
new text end
Sec. 20.
new text begin
[144.1508] MENTAL HEALTH PROVIDER SUPERVISION GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Mental health professional" means an individual with a qualification specified in
section 245I.04, subdivision 2.
new text end
new text begin
(c) "Underrepresented community" has the meaning given in section 148E.010,
subdivision 20.
new text end
new text begin Subd. 2. new text end
new text begin Grant program established. new text end
new text begin
The commissioner of health shall award grants
to licensed or certified mental health providers who meet the criteria in subdivision 3 to
fund supervision of interns and clinical trainees who are working toward becoming a licensed
mental health professional and to subsidize the costs of mental health professional licensing
applications and examination fees for clinical trainees.
new text end
new text begin Subd. 3. new text end
new text begin Eligible providers. new text end
new text begin
In order to be eligible for a grant under this section, a mental
health provider must:
new text end
new text begin
(1) provide at least 25 percent of the provider's yearly patient encounters to state public
program enrollees or patients receiving sliding fee schedule discounts through a formal
sliding fee schedule meeting the standards established by the United States Department of
Health and Human Services under Code of Federal Regulations, title 42, section 51c.303;
or
new text end
new text begin
(2) primarily serve persons from communities of color or underrepresented communities.
new text end
new text begin Subd. 4. new text end
new text begin Application; grant award. new text end
new text begin
A mental health provider seeking a grant under
this section must apply to the commissioner at a time and in a manner specified by the
commissioner. The commissioner shall review each application to determine if the application
is complete, the mental health provider is eligible for a grant, and the proposed project is
an allowable use of grant funds. The commissioner shall give preference to grant applicants
who work in rural or culturally specific organizations. The commissioner must determine
the grant amount awarded to applicants that the commissioner determines will receive a
grant.
new text end
new text begin Subd. 5. new text end
new text begin Allowable uses of grant funds. new text end
new text begin
A mental health provider must use grant funds
received under this section for one or more of the following:
new text end
new text begin
(1) to pay for direct supervision hours for interns and clinical trainees, in an amount up
to $7,500 per intern or clinical trainee;
new text end
new text begin
(2) to establish a program to provide supervision to multiple interns or clinical trainees;
or
new text end
new text begin
(3) to pay mental health professional licensing application and examination fees for
clinical trainees.
new text end
new text begin Subd. 6. new text end
new text begin Program oversight. new text end
new text begin
During the grant period, the commissioner may require
grant recipients to provide the commissioner with information necessary to evaluate the
program.
new text end
Sec. 21.
new text begin
[144.1509] MENTAL HEALTH PROFESSIONAL SCHOLARSHIP GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Mental health professional" means an individual with a qualification specified in
section 245I.04, subdivision 2.
new text end
new text begin
(c) "Underrepresented community" has the meaning given in section 148E.010,
subdivision 20.
new text end
new text begin Subd. 2. new text end
new text begin Grant program established. new text end
new text begin
A mental health professional scholarship program
is established to assist mental health providers in funding employee scholarships for master's
level education programs in order to create a pathway to becoming a mental health
professional.
new text end
new text begin Subd. 3. new text end
new text begin Provision of grants. new text end
new text begin
The commissioner of health shall award grants to licensed
or certified mental health providers who meet the criteria in subdivision 4 to provide tuition
reimbursement for master's level programs and certain related costs for individuals who
have worked for the mental health provider for at least the past two years in one or more of
the following roles:
new text end
new text begin
(1) a mental health behavioral aide who meets a qualification in section 245I.04,
subdivision 16;
new text end
new text begin
(2) a mental health certified family peer specialist who meets the qualifications in section
245I.04, subdivision 12;
new text end
new text begin
(3) a mental health certified peer specialist who meets the qualifications in section
245I.04, subdivision 10;
new text end
new text begin
(4) a mental health practitioner who meets a qualification in section 245I.04, subdivision
4;
new text end
new text begin
(5) a mental health rehabilitation worker who meets the qualifications in section 245I.04,
subdivision 14;
new text end
new text begin
(6) an individual employed in a role in which the individual provides face-to-face client
services at a mental health center or certified community behavioral health center; or
new text end
new text begin
(7) a staff person who provides care or services to residents of a residential treatment
facility.
new text end
new text begin Subd. 4. new text end
new text begin Eligibility. new text end
new text begin
In order to be eligible for a grant under this section, a mental health
provider must:
new text end
new text begin
(1) primarily provide at least 25 percent of the provider's yearly patient encounters to
state public program enrollees or patients receiving sliding fee schedule discounts through
a formal sliding fee schedule meeting the standards established by the United States
Department of Health and Human Services under Code of Federal Regulations, title 42,
section 51c.303; or
new text end
new text begin
(2) primarily serve people from communities of color or underrepresented communities.
new text end
new text begin Subd. 5. new text end
new text begin Request for proposals. new text end
new text begin
The commissioner must publish a request for proposals
in the State Register specifying provider eligibility requirements, criteria for a qualifying
employee scholarship program, provider selection criteria, documentation required for
program participation, the maximum award amount, and methods of evaluation. The
commissioner must publish additional requests for proposals each year in which funding is
available for this purpose.
new text end
new text begin Subd. 6. new text end
new text begin Application requirements. new text end
new text begin
An eligible provider seeking a grant under this
section must submit an application to the commissioner. An application must contain a
complete description of the employee scholarship program being proposed by the applicant,
including the need for the mental health provider to enhance the education of its workforce,
the process the mental health provider will use to determine which employees will be eligible
for scholarships, any other funding sources for scholarships, the amount of funding sought
for the scholarship program, a proposed budget detailing how funds will be spent, and plans
to retain eligible employees after completion of the education program.
new text end
new text begin Subd. 7. new text end
new text begin Selection process. new text end
new text begin
The commissioner shall determine a maximum award amount
for grants and shall select grant recipients based on the information provided in the grant
application, including the demonstrated need for the applicant provider to enhance the
education of its workforce, the proposed process to select employees for scholarships, the
applicant's proposed budget, and other criteria as determined by the commissioner. The
commissioner shall give preference to grant applicants who work in rural or culturally
specific organizations.
new text end
new text begin Subd. 8. new text end
new text begin Grant agreements. new text end
new text begin
Notwithstanding any law or rule to the contrary, funds
awarded to a grant recipient in a grant agreement do not lapse until the grant agreement
expires.
new text end
new text begin Subd. 9. new text end
new text begin Allowable uses of grant funds. new text end
new text begin
A mental health provider receiving a grant
under this section must use the grant funds for one or more of the following:
new text end
new text begin
(1) to provide employees with tuition reimbursement for a master's level program in a
discipline that will allow the employee to qualify as a mental health professional; or
new text end
new text begin
(2) for resources and supports, such as child care and transportation, that allow an
employee to attend a master's level program specified in clause (1).
new text end
new text begin Subd. 10. new text end
new text begin Reporting requirements. new text end
new text begin
A mental health provider receiving a grant under
this section shall submit to the commissioner an invoice for reimbursement and a report,
on a schedule determined by the commissioner and using a form supplied by the
commissioner. The report must include the amount spent on scholarships; the number of
employees who received scholarships; and, for each scholarship recipient, the recipient's
name, current position, amount awarded, educational institution attended, name of the
educational program, and expected or actual program completion date.
new text end
Sec. 22.
new text begin
[144.1511] CLINICAL HEALTH CARE TRAINING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Accredited clinical training" means the clinical training provided by a medical
education program that is accredited through an organization recognized by the Department
of Education, the Centers for Medicare and Medicaid Services, or another national body
that reviews the accrediting organizations for multiple disciplines and whose standards for
recognizing accrediting organizations are reviewed and approved by the commissioner of
health.
new text end
new text begin
(c) "Commissioner" means the commissioner of health.
new text end
new text begin
(d) "Clinical medical education program" means the accredited clinical training of
physicians, medical students and residents, doctor of pharmacy practitioners, doctors of
chiropractic, dentists, advanced practice registered nurses, clinical nurse specialists, certified
registered nurse anesthetists, nurse practitioners, certified nurse midwives, physician
assistants, dental therapists and advanced dental therapists, psychologists, clinical social
workers, community paramedics, community health workers, and other medical professions
as determined by the commissioner.
new text end
new text begin
(e) "Eligible entity" means an organization that is located in Minnesota, provides a
clinical medical education experience, and hosts students, residents or other trainee types
as determined by the commissioner and are from an accredited Minnesota teaching program
and institution.
new text end
new text begin
(f) "Teaching institution" means a hospital, medical center, clinic, or other organization
that conducts a clinical medical education program in Minnesota and which is accountable
to the accrediting body.
new text end
new text begin
(g) "Trainee" means a student, resident, fellow, or other postgraduate involved in a
clinical medical education program from an accredited Minnesota teaching program and
institution.
new text end
new text begin
(h) "Eligible trainee FTEs" means the number of trainees, as measured by full-time
equivalent counts, that are training in Minnesota at an entity with either currently active
medical assistance enrollment status and a National Provider Identification (NPI) number
or documentation that they provide sliding fee services. Training may occur in an inpatient
or ambulatory patient care setting or alternative setting as determined by the commissioner.
Training that occurs in nursing facility settings is not eligible for funding under this section.
new text end
new text begin Subd. 2. new text end
new text begin Application process. new text end
new text begin
(a) An eligible entity hosting clinical trainees from a
clinical medical education program and teaching institution is eligible for funds under
subdivision 3 if the entity:
new text end
new text begin
(1) is funded in part by sliding fee scale services or enrolled in the Minnesota health
care program;
new text end
new text begin
(2) faces increased financial pressure as a result of competition with nonteaching patient
care entities; and
new text end
new text begin
(3) emphasizes primary care or specialties that are in undersupply in rural or underserved
areas of Minnesota.
new text end
new text begin
(b) An entity hosting a clinical medical education program for advanced practice nursing
is eligible for funds under subdivision 3 if the program meets the eligibility requirements
in paragraph (a) and is sponsored by the University of Minnesota Academic Health Center,
the Mayo Foundation, or an institution that is part of the Minnesota State Colleges and
Universities system or a member of the Minnesota Private College Council.
new text end
new text begin
(c) An application must be submitted to the commissioner by an eligible entity or teaching
institution and contain the following information:
new text end
new text begin
(1) the official name and address and the site address of the clinical medical education
program where eligible trainees are hosted;
new text end
new text begin
(2) the name, title, and business address of those persons responsible for administering
the funds; and
new text end
new text begin
(3) for each applicant: (i) the type and specialty orientation of trainees in the program;
(ii) the name, entity address, and medical assistance provider number and national provider
identification number of each training site used in the program, as appropriate; (iii) the
federal tax identification number of each training site, where available; (iv) the total number
of trainees at each training site; (v) the total number of eligible trainee FTEs at each site;
and (vi) other supporting information the commissioner deems necessary.
new text end
new text begin
(d) An applicant that does not provide information requested by the commissioner shall
not be eligible for funds for the current funding cycle.
new text end
new text begin Subd. 3. new text end
new text begin Distribution of funds. new text end
new text begin
(a) The commissioner may distribute funds for clinical
training in areas of Minnesota and for professions listed in subdivision 1, paragraph (d)
determined by the commissioner as a high need area and profession shortage. The
commissioner shall annually distribute medical education funds to qualifying applicants
under this section based on costs to train, service level needs, and profession or training site
shortages. Use of funds is limited to related clinical training costs for eligible programs.
new text end
new text begin
(b) To ensure the quality of clinical training, eligible entities must demonstrate that they
hold contracts in good standing with eligible educational institutions that specify the terms,
expectations, and outcomes of the clinical training conducted at sites. Funds shall be
distributed in an administrative process determined by the commissioner to be efficient.
new text end
new text begin Subd. 4. new text end
new text begin Report. new text end
new text begin
(a) Teaching institutions receiving funds under this section must sign
and submit a medical education grant verification report (GVR) to verify that the correct
grant amount was forwarded to each eligible entity. If the teaching institution fails to submit
the GVR by the stated deadline, or to request and meet the deadline for an extension, the
sponsoring institution is required to return the full amount of funds received to the
commissioner within 30 days of receiving notice from the commissioner. The commissioner
shall distribute returned funds to the appropriate training sites in accordance with the
commissioner's approval letter.
new text end
new text begin
(b) Teaching institutions receiving funds under this section must provide any other
information the commissioner deems appropriate to evaluate the effectiveness of the use of
funds for medical education.
new text end
Sec. 23.
Minnesota Statutes 2020, section 144.383, is amended to read:
144.383 AUTHORITY OF COMMISSIONERnew text begin ; SAFE DRINKING WATERnew text end .
In order to deleted text begin insuredeleted text end new text begin ensurenew text end safe drinking water in all public water supplies, the commissioner
has the deleted text begin following powersdeleted text end new text begin power tonew text end :
deleted text begin (a) Todeleted text end new text begin (1)new text end approve the site, design, and construction and alteration of all public water
supplies and, for community and nontransient noncommunity water systems as defined in
Code of Federal Regulations, title 40, section 141.2, to approve documentation that
demonstrates the technical, managerial, and financial capacity of those systems to comply
with rules adopted under this section;
deleted text begin (b) Todeleted text end new text begin (2)new text end enter the premises of a public water supply, or part thereof, to inspect the
facilities and records kept pursuant to rules promulgated by the commissioner, to conduct
sanitary surveys and investigate the standard of operation and service delivered by public
water supplies;
deleted text begin (c) Todeleted text end new text begin (3)new text end contract with community health boards as defined in section 145A.02,
subdivision 5, for routine surveys, inspections, and testing of public water supply quality;
deleted text begin (d) Todeleted text end new text begin (4)new text end develop an emergency plan to protect the public when a decline in water
quality or quantity creates a serious health risk, and to issue emergency orders if a health
risk is imminent;
deleted text begin (e) Todeleted text end new text begin (5)new text end promulgate rules, pursuant to chapter 14 but no less stringent than federal
regulation, which may include the granting of variances and exemptionsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) maintain a database of lead service lines, provide technical assistance to community
water systems, and ensure the lead service inventory data is accessible to the public with
relevant educational materials about health risks related to lead and ways to reduce exposure.
new text end
Sec. 24.
Minnesota Statutes 2020, section 144.554, is amended to read:
144.554 HEALTH FACILITIES CONSTRUCTION PLAN SUBMITTAL AND
FEES.
For hospitals, nursing homes, boarding care homes, residential hospices, supervised
living facilities, freestanding outpatient surgical centers, and end-stage renal disease facilities,
the commissioner shall collect a fee for the review and approval of architectural, mechanical,
and electrical plans and specifications submitted before construction begins for each project
relative to construction of new buildings, additions to existing buildings, or remodeling or
alterations of existing buildings. All fees collected in this section shall be deposited in the
state treasury and credited to the state government special revenue fund. Fees must be paid
at the time of submission of final plans for review and are not refundable. The fee is
calculated as follows:
| Construction project total estimated cost |
Fee |
| $0 - $10,000 |
deleted text begin
$30
deleted text end
new text begin
$45 new text end |
| $10,001 - $50,000 |
deleted text begin
$150
deleted text end
new text begin
$225 new text end |
| $50,001 - $100,000 |
deleted text begin
$300
deleted text end
new text begin
$450 new text end |
| $100,001 - $150,000 |
deleted text begin
$450
deleted text end
new text begin
$675 new text end |
| $150,001 - $200,000 |
deleted text begin
$600
deleted text end
new text begin
$900 new text end |
| $200,001 - $250,000 |
deleted text begin
$750
deleted text end
new text begin
$1,125 new text end |
| $250,001 - $300,000 |
deleted text begin
$900
deleted text end
new text begin
$1,350 new text end |
| $300,001 - $350,000 |
deleted text begin
$1,050
deleted text end
new text begin
$1,575 new text end |
| $350,001 - $400,000 |
deleted text begin
$1,200
deleted text end
new text begin
$1,800 new text end |
| $400,001 - $450,000 |
deleted text begin
$1,350
deleted text end
new text begin
$2,025 new text end |
| $450,001 - $500,000 |
deleted text begin
$1,500
deleted text end
new text begin
$2,250 new text end |
| $500,001 - $550,000 |
deleted text begin
$1,650
deleted text end
new text begin
$2,475 new text end |
| $550,001 - $600,000 |
deleted text begin
$1,800
deleted text end
new text begin
$2,700 new text end |
| $600,001 - $650,000 |
deleted text begin
$1,950
deleted text end
new text begin
$2,925 new text end |
| $650,001 - $700,000 |
deleted text begin
$2,100
deleted text end
new text begin
$3,150 new text end |
| $700,001 - $750,000 |
deleted text begin
$2,250
deleted text end
new text begin
$3,375 new text end |
| $750,001 - $800,000 |
deleted text begin
$2,400
deleted text end
new text begin
$3,600 new text end |
| $800,001 - $850,000 |
deleted text begin
$2,550
deleted text end
new text begin
$3,825 new text end |
| $850,001 - $900,000 |
deleted text begin
$2,700
deleted text end
new text begin
$4,050 new text end |
| $900,001 - $950,000 |
deleted text begin
$2,850
deleted text end
new text begin
$4,275 new text end |
| $950,001 - $1,000,000 |
deleted text begin
$3,000
deleted text end
new text begin
$4,500 new text end |
| $1,000,001 - $1,050,000 |
deleted text begin
$3,150
deleted text end
new text begin
$4,725 new text end |
| $1,050,001 - $1,100,000 |
deleted text begin
$3,300
deleted text end
new text begin
$4,950 new text end |
| $1,100,001 - $1,150,000 |
deleted text begin
$3,450
deleted text end
new text begin
$5,175 new text end |
| $1,150,001 - $1,200,000 |
deleted text begin
$3,600
deleted text end
new text begin
$5,400 new text end |
| $1,200,001 - $1,250,000 |
deleted text begin
$3,750
deleted text end
new text begin
$5,625 new text end |
| $1,250,001 - $1,300,000 |
deleted text begin
$3,900
deleted text end
new text begin
$5,850 new text end |
| $1,300,001 - $1,350,000 |
deleted text begin
$4,050
deleted text end
new text begin
$6,075 new text end |
| $1,350,001 - $1,400,000 |
deleted text begin
$4,200
deleted text end
new text begin
$6,300 new text end |
| $1,400,001 - $1,450,000 |
deleted text begin
$4,350
deleted text end
new text begin
$6,525 new text end |
| $1,450,001 - $1,500,000 |
deleted text begin
$4,500
deleted text end
new text begin
$6,750 new text end |
| $1,500,001 and over |
deleted text begin
$4,800
deleted text end
new text begin
$7,200 new text end |
Sec. 25.
new text begin
[144.7051] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
For the purposes of sections 144.7051 to 144.7059, the
terms defined in this section have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of health.
new text end
new text begin Subd. 3. new text end
new text begin Daily staffing schedule. new text end
new text begin
"Daily staffing schedule" means the actual number
of full-time equivalent nonmanagerial care staff assigned to an inpatient care unit and
providing care in that unit during a 24-hour period and the actual number of patients assigned
to each direct care registered nurse present and providing care in the unit.
new text end
new text begin Subd. 4. new text end
new text begin Direct care registered nurse. new text end
new text begin
"Direct care registered nurse" means a registered
nurse, as defined in section 148.171, subdivision 20, who is nonsupervisory and
nonmanagerial and who directly provides nursing care to patients more than 60 percent of
the time.
new text end
new text begin Subd. 5. new text end
new text begin Hospital. new text end
new text begin
"Hospital" means any setting that is licensed as a hospital under
sections 144.50 to 144.56.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 26.
new text begin
[144.7053] HOSPITAL NURSE STAFFING COMMITTEES.
new text end
new text begin Subdivision 1. new text end
new text begin Hospital nurse staffing committee required. new text end
new text begin
Each hospital must establish
and maintain a functioning hospital nurse staffing committee. A hospital may assign the
functions and duties of a hospital nurse staffing committee to an existing committee, provided
the existing committee meets the membership requirements applicable to a hospital nurse
staffing committee.
new text end
new text begin Subd. 2. new text end
new text begin Committee membership. new text end
new text begin
(a) At least 35 percent of the committee's membership
must be direct care registered nurses typically assigned to a specific unit for an entire shift,
and at least 15 percent of the committee's membership must be other direct care workers
typically assigned to a specific unit for an entire shift. Direct care registered nurses and
other direct care workers who are members of a collective bargaining unit shall be appointed
or elected to the committee according to the guidelines of the applicable collective bargaining
agreement. If there is no collective bargaining agreement, direct care registered nurses shall
be elected to the committee by direct care registered nurses employed by the hospital, and
other direct care workers shall be elected to the committee by other direct care workers
employed by the hospital.
new text end
new text begin
(b) The hospital shall appoint no more than 50 percent of the committee's membership.
new text end
new text begin Subd. 3. new text end
new text begin Compensation. new text end
new text begin
A hospital must treat participation in committee meetings by
any hospital employee as scheduled work time and compensate each committee member at
the employee's existing rate of pay. A hospital must relieve all direct care registered nurse
members of the hospital nurse staffing committee of other work duties during the times at
which the committee meets.
new text end
new text begin Subd. 4. new text end
new text begin Meeting frequency. new text end
new text begin
Each hospital nurse staffing committee must meet at least
quarterly.
new text end
new text begin Subd. 5. new text end
new text begin Committee duties. new text end
new text begin
(a) Each hospital nurse staffing committee shall create,
implement, continuously evaluate, and update as needed evidence-based written core staffing
plans to guide the creation of daily staffing schedules for each inpatient care unit of the
hospital.
new text end
new text begin
(b) Each hospital nurse staffing committee must:
new text end
new text begin
(1) establish a secure and anonymous method for any hospital employee or patient to
submit directly to the committee any concerns related to safe staffing;
new text end
new text begin
(2) review each concern related to safe staffing submitted directly to the committee;
new text end
new text begin
(3) review the documentation of compliance maintained by the hospital under section
144.7056, subdivision 5;
new text end
new text begin
(4) conduct a trend analysis of the data related to all reported concerns regarding safe
staffing;
new text end
new text begin
(5) develop a mechanism for tracking and analyzing staffing trends within the hospital;
new text end
new text begin
(6) submit to the commissioner a nurse staffing report; and
new text end
new text begin
(7) record in the committee minutes for each meeting a summary of the discussions and
recommendations of the committee. Each committee must maintain the minutes, records,
and distributed materials for five years.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 27.
Minnesota Statutes 2020, section 144.7055, is amended to read:
144.7055 new text begin HOSPITAL CORE new text end STAFFING PLAN deleted text begin REPORTSdeleted text end .
Subdivision 1.
Definitions.
deleted text begin
(a) For the purposes of this section, the following terms have
the meanings given.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end "Core staffing plan" means deleted text begin the projected number of full-time equivalent
nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unitdeleted text end new text begin
a plan described in subdivision 2new text end .
deleted text begin (c)deleted text end new text begin (b)new text end "Nonmanagerial care staff" means registered nurses, licensed practical nurses,
and other health care workers, which may include but is not limited to nursing assistants,
nursing aides, patient care technicians, and patient care assistants, who perform
nonmanagerial direct patient care functions for more than 50 percent of their scheduled
hours on a given patient care unit.
deleted text begin (d)deleted text end new text begin (c)new text end "Inpatient care unit"new text begin or "unit"new text end means a designated inpatient area for assigning
patients and staff for which a deleted text begin distinct staffing plandeleted text end new text begin daily staffing schedulenew text end exists and that
operates 24 hours per day, seven days per week in a hospital setting. Inpatient care unit does
not include any hospital-based clinic, long-term care facility, or outpatient hospital
department.
deleted text begin (e)deleted text end new text begin (d)new text end "Staffing hours per patient day" means the number of full-time equivalent
nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
divided by the expected average number of patients upon which such assignments are based.
deleted text begin
(f) "Patient acuity tool" means a system for measuring an individual patient's need for
nursing care. This includes utilizing a professional registered nursing assessment of patient
condition to assess staffing need.
deleted text end
Subd. 2.
Hospitalnew text begin corenew text end staffing deleted text begin reportdeleted text end new text begin plansnew text end .
(a) The deleted text begin chief nursing executive or nursing
designeedeleted text end new text begin hospital nurse staffing committeenew text end of every deleted text begin reportingdeleted text end hospital deleted text begin in Minnesota under
section 144.50 willdeleted text end new text begin mustnew text end develop a core staffing plan for each deleted text begin patientdeleted text end new text begin inpatientnew text end care unit.
(b) Core staffing plans deleted text begin shalldeleted text end new text begin mustnew text end specifynew text begin all of the following:
new text end
new text begin (1) new text end thenew text begin projected number ofnew text end full-time equivalent deleted text begin fordeleted text end new text begin nonmanagerial care staff that will
be assigned in a 24-hour period tonew text end each deleted text begin patientdeleted text end new text begin inpatientnew text end care unit deleted text begin for each 24-hour period.deleted text end new text begin ;
new text end
new text begin
(2) the maximum number of patients on each inpatient care unit for whom a direct care
registered nurse can be assigned and for whom a licensed practical nurse or certified nursing
assistant can typically safely care;
new text end
new text begin
(3) criteria for determining when circumstances exist on each inpatient care unit such
that a direct care nurse cannot safely care for the typical number of patients and when
assigning a lower number of patients to each nurse on the inpatient unit would be appropriate;
new text end
new text begin
(4) a procedure for each inpatient care unit to make shift-to-shift adjustments in staffing
levels when such adjustments are required by patient acuity and nursing intensity in the
unit;
new text end
new text begin
(5) a contingency plan for each inpatient unit to safely address circumstances in which
patient care needs unexpectedly exceed the staffing resources provided for in a daily staffing
schedule. A contingency plan must include a method to quickly identify for each daily
staffing schedule additional direct care registered nurses who are available to provide direct
care on the inpatient care unit; and
new text end
new text begin
(6) strategies to enable direct care registered nurses to take breaks to which they are
entitled under law or under an applicable collective bargaining agreement.
new text end
(c) new text begin Core staffing plans must ensure that:
new text end
new text begin
(1) the person creating a daily staffing schedule has sufficiently detailed information to
create a daily staffing schedule that meets the requirements of the plan;
new text end
new text begin
(2) daily staffing nurse schedules do not rely on assigning individual nonmanagerial
care staff to work overtime hours in excess of 16 hours in a 24-hour period or to work
consecutive 24-hour periods requiring 16 or more hours;
new text end
new text begin
(3) a direct care registered nurse is not required or expected to perform functions outside
the nurse's professional license;
new text end
new text begin
(4) light duty direct care registered nurses are given appropriate assignments; and
new text end
new text begin
(5) daily staffing schedules do not interfere with applicable collective bargaining
agreements.
new text end
new text begin Subd. 2a. new text end
new text begin Development of hospital core staffing plans. new text end
new text begin (a) new text end Prior to deleted text begin submittingdeleted text end new text begin
completing or updatingnew text end the core staffing plan, deleted text begin as required in subdivision 3, hospitals shalldeleted text end new text begin
a hospital nurse staffing committee mustnew text end consult with representatives of the hospital medical
staff, managerial and nonmanagerial care staff, and other relevant hospital personnel about
the core staffing plan and the expected average number of patients upon which thenew text begin corenew text end
staffing plan is based.
new text begin
(b) When developing a core staffing plan, a hospital nurse staffing committee must
consider all of the following:
new text end
new text begin
(1) the individual needs and expected census of each inpatient care unit;
new text end
new text begin
(2) unit-specific patient acuity, including fall risk and behaviors requiring intervention,
such as physical aggression toward self or others, or destruction of property;
new text end
new text begin
(3) unit-specific demands on direct care registered nurses' time, including: frequency of
admissions, discharges, and transfers; frequency and complexity of patient evaluations and
assessments; frequency and complexity of nursing care planning; planning for patient
discharge; assessing for patient referral; patient education; and implementing infectious
disease protocols;
new text end
new text begin
(4) the architecture and geography of the inpatient care unit, including the placement of
patient rooms, treatment areas, nursing stations, medication preparation areas, and equipment;
new text end
new text begin
(5) mechanisms and procedures to provide for one-to-one patient observation for patients
on psychiatric or other units;
new text end
new text begin
(6) the stress under which direct care nurses are placed when required to work extreme
amounts of overtime, such as shifts in excess of 12 hours or multiple consecutive double
shifts;
new text end
new text begin
(7) the need for specialized equipment and technology on the unit;
new text end
new text begin
(8) other special characteristics of the unit or community patient population, including
age, cultural and linguistic diversity and needs, functional ability, communication skills,
and other relevant social and socioeconomic factors;
new text end
new text begin
(9) the skill mix of personnel other than direct care registered nurses providing or
supporting direct patient care on the unit;
new text end
new text begin
(10) mechanisms and procedures for identifying additional registered nurses who are
available for direct patient care when patients' unexpected needs exceed the planned workload
for direct care staff; and
new text end
new text begin
(11) demands on direct care registered nurses' time not directly related to providing
direct care on a unit, such as involvement in quality improvement activities, professional
development, service to the hospital, including serving on the hospital nurse staffing
committee, and service to the profession.
new text end
Subd. 3.
Standard electronic reporting deleted text begin developeddeleted text end new text begin of core staffing plansnew text end .
deleted text begin (a) Hospitalsdeleted text end new text begin
Each hospitalnew text end must submit the core staffing plansnew text begin approved by the hospital's nurse staffing
committeenew text end to the Minnesota Hospital Association deleted text begin by January 1, 2014deleted text end . The Minnesota
Hospital Association shall include each deleted text begin reportingdeleted text end hospital's core staffing deleted text begin plandeleted text end new text begin plansnew text end on the
Minnesota Hospital Association's Minnesota Hospital Quality Report website deleted text begin by April 1,
2014deleted text end new text begin by June 1, 2024new text end . new text begin Hospitals shall submit to the Minnesota Hospital Association new text end any
substantial deleted text begin changesdeleted text end new text begin updatesnew text end to deleted text begin thedeleted text end new text begin anew text end core staffing plan deleted text begin shall be updateddeleted text end within 30 daysnew text begin of
the approval of the updates by the hospital's nurse staffing committee or of amendment
through arbitration. The Minnesota Hospital Association shall update the Minnesota Hospital
Quality Report website with the updated core staffing plans within 30 days of receipt of the
updated plannew text end .
new text begin Subd. 4. new text end
new text begin Standard electronic reporting of direct patient care report. new text end
deleted text begin (b)deleted text end The Minnesota
Hospital Association shall include on its website for each reporting hospital on a quarterly
basis the actual direct patient care hours per patient and per unit. Hospitals must submit the
direct patient care report to the Minnesota Hospital Association deleted text begin by July 1, 2014, anddeleted text end quarterly
deleted text begin thereafterdeleted text end .
new text begin Subd. 5. new text end
new text begin Mandatory submission of core staffing plan to commissioner. new text end
new text begin
Each hospital
must submit the core staffing plans and any updates to the commissioner on the same
schedule described in subdivision 3. Core staffing plans held by the commissioner are public.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 28.
new text begin
[144.7056] IMPLEMENTATION OF HOSPITAL CORE STAFFING PLANS.
new text end
new text begin Subdivision 1. new text end
new text begin Plan implementation required. new text end
new text begin
A hospital must implement the core
staffing plans approved by a majority vote of the hospital nurse staffing committee.
new text end
new text begin Subd. 2. new text end
new text begin Public posting of core staffing plans. new text end
new text begin
A hospital must post the core staffing
plan for the inpatient care unit in a public area on the unit.
new text end
new text begin Subd. 3. new text end
new text begin Public posting of compliance with plan. new text end
new text begin
For each publicly posted core staffing
plan, a hospital must post a notice stating whether the current staffing on the unit complies
with the hospital's core staffing plan for that unit. The public notice of compliance must
include a list of the number of nonmanagerial care staff working on the unit during the
current shift and the number of patients assigned to each direct care registered nurse working
on the unit during the current shift. The list must enumerate the nonmanagerial care staff
by health care worker type. The public notice of compliance must be posted immediately
adjacent to the publicly posted core staffing plan.
new text end
new text begin Subd. 4. new text end
new text begin Public distribution of core staffing plan and notice of compliance. new text end
new text begin
(a) A
hospital must include with the posted materials described in subdivisions 2 and 3, a statement
that individual copies of the posted materials are available upon request to any patient on
the unit or to any visitor of a patient on the unit. The statement must include specific
instructions for obtaining copies of the posted materials.
new text end
new text begin
(b) A hospital must, within four hours after the request, provide individual copies of all
the posted materials described in subdivisions 2 and 3 to any patient on the unit or to any
visitor of a patient on the unit who requests the materials.
new text end
new text begin Subd. 5. new text end
new text begin Documentation of compliance. new text end
new text begin
Each hospital must document compliance with
its core staffing plans and maintain records demonstrating compliance for each inpatient
care unit for five years. Each hospital must provide its hospital nurse staffing committee
with access to all documentation required under this subdivision.
new text end
new text begin Subd. 6. new text end
new text begin Dispute resolution. new text end
new text begin
(a) If hospital management objects to a core staffing plan
approved by a majority vote of the hospital nurse staffing committee, the hospital may elect
to attempt to amend the core staffing plan through arbitration.
new text end
new text begin
(b) During an ongoing dispute resolution process, a hospital must continue to implement
the core staffing plan as written and approved by the hospital nurse staffing committee.
new text end
new text begin
(c) If the dispute resolution process results in an amendment to the core staffing plan,
the hospital must implement the amended core staffing plan.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 1, 2024.
new text end
Sec. 29.
new text begin
[144.7059] RETALIATION PROHIBITED.
new text end
new text begin
Neither a hospital or nor a health-related licensing board may retaliate against or discipline
a hospital employee regulated by the health-related licensing board, either formally or
informally, for:
new text end
new text begin
(1) challenging the process by which a hospital nurse staffing committee is formed or
conducts its business;
new text end
new text begin
(2) challenging a core staffing plan approved by a hospital nurse staffing committee;
new text end
new text begin
(3) objecting to or submitting a grievance related to a patient assignment that leads to a
direct care registered nurse violating medical restrictions recommended by the nurse's
medical provider; or
new text end
new text begin
(4) submitting a report of unsafe staffing conditions.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 1, 2024.
new text end
Sec. 30.
new text begin
[144.8611] DRUG OVERDOSE AND SUBSTANCE ABUSE PREVENTION.
new text end
new text begin Subdivision 1. new text end
new text begin Strategies. new text end
new text begin
The commissioner of health shall support collaboration and
coordination between state and community partners to develop, refine, and expand
comprehensive funding to address the drug overdose epidemic by implementing three
strategies: (1) regional multidisciplinary overdose prevention teams to implement overdose
prevention in local communities and local public health organizations; (2) enhance supportive
services for the homeless who are at risk of overdose by providing emergency and short-term
housing subsidies through the Homeless Overdose Prevention Hub; and (3) enhance employer
resources to promote health and well-being of employees through the recovery friendly
workplace initiative. These strategies address the underlying social conditions that impact
health status.
new text end
new text begin Subd. 2. new text end
new text begin Regional teams. new text end
new text begin
The commissioner of health shall establish community-based
prevention grants and contracts for the eight regional multidisciplinary overdose prevention
teams. These teams shall be geographically aligned with the eight emergency medical
services regions described in section 144E.52. The regional teams shall implement prevention
programs, policies, and practices that are specific to the challenges and responsive to the
data of the region.
new text end
new text begin Subd. 3. new text end
new text begin Homeless Overdose Prevention Hub. new text end
new text begin
The commissioner of health shall
establish a community-based grant to enhance supportive services for the homeless who
are at risk of overdose by providing emergency and short-term housing subsidies through
the Homeless Overdose Prevention Hub. The Homeless Overdose Prevention Hub serves
primarily urban American Indians in Minneapolis and Saint Paul and is managed by the
Native American Community Clinic.
new text end
new text begin Subd. 4. new text end
new text begin Workplace health. new text end
new text begin
The commissioner of health shall establish a grants and
contracts program to strengthen the recovery friendly workplace initiative. This initiative
helps create work environments that promote employee health, safety, and well-being by:
(1) preventing abuse and misuse of drugs in the first place; (2) providing training to
employers; and (3) reducing stigma and supporting recovery for people seeking services
and who are in recovery.
new text end
new text begin Subd. 5. new text end
new text begin Eligible grantees. new text end
new text begin
(a) Organizations eligible to receive grant funding under
subdivision 4 include not-for-profit agencies or organizations with existing organizational
structure, capacity, trainers, facilities, and infrastructure designed to deliver model workplace
policies and practices; that have training and education for employees, supervisors, and
executive leadership of companies, businesses, and industry; and that have the ability to
evaluate the three goals of the workplace initiative specified in subdivision 4.
new text end
new text begin
(b) At least one organization may be selected for a grant under subdivision 4 with
statewide reach and influence. Up to five smaller organizations may be selected to reach
specific geographic or population groups.
new text end
new text begin Subd. 6. new text end
new text begin Evaluation. new text end
new text begin
The commissioner of health shall design, conduct, and evaluate
each of the components of the drug overdose and substance abuse prevention program using
measures such as mortality, morbidity, homelessness, workforce wellness, employee
retention, and program reach.
new text end
new text begin Subd. 7. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 31.
Minnesota Statutes 2020, section 144.9501, subdivision 9, is amended to read:
Subd. 9.
Elevated blood lead level.
"Elevated blood lead level" means a diagnostic
blood lead test with a result that is equal to or greater than deleted text begin tendeleted text end new text begin 3.5new text end micrograms of lead per
deciliter of whole blood in any person, unless the commissioner finds that a lower
concentration is necessary to protect public health.
Sec. 32.
new text begin
[144.9981] CLIMATE RESILIENCY.
new text end
new text begin Subdivision 1. new text end
new text begin Climate resiliency program. new text end
new text begin
The commissioner of health shall implement
a climate resiliency program to:
new text end
new text begin
(1) increase awareness of climate change;
new text end
new text begin
(2) track the public health impacts of climate change and extreme weather events;
new text end
new text begin
(3) provide technical assistance and tools that support climate resiliency to local public
health organizations, Tribal health organizations, soil and water conservation districts, and
other local governmental and nongovernmental organizations; and
new text end
new text begin
(4) coordinate with the commissioners of the Pollution Control Agency, natural resources,
agriculture, and other state agencies in climate resiliency related planning and
implementation.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized; allocation. new text end
new text begin
(a) The commissioner of health shall manage
a grant program for the purpose of climate resiliency planning. The commissioner shall
award grants through a request for proposals process to local public health organizations,
Tribal health organizations, soil and water conservation districts, or other local organizations
for planning for the health impacts of extreme weather events and developing adaptation
actions. Priority shall be given to small rural water systems and organizations incorporating
the needs of private water supplies into their planning. Priority shall also be given to
organizations that serve communities that are disproportionately impacted by climate change.
new text end
new text begin
(b) Grantees must use the funds to develop a plan or implement strategies that will reduce
the risk of health impacts from extreme weather events. The grant application must include:
new text end
new text begin
(1) a description of the plan or project for which the grant funds will be used;
new text end
new text begin
(2) a description of the pathway between the plan or project and its impacts on health;
new text end
new text begin
(3) a description of the objectives, a work plan, and a timeline for implementation; and
new text end
new text begin
(4) the community or group the grant proposes to focus on.
new text end
Sec. 33.
new text begin
[145.361] LONG COVID; SUPPORTING SURVIVORS AND MONITORING
IMPACT.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
For the purpose of this section, "long COVID" means health
problems that people experience four or more weeks after being infected with SARS-CoV-2,
the virus that causes COVID-19. Long COVID is also called post COVID, long-haul COVID,
chronic COVID, post-acute COVID, or post-acute sequelae of COVID-19 (PASC).
new text end
new text begin Subd. 2. new text end
new text begin Statewide monitoring. new text end
new text begin
The commissioner of health shall establish a program
to conduct community needs assessments, perform epidemiologic studies, and establish a
population-based surveillance system to address long COVID. The purposes of these
assessments, studies, and surveillance system are to:
new text end
new text begin
(1) monitor trends in incidence, prevalence, mortality, care management, health outcomes,
quality of life, and needs of individuals with long COVID and to detect potential public
health problems, predict risks, and assist in investigating long COVID health disparities;
new text end
new text begin
(2) more accurately target intervention resources for communities and patients and their
families;
new text end
new text begin
(3) inform health professionals and citizens about risks, early detection, and treatment
of long COVID known to be elevated in their communities; and
new text end
new text begin
(4) promote high quality studies to provide better information for long COVID prevention
and control and to address public concerns and questions about long COVID.
new text end
new text begin Subd. 3. new text end
new text begin Partnerships. new text end
new text begin
The commissioner of health shall, in consultation with health
care professionals, the Department of Human Services, local public health organizations,
health insurers, employers, schools, long COVID survivors, and community organizations
serving people at high risk of long COVID, routinely identify priority actions and activities
to address the need for communication, services, resources, tools, strategies, and policies
to support long COVID survivors and their families.
new text end
new text begin Subd. 4. new text end
new text begin Grants and contracts. new text end
new text begin
The commissioner of health shall coordinate and
collaborate with community and organizational partners to implement evidence-informed
priority actions, including through community-based grants and contracts.
new text end
new text begin Subd. 5. new text end
new text begin Grant recipient and contractor eligibility. new text end
new text begin
The commissioner of health shall
award contracts and competitive grants to organizations that serve communities
disproportionately impacted by COVID-19 and long COVID including but not limited to
rural and low-income areas, Black and African Americans, African immigrants, American
Indians, Asian American-Pacific Islanders, Latino, LGBTQ+, and persons with disabilities.
Organizations may also address intersectionality within such groups.
new text end
new text begin Subd. 6. new text end
new text begin Grants and contracts authorized. new text end
new text begin
The commissioner of health shall award
grants and contracts to eligible organizations to plan, construct, and disseminate resources
and information to support survivors of long COVID, their caregivers, health care providers,
ancillary health care workers, workplaces, schools, communities, local and Tribal public
health, and other entities deemed necessary.
new text end
Sec. 34.
Minnesota Statutes 2020, section 145.56, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin 988; National Suicide Prevention Lifeline number. new text end
new text begin
The National Suicide
Prevention Lifeline is expanded to improve the quality of care and access to behavioral
health crisis services and to further health equity and save lives.
new text end
Sec. 35.
Minnesota Statutes 2020, section 145.56, is amended by adding a subdivision to
read:
new text begin Subd. 7. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Department" means the Department of Health.
new text end
new text begin
(d) "National Suicide Prevention Lifeline" means a national network of certified local
crisis centers maintained by the federal Substance Abuse and Mental Health Services
Administration that provides free and confidential emotional support to people in suicidal
crisis or emotional distress 24 hours a day, seven days a week.
new text end
new text begin
(e) "988 administrator" means the administrator of the 988 National Suicide Prevention
Lifeline.
new text end
new text begin
(f) "988 Hotline" or "Lifeline Center" means a state-identified center that is a member
of the National Suicide Prevention Lifeline network that responds to statewide or regional
988 contacts.
new text end
new text begin
(g) "Veterans Crisis Line" means the Veterans Crisis Line maintained by the Secretary
of Veterans Affairs under United States Code, title 38, section 170F(h).
new text end
Sec. 36.
Minnesota Statutes 2020, section 145.56, is amended by adding a subdivision to
read:
new text begin Subd. 8. new text end
new text begin 988 National Suicide Prevention Lifeline. new text end
new text begin
(a) The commissioner of health
shall administer the designated lifeline and oversee a Lifeline Center or a network of Lifeline
Centers to answer contacts from individuals accessing the National Suicide Prevention
Lifeline 24 hours per day, seven days per week.
new text end
new text begin
(b) The designated Lifeline Center(s) shall:
new text end
new text begin
(1) have an active agreement with the administrator of the 988 National Suicide
Prevention Lifeline for participation within the network;
new text end
new text begin
(2) meet the 988 administrator requirements and best practice guidelines for operational
and clinical standards;
new text end
new text begin
(3) provide data, report, and participate in evaluations and related quality improvement
activities as required by the 988 administrator and the department;
new text end
new text begin
(4) use technology that is interoperable across crisis and emergency response systems
used in the state, such as 911 systems, emergency medical services, and the National Suicide
Prevention Lifeline;
new text end
new text begin
(5) deploy crisis and outgoing services, including mobile crisis teams in accordance with
guidelines established by the 988 administrator and the department;
new text end
new text begin
(6) actively collaborate with local mobile crisis teams to coordinate linkages for persons
contacting the 988 Hotline for ongoing care needs;
new text end
new text begin
(7) offer follow-up services to individuals accessing the Lifeline Center that are consistent
with guidance established by the 988 administrator and the department; and
new text end
new text begin
(8) meet the requirements set by the 988 administrator and the department for serving
high risk and specialized populations.
new text end
new text begin
(c) The department shall collaborate with the National Suicide Prevention Lifeline and
Veterans Crisis Line networks for the purpose of ensuring consistency of public messaging
about 988 services.
new text end
Sec. 37.
new text begin
[145.871] UNIVERSAL, VOLUNTARY HOME VISITING PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible individuals and entities to establish voluntary home visiting services to families
expecting or caring for an infant, including families adopting an infant. The following
individuals and entities are eligible for a grant under this section: community health boards;
nonprofit organizations; Tribal Nations; and health care providers, including doulas,
community health workers, perinatal health educators, early childhood family education
home visiting providers, nurses, community health technicians, and local public health
nurses.
new text end
new text begin
(b) The grant money awarded under this section must be used to establish home visiting
services that:
new text end
new text begin
(1) provide a range of one to six visits that occur prenatally or within the first four months
of the expected birth or adoption of an infant; and
new text end
new text begin
(2) improve outcomes in two or more of the following areas:
new text end
new text begin
(i) maternal and newborn health;
new text end
new text begin
(ii) school readiness and achievement;
new text end
new text begin
(iii) family economic self-sufficiency;
new text end
new text begin
(iv) coordination and referral for other community resources and supports;
new text end
new text begin
(v) reduction in child injuries, abuse, or neglect; or
new text end
new text begin
(vi) reduction in crime or domestic violence.
new text end
new text begin
(c) The commissioner shall ensure that the voluntary home visiting services established
under this section are available to all families residing in the state by June 30, 2025. In
awarding grants prior to the home visiting services being available statewide, the
commissioner shall prioritize applicants serving high-risk or high-need populations of
pregnant women and families with infants, including populations with insufficient access
to prenatal care, high incidence of mental illness or substance use disorder, low
socioeconomic status, and other factors as determined by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Home visiting services. new text end
new text begin
(a) The home visiting services provided under this
section must, at a minimum:
new text end
new text begin
(1) offer information on infant care, child growth and development, positive parenting,
preventing diseases, preventing exposure to environmental hazards, and support services
in the community;
new text end
new text begin
(2) provide information on and referrals to health care services, including information
on and assistance in applying for health care coverage for which the child or family may
be eligible, and provide information on the availability of group prenatal care, preventative
services, developmental assessments, and public assistance programs as appropriate;
new text end
new text begin
(3) include an assessment of the physical, social, and emotional factors affecting the
family and provide information and referrals to address each family's identified needs;
new text end
new text begin
(4) connect families to additional resources available in the community, including early
care and education programs, health or mental health services, family literacy programs,
employment agencies, and social services, as needed;
new text end
new text begin
(5) utilize appropriate racial, ethnic, and cultural approaches to providing home visiting
services; and
new text end
new text begin
(6) be voluntary and free of charge to families.
new text end
new text begin
(b) Home visiting services under this section may be provided through telephone or
video communication when the commissioner determines the methods are necessary to
protect the health and safety of individuals receiving the visits and the home visiting
workforce.
new text end
new text begin Subd. 3. new text end
new text begin Administrative costs. new text end
new text begin
The commissioner may use up to seven percent of the
annual appropriation under this section to provide training and technical assistance, to
administer the program, and to conduct ongoing evaluations of the program. The
commissioner may contract for training, capacity-building support for grantees or potential
grantees, technical assistance, and evaluation support.
new text end
Sec. 38.
Minnesota Statutes 2020, section 145.924, is amended to read:
145.924 AIDS PREVENTION GRANTS.
(a) The commissioner may award grants to community health boards as defined in section
145A.02, subdivision 5, state agencies, state councils, or nonprofit corporations to provide
evaluation and counseling services to populations at risk for acquiring human
immunodeficiency virus infection, including, but not limited to, minorities, adolescents,
intravenous drug users, and homosexual men.
(b) The commissioner may award grants to agencies experienced in providing services
to communities of color, for the design of innovative outreach and education programs for
targeted groups within the community who may be at risk of acquiring the human
immunodeficiency virus infection, including intravenous drug users and their partners,
adolescents, gay and bisexual individuals and women. Grants shall be awarded on a request
for proposal basis and shall include funds for administrative costs. Priority for grants shall
be given to agencies or organizations that have experience in providing service to the
particular community which the grantee proposes to serve; that have policy makers
representative of the targeted population; that have experience in dealing with issues relating
to HIV/AIDS; and that have the capacity to deal effectively with persons of differing sexual
orientations. For purposes of this paragraph, the "communities of color" are: the
American-Indian community; the Hispanic community; the African-American community;
and the Asian-Pacific community.
(c) All state grants awarded under this section for programs targeted to adolescents shall
include the promotion of abstinence from sexual activity and drug use.
new text begin
(d) The commissioner may manage a program and award grants to agencies experienced
in syringe services programs for expanding access to harm reduction services and improving
linkages to care to prevent HIV/AIDS, hepatitis, and other infectious diseases for those
experiencing homelessness or housing instability.
new text end
Sec. 39.
new text begin
[145.9271] COMMUNITY SOLUTIONS FOR HEALTHY CHILD
DEVELOPMENT GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish the community
solutions for a healthy child development grant program. The purposes of the program are
to:
new text end
new text begin
(1) improve child development outcomes related to the well-being of children of color
and American Indian children from prenatal to grade 3 and their families, including but not
limited to the goals outlined by the Department of Human Service's early childhood systems
reform effort that include: early learning; health and well-being; economic security; and
safe, stable, nurturing relationships and environments, by funding community-based solutions
for challenges that are identified by the affected communities;
new text end
new text begin
(2) reduce racial disparities in children's health and development from prenatal to grade
3; and
new text end
new text begin
(3) promote racial and geographic equity.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
The commissioner of health shall:
new text end
new text begin
(1) develop a request for proposals for the healthy child development grant program in
consultation with the community solutions advisory council established in subdivision 3;
new text end
new text begin
(2) provide outreach, technical assistance, and program development support to increase
capacity for new and existing service providers in order to better meet statewide needs,
particularly in greater Minnesota and areas where services to reduce health disparities have
not been established;
new text end
new text begin
(3) review responses to requests for proposals, in consultation with the community
solutions advisory council, and award grants under this section;
new text end
new text begin
(4) ensure communication with the ethnic councils, Minnesota Indian Affairs Council,
and the Children's Cabinet on the request for proposal process;
new text end
new text begin
(5) establish a transparent and objective accountability process, in consultation with the
community solutions advisory council, focused on outcomes that grantees agree to achieve;
new text end
new text begin
(6) provide grantees with access to data to assist grantees in establishing and
implementing effective community-led solutions;
new text end
new text begin
(7) maintain data on outcomes reported by grantees; and
new text end
new text begin
(8) contract with an independent third-party entity to evaluate the success of the grant
program and to build the evidence base for effective community solutions in reducing health
disparities of children of color and American Indian children from prenatal to grade 3.
new text end
new text begin Subd. 3. new text end
new text begin
Community solutions advisory council; establishment; duties;
compensation.
new text end
new text begin
(a) The commissioner of health shall establish a community solutions
advisory council. By October 1, 2022, the commissioner shall convene a 12-member
community solutions advisory council. Members of the advisory council are:
new text end
new text begin
(1) two members representing the African Heritage community;
new text end
new text begin
(2) two members representing the Latino community;
new text end
new text begin
(3) two members representing the Asian-Pacific Islander community;
new text end
new text begin
(4) two members representing the American Indian community;
new text end
new text begin
(5) two parents who are Black, indigenous, or nonwhite people of color with children
under nine years of age;
new text end
new text begin
(6) one member with research or academic expertise in racial equity and healthy child
development; and
new text end
new text begin
(7) one member representing an organization that advocates on behalf of communities
of color or American Indians.
new text end
new text begin
(b) At least three of the 12 members of the advisory council must come from outside
the seven-county metropolitan area.
new text end
new text begin
(c) The community solutions advisory council shall:
new text end
new text begin
(1) advise the commissioner on the development of the request for proposals for
community solutions healthy child development grants. In advising the commissioner, the
council must consider how to build on the capacity of communities to promote child and
family well-being and address social determinants of healthy child development;
new text end
new text begin
(2) review responses to requests for proposals and advise the commissioner on the
selection of grantees and grant awards;
new text end
new text begin
(3) advise the commissioner on the establishment of a transparent and objective
accountability process focused on outcomes the grantees agree to achieve;
new text end
new text begin
(4) advise the commissioner on ongoing oversight and necessary support in the
implementation of the program; and
new text end
new text begin
(5) support the commissioner on other racial equity and early childhood grant efforts.
new text end
new text begin
(d) Each advisory council member shall be compensated as provided in section 15.059,
subdivision 3.
new text end
new text begin Subd. 4. new text end
new text begin Eligible grantees. new text end
new text begin
Organizations eligible to receive grant funding under this
section include:
new text end
new text begin
(1) organizations or entities that work with Black, indigenous, and non-Black people of
color communities;
new text end
new text begin
(2) Tribal nations and Tribal organizations as defined in section 658P of the Child Care
and Development Block Grant Act of 1990; and
new text end
new text begin
(3) organizations or entities focused on supporting healthy child development.
new text end
new text begin Subd. 5. new text end
new text begin
Strategic consideration and priority of proposals; eligible populations;
grant awards.
new text end
new text begin
(a) The commissioner, in consultation with the community solutions advisory
council, shall develop a request for proposals for healthy child development grants. In
developing the proposals and awarding the grants, the commissioner shall consider building
on the capacity of communities to promote child and family well-being and address social
determinants of healthy child development. Proposals must focus on increasing racial equity
and healthy child development and reducing health disparities experienced by children of
Black, nonwhite people of color, and American Indian communities from prenatal to grade
3 and their families.
new text end
new text begin
(b) In awarding the grants, the commissioner shall provide strategic consideration and
give priority to proposals from:
new text end
new text begin
(1) organizations or entities led by Black and other nonwhite people of color and serving
Black and nonwhite communities of color;
new text end
new text begin
(2) organizations or entities led by American Indians and serving American Indians,
including Tribal nations and Tribal organizations;
new text end
new text begin
(3) organizations or entities with proposals focused on healthy development from prenatal
to age three;
new text end
new text begin
(4) organizations or entities with proposals focusing on multigenerational solutions;
new text end
new text begin
(5) organizations or entities located in or with proposals to serve communities located
in counties that are moderate to high risk according to the Wilder Research Risk and Reach
Report; and
new text end
new text begin
(6) community-based organizations that have historically served communities of color
and American Indians and have not traditionally had access to state grant funding.
new text end
new text begin
(c) The advisory council may recommend additional strategic considerations and priorities
to the commissioner.
new text end
new text begin
(d) The first round of grants must be awarded no later than April 15, 2023.
new text end
new text begin Subd. 6. new text end
new text begin Geographic distribution of grants. new text end
new text begin
To the extent possible, the commissioner
and the advisory council shall ensure that grant funds are prioritized and awarded to
organizations and entities that are within counties that have a higher proportion of Black,
nonwhite people of color, and American Indians than the state average.
new text end
new text begin Subd. 7. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 40.
new text begin
[145.9272] LEAD TESTING AND REMEDIATION GRANT PROGRAM;
SCHOOLS, CHILD CARE CENTERS, FAMILY CHILD CARE PROVIDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of health shall establish a
grant program to test drinking water at licensed child care centers and licensed family child
care providers for the presence of lead and to remediate identified sources of lead in drinking
water at schools, licensed child care centers, and licensed family child care providers.
new text end
new text begin Subd. 2. new text end
new text begin Grant awards. new text end
new text begin
(a) The commissioner shall award grants through a request for
proposals process to schools, licensed child care centers, and licensed family child care
providers. The commissioner shall award grants in the following order of priority:
new text end
new text begin
(1) statewide testing of drinking water in licensed child care centers and licensed family
child care providers for the presence of lead and remediating identified sources of lead in
these settings; and
new text end
new text begin
(2) remediating identified sources of lead in drinking water in schools.
new text end
new text begin
(b) The commissioner shall prioritize grant awards for the purposes specified in paragraph
(a), clause (1) or (2), to settings with higher levels of lead detected in water samples, with
evidence of lead service lines or lead plumbing materials, or that serve or are in school
districts that serve disadvantaged communities.
new text end
new text begin Subd. 3. new text end
new text begin Uses of grant funds. new text end
new text begin
Licensed child care centers and licensed family child care
providers must use grant funds under this section to test their drinking water for lead;
remediate sources of lead contamination within the building, including lead service lines
and premises plumbing; and implement best practices for water management within the
building. Schools must use grant funds under this section to remediate sources of lead
contamination within the building and implement best practices for water management
within the building.
new text end
Sec. 41.
new text begin
[145.9274] REPORTS; SCHOOL TEST RESULTS AND REMEDIATION
EFFORTS FOR LEAD IN DRINKING WATER.
new text end
new text begin
(a) School districts and charter schools must report to the commissioner of health in a
form and manner determined by the commissioner:
new text end
new text begin
(1) test results regarding the presence of lead in drinking water in the school district's
or charter school's buildings; and
new text end
new text begin
(2) information on remediation efforts to address lead in drinking water, if a test reveals
lead in drinking water in an amount above 15 parts per billion.
new text end
new text begin
(b) The commissioner must post on the department website and annually update the test
results and information on remediation efforts reported under paragraph (a). The
commissioner must post test results and remediation efforts by school site.
new text end
Sec. 42.
new text begin
[145.9275] SKIN-LIGHTENING PRODUCTS PUBLIC AWARENESS AND
EDUCATION GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program. new text end
new text begin
The commissioner of health shall award grants through
a request for proposal process to community-based organizations that serve ethnic
communities and focus on public health outreach to Black and people of color communities
on the issues of colorism, skin-lightening products, and chemical exposures from these
products. Priority in awarding grants shall be given to organizations that have historically
provided services to ethnic communities on the skin-lightening and chemical exposure issue
for the past four years.
new text end
new text begin Subd. 2. new text end
new text begin Uses of grant funds. new text end
new text begin
Grant recipients must use grant funds awarded under this
section to conduct public awareness and education activities that are culturally specific and
community-based and that focus on:
new text end
new text begin
(1) increasing public awareness and providing education on the health dangers associated
with using skin-lightening creams and products that contain mercury and hydroquinone and
are manufactured in other countries, brought into this country, and sold illegally online or
in stores; the dangers of exposure to mercury through dermal absorption, inhalation,
hand-to-mouth contact, and contact with individuals who have used these skin-lightening
products; the health effects of mercury poisoning, including the permanent effects on the
central nervous system and kidneys; and the dangers to mothers and infants of using these
products or being exposed to these products during pregnancy and while breastfeeding;
new text end
new text begin
(2) identifying products that contain mercury and hydroquinone by testing skin-lightening
products;
new text end
new text begin
(3) developing a train the trainer curriculum to increase community knowledge and
influence behavior changes by training community leaders, cultural brokers, community
health workers, and educators;
new text end
new text begin
(4) continuing to build the self-esteem and overall wellness of young people who are
using skin-lightening products or are at risk of starting the practice of skin lightening; and
new text end
new text begin
(5) building the capacity of community-based organizations to continue to combat
skin-lightening practices and chemical exposure.
new text end
Sec. 43.
new text begin
[145.9282] COMMUNITY HEALTH WORKERS; REDUCING HEALTH
DISPARITIES WITH COMMUNITY-LED CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall support collaboration
and coordination between state and community partners to develop, refine, and expand the
community health workers profession across the state equipping them to address health
needs and to improve health outcomes by addressing the social conditions that impact health
status. Community health professionals' work expands beyond health care to bring health
and racial equity into public safety, social services, youth and family services, schools,
neighborhood associations, and more.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized; eligibility. new text end
new text begin
The commissioner of health shall establish a
community-based grant to expand and strengthen the community health workers workforce
across the state. The grantee must be a not-for-profit community organization serving,
convening, and supporting community health workers (CHW) statewide.
new text end
new text begin Subd. 3. new text end
new text begin Evaluation. new text end
new text begin
The commissioner of health shall design, conduct, and evaluate
the CHW initiative using measures of workforce capacity, employment opportunity, reach
of services, and return on investment, as well as descriptive measures of the extant CHW
models as they compare with the national community health workers' landscape. These
more proximal measures are collected and analyzed as foundational to longer-term change
in social determinants of health and rates of death and injury by suicide, overdose, firearms,
alcohol, and chronic disease.
new text end
new text begin Subd. 4. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 44.
new text begin
[145.9283] REDUCING HEALTH DISPARITIES AMONG PEOPLE WITH
DISABILITIES; GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Goal and establishment. new text end
new text begin
The commissioner of health shall support
collaboration and coordination between state and community partners to address equity
barriers to health care and preventative services for chronic diseases among people with
disabilities. The commissioner of health, in consultation with the Olmstead Implementation
Office, Department of Human Services, Board on Aging, health care professionals, local
public health organizations, and other community organizations that serve people with
disabilities, shall routinely identify priorities and action steps to address identified gaps in
services, resources, and tools.
new text end
new text begin Subd. 2. new text end
new text begin Assessment and tracking. new text end
new text begin
The commissioner of health shall conduct community
needs assessments and establish a health surveillance and tracking plan in collaboration
with community and organizational partners to identify and address health disparities.
new text end
new text begin Subd. 3. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner of health shall establish
community-based grants to support establishing inclusive evidence-based chronic disease
prevention and management services to address identified gaps and disparities.
new text end
new text begin Subd. 4. new text end
new text begin Technical assistance. new text end
new text begin
The commissioner of health shall provide and evaluate
training and capacity-building technical assistance on accessible preventive health care for
public health and health care providers of chronic disease prevention and management
programs and services.
new text end
new text begin Subd. 5. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 45.
new text begin
[145.9292] PUBLIC HEALTH AMERICORPS.
new text end
new text begin
The commissioner may award a grant to a statewide, nonprofit organization to support
Public Health AmeriCorps members. The organization awarded the grant shall provide the
commissioner with any information needed by the commissioner to evaluate the program
in the form and at the timelines specified by the commissioner.
new text end
Sec. 46.
new text begin
[145.987] HEALTHY BEGINNINGS, HEALTHY FAMILIES ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Purposes. new text end
new text begin
The purposes of the Healthy Beginnings, Healthy Families
Act are to: (1) address the significant disparities in early childhood outcomes and increase
the number of children who are school ready through establishing the Minnesota collaborative
to prevent infant mortality; (2) sustain the Help Me Connect online navigator; (3) improve
universal access to developmental and social-emotional screening and follow-up; and (4)
sustain and expand the model jail practices for children of incarcerated parents in Minnesota
jails.
new text end
new text begin Subd. 2. new text end
new text begin Minnesota collaborative to prevent infant mortality. new text end
new text begin
(a) The Minnesota
collaborative to prevent infant mortality is established. The goals of the Minnesota
collaborative to prevent infant mortality program are to:
new text end
new text begin
(1) build a statewide multisectoral partnership including the state government, local
public health organizations, Tribes, the private sector, and community nonprofit organizations
with the shared goal of decreasing infant mortality rates among populations with significant
disparities, including among Black, American Indian, and other nonwhite communities,
and rural populations;
new text end
new text begin
(2) address the leading causes of poor infant health outcomes such as premature birth,
infant sleep-related deaths, and congenital anomalies through strategies to change social
and environmental determinants of health; and
new text end
new text begin
(3) promote the development, availability, and use of data-informed, community-driven
strategies to improve infant health outcomes.
new text end
new text begin
(b) The commissioner of health shall establish a statewide partnership program to engage
communities, exchange best practices, share summary data on infant health, and promote
policies to improve birth outcomes and eliminate preventable infant mortality.
new text end
new text begin Subd. 3. new text end
new text begin Grants authorized. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible applicants to convene, coordinate, and implement data-driven strategies and culturally
relevant activities to improve infant health by reducing preterm births, sleep-related infant
deaths, and congenital malformations and by addressing social and environmental
determinants of health. Grants shall be awarded to support community nonprofit
organizations, Tribal governments, and community health boards. Grants shall be awarded
to all federally recognized Tribal governments whose proposals demonstrate the ability to
implement programs designed to achieve the purposes in subdivision 2 and other requirements
of this section. An eligible applicant must submit an application to the commissioner of
health on a form designated by the commissioner and by the deadline established by the
commissioner. The commissioner shall award grants to eligible applicants in metropolitan
and rural areas of the state and may consider geographic representation in grant awards.
new text end
new text begin
(b) Grantee activities shall:
new text end
new text begin
(1) address the leading cause or causes of infant mortality;
new text end
new text begin
(2) be based on community input;
new text end
new text begin
(3) be focused on policy, systems, and environmental changes that support infant health;
and
new text end
new text begin
(4) address the health disparities and inequities that are experienced in the grantee's
community.
new text end
new text begin
(c) The commissioner shall review each application to determine whether the application
is complete and whether the applicant and the project are eligible for a grant. In evaluating
applications under this subdivision, the commissioner shall establish criteria including but
not limited to: (1) the eligibility of the project; (2) the applicant's thoroughness and clarity
in describing the infant health issues grant funds are intended to address; (3) a description
of the applicant's proposed project; (4) a description of the population demographics and
service area of the proposed project; and (5) evidence of efficiencies and effectiveness
gained through collaborative efforts.
new text end
new text begin
(d) Grant recipients shall report their activities to the commissioner in a format and at
a time specified by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Technical assistance. new text end
new text begin
(a) The commissioner shall provide content expertise,
technical expertise, training to grant recipients, and advice on data-driven strategies.
new text end
new text begin
(b) For the purposes of carrying out the grant program under subdivision 3, including
for administrative purposes, the commissioner shall award contracts to appropriate entities
to assist in training and to provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) partnership development and capacity building;
new text end
new text begin
(2) Tribal support;
new text end
new text begin
(3) implementation support for specific infant health strategies;
new text end
new text begin
(4) communications, convening, and sharing lessons learned; and
new text end
new text begin
(5) health equity.
new text end
new text begin Subd. 5. new text end
new text begin Help Me Connect. new text end
new text begin
The Help Me Connect online navigator is established. The
goal of Help Me Connect is to connect pregnant and parenting families with young children
from birth to eight years of age with services in their local communities that support healthy
child development and family well-being. The commissioner of health shall work
collaboratively with the commissioners of human services and education to implement this
subdivision.
new text end
new text begin Subd. 6. new text end
new text begin Duties of Help Me Connect. new text end
new text begin
(a) Help Me Connect shall facilitate collaboration
across sectors covering child health, early learning and education, child welfare, and family
supports by:
new text end
new text begin
(1) providing early childhood provider outreach to support early detection, intervention,
and knowledge about local resources; and
new text end
new text begin
(2) linking children and families to appropriate community-based services.
new text end
new text begin
(b) Help Me Connect shall provide community outreach that includes support for and
participation in the help me connect system, including disseminating information and
compiling and maintaining a current resource directory that includes but is not limited to
primary and specialty medical care providers, early childhood education and child care
programs, developmental disabilities assessment and intervention programs, mental health
services, family and social support programs, child advocacy and legal services, public
health and human services and resources, and other appropriate early childhood information.
new text end
new text begin
(c) Help Me Connect shall maintain a centralized access point for parents and
professionals to obtain information, resources, and other support services.
new text end
new text begin
(d) Help Me Connect shall provide a centralized mechanism that facilitates
provider-to-provider referrals to community resources and monitors referrals to ensure that
families are connected to services.
new text end
new text begin
(e) Help Me Connect shall collect program evaluation data to increase the understanding
of all aspects of the current and ongoing system under this section, including identification
of gaps in service, barriers to finding and receiving appropriate service, and lack of resources.
new text end
new text begin Subd. 7. new text end
new text begin
Universal and voluntary developmental and social-emotional screening
and follow-up.
new text end
new text begin
(a) The commissioner shall establish a universal and voluntary developmental
and social-emotional screening to identify young children at risk for developmental and
behavioral concerns. Follow-up services shall be provided to connect families and young
children to appropriate community-based resources and programs. The commissioner of
health shall work with the commissioners of human services and education to implement
this subdivision and promote interagency coordination with other early childhood programs
including those that provide screening and assessment.
new text end
new text begin
(b) The commissioner shall:
new text end
new text begin
(1) increase the awareness of universal and voluntary developmental and social-emotional
screening and follow-up in coordination with community and state partners;
new text end
new text begin
(2) expand existing electronic screening systems to administer developmental and
social-emotional screening of children from birth to kindergarten entrance;
new text end
new text begin
(3) provide universal and voluntary periodic screening for developmental and
social-emotional delays based on current recommended best practices;
new text end
new text begin
(4) review and share the results of the screening with the child's parent or guardian;
new text end
new text begin
(5) support families in their role as caregivers by providing typical growth and
development information, anticipatory guidance, and linkages to early childhood resources
and programs;
new text end
new text begin
(6) ensure that children and families are linked to appropriate community-based services
and resources when any developmental or social-emotional concerns are identified through
screening; and
new text end
new text begin
(7) establish performance measures and collect, analyze, and share program data regarding
population-level outcomes of developmental and social-emotional screening, and make
referrals to community-based services and follow-up activities.
new text end
new text begin Subd. 8. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner shall award grants to community health
boards and Tribal nations to support follow-up services for children with developmental or
social-emotional concerns identified through screening in order to link children and their
families to appropriate community-based services and resources. The commissioner shall
provide technical assistance, content expertise, and training to grant recipients to ensure
that follow-up services are effectively provided.
new text end
new text begin Subd. 9. new text end
new text begin Model jails practices for incarcerated parents. new text end
new text begin
(a) The commissioner of
health may make special grants to counties, groups of counties, or nonprofit organizations
to implement model jails practices to benefit the children of incarcerated parents.
new text end
new text begin
(b) "Model jail practices" means a set of practices that correctional administrators can
implement to remove barriers that may prevent a child from cultivating or maintaining
relationships with the child's incarcerated parent or parents during and immediately after
incarceration without compromising the safety or security of the correctional facility.
new text end
new text begin Subd. 10. new text end
new text begin Grants authorized. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible county jails to implement model jail practices and separate grants to county
governments, Tribal governments, or nonprofit organizations in corresponding geographic
areas to build partnerships with county jails to support children of incarcerated parents and
their caregivers.
new text end
new text begin
(b) Grantee activities may include but are not limited to:
new text end
new text begin
(1) parenting classes or groups;
new text end
new text begin
(2) family-centered intake and assessment of inmate programs;
new text end
new text begin
(3) family notification, information, and communication strategies;
new text end
new text begin
(4) correctional staff training;
new text end
new text begin
(5) policies and practices for family visits; and
new text end
new text begin
(6) family-focused reentry planning.
new text end
new text begin
(c) Grant recipients shall report their activities to the commissioner in a format and at a
time specified by the commissioner.
new text end
new text begin Subd. 11. new text end
new text begin Technical assistance and oversight. new text end
new text begin
(a) The commissioner shall provide
content expertise, training to grant recipients, and advice on evidence-based strategies,
including evidence-based training to support incarcerated parents.
new text end
new text begin
(b) For the purposes of carrying out the grant program under subdivision 10, including
for administrative purposes, the commissioner shall award contracts to appropriate entities
to assist in training and provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) evidence-based training for incarcerated parents;
new text end
new text begin
(2) partnership building and community engagement;
new text end
new text begin
(3) evaluation of process and outcomes of model jail practices; and
new text end
new text begin
(4) expert guidance on reducing the harm caused to children of incarcerated parents and
application of model jail practices.
new text end
Sec. 47.
new text begin
[145.988] MINNESOTA SCHOOL HEALTH INITIATIVE.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
(a) The purpose of the Minnesota School Health Initiative is
to implement evidence-based practices to strengthen and expand health promotion and
health care delivery activities in schools to improve the holistic health of students. To better
serve students, the Minnesota School Health Initiative shall unify the best practices of the
school-based health center and Whole School, Whole Community, Whole Child models.
new text end
new text begin
(b) The commissioner of health and the commissioner of education shall coordinate the
projects and initiatives funded under this section with other efforts at the local, state, or
national level to avoid duplication and promote complementary efforts.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "School-based health center" or "comprehensive school-based health center" means
a safety net health care delivery model that is located in or near a school facility and that
offers comprehensive health care, including preventive and behavioral health services, by
licensed and qualified health professionals in accordance with federal, state, and local law.
When not located on school property, the school-based health center must have an established
relationship with one or more schools in the community and operate primarily to serve those
student groups.
new text end
new text begin
(c) "Sponsoring organization" means any of the following that operate a school-based
health center:
new text end
new text begin
(1) health care providers;
new text end
new text begin
(2) community clinics;
new text end
new text begin
(3) hospitals;
new text end
new text begin
(4) federally qualified health centers and look-alikes as defined in section 145.9269;
new text end
new text begin
(5) health care foundations or nonprofit organizations;
new text end
new text begin
(6) higher education institutions; or
new text end
new text begin
(7) local health departments.
new text end
new text begin Subd. 3. new text end
new text begin Expansion of Minnesota school-based health centers. new text end
new text begin
(a) The commissioner
of health shall administer a program to provide grants to school districts, school-based health
centers, and sponsoring organizations to support existing school-based health centers and
facilitate the growth of school-based health centers in Minnesota.
new text end
new text begin
(b) Grant funds distributed under this subdivision shall be used to support new or existing
school-based health centers that:
new text end
new text begin
(1) operate in partnership with a school or district and with the permission of the school
or district board;
new text end
new text begin
(2) provide health services through a sponsoring organization; and
new text end
new text begin
(3) provide health services to all students and youth within a school or district regardless
of ability to pay, insurance coverage, or immigration status, and in accordance with federal,
state, and local law.
new text end
new text begin
(c) Grant recipients shall report their activities and annual performance measures as
defined by the commissioner in a format and time specified by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin School-based health center services. new text end
new text begin
Services provided by a school-based
health center may include but are not limited to:
new text end
new text begin
(1) preventative health care;
new text end
new text begin
(2) chronic medical condition management, including diabetes and asthma care;
new text end
new text begin
(3) mental health care and crisis management;
new text end
new text begin
(4) acute care for illness and injury;
new text end
new text begin
(5) oral health care;
new text end
new text begin
(6) vision care;
new text end
new text begin
(7) nutritional counseling;
new text end
new text begin
(8) substance abuse counseling;
new text end
new text begin
(9) referral to a specialist, medical home, or hospital for care;
new text end
new text begin
(10) additional services that address social determinants of health; and
new text end
new text begin
(11) emerging services such as mobile health and telehealth.
new text end
new text begin Subd. 5. new text end
new text begin Sponsoring organization. new text end
new text begin
A sponsoring organization that agrees to operate a
school-based health center must enter into a memorandum of agreement with the school or
district. The memorandum of agreement must require the sponsoring organization to be
financially responsible for the operation of school-based health centers in the school or
district and must identify the costs that are the responsibility of the school or district, such
as Internet access, custodial services, utilities, and facility maintenance. To the greatest
extent possible, a sponsoring organization must bill private insurers, medical assistance,
and other public programs for services provided in the school-based health center in order
to maintain the financial sustainability of the school-based health center.
new text end
new text begin Subd. 6. new text end
new text begin Oral health in school settings. new text end
new text begin
(a) The commissioner of health shall administer
a program to provide competitive grants to schools, oral health providers, and other
community groups to build capacity and infrastructure to establish, expand, link, or strengthen
oral health services in school settings.
new text end
new text begin
(b) Grant funds distributed under this subdivision must be used to support new or existing
oral health services in schools that:
new text end
new text begin
(1) provide oral health risk assessment, screening, education, and anticipatory guidance;
new text end
new text begin
(2) provide oral health services, including fluoride varnish and dental sealants;
new text end
new text begin
(3) make referrals for restorative and other follow-up dental care as needed; and
new text end
new text begin
(4) provide free access to fluoridated drinking water to give students a healthy alternative
to sugar-sweetened beverages.
new text end
new text begin
(c) Grant recipients must collect, monitor, and submit to the commissioner of health
baseline and annual data and provide information to improve the quality and impact of oral
health strategies.
new text end
new text begin Subd. 7. new text end
new text begin Whole School, Whole Community, Whole Child grants. new text end
new text begin
(a) The commissioner
of health shall administer a program to provide competitive grants to local public health
organizations, schools, and community organizations using the evidence-based Whole
School, Whole Community, Whole Child (WSCC) model to increase alignment, integration,
and collaboration between public health and education sectors to improve each child's
cognitive, physical, oral, social, and emotional development.
new text end
new text begin
(b) Grant funds distributed under this subdivision must be used to support new or existing
programs that implement elements of the WSCC model in schools that:
new text end
new text begin
(1) align health and learning strategies to improve health outcomes and academic
achievement;
new text end
new text begin
(2) improve the physical, nutritional, psychological, social, and emotional environments
of schools;
new text end
new text begin
(3) create collaborative approaches to engage schools, parents and guardians, and
communities; and
new text end
new text begin
(4) promote and establish lifelong healthy behaviors.
new text end
new text begin
(c) Grant recipients shall report grant activities and progress to the commissioner in a
time and format specified by the commissioner.
new text end
new text begin Subd. 8. new text end
new text begin Technical assistance and oversight. new text end
new text begin
(a) The commissioner shall provide
content expertise, technical expertise, and training to grant recipients under subdivisions 6
and 7.
new text end
new text begin
(b) For the purposes of carrying out the grant program under this section, including for
administrative purposes, the commissioner shall award contracts to appropriate entities to
assist in training and provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) needs assessment;
new text end
new text begin
(2) community engagement and capacity building;
new text end
new text begin
(3) community asset building and risk behavior reduction;
new text end
new text begin
(4) dental provider training in calibration;
new text end
new text begin
(5) dental services related equipment, instruments, supplies;
new text end
new text begin
(6) communications;
new text end
new text begin
(7) community, school, health care, work site, and other site-specific strategies;
new text end
new text begin
(8) health equity;
new text end
new text begin
(9) data collection and analysis; and
new text end
new text begin
(10) evaluation.
new text end
Sec. 48.
Minnesota Statutes 2020, section 145A.131, subdivision 1, is amended to read:
Subdivision 1.
Funding formula for community health boards.
(a) Base funding for
each community health board eligible for a local public health grant under section 145A.03,
subdivision 7, shall be determined by each community health board's fiscal year 2003
allocations, prior to unallotment, for the following grant programs: community health
services subsidy; state and federal maternal and child health special projects grants; family
home visiting grants; TANF MN ENABL grants; TANF youth risk behavior grants; and
available women, infants, and children grant funds in fiscal year 2003, prior to unallotment,
distributed based on the proportion of WIC participants served in fiscal year 2003 within
the CHS service area.
(b) Base funding for a community health board eligible for a local public health grant
under section 145A.03, subdivision 7, as determined in paragraph (a), shall be adjusted by
the percentage difference between the base, as calculated in paragraph (a), and the funding
available for the local public health grant.
(c) Multicounty or multicity community health boards shall receive a local partnership
base of up to $5,000 per year for each county or city in the case of a multicity community
health board included in the community health board.
(d) The State Community Health new text begin Services new text end Advisory Committee may recommend a
formula to the commissioner to use in distributing funds to community health boards.
(e) Notwithstanding any adjustment in paragraph (b), community health boards, all or
a portion of which are located outside of the counties of Anoka, Chisago, Carver, Dakota,
Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington, and Wright, are eligible to receive
an increase equal to ten percent of the grant award to the community health board under
paragraph (a) starting July 1, 2015. The increase in calendar year 2015 shall be prorated for
the last six months of the year. For calendar years beginning on or after January 1, 2016,
the amount distributed under this paragraph shall be adjusted each year based on available
funding and the number of eligible community health boards.
new text begin
(f) Funding for foundational public health responsibilities shall be distributed based on
a formula determined by the commissioner in consultation with the State Community Health
Services Advisory Committee. Community health boards must use these funds as specified
in subdivision 5.
new text end
Sec. 49.
Minnesota Statutes 2020, section 145A.131, subdivision 5, is amended to read:
Subd. 5.
Use of funds.
new text begin (a) new text end Community health boards may use new text begin the base funding of new text end their
local public health grant funds new text begin distributed according to subdivision 1, paragraphs (a) to (e),
new text end to address the areas of public health responsibility and local priorities developed through
the community health assessment and community health improvement planning process.
new text begin
(b) A community health board must use funding for foundational public health
responsibilities that is distributed according to subdivision 1, paragraph (f), to fulfill
foundational public health responsibilities as defined by the commissioner in consultation
with the State Community Health Services Advisory Committee.
new text end
new text begin
(c) Notwithstanding paragraph (b), if a community health board can demonstrate that
foundational public health responsibilities are fulfilled, the community health board may
use funding for foundational public health responsibilities for local priorities developed
through the community health assessment and community health improvement planning
process.
new text end
new text begin
(d) Notwithstanding paragraphs (a) to (c), by July 1, 2026, community health boards
must use all local public health funds first to fulfill foundational public health responsibilities.
Once a community health board can demonstrate foundational public health responsibilities
are fulfilled, funds may be used for local priorities developed through the community health
assessment and community health improvement planning process.
new text end
Sec. 50.
Minnesota Statutes 2020, section 145A.14, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Tribal governments; foundational public health responsibilities. new text end
new text begin
The
commissioner shall distribute grants to Tribal governments for foundational public health
responsibilities as defined by each Tribal government.
new text end
Sec. 51.
Minnesota Statutes 2020, section 149A.01, subdivision 2, is amended to read:
Subd. 2.
Scope.
In Minnesota no person shall, without being licensed new text begin or registered new text end by
the commissioner of health:
(1) take charge of or remove from the place of death a dead human body;
(2) prepare a dead human body for final disposition, in any manner; or
(3) arrange, direct, or supervise a funeral, memorial service, or graveside service.
Sec. 52.
Minnesota Statutes 2020, section 149A.01, subdivision 3, is amended to read:
Subd. 3.
Exceptions to licensure.
(a) Except as otherwise provided in this chapter,
nothing in this chapter shall in any way interfere with the duties of:
(1) an anatomical bequest program located within an accredited school of medicine or
an accredited college of mortuary science;
(2) a person engaged in the performance of duties prescribed by law relating to the
conditions under which unclaimed dead human bodies are held subject to anatomical study;
(3) authorized personnel from a licensed ambulance service in the performance of their
duties;
(4) licensed medical personnel in the performance of their duties; or
(5) the coroner or medical examiner in the performance of the duties of their offices.
(b) This chapter does not apply to or interfere with the recognized customs or rites of
any culture or recognized religion in the ceremonial washing, dressing, casketing, and public
transportation of their dead, to the extent that all other provisions of this chapter are complied
with.
(c) Noncompensated persons with the right to control the dead human body, under section
149A.80, subdivision 2, may remove a body from the place of death; transport the body;
prepare the body for disposition, except embalming; or arrange for final disposition of the
body, provided that all actions are in compliance with this chapter.
(d) Persons serving internships pursuant to section 149A.20, subdivision 6, deleted text begin ordeleted text end students
officially registered for a practicum or clinical through a program of mortuary science
accredited by the American Board of Funeral Service Educationnew text begin , or transfer care specialists
registered pursuant to section 149A.47new text end are not required to be licensed, provided that the
persons or students are registered with the commissioner and act under the direct and
exclusive supervision of a person holding a current license to practice mortuary science in
Minnesota.
(e) Notwithstanding this subdivision, nothing in this section shall be construed to prohibit
an institution or entity from establishing, implementing, or enforcing a policy that permits
only persons licensed by the commissioner to remove or cause to be removed a dead body
or body part from the institution or entity.
(f) An unlicensed person may arrange for and direct or supervise a memorial service if
that person or that person's employer does not have charge of the dead human body. An
unlicensed person may not take charge of the dead human body, unless that person has the
right to control the dead human body under section 149A.80, subdivision 2, or is that person's
noncompensated designee.
Sec. 53.
Minnesota Statutes 2020, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 12c. new text end
new text begin Dead human body or body. new text end
new text begin
"Dead human body" or "body" includes an
identifiable human body part that is detached from a human body.
new text end
Sec. 54.
Minnesota Statutes 2020, section 149A.02, subdivision 13a, is amended to read:
Subd. 13a.
Direct supervision.
"Direct supervision" means overseeing the performance
of an individual. For the purpose of a clinical, practicum, deleted text begin ordeleted text end internship, new text begin or registration, new text end direct
supervision means that the supervisor is available to observe and correct, as needed, the
performance of the traineenew text begin or registrantnew text end . The mortician supervisor is accountable for the
actions of the clinical student, practicum student, deleted text begin ordeleted text end internnew text begin , or registrantnew text end throughout the
course of the training. The supervising mortician is accountable for any violations of law
or rule, in the performance of their duties, by the clinical student, practicum student, deleted text begin ordeleted text end
internnew text begin , or registrantnew text end .
Sec. 55.
Minnesota Statutes 2020, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 37d. new text end
new text begin Registrant. new text end
new text begin
"Registrant" means any person who is registered as a transfer
care specialist under section 149A.47.
new text end
Sec. 56.
Minnesota Statutes 2020, section 149A.02, is amended by adding a subdivision
to read:
new text begin Subd. 37e. new text end
new text begin Transfer care specialist. new text end
new text begin
"Transfer care specialist" means an individual who
is registered with the commissioner in accordance with section 149A.47 and is authorized
to perform the removal of a dead human body from the place of death under the direct
supervision of a licensed mortician.
new text end
Sec. 57.
Minnesota Statutes 2020, section 149A.03, is amended to read:
149A.03 DUTIES OF COMMISSIONER.
The commissioner shall:
(1) enforce all laws and adopt and enforce rules relating to the:
(i) removal, preparation, transportation, arrangements for disposition, and final disposition
of dead human bodies;
(ii) licensurenew text begin , registration,new text end and professional conduct of funeral directors, morticians,
interns, new text begin transfer care specialists, new text end practicum students, and clinical students;
(iii) licensing and operation of a funeral establishment;
(iv) licensing and operation of an alkaline hydrolysis facility; and
(v) licensing and operation of a crematory;
(2) provide copies of the requirements for licensurenew text begin , registration,new text end and permits to all
applicants;
(3) administer examinations and issue licensesnew text begin , registrations,new text end and permits to qualified
persons and other legal entities;
(4) maintain a record of the name and location of all current licenseesnew text begin , registrants,new text end and
interns;
(5) perform periodic compliance reviews and premise inspections of licensees;
(6) accept and investigate complaints relating to conduct governed by this chapter;
(7) maintain a record of all current preneed arrangement trust accounts;
(8) maintain a schedule of application, examination, permit, new text begin registration, new text end and licensure
fees, initial and renewal, sufficient to cover all necessary operating expenses;
(9) educate the public about the existence and content of the laws and rules for mortuary
science licensing and the removal, preparation, transportation, arrangements for disposition,
and final disposition of dead human bodies to enable consumers to file complaints against
licensees and others who may have violated those laws or rules;
(10) evaluate the laws, rules, and procedures regulating the practice of mortuary science
in order to refine the standards for licensing and to improve the regulatory and enforcement
methods used; and
(11) initiate proceedings to address and remedy deficiencies and inconsistencies in the
laws, rules, or procedures governing the practice of mortuary science and the removal,
preparation, transportation, arrangements for disposition, and final disposition of dead
human bodies.
Sec. 58.
Minnesota Statutes 2020, section 149A.09, is amended to read:
149A.09 DENIAL; REFUSAL TO REISSUE; REVOCATION; SUSPENSION;
LIMITATION OF LICENSEnew text begin , REGISTRATION,new text end OR PERMIT.
Subdivision 1.
Denial; refusal to renew; revocation; and suspension.
The regulatory
agency may deny, refuse to renew, revoke, or suspend any licensenew text begin , registration,new text end or permit
applied for or issued pursuant to this chapter when the person subject to regulation under
this chapter:
(1) does not meet or fails to maintain the minimum qualification for holding a licensenew text begin ,
registration,new text end or permit under this chapter;
(2) submits false or misleading material information to the regulatory agency in
connection with a licensenew text begin , registration,new text end or permit issued by the regulatory agency or the
application for a licensenew text begin , registration,new text end or permit;
(3) violates any law, rule, order, stipulation agreement, settlement, compliance agreement,
license, new text begin registration, new text end or permit that regulates the removal, preparation, transportation,
arrangements for disposition, or final disposition of dead human bodies in Minnesota or
any other state in the United States;
(4) is convicted of a crime, including a finding or verdict of guilt, an admission of guilt,
or a no contest plea in any court in Minnesota or any other jurisdiction in the United States.
"Conviction," as used in this subdivision, includes a conviction for an offense which, if
committed in this state, would be deemed a felony or gross misdemeanor without regard to
its designation elsewhere, or a criminal proceeding where a finding or verdict of guilty is
made or returned, but the adjudication of guilt is either withheld or not entered;
(5) is convicted of a crime, including a finding or verdict of guilt, an admission of guilt,
or a no contest plea in any court in Minnesota or any other jurisdiction in the United States
that the regulatory agency determines is reasonably related to the removal, preparation,
transportation, arrangements for disposition or final disposition of dead human bodies, or
the practice of mortuary science;
(6) is adjudicated as mentally incompetent, mentally ill, developmentally disabled, or
mentally ill and dangerous to the public;
(7) has a conservator or guardian appointed;
(8) fails to comply with an order issued by the regulatory agency or fails to pay an
administrative penalty imposed by the regulatory agency;
(9) owes uncontested delinquent taxes in the amount of $500 or more to the Minnesota
Department of Revenue, or any other governmental agency authorized to collect taxes
anywhere in the United States;
(10) is in arrears on any court ordered family or child support obligations; or
(11) engages in any conduct that, in the determination of the regulatory agency, is
unprofessional as prescribed in section 149A.70, subdivision 7, or renders the person unfit
to practice mortuary science or to operate a funeral establishment or crematory.
Subd. 2.
Hearings related to refusal to renew, suspension, or revocation of licensenew text begin ,
registration,new text end or permit.
If the regulatory agency proposes to deny renewal, suspend, or
revoke a licensenew text begin , registration,new text end or permit issued under this chapter, the regulatory agency
must first notify, in writing, the person against whom the action is proposed to be taken and
provide an opportunity to request a hearing under the contested case provisions of sections
14.57 to 14.62. If the subject of the proposed action does not request a hearing by notifying
the regulatory agency, by mail, within 20 calendar days after the receipt of the notice of
proposed action, the regulatory agency may proceed with the action without a hearing and
the action will be the final order of the regulatory agency.
Subd. 3.
Review of final order.
A judicial review of the final order issued by the
regulatory agency may be requested in the manner prescribed in sections 14.63 to 14.69.
Failure to request a hearing pursuant to subdivision 2 shall constitute a waiver of the right
to further agency or judicial review of the final order.
Subd. 4.
Limitations or qualifications placed on licensenew text begin , registration,new text end or permit.
The
regulatory agency may, where the facts support such action, place reasonable limitations
or qualifications on the right to practice mortuary science deleted text begin ordeleted text end new text begin ,new text end to operate a funeral
establishment or crematorynew text begin , or to conduct activities or actions permitted under this chapternew text end .
Subd. 5.
Restoring licensenew text begin , registration,new text end or permit.
The regulatory agency may, where
there is sufficient reason, restore a licensenew text begin , registration,new text end or permit that has been revoked,
reduce a period of suspension, or remove limitations or qualifications.
Sec. 59.
Minnesota Statutes 2020, section 149A.11, is amended to read:
149A.11 PUBLICATION OF DISCIPLINARY ACTIONS.
The regulatory agencies shall report all disciplinary measures or actions taken to the
commissioner. At least annually, the commissioner shall publish and make available to the
public a description of all disciplinary measures or actions taken by the regulatory agencies.
The publication shall include, for each disciplinary measure or action taken, the name and
business address of the licenseenew text begin , registrant,new text end or interndeleted text begin ,deleted text end new text begin ;new text end the nature of the misconductdeleted text begin ,deleted text end new text begin ;new text end and
the measure or action taken by the regulatory agency.
Sec. 60.
new text begin
[149A.47] TRANSFER CARE SPECIALIST.
new text end
new text begin Subdivision 1. new text end
new text begin General. new text end
new text begin
A transfer care specialist may remove a dead human body from
the place of death under the direct supervision of a licensed mortician if the transfer care
specialist is registered with the commissioner in accordance with this section. A transfer
care specialist is not licensed to engage in the practice of mortuary science and shall not
engage in the practice of mortuary science except as provided in this section.
new text end
new text begin Subd. 2. new text end
new text begin Registration. new text end
new text begin
To be eligible for registration as a transfer care specialist, an
applicant must submit to the commissioner:
new text end
new text begin
(1) a complete application on a form provided by the commissioner that includes at a
minimum:
new text end
new text begin
(i) the applicant's name, home address and telephone number, business name, and business
address and telephone number; and
new text end
new text begin
(ii) the name, license number, business name, and business address and telephone number
of the supervising licensed mortician;
new text end
new text begin
(2) proof of completion of a training program that meets the requirements specified in
subdivision 4; and
new text end
new text begin
(3) the appropriate fees specified in section 149A.65.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
A transfer care specialist registered under this section is authorized to
perform the removal of a dead human body from the place of death in accordance with this
chapter to a licensed funeral establishment. The transfer care specialist must work under
the direct supervision of a licensed mortician. The supervising mortician is responsible for
the work performed by the transfer care specialist. A licensed mortician may supervise up
to six transfer care specialists at any one time.
new text end
new text begin Subd. 4. new text end
new text begin Training program. new text end
new text begin
(a) Each transfer care specialist must complete a training
program that has been approved by the commissioner. To be approved, a training program
must be at least seven hours long and must cover, at a minimum, the following:
new text end
new text begin
(1) ethical care and transportation procedures for a deceased person;
new text end
new text begin
(2) health and safety concerns to the public and the individual performing the transfer
of the deceased person; and
new text end
new text begin
(3) all relevant state and federal laws and regulations related to the transfer and
transportation of deceased persons.
new text end
new text begin
(b) A transfer care specialist must complete a training program every five years.
new text end
new text begin Subd. 5. new text end
new text begin Registration renewal. new text end
new text begin
(a) A registration issued under this section expires one
year after the date of issuance and must be renewed to remain valid.
new text end
new text begin
(b) To renew a registration, the transfer care specialist must submit a completed renewal
application as provided by the commissioner and the appropriate fees specified in section
149A.65. Every five years, the renewal application must include proof of completion of a
training program that meets the requirements in subdivision 4.
new text end
Sec. 61.
Minnesota Statutes 2020, section 149A.60, is amended to read:
149A.60 PROHIBITED CONDUCT.
The regulatory agency may impose disciplinary measures or take disciplinary action
against a person whose conduct is subject to regulation under this chapter for failure to
comply with any provision of this chapter or laws, rules, orders, stipulation agreements,
settlements, compliance agreements, licenses, new text begin registrations, new text end and permits adopted, or issued
for the regulation of the removal, preparation, transportation, arrangements for disposition
or final disposition of dead human bodies, or for the regulation of the practice of mortuary
science.
Sec. 62.
Minnesota Statutes 2020, section 149A.61, subdivision 4, is amended to read:
Subd. 4.
Licenseesnew text begin , registrants,new text end and interns.
A licenseenew text begin , registrant,new text end or intern regulated
under this chapter may report to the commissioner any conduct that the licenseenew text begin , registrant,new text end
or intern has personal knowledge of, and reasonably believes constitutes grounds for,
disciplinary action under this chapter.
Sec. 63.
Minnesota Statutes 2020, section 149A.61, subdivision 5, is amended to read:
Subd. 5.
Courts.
The court administrator of district court or any court of competent
jurisdiction shall report to the commissioner any judgment or other determination of the
court that adjudges or includes a finding that a licenseenew text begin , registrant,new text end or intern is a person who
is mentally ill, mentally incompetent, guilty of a felony or gross misdemeanor, guilty of
violations of federal or state narcotics laws or controlled substances acts; appoints a guardian
or conservator for the licenseenew text begin , registrant,new text end or intern; or commits a licenseenew text begin , registrant,new text end or
intern.
Sec. 64.
Minnesota Statutes 2020, section 149A.62, is amended to read:
149A.62 IMMUNITY; REPORTING.
Any person, private agency, organization, society, association, licensee, new text begin registrant, new text end or
intern who, in good faith, submits information to a regulatory agency under section 149A.61
or otherwise reports violations or alleged violations of this chapter, is immune from civil
liability or criminal prosecution. This section does not prohibit disciplinary action taken by
the commissioner against any licenseenew text begin , registrant,new text end or intern pursuant to a self report of a
violation.
Sec. 65.
Minnesota Statutes 2020, section 149A.63, is amended to read:
149A.63 PROFESSIONAL COOPERATION.
A licensee, clinical student, practicum student, new text begin registrant, new text end intern, or applicant for licensure
under this chapter that is the subject of or part of an inspection or investigation by the
commissioner or the commissioner's designee shall cooperate fully with the inspection or
investigation. Failure to cooperate constitutes grounds for disciplinary action under this
chapter.
Sec. 66.
Minnesota Statutes 2020, section 149A.65, subdivision 2, is amended to read:
Subd. 2.
Mortuary science fees.
Fees for mortuary science are:
(1) $75 for the initial and renewal registration of a mortuary science intern;
(2) $125 for the mortuary science examination;
(3) $200 for issuance of initial and renewal mortuary science licenses;
(4) $100 late fee charge for a license renewal; deleted text begin and
deleted text end
(5) $250 for issuing a mortuary science license by endorsementnew text begin ; and
new text end
new text begin (6) $687 for the initial and renewal registration of a transfer care specialistnew text end .
Sec. 67.
Minnesota Statutes 2020, section 149A.70, subdivision 3, is amended to read:
Subd. 3.
Advertising.
No licensee, new text begin registrant, new text end clinical student, practicum student, or
intern shall publish or disseminate false, misleading, or deceptive advertising. False,
misleading, or deceptive advertising includes, but is not limited to:
(1) identifying, by using the names or pictures of, persons who are not licensed to practice
mortuary science in a way that leads the public to believe that those persons will provide
mortuary science services;
(2) using any name other than the names under which the funeral establishment, alkaline
hydrolysis facility, or crematory is known to or licensed by the commissioner;
(3) using a surname not directly, actively, or presently associated with a licensed funeral
establishment, alkaline hydrolysis facility, or crematory, unless the surname had been
previously and continuously used by the licensed funeral establishment, alkaline hydrolysis
facility, or crematory; and
(4) using a founding or establishing date or total years of service not directly or
continuously related to a name under which the funeral establishment, alkaline hydrolysis
facility, or crematory is currently or was previously licensed.
Any advertising or other printed material that contains the names or pictures of persons
affiliated with a funeral establishment, alkaline hydrolysis facility, or crematory shall state
the position held by the persons and shall identify each person who is licensed or unlicensed
under this chapter.
Sec. 68.
Minnesota Statutes 2020, section 149A.70, subdivision 4, is amended to read:
Subd. 4.
Solicitation of business.
No licensee shall directly or indirectly pay or cause
to be paid any sum of money or other valuable consideration for the securing of business
or for obtaining the authority to dispose of any dead human body.
For purposes of this subdivision, licensee includes a registered intern new text begin or transfer care
specialist new text end or any agent, representative, employee, or person acting on behalf of the licensee.
Sec. 69.
Minnesota Statutes 2020, section 149A.70, subdivision 5, is amended to read:
Subd. 5.
Reimbursement prohibited.
No licensee, clinical student, practicum student,
deleted text begin ordeleted text end internnew text begin , or transfer care specialistnew text end shall offer, solicit, or accept a commission, fee, bonus,
rebate, or other reimbursement in consideration for recommending or causing a dead human
body to be disposed of by a specific body donation program, funeral establishment, alkaline
hydrolysis facility, crematory, mausoleum, or cemetery.
Sec. 70.
Minnesota Statutes 2020, section 149A.70, subdivision 7, is amended to read:
Subd. 7.
Unprofessional conduct.
No licenseenew text begin , registrant,new text end or intern shall engage in or
permit others under the licensee'snew text begin , registrant's,new text end or intern's supervision or employment to
engage in unprofessional conduct. Unprofessional conduct includes, but is not limited to:
(1) harassing, abusing, or intimidating a customer, employee, or any other person
encountered while within the scope of practice, employment, or business;
(2) using profane, indecent, or obscene language within the immediate hearing of the
family or relatives of the deceased;
(3) failure to treat with dignity and respect the body of the deceased, any member of the
family or relatives of the deceased, any employee, or any other person encountered while
within the scope of practice, employment, or business;
(4) the habitual overindulgence in the use of or dependence on intoxicating liquors,
prescription drugs, over-the-counter drugs, illegal drugs, or any other mood altering
substances that substantially impair a person's work-related judgment or performance;
(5) revealing personally identifiable facts, data, or information about a decedent, customer,
member of the decedent's family, or employee acquired in the practice or business without
the prior consent of the individual, except as authorized by law;
(6) intentionally misleading or deceiving any customer in the sale of any goods or services
provided by the licensee;
(7) knowingly making a false statement in the procuring, preparation, or filing of any
required permit or document; or
(8) knowingly making a false statement on a record of death.
Sec. 71.
Minnesota Statutes 2020, section 149A.90, subdivision 2, is amended to read:
Subd. 2.
Removal from place of death.
No person subject to regulation under this
chapter shall remove or cause to be removed any dead human body from the place of death
without being licensed new text begin or registered new text end by the commissioner. Every dead human body shall be
removed from the place of death by a licensed mortician or funeral director, except as
provided in section 149A.01, subdivision 3new text begin , or 149A.47new text end .
Sec. 72.
Minnesota Statutes 2020, section 149A.90, subdivision 4, is amended to read:
Subd. 4.
Certificate of removal.
No dead human body shall be removed from the place
of death by a mortician deleted text begin ordeleted text end new text begin ,new text end funeral directornew text begin , or transfer care specialistnew text end or by a noncompensated
person with the right to control the dead human body without the completion of a certificate
of removal and, where possible, presentation of a copy of that certificate to the person or a
representative of the legal entity with physical or legal custody of the body at the death site.
The certificate of removal shall be in the format provided by the commissioner that contains,
at least, the following information:
(1) the name of the deceased, if known;
(2) the date and time of removal;
(3) a brief listing of the type and condition of any personal property removed with the
body;
(4) the location to which the body is being taken;
(5) the name, business address, and license number of the individual making the removal;
and
(6) the signatures of the individual making the removal and, where possible, the individual
or representative of the legal entity with physical or legal custody of the body at the death
site.
Sec. 73.
Minnesota Statutes 2020, section 149A.90, subdivision 5, is amended to read:
Subd. 5.
Retention of certificate of removal.
A copy of the certificate of removal shall
be given, where possible, to the person or representative of the legal entity having physical
or legal custody of the body at the death site. The original certificate of removal shall be
retained by the individual making the removal and shall be kept on file, at the funeral
establishment to which the body was taken, for a period of three calendar years following
the date of the removal. new text begin If the removal was performed by a transfer care specialist not
employed by the funeral establishment to which the body was taken, the transfer care
specialist shall retain a copy of the certificate on file at the transfer care specialist's business
address as registered with the commissioner for a period of three calendar years following
the date of removal. new text end Following this period, and subject to any other laws requiring retention
of records, the funeral establishment may then place the records in storage or reduce them
to microfilm, microfiche, laser disc, or any other method that can produce an accurate
reproduction of the original record, for retention for a period of ten calendar years from the
date of the removal of the body. At the end of this period and subject to any other laws
requiring retention of records, the funeral establishment may destroy the records by shredding,
incineration, or any other manner that protects the privacy of the individuals identified in
the records.
Sec. 74.
Minnesota Statutes 2020, section 149A.94, subdivision 1, is amended to read:
Subdivision 1.
Generally.
new text begin (a) new text end Every dead human body lying within the state, except
unclaimed bodies delivered for dissection by the medical examiner, those delivered for
anatomical study pursuant to section 149A.81, subdivision 2, or lawfully carried through
the state for the purpose of disposition elsewhere; and the remains of any dead human body
after dissection or anatomical study, shall be decently buried or entombed in a public or
private cemetery, alkaline hydrolyzed, or cremated within a reasonable time after death.
Where final disposition of a body will not be accomplished within 72 hours following death
or release of the body by a competent authority with jurisdiction over the body, the body
must be properly embalmed, refrigerated, or packed with dry ice. A body may not be deleted text begin kept
in refrigeration for a period exceeding six calendar days, ordeleted text end packed in dry ice for a period
that exceeds four calendar days, from the time of death or release of the body from the
coroner or medical examiner.new text begin A body may be kept in refrigeration for up to 30 calendar
days from the time of death or release of the body from the coroner or medical examiner,
provided the dignity of the body is maintained and the funeral establishment complies with
paragraph (b) if applicable. A body may be kept in refrigeration for more than 30 calendar
days from the time of death or release of the body from the coroner or medical examiner in
accordance with paragraphs (c) and (d).
new text end
new text begin
(b) For a body to be kept in refrigeration for between 15 and 30 calendar days, no later
than the 14th day of keeping the body in refrigeration the funeral establishment must notify
the person with the right to control final disposition that the body will be kept in refrigeration
for more than 14 days and that the person with the right to control final disposition has the
right to seek other arrangements.
new text end
new text begin
(c) For a body to be kept in refrigeration for more than 30 calendar days, the funeral
establishment must:
new text end
new text begin
(1) report at least the following to the commissioner on a form and in a manner prescribed
by the commissioner: body identification details determined by the commissioner, the funeral
establishment's plan to achieve final disposition of the body within the permitted time frame,
and other information required by the commissioner; and
new text end
new text begin
(2) store each refrigerated body in a manner that maintains the dignity of the body.
new text end
new text begin
(d) Each report filed with the commissioner under paragraph (c) authorizes a funeral
establishment to keep a body in refrigeration for an additional 30 calendar days.
new text end
new text begin
(e) Failure to submit a report required by paragraph (c) subjects a funeral establishment
to enforcement under this chapter.
new text end
Sec. 75.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 1a. new text end
new text begin Bona fide labor organization. new text end
new text begin
"Bona fide labor organization" means a labor
union that represents or is actively seeking to represent workers of a medical cannabis
manufacturer.
new text end
Sec. 76.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 5d. new text end
new text begin Indian lands. new text end
new text begin
"Indian lands" means all lands within the limits of any Indian
reservation within the boundaries of Minnesota and any lands within the boundaries of
Minnesota title which are either held in trust by the United States or over which an Indian
Tribe exercises governmental power.
new text end
Sec. 77.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 5e. new text end
new text begin Labor peace agreement. new text end
new text begin
"Labor peace agreement" means an agreement
between a medical cannabis manufacturer and a bona fide labor organization that protects
the state's interests by, at a minimum, prohibiting the labor organization from engaging in
picketing, work stoppages, or boycotts against the manufacturer. This type of agreement
shall not mandate a particular method of election or certification of the bona fide labor
organization.
new text end
Sec. 78.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 15. new text end
new text begin Tribal medical cannabis board. new text end
new text begin
"Tribal medical cannabis board" means an
agency established by each federally recognized Tribal government and duly authorized by
each Tribe's governing body to perform regulatory oversight and monitor compliance with
a Tribal medical cannabis program and applicable regulations.
new text end
Sec. 79.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Tribal medical cannabis program. new text end
new text begin
"Tribal medical cannabis program" means
a program established by a federally recognized Tribal government within the boundaries
of Minnesota regarding the commercial production, processing, sale or distribution, and
possession of medical cannabis and medical cannabis products.
new text end
Sec. 80.
Minnesota Statutes 2020, section 152.22, is amended by adding a subdivision to
read:
new text begin Subd. 17. new text end
new text begin Tribal medical cannabis program patient. new text end
new text begin
"Tribal medical cannabis program
patient" means a person who possesses a valid registration verification card or equivalent
document that is issued under the laws or regulations of a Tribal Nation within the boundaries
of Minnesota and that verifies that the person is enrolled in or authorized to participate in
that Tribal Nation's Tribal medical cannabis program.
new text end
Sec. 81.
Minnesota Statutes 2020, section 152.25, subdivision 1, is amended to read:
Subdivision 1.
Medical cannabis manufacturer registrationnew text begin and renewalnew text end .
(a) The
commissioner shall register deleted text begin twodeleted text end new text begin at least four and up to tennew text end in-state manufacturers for the
production of all medical cannabis within the state. deleted text begin Adeleted text end new text begin Thenew text end registration deleted text begin agreement between
the commissioner and a manufacturerdeleted text end is new text begin valid for two years, unless revoked under subdivision
1a, and is new text end nontransferable. deleted text begin The commissioner shall register new manufacturers or reregister
the existing manufacturers by December 1 every two years, using the factors described in
this subdivision. The commissioner shall accept applications after December 1, 2014, if one
of the manufacturers registered before December 1, 2014, ceases to be registered as a
manufacturer. The commissioner's determination that no manufacturer exists to fulfill the
duties under sections 152.22 to 152.37 is subject to judicial review in Ramsey County
District Court.deleted text end new text begin Once the commissioner has registered more than two manufacturers,
registration renewal for at least one manufacturer must occur each year. The commissioner
shall begin registering additional manufacturers by December 1, 2022. The commissioner
shall renew a registration if the manufacturer meets the factors described in this subdivision
and submits the registration renewal fee under section 152.35.
new text end
new text begin (b) An individual or entity seeking registration or registration renewal under this
subdivision must apply to the commissioner in a form and manner established by the
commissioner. As part of the application, the applicant must submit an attestation signed
by a bona fide labor organization stating that the applicant has entered into a labor peace
agreement. Before accepting applications for registration or registration renewal, the
commissioner must publish on the Office of Medical Cannabis website the application
scoring criteria established by the commissioner to determine whether the applicant meets
requirements for registration or registration renewal.new text end Data submitted during the application
process are private data on individuals or nonpublic data as defined in section 13.02 until
the manufacturer is registered under this section. Data on a manufacturer that is registered
are public data, unless the data are trade secret or security information under section 13.37.
deleted text begin (b)deleted text end new text begin (c)new text end As a condition for registrationdeleted text begin , a manufacturer must agree todeleted text end new text begin or registration
renewalnew text end :
deleted text begin
(1) begin supplying medical cannabis to patients by July 1, 2015; and
deleted text end
deleted text begin (2)deleted text end new text begin (1) a manufacturer mustnew text end comply with all requirements under sections 152.22 to
152.37deleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) if the manufacturer is a business entity, the manufacturer must be incorporated in
the state or otherwise formed or organized under the laws of the state; and
new text end
new text begin
(3) the manufacturer must fulfill commitments made in the application for registration
or registration renewal, including but not limited to maintenance of a labor peace agreement.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The commissioner shall consider the following factors when determining which
manufacturer to registernew text begin or when determining whether to renew a registrationnew text end :
(1) the technical expertise of the manufacturer in cultivating medical cannabis and
converting the medical cannabis into an acceptable delivery method under section 152.22,
subdivision 6;
(2) the qualifications of the manufacturer's employees;
(3) the long-term financial stability of the manufacturer;
(4) the ability to provide appropriate security measures on the premises of the
manufacturer;
(5) whether the manufacturer has demonstrated an ability to meet the medical cannabis
production needs required by sections 152.22 to 152.37; deleted text begin and
deleted text end
(6) the manufacturer's projection and ongoing assessment of fees on patients with a
qualifying medical conditiondeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) the manufacturer's inclusion of leadership or beneficial ownership, as defined in
section 302A.011, subdivision 41, by:
new text end
new text begin
(i) minority persons as defined in section 116M.14, subdivision 6;
new text end
new text begin
(ii) women;
new text end
new text begin
(iii) individuals with disabilities as defined in section 363A.03, subdivision 12; or
new text end
new text begin
(iv) military veterans who satisfy the requirements of section 197.447;
new text end
new text begin
(8) the extent to which registering the manufacturer or renewing the registration will
expand service to a currently underserved market;
new text end
new text begin
(9) the extent to which registering the manufacturer or renewing the registration will
promote development in a low-income area as defined in section 116J.982, subdivision 1,
paragraph (e);
new text end
new text begin
(10) beneficial ownership as defined in section 302A.011, subdivision 41, of the
manufacturer by Minnesota residents; and
new text end
new text begin
(11) other factors the commissioner determines are necessary to protect patient health
and ensure public safety.
new text end
new text begin
(e) Commitments made by an applicant in the application for registration or registration
renewal, including but not limited to maintenance of a labor peace agreement, shall be an
ongoing material condition of maintaining a manufacturer registration.
new text end
deleted text begin (d)deleted text end new text begin (f)new text end If an officer, director, or controlling person of the manufacturer pleads or is found
guilty of intentionally diverting medical cannabis to a person other than allowed by law
under section 152.33, subdivision 1, the commissioner may decide not to renew the
registration of the manufacturer, provided the violation occurred while the person was an
officer, director, or controlling person of the manufacturer.
deleted text begin
(e) The commissioner shall require each medical cannabis manufacturer to contract with
an independent laboratory to test medical cannabis produced by the manufacturer. The
commissioner shall approve the laboratory chosen by each manufacturer and require that
the laboratory report testing results to the manufacturer in a manner determined by the
commissioner.
deleted text end
Sec. 82.
Minnesota Statutes 2020, section 152.25, is amended by adding a subdivision to
read:
new text begin Subd. 1d. new text end
new text begin Background study. new text end
new text begin
(a) Before the commissioner registers a manufacturer or
renews a registration, each officer, director, and controlling person of the manufacturer
must consent to a background study and must submit to the commissioner a completed
criminal history records check consent form, a full set of classifiable fingerprints, and the
required fees. The commissioner must submit these materials to the Bureau of Criminal
Apprehension. The bureau must conduct a Minnesota criminal history records check, and
the superintendent is authorized to exchange fingerprints with the Federal Bureau of
Investigation to obtain national criminal history record information. The bureau must return
the results of the Minnesota and federal criminal history records checks to the commissioner.
new text end
new text begin
(b) The commissioner must not register a manufacturer or renew a registration if an
officer, director, or controlling person of the manufacturer has been convicted of, pled guilty
to, or received a stay of adjudication for:
new text end
new text begin
(1) a violation of state or federal law related to theft, fraud, embezzlement, breach of
fiduciary duty, or other financial misconduct that is a felony under Minnesota law or would
be a felony if committed in Minnesota; or
new text end
new text begin
(2) a violation of state or federal law relating to unlawful manufacture, distribution,
prescription, or dispensing of a controlled substance that is a felony under Minnesota law
or would be a felony if committed in Minnesota.
new text end
Sec. 83.
Minnesota Statutes 2020, section 152.29, subdivision 4, is amended to read:
Subd. 4.
Report.
new text begin (a) new text end Each manufacturer shall report to the commissioner on a monthly
basis the following information on each individual patient for the month prior to the report:
(1) the amount and dosages of medical cannabis distributed;
(2) the chemical composition of the medical cannabis; and
(3) the tracking number assigned to any medical cannabis distributed.
new text begin
(b) For transactions involving Tribal medical cannabis program patients, each
manufacturer shall report to the commissioner on a weekly basis the following information
on each individual Tribal medical cannabis program patient for the week prior to the report:
new text end
new text begin
(1) the name of the Tribal medical cannabis program in which the Tribal medical cannabis
program patient is enrolled;
new text end
new text begin
(2) the amount and dosages of medical cannabis distributed;
new text end
new text begin
(3) the chemical composition of the medical cannabis; and
new text end
new text begin
(4) the tracking number assigned to the medical cannabis distributed.
new text end
Sec. 84.
Minnesota Statutes 2020, section 152.29, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Distribution to Tribal medical cannabis program patient. new text end
new text begin
(a) A manufacturer
may distribute medical cannabis in accordance with subdivisions 1 to 4 to a Tribal medical
cannabis program patient.
new text end
new text begin
(b) Prior to distribution, the Tribal medical cannabis program patient must provide to
the manufacturer:
new text end
new text begin
(1) a valid medical cannabis registration verification card or equivalent document issued
by a Tribal medical cannabis program that indicates that the Tribal medical cannabis program
patient is authorized to use medical cannabis on Indian lands over which the Tribe has
jurisdiction; and
new text end
new text begin
(2) a valid photographic identification card issued by the Tribal medical cannabis
program, valid driver's license, or valid state identification card.
new text end
new text begin
(c) A manufacturer shall distribute medical cannabis to a Tribal medical cannabis program
patient only in a form allowed under section 152.22, subdivision 6.
new text end
Sec. 85.
new text begin
[152.291] TRIBAL MEDICAL CANNABIS PROGRAM;
MANUFACTURERS.
new text end
new text begin Subdivision 1. new text end
new text begin Manufacturer. new text end
new text begin
Notwithstanding the requirements and limitations in
section 152.29, subdivision 1, paragraph (a), a Tribal medical cannabis program operated
by a federally recognized Indian Tribe located in Minnesota shall be recognized as a medical
cannabis manufacturer.
new text end
new text begin Subd. 2. new text end
new text begin Manufacturer transportation. new text end
new text begin
(a) A manufacturer registered with a Tribal
medical cannabis program may transport medical cannabis to testing laboratories and to
other Indian lands in the state.
new text end
new text begin
(b) A manufacturer registered with a Tribal medical cannabis program must staff a motor
vehicle used to transport medical cannabis with at least two employees of the manufacturer.
Each employee in the transport vehicle must carry identification specifying that the employee
is an employee of the manufacturer, and one employee in the transport vehicle must carry
a detailed transportation manifest that includes the place and time of departure, the address
of the destination, and a description and count of the medical cannabis being transported.
new text end
Sec. 86.
Minnesota Statutes 2020, section 152.30, is amended to read:
152.30 PATIENT DUTIES.
(a) A patient shall apply to the commissioner for enrollment in the registry program by
submitting an application as required in section 152.27 and an annual registration fee as
determined under section 152.35.
(b) As a condition of continued enrollment, patients shall agree to:
(1) continue to receive regularly scheduled treatment for their qualifying medical
condition from their health care practitioner; and
(2) report changes in their qualifying medical condition to their health care practitioner.
(c) A patient shall only receive medical cannabis from a registered manufacturer new text begin or
Tribal medical cannabis program new text end but is not required to receive medical cannabis products
from only a registered manufacturernew text begin or Tribal medical cannabis programnew text end .
Sec. 87.
Minnesota Statutes 2020, section 152.32, is amended to read:
152.32 PROTECTIONS FOR REGISTRY PROGRAM PARTICIPATIONnew text begin OR
PARTICIPATION IN A TRIBAL MEDICAL CANNABIS PROGRAMnew text end .
Subdivision 1.
Presumption.
(a) There is a presumption that a patient enrolled in the
registry program under sections 152.22 to 152.37 new text begin or a Tribal medical cannabis program
patient enrolled in a Tribal medical cannabis program new text end is engaged in the authorized use of
medical cannabis.
(b) The presumption may be rebuttednew text begin :
new text end
new text begin (1)new text end by evidence that new text begin a patient's new text end conduct related to use of medical cannabis was not for
the purpose of treating or alleviating the patient's qualifying medical condition or symptoms
associated with the patient's qualifying medical conditionnew text begin ; or
new text end
new text begin (2) by evidence that a Tribal medical cannabis program patient's use of medical cannabis
was not for a purpose authorized by the Tribal medical cannabis programnew text end .
Subd. 2.
Criminal and civil protections.
(a) Subject to section 152.23, the following
are not violations under this chapter:
(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry programdeleted text begin , ordeleted text end new text begin ;new text end possession by a registered designated caregiver or the
parent, legal guardian, or spouse of a patient if the parent, legal guardian, or spouse is listed
on the registry verification;new text begin or use or possession of medical cannabis or medical cannabis
products by a Tribal medical cannabis program patient;
new text end
(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and
(3) possession of medical cannabis or medical cannabis products by any person while
carrying out the duties required under sections 152.22 to 152.37.
(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.
(c) The commissioner, new text begin members of a Tribal medical cannabis board, new text end the commissioner's
new text begin or Tribal medical cannabis board's new text end staff, the commissioner'snew text begin or Tribal medical cannabis
board'snew text end agents or contractors, and any health care practitioner are not subject to any civil or
disciplinary penalties by the Board of Medical Practice, the Board of Nursing, or by any
business, occupational, or professional licensing board or entity, solely for the participation
in the registry program under sections 152.22 to 152.37new text begin or in a Tribal medical cannabis
programnew text end . A pharmacist licensed under chapter 151 is not subject to any civil or disciplinary
penalties by the Board of Pharmacy when acting in accordance with the provisions of
sections 152.22 to 152.37. Nothing in this section affects a professional licensing board
from taking action in response to violations of any other section of law.
(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.
(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.
(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.
(g) No information contained in a report, document, or registry or obtained from a patient
new text begin or a Tribal medical cannabis program patient new text end under sections 152.22 to 152.37 may be
admitted as evidence in a criminal proceeding unless independently obtained or in connection
with a proceeding involving a violation of sections 152.22 to 152.37.
(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.
(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Courtnew text begin , a Tribal court,new text end or new text begin the new text end professional responsibility board for providing legal assistance
to prospective or registered manufacturers or others related to activity that is no longer
subject to criminal penalties under state law pursuant to sections 152.22 to 152.37new text begin , or for
providing legal assistance to a Tribal medical cannabis programnew text end .
(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry programnew text begin , or possession
of a verification or equivalent issued by a Tribal medical cannabis program by a person
entitled to possess such verification,new text end does not constitute probable cause or reasonable
suspicion, nor shall it be used to support a search of the person or property of the person
possessing or applying for the registry verificationnew text begin or equivalentnew text end , or otherwise subject the
person or property of the person to inspection by any governmental agency.
Subd. 3.
Discrimination prohibited.
(a) No school or landlord may refuse to enroll or
lease to and may not otherwise penalize a person solely for the person's status as a patient
enrolled in the registry program under sections 152.22 to 152.37new text begin or for the person's status
as a Tribal medical cannabis program patient enrolled in a Tribal medical cannabis programnew text end ,
unless failing to do so would violate federal law or regulations or cause the school or landlord
to lose a monetary or licensing-related benefit under federal law or regulations.
(b) For the purposes of medical care, including organ transplants, a registry program
enrollee's use of medical cannabis under sections 152.22 to 152.37new text begin , or a Tribal medical
cannabis program patient's use of medical cannabis as authorized by the Tribal medical
cannabis program,new text end is considered the equivalent of the authorized use of any other medication
used at the discretion of a physician or advanced practice registered nurse and does not
constitute the use of an illicit substance or otherwise disqualify a patient from needed medical
care.
(c) Unless a failure to do so would violate federal law or regulations or cause an employer
to lose a monetary or licensing-related benefit under federal law or regulations, an employer
may not discriminate against a person in hiring, termination, or any term or condition of
employment, or otherwise penalize a person, if the discrimination is based upon deleted text begin eitherdeleted text end new text begin anynew text end
of the following:
(1) the person's status as a patient enrolled in the registry program under sections 152.22
to 152.37; deleted text begin or
deleted text end
new text begin
(2) the person's status as a Tribal medical cannabis program patient enrolled in a Tribal
medical cannabis program; or
new text end
deleted text begin (2)deleted text end new text begin (3)new text end a patient's positive drug test for cannabis components or metabolites, unless the
patient used, possessed, or was impaired by medical cannabis on the premises of the place
of employment or during the hours of employment.
(d) An employee who is required to undergo employer drug testing pursuant to section
181.953 may present verification of enrollment in the patient registry new text begin or of enrollment in a
Tribal medical cannabis program new text end as part of the employee's explanation under section 181.953,
subdivision 6.
(e) A person shall not be denied custody of a minor child or visitation rights or parenting
time with a minor child solely based on the person's status as a patient enrolled in the registry
program under sections 152.22 to 152.37new text begin or on the person's status as a Tribal medical
cannabis program patient enrolled in a Tribal medical cannabis programnew text end . There shall be no
presumption of neglect or child endangerment for conduct allowed under sections 152.22
to 152.37new text begin or under a Tribal medical cannabis programnew text end , unless the person's behavior is such
that it creates an unreasonable danger to the safety of the minor as established by clear and
convincing evidence.
Sec. 88.
Minnesota Statutes 2020, section 152.33, subdivision 1, is amended to read:
Subdivision 1.
Intentional diversion; criminal penalty.
In addition to any other
applicable penalty in law, a manufacturer or an agent of a manufacturer who intentionally
transfers medical cannabis to a person other than another registered manufacturer, a patient,
a registered designated caregivernew text begin , a Tribal medical cannabis program patient,new text end or, if listed
on the registry verification, a parent, legal guardian, or spouse of a patient is guilty of a
felony punishable by imprisonment for not more than two years or by payment of a fine of
not more than $3,000, or both. A person convicted under this subdivision may not continue
to be affiliated with the manufacturer and is disqualified from further participation under
sections 152.22 to 152.37.
Sec. 89.
Minnesota Statutes 2020, section 152.35, is amended to read:
152.35 FEES; DEPOSIT OF REVENUE.
(a) The commissioner shall collect an enrollment fee of deleted text begin $200deleted text end new text begin $40new text end from patients enrolled
under deleted text begin thisdeleted text end sectionnew text begin 152.27new text end . deleted text begin If the patient provides evidence of receiving Social Security
disability insurance (SSDI), Supplemental Security Income (SSI), veterans disability, or
railroad disability payments, or being enrolled in medical assistance or MinnesotaCare, then
the fee shall be $50. For purposes of this section:
deleted text end
deleted text begin
(1) a patient is considered to receive SSDI if the patient was receiving SSDI at the time
the patient was transitioned to retirement benefits by the United States Social Security
Administration; and
deleted text end
deleted text begin
(2) veterans disability payments include VA dependency and indemnity compensation.
deleted text end
deleted text begin Unless a patient provides evidence of receiving payments from or participating in one of
the programs specifically listed in this paragraph, the commissioner of health must collect
the $200 enrollment fee from a patient to enroll the patient in the registry program.deleted text end The fees
shall be payable annually and are due on the anniversary date of the patient's enrollment.
The fee amount shall be deposited in the state treasury and credited to the state government
special revenue fund.
(b) The commissioner shall collect deleted text begin andeleted text end new text begin a nonrefundable registrationnew text end application fee of
deleted text begin $20,000deleted text end new text begin $10,000new text end from each entity submitting an application for registration as a medical
cannabis manufacturer. Revenue from the fee shall be deposited in the state treasury and
credited to the state government special revenue fund.
(c) The commissioner shall establish and collect an annualnew text begin registration renewalnew text end fee from
a medical cannabis manufacturer equal to the cost of regulating and inspecting the
manufacturer deleted text begin in that yeardeleted text end new text begin for the upcoming registration periodnew text end . Revenue from the fee amount
shall be deposited in the state treasury and credited to the state government special revenue
fund.
(d) A medical cannabis manufacturer may charge patients enrolled in the registry program
a reasonable fee for costs associated with the operations of the manufacturer. The
manufacturer may establish a sliding scale of patient fees based upon a patient's household
income and may accept private donations to reduce patient fees.
Sec. 90.
Laws 2021, First Special Session chapter 7, article 3, section 44, is amended to
read:
Sec. 44. MENTAL HEALTH CULTURAL COMMUNITY CONTINUING
EDUCATION GRANT PROGRAM.
new text begin (a) new text end The commissioner of health shall develop a grant program, in consultation with the
relevant mental health licensing boards, tonew text begin :
new text end
new text begin (1)new text end provide for the continuing education necessary for social workers, marriage and
family therapists, psychologists, and professional clinical counselors to become supervisors
for individuals pursuing licensure in mental health professionsnew text begin ;
new text end
new text begin
(2) cover the costs when supervision is required for professionals becoming supervisors;
and
new text end
new text begin (3) cover the supervisory costs for mental health practitioners pursuing licensure at the
professional levelnew text end .
new text begin (b)new text end Social workers, marriage and family therapists, psychologists, and professional
clinical counselors obtaining continuing education new text begin and mental health practitioners needing
supervised hours to become licensed as professionals new text end under this section must:
(1) be members of communities of color or underrepresented communities as defined
in Minnesota Statutes, section 148E.010, subdivision 20new text begin , or practice in a mental health
professional shortage areanew text end ; and
(2) deleted text begin work for community mental health providers anddeleted text end agree to deliver at least 25 percent
of their yearly patient encounters to state public program enrollees or patients receiving
sliding fee schedule discounts through a formal sliding fee schedule meeting the standards
established by the United States Department of Health and Human Services under Code of
Federal Regulations, title 42, section 51, chapter 303.
Sec. 91. new text begin BENEFIT AND COST ANALYSIS OF A UNIVERSAL HEALTH REFORM
PROPOSAL.
new text end
new text begin Subdivision 1. new text end
new text begin Contract for analysis of proposal. new text end
new text begin
The commissioner of health shall
contract with the University of Minnesota School of Public Health and the Carlson School
of Management to conduct an analysis of the benefits and costs of a legislative proposal for
a universal health care financing system and a similar analysis of the current health care
financing system to assist the state in comparing the proposal to the current system.
new text end
new text begin Subd. 2. new text end
new text begin Proposal. new text end
new text begin
The commissioner of health, with input from the commissioners of
human services and commerce, shall submit to the University of Minnesota for analysis a
legislative proposal known as the Minnesota Health Plan that would offer a universal health
care plan designed to meet the following principles:
new text end
new text begin
(1) ensure all Minnesotans are covered;
new text end
new text begin
(2) cover all necessary care, including dental, vision and hearing, mental health, chemical
dependency treatment, prescription drugs, medical equipment and supplies, long-term care,
and home care; and
new text end
new text begin
(3) allow patients to choose their doctors, hospitals, and other providers.
new text end
new text begin Subd. 3. new text end
new text begin Proposal analysis. new text end
new text begin
(a) The analysis must measure the performance of both the
Minnesota Health Plan and the current health care financing system over a ten-year period
to contrast the impact on:
new text end
new text begin
(1) the number of people covered versus the number of people who continue to lack
access to health care because of financial or other barriers, if any;
new text end
new text begin
(2) the completeness of the coverage and the number of people lacking coverage for
dental, long-term care, medical equipment or supplies, vision and hearing, or other health
services that are not covered, if any;
new text end
new text begin
(3) the adequacy of the coverage, the level of underinsured in the state, and whether
people with coverage can afford the care they need or whether cost prevents them from
accessing care;
new text end
new text begin
(4) the timeliness and appropriateness of the care received and whether people turn to
inappropriate care such as emergency rooms because of a lack of proper care in accordance
with clinical guidelines; and
new text end
new text begin
(5) total public and private health care spending in Minnesota under the current system
versus under the legislative proposal, including all spending by individuals, businesses, and
government. "Total public and private health care spending" means spending on all medical
care including but not limited to dental, vision and hearing, mental health, chemical
dependency treatment, prescription drugs, medical equipment and supplies, long-term care,
and home care, whether paid through premiums, co-pays and deductibles, other out-of-pocket
payments, or other funding from government, employers, or other sources. Total public and
private health care spending also includes the costs associated with administering, delivering,
and paying for the care. The costs of administering, delivering, and paying for the care
includes all expenses by insurers, providers, employers, individuals, and government to
select, negotiate, purchase, and administer insurance and care including but not limited to
coverage for health care, dental, long-term care, prescription drugs, medical expense portions
of workers compensation and automobile insurance, and the cost of administering and
paying for all health care products and services that are not covered by insurance. The
analysis of total health care spending shall examine whether there are savings or additional
costs under the legislative proposal compared to the existing system due to:
new text end
new text begin
(i) reduced insurance, billing, underwriting, marketing, evaluation, and other
administrative functions including savings from global budgeting for hospitals and
institutional care instead of billing for individual services provided;
new text end
new text begin
(ii) reduced prices on medical services and products including pharmaceuticals due to
price negotiations, if applicable under the proposal;
new text end
new text begin
(iii) changes in utilization, better health outcomes, and reduced time away from work
due to prevention, early intervention, health-promoting activities, and to the extent possible
given available data and resources;
new text end
new text begin
(iv) shortages or excess capacity of medical facilities and equipment under either the
current system or the proposal;
new text end
new text begin
(v) the impact on state, local, and federal government non-health-care expenditures such
as reduced crime and out-of-home placement costs due to mental health or chemical
dependency coverage; and
new text end
new text begin
(vi) job losses or gains in health care delivery, health billing and insurance administration,
and elsewhere in the economy under the proposal due to implementation of the reforms and
the resulting reduction of insurance and administrative burdens on businesses.
new text end
new text begin
(b) The analysts may consult with authors of the legislative proposal to gain understanding
or clarification of the specifics of the proposal. The analysis shall assume that the provisions
in the proposal are not preempted by federal law or that the federal government gives a
waiver to the preemptions.
new text end
new text begin
(c) The commissioner shall issue a final report by January 15, 2023, and may provide
interim reports and status updates to the governor and the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance.
new text end
Sec. 92. new text begin NURSING WORKFORCE REPORT.
new text end
new text begin
The commissioner of health shall provide a public report on the following topics:
new text end
new text begin
(1) Minnesota's supply of active licensed registered nurses;
new text end
new text begin
(2) trends in Minnesota regarding retention by hospitals of licensed registered nurses;
new text end
new text begin
(3) reasons licensed registered nurses are leaving direct care positions at hospitals; and
new text end
new text begin
(4) reasons licensed registered nurses are choosing not to renew their licenses and leaving
the profession.
new text end
Sec. 93. new text begin EMMETT LOUIS TILL VICTIMS RECOVERY PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Short title. new text end
new text begin
This section shall be known as the Emmett Louis Till Victims
Recovery Program.
new text end
new text begin Subd. 2. new text end
new text begin Program established; grants. new text end
new text begin
(a) The commissioner of health shall establish
the Emmett Louis Till Victims Recovery Program to address the health and wellness needs
of:
new text end
new text begin
(1) victims who experienced trauma, including historical trauma, resulting from events
such as assault or another violent physical act, intimidation, false accusations, wrongful
conviction, a hate crime, the violent death of a family member, or experiences of
discrimination or oppression based on the victim's race, ethnicity, or national origin; and
new text end
new text begin
(2) the families and heirs of victims described in clause (1), who experienced trauma,
including historical trauma, because of their proximity or connection to the victim.
new text end
new text begin
(b) The commissioner, in consultation with victims, families, and heirs who experienced
trauma and with community-based organizations that provide culturally appropriate services
to victims experiencing trauma and their families and heirs, shall award competitive grants
to applicants for projects to provide the following services to victims, families, and heirs
described in paragraph (a):
new text end
new text begin
(1) health and wellness services, which may include services and support to address
physical health, mental health, and cultural needs;
new text end
new text begin
(2) remembrance and legacy preservation activities;
new text end
new text begin
(3) cultural awareness services; and
new text end
new text begin
(4) community resources and services to promote healing for victims, families, and heirs
described in paragraph (a).
new text end
new text begin
(c) In awarding grants under this section, the commissioner must prioritize grant awards
to community-based organizations experienced in providing support and services to victims,
families, and heirs described in paragraph (a).
new text end
new text begin Subd. 3. new text end
new text begin Evaluation. new text end
new text begin
Grant recipients must provide the commissioner with information
required by the commissioner to evaluate the grant program, in a time and manner specified
by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Report. new text end
new text begin
By January 15, 2023, the commissioner must submit a status report
on the operation and results of the grant program, to the extent possible. The report must
be submitted to the chairs and ranking minority members of the legislative committees with
jurisdiction over health care. The report must include information on grant program activities
to date, services offered by grant recipients, and an assessment of the need to continue to
offer services to victims, families, and heirs who experienced trauma.
new text end
Sec. 94. new text begin IDENTIFY STRATEGIES FOR REDUCTION OF ADMINISTRATIVE
SPENDING AND LOW-VALUE CARE; REPORT.
new text end
new text begin
(a) The commissioner of health shall develop recommendations for strategies to reduce
the volume and growth of administrative spending by health care organizations and group
purchasers and the amount of low-value care delivered to Minnesota residents. In support
of the development of recommendations, the commissioner shall:
new text end
new text begin
(1) review the availability of data and identify gaps in the data infrastructure to estimate
aggregated and disaggregated administrative spending and low-value care;
new text end
new text begin
(2) based on available data, estimate the volume and change over time of administrative
spending and low-value care in Minnesota;
new text end
new text begin
(3) conduct an environmental scan and key informant interviews with experts in health
care finance, health economics, health care management or administration, or the
administration of health insurance benefits to identify drivers of spending growth for spending
on administrative services or the provision of low-value care; and
new text end
new text begin
(4) convene a clinical learning community and an employer task force to review the
evidence from clauses (1) to (3) and develop a set of actionable strategies to address
administrative spending volume and growth and the magnitude of the volume of low-value
care.
new text end
new text begin
(b) By December 15, 2024, the commissioner shall report the recommendations to the
chairs and ranking members of the legislative committees with jurisdiction over health and
human services financing and policy.
new text end
Sec. 95. new text begin INITIAL IMPLEMENTATION OF THE KEEPING NURSES AT THE
BEDSIDE ACT.
new text end
new text begin
(a) By April 1, 2024, each hospital must establish and convene a hospital nurse staffing
committee as described under Minnesota Statutes, section 144.7053.
new text end
new text begin
(b) By June 1, 2024, each hospital must implement core staffing plans developed by its
hospital nurse staffing committee and satisfy the plan posting requirements under Minnesota
Statutes, section 144.7056.
new text end
new text begin
(c) By June 1, 2024, each hospital must submit to the commissioner of health core
staffing plans meeting the requirements of Minnesota Statutes, section 144.7055.
new text end
Sec. 96. new text begin LEAD SERVICE LINE INVENTORY GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health must establish a grant
program to provide financial assistance to municipalities for producing an inventory of
publicly and privately owned lead service lines within their jurisdiction.
new text end
new text begin Subd. 2. new text end
new text begin Eligible uses. new text end
new text begin
A municipality receiving a grant under this section may use the
grant funds to:
new text end
new text begin
(1) survey households to determine the material of which their water service line is
made;
new text end
new text begin
(2) create publicly available databases or visualizations of lead service lines; and
new text end
new text begin
(3) comply with the lead service line inventory requirements in the Environmental
Protection Agency's Lead and Copper Rule.
new text end
Sec. 97. new text begin PAYMENT MECHANISMS IN RURAL HEALTH CARE.
new text end
new text begin
The commissioner of health shall develop a plan to assess readiness of rural communities
and rural health care providers to adopt value-based, global budgeting, or alternative payment
systems and recommend steps needed to implement. The commissioner may use the
development of case studies and modeling of alternate payment systems to demonstrate
value-based payment systems that ensure a baseline level of essential community or regional
health services and address population health needs. The commissioner shall develop
recommendations for pilot projects by January 1, 2025, with the aim of ensuring financial
viability of rural health care systems in the context of spending growth targets. The
commissioner shall share findings with the Health Care Affordability Board.
new text end
Sec. 98. new text begin PROGRAM TO DISTRIBUTE COVID-19 TESTS, MASKS, AND
RESPIRATORS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section.
new text end
new text begin
(b) "Antigen test" means a lateral flow immunoassay intended for the qualitative detection
of nucleocapsid protein antigens from the SARS-CoV-2 virus in nasal swabs, that has
emergency use authorization from the United States Food and Drug Administration and
that is authorized for nonprescription home use with self-collected nasal swabs.
new text end
new text begin
(c) "COVID-19 test" means a test authorized by the United States Food and Drug
Administration to detect the presence of genetic material of the SARS-CoV-2 virus either
through a molecular method that detects the RNA or nucleic acid component of the virus,
such as polymerase chain reaction or isothermal amplification, or through a rapid lateral
flow immunoassay that detects the nucleocapsid protein antigens from the SARS-CoV-2
virus.
new text end
new text begin
(d) "KN95 respirator" means a type of filtering facepiece respirator that is commonly
made and used in China, is designed and tested to meet an international standard, and does
not include an exhalation valve.
new text end
new text begin
(e) "Mask" means a face covering intended to contain droplets and particles in a person's
breath, cough, or sneeze.
new text end
new text begin
(f) "Respirator" means a face covering that filters the air and fits closely on the face to
filter out particles, including the SARS-CoV-2 virus.
new text end
new text begin Subd. 2. new text end
new text begin Program established. new text end
new text begin
In order to help reduce the number of cases of COVID-19
in the state, the commissioner of health must administer a program to distribute to individuals
in Minnesota, COVID-19 tests, including antigen tests; and masks and respirators, including
KN95 respirators and similar respirators approved by the Centers for Disease Control and
Prevention and authorized by the commissioner for distribution under this program. Masks
and respirators distributed under this program may include child-sized masks and respirators,
if such masks and respirators are available and the commissioner finds there is a need for
them. COVID-19 tests, masks, and respirators must be distributed at no cost to the individuals
receiving them and may be shipped directly to individuals; distributed through local health
departments, COVID community coordinators, and other community-based organizations;
and distributed through other means determined by the commissioner. The commissioner
may prioritize distribution under this section to communities and populations who are
disproportionately impacted by COVID-19 or who have difficulty accessing COVID-19
tests, masks, or respirators.
new text end
new text begin Subd. 3. new text end
new text begin Process to order COVID-19 tests, masks, and respirators. new text end
new text begin
The commissioner
may establish a process for individuals to order COVID-19 tests, masks, and respirators to
be shipped directly to the individual.
new text end
new text begin Subd. 4. new text end
new text begin Notice. new text end
new text begin
An entity distributing KN95 respirators or similar respirators under this
section may include with the respirators a notice that individuals with a medical condition
that may make it difficult to wear a KN95 respirator or similar respirator should consult
with a health care provider before use.
new text end
new text begin Subd. 5. new text end
new text begin Coordination. new text end
new text begin
The commissioner may coordinate this program with other state
and federal programs that distribute COVID-19 tests, masks, or respirators to the public.
new text end
Sec. 99. new text begin REPORT ON TRANSPARENCY OF HEALTH CARE PAYMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Non-claims-based payments" means payments to health care providers designed to
support and reward value of health care services over volume of health care services and
includes alternative payment models or incentives, payments for infrastructure expenditures
or investments, and payments for workforce expenditures or investments.
new text end
new text begin
(d) "Nonpublic data" has the meaning given in Minnesota Statutes, section 13.02,
subdivision 9.
new text end
new text begin
(e) "Primary care services" means integrated, accessible health care services provided
by clinicians who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with patients, and practicing in the context of
family and community. Primary care services include but are not limited to preventive
services, office visits, annual physicals, pre-operative physicals, assessments, care
coordination, development of treatment plans, management of chronic conditions, and
diagnostic tests.
new text end
new text begin Subd. 2. new text end
new text begin Report. new text end
new text begin
(a) To provide the legislature with information needed to meet the
evolving health care needs of Minnesotans, the commissioner shall report to the legislature
by February 15, 2023, on the volume and distribution of health care spending across payment
models used by health plan companies and third-party administrators, with a particular focus
on value-based care models and primary care spending.
new text end
new text begin
(b) The report must include specific health plan and third-party administrator estimates
of health care spending for claims-based payments and non-claims-based payments for the
most recent available year, reported separately for Minnesotans enrolled in state health care
programs, Medicare Advantage, and commercial health insurance. The report must also
include recommendations on changes needed to gather better data from health plan companies
and third-party administrators on the use of value-based payments that pay for value of
health care services provided over volume of services provided, promote the health of all
Minnesotans, reduce health disparities, and support the provision of primary care services
and preventive services.
new text end
new text begin
(c) In preparing the report, the commissioner shall:
new text end
new text begin
(1) describe the form, manner, and timeline for submission of data by health plan
companies and third-party administrators to produce estimates as specified in paragraph
(b);
new text end
new text begin
(2) collect summary data that permits the computation of:
new text end
new text begin
(i) the percentage of total payments that are non-claims-based payments; and
new text end
new text begin
(ii) the percentage of payments in item (i) that are for primary care services;
new text end
new text begin
(3) where data was not directly derived, specify the methods used to estimate data
elements;
new text end
new text begin
(4) notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, conduct analyses
of the magnitude of primary care payments using data collected by the commissioner under
Minnesota Statutes, section 62U.04; and
new text end
new text begin
(5) conduct interviews with health plan companies and third-party administrators to
better understand the types of non-claims-based payments and models in use, the purposes
or goals of each, the criteria for health care providers to qualify for these payments, and the
timing and structure of health plan companies or third-party administrators making these
payments to health care provider organizations.
new text end
new text begin
(d) Health plan companies and third-party administrators must comply with data requests
from the commissioner under this section within 60 days after receiving the request.
new text end
new text begin
(e) Data collected under this section are nonpublic data. Notwithstanding the definition
of summary data in Minnesota Statutes, section 13.02, subdivision 19, summary data prepared
under this section may be derived from nonpublic data. The commissioner shall establish
procedures and safeguards to protect the integrity and confidentiality of any data maintained
by the commissioner.
new text end
Sec. 100. new text begin SAFETY IMPROVEMENTS FOR STATE LICENSED LONG-TERM
CARE FACILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin
Temporary grant program for long-term care safety
improvements.
new text end
new text begin
The commissioner of health shall develop, implement, and manage a
temporary, competitive grant process for state-licensed long-term care facilities to improve
their ability to reduce the transmission of COVID-19 or other similar conditions.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Eligible facility" means:
new text end
new text begin
(1) an assisted living facility licensed under chapter 144G;
new text end
new text begin
(2) a supervised living facility licensed under chapter 144;
new text end
new text begin
(3) a boarding care facility that is not federally certified and is licensed under chapter
144; and
new text end
new text begin
(4) a nursing home that is not federally certified and is licensed under chapter 144A.
new text end
new text begin
(c) "Eligible project" means a modernization project to update, remodel, or replace
outdated equipment, systems, technology, or physical spaces.
new text end
new text begin Subd. 3. new text end
new text begin Program. new text end
new text begin
(a) The commissioner of health shall award improvement grants to
an eligible facility. An improvement grant shall not exceed $1,250,000.
new text end
new text begin
(b) Funds may be used to improve the safety, quality of care, and livability of aging
infrastructure in a Department of Health licensed eligible facility with an emphasis on
reducing the transmission risk of COVID-19 and other infections. Projects include but are
not limited to:
new text end
new text begin
(1) heating, ventilation, and air-conditioning systems improvements to reduce airborne
exposures;
new text end
new text begin
(2) physical space changes for infection control; and
new text end
new text begin
(3) technology improvements to reduce social isolation and improve resident or client
well-being.
new text end
new text begin
(c) Notwithstanding any law to the contrary, funds awarded in a grant agreement do not
lapse until expended by the grantee.
new text end
new text begin Subd. 4. new text end
new text begin Applications. new text end
new text begin
An eligible facility seeking a grant shall apply to the
commissioner. The application must include a description of the resident population
demographics, the problem the proposed project will address, a description of the project
including construction and remodeling drawings or specifications, sources of funds for the
project, including any in-kind resources, uses of funds for the project, the results expected,
and a plan to maintain or operate any facility or equipment included in the project. The
applicant must describe achievable objectives, a timetable, and roles and capabilities of
responsible individuals and organization. An applicant must submit to the commissioner
evidence that competitive bidding was used to select contractors for the project.
new text end
new text begin Subd. 5. new text end
new text begin Consideration of applications. new text end
new text begin
The commissioner shall review each application
to determine if the application is complete and if the facility and the project are eligible for
a grant. In evaluating applications, the commissioner shall develop a standardized scoring
system that assesses: (1) the applicant's understanding of the problem, description of the
project and the likelihood of a successful outcome of the project; (2) the extent to which
the project will reduce the transmission of COVID-19; (3) the extent to which the applicant
has demonstrated that it has made adequate provisions to ensure proper and efficient operation
of the facility once the project is completed; (4) and other relevant factors as determined
by the commissioner. During application review, the commissioner may request additional
information about a proposed project, including information on project cost. Failure to
provide the information requested disqualifies an applicant.
new text end
new text begin Subd. 6. new text end
new text begin Program oversight. new text end
new text begin
The commissioner shall determine the amount of a grant
to be given to an eligible facility based on the relative score of each eligible facility's
application, other relevant factors discussed during the review, and the funds available to
the commissioner. During the grant period and within one year after completion of the grant
period, the commissioner may collect from an eligible facility receiving a grant, any
information necessary to evaluate the program.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
This section expires June 30, 2025.
new text end
Sec. 101. new text begin STUDY OF THE DEVELOPMENT OF A STATEWIDE REGISTRY FOR
PROVIDER ORDERS FOR LIFE-SUSTAINING TREATMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Life-sustaining treatment" means any medical procedure, pharmaceutical drug,
medical device, or medical intervention that maintains life by sustaining, restoring, or
supplanting a vital function. Life-sustaining treatment does not include routine care necessary
to sustain patient cleanliness and comfort.
new text end
new text begin
(d) "POLST" means a provider order for life-sustaining treatment, signed by a physician,
advanced practice registered nurse, or physician assistant, to ensure that the medical treatment
preferences of a patient with an advanced serious illness who is nearing the end of life are
honored.
new text end
new text begin
(e) "POLST form" means a portable medical form used to communicate a physician's
order to help ensure that a patient's medical treatment preferences are conveyed to emergency
medical service personnel and other health care providers.
new text end
new text begin Subd. 2. new text end
new text begin Study. new text end
new text begin
(a) The commissioner, in consultation with the advisory committee
established in paragraph (c), shall study the issues related to creating a statewide registry
of POLST forms to ensure that a patient's medical treatment preferences are followed by
all health care providers. The registry must allow for the submission of completed POLST
forms and for the forms to be accessed by health care providers and emergency medical
service personnel in a timely manner, for the provision of care or services.
new text end
new text begin
(b) As a part of the study, the commissioner shall develop recommendations on the
following:
new text end
new text begin
(1) electronic capture, storage, and security of information in the registry;
new text end
new text begin
(2) procedures to protect the accuracy and confidentiality of information submitted to
the registry;
new text end
new text begin
(3) limits as to who can access the registry;
new text end
new text begin
(4) where the registry should be housed;
new text end
new text begin
(5) ongoing funding models for the registry; and
new text end
new text begin
(6) any other action needed to ensure that patients' rights are protected and that their
health care decisions are followed.
new text end
new text begin
(c) The commissioner shall create an advisory committee with members representing
physicians, physician assistants, advanced practice registered nurses, nursing homes,
emergency medical service providers, hospice and palliative care providers, the disability
community, attorneys, medical ethicists, and the religious community.
new text end
new text begin Subd. 3. new text end
new text begin Report. new text end
new text begin
The commissioner shall submit a report on the results of the study,
including recommendations on establishing a statewide registry of POLST forms, to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance by February 1, 2023.
new text end
Sec. 102. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall codify Laws 2021, First Special Session chapter 7, article
3, section 44, as Minnesota Statutes, section 144.1512. The revisor of statutes may make
any necessary cross-reference changes.
new text end
new text begin
(b) The revisor of statutes shall correct cross-references in Minnesota Statutes to conform
with the relettering of paragraphs in Minnesota Statutes, section 144.1501, subdivision 1.
new text end
new text begin
(c) In Minnesota Statutes, section 144.7055, the revisor shall renumber paragraphs (b)
to (e) alphabetically as individual subdivisions under Minnesota Statutes, section 144.7051.
The revisor shall make any necessary changes to sentence structure for this renumbering
while preserving the meaning of the text. The revisor shall also make necessary
cross-reference changes in Minnesota Statutes and Minnesota Rules consistent with the
renumbering.
new text end
new text begin
(d) The revisor of statutes shall renumber Minnesota Statutes, sections 145A.145 and
145A.17, as new sections following Minnesota Statutes, section 145.871. The revisor shall
also make necessary cross-reference changes consistent with the renumbering.
new text end
ARTICLE 2
DEPARTMENT OF HEALTH POLICY
Section 1.
Minnesota Statutes 2021 Supplement, section 144.0724, subdivision 4, is
amended to read:
Subd. 4.
Resident assessment schedule.
(a) A facility must conduct and electronically
submit to the federal database MDS assessments that conform with the assessment schedule
defined by the Long Term Care Facility Resident Assessment Instrument User's Manual,
version 3.0, or its successor issued by the Centers for Medicare and Medicaid Services. The
commissioner of health may substitute successor manuals or question and answer documents
published by the United States Department of Health and Human Services, Centers for
Medicare and Medicaid Services, to replace or supplement the current version of the manual
or document.
(b) The assessments required under the Omnibus Budget Reconciliation Act of 1987
(OBRA) used to determine a case mix classification for reimbursement include deleted text begin the followingdeleted text end :
(1) a new admission comprehensive assessment, which must have an assessment reference
date (ARD) within 14 calendar days after admission, excluding readmissions;
(2) an annual comprehensive assessment, which must have an ARD within 92 days of
a previous quarterly review assessment or a previous comprehensive assessment, which
must occur at least once every 366 days;
(3) a significant change in status comprehensive assessment, which must have an ARD
within 14 days after the facility determines, or should have determined, that there has been
a significant change in the resident's physical or mental condition, whether an improvement
or a decline, and regardless of the amount of time since the last comprehensive assessment
or quarterly review assessment;
(4) a quarterly review assessment must have an ARD within 92 days of the ARD of the
previous quarterly review assessment or a previous comprehensive assessment;
(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification;
(6) any significant correction to a prior quarterly review assessment, if the assessment
being corrected is the current one being used for RUG classification;
(7) a required significant change in status assessment when:
(i) all speech, occupational, and physical therapies have ended. new text begin If the most recent OBRA
comprehensive or quarterly assessment completed does not result in a rehabilitation case
mix classification, then the significant change in status assessment is not required. new text end The ARD
of this assessment must be set on day eight after all therapy services have ended; and
(ii) isolation for an infectious disease has ended. new text begin If isolation was not coded on the most
recent OBRA comprehensive or quarterly assessment completed, then the significant change
in status assessment is not required. new text end The ARD of this assessment must be set on day 15 after
isolation has ended; and
(8) any modifications to the most recent assessments under clauses (1) to (7).
(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and
(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.
Sec. 2.
Minnesota Statutes 2020, section 144.1201, subdivision 2, is amended to read:
Subd. 2.
deleted text begin By-product nucleardeleted text end new text begin Byproductnew text end material.
"deleted text begin By-product nucleardeleted text end new text begin Byproductnew text end
material" means deleted text begin a radioactive material, other than special nuclear material, yielded in or
made radioactive by exposure to radiation created incident to the process of producing or
utilizing special nuclear material.deleted text end new text begin :
new text end
new text begin
(1) any radioactive material, except special nuclear material, yielded in or made
radioactive by exposure to the radiation incident to the process of producing or using special
nuclear material;
new text end
new text begin
(2) the tailings or wastes produced by the extraction or concentration of uranium or
thorium from ore processed primarily for its source material content, including discrete
surface wastes resulting from uranium solution extraction processes. Underground ore
bodies depleted by these solution extraction operations do not constitute byproduct material
within this definition;
new text end
new text begin
(3) any discrete source of radium-226 that is produced, extracted, or converted after
extraction for commercial, medical, or research activity, or any material that:
new text end
new text begin
(i) has been made radioactive by use of a particle accelerator; and
new text end
new text begin
(ii) is produced, extracted, or converted after extraction for commercial, medical, or
research activity; and
new text end
new text begin
(4) any discrete source of naturally occurring radioactive material, other than source
nuclear material, that:
new text end
new text begin
(i) the United States Nuclear Regulatory Commission, in consultation with the
Administrator of the Environmental Protection Agency, the Secretary of Energy, the Secretary
of Homeland Security, and the head of any other appropriate federal agency determines
would pose a threat similar to the threat posed by a discrete source of radium-226 to the
public health and safety or the common defense and security; and
new text end
new text begin
(ii) is extracted or converted after extraction for use in a commercial, medical, or research
activity.
new text end
Sec. 3.
Minnesota Statutes 2020, section 144.1201, subdivision 4, is amended to read:
Subd. 4.
Radioactive material.
"Radioactive material" means a matter that emits
radiation. Radioactive material includes special nuclear material, source nuclear material,
and deleted text begin by-product nucleardeleted text end new text begin byproductnew text end material.
Sec. 4.
Minnesota Statutes 2021 Supplement, section 144.1481, subdivision 1, is amended
to read:
Subdivision 1.
Establishment; membership.
The commissioner of health shall establish
a deleted text begin 16-memberdeleted text end new text begin 21-membernew text end Rural Health Advisory Committee. The committee shall consist
of the following members, all of whom must reside outside the seven-county metropolitan
area, as defined in section 473.121, subdivision 2:
(1) two members from the house of representatives of the state of Minnesota, one from
the majority party and one from the minority party;
(2) two members from the senate of the state of Minnesota, one from the majority party
and one from the minority party;
(3) a volunteer member of an ambulance service based outside the seven-county
metropolitan area;
(4) a representative of a hospital located outside the seven-county metropolitan area;
(5) a representative of a nursing home located outside the seven-county metropolitan
area;
(6) a medical doctor or doctor of osteopathic medicine licensed under chapter 147;
(7) a dentist licensed under chapter 150A;
(8) deleted text begin a midlevel practitionerdeleted text end new text begin an advanced practice providernew text end ;
(9) a registered nurse or licensed practical nurse;
(10) a licensed health care professional from an occupation not otherwise represented
on the committee;
(11) a representative of an institution of higher education located outside the seven-county
metropolitan area that provides training for rural health care providers; deleted text begin and
deleted text end
new text begin
(12) a member of a Tribal nation;
new text end
new text begin
(13) a representative of a local public health agency or community health board;
new text end
new text begin
(14) a health professional or advocate with experience working with people with mental
illness;
new text end
new text begin
(15) a representative of a community organization that works with individuals
experiencing health disparities;
new text end
new text begin
(16) an individual with expertise in economic development, or an employer working
outside the seven-county metropolitan area; and
new text end
deleted text begin (12)deleted text end new text begin (17)new text end three consumers, at least one of whom must be deleted text begin an advocate for persons who
are mentally ill or developmentally disableddeleted text end new text begin from a community experiencing health
disparitiesnew text end .
The commissioner will make recommendations for committee membership. Committee
members will be appointed by the governor. In making appointments, the governor shall
ensure that appointments provide geographic balance among those areas of the state outside
the seven-county metropolitan area. The chair of the committee shall be elected by the
members. The advisory committee is governed by section 15.059, except that the members
do not receive per diem compensation.
Sec. 5.
Minnesota Statutes 2020, section 144.1503, is amended to read:
144.1503 HOME AND COMMUNITY-BASED SERVICES EMPLOYEE
SCHOLARSHIP new text begin AND LOAN FORGIVENESS new text end PROGRAM.
Subdivision 1.
Creation.
The home and community-based services employee scholarship
new text begin and loan forgiveness new text end grant program is established deleted text begin for the purpose of assistingdeleted text end new text begin to assistnew text end
qualified provider applicants deleted text begin to funddeleted text end new text begin in fundingnew text end employee scholarships new text begin and qualified
educational loan repayments new text end for educationnew text begin , training, field experience, and examinationsnew text end in
nursing deleted text begin anddeleted text end new text begin ,new text end other health care fieldsnew text begin , and licensure as an assisted living director under section
144A.20, subdivision 4new text end .
new text begin Subd. 1a. new text end
new text begin Definition. new text end
new text begin
For purposes of this section, "qualified educational loan" means
a government, commercial, or foundation loan secured by an employee of a qualifying
provider for actual costs paid for tuition, training, and examinations; reasonable education,
training, and field experience expenses; and reasonable living expenses related to the
employee's graduate or undergraduate education.
new text end
Subd. 2.
Provision of grants.
The commissioner shall make grants available to qualified
providers of older adult services. Grants must be used by home and community-based service
providers to recruit and train staff through the establishment of an employee scholarship
new text begin and loan forgiveness new text end fund.
Subd. 3.
Eligibility.
(a) Eligible providers must primarily provide services to individuals
who are 65 years of age and older in home and community-based settings, including housing
with services establishments as defined in section 144D.01, subdivision 4; new text begin assisted living
facilities as defined in section 144G.08, subdivision 7; new text end adult day care as defined in section
245A.02, subdivision 2a; and home care services as defined in section 144A.43, subdivision
3.
(b) Qualifying providers must establish a home and community-based services employee
scholarship new text begin and loan forgiveness new text end program, as specified in subdivision 4. Providers that
receive funding under this section must use the funds to award scholarships tonew text begin , and to repay
qualified educational loans of,new text end employees who work an average of at least 16 hours per
week for the provider.
Subd. 4.
Home and community-based services employee scholarship new text begin and loan
forgiveness new text end program.
Each qualifying provider under this section must propose a home
and community-based services employee scholarship new text begin and loan forgiveness new text end program. Providers
must establish criteria by which funds are to be distributed among employees. At a minimum,
the scholarship new text begin and loan forgiveness new text end program must cover employee costsnew text begin and repay qualified
educational loans of employeesnew text end related to a course of study that is expected to lead to career
advancement with the provider or in the field of long-term care, including home care, care
of persons with disabilities, deleted text begin ordeleted text end nursingnew text begin , or management as a licensed assisted living directornew text end .
Subd. 5.
Participating providers.
The commissioner shall publish a request for proposals
in the State Register, specifying provider eligibility requirements, criteria for a qualifying
employee scholarship new text begin and loan forgiveness new text end program, provider selection criteria,
documentation required for program participation, maximum award amount, and methods
of evaluation. The commissioner must publish additional requests for proposals each year
in which funding is available for this purpose.
Subd. 6.
Application requirements.
Eligible providers seeking a grant shall submit an
application to the commissioner. Applications must contain a complete description of the
employee scholarship new text begin and loan forgiveness new text end program being proposed by the applicant,
including the need for the organization to enhance the education of its workforce, the process
for determining which employees will be eligible for scholarshipsnew text begin or loan repaymentnew text end , any
other sources of funding for scholarshipsnew text begin or loan repaymentnew text end , the expected degrees or
credentials eligible for scholarshipsnew text begin or loan repaymentnew text end , the amount of funding sought for
the scholarship new text begin and loan forgiveness new text end program, a proposed budget detailing how funds will
be spent, and plans for retaining eligible employees after completion of their scholarshipnew text begin
or repayment of their loannew text end .
Subd. 7.
Selection process.
The commissioner shall determine a maximum award for
grants and make grant selections based on the information provided in the grant application,
including the demonstrated need for an applicant provider to enhance the education of its
workforce, the proposed employee scholarship new text begin and loan forgiveness new text end selection process, the
applicant's proposed budget, and other criteria as determined by the commissioner.
Notwithstanding any law or rule to the contrary, funds awarded to grantees in a grant
agreement do not lapse until the grant agreement expires.
Subd. 8.
Reporting requirements.
Participating providers shall submit an invoice for
reimbursement and a report to the commissioner on a schedule determined by the
commissioner and on a form supplied by the commissioner. The report shall include the
amount spent on scholarshipsnew text begin and loan repaymentnew text end ; the number of employees who received
scholarshipsnew text begin and the number of employees for whom loans were repaidnew text end ; and, for each
scholarship new text begin or loan forgiveness new text end recipient, the name of the recipient, the current position of
the recipient, the amount awardednew text begin or loan amount repaidnew text end , the educational institution attended,
the nature of the educational program, and the expected or actual program completion date.
During the grant period, the commissioner may require and collect from grant recipients
other information necessary to evaluate the program.
Sec. 6.
Minnesota Statutes 2020, section 144.1911, subdivision 4, is amended to read:
Subd. 4.
Career guidance and support services.
deleted text begin (a)deleted text end The commissioner shall award
grants to eligible nonprofit organizations new text begin and eligible postsecondary educational institutions,
including the University of Minnesota, new text end to provide career guidance and support services to
immigrant international medical graduates seeking to enter the Minnesota health workforce.
Eligible grant activities include the following:
(1) educational and career navigation, including information on training and licensing
requirements for physician and nonphysician health care professions, and guidance in
determining which pathway is best suited for an individual international medical graduate
based on the graduate's skills, experience, resources, and interests;
(2) support in becoming proficient in medical English;
(3) support in becoming proficient in the use of information technology, including
computer skills and use of electronic health record technology;
(4) support for increasing knowledge of and familiarity with the United States health
care system;
(5) support for other foundational skills identified by the commissioner;
(6) support for immigrant international medical graduates in becoming certified by the
Educational Commission on Foreign Medical Graduates, including help with preparation
for required licensing examinations and financial assistance for fees; and
(7) assistance to international medical graduates in registering with the program's
Minnesota international medical graduate roster.
deleted text begin
(b) The commissioner shall award the initial grants under this subdivision by December
31, 2015.
deleted text end
Sec. 7.
Minnesota Statutes 2020, section 144.292, subdivision 6, is amended to read:
Subd. 6.
Cost.
(a) When a patient requests a copy of the patient's record for purposes of
reviewing current medical care, the provider must not charge a fee.
(b) When a provider or its representative makes copies of patient records upon a patient's
request under this section, the provider or its representative may charge the patient or the
patient's representative no more than 75 cents per page, plus $10 for time spent retrieving
and copying the records, unless other law or a rule or contract provide for a lower maximum
charge. This limitation does not apply to x-rays. The provider may charge a patient no more
than the actual cost of reproducing x-rays, plus no more than $10 for the time spent retrieving
and copying the x-rays.
(c) The respective maximum charges of 75 cents per page and $10 for time provided in
this subdivision are in effect for calendar year 1992 and may be adjusted annually each
calendar year as provided in this subdivision. The permissible maximum charges shall
change each year by an amount that reflects the change, as compared to the previous year,
in the Consumer Price Index for all Urban Consumers, Minneapolis-St. Paul (CPI-U),
published by the Department of Labor.
(d) A provider or its representative may charge the $10 retrieval fee, but must not charge
a per page fee to provide copies of records requested by a patient or the patient's authorized
representative if the request for copies of records is for purposes of appealing a denial of
Social Security disability income or Social Security disability benefits under title II or title
XVI of the Social Security Act; except that no fee shall be charged to a deleted text begin persondeleted text end new text begin patientnew text end who
is receiving public assistance, new text begin or to a patient new text end who is represented by an attorney on behalf
of a civil legal services program or a volunteer attorney program based on indigency. For
the purpose of further appeals, a patient may receive no more than two medical record
updates without charge, but only for medical record information previously not provided.
For purposes of this paragraph, a patient's authorized representative does not include units
of state government engaged in the adjudication of Social Security disability claims.
Sec. 8.
Minnesota Statutes 2020, section 144.497, is amended to read:
144.497 ST ELEVATION MYOCARDIAL INFARCTION.
The commissioner of health shall assess deleted text begin and report ondeleted text end the quality of care provided in
the state for ST elevation myocardial infarction response and treatment. The commissioner
shall:
(1) utilize and analyze data provided by ST elevation myocardial infarction receiving
centers to the ACTION Registry-Get with the guidelines or an equivalent data platform that
does not identify individuals or associate specific ST elevation myocardial infarction heart
attack events with an identifiable individual;new text begin and
new text end
deleted text begin
(2) quarterly post a summary report of the data in aggregate form on the Department of
Health website;
deleted text end
deleted text begin
(3) annually inform the legislative committees with jurisdiction over public health of
progress toward improving the quality of care and patient outcomes for ST elevation
myocardial infarctions; and
deleted text end
deleted text begin (4)deleted text end new text begin (2)new text end coordinate to the extent possible with national voluntary health organizations
involved in ST elevation myocardial infarction heart attack quality improvement to encourage
ST elevation myocardial infarction receiving centers to report data consistent with nationally
recognized guidelines on the treatment of individuals with confirmed ST elevation myocardial
infarction heart attacks within the state and encourage sharing of information among health
care providers on ways to improve the quality of care of ST elevation myocardial infarction
patients in Minnesota.
Sec. 9.
Minnesota Statutes 2021 Supplement, section 144.551, subdivision 1, is amended
to read:
Subdivision 1.
Restricted construction or modification.
(a) The following construction
or modification may not be commenced:
(1) any erection, building, alteration, reconstruction, modernization, improvement,
extension, lease, or other acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one physical facility, complex, or site
to another, or otherwise results in an increase or redistribution of hospital beds within the
state; and
(2) the establishment of a new hospital.
(b) This section does not apply to:
(1) construction or relocation within a county by a hospital, clinic, or other health care
facility that is a national referral center engaged in substantial programs of patient care,
medical research, and medical education meeting state and national needs that receives more
than 40 percent of its patients from outside the state of Minnesota;
(2) a project for construction or modification for which a health care facility held an
approved certificate of need on May 1, 1984, regardless of the date of expiration of the
certificate;
(3) a project for which a certificate of need was denied before July 1, 1990, if a timely
appeal results in an order reversing the denial;
(4) a project exempted from certificate of need requirements by Laws 1981, chapter 200,
section 2;
(5) a project involving consolidation of pediatric specialty hospital services within the
Minneapolis-St. Paul metropolitan area that would not result in a net increase in the number
of pediatric specialty hospital beds among the hospitals being consolidated;
(6) a project involving the temporary relocation of pediatric-orthopedic hospital beds to
an existing licensed hospital that will allow for the reconstruction of a new philanthropic,
pediatric-orthopedic hospital on an existing site and that will not result in a net increase in
the number of hospital beds. Upon completion of the reconstruction, the licenses of both
hospitals must be reinstated at the capacity that existed on each site before the relocation;
(7) the relocation or redistribution of hospital beds within a hospital building or
identifiable complex of buildings provided the relocation or redistribution does not result
in: (i) an increase in the overall bed capacity at that site; (ii) relocation of hospital beds from
one physical site or complex to another; or (iii) redistribution of hospital beds within the
state or a region of the state;
(8) relocation or redistribution of hospital beds within a hospital corporate system that
involves the transfer of beds from a closed facility site or complex to an existing site or
complex provided that: (i) no more than 50 percent of the capacity of the closed facility is
transferred; (ii) the capacity of the site or complex to which the beds are transferred does
not increase by more than 50 percent; (iii) the beds are not transferred outside of a federal
health systems agency boundary in place on July 1, 1983; (iv) the relocation or redistribution
does not involve the construction of a new hospital building; and (v) the transferred beds
are used first to replace within the hospital corporate system the total number of beds
previously used in the closed facility site or complex for mental health services and substance
use disorder services. Only after the hospital corporate system has fulfilled the requirements
of this item may the remainder of the available capacity of the closed facility site or complex
be transferred for any other purpose;
(9) a construction project involving up to 35 new beds in a psychiatric hospital in Rice
County that primarily serves adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;
(10) a project to replace a hospital or hospitals with a combined licensed capacity of
130 beds or less if: (i) the new hospital site is located within five miles of the current site;
and (ii) the total licensed capacity of the replacement hospital, either at the time of
construction of the initial building or as the result of future expansion, will not exceed 70
licensed hospital beds, or the combined licensed capacity of the hospitals, whichever is less;
(11) the relocation of licensed hospital beds from an existing state facility operated by
the commissioner of human services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one regional treatment center site
to another; or from one building or site to a new or existing building or site on the same
campus;
(12) the construction or relocation of hospital beds operated by a hospital having a
statutory obligation to provide hospital and medical services for the indigent that does not
result in a net increase in the number of hospital beds, notwithstanding section 144.552, 27
beds, of which 12 serve mental health needs, may be transferred from Hennepin County
Medical Center to Regions Hospital under this clause;
(13) a construction project involving the addition of up to 31 new beds in an existing
nonfederal hospital in Beltrami County;
(14) a construction project involving the addition of up to eight new beds in an existing
nonfederal hospital in Otter Tail County with 100 licensed acute care beds;
(15) a construction project involving the addition of 20 new hospital beds in an existing
hospital in Carver County serving the southwest suburban metropolitan area;
(16) a project for the construction or relocation of up to 20 hospital beds for the operation
of up to two psychiatric facilities or units for children provided that the operation of the
facilities or units have received the approval of the commissioner of human services;
(17) a project involving the addition of 14 new hospital beds to be used for rehabilitation
services in an existing hospital in Itasca County;
(18) a project to add 20 licensed beds in existing space at a hospital in Hennepin County
that closed 20 rehabilitation beds in 2002, provided that the beds are used only for
rehabilitation in the hospital's current rehabilitation building. If the beds are used for another
purpose or moved to another location, the hospital's licensed capacity is reduced by 20 beds;
(19) a critical access hospital established under section 144.1483, clause (9), and section
1820 of the federal Social Security Act, United States Code, title 42, section 1395i-4, that
delicensed beds since enactment of the Balanced Budget Act of 1997, Public Law 105-33,
to the extent that the critical access hospital does not seek to exceed the maximum number
of beds permitted such hospital under federal law;
(20) notwithstanding section 144.552, a project for the construction of a new hospital
in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:
(i) the project, including each hospital or health system that will own or control the entity
that will hold the new hospital license, is approved by a resolution of the Maple Grove City
Council as of March 1, 2006;
(ii) the entity that will hold the new hospital license will be owned or controlled by one
or more not-for-profit hospitals or health systems that have previously submitted a plan or
plans for a project in Maple Grove as required under section 144.552, and the plan or plans
have been found to be in the public interest by the commissioner of health as of April 1,
2005;
(iii) the new hospital's initial inpatient services must include, but are not limited to,
medical and surgical services, obstetrical and gynecological services, intensive care services,
orthopedic services, pediatric services, noninvasive cardiac diagnostics, behavioral health
services, and emergency room services;
(iv) the new hospital:
(A) will have the ability to provide and staff sufficient new beds to meet the growing
needs of the Maple Grove service area and the surrounding communities currently being
served by the hospital or health system that will own or control the entity that will hold the
new hospital license;
(B) will provide uncompensated care;
(C) will provide mental health services, including inpatient beds;
(D) will be a site for workforce development for a broad spectrum of health-care-related
occupations and have a commitment to providing clinical training programs for physicians
and other health care providers;
(E) will demonstrate a commitment to quality care and patient safety;
(F) will have an electronic medical records system, including physician order entry;
(G) will provide a broad range of senior services;
(H) will provide emergency medical services that will coordinate care with regional
providers of trauma services and licensed emergency ambulance services in order to enhance
the continuity of care for emergency medical patients; and
(I) will be completed by December 31, 2009, unless delayed by circumstances beyond
the control of the entity holding the new hospital license; and
(v) as of 30 days following submission of a written plan, the commissioner of health
has not determined that the hospitals or health systems that will own or control the entity
that will hold the new hospital license are unable to meet the criteria of this clause;
(21) a project approved under section 144.553;
(22) a project for the construction of a hospital with up to 25 beds in Cass County within
a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's license holder
is approved by the Cass County Board;
(23) a project for an acute care hospital in Fergus Falls that will increase the bed capacity
from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16 and closing
a separately licensed 13-bed skilled nursing facility;
(24) notwithstanding section 144.552, a project for the construction and expansion of a
specialty psychiatric hospital in Hennepin County for up to 50 beds, exclusively for patients
who are under 21 years of age on the date of admission. The commissioner conducted a
public interest review of the mental health needs of Minnesota and the Twin Cities
metropolitan area in 2008. No further public interest review shall be conducted for the
construction or expansion project under this clause;
(25) a project for a 16-bed psychiatric hospital in the city of Thief River Falls, if the
commissioner finds the project is in the public interest after the public interest review
conducted under section 144.552 is complete;
(26)(i) a project for a 20-bed psychiatric hospital, within an existing facility in the city
of Maple Grove, exclusively for patients who are under 21 years of age on the date of
admission, if the commissioner finds the project is in the public interest after the public
interest review conducted under section 144.552 is complete;
(ii) this project shall serve patients in the continuing care benefit program under section
256.9693. The project may also serve patients not in the continuing care benefit program;
and
(iii) if the project ceases to participate in the continuing care benefit program, the
commissioner must complete a subsequent public interest review under section 144.552. If
the project is found not to be in the public interest, the license must be terminated six months
from the date of that finding. If the commissioner of human services terminates the contract
without cause or reduces per diem payment rates for patients under the continuing care
benefit program below the rates in effect for services provided on December 31, 2015, the
project may cease to participate in the continuing care benefit program and continue to
operate without a subsequent public interest review;
(27) a project involving the addition of 21 new beds in an existing psychiatric hospital
in Hennepin County that is exclusively for patients who are under 21 years of age on the
date of admission;
(28) a project to add 55 licensed beds in an existing safety net, level I trauma center
hospital in Ramsey County as designated under section 383A.91, subdivision 5, of which
15 beds are to be used for inpatient mental health and 40 are to be used for other services.
In addition, five unlicensed observation mental health beds shall be added;
(29) upon submission of a plan to the commissioner for public interest review under
section 144.552 and the addition of the 15 inpatient mental health beds specified in clause
(28), to its bed capacity, a project to add 45 licensed beds in an existing safety net, level I
trauma center hospital in Ramsey County as designated under section 383A.91, subdivision
5. Five of the 45 additional beds authorized under this clause must be designated for use
for inpatient mental health and must be added to the hospital's bed capacity before the
remaining 40 beds are added. Notwithstanding section 144.552, the hospital may add licensed
beds under this clause prior to completion of the public interest review, provided the hospital
submits its plan by the 2021 deadline and adheres to the timelines for the public interest
review described in section 144.552; deleted text begin or
deleted text end
(30) upon submission of a plan to the commissioner for public interest review under
section 144.552, a project to add up to 30 licensed beds in an existing psychiatric hospital
in Hennepin County that exclusively provides care to patients who are under 21 years of
age on the date of admission. Notwithstanding section 144.552, the psychiatric hospital
may add licensed beds under this clause prior to completion of the public interest review,
provided the hospital submits its plan by the 2021 deadline and adheres to the timelines for
the public interest review described in section 144.552deleted text begin .deleted text end new text begin ;
new text end
new text begin
(31) a project to add licensed beds in a hospital in Cook County that: (i) is designated
as a critical access hospital under section 144.1483, clause (9), and United States Code, title
42, section 1395i-4; (ii) has a licensed bed capacity of fewer than 25 beds; and (iii) has an
attached nursing home, so long as the total number of licensed beds in the hospital after the
bed addition does not exceed 25 beds; or
new text end
new text begin
(32) upon submission of a plan to the commissioner for public interest review under
section 144.552, a project to add 22 licensed beds at a Minnesota freestanding children's
hospital in St. Paul that is part of an independent pediatric health system with freestanding
inpatient hospitals located in Minneapolis and St. Paul. The beds shall be utilized for pediatric
inpatient behavioral health services. Notwithstanding section 144.552, the hospital may add
licensed beds under this clause prior to completion of the public interest review, provided
the hospital submits its plan by the 2022 deadline and adheres to the timelines for the public
interest review described in section 144.552.
new text end
Sec. 10.
Minnesota Statutes 2020, section 144.565, subdivision 4, is amended to read:
Subd. 4.
Definitions.
(a) For purposes of this section, the following terms have the
meanings givendeleted text begin :deleted text end new text begin .
new text end
(b) "Diagnostic imaging facility" means a health care facility that is not a hospital or
location licensed as a hospital which offers diagnostic imaging services in Minnesota,
regardless of whether the equipment used to provide the service is owned or leased. For the
purposes of this section, diagnostic imaging facility includes, but is not limited to, facilities
such as a physician's office, clinic, mobile transport vehicle, outpatient imaging center, or
surgical center.new text begin A dental clinic or office is not considered a diagnostic imaging facility for
the purpose of this section when the clinic or office performs diagnostic imaging through
dental cone beam computerized tomography.
new text end
(c) "Diagnostic imaging service" means the use of ionizing radiation or other imaging
technique on a human patient includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end magnetic resonance imaging
(MRI) or computerized tomography (CT)new text begin other than dental cone beam computerized
tomographynew text end , positron emission tomography (PET), or single photon emission computerized
tomography (SPECT) scans using fixed, portable, or mobile equipment.
(d) "Financial or economic interest" means a direct or indirect:
(1) equity or debt security issued by an entity, including, but not limited to, shares of
stock in a corporation, membership in a limited liability company, beneficial interest in a
trust, units or other interests in a partnership, bonds, debentures, notes or other equity
interests or debt instruments, or any contractual arrangements;
(2) membership, proprietary interest, or co-ownership with an individual, group, or
organization to which patients, clients, or customers are referred to; or
(3) employer-employee or independent contractor relationship, including, but not limited
to, those that may occur in a limited partnership, profit-sharing arrangement, or other similar
arrangement with any facility to which patients are referred, including any compensation
between a facility and a health care provider, the group practice of which the provider is a
member or employee or a related party with respect to any of them.
(e) "Fixed equipment" means a stationary diagnostic imaging machine installed in a
permanent location.
(f) "Mobile equipment" means a diagnostic imaging machine in a self-contained transport
vehicle designed to be brought to a temporary offsite location to perform diagnostic imaging
services.
(g) "Portable equipment" means a diagnostic imaging machine designed to be temporarily
transported within a permanent location to perform diagnostic imaging services.
(h) "Provider of diagnostic imaging services" means a diagnostic imaging facility or an
entity that offers and bills for diagnostic imaging services at a facility owned or leased by
the entity.
Sec. 11.
Minnesota Statutes 2020, section 144.586, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Screening for eligibility for health coverage or assistance. new text end
new text begin
(a) A hospital
must screen a patient who is uninsured or whose insurance coverage status is not known by
the hospital, for eligibility for charity care from the hospital, eligibility for state or federal
public health care programs using presumptive eligibility or another similar process, and
eligibility for a premium tax credit. The hospital must attempt to complete this screening
process in person or by telephone within 30 days after the patient's admission to the hospital.
new text end
new text begin
(b) If the patient is eligible for charity care from the hospital, the hospital must assist
the patient in applying for charity care and must refer the patient to the appropriate
department in the hospital for follow-up.
new text end
new text begin
(c) If the patient is presumptively eligible for a public health care program, the hospital
must assist the patient in completing an insurance affordability program application, help
schedule an appointment for the patient with a navigator organization, or provide the patient
with contact information for navigator services. If the patient is eligible for a premium tax
credit, the hospital may schedule an appointment for the patient with a navigator organization
or provide the patient with contact information for navigator services.
new text end
new text begin
(d) A patient may decline to participate in the screening process, to apply for charity
care, to complete an insurance affordability program application, to schedule an appointment
with a navigator organization, or to accept information about navigator services.
new text end
new text begin
(e) For purposes of this subdivision:
new text end
new text begin
(1) "hospital" means a private, nonprofit, or municipal hospital licensed under sections
144.50 to 144.56;
new text end
new text begin
(2) "navigator" has the meaning given in section 62V.02, subdivision 9;
new text end
new text begin
(3) "premium tax credit" means a tax credit or premium subsidy under the federal Patient
Protection and Affordable Care Act, Public Law 111-148, as amended, including the federal
Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any
amendments to and federal guidance and regulations issued under these acts; and
new text end
new text begin
(4) "presumptive eligibility" has the meaning given in section 256B.057, subdivision
12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective November 1, 2022.
new text end
Sec. 12.
Minnesota Statutes 2020, section 144.6502, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Commissioner" means the commissioner of health.
(c) "Department" means the Department of Health.
(d) "Electronic monitoring" means the placement and use of an electronic monitoring
device deleted text begin by a residentdeleted text end in the resident's room or private living unit in accordance with this
section.
(e) "Electronic monitoring device" means a camera or other device that captures, records,
or broadcasts audio, video, or both, that is placed in a resident's room or private living unit
and is used to monitor the resident or activities in the room or private living unit.
(f) "Facility" means a facility that is:
(1) licensed as a nursing home under chapter 144A;
(2) licensed as a boarding care home under sections 144.50 to 144.56;
(3) until August 1, 2021, a housing with services establishment registered under chapter
144D that is either subject to chapter 144G or has a disclosed special unit under section
325F.72; or
(4) on or after August 1, 2021, an assisted living facility.
(g) "Resident" means a person 18 years of age or older residing in a facility.
(h) "Resident representative" means one of the following in the order of priority listed,
to the extent the person may reasonably be identified and located:
(1) a court-appointed guardian;
(2) a health care agent as defined in section 145C.01, subdivision 2; or
(3) a person who is not an agent of a facility or of a home care provider designated in
writing by the resident and maintained in the resident's records on file with the facility.
Sec. 13.
Minnesota Statutes 2020, section 144.651, is amended by adding a subdivision
to read:
new text begin Subd. 10a. new text end
new text begin Designated support person for pregnant patient. new text end
new text begin
(a) A health care provider
and a health care facility must allow, at a minimum, one designated support person of a
pregnant patient's choosing to be physically present while the patient is receiving health
care services including during a hospital stay.
new text end
new text begin
(b) For purposes of this subdivision, "designated support person" means any person
necessary to provide comfort to the patient including but not limited to the patient's spouse,
partner, family member, or another person related by affinity. Certified doulas and traditional
midwives may not be counted toward the limit of one designated support person.
new text end
Sec. 14.
Minnesota Statutes 2020, section 144.69, is amended to read:
144.69 CLASSIFICATION OF DATA ON INDIVIDUALS.
new text begin Subdivision 1. new text end
new text begin Data collected by the cancer reporting system. new text end
Notwithstanding any
law to the contrary, including section 13.05, subdivision 9, data collected on individuals by
the cancer deleted text begin surveillancedeleted text end new text begin reportingnew text end system, including the names and personal identifiers of
persons required in section 144.68 to report, shall be private and may only be used for the
purposes set forth in this section and sections 144.671, 144.672, and 144.68. Any disclosure
other than is provided for in this section and sections 144.671, 144.672, and 144.68, is
declared to be a misdemeanor and punishable as such. Except as provided by rule, and as
part of an epidemiologic investigation, an officer or employee of the commissioner of health
may interview patients named in any such report, or relatives of any such patient, only after
deleted text begin the consent ofdeleted text end new text begin notifyingnew text end the attending physician, advanced practice registered nurse, or
surgeon deleted text begin is obtaineddeleted text end .
new text begin Subd. 2. new text end
new text begin
Transfers of information to non-Minnesota state and federal government
agencies.
new text end
new text begin
(a) Information containing personal identifiers collected by the cancer reporting
system may be provided to the statewide cancer registry of other states solely for the purposes
consistent with this section and sections 144.671, 144.672, and 144.68, provided that the
other state agrees to maintain the classification of the information as provided under
subdivision 1.
new text end
new text begin
(b) Information, excluding direct identifiers such as name, Social Security number,
telephone number, and street address, collected by the cancer reporting system may be
provided to the Centers for Disease Control and Prevention's National Program of Cancer
Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results
Program registry.
new text end
Sec. 15.
Minnesota Statutes 2021 Supplement, section 144.9501, subdivision 17, is amended
to read:
Subd. 17.
Lead hazard reduction.
new text begin (a) new text end "Lead hazard reduction" means abatementnew text begin , swab
team services,new text end or interim controls undertaken to make a residence, child care facility, school,
playground, or other location where lead hazards are identified lead-safe by complying with
the lead standards and methods adopted under section 144.9508.
new text begin
(b) Lead hazard reduction does not include renovation activity that is primarily intended
to remodel, repair, or restore a given structure or dwelling rather than abate or control
lead-based paint hazards.
new text end
new text begin
(c) Lead hazard reduction does not include activities that disturb painted surfaces that
total:
new text end
new text begin
(1) less than 20 square feet (two square meters) on exterior surfaces; or
new text end
new text begin
(2) less than two square feet (0.2 square meters) in an interior room.
new text end
Sec. 16.
Minnesota Statutes 2020, section 144.9501, subdivision 26a, is amended to read:
Subd. 26a.
Regulated lead work.
deleted text begin (a)deleted text end "Regulated lead work" means:
(1) abatement;
(2) interim controls;
(3) a clearance inspection;
(4) a lead hazard screen;
(5) a lead inspection;
(6) a lead risk assessment;
(7) lead project designer services;
(8) lead sampling technician services;
(9) swab team services;
(10) renovation activities; deleted text begin or
deleted text end
new text begin
(11) lead hazard reduction; or
new text end
deleted text begin (11)deleted text end new text begin (12)new text end activities performed to comply with lead orders issued by deleted text begin a community health
boarddeleted text end new text begin an assessing agencynew text end .
deleted text begin
(b) Regulated lead work does not include abatement, interim controls, swab team services,
or renovation activities that disturb painted surfaces that total no more than:
deleted text end
deleted text begin
(1) 20 square feet (two square meters) on exterior surfaces; or
deleted text end
deleted text begin
(2) six square feet (0.6 square meters) in an interior room.
deleted text end
Sec. 17.
Minnesota Statutes 2020, section 144.9501, subdivision 26b, is amended to read:
Subd. 26b.
Renovation.
new text begin (a) new text end "Renovation" means the modification of any pre-1978
affected property new text begin for compensation new text end that results in the disturbance of known or presumed
lead-containing painted surfaces defined under section 144.9508, unless that activity is
performed as lead hazard reduction. A renovation performed for the purpose of converting
a building or part of a building into an affected property is a renovation under this
subdivision.
new text begin
(b) Renovation does not include activities that disturb painted surfaces that total:
new text end
new text begin
(1) less than 20 square feet (two square meters) on exterior surfaces; or
new text end
new text begin
(2) less than six square feet (0.6 square meters) in an interior room.
new text end
Sec. 18.
Minnesota Statutes 2020, section 144.9505, subdivision 1, is amended to read:
Subdivision 1.
Licensing, certification, and permitting.
(a) Fees collected under this
section shall be deposited into the state treasury and credited to the state government special
revenue fund.
(b) Persons shall not advertise or otherwise present themselves as lead supervisors, lead
workers, lead inspectors, lead risk assessors, lead sampling technicians, lead project designers,
renovation firms, or lead firms unless they have licenses or certificates issued by the
commissioner under this section.
(c) The fees required in this section for inspectors, risk assessors, and certified lead firms
are waived for state or local government employees performing services for or as an assessing
agency.
(d) An individual who is the owner of property on which deleted text begin regulated lead workdeleted text end new text begin lead hazard
reductionnew text end is to be performed or an adult individual who is related to the property owner, as
defined under section 245A.02, subdivision 13, is exempt from the requirements to obtain
a license and pay a fee according to this section.
(e) A person that employs individuals to perform deleted text begin regulated lead workdeleted text end new text begin lead hazard
reduction, clearance inspections, lead risk assessments, lead inspections, lead hazard screens,
lead project designer services, lead sampling technician services, and swab team servicesnew text end
outside of the person's property must obtain certification as a certified lead firm. An
individual who performs lead hazard reduction, lead hazard screens, lead inspections, lead
risk assessments, clearance inspections, lead project designer services, lead sampling
technician services, swab team services, and activities performed to comply with lead orders
must be employed by a certified lead firm, unless the individual is a sole proprietor and
does not employ any other individualsdeleted text begin ,deleted text end new text begin ;new text end the individual is employed by a person that does
not perform deleted text begin regulated lead workdeleted text end new text begin lead hazard reduction, clearance inspections, lead risk
assessments, lead inspections, lead hazard screens, lead project designer services, lead
sampling technician services, and swab team servicesnew text end outside of the person's propertydeleted text begin ,deleted text end new text begin ;new text end or
the individual is employed by an assessing agency.
Sec. 19.
Minnesota Statutes 2020, section 144.9505, subdivision 1h, is amended to read:
Subd. 1h.
Certified renovation firm.
A person who deleted text begin employs individuals to performdeleted text end new text begin
performsnew text end renovation activities deleted text begin outside of the person's propertydeleted text end must obtain certification as
a renovation firm. The certificate must be in writing, contain an expiration date, be signed
by the commissioner, and give the name and address of the person to whom it is issued. A
renovation firm certificate is valid for two years. The certification fee is $100, is
nonrefundable, and must be submitted with each application. The renovation firm certificate
or a copy of the certificate must be readily available at the worksite for review by the
contracting entity, the commissioner, and other public health officials charged with the
health, safety, and welfare of the state's citizens.
Sec. 20.
Minnesota Statutes 2020, section 144A.01, is amended to read:
144A.01 DEFINITIONS.
Subdivision 1.
Scope.
For the purposes of sections 144A.01 to 144A.27, the terms
defined in this section have the meanings given them.
Subd. 2.
Commissioner of health.
"Commissioner of health" means the state
commissioner of health established by section 144.011.
Subd. 3.
Board of Executivesnew text begin for Long Term Services and Supportsnew text end .
"Board of
Executivesnew text begin for Long Term Services and Supportsnew text end " means the Board of Executives for Long
Term Services and Supports established by section 144A.19.
Subd. 3a.
Certified.
"Certified" means certified for participation as a provider in the
Medicare or Medicaid programs under title XVIII or XIX of the Social Security Act.
Subd. 4.
Controlling person.
(a) "Controlling person" means deleted text begin any public body,
governmental agency, business entity,deleted text end new text begin an owner and the following individuals and entities,
if applicable:
new text end
new text begin (1) eachnew text end officernew text begin of the organizationnew text end , new text begin including the chief executive officer and the chief
financial officer;
new text end
new text begin (2) the new text end nursing home administratordeleted text begin ,deleted text end new text begin ;new text end or deleted text begin director whose responsibilities include the
direction of the management or policies of a nursing home
deleted text end
new text begin (3) any managerial officialnew text end .
new text begin (b) new text end "Controlling person" also means any new text begin entity or natural new text end person whodeleted text begin , directly or
indirectly, beneficially owns anydeleted text end new text begin has any direct or indirect ownershipnew text end interest in:
(1) any corporation, partnership or other business association which is a controlling
person;
(2) the land on which a nursing home is located;
(3) the structure in which a nursing home is located;
(4) any new text begin entity with at least a five percent new text end mortgage, contract for deed, new text begin deed of trust, new text end or
other deleted text begin obligation secured in whole or part bydeleted text end new text begin security interest innew text end the land or structure
comprising a nursing home; or
(5) any lease or sublease of the land, structure, or facilities comprising a nursing home.
deleted text begin (b)deleted text end new text begin (c)new text end "Controlling person" does not include:
(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
directly or through a subsidiary operates a nursing home;
new text begin
(2) government and government-sponsored entities such as the United States Department
of Housing and Urban Development, Ginnie Mae, Fannie Mae, Freddie Mac, and the
Minnesota Housing Finance Agency which provide loans, financing, and insurance products
for housing sites;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end an individual new text begin who is a new text end state new text begin or federal new text end official deleted text begin ordeleted text end new text begin , anew text end state new text begin or federal new text end employee, or
a member or employee of the governing body of a political subdivision of the state deleted text begin whichdeleted text end new text begin
or federal government thatnew text end operates one or more nursing homes, unless the individual is
also an officer deleted text begin or director of adeleted text end new text begin , owner, or managerial official of thenew text end nursing home, receives
any remuneration from a nursing home, or deleted text begin owns any of the beneficial interestsdeleted text end new text begin who is a
controlling personnew text end not new text begin otherwise new text end excluded in this subdivision;
deleted text begin (3)deleted text end new text begin (4)new text end a natural person who is a member of a tax-exempt organization under section
290.05, subdivision 2, unless the individual is also deleted text begin an officer or director of a nursing home,
or owns any of the beneficial interestsdeleted text end new text begin a controlling personnew text end not new text begin otherwise new text end excluded in this
subdivision; and
deleted text begin (4)deleted text end new text begin (5)new text end a natural person who owns less than five percent of the outstanding common
shares of a corporation:
(i) whose securities are exempt by virtue of section 80A.45, clause (6); or
(ii) whose transactions are exempt by virtue of section 80A.46, clause (7).
Subd. 4a.
Emergency.
"Emergency" means a situation or physical condition that creates
or probably will create an immediate and serious threat to a resident's health or safety.
Subd. 5.
Nursing home.
"Nursing home" means a facility or that part of a facility which
provides nursing care to five or more persons. "Nursing home" does not include a facility
or that part of a facility which is a hospital, a hospital with approved swing beds as defined
in section 144.562, clinic, doctor's office, diagnostic or treatment center, or a residential
program licensed pursuant to sections 245A.01 to 245A.16 or 252.28.
Subd. 6.
Nursing care.
"Nursing care" means health evaluation and treatment of patients
and residents who are not in need of an acute care facility but who require nursing supervision
on an inpatient basis. The commissioner of health may by rule establish levels of nursing
care.
Subd. 7.
Uncorrected violation.
"Uncorrected violation" means a violation of a statute
or rule or any other deficiency for which a notice of noncompliance has been issued and
fine assessed and allowed to be recovered pursuant to section 144A.10, subdivision 8.
Subd. 8.
Managerial deleted text begin employeedeleted text end new text begin officialnew text end .
"Managerial deleted text begin employeedeleted text end new text begin officialnew text end " means an
deleted text begin employee of adeleted text end new text begin individual who has the decision-making authority related to the operation of
thenew text end nursing home deleted text begin whose duties includedeleted text end new text begin and the responsibility for either: (1) the ongoing
management of the nursing home; or (2)new text end the direction of deleted text begin some or all of the management ordeleted text end
policiesnew text begin , services, or employeesnew text end of the nursing home.
Subd. 9.
Nursing home administrator.
"Nursing home administrator" means a person
who administers, manages, supervises, or is in general administrative charge of a nursing
home, whether or not the individual has an ownership interest in the home, and whether or
not the person's functions and duties are shared with one or more individuals, and who is
licensed pursuant to section 144A.21.
Subd. 10.
Repeated violation.
"Repeated violation" means the issuance of two or more
correction orders, within a 12-month period, for a violation of the same provision of a statute
or rule.
new text begin Subd. 11. new text end
new text begin Change of ownership. new text end
new text begin
"Change of ownership" means a change in the licensee.
new text end
new text begin Subd. 12. new text end
new text begin Direct ownership interest. new text end
new text begin
"Direct ownership interest" means an individual
or legal entity with the possession of at least five percent equity in capital, stock, or profits
of the licensee or who is a member of a limited liability company of the licensee.
new text end
new text begin Subd. 13. new text end
new text begin Indirect ownership interest. new text end
new text begin
"Indirect ownership interest" means an individual
or legal entity with a direct ownership interest in an entity that has a direct or indirect
ownership interest of at least five percent in an entity that is a licensee.
new text end
new text begin Subd. 14. new text end
new text begin Licensee. new text end
new text begin
"Licensee" means a person or legal entity to whom the commissioner
issues a license for a nursing home and who is responsible for the management, control,
and operation of the nursing home.
new text end
new text begin Subd. 15. new text end
new text begin Management agreement. new text end
new text begin
"Management agreement" means a written, executed
agreement between a licensee and manager regarding the provision of certain services on
behalf of the licensee.
new text end
new text begin Subd. 16. new text end
new text begin Manager. new text end
new text begin
"Manager" means an individual or legal entity designated by the
licensee through a management agreement to act on behalf of the licensee in the on-site
management of the nursing home.
new text end
new text begin Subd. 17. new text end
new text begin Owner. new text end
new text begin
"Owner" means: (1) an individual or legal entity that has a direct or
indirect ownership interest of five percent or more in a licensee; and (2) for purposes of this
chapter, owner of a nonprofit corporation means the president and treasurer of the board of
directors; and (3) for an entity owned by an employee stock ownership plan, owner means
the president and treasurer of the entity. A government entity that is issued a license under
this chapter shall be designated the owner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 21.
Minnesota Statutes 2020, section 144A.03, subdivision 1, is amended to read:
Subdivision 1.
Form; requirements.
new text begin (a) new text end The commissioner of health by rule shall
establish forms and procedures for the processing of nursing home license applications.
new text begin (b) new text end An application for a nursing home license shall include deleted text begin the following informationdeleted text end :
(1) the deleted text begin namesdeleted text end new text begin business namenew text end and deleted text begin addresses of all controlling persons and managerial
employees of the facility to be licenseddeleted text end new text begin legal entity name of the licenseenew text end ;
(2) the new text begin street new text end addressnew text begin , mailing address,new text end and legal property description of the facility;
new text begin
(3) the names, e-mail addresses, telephone numbers, and mailing addresses of all owners,
controlling persons, managerial officials, and the nursing home administrator;
new text end
new text begin
(4) the name and e-mail address of the managing agent and manager, if applicable;
new text end
new text begin
(5) the licensed bed capacity;
new text end
new text begin
(6) the license fee in the amount specified in section 144.122;
new text end
new text begin
(7) documentation of compliance with the background study requirements in section
144.057 for the owner, controlling persons, and managerial officials. Each application for
a new license must include documentation for the applicant and for each individual with
five percent or more direct or indirect ownership in the applicant;
new text end
deleted text begin (3)deleted text end new text begin (8)new text end a copy of the architectural and engineering plans and specifications of the facility
as prepared and certified by an architect or engineer registered to practice in this state; deleted text begin and
deleted text end
new text begin
(9) a representative copy of the executed lease agreement between the landlord and the
licensee, if applicable;
new text end
new text begin
(10) a representative copy of the management agreement, if applicable;
new text end
new text begin
(11) a representative copy of the operations transfer agreement or similar agreement, if
applicable;
new text end
new text begin
(12) an organizational chart that identifies all organizations and individuals with an
ownership interest in the licensee of five percent or greater and that specifies their relationship
with the licensee and with each other;
new text end
new text begin
(13) whether the applicant, owner, controlling person, managerial official, or nursing
home administrator of the facility has ever been convicted of:
new text end
new text begin
(i) a crime or found civilly liable for a federal or state felony-level offense that was
detrimental to the best interests of the facility and its residents within the last ten years
preceding submission of the license application. Offenses include: (A) felony crimes against
persons and other similar crimes for which the individual was convicted, including guilty
pleas and adjudicated pretrial diversions; (B) financial crimes such as extortion,
embezzlement, income tax evasion, insurance fraud, and other similar crimes for which the
individual was convicted, including guilty pleas and adjudicated pretrial diversions; (C)
any felonies involving malpractice that resulted in a conviction of criminal neglect or
misconduct; and (D) any felonies that would result in a mandatory exclusion under section
1128(a) of the Social Security Act;
new text end
new text begin
(ii) any misdemeanor under federal or state law related to the delivery of an item or
service under Medicaid or a state health care program or the abuse or neglect of a patient
in connection with the delivery of a health care item or service;
new text end
new text begin
(iii) any misdemeanor under federal or state law related to theft, fraud, embezzlement,
breach of fiduciary duty, or other financial misconduct in connection with the delivery of
a health care item or service;
new text end
new text begin
(iv) any felony or misdemeanor under federal or state law relating to the interference
with or obstruction of any investigation into any criminal offense described in Code of
Federal Regulations, title 42, section 1001.101 or 1001.201; or
new text end
new text begin
(v) any felony or misdemeanor under federal or state law relating to the unlawful
manufacture, distribution, prescription, or dispensing of a controlled substance;
new text end
new text begin
(14) whether the applicant, owner, controlling person, managerial official, or nursing
home administrator of the facility has had:
new text end
new text begin
(i) any revocation or suspension of a license to provide health care by any state licensing
authority. This includes the surrender of the license while a formal disciplinary proceeding
was pending before a state licensing authority;
new text end
new text begin
(ii) any revocation or suspension of accreditation; or
new text end
new text begin
(iii) any suspension or exclusion from participation in, or any sanction imposed by, a
federal or state health care program or any debarment from participation in any federal
executive branch procurement or nonprocurement program;
new text end
new text begin
(15) whether in the preceding three years the applicant or any owner, controlling person,
managerial official, or nursing home administrator of the facility has a record of defaulting
in the payment of money collected for others, including the discharge of debts through
bankruptcy proceedings;
new text end
new text begin
(16) the signature of the owner of the licensee or an authorized agent of the licensee;
new text end
new text begin
(17) identification of all states where the applicant or individual having a five percent
or more ownership currently or previously has been licensed as an owner or operator of a
long-term care, community-based, or health care facility or agency where the applicant's or
individual's license or federal certification has been denied, suspended, restricted, conditioned,
refused, not renewed, or revoked under a private or state-controlled receivership or where
these same actions are pending under the laws of any state or federal authority; and
new text end
deleted text begin (4)deleted text end new text begin (18)new text end any other relevant information which the commissioner of health by rule or
otherwise may determine is necessary to properly evaluate an application for license.
new text begin (c) new text end A controlling person which is a corporation shall submit copies of its articles of
incorporation and bylaws and any amendments thereto as they occur, together with the
names and addresses of its officers and directors. A controlling person which is a foreign
corporation shall furnish the commissioner of health with a copy of its certificate of authority
to do business in this state. deleted text begin An application on behalf of a controlling person which is a
corporation, association or a governmental unit or instrumentality shall be signed by at least
two officers or managing agents of that entity.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 22.
Minnesota Statutes 2020, section 144A.04, subdivision 4, is amended to read:
Subd. 4.
Controlling person restrictions.
(a) The new text begin commissioner has discretion to bar
any new text end controlling persons of a nursing home deleted text begin may not include anydeleted text end new text begin if thenew text end person deleted text begin whodeleted text end was a
controlling person of deleted text begin anotherdeleted text end new text begin any othernew text end nursing home deleted text begin during any period of timedeleted text end new text begin , assisted
living facility, long-term care or health care facility, or agencynew text end in the previous two-year
periodnew text begin andnew text end :
(1) during deleted text begin whichdeleted text end new text begin that period ofnew text end time deleted text begin of control that other nursing homedeleted text end new text begin the facility or
agencynew text end incurred the following number of uncorrected or repeated violations:
(i) two or more uncorrected violations or one or more repeated violations which created
an imminent risk to direct resident new text begin or client new text end care or safety; or
(ii) four or more uncorrected violations or two or more repeated violations deleted text begin of any nature
for which the fines are in the four highest daily fine categories prescribed in ruledeleted text end new text begin that created
an imminent risk to direct resident or client care or safetynew text end ; or
(2) deleted text begin whodeleted text end new text begin during that period of time,new text end was convicted of a felony or gross misdemeanor that
deleted text begin relatesdeleted text end new text begin relatednew text end to operation of the deleted text begin nursing homedeleted text end new text begin facility or agencynew text end or directly deleted text begin affectsdeleted text end new text begin affectednew text end
resident safety or caredeleted text begin , during that perioddeleted text end .
(b) The provisions of this subdivision shall not apply to any controlling person who had
no legal authority to affect or change decisions related to the operation of the nursing home
which incurred the uncorrected violations.
new text begin
(c) When the commissioner bars a controlling person under this subdivision, the
controlling person has the right to appeal under chapter 14.
new text end
Sec. 23.
Minnesota Statutes 2020, section 144A.04, subdivision 6, is amended to read:
Subd. 6.
Managerial deleted text begin employeedeleted text end new text begin officialnew text end or licensed administrator; employment
prohibitions.
A nursing home may not employ as a managerial deleted text begin employeedeleted text end new text begin officialnew text end or as its
licensed administrator any person who was a managerial deleted text begin employeedeleted text end new text begin officialnew text end or the licensed
administrator of another facility during any period of time in the previous two-year period:
(1) during which time of employment that other nursing home incurred the following
number of uncorrected violations which were in the jurisdiction and control of the managerial
deleted text begin employeedeleted text end new text begin officialnew text end or the administrator:
(i) two or more uncorrected violations deleted text begin or one or more repeated violations which created
an imminent risk to direct resident care or safetydeleted text end ; or
(ii) four or more uncorrected violations or two or more repeated violations of any nature
for which the fines are in the four highest daily fine categories prescribed in rule; or
(2) who was convicted of a felony or gross misdemeanor that relates to operation of the
nursing home or directly affects resident safety or care, during that period.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 24.
Minnesota Statutes 2020, section 144A.06, is amended to read:
144A.06 TRANSFER OF deleted text begin INTERESTSdeleted text end new text begin LICENSE PROHIBITEDnew text end .
Subdivision 1.
deleted text begin Notice; expiration of licensedeleted text end new text begin Transfers prohibitednew text end .
deleted text begin
Any controlling
person who makes any transfer of a beneficial interest in a nursing home shall notify the
commissioner of health of the transfer within 14 days of its occurrence. The notification
shall identify by name and address the transferor and transferee and shall specify the nature
and amount of the transferred interest. On determining that the transferred beneficial interest
exceeds ten percent of the total beneficial interest in the nursing home facility, the structure
in which the facility is located, or the land upon which the structure is located, the
commissioner may, and on determining that the transferred beneficial interest exceeds 50
percent of the total beneficial interest in the facility, the structure in which the facility is
located, or the land upon which the structure is located, the commissioner shall require that
the license of the nursing home expire 90 days after the date of transfer. The commissioner
of health shall notify the nursing home by certified mail of the expiration of the license at
least 60 days prior to the date of expiration.
deleted text end
new text begin
A nursing home license may not be transferred.
new text end
Subd. 2.
deleted text begin Relicensuredeleted text end new text begin New license required; change of ownershipnew text end .
new text begin (a) new text end The
commissioner of health by rule shall prescribe procedures for deleted text begin relicensuredeleted text end new text begin licensurenew text end under
this section. deleted text begin The commissioner of health shall relicense a nursing home if the facility satisfies
the requirements for license renewal established by section 144A.05. A facility shall not be
relicensed by the commissioner if at the time of transfer there are any uncorrected violations.
The commissioner of health may temporarily waive correction of one or more violations if
the commissioner determines that:
deleted text end
deleted text begin
(1) temporary noncorrection of the violation will not create an imminent risk of harm
to a nursing home resident; and
deleted text end
deleted text begin
(2) a controlling person on behalf of all other controlling persons:
deleted text end
deleted text begin
(i) has entered into a contract to obtain the materials or labor necessary to correct the
violation, but the supplier or other contractor has failed to perform the terms of the contract
and the inability of the nursing home to correct the violation is due solely to that failure; or
deleted text end
deleted text begin
(ii) is otherwise making a diligent good faith effort to correct the violation.
deleted text end
new text begin
(b) A new license is required and the prospective licensee must apply for a license prior
to operating a currently licensed nursing home. The licensee must change whenever one of
the following events occur:
new text end
new text begin
(1) the form of the licensee's legal entity structure is converted or changed to a different
type of legal entity structure;
new text end
new text begin
(2) the licensee dissolves, consolidates, or merges with another legal organization and
the licensee's legal organization does not survive;
new text end
new text begin
(3) within the previous 24 months, 50 percent or more of the licensee's ownership interest
is transferred, whether by a single transaction or multiple transactions to:
new text end
new text begin
(i) a different person; or
new text end
new text begin
(ii) a person who had less than a five percent ownership interest in the facility at the
time of the first transaction; or
new text end
new text begin
(4) any other event or combination of events that results in a substitution, elimination,
or withdrawal of the licensee's responsibility for the facility.
new text end
new text begin Subd. 3. new text end
new text begin Compliance. new text end
new text begin
The commissioner must consult with the commissioner of human
services regarding the history of financial and cost reporting compliance of the prospective
licensee and prospective licensee's financial operations in any nursing home that the
prospective licensee or any controlling person listed in the license application has had an
interest in.
new text end
new text begin Subd. 4. new text end
new text begin Facility operation. new text end
new text begin
The current licensee remains responsible for the operation
of the nursing home until the nursing home is licensed to the prospective licensee.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 25.
new text begin
[144A.32] CONSIDERATION OF APPLICATIONS.
new text end
new text begin
(a) Before issuing a license or renewing an existing license, the commissioner shall
consider an applicant's compliance history in providing care in a facility that provides care
to children, the elderly, ill individuals, or individuals with disabilities.
new text end
new text begin
(b) The applicant's compliance history shall include repeat violations, rule violations,
and any license or certification involuntarily suspended or terminated during an enforcement
process.
new text end
new text begin
(c) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license
or impose conditions if:
new text end
new text begin
(1) the applicant fails to provide complete and accurate information on the application
and the commissioner concludes that the missing or corrected information is needed to
determine if a license is granted;
new text end
new text begin
(2) the applicant, knowingly or with reason to know, made a false statement of a material
fact in an application for the license or any data attached to the application or in any matter
under investigation by the department;
new text end
new text begin
(3) the applicant refused to allow agents of the commissioner to inspect the applicant's
books, records, files related to the license application, or any portion of the premises;
new text end
new text begin
(4) the applicant willfully prevented, interfered with, or attempted to impede in any way:
new text end
new text begin
(i) the work of any authorized representative of the commissioner, the ombudsman for
long-term care, or the ombudsman for mental health and developmental disabilities; or
new text end
new text begin
(ii) the duties of the commissioner, local law enforcement, city or county attorneys, adult
protection, county case managers, or other local government personnel;
new text end
new text begin
(5) the applicant has a history of noncompliance with federal or state regulations that
were detrimental to the health, welfare, or safety of a resident or a client; or
new text end
new text begin
(6) the applicant violates any requirement in this chapter or chapter 256R.
new text end
new text begin
(d) If a license is denied, the applicant has the reconsideration rights available under
chapter 14.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 26.
Minnesota Statutes 2020, section 144A.4799, subdivision 1, is amended to read:
Subdivision 1.
Membership.
The commissioner of health shall appoint deleted text begin eightdeleted text end new text begin 13new text end persons
to a home care and assisted living program advisory council consisting of the following:
(1) deleted text begin threedeleted text end new text begin twonew text end public members as defined in section 214.02 who shall be persons who
are currently receiving home care services, persons who have received home care services
within five years of the application date, persons who have family members receiving home
care services, or persons who have family members who have received home care services
within five years of the application date;
(2) deleted text begin threedeleted text end new text begin twonew text end Minnesota home care licensees representing basic and comprehensive
levels of licensure who may be a managerial official, an administrator, a supervising
registered nurse, or an unlicensed personnel performing home care tasks;
(3) one member representing the Minnesota Board of Nursing;
(4) one member representing the Office of Ombudsman for Long-Term Care; deleted text begin and
deleted text end
new text begin
(5) one member representing the Office of Ombudsman for Mental Health and
Developmental Disabilities;
new text end
deleted text begin (5)deleted text end new text begin (6)new text end beginning July 1, 2021, one member of a county health and human services or
county adult protection officedeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) two Minnesota assisted living facility licensees representing assisted living facilities
and assisted living facilities with dementia care levels of licensure who may be the facility's
assisted living director, managerial official, or clinical nurse supervisor;
new text end
new text begin
(8) one organization representing long-term care providers, home care providers, and
assisted living providers in Minnesota; and
new text end
new text begin
(9) two public members as defined in section 214.02. One public member shall be a
person who either is or has been a resident in an assisted living facility and one public
member shall be a person who has or had a family member living in an assisted living
facility setting.
new text end
Sec. 27.
Minnesota Statutes 2020, section 144A.4799, subdivision 3, is amended to read:
Subd. 3.
Duties.
(a) At the commissioner's request, the advisory council shall provide
advice regarding regulations of Department of Health licensed new text begin assisted living and new text end home
care providers in this chapter, including advice on the following:
(1) community standards for home care practices;
(2) enforcement of licensing standards and whether certain disciplinary actions are
appropriate;
(3) ways of distributing information to licensees and consumers of home care and assisted
livingnew text begin services defined under chapter 144Gnew text end ;
(4) training standards;
(5) identifying emerging issues and opportunities in home care and assisted livingnew text begin services
defined under chapter 144Gnew text end ;
(6) identifying the use of technology in home and telehealth capabilities;
(7) allowable home care licensing modifications and exemptions, including a method
for an integrated license with an existing license for rural licensed nursing homes to provide
limited home care services in an adjacent independent living apartment building owned by
the licensed nursing home; and
(8) recommendations for studies using the data in section 62U.04, subdivision 4, including
but not limited to studies concerning costs related to dementia and chronic disease among
an elderly population over 60 and additional long-term care costs, as described in section
62U.10, subdivision 6.
(b) The advisory council shall perform other duties as directed by the commissioner.
(c) The advisory council shall annually make recommendations to the commissioner for
the purposes in section 144A.474, subdivision 11, paragraph (i). The recommendations shall
address ways the commissioner may improve protection of the public under existing statutes
and laws and include but are not limited to projects that create and administer training of
licensees and their employees to improve residents' lives, supporting ways that licensees
can improve and enhance quality care and ways to provide technical assistance to licensees
to improve compliance; information technology and data projects that analyze and
communicate information about trends of violations or lead to ways of improving client
care; communications strategies to licensees and the public; and other projects or pilots that
benefit clients, families, and the public.
Sec. 28.
Minnesota Statutes 2020, section 144A.75, subdivision 12, is amended to read:
Subd. 12.
Palliative care.
"Palliative care" means deleted text begin the total active care of patients whose
disease is not responsive to curative treatment. Control of pain, of other symptoms, and of
psychological, social, and spiritual problems is paramountdeleted text end new text begin specialized medical care for
people living with a serious illness or life-limiting conditionnew text end . new text begin This type of care is focused
on reducing the pain, symptoms, and stress of a serious illness or condition. Palliative care
is a team-based approach to care, providing essential support at any age or stage of a serious
illness or condition, and is often provided together with curative treatment. new text end The goal of
palliative care is deleted text begin the achievement of the best quality of life for patients and their familiesdeleted text end new text begin
to improve quality of life for both the patient and the patient's family or care partnernew text end .
Sec. 29.
Minnesota Statutes 2020, section 144G.08, is amended by adding a subdivision
to read:
new text begin Subd. 62a. new text end
new text begin Serious injury. new text end
new text begin
"Serious injury" has the meaning given in section 245.91,
subdivision 6.
new text end
Sec. 30.
Minnesota Statutes 2020, section 144G.15, is amended to read:
144G.15 CONSIDERATION OF APPLICATIONS.
(a) Before issuing a provisional license or license or renewing a license, the commissioner
shall consider an applicant's compliance history in providing care in new text begin this state or any other
state in new text end a facility that provides care to children, the elderly, ill individuals, or individuals
with disabilities.
(b) The applicant's compliance history shall include repeat violation, rule violations, and
any license or certification involuntarily suspended or terminated during an enforcement
process.
(c) The commissioner may deny, revoke, suspend, restrict, or refuse to renew the license
or impose conditions if:
(1) the applicant fails to provide complete and accurate information on the application
and the commissioner concludes that the missing or corrected information is needed to
determine if a license shall be granted;
(2) the applicant, knowingly or with reason to know, made a false statement of a material
fact in an application for the license or any data attached to the application or in any matter
under investigation by the department;
(3) the applicant refused to allow agents of the commissioner to inspect its books, records,
and files related to the license application, or any portion of the premises;
(4) the applicant willfully prevented, interfered with, or attempted to impede in any way:
(i) the work of any authorized representative of the commissioner, the ombudsman for
long-term care, or the ombudsman for mental health and developmental disabilities; or (ii)
the duties of the commissioner, local law enforcement, city or county attorneys, adult
protection, county case managers, or other local government personnel;
(5) the applicantnew text begin , owner, controlling individual, managerial official, or assisted living
director for the facilitynew text end has a history of noncompliance with federal or state regulations that
were detrimental to the health, welfare, or safety of a resident or a client; or
(6) the applicant violates any requirement in this chapter.
(d) If a license is denied, the applicant has the reconsideration rights available under
section 144G.16, subdivision 4.
Sec. 31.
Minnesota Statutes 2020, section 144G.17, is amended to read:
144G.17 LICENSE RENEWAL.
A license that is not a provisional license may be renewed for a period of up to one year
if the licensee:
(1) submits an application for renewal in the format provided by the commissioner at
least 60 calendar days before expiration of the license;
(2) submits the renewal fee under section 144G.12, subdivision 3;
(3) submits the late fee under section 144G.12, subdivision 4, if the renewal application
is received less than 30 days before the expiration date of the license or after the expiration
of the license;
(4) provides information sufficient to show that the applicant meets the requirements of
licensure, including items required under section 144G.12, subdivision 1; deleted text begin and
deleted text end
new text begin
(5) provides information sufficient to show the licensee provided assisted living services
to at least one resident during the immediately preceding license year and at the assisted
living facility listed on the license; and
new text end
deleted text begin (5)deleted text end new text begin (6)new text end provides any other information deemed necessary by the commissioner.
Sec. 32.
Minnesota Statutes 2020, section 144G.19, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Change of licensee. new text end
new text begin
Notwithstanding any other provision of law, a change of
licensee under subdivision 2 does not require the facility to meet the design requirements
of section 144G.45, subdivisions 4 to 6, or 144G.81, subdivision 3.
new text end
Sec. 33.
Minnesota Statutes 2020, section 144G.20, subdivision 1, is amended to read:
Subdivision 1.
Conditions.
(a) The commissioner may refuse to grant a provisional
license, refuse to grant a license as a result of a change in ownership, refuse to renew a
license, suspend or revoke a license, or impose a conditional license if the owner, controlling
individual, or employee of an assisted living facility:
(1) is in violation of, or during the term of the license has violated, any of the requirements
in this chapter or adopted rules;
(2) permits, aids, or abets the commission of any illegal act in the provision of assisted
living services;
(3) performs any act detrimental to the health, safety, and welfare of a resident;
(4) obtains the license by fraud or misrepresentation;
(5) knowingly makes a false statement of a material fact in the application for a license
or in any other record or report required by this chapter;
(6) denies representatives of the department access to any part of the facility's books,
records, files, or employees;
(7) interferes with or impedes a representative of the department in contacting the facility's
residents;
(8) interferes with or impedes ombudsman access according to section 256.9742,
subdivision 4new text begin , or interferes with or impedes access by the Office of Ombudsman for Mental
Health and Developmental Disabilities according to section 245.94, subdivision 1new text end ;
(9) interferes with or impedes a representative of the department in the enforcement of
this chapter or fails to fully cooperate with an inspection, survey, or investigation by the
department;
(10) destroys or makes unavailable any records or other evidence relating to the assisted
living facility's compliance with this chapter;
(11) refuses to initiate a background study under section 144.057 or 245A.04;
(12) fails to timely pay any fines assessed by the commissioner;
(13) violates any local, city, or township ordinance relating to housing or assisted living
services;
(14) has repeated incidents of personnel performing services beyond their competency
level; or
(15) has operated beyond the scope of the assisted living facility's license category.
(b) A violation by a contractor providing the assisted living services of the facility is a
violation by the facility.
Sec. 34.
Minnesota Statutes 2020, section 144G.20, subdivision 4, is amended to read:
Subd. 4.
Mandatory revocation.
Notwithstanding the provisions of subdivision 13,
paragraph (a), the commissioner must revoke a license if a controlling individual of the
facility is convicted of a felony or gross misdemeanor that relates to operation of the facility
or directly affects resident safety or care. The commissioner shall notify the facility and the
Office of Ombudsman for Long-Term Care new text begin and the Office of Ombudsman for Mental Health
and Developmental Disabilities new text end 30 calendar days in advance of the date of revocation.
Sec. 35.
Minnesota Statutes 2020, section 144G.20, subdivision 5, is amended to read:
Subd. 5.
Owners and managerial officials; refusal to grant license.
(a) The owners
and managerial officials of a facility whose Minnesota license has not been renewed or
whose deleted text begin Minnesotadeleted text end license new text begin in this state or any other state new text end has been revoked because of
noncompliance with applicable laws or rules shall not be eligible to apply for nor will be
granted an assisted living facility license under this chapter or a home care provider license
under chapter 144A, or be given status as an enrolled personal care assistance provider
agency or personal care assistant by the Department of Human Services under section
256B.0659, for five years following the effective date of the nonrenewal or revocation. If
the owners or managerial officials already have enrollment status, the Department of Human
Services shall terminate that enrollment.
(b) The commissioner shall not issue a license to a facility for five years following the
effective date of license nonrenewal or revocation if the owners or managerial officials,
including any individual who was an owner or managerial official of another licensed
provider, had a deleted text begin Minnesotadeleted text end license new text begin in this state or any other state new text end that was not renewed or
was revoked as described in paragraph (a).
(c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall suspend
or revoke, the license of a facility that includes any individual as an owner or managerial
official who was an owner or managerial official of a facility whose deleted text begin Minnesotadeleted text end license new text begin in
this state or any other state new text end was not renewed or was revoked as described in paragraph (a)
for five years following the effective date of the nonrenewal or revocation.
(d) The commissioner shall notify the facility 30 calendar days in advance of the date
of nonrenewal, suspension, or revocation of the license.
Sec. 36.
Minnesota Statutes 2020, section 144G.20, subdivision 8, is amended to read:
Subd. 8.
Controlling individual restrictions.
(a) The commissioner has discretion to
bar any controlling individual of a facility if the person was a controlling individual of any
other nursing homenew text begin , home care provider licensed under chapter 144A, or given status as an
enrolled personal care assistance provider agency or personal care assistant by the Department
of Human Services under section 256B.0659,new text end or assisted living facility in the previous
two-year period and:
(1) during that period of time the nursing homenew text begin , home care provider licensed under
chapter 144A, or given status as an enrolled personal care assistance provider agency or
personal care assistant by the Department of Human Services under section 256B.0659,new text end or
assisted living facility incurred the following number of uncorrected or repeated violations:
(i) two or more repeated violations that created an imminent risk to direct resident care
or safety; or
(ii) four or more uncorrected violations that created an imminent risk to direct resident
care or safety; or
(2) during that period of time, was convicted of a felony or gross misdemeanor that
related to the operation of the nursing homenew text begin , home care provider licensed under chapter
144A, or given status as an enrolled personal care assistance provider agency or personal
care assistant by the Department of Human Services under section 256B.0659,new text end or assisted
living facility, or directly affected resident safety or care.
(b) When the commissioner bars a controlling individual under this subdivision, the
controlling individual may appeal the commissioner's decision under chapter 14.
Sec. 37.
Minnesota Statutes 2020, section 144G.20, subdivision 9, is amended to read:
Subd. 9.
Exception to controlling individual restrictions.
Subdivision 8 does not apply
to any controlling individual of the facility who had no legal authority to affect or change
decisions related to the operation of the nursing home deleted text begin ordeleted text end new text begin ,new text end assisted living facilitynew text begin , or home
carenew text end that incurred the uncorrected new text begin or repeated new text end violations.
Sec. 38.
Minnesota Statutes 2020, section 144G.20, subdivision 12, is amended to read:
Subd. 12.
Notice to residents.
(a) Within five business days after proceedings are initiated
by the commissioner to revoke or suspend a facility's license, or a decision by the
commissioner not to renew a living facility's license, the controlling individual of the facility
or a designee must provide to the commissioner deleted text begin anddeleted text end new text begin ,new text end the ombudsman for long-term carenew text begin ,
and the Office of Ombudsman for Mental Health and Developmental Disabilitiesnew text end the names
of residents and the names and addresses of the residents' designated representatives and
legal representatives, and family or other contacts listed in the assisted living contract.
(b) The controlling individual or designees of the facility must provide updated
information each month until the proceeding is concluded. If the controlling individual or
designee of the facility fails to provide the information within this time, the facility is subject
to the issuance of:
(1) a correction order; and
(2) a penalty assessment by the commissioner in rule.
(c) Notwithstanding subdivisions 21 and 22, any correction order issued under this
subdivision must require that the facility immediately comply with the request for information
and that, as of the date of the issuance of the correction order, the facility shall forfeit to the
state a $500 fine the first day of noncompliance and an increase in the $500 fine by $100
increments for each day the noncompliance continues.
(d) Information provided under this subdivision may be used by the commissioner deleted text begin ordeleted text end new text begin ,new text end
the ombudsman for long-term carenew text begin , or the Office of Ombudsman for Mental Health and
Developmental Disabilitiesnew text end only for the purpose of providing affected consumers information
about the status of the proceedings.
(e) Within ten business days after the commissioner initiates proceedings to revoke,
suspend, or not renew a facility license, the commissioner must send a written notice of the
action and the process involved to each resident of the facility, legal representatives and
designated representatives, and at the commissioner's discretion, additional resident contacts.
(f) The commissioner shall provide the ombudsman for long-term care new text begin and the Office
of Ombudsman for Mental Health and Developmental Disabilities new text end with monthly information
on the department's actions and the status of the proceedings.
Sec. 39.
Minnesota Statutes 2020, section 144G.20, subdivision 15, is amended to read:
Subd. 15.
Plan required.
(a) The process of suspending, revoking, or refusing to renew
a license must include a plan for transferring affected residents' cares to other providers by
the facility. The commissioner shall monitor the transfer plan. Within three calendar days
of being notified of the final revocation, refusal to renew, or suspension, the licensee shall
provide the commissioner, the lead agencies as defined in section 256B.0911, county adult
protection and case managers, deleted text begin anddeleted text end the ombudsman for long-term carenew text begin , and the Office of
Ombudsman for Mental Health and Developmental Disabilitiesnew text end with the following
information:
(1) a list of all residents, including full names and all contact information on file;
(2) a list of the resident's legal representatives and designated representatives and family
or other contacts listed in the assisted living contract, including full names and all contact
information on file;
(3) the location or current residence of each resident;
(4) the payor sources for each resident, including payor source identification numbers;
and
(5) for each resident, a copy of the resident's service plan and a list of the types of services
being provided.
(b) The revocation, refusal to renew, or suspension notification requirement is satisfied
by mailing the notice to the address in the license record. The licensee shall cooperate with
the commissioner and the lead agencies, county adult protection and case managers, deleted text begin anddeleted text end
the ombudsman for long-term carenew text begin , and the Office of Ombudsman for Mental Health and
Developmental Disabilitiesnew text end during the process of transferring care of residents to qualified
providers. Within three calendar days of being notified of the final revocation, refusal to
renew, or suspension action, the facility must notify and disclose to each of the residents,
or the resident's legal and designated representatives or emergency contact persons, that the
commissioner is taking action against the facility's license by providing a copy of the
revocation, refusal to renew, or suspension notice issued by the commissioner. If the facility
does not comply with the disclosure requirements in this section, the commissioner shall
notify the residents, legal and designated representatives, or emergency contact persons
about the actions being taken. Lead agencies, county adult protection and case managers,
and the Office of Ombudsman for Long-Term Care may also provide this information. The
revocation, refusal to renew, or suspension notice is public data except for any private data
contained therein.
(c) A facility subject to this subdivision may continue operating while residents are being
transferred to other service providers.
Sec. 40.
Minnesota Statutes 2020, section 144G.30, subdivision 5, is amended to read:
Subd. 5.
Correction orders.
(a) A correction order may be issued whenever the
commissioner finds upon survey or during a complaint investigation that a facility, a
managerial official, new text begin an agent of the facility, new text end or an employee of the facility is not in compliance
with this chapter. The correction order shall cite the specific statute and document areas of
noncompliance and the time allowed for correction.
(b) The commissioner shall mail or e-mail copies of any correction order to the facility
within 30 calendar days after the survey exit date. A copy of each correction order and
copies of any documentation supplied to the commissioner shall be kept on file by the
facility and public documents shall be made available for viewing by any person upon
request. Copies may be kept electronically.
(c) By the correction order date, the facility must document in the facility's records any
action taken to comply with the correction order. The commissioner may request a copy of
this documentation and the facility's action to respond to the correction order in future
surveys, upon a complaint investigation, and as otherwise needed.
Sec. 41.
Minnesota Statutes 2020, section 144G.31, subdivision 4, is amended to read:
Subd. 4.
Fine amounts.
(a) Fines and enforcement actions under this subdivision may
be assessed based on the level and scope of the violations described in subdivisions 2 and
3 as follows and may be imposed immediately with no opportunity to correct the violation
prior to imposition:
(1) Level 1, no fines or enforcement;
(2) Level 2, a fine of $500 per violation, in addition to any enforcement mechanism
authorized in section 144G.20 for widespread violations;
(3) Level 3, a fine of $3,000 per violation deleted text begin per incidentdeleted text end , in addition to any enforcement
mechanism authorized in section 144G.20;
(4) Level 4, a fine of $5,000 per deleted text begin incidentdeleted text end new text begin violationnew text end , in addition to any enforcement
mechanism authorized in section 144G.20; and
(5) for maltreatment violations for which the licensee was determined to be responsible
for the maltreatment under section 626.557, subdivision 9c, paragraph (c), a fine of $1,000
new text begin per incidentnew text end . A fine of $5,000 new text begin per incidentnew text end may be imposed if the commissioner determines
the licensee is responsible for maltreatment consisting of sexual assault, death, or abuse
resulting in serious injury.
(b) When a fine is assessed against a facility for substantiated maltreatment, the
commissioner shall not also impose an immediate fine under this chapter for the same
circumstance.
Sec. 42.
Minnesota Statutes 2020, section 144G.31, subdivision 8, is amended to read:
Subd. 8.
Deposit of fines.
Fines collected under this section shall be deposited in a
dedicated special revenue account. On an annual basis, the balance in the special revenue
account shall be appropriated to the commissioner for special projects to improve deleted text begin home
caredeleted text end new text begin resident quality of care and outcomes in assisted living facilities licensed under this
chapternew text end in Minnesota as recommended by the advisory council established in section
144A.4799.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively for fines collected on or
after August 1, 2021.
new text end
Sec. 43.
Minnesota Statutes 2020, section 144G.41, subdivision 7, is amended to read:
Subd. 7.
Resident grievances; reporting maltreatment.
All facilities must post in a
conspicuous place information about the facilities' grievance procedure, and the name,
telephone number, and e-mail contact information for the individuals who are responsible
for handling resident grievances. The notice must also have the contact information for the
deleted text begin state and applicable regionaldeleted text end Office of Ombudsman for Long-Term Care and the Office of
Ombudsman for Mental Health and Developmental Disabilities, and must have information
for reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center.new text begin The
notice must also state that if an individual has a complaint about the facility or person
providing services, the individual may contact the Office of Health Facility Complaints at
the Minnesota Department of Health.
new text end
Sec. 44.
Minnesota Statutes 2020, section 144G.41, subdivision 8, is amended to read:
Subd. 8.
Protecting resident rights.
All facilities shall ensure that every resident has
access to consumer advocacy or legal services by:
(1) providing names and contact information, including telephone numbers and e-mail
addresses of at least three organizations that provide advocacy or legal services to residentsnew text begin ,
one of which must include the designated protection and advocacy organization in Minnesota
that provides advice and representation to individuals with disabilitiesnew text end ;
(2) providing the name and contact information for the Minnesota Office of Ombudsman
for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental
Disabilitiesdeleted text begin , including both the state and regional contact informationdeleted text end ;
(3) assisting residents in obtaining information on whether Medicare or medical assistance
under chapter 256B will pay for services;
(4) making reasonable accommodations for people who have communication disabilities
and those who speak a language other than English; and
(5) providing all information and notices in plain language and in terms the residents
can understand.
Sec. 45.
Minnesota Statutes 2020, section 144G.42, subdivision 10, is amended to read:
Subd. 10.
Disaster planning and emergency preparedness plan.
(a) The facility must
meet the following requirements:
(1) have a written emergency disaster plan that contains a plan for evacuation, addresses
elements of sheltering in place, identifies temporary relocation sites, and details staff
assignments in the event of a disaster or an emergency;
(2) post an emergency disaster plan prominently;
(3) provide building emergency exit diagrams to all residents;
(4) post emergency exit diagrams on each floor; and
(5) have a written policy and procedure regarding missing deleted text begin tenantdeleted text end residents.
(b) The facility must provide emergency and disaster training to all staff during the initial
staff orientation and annually thereafter and must make emergency and disaster training
annually available to all residents. Staff who have not received emergency and disaster
training are allowed to work only when trained staff are also working on site.
(c) The facility must meet any additional requirements adopted in rule.
Sec. 46.
Minnesota Statutes 2020, section 144G.50, subdivision 2, is amended to read:
Subd. 2.
Contract information.
(a) The contract must include in a conspicuous place
and manner on the contract the legal name and the deleted text begin license numberdeleted text end new text begin health facility identificationnew text end
of the facility.
(b) The contract must include the name, telephone number, and physical mailing address,
which may not be a public or private post office box, of:
(1) the facility and contracted service provider when applicable;
(2) the licensee of the facility;
(3) the managing agent of the facility, if applicable; and
(4) the authorized agent for the facility.
(c) The contract must include:
(1) a disclosure of the category of assisted living facility license held by the facility and,
if the facility is not an assisted living facility with dementia care, a disclosure that it does
not hold an assisted living facility with dementia care license;
(2) a description of all the terms and conditions of the contract, including a description
of and any limitations to the housing or assisted living services to be provided for the
contracted amount;
(3) a delineation of the cost and nature of any other services to be provided for an
additional fee;
(4) a delineation and description of any additional fees the resident may be required to
pay if the resident's condition changes during the term of the contract;
(5) a delineation of the grounds under which the resident may be deleted text begin discharged, evicted,
ordeleted text end transferred or have new text begin housing or new text end services terminatednew text begin or be subject to an emergency
relocationnew text end ;
(6) billing and payment procedures and requirements; and
(7) disclosure of the facility's ability to provide specialized diets.
(d) The contract must include a description of the facility's complaint resolution process
available to residents, including the name and contact information of the person representing
the facility who is designated to handle and resolve complaints.
(e) The contract must include a clear and conspicuous notice of:
(1) the right under section 144G.54 to appeal the termination of an assisted living contract;
(2) the facility's policy regarding transfer of residents within the facility, under what
circumstances a transfer may occur, and the circumstances under which resident consent is
required for a transfer;
(3) contact information for the Office of Ombudsman for Long-Term Care, the
Ombudsman for Mental Health and Developmental Disabilities, and the Office of Health
Facility Complaints;
(4) the resident's right to obtain services from an unaffiliated service provider;
(5) a description of the facility's policies related to medical assistance waivers under
chapter 256S and section 256B.49 and the housing support program under chapter 256I,
including:
(i) whether the facility is enrolled with the commissioner of human services to provide
customized living services under medical assistance waivers;
(ii) whether the facility has an agreement to provide housing support under section
256I.04, subdivision 2, paragraph (b);
(iii) whether there is a limit on the number of people residing at the facility who can
receive customized living services or participate in the housing support program at any
point in time. If so, the limit must be provided;
(iv) whether the facility requires a resident to pay privately for a period of time prior to
accepting payment under medical assistance waivers or the housing support program, and
if so, the length of time that private payment is required;
(v) a statement that medical assistance waivers provide payment for services, but do not
cover the cost of rent;
(vi) a statement that residents may be eligible for assistance with rent through the housing
support program; and
(vii) a description of the rent requirements for people who are eligible for medical
assistance waivers but who are not eligible for assistance through the housing support
program;
(6) the contact information to obtain long-term care consulting services under section
256B.0911; and
(7) the toll-free phone number for the Minnesota Adult Abuse Reporting Center.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, except
that the amendment to paragraph (a) is effective for assisted living contracts executed on
or after August 1, 2022.
new text end
Sec. 47.
Minnesota Statutes 2020, section 144G.52, subdivision 2, is amended to read:
Subd. 2.
Prerequisite to termination of a contract.
(a) Before issuing a notice of
termination of an assisted living contract, a facility must schedule and participate in a meeting
with the resident and the resident's legal representative and designated representative. The
purposes of the meeting are to:
(1) explain in detail the reasons for the proposed termination; and
(2) identify and offer reasonable accommodations or modifications, interventions, or
alternatives to avoid the termination or enable the resident to remain in the facility, including
but not limited to securing services from another provider of the resident's choosing that
may allow the resident to avoid the termination. A facility is not required to offer
accommodations, modifications, interventions, or alternatives that fundamentally alter the
nature of the operation of the facility.
(b) The meeting must be scheduled to take place at least seven days before a notice of
termination is issued. The facility must make reasonable efforts to ensure that the resident,
legal representative, and designated representative are able to attend the meeting.
(c) The facility must notify the resident that the resident may invite family members,
relevant health professionals, a representative of the Office of Ombudsman for Long-Term
Care, new text begin a representative of the Office of Ombudsman for Mental Health and Developmental
Disabilities, new text end or other persons of the resident's choosing to participate in the meeting. For
residents who receive home and community-based waiver services under chapter 256S and
section 256B.49, the facility must notify the resident's case manager of the meeting.
(d) In the event of an emergency relocation under subdivision 9, where the facility intends
to issue a notice of termination and an in-person meeting is impractical or impossible, the
facility deleted text begin may attempt to schedule and participate in a meeting under this subdivision viadeleted text end new text begin must
usenew text end telephone, video, or other new text begin electronic new text end meansnew text begin to conduct and participate in the meeting
required under this subdivision and rules within Minnesota Rules, chapter 4659new text end .
Sec. 48.
Minnesota Statutes 2020, section 144G.52, subdivision 8, is amended to read:
Subd. 8.
Content of notice of termination.
The notice required under subdivision 7
must contain, at a minimum:
(1) the effective date of the termination of the assisted living contract;
(2) a detailed explanation of the basis for the termination, including the clinical or other
supporting rationale;
(3) a detailed explanation of the conditions under which a new or amended contract may
be executed;
(4) a statement that the resident has the right to appeal the termination by requesting a
hearing, and information concerning the time frame within which the request must be
submitted and the contact information for the agency to which the request must be submitted;
(5) a statement that the facility must participate in a coordinated move to another provider
or caregiver, as required under section 144G.55;
(6) the name and contact information of the person employed by the facility with whom
the resident may discuss the notice of termination;
(7) information on how to contact the Office of Ombudsman for Long-Term Care new text begin and
the Office of Ombudsman for Mental Health and Developmental Disabilities new text end to request an
advocate to assist regarding the termination;
(8) information on how to contact the Senior LinkAge Line under section 256.975,
subdivision 7, and an explanation that the Senior LinkAge Line may provide information
about other available housing or service options; and
(9) if the termination is only for services, a statement that the resident may remain in
the facility and may secure any necessary services from another provider of the resident's
choosing.
Sec. 49.
Minnesota Statutes 2020, section 144G.52, subdivision 9, is amended to read:
Subd. 9.
Emergency relocation.
(a) A facility may remove a resident from the facility
in an emergency if necessary due to a resident's urgent medical needs or an imminent risk
the resident poses to the health or safety of another facility resident or facility staff member.
An emergency relocation is not a termination.
(b) In the event of an emergency relocation, the facility must provide a written notice
that contains, at a minimum:
(1) the reason for the relocation;
(2) the name and contact information for the location to which the resident has been
relocated and any new service provider;
(3) contact information for the Office of Ombudsman for Long-Term Carenew text begin and the Office
of Ombudsman for Mental Health and Developmental Disabilitiesnew text end ;
(4) if known and applicable, the approximate date or range of dates within which the
resident is expected to return to the facility, or a statement that a return date is not currently
known; and
(5) a statement that, if the facility refuses to provide housing or services after a relocation,
the resident has the right to appeal under section 144G.54. The facility must provide contact
information for the agency to which the resident may submit an appeal.
(c) The notice required under paragraph (b) must be delivered as soon as practicable to:
(1) the resident, legal representative, and designated representative;
(2) for residents who receive home and community-based waiver services under chapter
256S and section 256B.49, the resident's case manager; and
(3) the Office of Ombudsman for Long-Term Care if the resident has been relocated
and has not returned to the facility within four days.
(d) Following an emergency relocation, a facility's refusal to provide housing or services
constitutes a termination and triggers the termination process in this section.
Sec. 50.
Minnesota Statutes 2020, section 144G.53, is amended to read:
144G.53 NONRENEWAL OF HOUSING.
(a) If a facility decides to not renew a resident's housing under a contract, the facility
must either (1) provide the resident with 60 calendar days' notice of the nonrenewal and
assistance with relocation planning, or (2) follow the termination procedure under section
144G.52.
(b) The notice must include the reason for the nonrenewal and contact information of
the Office of Ombudsman for Long-Term Carenew text begin and the Office of Ombudsman for Mental
Health and Developmental Disabilitiesnew text end .
(c) A facility must:
(1) provide notice of the nonrenewal to the Office of Ombudsman for Long-Term Care;
(2) for residents who receive home and community-based waiver services under chapter
256S and section 256B.49, provide notice to the resident's case manager;
(3) ensure a coordinated move to a safe location, as defined in section 144G.55,
subdivision 2, that is appropriate for the resident;
(4) ensure a coordinated move to an appropriate service provider identified by the facility,
if services are still needed and desired by the resident;
(5) consult and cooperate with the resident, legal representative, designated representative,
case manager for a resident who receives home and community-based waiver services under
chapter 256S and section 256B.49, relevant health professionals, and any other persons of
the resident's choosing to make arrangements to move the resident, including consideration
of the resident's goals; and
(6) prepare a written plan to prepare for the move.
(d) A resident may decline to move to the location the facility identifies or to accept
services from a service provider the facility identifies, and may instead choose to move to
a location of the resident's choosing or receive services from a service provider of the
resident's choosing within the timeline prescribed in the nonrenewal notice.
Sec. 51.
Minnesota Statutes 2020, section 144G.55, subdivision 1, is amended to read:
Subdivision 1.
Duties of facility.
(a) If a facility terminates an assisted living contract,
reduces services to the extent that a resident needs to movenew text begin or obtain a new service provider
or the facility has its license restricted under section 144G.20new text end , or new text begin the facility new text end conducts a
planned closure under section 144G.57, the facility:
(1) must ensure, subject to paragraph (c), a coordinated move to a safe location that is
appropriate for the resident and that is identified by the facility prior to any hearing under
section 144G.54;
(2) must ensure a coordinated move of the resident to an appropriate service provider
identified by the facility prior to any hearing under section 144G.54, provided services are
still needed and desired by the resident; and
(3) must consult and cooperate with the resident, legal representative, designated
representative, case manager for a resident who receives home and community-based waiver
services under chapter 256S and section 256B.49, relevant health professionals, and any
other persons of the resident's choosing to make arrangements to move the resident, including
consideration of the resident's goals.
(b) A facility may satisfy the requirements of paragraph (a), clauses (1) and (2), by
moving the resident to a different location within the same facility, if appropriate for the
resident.
(c) A resident may decline to move to the location the facility identifies or to accept
services from a service provider the facility identifies, and may choose instead to move to
a location of the resident's choosing or receive services from a service provider of the
resident's choosing within the timeline prescribed in the termination notice.
(d) Sixty days before the facility plans to reduce or eliminate one or more services for
a particular resident, the facility must provide written notice of the reduction that includes:
(1) a detailed explanation of the reasons for the reduction and the date of the reduction;
(2) the contact information for the Office of Ombudsman for Long-Term Carenew text begin , the Office
of Ombudsman for Mental Health and Developmental Disabilities,new text end and the name and contact
information of the person employed by the facility with whom the resident may discuss the
reduction of services;
(3) a statement that if the services being reduced are still needed by the resident, the
resident may remain in the facility and seek services from another provider; and
(4) a statement that if the reduction makes the resident need to move, the facility must
participate in a coordinated move of the resident to another provider or caregiver, as required
under this section.
(e) In the event of an unanticipated reduction in services caused by extraordinary
circumstances, the facility must provide the notice required under paragraph (d) as soon as
possible.
(f) If the facility, a resident, a legal representative, or a designated representative
determines that a reduction in services will make a resident need to move to a new location,
the facility must ensure a coordinated move in accordance with this section, and must provide
notice to the Office of Ombudsman for Long-Term Care.
(g) Nothing in this section affects a resident's right to remain in the facility and seek
services from another provider.
Sec. 52.
Minnesota Statutes 2020, section 144G.55, subdivision 3, is amended to read:
Subd. 3.
Relocation plan required.
The facility must prepare a relocation plan to prepare
for the move to deleted text begin thedeleted text end new text begin anew text end new new text begin safe new text end location or new text begin appropriate new text end service providernew text begin , as required by this
sectionnew text end .
Sec. 53.
Minnesota Statutes 2020, section 144G.56, subdivision 3, is amended to read:
Subd. 3.
Notice required.
(a) A facility must provide at least 30 calendar days' advance
written notice to the resident and the resident's legal and designated representative of a
facility-initiated transfer. The notice must include:
(1) the effective date of the proposed transfer;
(2) the proposed transfer location;
(3) a statement that the resident may refuse the proposed transfer, and may discuss any
consequences of a refusal with staff of the facility;
(4) the name and contact information of a person employed by the facility with whom
the resident may discuss the notice of transfer; and
(5) contact information for the Office of Ombudsman for Long-Term Carenew text begin and the Office
of Ombudsman for Mental Health and Developmental Disabilitiesnew text end .
(b) Notwithstanding paragraph (a), a facility may conduct a facility-initiated transfer of
a resident with less than 30 days' written notice if the transfer is necessary due to:
(1) conditions that render the resident's room or private living unit uninhabitable;
(2) the resident's urgent medical needs; or
(3) a risk to the health or safety of another resident of the facility.
Sec. 54.
Minnesota Statutes 2020, section 144G.56, subdivision 5, is amended to read:
Subd. 5.
Changes in facility operations.
(a) In situations where there is a curtailment,
reduction, or capital improvement within a facility necessitating transfers, the facility must:
(1) minimize the number of transfers it initiates to complete the project or change in
operations;
(2) consider individual resident needs and preferences;
(3) provide reasonable accommodations for individual resident requests regarding the
transfers; and
(4) in advance of any notice to any residents, legal representatives, or designated
representatives, provide notice to the Office of Ombudsman for Long-Term Care anddeleted text begin , when
appropriate,deleted text end the Office of Ombudsman for Mental Health and Developmental Disabilities
of the curtailment, reduction, or capital improvement and the corresponding needed transfers.
Sec. 55.
Minnesota Statutes 2020, section 144G.57, subdivision 1, is amended to read:
Subdivision 1.
Closure plan required.
In the event that an assisted living facility elects
to voluntarily close the facility, the facility must notify the commissioner deleted text begin anddeleted text end new text begin ,new text end the Office
of Ombudsman for Long-Term Carenew text begin , and the Office of Ombudsman for Mental Health and
Developmental Disabilitiesnew text end in writing by submitting a proposed closure plan.
Sec. 56.
Minnesota Statutes 2020, section 144G.57, subdivision 3, is amended to read:
Subd. 3.
Commissioner's approval required prior to implementation.
(a) The plan
shall be subject to the commissioner's approval and subdivision 6. The facility shall take
no action to close the residence prior to the commissioner's approval of the plan. The
commissioner shall approve or otherwise respond to the plan as soon as practicable.
(b) The commissioner may require the facility to work with a transitional team comprised
of department staff, staff of the Office of Ombudsman for Long-Term Care, new text begin the Office of
Ombudsman for Mental Health and Developmental Disabilities, new text end and other professionals the
commissioner deems necessary to assist in the proper relocation of residents.
Sec. 57.
Minnesota Statutes 2020, section 144G.57, subdivision 5, is amended to read:
Subd. 5.
Notice to residents.
After the commissioner has approved the relocation plan
and at least 60 calendar days before closing, except as provided under subdivision 6, the
facility must notify residents, designated representatives, and legal representatives of the
closure, the proposed date of closure, the contact information of the ombudsman for long-term
carenew text begin and the ombudsman for mental health and developmental disabilitiesnew text end , and that the
facility will follow the termination planning requirements under section 144G.55, and final
accounting and return requirements under section 144G.42, subdivision 5. For residents
who receive home and community-based waiver services under chapter 256S and section
256B.49, the facility must also provide this information to the resident's case manager.
Sec. 58.
Minnesota Statutes 2020, section 144G.70, subdivision 2, is amended to read:
Subd. 2.
Initial reviews, assessments, and monitoring.
(a) Residents who are not
receiving any new text begin assisted living new text end services shall not be required to undergo an initial nursing
assessment.
(b) An assisted living facility shall conduct a nursing assessment by a registered nurse
of the physical and cognitive needs of the prospective resident and propose a temporary
service plan prior to the date on which a prospective resident executes a contract with a
facility or the date on which a prospective resident moves in, whichever is earlier. If
necessitated by either the geographic distance between the prospective resident and the
facility, or urgent or unexpected circumstances, the assessment may be conducted using
telecommunication methods based on practice standards that meet the resident's needs and
reflect person-centered planning and care delivery.
(c) Resident reassessment and monitoring must be conducted no more than 14 calendar
days after initiation of services. Ongoing resident reassessment and monitoring must be
conducted as needed based on changes in the needs of the resident and cannot exceed 90
calendar days from the last date of the assessment.
(d) For residents only receiving assisted living services specified in section 144G.08,
subdivision 9, clauses (1) to (5), the facility shall complete an individualized initial review
of the resident's needs and preferences. The initial review must be completed within 30
calendar days of the start of services. Resident monitoring and review must be conducted
as needed based on changes in the needs of the resident and cannot exceed 90 calendar days
from the date of the last review.
(e) A facility must inform the prospective resident of the availability of and contact
information for long-term care consultation services under section 256B.0911, prior to the
date on which a prospective resident executes a contract with a facility or the date on which
a prospective resident moves in, whichever is earlier.
Sec. 59.
Minnesota Statutes 2020, section 144G.70, subdivision 4, is amended to read:
Subd. 4.
Service plan, implementation, and revisions to service plan.
(a) No later
than 14 calendar days after the date that services are first provided, an assisted living facility
shall finalize a current written service plan.
(b) The service plan and any revisions must include a signature or other authentication
by the facility and by the resident documenting agreement on the services to be provided.
The service plan must be revised, if needed, based on resident reassessment under subdivision
2. The facility must provide information to the resident about changes to the facility's fee
for services and how to contact the Office of Ombudsman for Long-Term Carenew text begin and the
Office of Ombudsman for Mental Health and Developmental Disabilitiesnew text end .
(c) The facility must implement and provide all services required by the current service
plan.
(d) The service plan and the revised service plan must be entered into the resident record,
including notice of a change in a resident's fees when applicable.
(e) Staff providing services must be informed of the current written service plan.
(f) The service plan must include:
(1) a description of the services to be provided, the fees for services, and the frequency
of each service, according to the resident's current assessment and resident preferences;
(2) the identification of staff or categories of staff who will provide the services;
(3) the schedule and methods of monitoring assessments of the resident;
(4) the schedule and methods of monitoring staff providing services; and
(5) a contingency plan that includes:
(i) the action to be taken if the scheduled service cannot be provided;
(ii) information and a method to contact the facility;
(iii) the names and contact information of persons the resident wishes to have notified
in an emergency or if there is a significant adverse change in the resident's condition,
including identification of and information as to who has authority to sign for the resident
in an emergency; and
(iv) the circumstances in which emergency medical services are not to be summoned
consistent with chapters 145B and 145C, and declarations made by the resident under those
chapters.
Sec. 60.
Minnesota Statutes 2020, section 144G.80, subdivision 2, is amended to read:
Subd. 2.
Demonstrated capacity.
(a) An applicant for licensure as an assisted living
facility with dementia care must have the ability to provide services in a manner that is
consistent with the requirements in this section. The commissioner shall consider the
following criteria, including, but not limited to:
(1) the experience of the deleted text begin applicant indeleted text end new text begin applicant's assisted living director, managerial
official, and clinical nurse supervisornew text end managing residents with dementia or previous long-term
care experience; and
(2) the compliance history of the applicant in the operation of any care facility licensed,
certified, or registered under federal or state law.
(b) If the deleted text begin applicant doesdeleted text end new text begin applicant's assisted living director and clinical nurse supervisor
donew text end not have experience in managing residents with dementia, the applicant must employ a
consultant for at least the first six months of operation. The consultant must meet the
requirements in paragraph (a), clause (1), and make recommendations on providing dementia
care services consistent with the requirements of this chapter. The consultant must (1) have
two years of work experience related to dementia, health care, gerontology, or a related
field, and (2) have completed at least the minimum core training requirements in section
144G.64. The applicant must document an acceptable plan to address the consultant's
identified concerns and must either implement the recommendations or document in the
plan any consultant recommendations that the applicant chooses not to implement. The
commissioner must review the applicant's plan upon request.
(c) The commissioner shall conduct an on-site inspection prior to the issuance of an
assisted living facility with dementia care license to ensure compliance with the physical
environment requirements.
(d) The label "Assisted Living Facility with Dementia Care" must be identified on the
license.
Sec. 61.
Minnesota Statutes 2020, section 144G.90, subdivision 1, is amended to read:
Subdivision 1.
Assisted living bill of rights; notification to resident.
(a) An assisted
living facility must provide the resident a written notice of the rights under section 144G.91
before the initiation of services to that resident. The facility shall make all reasonable efforts
to provide notice of the rights to the resident in a language the resident can understand.
(b) In addition to the text of the assisted living bill of rights in section 144G.91, the
notice shall also contain the following statement describing how to file a complaint or report
suspected abuse:
"If you want to report suspected abuse, neglect, or financial exploitation, you may contact
the Minnesota Adult Abuse Reporting Center (MAARC). If you have a complaint about
the facility or person providing your services, you may contact the Office of Health Facility
Complaints, Minnesota Department of Health. new text begin If you would like to request advocacy services,
new text end you may deleted text begin alsodeleted text end contact the Office of Ombudsman for Long-Term Care or the Office of
Ombudsman for Mental Health and Developmental Disabilities."
(c) The statement must include contact information for the Minnesota Adult Abuse
Reporting Center and the telephone number, website address, e-mail address, mailing
address, and street address of the Office of Health Facility Complaints at the Minnesota
Department of Health, the Office of Ombudsman for Long-Term Care, and the Office of
Ombudsman for Mental Health and Developmental Disabilities. The statement must include
the facility's name, address, e-mail, telephone number, and name or title of the person at
the facility to whom problems or complaints may be directed. It must also include a statement
that the facility will not retaliate because of a complaint.
(d) A facility must obtain written acknowledgment from the resident of the resident's
receipt of the assisted living bill of rights or shall document why an acknowledgment cannot
be obtained. Acknowledgment of receipt shall be retained in the resident's record.
Sec. 62.
Minnesota Statutes 2020, section 144G.90, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Notice to residents. new text end
new text begin
For any notice to a resident, legal representative, or
designated representative provided under this chapter or under Minnesota Rules, chapter
4659, that is required to include information regarding the Office of Ombudsman for
Long-Term Care and the Office of Ombudsman for Mental Health and Developmental
Disabilities, the notice must contain the following language: "You may contact the
Ombudsman for Long-Term Care for questions about your rights as an assisted living facility
resident and to request advocacy services. As an assisted living facility resident, you may
contact the Ombudsman for Mental Health and Developmental Disabilities to request
advocacy regarding your rights, concerns, or questions on issues relating to services for
mental health, developmental disabilities, or chemical dependency."
new text end
Sec. 63.
Minnesota Statutes 2020, section 144G.91, subdivision 13, is amended to read:
Subd. 13.
Personal and treatment privacy.
(a) Residents have the right to consideration
of their privacy, individuality, and cultural identity as related to their social, religious, and
psychological well-being. Staff must respect the privacy of a resident's space by knocking
on the door and seeking consent before entering, except in an emergency or deleted text begin where clearly
inadvisable ordeleted text end unless otherwise documented in the resident's service plan.
(b) Residents have the right to have and use a lockable door to the resident's unit. The
facility shall provide locks on the resident's unit. Only a staff member with a specific need
to enter the unit shall have keys. This right may be restricted in certain circumstances if
necessary for a resident's health and safety and documented in the resident's service plan.
(c) Residents have the right to respect and privacy regarding the resident's service plan.
Case discussion, consultation, examination, and treatment are confidential and must be
conducted discreetly. Privacy must be respected during toileting, bathing, and other activities
of personal hygiene, except as needed for resident safety or assistance.
Sec. 64.
Minnesota Statutes 2020, section 144G.91, subdivision 21, is amended to read:
Subd. 21.
Access to counsel and advocacy services.
Residents have the right to the
immediate access by:
(1) the resident's legal counsel;
(2) any representative of the protection and advocacy system designated by the state
under Code of Federal Regulations, title 45, section 1326.21; or
(3) any representative of the Office of Ombudsman for Long-Term Carenew text begin or the Office
of Ombudsman for Mental Health and Developmental Disabilitiesnew text end .
Sec. 65.
Minnesota Statutes 2020, section 144G.92, subdivision 1, is amended to read:
Subdivision 1.
Retaliation prohibited.
A facility or agent of a facility may not retaliate
against a resident or employee if the resident, employee, or any person acting on behalf of
the resident:
(1) files a good faith complaint or grievance, makes a good faith inquiry, or asserts any
right;
(2) indicates a good faith intention to file a complaint or grievance, make an inquiry, or
assert any right;
(3) files, in good faith, or indicates an intention to file a maltreatment report, whether
mandatory or voluntary, under section 626.557;
(4) seeks assistance from or reports a reasonable suspicion of a crime or systemic
problems or concerns to the director or manager of the facility, the Office of Ombudsman
for Long-Term Care, new text begin the Office of Ombudsman for Mental Health and Developmental
Disabilities, new text end a regulatory or other government agency, or a legal or advocacy organization;
(5) advocates or seeks advocacy assistance for necessary or improved care or services
or enforcement of rights under this section or other law;
(6) takes or indicates an intention to take civil action;
(7) participates or indicates an intention to participate in any investigation or
administrative or judicial proceeding;
(8) contracts or indicates an intention to contract to receive services from a service
provider of the resident's choice other than the facility; or
(9) places or indicates an intention to place a camera or electronic monitoring device in
the resident's private space as provided under section 144.6502.
Sec. 66.
Minnesota Statutes 2020, section 144G.93, is amended to read:
144G.93 CONSUMER ADVOCACY AND LEGAL SERVICES.
Upon execution of an assisted living contract, every facility must provide the resident
with the names and contact information, including telephone numbers and e-mail addresses,
of:
(1) nonprofit organizations that provide advocacy or legal services to residents including
but not limited to the designated protection and advocacy organization in Minnesota that
provides advice and representation to individuals with disabilities; and
(2) the Office of Ombudsman for Long-Term Caredeleted text begin , including both the state and regional
contact informationdeleted text end new text begin and the Office of Ombudsman for Mental Health and Developmental
Disabilitiesnew text end .
Sec. 67.
Minnesota Statutes 2020, section 144G.95, is amended to read:
144G.95 OFFICE OF OMBUDSMAN FOR LONG-TERM CAREnew text begin AND OFFICE
OF OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL
DISABILITIESnew text end .
Subdivision 1.
Immunity from liability.
new text begin (a) new text end The Office of Ombudsman for Long-Term
Care and representatives of the office are immune from liability for conduct described in
section 256.9742, subdivision 2.
new text begin
(b) The Office of Ombudsman for Mental Health and Developmental Disabilities and
representatives of the office are immune from liability for conduct described in section
245.96.
new text end
Subd. 2.
Data classification.
new text begin (a) new text end All forms and notices received by the Office of
Ombudsman for Long-Term Care under this chapter are classified under section 256.9744.
new text begin
(b) All data collected or received by the Office of Ombudsman for Mental Health and
Developmental Disabilities are classified under section 245.94.
new text end
Sec. 68.
new text begin
[145.9231] HEALTH EQUITY ADVISORY AND LEADERSHIP (HEAL)
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; composition of advisory council. new text end
new text begin
(a) The commissioner
shall establish and appoint a Health Equity Advisory and Leadership (HEAL) Council to
provide guidance to the commissioner of health regarding strengthening and improving the
health of communities most impacted by health inequities across the state. The council shall
consist of 18 members who will provide representation from the following groups:
new text end
new text begin
(1) African American and African heritage communities;
new text end
new text begin
(2) Asian American and Pacific Islander communities;
new text end
new text begin
(3) Latina/o/x communities;
new text end
new text begin
(4) American Indian communities and Tribal Government/Nations;
new text end
new text begin
(5) disability communities;
new text end
new text begin
(6) lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities; and
new text end
new text begin
(7) representatives who reside outside the seven-county metropolitan area.
new text end
new text begin
(b) No members shall be employees of the Minnesota Department of Health.
new text end
new text begin Subd. 2. new text end
new text begin Organization and meetings. new text end
new text begin
The advisory council shall be organized and
administered under section 15.059, except that the members do not receive per diem
compensation. Meetings shall be held at least quarterly and hosted by the department.
Subcommittees may be developed as necessary. Advisory council meetings are subject to
Open Meeting Law under chapter 13D.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
The advisory council shall:
new text end
new text begin
(1) advise the commissioner on health equity issues and the health equity priorities and
concerns of the populations specified in subdivision 1;
new text end
new text begin
(2) assist the agency in efforts to advance health equity, including consulting in specific
agency policies and programs, providing ideas and input about potential budget and policy
proposals, and recommending review of particular agency policies, standards, or procedures
that may create or perpetuate health inequities; and
new text end
new text begin
(3) assist the agency in developing and monitoring meaningful performance measures
related to advancing health equity.
new text end
new text begin Subd. 4. new text end
new text begin Expiration. new text end
new text begin
Notwithstanding section 15.059, subdivision 6, the advisory council
shall remain in existence until health inequities in the state are eliminated. Health inequities
will be considered eliminated when race, ethnicity, income, gender, gender identity,
geographic location, or other identity or social marker will no longer be predictors of health
outcomes in the state. Section 145.928 describes nine health disparities that must be
considered when determining whether health inequities have been eliminated in the state.
new text end
Sec. 69.
Minnesota Statutes 2020, section 146B.04, subdivision 1, is amended to read:
Subdivision 1.
General.
Before an individual may work as a guest artist, the
commissioner shall issue a temporary license to the guest artist. The guest artist shall submit
an application to the commissioner on a form provided by the commissioner. new text begin The
commissioner must receive the application at least 14 calendar days before the guest artist
applicant conducts a body art procedure. new text end The form must include:
(1) the name, home address, and date of birth of the guest artist;
(2) the name of the licensed technician sponsoring the guest artist;
(3) proof of having satisfactorily completed coursework within the year preceding
application and approved by the commissioner on bloodborne pathogens, the prevention of
disease transmission, infection control, and aseptic technique;
(4) the starting and anticipated completion dates the guest artist will be working; and
(5) a copy of any current body art credential or licensure issued by another local or state
jurisdiction.
Sec. 70.
Minnesota Statutes 2020, section 152.22, subdivision 8, is amended to read:
Subd. 8.
Medical cannabis deleted text begin productdeleted text end new text begin paraphernalianew text end .
"Medical cannabis deleted text begin productdeleted text end new text begin
paraphernalianew text end " means any delivery device or related supplies and educational materials used
in the administration of medical cannabis for a patient with a qualifying medical condition
enrolled in the registry program.
Sec. 71.
Minnesota Statutes 2020, section 152.25, subdivision 1, is amended to read:
Subdivision 1.
Medical cannabis manufacturer registration.
(a) The commissioner
shall register two in-state manufacturers for the production of all medical cannabis within
the state. A registration agreement between the commissioner and a manufacturer is
nontransferable. The commissioner shall register new manufacturers or reregister the existing
manufacturers by December 1 every two years, using the factors described in this subdivision.
The commissioner shall accept applications after December 1, 2014, if one of the
manufacturers registered before December 1, 2014, ceases to be registered as a manufacturer.
The commissioner's determination that no manufacturer exists to fulfill the duties under
sections 152.22 to 152.37 is subject to judicial review in Ramsey County District Court.
Data submitted during the application process are private data on individuals or nonpublic
data as defined in section 13.02 until the manufacturer is registered under this section. Data
on a manufacturer that is registered are public data, unless the data are trade secret or security
information under section 13.37.
(b) As a condition for registration, a manufacturer must agree to:
(1) begin supplying medical cannabis to patients deleted text begin by July 1, 2015deleted text end new text begin within eight months
of its initial registrationnew text end ; and
(2) comply with all requirements under sections 152.22 to 152.37.
(c) The commissioner shall consider the following factors when determining which
manufacturer to register:
(1) the technical expertise of the manufacturer in cultivating medical cannabis and
converting the medical cannabis into an acceptable delivery method under section 152.22,
subdivision 6;
(2) the qualifications of the manufacturer's employees;
(3) the long-term financial stability of the manufacturer;
(4) the ability to provide appropriate security measures on the premises of the
manufacturer;
(5) whether the manufacturer has demonstrated an ability to meet the medical cannabis
production needs required by sections 152.22 to 152.37; and
(6) the manufacturer's projection and ongoing assessment of fees on patients with a
qualifying medical condition.
(d) If an officer, director, or controlling person of the manufacturer pleads or is found
guilty of intentionally diverting medical cannabis to a person other than allowed by law
under section 152.33, subdivision 1, the commissioner may decide not to renew the
registration of the manufacturer, provided the violation occurred while the person was an
officer, director, or controlling person of the manufacturer.
(e) The commissioner shall require each medical cannabis manufacturer to contract with
an independent laboratory to test medical cannabis produced by the manufacturer. The
commissioner shall approve the laboratory chosen by each manufacturer and require that
the laboratory report testing results to the manufacturer in a manner determined by the
commissioner.
new text begin
(f) The commissioner shall implement a state-centralized medical cannabis electronic
database to monitor and track the manufacturers' medical cannabis inventories from the
seed or clone source through cultivation, processing, testing, and distribution or disposal.
The inventory tracking database must allow for information regarding medical cannabis to
be updated instantaneously. Any manufacturer or third-party laboratory licensed under this
chapter must submit to the commissioner any information the commissioner deems necessary
for maintaining the inventory tracking database. The commissioner may contract with a
separate entity to establish and maintain all or any part of the inventory tracking database.
The provisions of section 13.05, subdivision 11, apply to a contract entered between the
commissioner and a third party under this paragraph.
new text end
Sec. 72.
Minnesota Statutes 2021 Supplement, section 152.27, subdivision 2, is amended
to read:
Subd. 2.
Commissioner duties.
(a) The commissioner shall:
(1) give notice of the program to health care practitioners in the state who are eligible
to serve as health care practitioners and explain the purposes and requirements of the
program;
(2) allow each health care practitioner who meets or agrees to meet the program's
requirements and who requests to participate, to be included in the registry program to
collect data for the patient registry;
(3) provide explanatory information and assistance to each health care practitioner in
understanding the nature of therapeutic use of medical cannabis within program requirements;
(4) create and provide a certification to be used by a health care practitioner for the
practitioner to certify whether a patient has been diagnosed with a qualifying medical
condition deleted text begin and include in the certification an option for the practitioner to certify whether
the patient, in the health care practitioner's medical opinion, is developmentally or physically
disabled and, as a result of that disability, the patient requires assistance in administering
medical cannabis or obtaining medical cannabis from a distribution facilitydeleted text end ;
(5) supervise the participation of the health care practitioner in conducting patient
treatment and health records reporting in a manner that ensures stringent security and
record-keeping requirements and that prevents the unauthorized release of private data on
individuals as defined by section 13.02;
(6) develop safety criteria for patients with a qualifying medical condition as a
requirement of the patient's participation in the program, to prevent the patient from
undertaking any task under the influence of medical cannabis that would constitute negligence
or professional malpractice on the part of the patient; and
(7) conduct research and studies based on data from health records submitted to the
registry program and submit reports on intermediate or final research results to the legislature
and major scientific journals. The commissioner may contract with a third party to complete
the requirements of this clause. Any reports submitted must comply with section 152.28,
subdivision 2.
(b) The commissioner may add a delivery method under section 152.22, subdivision 6,
or add, remove, or modify a qualifying medical condition under section 152.22, subdivision
14, upon a petition from a member of the public or the task force on medical cannabis
therapeutic research or as directed by law. The commissioner shall evaluate all petitions to
add a qualifying medical condition or to remove or modify an existing qualifying medical
condition submitted by the task force on medical cannabis therapeutic research or as directed
by law and may make the addition, removal, or modification if the commissioner determines
the addition, removal, or modification is warranted based on the best available evidence
and research. If the commissioner wishes to add a delivery method under section 152.22,
subdivision 6, or add or remove a qualifying medical condition under section 152.22,
subdivision 14, the commissioner must notify the chairs and ranking minority members of
the legislative policy committees having jurisdiction over health and public safety of the
addition or removal and the reasons for its addition or removal, including any written
comments received by the commissioner from the public and any guidance received from
the task force on medical cannabis research, by January 15 of the year in which the
commissioner wishes to make the change. The change shall be effective on August 1 of that
year, unless the legislature by law provides otherwise.
Sec. 73.
Minnesota Statutes 2021 Supplement, section 152.29, subdivision 1, is amended
to read:
Subdivision 1.
Manufacturer; requirements.
(a) A manufacturer may operate eight
distribution facilities, which may include the manufacturer's single location for cultivation,
harvesting, manufacturing, packaging, and processing but is not required to include that
location. The commissioner shall designate the geographical service areas to be served by
each manufacturer based on geographical need throughout the state to improve patient
access. A manufacturer shall not have more than two distribution facilities in each
geographical service area assigned to the manufacturer by the commissioner. A manufacturer
shall operate only one location where all cultivation, harvesting, manufacturing, packaging,
and processing of medical cannabis shall be conducted. This location may be one of the
manufacturer's distribution facility sites. The additional distribution facilities may dispense
medical cannabis and medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end but may not contain any
medical cannabis in a form other than those forms allowed under section 152.22, subdivision
6, and the manufacturer shall not conduct any cultivation, harvesting, manufacturing,
packaging, or processing at the other distribution facility sites. Any distribution facility
operated by the manufacturer is subject to all of the requirements applying to the
manufacturer under sections 152.22 to 152.37, including, but not limited to, security and
distribution requirements.
(b) A manufacturer may acquire hemp grown in this state from a hemp grower, and may
acquire hemp products produced by a hemp processor. A manufacturer may manufacture
or process hemp and hemp products into an allowable form of medical cannabis under
section 152.22, subdivision 6. Hemp and hemp products acquired by a manufacturer under
this paragraph are subject to the same quality control program, security and testing
requirements, and other requirements that apply to medical cannabis under sections 152.22
to 152.37 and Minnesota Rules, chapter 4770.
(c) A medical cannabis manufacturer shall contract with a laboratory approved by the
commissioner, subject to any additional requirements set by the commissioner, for purposes
of testing medical cannabis manufactured or hemp or hemp products acquired by the medical
cannabis manufacturer as to content, contamination, and consistency to verify the medical
cannabis meets the requirements of section 152.22, subdivision 6.new text begin The laboratory must
collect, or contract with a third party that is not a manufacturer to collect, from the
manufacturer's production facility the medical cannabis samples it will test.new text end The cost ofnew text begin
collecting samples andnew text end laboratory testing shall be paid by the manufacturer.
(d) The operating documents of a manufacturer must include:
(1) procedures for the oversight of the manufacturer and procedures to ensure accurate
record keeping;
(2) procedures for the implementation of appropriate security measures to deter and
prevent the theft of medical cannabis and unauthorized entrance into areas containing medical
cannabis; and
(3) procedures for the delivery and transportation of hemp between hemp growers and
manufacturers and for the delivery and transportation of hemp products between hemp
processors and manufacturers.
(e) A manufacturer shall implement security requirements, including requirements for
the delivery and transportation of hemp and hemp products, protection of each location by
a fully operational security alarm system, facility access controls, perimeter intrusion
detection systems, and a personnel identification system.
(f) A manufacturer shall not share office space with, refer patients to a health care
practitioner, or have any financial relationship with a health care practitioner.
(g) A manufacturer shall not permit any person to consume medical cannabis on the
property of the manufacturer.
(h) A manufacturer is subject to reasonable inspection by the commissioner.
(i) For purposes of sections 152.22 to 152.37, a medical cannabis manufacturer is not
subject to the Board of Pharmacy licensure or regulatory requirements under chapter 151.
(j) A medical cannabis manufacturer may not employ any person who is under 21 years
of age or who has been convicted of a disqualifying felony offense. An employee of a
medical cannabis manufacturer must submit a completed criminal history records check
consent form, a full set of classifiable fingerprints, and the required fees for submission to
the Bureau of Criminal Apprehension before an employee may begin working with the
manufacturer. The bureau must conduct a Minnesota criminal history records check and
the superintendent is authorized to exchange the fingerprints with the Federal Bureau of
Investigation to obtain the applicant's national criminal history record information. The
bureau shall return the results of the Minnesota and federal criminal history records checks
to the commissioner.
(k) A manufacturer may not operate in any location, whether for distribution or
cultivation, harvesting, manufacturing, packaging, or processing, within 1,000 feet of a
public or private school existing before the date of the manufacturer's registration with the
commissioner.
(l) A manufacturer shall comply with reasonable restrictions set by the commissioner
relating to signage, marketing, display, and advertising of medical cannabis.
(m) Before a manufacturer acquires hemp from a hemp grower or hemp products from
a hemp processor, the manufacturer must verify that the hemp grower or hemp processor
has a valid license issued by the commissioner of agriculture under chapter 18K.
(n) Until a state-centralized, seed-to-sale system is implemented that can track a specific
medical cannabis plant from cultivation through testing and point of sale, the commissioner
shall conduct at least one unannounced inspection per year of each manufacturer that includes
inspection of:
(1) business operations;
(2) physical locations of the manufacturer's manufacturing facility and distribution
facilities;
(3) financial information and inventory documentation, including laboratory testing
results; and
(4) physical and electronic security alarm systems.
Sec. 74.
Minnesota Statutes 2021 Supplement, section 152.29, subdivision 3, is amended
to read:
Subd. 3.
Manufacturer; distribution.
(a) A manufacturer shall require that employees
licensed as pharmacists pursuant to chapter 151 be the only employees to give final approval
for the distribution of medical cannabis to a patient. A manufacturer may transport medical
cannabis or medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end that have been cultivated, harvested,
manufactured, packaged, and processed by that manufacturer to another registered
manufacturer for the other manufacturer to distribute.
(b) A manufacturer may distribute medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end , whether
or not the deleted text begin productsdeleted text end new text begin medical cannabis paraphernalianew text end have been manufactured by that
manufacturer.
(c) Prior to distribution of any medical cannabis, the manufacturer shall:
(1) verify that the manufacturer has received the registry verification from the
commissioner for that individual patient;
(2) verify that the person requesting the distribution of medical cannabis is the patient,
the patient's registered designated caregiver, or the patient's parent, legal guardian, or spouse
listed in the registry verification using the procedures described in section 152.11, subdivision
2d;
(3) assign a tracking number to any medical cannabis distributed from the manufacturer;
(4) ensure that any employee of the manufacturer licensed as a pharmacist pursuant to
chapter 151 has consulted with the patient to determine the proper dosage for the individual
patient after reviewing the ranges of chemical compositions of the medical cannabis and
the ranges of proper dosages reported by the commissioner. For purposes of this clause, a
consultation may be conducted remotely by secure videoconference, telephone, or other
remote means, so long as the employee providing the consultation is able to confirm the
identity of the patient and the consultation adheres to patient privacy requirements that apply
to health care services delivered through telehealth. A pharmacist consultation under this
clause is not required when a manufacturer is distributing medical cannabis to a patient
according to a patient-specific dosage plan established with that manufacturer and is not
modifying the dosage or product being distributed under that plan and the medical cannabis
is distributed by a pharmacy technician;
(5) properly package medical cannabis in compliance with the United States Poison
Prevention Packing Act regarding child-resistant packaging and exemptions for packaging
for elderly patients, and label distributed medical cannabis with a list of all active ingredients
and individually identifying information, including:
(i) the patient's name and date of birth;
(ii) the name and date of birth of the patient's registered designated caregiver or, if listed
on the registry verification, the name of the patient's parent or legal guardian, if applicable;
(iii) the patient's registry identification number;
(iv) the chemical composition of the medical cannabis; and
(v) the dosage; and
(6) ensure that the medical cannabis distributed contains a maximum of a 90-day supply
of the dosage determined for that patient.
(d) A manufacturer shall require any employee of the manufacturer who is transporting
medical cannabis or medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end to a distribution facility or to
another registered manufacturer to carry identification showing that the person is an employee
of the manufacturer.
(e) A manufacturer shall distribute medical cannabis in dried raw cannabis form only
to a patient age 21 or older, or to the registered designated caregiver, parent, legal guardian,
or spouse of a patient age 21 or older.
Sec. 75.
Minnesota Statutes 2020, section 152.29, subdivision 3a, is amended to read:
Subd. 3a.
Transportation of medical cannabis; new text begin transport new text end staffing.
(a) A medical
cannabis manufacturer may staff a transport motor vehicle with only one employee if the
medical cannabis manufacturer is transporting medical cannabis to deleted text begin either a certified
laboratory for the purpose of testing ordeleted text end a facility for the purpose of disposal. If the medical
cannabis manufacturer is transporting medical cannabis for any other purpose or destination,
the transport motor vehicle must be staffed with a minimum of two employees as required
by rules adopted by the commissioner.
(b) Notwithstanding paragraph (a), a medical cannabis manufacturer that is only
transporting hemp for any purpose may staff the transport motor vehicle with only one
employee.
new text begin
(c) A medical cannabis manufacturer may contract with a third party for armored car
services for deliveries of medical cannabis from its production facility to distribution
facilities. A medical cannabis manufacturer that contracts for armored car services remains
responsible for compliance with transportation manifest and inventory tracking requirements
in rules adopted by the commissioner.
new text end
new text begin
(d) A third-party testing laboratory may staff a transport motor vehicle with one or more
employees when transporting medical cannabis from a manufacturer's production facility
to the testing laboratory for the purpose of testing samples.
new text end
new text begin
(e) Department of Health staff may transport medical cannabis for the purposes of
delivering medical cannabis and other samples to a laboratory for testing under rules adopted
by the commissioner and in cases of special investigations when the commissioner has
determined there is a potential threat to public health. The transport motor vehicle must be
staffed by a minimum of two Department of Health employees. The employees must carry
their Department of Health identification cards and a transport manifest that meets the
requirements in Minnesota Rules, part 4770.1100, subpart 2.
new text end
new text begin
(f) A Tribal medical cannabis program operated by a federally recognized Indian Tribe
located within the state of Minnesota may transport samples of medical cannabis to testing
laboratories and to other Indian lands in the state. Transport vehicles must be staffed by at
least two employees of the Tribal medical cannabis program. Transporters must carry
identification identifying them as employees of the Tribal medical cannabis program and
a detailed transportation manifest that includes the place and time of departure, the address
of the destination, and a description and count of the medical cannabis being transported.
new text end
Sec. 76.
Minnesota Statutes 2020, section 152.30, is amended to read:
152.30 PATIENT DUTIES.
(a) A patient shall apply to the commissioner for enrollment in the registry program by
submitting an application as required in section 152.27 and an annual registration fee as
determined under section 152.35.
(b) As a condition of continued enrollment, patients shall agree to:
(1) continue to receive regularly scheduled treatment for their qualifying medical
condition from their health care practitioner; and
(2) report changes in their qualifying medical condition to their health care practitioner.
(c) A patient shall only receive medical cannabis from a registered manufacturer but is
not required to receive medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end from only a registered
manufacturer.
Sec. 77.
Minnesota Statutes 2020, section 152.32, subdivision 2, is amended to read:
Subd. 2.
Criminal and civil protections.
(a) Subject to section 152.23, the following
are not violations under this chapter:
(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry program, or possession by a registered designated caregiver or the
parent, legal guardian, or spouse of a patient if the parent, legal guardian, or spouse is listed
on the registry verification;
(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and
(3) possession of medical cannabis or medical cannabis deleted text begin productsdeleted text end new text begin paraphernalianew text end by any
person while carrying out the duties required under sections 152.22 to 152.37.
(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.
(c) The commissioner, the commissioner's staff, the commissioner's agents or contractors,
and any health care practitioner are not subject to any civil or disciplinary penalties by the
Board of Medical Practice, the Board of Nursing, or by any business, occupational, or
professional licensing board or entity, solely for the participation in the registry program
under sections 152.22 to 152.37. A pharmacist licensed under chapter 151 is not subject to
any civil or disciplinary penalties by the Board of Pharmacy when acting in accordance
with the provisions of sections 152.22 to 152.37. Nothing in this section affects a professional
licensing board from taking action in response to violations of any other section of law.
(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.
(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.
(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.
(g) No information contained in a report, document, or registry or obtained from a patient
under sections 152.22 to 152.37 may be admitted as evidence in a criminal proceeding
unless independently obtained or in connection with a proceeding involving a violation of
sections 152.22 to 152.37.
(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.
(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Court or professional responsibility board for providing legal assistance to prospective or
registered manufacturers or others related to activity that is no longer subject to criminal
penalties under state law pursuant to sections 152.22 to 152.37.
(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry program does not constitute
probable cause or reasonable suspicion, nor shall it be used to support a search of the person
or property of the person possessing or applying for the registry verification, or otherwise
subject the person or property of the person to inspection by any governmental agency.
Sec. 78.
Minnesota Statutes 2020, section 152.36, is amended to read:
152.36 IMPACT ASSESSMENT OF MEDICAL CANNABIS THERAPEUTIC
RESEARCH.
Subdivision 1.
Task force on medical cannabis therapeutic research.
(a) A 23-member
task force on medical cannabis therapeutic research is created to conduct an impact
assessment of medical cannabis therapeutic research. The task force shall consist of the
following members:
(1) two members of the house of representatives, one selected by the speaker of the
house, the other selected by the minority leader;
(2) two members of the senate, one selected by the majority leader, the other selected
by the minority leader;
(3) four members representing consumers or patients enrolled in the registry program,
including at least two parents of patients under age 18;
(4) four members representing health care providers, including one licensed pharmacist;
(5) four members representing law enforcement, one from the Minnesota Chiefs of
Police Association, one from the Minnesota Sheriff's Association, one from the Minnesota
Police and Peace Officers Association, and one from the Minnesota County Attorneys
Association;
(6) four members representing substance use disorder treatment providers; and
(7) the commissioners of health, human services, and public safety.
(b) Task force members listed under paragraph (a), clauses (3), (4), (5), and (6), shall
be appointed by the governor under the appointment process in section 15.0597. Members
shall serve on the task force at the pleasure of the appointing authority. deleted text begin All members must
be appointed by July 15, 2014, and the commissioner of health shall convene the first meeting
of the task force by August 1, 2014.
deleted text end
(c) There shall be two cochairs of the task force chosen from the members listed under
paragraph (a). One cochair shall be selected by the speaker of the house and the other cochair
shall be selected by the majority leader of the senate. The authority to convene meetings
shall alternate between the cochairs.
(d) Members of the task force other than those in paragraph (a), clauses (1), (2), and (7),
shall receive expenses as provided in section 15.059, subdivision 6.
Subd. 1a.
Administration.
The commissioner of health shall provide administrative and
technical support to the task force.
Subd. 2.
Impact assessment.
The task force shall hold hearings to evaluate the impact
of the use of medical cannabis and hemp and Minnesota's activities involving medical
cannabis and hemp, including, but not limited to:
(1) program design and implementation;
(2) the impact on the health care provider community;
(3) patient experiences;
(4) the impact on the incidence of substance abuse;
(5) access to and quality of medical cannabis, hemp, and medical cannabis deleted text begin productsdeleted text end new text begin
paraphernalianew text end ;
(6) the impact on law enforcement and prosecutions;
(7) public awareness and perception; and
(8) any unintended consequences.
deleted text begin Subd. 3. deleted text end
deleted text begin Cost assessment. deleted text end
deleted text begin
By January 15 of each year, beginning January 15, 2015,
and ending January 15, 2019, the commissioners of state departments impacted by the
medical cannabis therapeutic research study shall report to the cochairs of the task force on
the costs incurred by each department on implementing sections 152.22 to 152.37. The
reports must compare actual costs to the estimated costs of implementing these sections and
must be submitted to the task force on medical cannabis therapeutic research.
deleted text end
Subd. 4.
Reports to the legislature.
(a) The cochairs of the task force shall submit deleted text begin the
following reportsdeleted text end new text begin an impact assessment reportnew text end to the chairs and ranking minority members
of the legislative committees and divisions with jurisdiction over health and human services,
public safety, judiciary, and civil lawdeleted text begin :
deleted text end
deleted text begin (1)deleted text end by February 1, 2015, deleted text begin a report on the design and implementation of the registry
program;deleted text end and every two years thereafterdeleted text begin , a complete impact assessment report; anddeleted text end new text begin .
new text end
deleted text begin
(2) upon receipt of a cost assessment from a commissioner of a state agency, the
completed cost assessment.
deleted text end
(b) The task force may make recommendations to the legislature on whether to add or
remove conditions from the list of qualifying medical conditions.
Subd. 5.
No expiration.
The task force on medical cannabis therapeutic research does
not expire.
Sec. 79. new text begin COMMISSIONER OF HEALTH; RECOMMENDATION REGARDING
EXCEPTION TO HOSPITAL CONSTRUCTION MORATORIUM.
new text end
new text begin
By February 1, 2023, the commissioner of health, in consultation with the commissioner
of human services, shall make a recommendation to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services finance as
to whether Minnesota Statutes, section 144.551, subdivision 1, should be amended to
authorize exceptions, for hospitals in other counties and without a public interest review,
that are substantially similar to the exception in Minnesota Statutes, section 144.551,
subdivision 1, paragraph (b), clause (31).
new text end
Sec. 80. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall change the term "cancer surveillance system" to "cancer
reporting system" wherever it appears in Minnesota Statutes and Minnesota Rules.
new text end
new text begin
(b) The revisor of statutes shall make any necessary cross-reference changes required
as a result of the amendments in this article to Minnesota Statutes, sections 144A.01;
144A.03, subdivision 1; 144A.04, subdivisions 4 and 6; and 144A.06.
new text end
Sec. 81. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2021 Supplement, section 144G.07, subdivision 6,
new text end
new text begin
is repealed.
new text end
ARTICLE 3
HEALTH CARE FINANCE
Section 1.
new text begin
[62J.86] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
For the purposes of sections 62J.86 to 62J.92, the following
terms have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Advisory council. new text end
new text begin
"Advisory council" means the Health Care Affordability
Advisory Council established under section 62J.88.
new text end
new text begin Subd. 3. new text end
new text begin Board. new text end
new text begin
"Board" means the Health Care Affordability Board established under
section 62J.87.
new text end
Sec. 2.
new text begin
[62J.87] HEALTH CARE AFFORDABILITY BOARD.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The Health Care Affordability Board is established and
shall be governed as a board under section 15.012, paragraph (a), to protect consumers,
state and local governments, health plan companies, providers, and other health care system
stakeholders from unaffordable health care costs. The board must be operational by January
1, 2023.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The Health Care Affordability Board consists of 13 members,
appointed as follows:
new text end
new text begin
(1) five members appointed by the governor;
new text end
new text begin
(2) two members appointed by the majority leader of the senate;
new text end
new text begin
(3) two members appointed by the minority leader of the senate;
new text end
new text begin
(4) two members appointed by the speaker of the house; and
new text end
new text begin
(5) two members appointed by the minority leader of the house of representatives.
new text end
new text begin
(b) All appointed members must have knowledge and demonstrated expertise in one or
more of the following areas: health care finance, health economics, health care management
or administration at a senior level, health care consumer advocacy, representing the health
care workforce as a leader in a labor organization, purchasing health care insurance as a
health benefits administrator, delivery of primary care, health plan company administration,
public or population health, and addressing health disparities and structural inequities.
new text end
new text begin
(c) A member may not participate in board proceedings involving an organization,
activity, or transaction in which the member has either a direct or indirect financial interest,
other than as an individual consumer of health services.
new text end
new text begin
(d) The Legislative Coordinating Commission shall coordinate appointments under this
subdivision to ensure that board members are appointed by August 1, 2022, and that board
members as a whole meet all of the criteria related to the knowledge and expertise specified
in paragraph (b).
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) Board appointees shall serve four-year terms. A board member shall
not serve more than three consecutive terms.
new text end
new text begin
(b) A board member may resign at any time by giving written notice to the board.
new text end
new text begin Subd. 4. new text end
new text begin Chair; other officers. new text end
new text begin
(a) The governor shall designate an acting chair from
the members appointed by the governor.
new text end
new text begin
(b) The board shall elect a chair to replace the acting chair at the first meeting of the
board by a majority of the members. The chair shall serve for two years.
new text end
new text begin
(c) The board shall elect a vice-chair and other officers from its membership as it deems
necessary.
new text end
new text begin Subd. 5. new text end
new text begin Staff; technical assistance; contracting. new text end
new text begin
(a) The board shall hire a full-time
executive director and other staff, who shall serve in the unclassified service. The executive
director must have significant knowledge and expertise in health economics and demonstrated
experience in health policy.
new text end
new text begin
(b) The attorney general shall provide legal services to the board.
new text end
new text begin
(c) The Department of Health shall provide technical assistance to the board in analyzing
health care trends and costs and in setting health care spending growth targets.
new text end
new text begin
(d) The board may employ or contract for professional and technical assistance, including
actuarial assistance, as the board deems necessary to perform the board's duties.
new text end
new text begin Subd. 6. new text end
new text begin Access to information. new text end
new text begin
(a) The board may request that a state agency provide
the board with any publicly available information in a usable format as requested by the
board, at no cost to the board.
new text end
new text begin
(b) The board may request from a state agency unique or custom data sets, and the agency
may charge the board for providing the data at the same rate the agency would charge any
other public or private entity.
new text end
new text begin
(c) Any information provided to the board by a state agency must be de-identified. For
purposes of this subdivision, "de-identification" means the process used to prevent the
identity of a person or business from being connected with the information and ensuring
all identifiable information has been removed.
new text end
new text begin
(d) Any data submitted to the board retains its original classification under the Minnesota
Data Practices Act in chapter 13.
new text end
new text begin Subd. 7. new text end
new text begin Compensation. new text end
new text begin
Board members shall not receive compensation but may receive
reimbursement for expenses as authorized under section 15.059, subdivision 3.
new text end
new text begin Subd. 8. new text end
new text begin Meetings. new text end
new text begin
(a) Meetings of the board are subject to chapter 13D. The board shall
meet publicly at least quarterly. The board may meet in closed session when reviewing
proprietary information as specified in section 62J.71, subdivision 4.
new text end
new text begin
(b) The board shall announce each public meeting at least two weeks prior to the
scheduled date of the meeting. Any materials for the meeting must be made public at least
one week prior to the scheduled date of the meeting.
new text end
new text begin
(c) At each public meeting, the board shall provide the opportunity for comments from
the public, including the opportunity for written comments to be submitted to the board
prior to a decision by the board.
new text end
Sec. 3.
new text begin
[62J.88] HEALTH CARE AFFORDABILITY ADVISORY COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The governor shall appoint a Health Care Affordability
Advisory Council of up to 15 members to provide advice to the board on health care costs
and access issues and to represent the views of patients and other stakeholders. Members
of the advisory council must be appointed based on their knowledge and demonstrated
expertise in one or more of the following areas: health care delivery, ensuring health care
access for diverse populations, public and population health, patient perspectives, health
care cost trends and drivers, clinical and health services research, innovation in health care
delivery, and health care benefits management.
new text end
new text begin Subd. 2. new text end
new text begin Duties; reports. new text end
new text begin
(a) The council shall provide technical recommendations to
the board on:
new text end
new text begin
(1) the identification of economic indicators and other metrics related to the development
and setting of health care spending growth targets;
new text end
new text begin
(2) data sources for measuring health care spending; and
new text end
new text begin
(3) measurement of the impact of health care spending growth targets on diverse
communities and populations, including but not limited to those communities and populations
adversely affected by health disparities.
new text end
new text begin
(b) The council shall report technical recommendations and a summary of its activities
to the board at least annually, and shall submit additional reports on its activities and
recommendations to the board, as requested by the board or at the discretion of the council.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) The initial appointed advisory council members shall serve staggered
terms of two, three, or four years determined by lot by the secretary of state. Following the
initial appointments, advisory council members shall serve four-year terms.
new text end
new text begin
(b) Removal and vacancies of advisory council members are governed by section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Compensation. new text end
new text begin
Advisory council members may be compensated according to
section 15.059.
new text end
new text begin Subd. 5. new text end
new text begin Meetings. new text end
new text begin
The advisory council shall meet at least quarterly. Meetings of the
advisory council are subject to chapter 13D.
new text end
new text begin Subd. 6. new text end
new text begin Exemption. new text end
new text begin
Notwithstanding section 15.059, the advisory council shall not
expire.
new text end
Sec. 4.
new text begin
[62J.89] DUTIES OF THE BOARD.
new text end
new text begin Subdivision 1. new text end
new text begin General. new text end
new text begin
(a) The board shall monitor the administration and reform of
the health care delivery and payment systems in the state. The board shall:
new text end
new text begin
(1) set health care spending growth targets for the state, as specified under section 62J.90;
new text end
new text begin
(2) enhance the transparency of provider organizations;
new text end
new text begin
(3) monitor the adoption and effectiveness of alternative payment methodologies;
new text end
new text begin
(4) foster innovative health care delivery and payment models that lower health care
cost growth while improving the quality of patient care;
new text end
new text begin
(5) monitor and review the impact of changes within the health care marketplace; and
new text end
new text begin
(6) monitor patient access to necessary health care services.
new text end
new text begin
(b) The board shall establish goals to reduce health care disparities in racial and ethnic
communities and to ensure access to quality care for persons with disabilities or with chronic
or complex health conditions.
new text end
new text begin Subd. 2. new text end
new text begin Market trends. new text end
new text begin
The board shall monitor efforts to reform the health care
delivery and payment system in Minnesota to understand emerging trends in the commercial
health insurance market, including large self-insured employers and the state's public health
care programs, in order to identify opportunities for state action to achieve:
new text end
new text begin
(1) improved patient experience of care, including quality and satisfaction;
new text end
new text begin
(2) improved health of all populations, including a reduction in health disparities; and
new text end
new text begin
(3) a reduction in the growth of health care costs.
new text end
new text begin Subd. 3. new text end
new text begin Recommendations for reform. new text end
new text begin
The board shall recommend legislative policy,
market, or any other reforms to:
new text end
new text begin
(1) lower the rate of growth in commercial health care costs and public health care
program spending in the state;
new text end
new text begin
(2) positively impact the state's rankings in the areas listed in this subdivision and
subdivision 2; and
new text end
new text begin
(3) improve the quality and value of care for all Minnesotans, and for specific populations
adversely affected by health inequities.
new text end
new text begin Subd. 4. new text end
new text begin Office of Patient Protection. new text end
new text begin
The board shall establish an Office of Patient
Protection, to be operational by January 1, 2024. The office shall assist consumers with
issues related to access and quality of health care, and advise the legislature on ways to
reduce consumer health care spending and improve consumer experiences by reducing
complexity for consumers.
new text end
Sec. 5.
new text begin
[62J.90] HEALTH CARE SPENDING GROWTH TARGETS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment and administration. new text end
new text begin
The board shall establish and
administer the health care spending growth target program to limit health care spending
growth in the state, and shall report regularly to the legislature and the public on progress
toward these targets.
new text end
new text begin Subd. 2. new text end
new text begin Methodology. new text end
new text begin
(a) The board shall develop a methodology to establish annual
health care spending growth targets and the economic indicators to be used in establishing
the initial and subsequent target levels.
new text end
new text begin
(b) The health care spending growth target must:
new text end
new text begin
(1) use a clear and operational definition of total state health care spending;
new text end
new text begin
(2) promote a predictable and sustainable rate of growth for total health care spending
as measured by an established economic indicator, such as the rate of increase of the state's
economy or of the personal income of residents of this state, or a combination;
new text end
new text begin
(3) define the health care markets and the entities to which the targets apply;
new text end
new text begin
(4) take into consideration the potential for variability in targets across public and private
payers;
new text end
new text begin
(5) account for the health status of patients; and
new text end
new text begin
(6) incorporate specific benchmarks related to health equity.
new text end
new text begin
(c) In developing, implementing, and evaluating the growth target program, the board
shall:
new text end
new text begin
(1) consider the incorporation of quality of care and primary care spending goals;
new text end
new text begin
(2) ensure that the program does not place a disproportionate burden on communities
most impacted by health disparities, the providers who primarily serve communities most
impacted by health disparities, or individuals who reside in rural areas or have high health
care needs;
new text end
new text begin
(3) explicitly consider payment models that help ensure financial sustainability of rural
health care delivery systems and the ability to provide population health;
new text end
new text begin
(4) allow setting growth targets that encourage an individual health care entity to serve
populations with greater health care risks by incorporating:
new text end
new text begin
(i) a risk factor adjustment reflecting the health status of the entity's patient mix; and
new text end
new text begin
(ii) an equity adjustment accounting for the social determinants of health and other
factors related to health equity for the entity's patient mix;
new text end
new text begin
(5) ensure that growth targets:
new text end
new text begin
(i) do not constrain the Minnesota health care workforce, including the need to provide
competitive wages and benefits;
new text end
new text begin
(ii) do not limit the use of collective bargaining or place a floor or ceiling on health care
workforce compensation; and
new text end
new text begin
(iii) promote workforce stability and maintain high-quality health care jobs; and
new text end
new text begin
(6) consult with the advisory council and other stakeholders.
new text end
new text begin Subd. 3. new text end
new text begin Data. new text end
new text begin
The board shall identify data to be used for tracking performance in
meeting the growth target and identify methods of data collection necessary for efficient
implementation by the board. In identifying data and methods, the board shall:
new text end
new text begin
(1) consider the availability, timeliness, quality, and usefulness of existing data, including
the data collected under section 62U.04;
new text end
new text begin
(2) assess the need for additional investments in data collection, data validation, or data
analysis capacity to support the board in performing its duties; and
new text end
new text begin
(3) minimize the reporting burden to the extent possible.
new text end
new text begin Subd. 4. new text end
new text begin Setting growth targets; related duties. new text end
new text begin
(a) The board, by June 15, 2023, and
by June 15 of each succeeding calendar year through June 15, 2027, shall establish annual
health care spending growth targets for the next calendar year consistent with the
requirements of this section. The board shall set annual health care spending growth targets
for the five-year period from January 1, 2024, through December 31, 2028.
new text end
new text begin
(b) The board shall periodically review all components of the health care spending
growth target program methodology, economic indicators, and other factors. The board may
revise the annual spending growth targets after a public hearing, as appropriate. If the board
revises a spending growth target, the board must provide public notice at least 60 days
before the start of the calendar year to which the revised growth target will apply.
new text end
new text begin
(c) The board, based on an analysis of drivers of health care spending and evidence from
public testimony, shall evaluate strategies and new policies, including the establishment of
accountability mechanisms, that are able to contribute to meeting growth targets and limiting
health care spending growth without increasing disparities in access to health care.
new text end
new text begin Subd. 5. new text end
new text begin Hearings. new text end
new text begin
At least annually, the board shall hold public hearings to present
findings from spending growth target monitoring. The board shall also regularly hold public
hearings to take testimony from stakeholders on health care spending growth, setting and
revising health care spending growth targets, the impact of spending growth and growth
targets on health care access and quality, and as needed to perform the duties assigned under
section 62J.89, subdivisions 1, 2, and 3.
new text end
Sec. 6.
new text begin
[62J.91] NOTICE TO HEALTH CARE ENTITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Notice. new text end
new text begin
(a) The board shall provide notice to all health care entities that
have been identified by the board as exceeding the spending growth target for any given
year.
new text end
new text begin
(b) For purposes of this section, "health care entity" must be defined by the board during
the development of the health care spending growth methodology. When developing this
methodology, the board shall consider a definition of health care entity that includes clinics,
hospitals, ambulatory surgical centers, physician organizations, accountable care
organizations, integrated provider and plan systems, and other entities defined by the board,
provided that physician organizations with a patient panel of 15,000 or fewer, or which
represent providers who collectively receive less than $25,000,000 in annual net patient
service revenue from health plan companies and other payers, are exempt.
new text end
new text begin Subd. 2. new text end
new text begin Performance improvement plans. new text end
new text begin
(a) The board shall establish and implement
procedures to assist health care entities to improve efficiency and reduce cost growth by
requiring some or all health care entities provided notice under subdivision 1 to file and
implement a performance improvement plan. The board shall provide written notice of this
requirement to health care entities.
new text end
new text begin
(b) Within 45 days of receiving a notice of the requirement to file a performance
improvement plan, a health care entity shall:
new text end
new text begin
(1) file a performance improvement plan with the board; or
new text end
new text begin
(2) file an application with the board to waive the requirement to file a performance
improvement plan or extend the timeline for filing a performance improvement plan.
new text end
new text begin
(c) The health care entity may file any documentation or supporting evidence with the
board to support the health care entity's application to waive or extend the timeline to file
a performance improvement plan. The board shall require the health care entity to submit
any other relevant information it deems necessary in considering the waiver or extension
application, provided that this information must be made public at the discretion of the
board. The board may waive or delay the requirement for a health care entity to file a
performance improvement plan in response to a waiver or extension request in light of all
information received from the health care entity, based on a consideration of the following
factors:
new text end
new text begin
(1) the costs, price, and utilization trends of the health care entity over time, and any
demonstrated improvement in reducing per capita medical expenses adjusted by health
status;
new text end
new text begin
(2) any ongoing strategies or investments that the health care entity is implementing to
improve future long-term efficiency and reduce cost growth;
new text end
new text begin
(3) whether the factors that led to increased costs for the health care entity can reasonably
be considered to be unanticipated and outside of the control of the entity. These factors may
include but are not limited to age and other health status adjusted factors and other cost
inputs such as pharmaceutical expenses and medical device expenses;
new text end
new text begin
(4) the overall financial condition of the health care entity; and
new text end
new text begin
(5) any other factors the board considers relevant. If the board declines to waive or
extend the requirement for the health care entity to file a performance improvement plan,
the board shall provide written notice to the health care entity that its application for a waiver
or extension was denied and the health care entity shall file a performance improvement
plan.
new text end
new text begin
(d) A health care entity shall file a performance improvement plan with the board:
new text end
new text begin
(1) within 45 days of receipt of an initial notice;
new text end
new text begin
(2) if the health care entity has requested a waiver or extension, within 45 days of receipt
of a notice that such waiver or extension has been denied; or
new text end
new text begin
(3) if the health care entity is granted an extension, on the date given on the extension.
new text end
new text begin
(e) The performance improvement plan must identify the causes of the entity's cost
growth and include but not be limited to specific strategies, adjustments, and action steps
the entity proposes to implement to improve cost performance. The proposed performance
improvement plan must include specific identifiable and measurable expected outcomes
and a timetable for implementation. The timetable for a performance improvement plan
must not exceed 18 months.
new text end
new text begin
(f) The board shall approve any performance improvement plan it determines is
reasonably likely to address the underlying cause of the entity's cost growth and has a
reasonable expectation for successful implementation. If the board determines that the
performance improvement plan is unacceptable or incomplete, the board may provide
consultation on the criteria that have not been met and may allow an additional time period
of up to 30 calendar days for resubmission. Upon approval of the proposed performance
improvement plan, the board shall notify the health care entity to begin immediate
implementation of the performance improvement plan. The board shall provide public notice
on its website identifying that the health care entity is implementing a performance
improvement plan. All health care entities implementing an approved performance
improvement plan shall be subject to additional reporting requirements and compliance
monitoring, as determined by the board. The board shall provide assistance to the health
care entity in the successful implementation of the performance improvement plan.
new text end
new text begin
(g) All health care entities shall in good faith work to implement the performance
improvement plan. At any point during the implementation of the performance improvement
plan, the health care entity may file amendments to the performance improvement plan,
subject to approval of the board. At the conclusion of the timetable established in the
performance improvement plan, the health care entity shall report to the board regarding
the outcome of the performance improvement plan. If the board determines the performance
improvement plan was not implemented successfully, the board shall:
new text end
new text begin
(1) extend the implementation timetable of the existing performance improvement plan;
new text end
new text begin
(2) approve amendments to the performance improvement plan as proposed by the health
care entity;
new text end
new text begin
(3) require the health care entity to submit a new performance improvement plan; or
new text end
new text begin
(4) waive or delay the requirement to file any additional performance improvement
plans.
new text end
new text begin
(h) Upon the successful completion of the performance improvement plan, the board
shall remove the identity of the health care entity from the board's website. The board may
assist health care entities with implementing the performance improvement plans or otherwise
ensure compliance with this subdivision.
new text end
new text begin
(i) If the board determines that a health care entity has:
new text end
new text begin
(1) willfully neglected to file a performance improvement plan with the board within
45 days as required;
new text end
new text begin
(2) failed to file an acceptable performance improvement plan in good faith with the
board;
new text end
new text begin
(3) failed to implement the performance improvement plan in good faith; or
new text end
new text begin
(4) knowingly failed to provide information required by this subdivision to the board or
knowingly provided false information, the board may assess a civil penalty to the health
care entity of not more than $50,000. The board must only impose a civil penalty as a last
resort.
new text end
Sec. 7.
new text begin
[62J.92] REPORTING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin General requirement. new text end
new text begin
(a) The board shall present the reports required
by this section to the chairs and ranking members of the legislative committees with primary
jurisdiction over health care finance and policy. The board shall also make these reports
available to the public on the board's website.
new text end
new text begin
(b) The board may contract with a third-party vendor for technical assistance in preparing
the reports.
new text end
new text begin Subd. 2. new text end
new text begin Progress reports. new text end
new text begin
The board shall submit written progress updates about the
development and implementation of the health care spending growth target program by
February 15, 2024, and February 15, 2025. The updates must include reporting on board
membership and activities, program design decisions, planned timelines for implementation
of the program, and the progress of implementation. The reports must include the
methodological details underlying program design decisions.
new text end
new text begin Subd. 3. new text end
new text begin Health care spending trends. new text end
new text begin
By December 15, 2024, and every December
15 thereafter, the board shall submit a report on health care spending trends and the health
care spending growth target program that includes:
new text end
new text begin
(1) spending growth in aggregate and for entities subject to health care spending growth
targets relative to established target levels;
new text end
new text begin
(2) findings from analyses of drivers of health care spending growth;
new text end
new text begin
(3) estimates of the impact of health care spending growth on Minnesota residents,
including for communities most impacted by health disparities, related to their access to
insurance and care, value of health care, and the ability to pursue other spending priorities;
new text end
new text begin
(4) the potential and observed impact of the health care growth targets on the financial
viability of the rural delivery system;
new text end
new text begin
(5) changes under consideration for revising the methodology to monitor or set growth
targets;
new text end
new text begin
(6) recommendations for initiatives to assist health care entities in meeting health care
spending growth targets, including broader and more transparent adoption of value-based
payment arrangements; and
new text end
new text begin
(7) the number of health care entities whose spending growth exceeded growth targets,
information on performance improvement plans and the extent to which the plans were
completed, and any civil penalties imposed on health care entities related to noncompliance
with performance improvement plans and related requirements.
new text end
Sec. 8.
Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:
(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; deleted text begin and
deleted text end
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patients, payers, or providers;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) to provide technical assistance to the Health Care Affordability Board to implement
sections 62J.86 to 62J.92.
new text end
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
Sec. 9.
Minnesota Statutes 2020, section 256.01, is amended by adding a subdivision to
read:
new text begin Subd. 43. new text end
new text begin Education on contraceptive options. new text end
new text begin
The commissioner shall require hospitals
and primary care providers serving medical assistance and MinnesotaCare enrollees to
develop and implement protocols to provide these enrollees, when appropriate, with
comprehensive and scientifically accurate information on the full range of contraceptive
options in a medically ethical, culturally competent, and noncoercive manner. The
information provided must be designed to assist enrollees in identifying the contraceptive
method that best meets their needs and the needs of their families. The protocol must specify
the enrollee categories to which this requirement will be applied, the process to be used,
and the information and resources to be provided. Hospitals and providers must make this
protocol available to the commissioner upon request.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256.969, is amended by adding a subdivision
to read:
new text begin Subd. 31. new text end
new text begin Long-acting reversible contraceptives. new text end
new text begin
(a) The commissioner must provide
separate reimbursement to hospitals for long-acting reversible contraceptives provided
immediately postpartum in the inpatient hospital setting. This payment must be in addition
to the diagnostic related group (DRG) reimbursement for labor and delivery.
new text end
new text begin
(b) The commissioner must require managed care and county-based purchasing plans
to comply with this subdivision when providing services to medical assistance enrollees.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.021, subdivision 4, is amended to read:
Subd. 4.
Projects.
The commissioner shall request permission and funding to further
the following initiatives.
(a) Health care delivery demonstration projects. This project involves testing alternative
payment and service delivery models in accordance with sections 256B.0755 and 256B.0756.
These demonstrations will allow the Minnesota Department of Human Services to engage
in alternative payment arrangements with provider organizations that provide services to a
specified patient population for an agreed upon total cost of care or risk/gain sharing payment
arrangement, but are not limited to these models of care delivery or payment. Quality of
care and patient experience will be measured and incorporated into payment models alongside
the cost of care. Demonstration sites should include Minnesota health care programs
fee-for-services recipients and managed care enrollees and support a robust primary care
model and improved care coordination for recipients.
(b) Promote personal responsibility and encourage and reward healthy outcomes. This
project provides Medicaid funding to provide individual and group incentives to encourage
healthy behavior, prevent the onset of chronic disease, and reward healthy outcomes. Focus
areas may include diabetes prevention and management, tobacco cessation, reducing weight,
lowering cholesterol, and lowering blood pressure.
(c) Encourage utilization of high quality, cost-effective care. This project creates
incentives deleted text begin through Medicaid and MinnesotaCare enrollee cost-sharing and other meansdeleted text end to
encourage the utilization of high-quality, low-cost, high-value providers, as determined by
the state's provider peer grouping initiative under section 62U.04.
(d) Adults without children. This proposal includes requesting federal authority to impose
a limit on assets for adults without children in medical assistance, as defined in section
256B.055, subdivision 15, who have a household income equal to or less than 75 percent
of the federal poverty limit, and to impose a 180-day durational residency requirement in
MinnesotaCare, consistent with section 256L.09, subdivision 4, for adults without children,
regardless of income.
(e) Empower and encourage work, housing, and independence. This project provides
services and supports for individuals who have an identified health or disabling condition
but are not yet certified as disabled, in order to delay or prevent permanent disability, reduce
the need for intensive health care and long-term care services and supports, and to help
maintain or obtain employment or assist in return to work. Benefits may include:
(1) coordination with health care homes or health care coordinators;
(2) assessment for wellness, housing needs, employment, planning, and goal setting;
(3) training services;
(4) job placement services;
(5) career counseling;
(6) benefit counseling;
(7) worker supports and coaching;
(8) assessment of workplace accommodations;
(9) transitional housing services; and
(10) assistance in maintaining housing.
(f) Redesign home and community-based services. This project realigns existing funding,
services, and supports for people with disabilities and older Minnesotans to ensure community
integration and a more sustainable service system. This may involve changes that promote
a range of services to flexibly respond to the following needs:
(1) provide people less expensive alternatives to medical assistance services;
(2) offer more flexible and updated community support services under the Medicaid
state plan;
(3) provide an individual budget and increased opportunity for self-direction;
(4) strengthen family and caregiver support services;
(5) allow persons to pool resources or save funds beyond a fiscal year to cover unexpected
needs or foster development of needed services;
(6) use of home and community-based waiver programs for people whose needs cannot
be met with the expanded Medicaid state plan community support service options;
(7) target access to residential care for those with higher needs;
(8) develop capacity within the community for crisis intervention and prevention;
(9) redesign case management;
(10) offer life planning services for families to plan for the future of their child with a
disability;
(11) enhance self-advocacy and life planning for people with disabilities;
(12) improve information and assistance to inform long-term care decisions; and
(13) increase quality assurance, performance measurement, and outcome-based
reimbursement.
This project may include different levels of long-term supports that allow seniors to remain
in their homes and communities, and expand care transitions from acute care to community
care to prevent hospitalizations and nursing home placement. The levels of support for
seniors may range from basic community services for those with lower needs, access to
residential services if a person has higher needs, and targets access to nursing home care to
those with rehabilitation or high medical needs. This may involve the establishment of
medical need thresholds to accommodate the level of support needed; provision of a
long-term care consultation to persons seeking residential services, regardless of payer
source; adjustment of incentives to providers and care coordination organizations to achieve
desired outcomes; and a required coordination with medical assistance basic care benefit
and Medicare/Medigap benefit. This proposal will improve access to housing and improve
capacity to maintain individuals in their existing home; adjust screening and assessment
tools, as needed; improve transition and relocation efforts; seek federal financial participation
for alternative care and essential community supports; and provide Medigap coverage for
people having lower needs.
(g) Coordinate and streamline services for people with complex needs, including those
with multiple diagnoses of physical, mental, and developmental conditions. This project
will coordinate and streamline medical assistance benefits for people with complex needs
and multiple diagnoses. It would include changes that:
(1) develop community-based service provider capacity to serve the needs of this group;
(2) build assessment and care coordination expertise specific to people with multiple
diagnoses;
(3) adopt service delivery models that allow coordinated access to a range of services
for people with complex needs;
(4) reduce administrative complexity;
(5) measure the improvements in the state's ability to respond to the needs of this
population; and
(6) increase the cost-effectiveness for the state budget.
(h) Implement nursing home level of care criteria. This project involves obtaining any
necessary federal approval in order to implement the changes to the level of care criteria in
section 144.0724, subdivision 11, and implement further changes necessary to achieve
reform of the home and community-based service system.
(i) Improve integration of Medicare and Medicaid. This project involves reducing
fragmentation in the health care delivery system to improve care for people eligible for both
Medicare and Medicaid, and to align fiscal incentives between primary, acute, and long-term
care. The proposal may include:
(1) requesting an exception to the new Medicare methodology for payment adjustment
for fully integrated special needs plans for dual eligible individuals;
(2) testing risk adjustment models that may be more favorable to capturing the needs of
frail dually eligible individuals;
(3) requesting an exemption from the Medicare bidding process for fully integrated
special needs plans for the dually eligible;
(4) modifying the Medicare bid process to recognize additional costs of health home
services; and
(5) requesting permission for risk-sharing and gain-sharing.
(j) Intensive residential treatment services. This project would involve providing intensive
residential treatment services for individuals who have serious mental illness and who have
other complex needs. This proposal would allow such individuals to remain in these settings
after mental health symptoms have stabilized, in order to maintain their mental health and
avoid more costly or unnecessary hospital or other residential care due to their other complex
conditions. The commissioner may pursue a specialized rate for projects created under this
section.
(k) Seek federal Medicaid matching funds for Anoka-Metro Regional Treatment Center
(AMRTC). This project involves seeking Medicaid reimbursement for medical services
provided to patients to AMRTC, including requesting a waiver of United States Code, title
42, section 1396d, which prohibits Medicaid reimbursement for expenditures for services
provided by hospitals with more than 16 beds that are primarily focused on the treatment
of mental illness. This waiver would allow AMRTC to serve as a statewide resource to
provide diagnostics and treatment for people with the most complex conditions.
(l) Waivers to allow Medicaid eligibility for children under age 21 receiving care in
residential facilities. This proposal would seek Medicaid reimbursement for any
Medicaid-covered service for children who are placed in residential settings that are
determined to be "institutions for mental diseases," under United States Code, title 42,
section 1396d.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 12.
Minnesota Statutes 2021 Supplement, section 256B.0371, subdivision 4, is
amended to read:
Subd. 4.
Dental utilization report.
(a) The commissioner shall submit an annual report
beginning March 15, 2022, and ending March 15, 2026, to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance that includes the percentage for adults and children one through 20 years
of age for the most recent complete calendar year receiving at least one dental visit for both
fee-for-service and the prepaid medical assistance program. The report must include:
(1) statewide utilization for both fee-for-service and for the prepaid medical assistance
program;
(2) utilization by county;
(3) utilization by children receiving dental services through fee-for-service and through
a managed care plan or county-based purchasing plan;
(4) utilization by adults receiving dental services through fee-for-service and through a
managed care plan or county-based purchasing plan.
(b) The report must also include a description of any corrective action plans required to
be submitted under subdivision 2.
(c) The initial report due on March 15, 2022, must include the utilization metrics described
in paragraph (a) for each of the following calendar years: 2017, 2018, 2019, and 2020.
new text begin
(d) In the annual report due on March 15, 2023, and in each report due thereafter, the
commissioner shall include the following:
new text end
new text begin
(1) the number of dentists enrolled with the commissioner as a medical assistance dental
provider and the congressional district or districts in which the dentist provides services;
new text end
new text begin
(2) the number of enrolled dentists who provided fee-for-service dental services to
medical assistance or MinnesotaCare patients within the previous calendar year in the
following increments: one to nine patients, ten to 100 patients, and over 100 patients;
new text end
new text begin
(3) the number of enrolled dentists who provided dental services to medical assistance
or MinnesotaCare patients through a managed care plan or county-based purchasing plan
within the previous calendar year in the following increments: one to nine patients, ten to
100 patients, and over 100 patients; and
new text end
new text begin
(4) the number of dentists who provided dental services to a new patient who was enrolled
in medical assistance or MinnesotaCare within the previous calendar year.
new text end
new text begin
(e) The report due on March 15, 2023, must include the metrics described in paragraph
(d) for each of the following years: 2017, 2018, 2019, 2020, and 2021.
new text end
Sec. 13.
Minnesota Statutes 2021 Supplement, section 256B.04, subdivision 14, is amended
to read:
Subd. 14.
Competitive bidding.
(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies;
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems; and
(ix) allergen-reducing products as described in section 256B.0625, subdivision 67,
paragraph (c) or (d);
(5) nonemergency medical transportation level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursements; and
(6) drugs.
(b) Rate changes deleted text begin and recipient cost-sharingdeleted text end under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C for special transportation services or
incontinence products and related supplies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 14.
Minnesota Statutes 2021 Supplement, section 256B.04, subdivision 14, is amended
to read:
Subd. 14.
Competitive bidding.
(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies;
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems; and
(ix) allergen-reducing products as described in section 256B.0625, subdivision 67,
paragraph (c) or (d);
(5) nonemergency medical transportation level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursements; deleted text begin and
deleted text end
(6) drugsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) quitline services as described in section 256B.0625, subdivision 68.
new text end
(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C for special transportation services or
incontinence products and related supplies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256B.055, subdivision 17, is amended to read:
Subd. 17.
Adults who were in foster care at the age of 18.
new text begin (a) new text end Medical assistance may
be paid for a person under 26 years of age who was in foster care under the commissioner's
responsibility on the date of attaining 18 years of agenew text begin or oldernew text end , and who was enrolled in
medical assistance under deleted text begin thedeleted text end new text begin anew text end state plan or a waiver of deleted text begin thedeleted text end new text begin anew text end plan while in foster care, in
accordance with section 2004 of the Affordable Care Act.
new text begin
(b) Beginning January 1, 2023, medical assistance may be paid for a person under 26
years of age who was in foster care and enrolled in another state's Medicaid program while
in foster care, in accordance with Public Law 115-271, section 1002, the Substance
Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and
Communities Act.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.056, subdivision 3, is amended to read:
Subd. 3.
Asset limitations for certain individuals.
(a) To be eligible for medical
assistance, a person must not individually own more than deleted text begin $3,000deleted text end new text begin $20,000new text end in assets, or if a
member of a household with two family members, husband and wife, or parent and child,
the household must not own more than deleted text begin $6,000deleted text end new text begin $40,000new text end in assets, plus $200 for each
additional legal dependent. In addition to these maximum amounts, an eligible individual
or family may accrue interest on these amounts, but they must be reduced to the maximum
at the time of an eligibility redetermination. The accumulation of the clothing and personal
needs allowance according to section 256B.35 must also be reduced to the maximum at the
time of the eligibility redetermination. The value of assets that are not considered in
determining eligibility for medical assistance is the value of those assets excluded under
the Supplemental Security Income program for aged, blind, and disabled persons, with the
following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;
(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;
(4) assets designated as burial expenses are excluded to the same extent excluded by the
Supplemental Security Income program. Burial expenses funded by annuity contracts or
life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;
(5) for a person who no longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical assistance under section 256B.057,
subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility
as an employed person with a disability, to the extent that the person's total assets remain
within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
(6) a designated employment incentives asset account is disregarded when determining
eligibility for medical assistance for a person age 65 years or older under section 256B.055,
subdivision 7. An employment incentives asset account must only be designated by a person
who has been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person and the person's spouse in the last month of enrollment
in medical assistance under section 256B.057, subdivision 9. Qualified assets include
retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's
other nonexcluded assets. An employment incentives asset account is no longer designated
when a person loses medical assistance eligibility for a calendar month or more before
turning age 65. A person who loses medical assistance eligibility before age 65 can establish
a new designated employment incentives asset account by establishing a new
24-consecutive-month period of enrollment under section 256B.057, subdivision 9. The
income of a spouse of a person enrolled in medical assistance under section 256B.057,
subdivision 9, during each of the 24 consecutive months before the person's 65th birthday
must be disregarded when determining eligibility for medical assistance under section
256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions
in section 256B.059; deleted text begin and
deleted text end
(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) for individuals who were enrolled in medical assistance during the COVID-19 federal
public health emergency declared by the United States Secretary of Health and Human
Services and who are subject to the asset limits established by this subdivision, assets in
excess of the limits must be disregarded until 95 days after the individual's first renewal
occurring after the expiration of the COVID-19 federal public health emergency declared
by the United States Secretary of Health and Human Services.
new text end
(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.
new text begin EFFECTIVE DATE. new text end
new text begin
The amendment to paragraph (a) increasing the asset limits is
effective January 1, 2025, or upon federal approval, whichever is later. The amendment to
paragraph (a) adding clause (8) is effective July 1, 2022, or upon federal approval, whichever
is later. The commissioner of human services shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.056, subdivision 4, is amended to read:
Subd. 4.
Income.
(a) To be eligible for medical assistance, a person eligible under section
256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of the federal
poverty guidelinesnew text begin , and effective January 1, 2025, income up to 133 percent of the federal
poverty guidelinesnew text end . Effective January 1, 2000, and each successive January, recipients of
Supplemental Security Income may have an income up to the Supplemental Security Income
standard in effect on that date.
(b) To be eligible for medical assistance under section 256B.055, subdivision 3a, a parent
or caretaker relative may have an income up to 133 percent of the federal poverty guidelines
for the household size.
(c) To be eligible for medical assistance under section 256B.055, subdivision 15, a
person may have an income up to 133 percent of federal poverty guidelines for the household
size.
(d) To be eligible for medical assistance under section 256B.055, subdivision 16, a child
age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines for
the household size.
(e) To be eligible for medical assistance under section 256B.055, subdivision 3a, a child
under age 19 may have income up to 275 percent of the federal poverty guidelines for the
household size.
(f) In computing income to determine eligibility of persons under paragraphs (a) to (e)
who are not residents of long-term care facilities, the commissioner shall disregard increases
in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. For persons
eligible under paragraph (a), veteran aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.
Sec. 18.
Minnesota Statutes 2020, section 256B.056, subdivision 7, is amended to read:
Subd. 7.
Period of eligibility.
(a) Eligibility is available for the month of application
and for three months prior to application if the person was eligible in those prior months.
A redetermination of eligibility must occur every 12 months.
(b) For a person eligible for an insurance affordability program as defined in section
256B.02, subdivision 19, who reports a change that makes the person eligible for medical
assistance, eligibility is available for the month the change was reported and for three months
prior to the month the change was reported, if the person was eligible in those prior months.
new text begin
(c) Once determined eligible for medical assistance, a child under the age of 21 is
continuously eligible for a period of up to 12 months, unless:
new text end
new text begin
(1) the child reaches age 21;
new text end
new text begin
(2) the child requests voluntary termination of coverage;
new text end
new text begin
(3) the child ceases to be a resident of Minnesota;
new text end
new text begin
(4) the child dies; or
new text end
new text begin
(5) the agency determines the child's eligibility was erroneously granted due to agency
error or enrollee fraud, abuse, or perjury.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 19.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 9, is
amended to read:
Subd. 9.
Dental services.
(a) Medical assistance covers new text begin medically necessary new text end dental
services.
deleted text begin
(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
deleted text end
deleted text begin
(1) comprehensive exams, limited to once every five years;
deleted text end
deleted text begin
(2) periodic exams, limited to one per year;
deleted text end
deleted text begin
(3) limited exams;
deleted text end
deleted text begin
(4) bitewing x-rays, limited to one per year;
deleted text end
deleted text begin
(5) periapical x-rays;
deleted text end
deleted text begin
(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;
deleted text end
deleted text begin
(7) prophylaxis, limited to one per year;
deleted text end
deleted text begin
(8) application of fluoride varnish, limited to one per year;
deleted text end
deleted text begin
(9) posterior fillings, all at the amalgam rate;
deleted text end
deleted text begin
(10) anterior fillings;
deleted text end
deleted text begin
(11) endodontics, limited to root canals on the anterior and premolars only;
deleted text end
deleted text begin
(12) removable prostheses, each dental arch limited to one every six years;
deleted text end
deleted text begin
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
deleted text end
deleted text begin
(14) palliative treatment and sedative fillings for relief of pain;
deleted text end
deleted text begin
(15) full-mouth debridement, limited to one every five years; and
deleted text end
deleted text begin
(16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
deleted text end
deleted text begin
(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:
deleted text end
deleted text begin
(1) periodontics, limited to periodontal scaling and root planing once every two years;
deleted text end
deleted text begin
(2) general anesthesia; and
deleted text end
deleted text begin
(3) full-mouth survey once every five years.
deleted text end
deleted text begin (d) Medical assistance covers medically necessary dental services for children and
pregnant women.deleted text end The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants are covered once every five years per permanent molar deleted text begin for
children onlydeleted text end ;
(3) application of fluoride varnish is covered once every six months; and
(4) orthodontia is eligible for coverage for children only.
deleted text begin (e)deleted text end new text begin (b)new text end In addition to the services specified in deleted text begin paragraphs (b) and (c)deleted text end new text begin paragraph (a)new text end ,
medical assistance covers the following services deleted text begin for adultsdeleted text end :
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
deleted text begin (f)deleted text end new text begin (c)new text end The commissioner shall not require prior authorization for the services included
in paragraph deleted text begin (e)deleted text end new text begin (b)new text end , clauses (1) to (3), and shall prohibit managed care and county-based
purchasing plans from requiring prior authorization for the services included in paragraph
deleted text begin (e)deleted text end new text begin (b)new text end , clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 17, is
amended to read:
Subd. 17.
Transportation costs.
(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:
(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;
(2) ambulances, as defined in section 144E.001, subdivision 2;
(3) taxicabs that meet the requirements of this subdivision;
(4) public transit, as defined in section 174.22, subdivision 7; or
(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472,
subdivision 1, paragraph (h).
(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.
(d) An organization may be terminated, denied, or suspended from enrollment if:
(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:
(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and
(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.
(e) The administrative agency of nonemergency medical transportation must:
(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;
(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;
(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and
(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.
(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
(g) The commissioner may use an order by the recipient's attending physician, advanced
practice registered nurse, or a medical or mental health professional to certify that the
recipient requires nonemergency medical transportation services. Nonemergency medical
transportation providers shall perform driver-assisted services for eligible individuals, when
appropriate. Driver-assisted service includes passenger pickup at and return to the individual's
residence or place of business, assistance with admittance of the individual to the medical
facility, and assistance in passenger securement or in securing of wheelchairs, child seats,
or stretchers in the vehicle.
Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.
Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.
(h) The administrative agency shall use the level of service process established by the
commissioner in consultation with the Nonemergency Medical Transportation Advisory
Committee to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.
(i) The covered modes of transportation are:
(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;
(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;
(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;
(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;
(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;
(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and
(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.
(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.
(k) The commissioner shall:
(1) in consultation with the Nonemergency Medical Transportation Advisory Committee,
verify that the mode and use of nonemergency medical transportation is appropriate;
(2) verify that the client is going to an approved medical appointment; and
(3) investigate all complaints and appeals.
(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:
(1) $0.22 per mile for client reimbursement;
(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;
(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;
(4) $13 for the base rate and $1.30 per mile for assisted transport;
(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;
(6) $75 for the base rate and $2.40 per mile for protected transport; and
(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.
(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:
(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and
(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).
(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.
(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.
(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).
new text begin
(r) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent
up or down for every increase or decrease of ten cents for the price of gasoline. The increase
or decrease must be calculated using a base gasoline price of $3.00. The percentage increase
or decrease must be calculated using the average of the most recently available price of all
grades of gasoline for Minnesota as posted publicly by the United States Energy Information
Administration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0625, subdivision 17a, is amended to
read:
Subd. 17a.
Payment for ambulance services.
(a) Medical assistance covers ambulance
services. Providers shall bill ambulance services according to Medicare criteria.
Nonemergency ambulance services shall not be paid as emergencies. Effective for services
rendered on or after July 1, 2001, medical assistance payments for ambulance services shall
be paid at the Medicare reimbursement rate or at the medical assistance payment rate in
effect on July 1, 2000, whichever is greater.
(b) Effective for services provided on or after July 1, 2016, medical assistance payment
rates for ambulance services identified in this paragraph are increased by five percent.
Capitation payments made to managed care plans and county-based purchasing plans for
ambulance services provided on or after January 1, 2017, shall be increased to reflect this
rate increase. The increased rate described in this paragraph applies to ambulance service
providers whose base of operations as defined in section 144E.10 is located:
(1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or
(2) within a municipality with a population of less than 1,000.
new text begin
(c) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one
percent up or down for every increase or decrease of ten cents for the price of gasoline. The
increase or decrease must be calculated using a base gasoline price of $3.00. The percentage
increase or decrease must be calculated using the average of the most recently available
price of all grades of gasoline for Minnesota as posted publicly by the United States Energy
Information Administration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.0625, subdivision 18h, is amended to
read:
Subd. 18h.
new text begin Nonemergency medical transportation provisions related to new text end managed
care.
(a) The following new text begin nonemergency medical transportation new text end subdivisions apply to managed
care plans and county-based purchasing plans:
(1) subdivision 17, paragraphs (a), (b), (i), and (n);
(2) subdivision 18; and
(3) subdivision 18a.
(b) A nonemergency medical transportation provider must comply with the operating
standards for special transportation service specified in sections 174.29 to 174.30 and
Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire
vehicles are exempt from the requirements in this paragraph.
new text begin
(c) Managed care and county-based purchasing plans must provide a fuel adjustment
for nonemergency medical transportation payment rates when the price of gasoline exceeds
$3.00 per gallon.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256B.0625, subdivision 22, is amended to read:
Subd. 22.
Hospice care.
Medical assistance covers hospice care services under Public
Law 99-272, section 9505, to the extent authorized by rule, except that a recipient age 21
or under who elects to receive hospice services does not waive coverage for services that
are related to the treatment of the condition for which a diagnosis of terminal illness has
been made.new text begin Hospice respite and end-of-life care under subdivision 22a are not hospice care
services under this subdivision.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 22a. new text end
new text begin
Residential hospice facility; hospice respite and end-of-life care for
children.
new text end
new text begin
(a) Medical assistance covers hospice respite and end-of-life care if the care is
for recipients age 21 or under who elect to receive hospice care delivered in a facility that
is licensed under sections 144A.75 to 144A.755 and that is a residential hospice facility
under section 144A.75, subdivision 13, paragraph (a). Hospice care services under
subdivision 22 are not hospice respite or end-of-life care under this subdivision.
new text end
new text begin
(b) The payment rates for coverage under this subdivision must be 100 percent of the
Medicare rate for continuous home care hospice services as published in the Centers for
Medicare and Medicaid Services annual final rule updating payments and policies for hospice
care. Payment for hospice respite and end-of-life care under this subdivision must be made
from state funds, though the commissioner shall seek to obtain federal financial participation
for the payments. Payment for hospice respite and end-of-life care must be paid to the
residential hospice facility and are not included in any limits or cap amount applicable to
hospice services payments to the elected hospice services provider.
new text end
new text begin
(c) Certification of the residential hospice facility by the federal Medicare program must
not be a requirement of medical assistance payment for hospice respite and end-of-life care
under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.0625, subdivision 28b, is amended to
read:
Subd. 28b.
Doula services.
Medical assistance covers doula services provided by a
certified doula as defined in section 148.995, subdivision 2, of the mother's choice. For
purposes of this section, "doula services" means childbirth education and support services,
including emotional and physical support provided during pregnancy, labor, birth, and
postpartum.new text begin The commissioner shall enroll doula agencies and individual treating doulas
in order to provide direct reimbursement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, subject to federal
approval. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end
Sec. 26.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 30, is
amended to read:
Subd. 30.
Other clinic services.
(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.
(b) A federally qualified health center (FQHC) that is beginning initial operation shall
submit an estimate of budgeted costs and visits for the initial reporting period in the form
and detail required by the commissioner. An FQHC that is already in operation shall submit
an initial report using actual costs and visits for the initial reporting period. Within 90 days
of the end of its reporting period, an FQHC shall submit, in the form and detail required by
the commissioner, a report of its operations, including allowable costs actually incurred for
the period and the actual number of visits for services furnished during the period, and other
information required by the commissioner. FQHCs that file Medicare cost reports shall
provide the commissioner with a copy of the most recent Medicare cost report filed with
the Medicare program intermediary for the reporting year which support the costs claimed
on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), an FQHC or rural health clinic must apply for designation
as an essential community provider within six months of final adoption of rules by the
Department of Health according to section 62Q.19, subdivision 7. For those FQHCs and
rural health clinics that have applied for essential community provider status within the
six-month time prescribed, medical assistance payments will continue to be made according
to paragraphs (a) and (b) for the first three years after application. For FQHCs and rural
health clinics that either do not apply within the time specified above or who have had
essential community provider status for three years, medical assistance payments for health
services provided by these entities shall be according to the same rates and conditions
applicable to the same service provided by health care providers that are not FQHCs or rural
health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring an FQHC or a rural
health clinic to make application for an essential community provider designation in order
to have cost-based payments made according to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, through December 31, 2020, each FQHC and rural health
clinic may elect to be paid either under the prospective payment system established in United
States Code, title 42, section 1396a(aa), or under an alternative payment methodology
consistent with the requirements of United States Code, title 42, section 1396a(aa), and
approved by the Centers for Medicare and Medicaid Services. The alternative payment
methodology shall be 100 percent of cost as determined according to Medicare cost
principles.
(g) Effective for services provided on or after January 1, 2021, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f) or the alternative payment
methodology described in paragraph (l).
(h) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;
(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.
(i) Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner. the commissioner shall determine the most feasible method for paying claims
from the following options:
(1) FQHCs and rural health clinics submit claims directly to the commissioner for
payment, and the commissioner provides claims information for recipients enrolled in a
managed care or county-based purchasing plan to the plan, on a regular basis; or
(2) FQHCs and rural health clinics submit claims for recipients enrolled in a managed
care or county-based purchasing plan to the plan, and those claims are submitted by the
plan to the commissioner for payment to the clinic.
(j) For clinic services provided prior to January 1, 2015, the commissioner shall calculate
and pay monthly the proposed managed care supplemental payments to clinics, and clinics
shall conduct a timely review of the payment calculation data in order to finalize all
supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.
(k) The commissioner shall seek a federal waiver, authorized under section 1115 of the
Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.
(l) All claims for payment of clinic services provided by FQHCs and rural health clinics,
that have elected to be paid under this paragraph, shall be paid by the commissioner according
to the following requirements:
(1) the commissioner shall establish a single medical and single dental organization
encounter rate for each FQHC and rural health clinic when applicable;
(2) each FQHC and rural health clinic is eligible for same day reimbursement of one
medical and one dental organization encounter rate if eligible medical and dental visits are
provided on the same day;
(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance
with current applicable Medicare cost principles, their allowable costs, including direct
patient care costs and patient-related support services. Nonallowable costs include, but are
not limited to:
(i) general social services and administrative costs;
(ii) retail pharmacy;
(iii) patient incentives, food, housing assistance, and utility assistance;
(iv) external lab and x-ray;
(v) navigation services;
(vi) health care taxes;
(vii) advertising, public relations, and marketing;
(viii) office entertainment costs, food, alcohol, and gifts;
(ix) contributions and donations;
(x) bad debts or losses on awards or contracts;
(xi) fines, penalties, damages, or other settlements;
(xii) fund-raising, investment management, and associated administrative costs;
(xiii) research and associated administrative costs;
(xiv) nonpaid workers;
(xv) lobbying;
(xvi) scholarships and student aid; and
(xvii) nonmedical assistance covered services;
(4) the commissioner shall review the list of nonallowable costs in the years between
the rebasing process established in clause (5), in consultation with the Minnesota Association
of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall
publish the list and any updates in the Minnesota health care programs provider manual;
(5) the initial applicable base year organization encounter rates for FQHCs and rural
health clinics shall be computed for services delivered on or after January 1, 2021, and:
(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from 2017 and 2018;
(ii) must be according to current applicable Medicare cost principles as applicable to
FQHCs and rural health clinics without the application of productivity screens and upper
payment limits or the Medicare prospective payment system FQHC aggregate mean upper
payment limit;
(iii) must be subsequently rebased every two years thereafter using the Medicare cost
reports that are three and four years prior to the rebasing year. Years in which organizational
cost or claims volume is reduced or altered due to a pandemic, disease, or other public health
emergency shall not be used as part of a base year when the base year includes more than
one year. The commissioner may use the Medicare cost reports of a year unaffected by a
pandemic, disease, or other public health emergency, or previous two consecutive years,
inflated to the base year as established under item (iv);
(iv) must be inflated to the base year using the inflation factor described in clause (6);
and
(v) the commissioner must provide for a 60-day appeals process under section 14.57;
(6) the commissioner shall annually inflate the applicable organization encounter rates
for FQHCs and rural health clinics from the base year payment rate to the effective date by
using the CMS FQHC Market Basket inflator established under United States Code, title
42, section 1395m(o), less productivity;
(7) FQHCs and rural health clinics that have elected the alternative payment methodology
under this paragraph shall submit all necessary documentation required by the commissioner
to compute the rebased organization encounter rates no later than six months following the
date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid
Services;
(8) the commissioner shall reimburse FQHCs and rural health clinics an additional
amount relative to their medical and dental organization encounter rates that is attributable
to the tax required to be paid according to section 295.52, if applicable;
(9) FQHCs and rural health clinics may submit change of scope requests to the
commissioner if the change of scope would result in an increase or decrease of 2.5 percent
or higher in the medical or dental organization encounter rate currently received by the
FQHC or rural health clinic;
(10) for FQHCs and rural health clinics seeking a change in scope with the commissioner
under clause (9) that requires the approval of the scope change by the federal Health
Resources Services Administration:
(i) FQHCs and rural health clinics shall submit the change of scope request, including
the start date of services, to the commissioner within seven business days of submission of
the scope change to the federal Health Resources Services Administration;
(ii) the commissioner shall establish the effective date of the payment change as the
federal Health Resources Services Administration date of approval of the FQHC's or rural
health clinic's scope change request, or the effective start date of services, whichever is
later; and
(iii) within 45 days of one year after the effective date established in item (ii), the
commissioner shall conduct a retroactive review to determine if the actual costs established
under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in
the medical or dental organization encounter rate, and if this is the case, the commissioner
shall revise the rate accordingly and shall adjust payments retrospectively to the effective
date established in item (ii);
(11) for change of scope requests that do not require federal Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request, or the effective
start date of the service, whichever is later. The commissioner shall provide a response to
the FQHC's or rural health clinic's request within 45 days of submission and provide a final
approval within 120 days of submission. This timeline may be waived at the mutual
agreement of the commissioner and the FQHC or rural health clinic if more information is
needed to evaluate the request;
(12) the commissioner, when establishing organization encounter rates for new FQHCs
and rural health clinics, shall consider the patient caseload of existing FQHCs and rural
health clinics in a 60-mile radius for organizations established outside of the seven-county
metropolitan area, and in a 30-mile radius for organizations in the seven-county metropolitan
area. If this information is not available, the commissioner may use Medicare cost reports
or audited financial statements to establish base rates;
(13) the commissioner shall establish a quality measures workgroup that includes
representatives from the Minnesota Association of Community Health Centers, FQHCs,
and rural health clinics, to evaluate clinical and nonclinical measures; and
(14) the commissioner shall not disallow or reduce costs that are related to an FQHC's
or rural health clinic's participation in health care educational programs to the extent that
the costs are not accounted for in the alternative payment methodology encounter rate
established in this paragraph.
new text begin
(m) Effective July 1, 2022, an enrolled Indian Health Service facility or a Tribal health
center operating under a 638 contract or compact may elect to also enroll as a Tribal FQHC.
No requirements that otherwise apply to FQHCs covered in this subdivision apply to Tribal
FQHCs enrolled under this paragraph, except those necessary to comply with federal
regulations. The commissioner shall establish an alternative payment method for Tribal
FQHCs enrolled under this paragraph that uses the same method and rates applicable to a
Tribal facility or health center that does not enroll as a Tribal FQHC.
new text end
Sec. 27.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 31, is
amended to read:
Subd. 31.
Medical supplies and equipment.
(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.
(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.
(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:
(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;
(2) the vendor serves ten or fewer medical assistance recipients per year;
(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and
(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.
(d) new text begin "new text end Durable medical equipmentnew text begin "new text end means a device or equipment that:
(1) can withstand repeated use;
(2) is generally not useful in the absence of an illness, injury, or disability; and
(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.
(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.
(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.
(g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 440.70.
(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or
(d), shall be considered durable medical equipment.
new text begin
(i) Seizure detection devices are covered as durable medical equipment under this
subdivision if:
new text end
new text begin
(1) the seizure detection device is medically appropriate based on the recipient's medical
condition or status; and
new text end
new text begin
(2) the recipient's health care provider has identified that a seizure detection device
would:
new text end
new text begin
(i) likely assist in reducing bodily harm to or death of the recipient as a result of the
recipient experiencing a seizure; or
new text end
new text begin
(ii) provide data to the health care provider necessary to appropriately diagnose or treat
the recipient's health condition that causes the seizure activity.
new text end
new text begin
(j) For purposes of paragraph (i), "seizure detection device" means a United States Food
and Drug Administration approved monitoring device and any related service or subscription
supporting the prescribed use of the device, including technology that:
new text end
new text begin
(1) provides ongoing patient monitoring and alert services that detects nocturnal seizure
activity and transmits notification of the seizure activity to a caregiver for appropriate
medical response; or
new text end
new text begin
(2) collects data of the seizure activity of the recipient that can be used by a health care
provider to diagnose or appropriately treat a health care condition that causes the seizure
activity.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 68. new text end
new text begin Tobacco and nicotine cessation. new text end
new text begin
(a) Medical assistance covers tobacco and
nicotine cessation services, drugs to treat tobacco and nicotine addiction or dependence,
and drugs to help individuals discontinue use of tobacco and nicotine products. Medical
assistance must cover services and drugs as provided in this subdivision consistent with
evidence-based or evidence-informed best practices.
new text end
new text begin
(b) Medical assistance must cover in-person individual and group tobacco and nicotine
cessation education and counseling services if provided by a health care practitioner whose
scope of practice encompasses tobacco and nicotine cessation education and counseling.
Service providers include but are not limited to the following:
new text end
new text begin
(1) mental health practitioners under section 245.462, subdivision 17;
new text end
new text begin
(2) mental health professionals under section 245.462, subdivision 18;
new text end
new text begin
(3) mental health certified peer specialists under section 256B.0615;
new text end
new text begin
(4) alcohol and drug counselors licensed under chapter 148F;
new text end
new text begin
(5) recovery peers as defined in section 245F.02, subdivision 21;
new text end
new text begin
(6) certified tobacco treatment specialists;
new text end
new text begin
(7) community health workers;
new text end
new text begin
(8) physicians;
new text end
new text begin
(9) physician assistants;
new text end
new text begin
(10) advanced practice registered nurses; or
new text end
new text begin
(11) other licensed or nonlicensed professionals or paraprofessionals with training in
providing tobacco and nicotine cessation education and counseling services.
new text end
new text begin
(c) Medical assistance covers telephone cessation counseling services provided through
a quitline. Notwithstanding subdivision 3b, quitline services may be provided through
audio-only communications. The commissioner may use volume purchasing for quitline
services consistent with section 256B.04, subdivision 14.
new text end
new text begin
(d) Medical assistance must cover all prescription and over-the-counter pharmacotherapy
drugs approved by the United States Food and Drug Administration for cessation of tobacco
and nicotine use or treatment of tobacco and nicotine dependence, and that are subject to a
Medicaid drug rebate agreement.
new text end
new text begin
(e) Services covered under this subdivision may be provided by telemedicine.
new text end
new text begin
(f) The commissioner must not:
new text end
new text begin
(1) restrict or limit the type, duration, or frequency of tobacco and nicotine cessation
services;
new text end
new text begin
(2) prohibit the simultaneous use of multiple cessation services, including but not limited
to simultaneous use of counseling and drugs;
new text end
new text begin
(3) require counseling prior to receiving drugs or as a condition of receiving drugs;
new text end
new text begin
(4) limit pharmacotherapy drug dosage amounts for a dosing regimen for treatment of
a medically accepted indication, as defined in United States Code, title 42, section
1396r-8(k)(6); limit dosing frequency; or impose duration limits;
new text end
new text begin
(5) prohibit simultaneous use of multiple drugs, including prescription and
over-the-counter drugs;
new text end
new text begin
(6) require or authorize step therapy; or
new text end
new text begin
(7) require or utilize prior authorization or require a co-payment or deductible for any
tobacco and nicotine cessation services and drugs covered under this subdivision.
new text end
new text begin
(g) The commissioner must require all participating entities under contract with the
commissioner to comply with this subdivision when providing coverage, services, or care
management for medical assistance and MinnesotaCare enrollees. For purposes of this
subdivision, "participating entity" means any of the following:
new text end
new text begin
(1) a health carrier as defined in section 62A.011, subdivision 2;
new text end
new text begin
(2) a county-based purchasing plan established under section 256B.692;
new text end
new text begin
(3) an accountable care organization or other entity participating as an integrated health
partnership under section 256B.0755;
new text end
new text begin
(4) an entity operating a county integrated health care delivery network pilot project
authorized under section 256B.0756;
new text end
new text begin
(5) a network of health care providers established to offer services under medical
assistance or MinnesotaCare; or
new text end
new text begin
(6) any other entity that has a contract with the commissioner to cover, provide, or
manage health care services provided to medical assistance or MinnesotaCare enrollees on
a capitated or risk-based payment arrangement or under a reimbursement methodology with
substantial financial incentives to reduce the total cost of health care for a population of
patients that is enrolled with or assigned or attributed to the entity.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.0631, as amended by Laws 2021, First
Special Session chapter 7, article 1, section 17, is amended to read:
256B.0631 MEDICAL ASSISTANCE CO-PAYMENTS.
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011new text begin , through December 31, 2022new text end :
(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes of this
subdivision, a visit means an episode of service which is required because of a recipient's
symptoms, diagnosis, or established illness, and which is delivered in an ambulatory setting
by a physician or physician assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometrist;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription, $1 per generic drug prescription, and $1 per
prescription for a brand-name multisource drug listed in preferred status on the preferred
drug list, subject to a $12 per month maximum for prescription drug co-payments. No
co-payments shall apply to antipsychotic drugs when used for the treatment of mental illness;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.
new text begin
(f) Paragraphs (a) to (e) apply only for services provided through December 31, 2022.
Effective for services provided on or after January 1, 2023, the medical assistance program
shall not require deductibles, co-payments, coinsurance, or any other form of enrollee
cost-sharing.
new text end
Subd. 2.
Exceptions.
Co-payments and deductibles shall be subjectnew text begin , through December
31, 2022,new text end to the following exceptions:
(1) children under the age of 21;
(2) pregnant women for services that relate to the pregnancy or any other medical
condition that may complicate the pregnancy;
(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
intermediate care facility for the developmentally disabled;
(4) recipients receiving hospice care;
(5) 100 percent federally funded services provided by an Indian health service;
(6) emergency services;
(7) family planning services;
(8) services that are paid by Medicare, resulting in the medical assistance program paying
for the coinsurance and deductible;
(9) co-payments that exceed one per day per provider for nonpreventive visits, eyeglasses,
and nonemergency visits to a hospital-based emergency room;
(10) services, fee-for-service payments subject to volume purchase through competitive
bidding;
(11) American Indians who meet the requirements in Code of Federal Regulations, title
42, sections 447.51 and 447.56;
(12) persons needing treatment for breast or cervical cancer as described under section
256B.057, subdivision 10; and
(13) services that currently have a rating of A or B from the United States Preventive
Services Task Force (USPSTF), immunizations recommended by the Advisory Committee
on Immunization Practices of the Centers for Disease Control and Prevention, and preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130.
Subd. 3.
Collection.
(a) The medical assistance reimbursement to the provider shall be
reduced by the amount of the co-payment or deductible, except that reimbursements shall
not be reduced:
(1) once a recipient has reached the $12 per month maximum for prescription drug
co-payments; or
(2) for a recipient who has met their monthly five percent cost-sharing limit.
(b) The provider collects the co-payment or deductible from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment or deductible.
(c) Medical assistance reimbursement to fee-for-service providers and payments to
managed care plans shall not be increased as a result of the removal of co-payments or
deductibles effective on or after January 1, 2009.
new text begin
(d) Paragraphs (a) to (c) apply only for services provided through December 31, 2022.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256B.69, subdivision 4, is amended to read:
Subd. 4.
Limitation of choicenew text begin ; opportunity to opt outnew text end .
(a) The commissioner shall
develop criteria to determine when limitation of choice may be implemented in the
experimental countiesnew text begin , but shall provide all eligible individuals the opportunity to opt out
of enrollment in managed care under this sectionnew text end . The criteria shall ensure that all eligible
individuals in the county have continuing access to the full range of medical assistance
services as specified in subdivision 6.
(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:
(1) persons eligible for medical assistance according to section 256B.055, subdivision
1;
(2) persons eligible for medical assistance due to blindness or disability as determined
by the Social Security Administration or the state medical review team, unless:
(i) they are 65 years of age or older; or
(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
Security Act;
(3) recipients who currently have private coverage through a health maintenance
organization;
(4) recipients who are eligible for medical assistance by spending down excess income
for medical expenses other than the nursing facility per diem expense;
(5) recipients who receive benefits under the Refugee Assistance Program, established
under United States Code, title 8, section 1522(e);
(6) children who are both determined to be severely emotionally disturbed and receiving
case management services according to section 256B.0625, subdivision 20, except children
who are eligible for and who decline enrollment in an approved preferred integrated network
under section 245.4682;
(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;
(8) persons eligible for medical assistance according to section 256B.057, subdivision
10;
(9) persons with access to cost-effective employer-sponsored private health insurance
or persons enrolled in a non-Medicare individual health plan determined to be cost-effective
according to section 256B.0625, subdivision 15; and
(10) persons who are absent from the state for more than 30 consecutive days but still
deemed a resident of Minnesota, identified in accordance with section 256B.056, subdivision
1, paragraph (b).
Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an elective
basis. The commissioner may enroll recipients in the prepaid medical assistance program
for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by spending
down excess income.
(c) The commissioner may allow persons with a one-month spenddown who are otherwise
eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay their monthly
spenddown to the state.
(d) The commissioner may requirenew text begin , subject to the opt-out provision under paragraph (a),new text end
those individuals to enroll in the prepaid medical assistance program who otherwise would
have been excluded under paragraph (b), clauses (1), (3), and (8), and under Minnesota
Rules, part 9500.1452, subpart 2, items H, K, and L.
(e) Before limitation of choice is implemented, eligible individuals shall be notified and
new text begin given the opportunity to opt out of managed care enrollment. new text end After notification, new text begin those
individuals who choose not to opt out new text end shall be allowed to choose only among demonstration
providers. The commissioner may assign an individual with private coverage through a
health maintenance organization, to the same health maintenance organization for medical
assistance coverage, if the health maintenance organization is under contract for medical
assistance in the individual's county of residence. After initially choosing a provider, the
recipient is allowed to change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in the project for any reason,
a recipient enrolled with that provider must select a new provider but may change providers
without cause once more within the first 60 days after enrollment with the second provider.
(f) An infant born to a woman who is eligible for and receiving medical assistance and
who is enrolled in the prepaid medical assistance program shall be retroactively enrolled to
the month of birth in the same managed care plan as the mother once the child is enrolled
in medical assistance unless the child is determined to be excluded from enrollment in a
prepaid plan under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256B.69, subdivision 5c, is amended to read:
Subd. 5c.
Medical education and research fund.
(a) The commissioner of human
services shall transfer each year to the medical education and research fund established
under section 62J.692, an amount specified in this subdivision. The commissioner shall
calculate the following:
(1) an amount equal to the reduction in the prepaid medical assistance payments as
specified in this clause. After January 1, 2002, the county medical assistance capitation base
rate prior to plan specific adjustments is reduced 6.3 percent for Hennepin County, two
percent for the remaining metropolitan counties, and 1.6 percent for nonmetropolitan
Minnesota counties. Nursing facility and elderly waiver payments and demonstration project
payments operating under subdivision 23 are excluded from this reduction. The amount
calculated under this clause shall not be adjusted for periods already paid due to subsequent
changes to the capitation payments;
(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this section;
(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates paid
under this section; and
(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid under
this section.
(b) This subdivision shall be effective upon approval of a federal waiver which allows
federal financial participation in the medical education and research fund. The amount
specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount transferred
for fiscal year 2009. Any excess shall first reduce the amounts specified under paragraph
(a), clauses (2) to (4). Any excess following this reduction shall proportionally reduce the
amount specified under paragraph (a), clause (1).
(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
shall transfer $21,714,000 each fiscal year to the medical education and research fund.
(d) Beginning September 1, 2011, of the amount in paragraph (a), following the transfer
under paragraph (c), the commissioner shall transfer to the medical education research fund
deleted text begin $23,936,000 in fiscal years 2012 and 2013 anddeleted text end $49,552,000 in fiscal year 2014 and thereafter.
new text begin
(e) If the federal waiver described in paragraph (b) is not renewed, the transfer described
in paragraph (c) and corresponding payments under section 62J.692, subdivision 7, are
terminated effective the first month in which the waiver is no longer in effect, and the state
share of the amount described in paragraph (d) must be transferred to the medical education
and research fund and distributed according to the provisions of section 62J.692, subdivision
4a.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256B.69, subdivision 28, is amended to read:
Subd. 28.
Medicare special needs plans; medical assistance basic health care.
(a)
The commissioner may contract with demonstration providers and current or former sponsors
of qualified Medicare-approved special needs plans, to provide medical assistance basic
health care services to persons with disabilities, including those with developmental
disabilities. Basic health care services include:
(1) those services covered by the medical assistance state plan except for ICF/DD services,
home and community-based waiver services, case management for persons with
developmental disabilities under section 256B.0625, subdivision 20a, and personal care and
certain home care services defined by the commissioner in consultation with the stakeholder
group established under paragraph (d); and
(2) basic health care services may also include risk for up to 100 days of nursing facility
services for persons who reside in a noninstitutional setting and home health services related
to rehabilitation as defined by the commissioner after consultation with the stakeholder
group.
The commissioner may exclude other medical assistance services from the basic health
care benefit set. Enrollees in these plans can access any excluded services on the same basis
as other medical assistance recipients who have not enrolled.
(b) The commissioner may contract with demonstration providers and current and former
sponsors of qualified Medicare special needs plans, to provide basic health care services
under medical assistance to persons who are dually eligible for both Medicare and Medicaid
and those Social Security beneficiaries eligible for Medicaid but in the waiting period for
Medicare. The commissioner shall consult with the stakeholder group under paragraph (d)
in developing program specifications for these services. Payment for Medicaid services
provided under this subdivision for the months of May and June will be made no earlier
than July 1 of the same calendar year.
(c) deleted text begin Notwithstanding subdivision 4, beginning January 1, 2012,deleted text end The commissioner shall
enroll persons with disabilities in managed care under this section, unless the individual
chooses to opt out of enrollment. The commissioner shall establish enrollment and opt out
procedures consistent with applicable enrollment procedures under this section.
(d) The commissioner shall establish a state-level stakeholder group to provide advice
on managed care programs for persons with disabilities, including both MnDHO and contracts
with special needs plans that provide basic health care services as described in paragraphs
(a) and (b). The stakeholder group shall provide advice on program expansions under this
subdivision and subdivision 23, including:
(1) implementation efforts;
(2) consumer protections; and
(3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.
(e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the counties
covered by the plan, members, consumer advocates, and providers, for advice on issues that
arise in the local or regional area.
(f) The commissioner is prohibited from providing the names of potential enrollees to
health plans for marketing purposes. The commissioner shall mail no more than two sets
of marketing materials per contract year to potential enrollees on behalf of health plans, at
the health plan's request. The marketing materials shall be mailed by the commissioner
within 30 days of receipt of these materials from the health plan. The health plans shall
cover any costs incurred by the commissioner for mailing marketing materials.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256B.69, subdivision 36, is amended to read:
Subd. 36.
Enrollee support system.
(a) The commissioner shall establish an enrollee
support system that provides support to an enrollee before and during enrollment in a
managed care plan.
(b) The enrollee support system must:
(1) provide access to counseling for each potential enrollee on choosing a managed care
plannew text begin or opting out of managed carenew text end ;
(2) assist an enrollee in understanding enrollment in a managed care plan;
(3) provide an access point for complaints regarding enrollment, covered services, and
other related matters;
(4) provide information on an enrollee's grievance and appeal rights within the managed
care organization and the state's fair hearing process, including an enrollee's rights and
responsibilities; and
(5) provide assistance to an enrollee, upon request, in navigating the grievance and
appeals process within the managed care organization and in appealing adverse benefit
determinations made by the managed care organization to the state's fair hearing process
after the managed care organization's internal appeals process has been exhausted. Assistance
does not include providing representation to an enrollee at the state's fair hearing, but may
include a referral to appropriate legal representation sources.
(c) Outreach to enrollees through the support system must be accessible to an enrollee
through multiple formats, including telephone, Internet, in-person, and, if requested, through
auxiliary aids and services.
(d) The commissioner may designate enrollment brokers to assist enrollees on selecting
a managed care organization and providing necessary enrollment information. For purposes
of this subdivision, "enrollment broker" means an individual or entity that performs choice
counseling or enrollment activities in accordance with Code of Federal Regulations, part
42, section 438.810, or both.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256B.692, subdivision 1, is amended to read:
Subdivision 1.
In general.
County boards or groups of county boards may elect to
purchase or provide health care services on behalf of persons eligible for medical assistance
who would otherwise be required to or may elect to participate in the prepaid medical
assistance program according to section 256B.69new text begin , subject to the opt-out provision of section
256B.69, subdivision 4, paragraph (a)new text end . Counties that elect to purchase or provide health
care under this section must provide all services included in prepaid managed care programs
according to section 256B.69, subdivisions 1 to 22. County-based purchasing under this
section is governed by section 256B.69, unless otherwise provided for under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256B.6925, subdivision 1, is amended to read:
Subdivision 1.
Information provided by commissioner.
The commissioner shall provide
to each potential enrollee the following information:
(1) basic features of receiving services through managed care;
(2) which individuals are excluded from managed care enrollment, subject to deleted text begin mandatory
managed care enrollmentdeleted text end new text begin the opt-out provision of section 256B.69, subdivision 4, paragraph
(a)new text end , or who may choose to enroll voluntarily;
(3) deleted text begin for mandatory and voluntary enrollment,deleted text end the length of the enrollment period and
information about an enrollee's right to disenroll in accordance with Code of Federal
Regulations, part 42, section 438.56;
(4) the service area covered by each managed care organization;
(5) covered services, including services provided by the managed care organization and
services provided by the commissioner;
(6) the provider directory and drug formulary for each managed care organization;
(7) cost-sharing requirements;
(8) requirements for adequate access to services, including provider network adequacy
standards;
(9) a managed care organization's responsibility for coordination of enrollee care; and
(10) quality and performance indicators, including enrollee satisfaction for each managed
care organization, if available.
Sec. 36.
Minnesota Statutes 2020, section 256B.6925, subdivision 1, is amended to read:
Subdivision 1.
Information provided by commissioner.
The commissioner shall provide
to each potential enrollee the following information:
(1) basic features of receiving services through managed care;
(2) which individuals are excluded from managed care enrollment, subject to mandatory
managed care enrollment, or who may choose to enroll voluntarily;
(3) for mandatory and voluntary enrollment, the length of the enrollment period and
information about an enrollee's right to disenroll in accordance with Code of Federal
Regulations, part 42, section 438.56;
(4) the service area covered by each managed care organization;
(5) covered services, including services provided by the managed care organization and
services provided by the commissioner;
(6) the provider directory and drug formulary for each managed care organization;
deleted text begin
(7) cost-sharing requirements;
deleted text end
deleted text begin (8)deleted text end new text begin (7)new text end requirements for adequate access to services, including provider network adequacy
standards;
deleted text begin (9)deleted text end new text begin (8)new text end a managed care organization's responsibility for coordination of enrollee care;
and
deleted text begin (10)deleted text end new text begin (9)new text end quality and performance indicators, including enrollee satisfaction for each
managed care organization, if available.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.6925, subdivision 2, is amended to read:
Subd. 2.
Information provided by managed care organization.
The commissioner
shall ensure that managed care organizations provide to each enrollee the following
information:
(1) an enrollee handbook within a reasonable time after receiving notice of the enrollee's
enrollment. The handbook must, at a minimum, include information on benefits provided,
how and where to access benefits, deleted text begin cost-sharing requirements,deleted text end how transportation is provided,
and other information as required by Code of Federal Regulations, part 42, section 438.10,
paragraph (g);
(2) a provider directory for the following provider types: physicians, specialists, hospitals,
pharmacies, behavioral health providers, and long-term supports and services providers, as
appropriate. The directory must include the provider's name, group affiliation, street address,
telephone number, website, specialty if applicable, whether the provider accepts new
enrollees, the provider's cultural and linguistic capabilities as identified in Code of Federal
Regulations, part 42, section 438.10, paragraph (h), and whether the provider's office
accommodates people with disabilities;
(3) a drug formulary that includes both generic and name brand medications that are
covered and each medication tier, if applicable;
(4) written notice of termination of a contracted provider. Within 15 calendar days after
receipt or issuance of the termination notice, the managed care organization must make a
good faith effort to provide notice to each enrollee who received primary care from, or was
seen on a regular basis by, the terminated provider; and
(5) upon enrollee request, the managed care organization's physician incentive plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 38.
Minnesota Statutes 2020, section 256B.6928, subdivision 3, is amended to read:
Subd. 3.
Rate development standards.
(a) In developing capitation rates, the
commissioner shall:
(1) identify and develop base utilization and price data, including validated encounter
data and audited financial reports received from the managed care organizations that
demonstrate experience for the populations served by the managed care organizations, for
the three most recent and complete years before the rating period;
(2) develop and apply reasonable trend factors, including cost and utilization, to base
data that are developed from actual experience of the medical assistance population or a
similar population according to generally accepted actuarial practices and principles;
(3) develop the nonbenefit component of the rate to account for reasonable expenses
related to the managed care organization's administration; taxes; licensing and regulatory
fees; contribution to reserves; risk margin; cost of capital and other operational costs
associated with the managed care organization's provision of covered services to enrollees;
deleted text begin
(4) consider the value of cost-sharing for rate development purposes, regardless of
whether the managed care organization imposes the cost-sharing on the enrollee or the
cost-sharing is collected by the provider;
deleted text end
deleted text begin (5)deleted text end new text begin (4)new text end make appropriate and reasonable adjustments to account for changes to the base
data, programmatic changes, changes to nonbenefit components, and any other adjustment
necessary to establish actuarially sound rates. Each adjustment must reasonably support the
development of an accurate base data set for purposes of rate setting, reflect the health status
of the enrolled population, and be developed in accordance with generally accepted actuarial
principles and practices;
deleted text begin (6)deleted text end new text begin (5)new text end consider the managed care organization's past medical loss ratio in the development
of the capitation rates and consider the projected medical loss ratio; and
deleted text begin (7)deleted text end new text begin (6)new text end select a prospective or retrospective risk adjustment methodology that must be
developed in a budget-neutral manner consistent with generally accepted actuarial principles
and practices.
(b) The base data must be derived from the medical assistance population or, if data on
the medical assistance population is not available, derived from a similar population and
adjusted to make the utilization and price data comparable to the medical assistance
population. Data must be in accordance with actuarial standards for data quality and an
explanation of why that specific data is used must be provided in the rate certification. If
the commissioner is unable to base the rates on data that are within the three most recent
and complete years before the rating period, the commissioner may request an approval
from the Centers for Medicare and Medicaid Services for an exception. The request must
describe why an exception is necessary and describe the actions that the commissioner
intends to take to comply with the request.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256B.76, subdivision 1, is amended to read:
Subdivision 1.
Physician reimbursement.
(a) Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for physician services as follows:
(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care," "critical
care," cesarean delivery and pharmacologic management provided to psychiatric patients,
and level three codes for enhanced services for prenatal high risk, shall be paid at the lower
of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992;
(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect on
September 30, 1992.
(b) Effective for services rendered on or after January 1, 2000, payment rates for physician
and professional services shall be increased by three percent over the rates in effect on
December 31, 1999, except for home health agency and family planning agency services.
The increases in this paragraph shall be implemented January 1, 2000, for managed care.
(c) Effective for services rendered on or after July 1, 2009, payment rates for physician
and professional services shall be reduced by five percent, except that for the period July
1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical
assistance and general assistance medical care programs, over the rates in effect on June
30, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other
outpatient visits, preventive medicine visits and family planning visits billed by physicians,
advanced practice nurses, or physician assistants in a family planning agency or in one of
the following primary care practices: general practice, general internal medicine, general
pediatrics, general geriatrics, and family medicine. This reduction and the reductions in
paragraph (d) do not apply to federally qualified health centers, rural health centers, and
Indian health services. Effective October 1, 2009, payments made to managed care plans
and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall
reflect the payment reduction described in this paragraph.
(d) Effective for services rendered on or after July 1, 2010, payment rates for physician
and professional services shall be reduced an additional seven percent over the five percent
reduction in rates described in paragraph (c). This additional reduction does not apply to
physical therapy services, occupational therapy services, and speech pathology and related
services provided on or after July 1, 2010. This additional reduction does not apply to
physician services billed by a psychiatrist or an advanced practice nurse with a specialty in
mental health. Effective October 1, 2010, payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the payment reduction described in this paragraph.
(e) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for physician and professional services shall be reduced three percent from
the rates in effect on August 31, 2011. This reduction does not apply to physical therapy
services, occupational therapy services, and speech pathology and related services.
(f) Effective for services rendered on or after September 1, 2014, payment rates for
physician and professional services, including physical therapy, occupational therapy, speech
pathology, and mental health services shall be increased by five percent from the rates in
effect on August 31, 2014. In calculating this rate increase, the commissioner shall not
include in the base rate for August 31, 2014, the rate increase provided under section
256B.76, subdivision 7. This increase does not apply to federally qualified health centers,
rural health centers, and Indian health services. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
(g) Effective for services rendered on or after July 1, 2015, payment rates for physical
therapy, occupational therapy, and speech pathology and related services provided by a
hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause
(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments
made to managed care plans and county-based purchasing plans shall not be adjusted to
reflect payments under this paragraph.
(h) Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
new text begin
(i) Medical assistance may reimburse for the cost incurred to pay the Department of
Health for metabolic disorder testing of newborns who are medical assistance recipients
when the sample is collected outside of an inpatient hospital setting or freestanding birth
center setting because the newborn was born outside of a hospital or freestanding birth
center or because it is not medically appropriate to collect the sample during the inpatient
stay for the birth.
new text end
Sec. 40.
Minnesota Statutes 2020, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.
(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016new text begin , or after December 31,
2022new text end .
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin
(d) Paragraphs (a) to (c) apply only to services provided through December 31, 2022.
Effective for services provided on or after January 1, 2023, the MinnesotaCare program
shall not require deductibles, co-payments, coinsurance, or any other form of enrollee
cost-sharing.
new text end
Sec. 41.
Minnesota Statutes 2020, section 256L.04, subdivision 1c, is amended to read:
Subd. 1c.
General requirements.
To be eligible for MinnesotaCare, a person must meet
the eligibility requirements of this section. A person eligible for MinnesotaCare deleted text begin shalldeleted text end new text begin with
an income less than or equal to 200 percent of the federal poverty guidelines mustnew text end not be
considered a qualified individual under section 1312 of the Affordable Care Act, and is not
eligible for enrollment in a qualified health plan offered through MNsure under chapter
62V.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 42.
Minnesota Statutes 2020, section 256L.04, subdivision 7a, is amended to read:
Subd. 7a.
Ineligibility.
Adults whose income is greater than the limits established under
this section may not enroll in the MinnesotaCare programnew text begin , except as provided in subdivision
15new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 43.
Minnesota Statutes 2020, section 256L.04, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin Persons eligible for public option. new text end
new text begin
(a) Families and individuals with income
above the maximum income eligibility limit specified in subdivision 1 or 7, who meet all
other MinnesotaCare eligibility requirements, are eligible for MinnesotaCare. All other
provisions of this chapter apply unless otherwise specified.
new text end
new text begin
(b) Families and individuals may enroll in MinnesotaCare under this subdivision only
during an annual open enrollment period or special enrollment period, as designated by
MNsure in compliance with Code of Federal Regulations, title 45, parts 155.410 and 155.420.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 44.
Minnesota Statutes 2020, section 256L.07, subdivision 1, is amended to read:
Subdivision 1.
General requirements.
Individuals enrolled in MinnesotaCare under
section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7, whose income increases above 200 percent of the federal poverty
guidelinesdeleted text begin ,deleted text end are no longer eligible for the program and deleted text begin shalldeleted text end new text begin mustnew text end be disenrolled by the
commissionernew text begin , unless the individuals continue MinnesotaCare enrollment through the public
option under section 256L.04, subdivision 15new text end . For persons disenrolled under this subdivision,
MinnesotaCare coverage terminates the last day of the calendar month in which the
commissioner sends advance notice according to Code of Federal Regulations, title 42,
section 431.211, that indicates the income of a family or individual exceeds program income
limits.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, but only if the commissioner of human services certifies to the legislature
that implementation of this section will not result in federal penalties to federal basic health
program funding for MinnesotaCare enrollees with incomes not exceeding 200 percent of
the federal poverty guidelines. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end
Sec. 45.
Minnesota Statutes 2021 Supplement, section 256L.15, subdivision 2, is amended
to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.
deleted text begin
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Paragraph deleted text begin (b)deleted text end new text begin (a)new text end does not apply todeleted text begin :
deleted text end
deleted text begin (1)deleted text end children 20 years of age or youngerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
deleted text end
deleted text begin
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
deleted text end
|
deleted text begin
Federal Poverty Guideline Greater than or Equal to deleted text end |
deleted text begin
Less than deleted text end |
deleted text begin
Individual Premium Amount deleted text end |
|
deleted text begin
35% deleted text end |
deleted text begin
55% deleted text end |
deleted text begin
$4 deleted text end |
|
deleted text begin
55% deleted text end |
deleted text begin
80% deleted text end |
deleted text begin
$6 deleted text end |
|
deleted text begin
80% deleted text end |
deleted text begin
90% deleted text end |
deleted text begin
$8 deleted text end |
|
deleted text begin
90% deleted text end |
deleted text begin
100% deleted text end |
deleted text begin
$10 deleted text end |
|
deleted text begin
100% deleted text end |
deleted text begin
110% deleted text end |
deleted text begin
$12 deleted text end |
|
deleted text begin
110% deleted text end |
deleted text begin
120% deleted text end |
deleted text begin
$14 deleted text end |
|
deleted text begin
120% deleted text end |
deleted text begin
130% deleted text end |
deleted text begin
$15 deleted text end |
|
deleted text begin
130% deleted text end |
deleted text begin
140% deleted text end |
deleted text begin
$16 deleted text end |
|
deleted text begin
140% deleted text end |
deleted text begin
150% deleted text end |
deleted text begin
$25 deleted text end |
|
deleted text begin
150% deleted text end |
deleted text begin
160% deleted text end |
deleted text begin
$37 deleted text end |
|
deleted text begin
160% deleted text end |
deleted text begin
170% deleted text end |
deleted text begin
$44 deleted text end |
|
deleted text begin
170% deleted text end |
deleted text begin
180% deleted text end |
deleted text begin
$52 deleted text end |
|
deleted text begin
180% deleted text end |
deleted text begin
190% deleted text end |
deleted text begin
$61 deleted text end |
|
deleted text begin
190% deleted text end |
deleted text begin
200% deleted text end |
deleted text begin
$71 deleted text end |
|
deleted text begin
200% deleted text end |
deleted text begin
$80 deleted text end |
deleted text begin (e)deleted text end new text begin (c)new text end Beginning January 1, deleted text begin 2021deleted text end new text begin 2023new text end ,new text begin the commissioner shall continue to charge
premiums in accordance with the simplified premium scale established to comply with the
American Rescue Plan Act of 2021, in effect from January 1, 2021, through December 31,
2022, for families and individuals eligible under section 256L.04, subdivisions 1 and 7.new text end The
commissioner shall adjust the premium scale deleted text begin established under paragraph (d)deleted text end new text begin as needednew text end to
ensure that premiums do not exceed the amount that an individual would have been required
to pay if the individual was enrolled in an applicable benchmark plan in accordance with
the Code of Federal Regulations, title 42, section 600.505 (a)(1).
new text begin
(d) The commissioner shall establish a sliding premium scale for persons eligible through
the buy-in option under section 256L.04, subdivision 15. Beginning January 1, 2025, persons
eligible through the buy-in option shall pay premiums according to the premium scale
established by the commissioner. Persons 20 years of age or younger are exempt from
paying premiums.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, except that the sliding
premium scale established under paragraph (d) is effective January 1, 2025, or upon federal
approval, whichever is later, but only if the commissioner of human services certifies to the
legislature that implementation of paragraph (d) will not result in federal penalties to federal
basic health program funding for MinnesotaCare enrollees with incomes not exceeding 200
percent of the federal poverty guidelines. The commissioner of human services shall notify
the revisor of statutes when federal approval is obtained.
new text end
Sec. 46.
Laws 2015, chapter 71, article 14, section 2, subdivision 5, as amended by Laws
2015, First Special Session chapter 6, section 1, is amended to read:
Subd. 5.Grant Programs
|
||||||
The amounts that may be spent from this
appropriation for each purpose are as follows:
| (a) Support Services Grants |
||||||
| Appropriations by Fund |
||
| General |
13,133,000 |
8,715,000 |
| Federal TANF |
96,311,000 |
96,311,000 |
| (b) Basic Sliding Fee Child Care Assistance Grants |
48,439,000 |
51,559,000 |
||||
Basic Sliding Fee Waiting List Allocation.
Notwithstanding Minnesota Statutes, section
119B.03, $5,413,000 in fiscal year 2016 is to
reduce the basic sliding fee program waiting
list as follows:
(1) The calendar year 2016 allocation shall be
increased to serve families on the waiting list.
To receive funds appropriated for this purpose,
a county must have:
(i) a waiting list in the most recent published
waiting list month;
(ii) an average of at least ten families on the
most recent six months of published waiting
list; and
(iii) total expenditures in calendar year 2014
that met or exceeded 80 percent of the county's
available final allocation.
(2) Funds shall be distributed proportionately
based on the average of the most recent six
months of published waiting lists to counties
that meet the criteria in clause (1).
(3) Allocations in calendar years 2017 and
beyond shall be calculated using the allocation
formula in Minnesota Statutes, section
119B.03.
(4) The guaranteed floor for calendar year
2017 shall be based on the revised calendar
year 2016 allocation.
Base Level Adjustment. The general fund
base is increased by $810,000 in fiscal year
2018 and increased by $821,000 in fiscal year
2019.
| (c) Child Care Development Grants |
1,737,000 |
1,737,000 |
||||
| (d) Child Support Enforcement Grants |
50,000 |
50,000 |
||||
| (e) Children's Services Grants |
||||||
| Appropriations by Fund |
||
| General |
39,015,000 |
38,665,000 |
| Federal TANF |
140,000 |
140,000 |
Safe Place for Newborns. $350,000 from the
general fund in fiscal year 2016 is to distribute
information on the Safe Place for Newborns
law in Minnesota to increase public awareness
of the law. This is a onetime appropriation.
Child Protection. $23,350,000 in fiscal year
2016 and $23,350,000 in fiscal year 2017 are
to address child protection staffing and
services under Minnesota Statutes, section
256M.41. $1,650,000 in fiscal year 2016 and
$1,650,000 in fiscal year 2017 are for child
protection grants to address child welfare
disparities under Minnesota Statutes, section
256E.28.
Title IV-E Adoption Assistance. Additional
federal reimbursement to the state as a result
of the Fostering Connections to Success and
Increasing Adoptions Act's expanded
eligibility for title IV-E adoption assistance is
appropriated to the commissioner for
postadoption services, including a
parent-to-parent support network.
Adoption Assistance Incentive Grants.
Federal funds available during fiscal years
2016 and 2017 for adoption incentive grants
are appropriated to the commissioner for
postadoption services, including a
parent-to-parent support network.
| (f) Children and Community Service Grants |
56,301,000 |
56,301,000 |
||||
| (g) Children and Economic Support Grants |
26,778,000 |
26,966,000 |
||||
Mobile Food Shelf Grants. (a) $1,000,000
in fiscal year 2016 and $1,000,000 in fiscal
year 2017 are for a grant to Hunger Solutions.
This is a onetime appropriation and is
available until June 30, 2017.
(b) Hunger Solutions shall award grants of up
to $75,000 on a competitive basis. Grant
applications must include:
(1) the location of the project;
(2) a description of the mobile program,
including size and scope;
(3) evidence regarding the unserved or
underserved nature of the community in which
the project is to be located;
(4) evidence of community support for the
project;
(5) the total cost of the project;
(6) the amount of the grant request and how
funds will be used;
(7) sources of funding or in-kind contributions
for the project that will supplement any grant
award;
(8) a commitment to mobile programs by the
applicant and an ongoing commitment to
maintain the mobile program; and
(9) any additional information requested by
Hunger Solutions.
(c) Priority may be given to applicants who:
(1) serve underserved areas;
(2) create a new or expand an existing mobile
program;
(3) serve areas where a high amount of need
is identified;
(4) provide evidence of strong support for the
project from citizens and other institutions in
the community;
(5) leverage funding for the project from other
private and public sources; and
(6) commit to maintaining the program on a
multilayer basis.
Homeless Youth Act. At least $500,000 of
the appropriation for the Homeless Youth Act
must be awarded to providers in greater
Minnesota, with at least 25 percent of this
amount for new applicant providers. The
commissioner shall provide outreach and
technical assistance to greater Minnesota
providers and new providers to encourage
responding to the request for proposals.
Stearns County Veterans Housing. $85,000
in fiscal year 2016 and $85,000 in fiscal year
2017 are for a grant to Stearns County to
provide administrative funding in support of
a service provider serving veterans in Stearns
County. The administrative funding grant may
be used to support group residential housing
services, corrections-related services, veteran
services, and other social services related to
the service provider serving veterans in
Stearns County.
Safe Harbor. $800,000 in fiscal year 2016
and $800,000 in fiscal year 2017 are from the
general fund for emergency shelter and
transitional and long-term housing beds for
sexually exploited youth and youth at risk of
sexual exploitation. Of this appropriation,
$150,000 in fiscal year 2016 and $150,000 in
fiscal year 2017 are from the general fund for
statewide youth outreach workers connecting
sexually exploited youth and youth at risk of
sexual exploitation with shelter and services.
Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2016 do not
cancel but are available for this purpose in
fiscal year 2017.
Base Level Adjustment. The general fund
base is decreased by $816,000 in fiscal year
2018 and is decreased by $606,000 in fiscal
year 2019.
| (h) Health Care Grants |
||||||
| Appropriations by Fund |
||
| General |
536,000 |
2,482,000 |
| Health Care Access |
3,341,000 |
3,465,000 |
Grants for Periodic Data Matching for
Medical Assistance and MinnesotaCare. Of
the general fund appropriation, $26,000 in
fiscal year 2016 and $1,276,000 in fiscal year
2017 are for grants to counties for costs related
to periodic data matching for medical
assistance and MinnesotaCare recipients under
Minnesota Statutes, section 256B.0561. The
commissioner must distribute these grants to
counties in proportion to each county's number
of cases in the prior year in the affected
programs.
Base Level Adjustment. The general fund
base is deleted text begin increased by $1,637,000 in fiscal year
2018 and increased by $1,229,000 in fiscal
year 2019deleted text end new text begin maintained in fiscal years 2020 and
2021new text end .
| (i) Other Long-Term Care Grants |
1,551,000 |
3,069,000 |
||||
Transition Populations. $1,551,000 in fiscal
year 2016 and $1,725,000 in fiscal year 2017
are for home and community-based services
transition grants to assist in providing home
and community-based services and treatment
for transition populations under Minnesota
Statutes, section 256.478.
Base Level Adjustment. The general fund
base is increased by $156,000 in fiscal year
2018 and by $581,000 in fiscal year 2019.
| (j) Aging and Adult Services Grants |
28,463,000 |
28,162,000 |
||||
Dementia Grants. $750,000 in fiscal year
2016 and $750,000 in fiscal year 2017 are for
the Minnesota Board on Aging for regional
and local dementia grants authorized in
Minnesota Statutes, section 256.975,
subdivision 11.
| (k) Deaf and Hard-of-Hearing Grants |
2,225,000 |
2,375,000 |
||||
Deaf, Deafblind, and Hard-of-Hearing
Grants. $350,000 in fiscal year 2016 and
$500,000 in fiscal year 2017 are for deaf and
hard-of-hearing grants. The funds must be
used to increase the number of deafblind
Minnesotans receiving services under
Minnesota Statutes, section 256C.261, and to
provide linguistically and culturally
appropriate mental health services to children
who are deaf, deafblind, and hard-of-hearing.
This is a onetime appropriation.
Base Level Adjustment. The general fund
base is decreased by $500,000 in fiscal year
2018 and by $500,000 in fiscal year 2019.
| (l) Disabilities Grants |
20,820,000 |
20,858,000 |
||||
State Quality Council. $573,000 in fiscal
year 2016 and $600,000 in fiscal year 2017
are for the State Quality Council to provide
technical assistance and monitoring of
person-centered outcomes related to inclusive
community living and employment. The
funding must be used by the State Quality
Council to assure a statewide plan for systems
change in person-centered planning that will
achieve desired outcomes including increased
integrated employment and community living.
| (m) Adult Mental Health Grants |
||||||
| Appropriations by Fund |
||
| General |
69,992,000 |
71,244,000 |
| Health Care Access |
1,575,000 |
2,473,000 |
| Lottery Prize |
1,733,000 |
1,733,000 |
Funding Usage. Up to 75 percent of a fiscal
year's appropriation for adult mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
Culturally Specific Mental Health Services.
$100,000 in fiscal year 2016 is for grants to
nonprofit organizations to provide resources
and referrals for culturally specific mental
health services to Southeast Asian veterans
born before 1965 who do not qualify for
services available to veterans formally
discharged from the United States armed
forces.
Problem Gambling. $225,000 in fiscal year
2016 and $225,000 in fiscal year 2017 are
from the lottery prize fund for a grant to the
state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
and training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
Sustainability Grants. $2,125,000 in fiscal
year 2016 and $2,125,000 in fiscal year 2017
are for sustainability grants under Minnesota
Statutes, section 256B.0622, subdivision 11.
Beltrami County Mental Health Services
Grant. $1,000,000 in fiscal year 2016 and
$1,000,000 in fiscal year 2017 are from the
general fund for a grant to Beltrami County
to fund the planning and development of a
comprehensive mental health services program
under article 2, section 41, Comprehensive
Mental Health Program in Beltrami County.
This is a onetime appropriation.
Base Level Adjustment. The general fund
base is increased by $723,000 in fiscal year
2018 and by $723,000 in fiscal year 2019. The
health care access fund base is decreased by
$1,723,000 in fiscal year 2018 and by
$1,723,000 in fiscal year 2019.
| (n) Child Mental Health Grants |
23,386,000 |
24,313,000 |
||||
Services and Supports for First Episode
Psychosis. $177,000 in fiscal year 2017 is for
grants under Minnesota Statutes, section
245.4889, to mental health providers to pilot
evidence-based interventions for youth at risk
of developing or experiencing a first episode
of psychosis and for a public awareness
campaign on the signs and symptoms of
psychosis. The base for these grants is
$236,000 in fiscal year 2018 and $301,000 in
fiscal year 2019.
Adverse Childhood Experiences. The base
for grants under Minnesota Statutes, section
245.4889, to children's mental health and
family services collaboratives for adverse
childhood experiences (ACEs) training grants
and for an interactive Web site connection to
support ACEs in Minnesota is $363,000 in
fiscal year 2018 and $363,000 in fiscal year
2019.
Funding Usage. Up to 75 percent of a fiscal
year's appropriation for child mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
Base Level Adjustment. The general fund
base is increased by $422,000 in fiscal year
2018 and is increased by $487,000 in fiscal
year 2019.
| (o) Chemical Dependency Treatment Support Grants |
1,561,000 |
1,561,000 |
||||
Chemical Dependency Prevention. $150,000
in fiscal year 2016 and $150,000 in fiscal year
2017 are for grants to nonprofit organizations
to provide chemical dependency prevention
programs in secondary schools. When making
grants, the commissioner must consider the
expertise, prior experience, and outcomes
achieved by applicants that have provided
prevention programming in secondary
education environments. An applicant for the
grant funds must provide verification to the
commissioner that the applicant has available
and will contribute sufficient funds to match
the grant given by the commissioner. This is
a onetime appropriation.
Fetal Alcohol Syndrome Grants. $250,000
in fiscal year 2016 and $250,000 in fiscal year
2017 are for grants to be administered by the
Minnesota Organization on Fetal Alcohol
Syndrome to provide comprehensive,
gender-specific services to pregnant and
parenting women suspected of or known to
use or abuse alcohol or other drugs. This
appropriation is for grants to no fewer than
three eligible recipients. Minnesota
Organization on Fetal Alcohol Syndrome must
report to the commissioner of human services
annually by January 15 on the grants funded
by this appropriation. The report must include
measurable outcomes for the previous year,
including the number of pregnant women
served and the number of toxic-free babies
born.
Base Level Adjustment. The general fund
base is decreased by $150,000 in fiscal year
2018 and by $150,000 in fiscal year 2019.
Sec. 47.
Laws 2020, First Special Session chapter 7, section 1, subdivision 1, as amended
by Laws 2021, First Special Session chapter 7, article 2, section 71, is amended to read:
Subdivision 1.
Waivers and modifications; federal funding extension.
When the
peacetime emergency declared by the governor in response to the COVID-19 outbreak
expires, is terminated, or is rescinded by the proper authority, the following waivers and
modifications to human services programs issued by the commissioner of human services
pursuant to Executive Orders 20-11 and 20-12 that are required to comply with federal law
may remain in effect for the time period set out in applicable federal law or for the time
period set out in any applicable federally approved waiver or state plan amendment,
whichever is later:
(1) CV15: allowing telephone or video visits for waiver programs;
(2) CV17: preserving health care coverage for Medical Assistance and MinnesotaCarenew text begin
as needed to comply with federal guidance from the Centers for Medicare and Medicaid
Services, and until the enrollee's first renewal following the resumption of medical assistance
and MinnesotaCare renewals after the end of the COVID-19 public health emergency
declared by the United States Secretary of Health and Human Servicesnew text end ;
(3) CV18: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(4) CV20: eliminating cost-sharing for COVID-19 diagnosis and treatment;
(5) CV24: allowing telephone or video use for targeted case management visits;
(6) CV30: expanding telemedicine in health care, mental health, and substance use
disorder settings;
(7) CV37: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(8) CV39: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(9) CV42: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(10) CV43: expanding remote home and community-based waiver services;
(11) CV44: allowing remote delivery of adult day services;
(12) CV59: modifying eligibility period for the federally funded Refugee Cash Assistance
Program;
(13) CV60: modifying eligibility period for the federally funded Refugee Social Services
Program; and
(14) CV109: providing 15 percent increase for Minnesota Food Assistance Program and
Minnesota Family Investment Program maximum food benefits.
Sec. 48.
Laws 2021, First Special Session chapter 7, article 1, section 36, is amended to
read:
Sec. 36. RESPONSE TO COVID-19 PUBLIC HEALTH EMERGENCY.
(a) Notwithstanding Minnesota Statutes, section 256B.057, subdivision 9, 256L.06,
subdivision 3, or any other provision to the contrary, the commissioner shall not collect any
unpaid premium for a coverage month deleted text begin that occurred duringdeleted text end new text begin until the enrollee's first renewal
after the resumption of medical assistance renewals following the end ofnew text end the COVID-19
public health emergency declared by the United States Secretary of Health and Human
Services.
(b) Notwithstanding any provision to the contrary, periodic data matching under
Minnesota Statutes, section 256B.0561, subdivision 2, may be suspended for up to deleted text begin sixdeleted text end new text begin 12new text end
months following the deleted text begin last day ofdeleted text end new text begin resumption of medical assistance and MinnesotaCare
renewals after the end ofnew text end the COVID-19 public health emergency declared by the United
States Secretary of Health and Human Services.
(c) Notwithstanding any provision to the contrary, the requirement for the commissioner
of human services to issue an annual report on periodic data matching under Minnesota
Statutes, section 256B.0561, is suspended for one year following the last day of the
COVID-19 public health emergency declared by the United States Secretary of Health and
Human Services.
new text begin
(d) The commissioner of human services shall take necessary actions to comply with
federal guidance pertaining to the appropriate redetermination of medical assistance enrollee
eligibility following the end of the COVID-19 public health emergency declared by the
United States Secretary of Health and Human Services and may waive currently existing
Minnesota statutes to the minimum level necessary to achieve federal compliance. All
changes implemented must be reported to the chairs and ranking minority members of the
legislative committees with jurisdiction over human services within 90 days.
new text end
Sec. 49. new text begin DENTAL HOME PILOT PROJECT.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; requirements. new text end
new text begin
(a) The commissioner of human services
shall establish a dental home pilot project to increase access of medical assistance and
MinnesotaCare enrollees to dental care, improve patient experience, and improve oral health
clinical outcomes, in a manner that sustains the financial viability of the dental workforce
and broader dental care delivery and financing system. Dental homes must provide
high-quality, patient-centered, comprehensive, and coordinated oral health services across
clinical and community-based settings, including virtual oral health care.
new text end
new text begin
(b) The design and operation of the dental home pilot project must be consistent with
the recommendations made by the Dental Services Advisory Committee to the legislature
under Laws 2021, First Special Session chapter 7, article 1, section 33.
new text end
new text begin
(c) The commissioner shall establish baseline requirements and performance measures
for dental homes participating in the pilot project. These baseline requirements and
performance measures must address access and patient experience and oral health clinical
outcomes.
new text end
new text begin Subd. 2. new text end
new text begin Project design and timeline. new text end
new text begin
(a) The commissioner shall issue a preliminary
project description and a request for information to obtain stakeholder feedback and input
on project design issues, including but not limited to:
new text end
new text begin
(1) the timeline for project implementation;
new text end
new text begin
(2) the length of each project phase and the date for full project implementation;
new text end
new text begin
(3) the number of providers to be selected for participation;
new text end
new text begin
(4) grant amounts;
new text end
new text begin
(5) criteria and procedures for any value-based payments;
new text end
new text begin
(6) the extent to which pilot project requirements may vary with provider characteristics;
new text end
new text begin
(7) procedures for data collection;
new text end
new text begin
(8) the role of dental partners, such as dental professional organizations and educational
institutions;
new text end
new text begin
(9) provider support and education; and
new text end
new text begin
(10) other topics identified by the commissioner.
new text end
new text begin
(b) The commissioner shall consider the feedback and input obtained in paragraph (a)
and shall develop and issue a request for proposals for participation in the pilot project.
new text end
new text begin
(c) The pilot project must be implemented by July 1, 2023, and must include initial pilot
testing and the collection and analysis of data on baseline requirements and performance
measures to evaluate whether these requirements and measures are appropriate. Under this
phase, the commissioner shall provide grants to individual providers and provider networks
in addition to medical assistance and MinnesotaCare payments received for services provided.
new text end
new text begin
(d) The pilot project may test and analyze value-based payments to providers to determine
whether varying payments based on dental home performance measures is appropriate and
effective.
new text end
new text begin
(e) The commissioner shall ensure provider diversity in selecting project participants.
In selecting providers, the commissioner shall consider: geographic distribution; provider
size, type, and location; providers serving different priority populations; health equity issues;
and provider accessibility for patients with varying levels and types of disability.
new text end
new text begin
(f) In designing and implementing the pilot project, the commissioner shall regularly
consult with project participants and other stakeholders, and as relevant shall continue to
seek the input of participants and other stakeholders on the topics listed in paragraph (a).
new text end
new text begin Subd. 3. new text end
new text begin Reporting. new text end
new text begin
(a) The commissioner, beginning February 15, 2023, and each
February 15 thereafter for the duration of the demonstration project, shall report on the
design, implementation, operation, and results of the demonstration project to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
care finance and policy.
new text end
new text begin
(b) The commissioner, within six months from the date the pilot project ceases operation,
shall report to the chairs and ranking minority members of the legislative committees with
jurisdiction over health care finance and policy on the results of the demonstration project,
and shall include in the report recommendations on whether the demonstration project, or
specific features of the demonstration project, should be extended to all dental providers
serving medical assistance and MinnesotaCare enrollees.
new text end
Sec. 50. new text begin SMALL EMPLOYER PUBLIC OPTION.
new text end
new text begin
The commissioner of human services, in consultation with representatives of small
employers, shall develop a small employer public option that allows employees of businesses
with fewer than 50 employees to receive employer contributions toward MinnesotaCare.
The commissioner shall determine whether the employer makes contributions to the
commissioner directly or the employee makes contributions through a qualified small
employer health reimbursement arrangement account or other arrangement. In determining
the structure of the small employer public option, the commissioner shall consult with
federal officials to determine which arrangement will result in the employer contributions
being tax deductible to the employer and not being considered taxable income to the
employee. The commissioner shall present recommendations for a small employer public
option to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance by December 15, 2023.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51. new text begin TRANSITION TO MINNESOTACARE PUBLIC OPTION.
new text end
new text begin
(a) The commissioner of human services shall continue to administer MinnesotaCare
as a basic health program in accordance with Minnesota Statutes, section 256L.02,
subdivision 5, and shall seek federal waivers, approvals, and law changes necessary to
implement this act.
new text end
new text begin
(b) The commissioner shall present an implementation plan for the MinnesotaCare public
option under Minnesota Statutes, section 256L.04, subdivision 15, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care policy
and finance by December 15, 2023. The plan must include:
new text end
new text begin
(1) recommendations for any changes to the MinnesotaCare public option necessary to
continue federal basic health program funding or to receive other federal funding;
new text end
new text begin
(2) recommendations for implementing any small employer option in a manner that
would allow any employee payments toward premiums to be pretax;
new text end
new text begin
(3) recommendations for ensuring sufficient provider participation in MinnesotaCare;
new text end
new text begin
(4) estimates of state costs related to the MinnesotaCare public option;
new text end
new text begin
(5) a description of the proposed premium scale for persons eligible through the public
option, including an analysis of the extent to which the proposed premium scale:
new text end
new text begin
(i) ensures affordable premiums for persons across the income spectrum enrolled under
the public option; and
new text end
new text begin
(ii) avoids premium cliffs for persons transitioning to and enrolled under the public
option; and
new text end
new text begin
(6) draft legislation that includes any additional policy and conforming changes necessary
to implement the MinnesotaCare public option and the implementation plan
recommendations.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 52. new text begin REQUEST FOR FEDERAL APPROVAL.
new text end
new text begin
(a) The commissioner of human services shall seek any federal waivers, approvals, and
law changes necessary to implement this act, including but not limited to those waivers,
approvals, and law changes necessary to allow the state to:
new text end
new text begin
(1) continue receiving federal basic health program payments for basic health
program-eligible MinnesotaCare enrollees and to receive other federal funding for the
MinnesotaCare public option; and
new text end
new text begin
(2) receive federal payments equal to the value of premium tax credits and cost-sharing
reductions that MinnesotaCare enrollees with household incomes greater than 200 percent
of the federal poverty guidelines would otherwise have received.
new text end
new text begin
(b) In implementing this section, the commissioner of human services shall consult with
the commissioner of commerce and the Board of Directors of MNsure and may contract
for technical and actuarial assistance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 53. new text begin DELIVERY REFORM ANALYSIS REPORT.
new text end
new text begin
(a) The commissioner of human services shall present to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance,
by January 15, 2024, a report comparing service delivery and payment system models for
delivering services to medical assistance enrollees for whom income eligibility is determined
using the modified adjusted gross income methodology under Minnesota Statutes, section
256B.056, subdivision 1a, paragraph (b), clause (1), and MinnesotaCare enrollees eligible
under Minnesota Statutes, chapter 256L. The report must compare the current delivery
model with at least two alternative models. The alternative models must include a state-based
model in which the state holds the plan risk as the insurer and may contract with a third-party
administrator for claims processing and plan administration. The alternative models may
include but are not limited to:
new text end
new text begin
(1) expanding the use of integrated health partnerships under Minnesota Statutes, section
256B.0755;
new text end
new text begin
(2) delivering care under fee-for-service through a primary care case management system;
and
new text end
new text begin
(3) continuing to contract with managed care and county-based purchasing plans for
some or all enrollees under modified contracts.
new text end
new text begin
(b) The report must include:
new text end
new text begin
(1) a description of how each model would address:
new text end
new text begin
(i) racial and other inequities in the delivery of health care and health care outcomes;
new text end
new text begin
(ii) geographic inequities in the delivery of health care;
new text end
new text begin
(iii) the provision of incentives for preventive care and other best practices;
new text end
new text begin
(iv) reimbursement of providers for high-quality, value-based care at levels sufficient
to sustain or increase enrollee access to care; and
new text end
new text begin
(v) transparency and simplicity for enrollees, health care providers, and policymakers;
new text end
new text begin
(2) a comparison of the projected cost of each model; and
new text end
new text begin
(3) an implementation timeline for each model that includes the earliest date by which
each model could be implemented if authorized during the 2024 legislative session and a
discussion of barriers to implementation.
new text end
Sec. 54. new text begin RECOMMENDATIONS; OFFICE OF PATIENT PROTECTION.
new text end
new text begin
(a) The commissioners of human services, health, and commerce and the MNsure board
shall submit to the health care affordability board and the chairs and ranking minority
members of the legislative committees with primary jurisdiction over health and human
services finance and policy and commerce by January 15, 2023, a report on the organization
and duties of the Office of Patient Protection, to be established under Minnesota Statutes,
section 62J.89, subdivision 4. The report must include recommendations on how the office
shall:
new text end
new text begin
(1) coordinate or consolidate within the office existing state agency patient protection
activities, including but not limited to the activities of ombudsman offices and the MNsure
board;
new text end
new text begin
(2) enforce standards and procedures under Minnesota Statutes, chapter 62M, for
utilization review organizations;
new text end
new text begin
(3) work with private sector and state agency consumer assistance programs to assist
consumers with questions or concerns relating to public programs and private insurance
coverage;
new text end
new text begin
(4) establish and implement procedures to assist consumers aggrieved by restrictions on
patient choice, denials of services, and reductions in quality of care resulting from any final
action by a payer or provider; and
new text end
new text begin
(5) make health plan company quality of care and patient satisfaction information and
other information collected by the office readily accessible to consumers on the board's
website.
new text end
new text begin
(b) The commissioners and the MNsure board shall consult with stakeholders as they
develop the recommendations. The stakeholders consulted must include but are not limited
to organizations and individuals representing: underserved communities; persons with
disabilities; low-income Minnesotans; senior citizens; and public and private sector health
plan enrollees, including persons who purchase coverage through MNsure, health plan
companies, and public and private sector purchasers of health coverage.
new text end
new text begin
(c) The commissioners and the MNsure board may contract with a third party to develop
the report and recommendations.
new text end
Sec. 55. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 256B.063,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
ARTICLE 4
HEALTH CARE POLICY
Section 1.
Minnesota Statutes 2020, section 62J.2930, subdivision 3, is amended to read:
Subd. 3.
Consumer information.
(a) The information clearinghouse or another entity
designated by the commissioner shall provide consumer information to health plan company
enrollees to:
(1) assist enrollees in understanding their rights;
(2) explain and assist in the use of all available complaint systems, including internal
complaint systems within health carriers, community integrated service networks, and the
Departments of Health and Commerce;
(3) provide information on coverage options in each region of the state;
(4) provide information on the availability of purchasing pools and enrollee subsidies;
and
(5) help consumers use the health care system to obtain coverage.
(b) The information clearinghouse or other entity designated by the commissioner for
the purposes of this subdivision shall not:
(1) provide legal services to consumers;
(2) represent a consumer or enrollee; or
(3) serve as an advocate for consumers in disputes with health plan companies.
(c) Nothing in this subdivision shall interfere with the ombudsman program established
under section deleted text begin 256B.69, subdivision 20deleted text end new text begin 256B.6903new text end , or other existing ombudsman programs.
Sec. 2.
Minnesota Statutes 2020, section 256B.055, subdivision 2, is amended to read:
Subd. 2.
Subsidized foster children.
Medical assistance may be paid for a child eligible
for or receiving foster care maintenance payments under Title IV-E of the Social Security
Act, United States Code, title 42, sections 670 to 676, and for a child who is not eligible for
Title IV-E of the Social Security Act but who is deleted text begin determined eligible fordeleted text end new text begin placed innew text end foster
carenew text begin as determined by Minnesota Statutesnew text end or kinship assistance under chapter 256N.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256B.056, subdivision 3b, is amended to read:
Subd. 3b.
Treatment of trusts.
new text begin
(a) It is the public policy of this state that individuals
use all available resources to pay for the cost of long-term care services, as defined in section
256B.0595, before turning to Minnesota health care program funds, and that trust instruments
should not be permitted to shield available resources of an individual or an individual's
spouse from such use.
new text end
deleted text begin (a)deleted text end new text begin (b)new text end A "medical assistance qualifying trust" is a revocable or irrevocable trust, or
similar legal device, established on or before August 10, 1993, by a person or the person's
spouse under the terms of which the person receives or could receive payments from the
trust principal or income and the trustee has discretion in making payments to the person
from the trust principal or income. Notwithstanding that definition, a medical assistance
qualifying trust does not include: (1) a trust set up by will; (2) a trust set up before April 7,
1986, solely to benefit a person with a developmental disability living in an intermediate
care facility for persons with developmental disabilities; or (3) a trust set up by a person
with payments made by the Social Security Administration pursuant to the United States
Supreme Court decision in Sullivan v. Zebley, 110 S. Ct. 885 (1990). The maximum amount
of payments that a trustee of a medical assistance qualifying trust may make to a person
under the terms of the trust is considered to be available assets to the person, without regard
to whether the trustee actually makes the maximum payments to the person and without
regard to the purpose for which the medical assistance qualifying trust was established.
deleted text begin (b)deleted text end new text begin (c)new text end Trusts established after August 10, 1993, are treated according to United States
Code, title 42, section 1396p(d).
deleted text begin (c)deleted text end new text begin (d)new text end For purposes of paragraph deleted text begin (d)deleted text end new text begin (e)new text end , a pooled trust means a trust established under
United States Code, title 42, section 1396p(d)(4)(C).
deleted text begin (d)deleted text end new text begin (e)new text end A beneficiary's interest in a pooled trust is considered an available asset unless
the trust provides that upon the death of the beneficiary or termination of the trust during
the beneficiary's lifetime, whichever is sooner, the department receives any amount, up to
the amount of medical assistance benefits paid on behalf of the beneficiary, remaining in
the beneficiary's trust account after a deduction for reasonable administrative fees and
expenses, and an additional remainder amount. The retained remainder amount of the
subaccount must not exceed ten percent of the account value at the time of the beneficiary's
death or termination of the trust, and must only be used for the benefit of disabled individuals
who have a beneficiary interest in the pooled trust.
deleted text begin (e)deleted text end new text begin (f)new text end Trusts may be established on or after December 12, 2016, by a person who has
been determined to be disabled, according to United States Code, title 42, section
1396p(d)(4)(A), as amended by section 5007 of the 21st Century Cures Act, Public Law
114-255.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256B.056, subdivision 3c, is amended to read:
Subd. 3c.
Asset limitations for families and children.
(a) A household of two or more
persons must not own more than $20,000 in total net assets, and a household of one person
must not own more than $10,000 in total net assets. In addition to these maximum amounts,
an eligible individual or family may accrue interest on these amounts, but they must be
reduced to the maximum at the time of an eligibility redetermination. The value of assets
that are not considered in determining eligibility for medical assistance for families and
children is the value of those assets excluded under the AFDC state plan as of July 16, 1996,
as required by the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (PRWORA), Public Law 104-193, with the following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business up to $200,000 are not considered;
(3) one motor vehicle is excluded for each person of legal driving age who is employed
or seeking employment;
(4) assets designated as burial expenses are excluded to the same extent they are excluded
by the Supplemental Security Income program;
(5) court-ordered settlements up to $10,000 are not considered;
(6) individual retirement accounts and funds are not considered;
(7) assets owned by children are not considered; and
(8) deleted text begin effective July 1, 2009,deleted text end certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
(b) deleted text begin Beginning January 1, 2014, this subdivisiondeleted text end new text begin Paragraph (a)new text end applies only to parents
and caretaker relatives who qualify for medical assistance under subdivision 5.
new text begin
(c) Eligibility for children under age 21 must be determined without regard to the asset
limitations described in paragraphs (a) and (b) and subdivision 3.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256B.056, subdivision 11, is amended to read:
Subd. 11.
Treatment of annuities.
(a) Any person requesting medical assistance payment
of long-term care services shall provide a complete description of any interest either the
person or the person's spouse has in annuities on a form designated by the department. The
form shall include a statement that the state becomes a preferred remainder beneficiary of
annuities or similar financial instruments by virtue of the receipt of medical assistance
payment of long-term care services. The person and the person's spouse shall furnish the
agency responsible for determining eligibility with complete current copies of their annuities
and related documents and complete the form designating the state as the preferred remainder
beneficiary for each annuity in which the person or the person's spouse has an interest.
(b) The department shall provide notice to the issuer of the department's right under this
section as a preferred remainder beneficiary under the annuity or similar financial instrument
for medical assistance furnished to the person or the person's spouse, and provide notice of
the issuer's responsibilities as provided in paragraph (c).
(c) An issuer of an annuity or similar financial instrument who receives notice of the
state's right to be named a preferred remainder beneficiary as described in paragraph (b)
shall provide confirmation to the requesting agency that the state has been made a preferred
remainder beneficiary. The issuer shall also notify the county agency when a change in the
amount of income or principal being withdrawn from the annuity or other similar financial
instrument or a change in the state's preferred remainder beneficiary designation under the
annuity or other similar financial instrument occurs. The county agency shall provide the
issuer with the name, address, and telephone number of a unit within the department that
the issuer can contact to comply with this paragraph.
(d) "Preferred remainder beneficiary" for purposes of this subdivision and sections
256B.0594 and 256B.0595 means the state is a remainder beneficiary in the first position
in an amount equal to the amount of medical assistance paid on behalf of the institutionalized
person, or is a remainder beneficiary in the second position if the institutionalized person
designates and is survived by a remainder beneficiary who is (1) a spouse who does not
reside in a medical institution, (2) a minor child, or (3) a child of any age who is blind or
permanently and totally disabled as defined in the Supplemental Security Income program.
Notwithstanding this paragraph, the state is the remainder beneficiary in the first position
if the spouse or child disposes of the remainder for less than fair market value.
(e) For purposes of this subdivision, "institutionalized person" and "long-term care
services" have the meanings given in section 256B.0595, subdivision 1, paragraph deleted text begin (g)deleted text end new text begin (f)new text end .
(f) For purposes of this subdivision, "medical institution" means a skilled nursing facility,
intermediate care facility, intermediate care facility for persons with developmental
disabilities, nursing facility, or inpatient hospital.
Sec. 6.
Minnesota Statutes 2020, section 256B.0595, subdivision 1, is amended to read:
Subdivision 1.
Prohibited transfers.
(a) Effective for transfers made after August 10,
1993, an institutionalized person, an institutionalized person's spouse, or any person, court,
or administrative body with legal authority to act in place of, on behalf of, at the direction
of, or upon the request of the institutionalized person or institutionalized person's spouse,
may not give away, sell, or dispose of, for less than fair market value, any asset or interest
therein, except assets other than the homestead that are excluded under the Supplemental
Security Income program, for the purpose of establishing or maintaining medical assistance
eligibility. This applies to all transfers, including those made by a community spouse after
the month in which the institutionalized spouse is determined eligible for medical assistance.
For purposes of determining eligibility for long-term care services, any transfer of such
assets within 36 months before or any time after an institutionalized person requests medical
assistance payment of long-term care services, or 36 months before or any time after a
medical assistance recipient becomes an institutionalized person, for less than fair market
value may be considered. Any such transfer is presumed to have been made for the purpose
of establishing or maintaining medical assistance eligibility and the institutionalized person
is ineligible for long-term care services for the period of time determined under subdivision
2, unless the institutionalized person furnishes convincing evidence to establish that the
transaction was exclusively for another purpose, or unless the transfer is permitted under
subdivision 3 or 4. In the case of payments from a trust or portions of a trust that are
considered transfers of assets under federal law, or in the case of any other disposal of assets
made on or after February 8, 2006, any transfers made within 60 months before or any time
after an institutionalized person requests medical assistance payment of long-term care
services and within 60 months before or any time after a medical assistance recipient becomes
an institutionalized person, may be considered.
(b) This section applies to transfers, for less than fair market value, of income or assets,
including assets that are considered income in the month received, such as inheritances,
court settlements, and retroactive benefit payments or income to which the institutionalized
person or the institutionalized person's spouse is entitled but does not receive due to action
by the institutionalized person, the institutionalized person's spouse, or any person, court,
or administrative body with legal authority to act in place of, on behalf of, at the direction
of, or upon the request of the institutionalized person or the institutionalized person's spouse.
(c) This section applies to payments for care or personal services provided by a relative,
unless the compensation was stipulated in a notarized, written agreement deleted text begin whichdeleted text end new text begin thatnew text end was
in existence when the service was performed, the care or services directly benefited the
person, and the payments made represented reasonable compensation for the care or services
provided. A notarized written agreement is not required if payment for the services was
made within 60 days after the service was provided.
deleted text begin
(d) This section applies to the portion of any asset or interest that an institutionalized
person, an institutionalized person's spouse, or any person, court, or administrative body
with legal authority to act in place of, on behalf of, at the direction of, or upon the request
of the institutionalized person or the institutionalized person's spouse, transfers to any
annuity that exceeds the value of the benefit likely to be returned to the institutionalized
person or institutionalized person's spouse while alive, based on estimated life expectancy
as determined according to the current actuarial tables published by the Office of the Chief
Actuary of the Social Security Administration. The commissioner may adopt rules reducing
life expectancies based on the need for long-term care. This section applies to an annuity
purchased on or after March 1, 2002, that:
deleted text end
deleted text begin
(1) is not purchased from an insurance company or financial institution that is subject
to licensing or regulation by the Minnesota Department of Commerce or a similar regulatory
agency of another state;
deleted text end
deleted text begin
(2) does not pay out principal and interest in equal monthly installments; or
deleted text end
deleted text begin
(3) does not begin payment at the earliest possible date after annuitization.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end Effective for transactions, including the purchase of an annuity, occurring on or
after February 8, 2006, by or on behalf of an institutionalized person who has applied for
or is receiving long-term care services or the institutionalized person's spouse shall be treated
as the disposal of an asset for less than fair market value unless the department is named a
preferred remainder beneficiary as described in section 256B.056, subdivision 11. Any
subsequent change to the designation of the department as a preferred remainder beneficiary
shall result in the annuity being treated as a disposal of assets for less than fair market value.
The amount of such transfer shall be the maximum amount the institutionalized person or
the institutionalized person's spouse could receive from the annuity or similar financial
instrument. Any change in the amount of the income or principal being withdrawn from the
annuity or other similar financial instrument at the time of the most recent disclosure shall
be deemed to be a transfer of assets for less than fair market value unless the institutionalized
person or the institutionalized person's spouse demonstrates that the transaction was for fair
market value. In the event a distribution of income or principal has been improperly
distributed or disbursed from an annuity or other retirement planning instrument of an
institutionalized person or the institutionalized person's spouse, a cause of action exists
against the individual receiving the improper distribution for the cost of medical assistance
services provided or the amount of the improper distribution, whichever is less.
deleted text begin (f)deleted text end new text begin (e)new text end Effective for transactions, including the purchase of an annuity, occurring on or
after February 8, 2006, by or on behalf of an institutionalized person applying for or receiving
long-term care services shall be treated as a disposal of assets for less than fair market value
unless it is:
(1) an annuity described in subsection (b) or (q) of section 408 of the Internal Revenue
Code of 1986; or
(2) purchased with proceeds from:
(i) an account or trust described in subsection (a), (c), or (p) of section 408 of the Internal
Revenue Code;
(ii) a simplified employee pension within the meaning of section 408(k) of the Internal
Revenue Code; or
(iii) a Roth IRA described in section 408A of the Internal Revenue Code; or
(3) an annuity that is irrevocable and nonassignable; is actuarially sound as determined
in accordance with actuarial publications of the Office of the Chief Actuary of the Social
Security Administration; and provides for payments in equal amounts during the term of
the annuity, with no deferral and no balloon payments made.
deleted text begin (g)deleted text end new text begin (f)new text end For purposes of this section, long-term care services include services in a nursing
facility, services that are eligible for payment according to section 256B.0625, subdivision
2, because they are provided in a swing bed, intermediate care facility for persons with
developmental disabilities, and home and community-based services provided pursuant to
chapter 256S and sections 256B.092 and 256B.49. For purposes of this subdivision and
subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient in
a nursing facility or in a swing bed, or intermediate care facility for persons with
developmental disabilities or who is receiving home and community-based services under
chapter 256S and sections 256B.092 and 256B.49.
deleted text begin (h)deleted text end new text begin (g)new text end This section applies to funds used to purchase a promissory note, loan, or mortgage
unless the note, loan, or mortgage:
(1) has a repayment term that is actuarially sound;
(2) provides for payments to be made in equal amounts during the term of the loan, with
no deferral and no balloon payments made; and
(3) prohibits the cancellation of the balance upon the death of the lender.
new text begin (h) new text end In the case of a promissory note, loan, or mortgage that does not meet an exception
innew text begin paragraph (g),new text end clauses (1) to (3), the value of such note, loan, or mortgage shall be the
outstanding balance due as of the date of the institutionalized person's request for medical
assistance payment of long-term care services.
(i) This section applies to the purchase of a life estate interest in another person's home
unless the purchaser resides in the home for a period of at least one year after the date of
purchase.
(j) This section applies to transfers into a pooled trust that qualifies under United States
Code, title 42, section 1396p(d)(4)(C), by:
(1) a person age 65 or older or the person's spouse; or
(2) any person, court, or administrative body with legal authority to act in place of, on
behalf of, at the direction of, or upon the request of a person age 65 or older or the person's
spouse.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 3b, is
amended to read:
Subd. 3b.
Telehealth services.
(a) Medical assistance covers medically necessary services
and consultations delivered by a health care provider through telehealth in the same manner
as if the service or consultation was delivered through in-person contact. Services or
consultations delivered through telehealth shall be paid at the full allowable rate.
(b) The commissioner may establish criteria that a health care provider must attest to in
order to demonstrate the safety or efficacy of delivering a particular service through
telehealth. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
through telehealth;
(2) has written policies and procedures specific to services delivered through telehealth
that are regularly reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the service is delivered through telehealth;
(4) has established protocols addressing how and when to discontinue telehealth services;
and
(5) has an established quality assurance process related to delivering services through
telehealth.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service delivered through telehealth to a medical assistance enrollee.
Health care service records for services delivered through telehealth must meet the
requirements set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must
document:
(1) the type of service delivered through telehealth;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the health care provider's basis for determining that telehealth is an appropriate and
effective means for delivering the service to the enrollee;
(4) the mode of transmission used to deliver the service through telehealth and records
evidencing that a particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's consultation with another physician
through telehealth, the written opinion from the consulting physician providing the telehealth
consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) Telehealth visitsdeleted text begin , as described in this subdivision provided through audio and visual
communication,deleted text end may be used to satisfy the face-to-face requirement for reimbursement
under the payment methods that apply to a federally qualified health center, rural health
clinic, Indian health service, 638 Tribal clinic, and certified community behavioral health
clinic, if the service would have otherwise qualified for payment if performed in person.
(e) For mental health services or assessments delivered through telehealth that are based
on an individual treatment plan, the provider may document the client's verbal approval or
electronic written approval of the treatment plan or change in the treatment plan in lieu of
the client's signature in accordance with Minnesota Rules, part 9505.0371.
(f) For purposes of this subdivision, unless otherwise covered under this chapter:
(1) "telehealth" means the delivery of health care services or consultations deleted text begin through the
use ofdeleted text end new text begin usingnew text end real-time two-way interactive audio and visual communication new text begin or accessible
telemedicine video-based platforms new text end to provide or support health care delivery and facilitate
the assessment, diagnosis, consultation, treatment, education, and care management of a
patient's health care. Telehealth includes the application of secure video conferencingdeleted text begin ,deleted text end new text begin
consisting of a real-time, full-motion synchronized video;new text end store-and-forward technologydeleted text begin ,deleted text end new text begin ;new text end
and synchronous interactions between a patient located at an originating site and a health
care provider located at a distant site. Telehealth does not include communication between
health care providers, or between a health care provider and a patient that consists solely
of an audio-only communication, e-mail, or facsimile transmission or as specified by law;
(2) "health care provider" meansnew text begin :
new text end
new text begin (i)new text end a health care provider as defined under section 62A.673deleted text begin ,deleted text end new text begin ;
new text end
new text begin (ii)new text end a community paramedic as defined under section 144E.001, subdivision 5fdeleted text begin ,deleted text end new text begin ;
new text end
new text begin (iii)new text end a community health worker who meets the criteria under subdivision 49, paragraph
(a)deleted text begin ,deleted text end new text begin ;
new text end
new text begin (iv)new text end a mental health certified peer specialist under section 256B.0615, subdivision 5deleted text begin ,deleted text end new text begin ;
new text end
new text begin (v)new text end a mental health certified family peer specialist under section 256B.0616, subdivision
5deleted text begin ,deleted text end new text begin ;
new text end
new text begin (vi)new text end a mental health rehabilitation worker under section 256B.0623, subdivision 5,
paragraph (a), clause (4), and paragraph (b)deleted text begin ,deleted text end new text begin ;
new text end
new text begin (vii)new text end a mental health behavioral aide under section 256B.0943, subdivision 7, paragraph
(b), clause (3)deleted text begin ,deleted text end new text begin ;
new text end
new text begin (viii)new text end a treatment coordinator under section 245G.11, subdivision 7deleted text begin ,deleted text end new text begin ;
new text end
new text begin (ix)new text end an alcohol and drug counselor under section 245G.11, subdivision 5deleted text begin ,deleted text end new text begin ; or
new text end
new text begin (x)new text end a recovery peer under section 245G.11, subdivision 8; and
(3) "originating site," "distant site," and "store-and-forward technology" have the
meanings given in section 62A.673, subdivision 2.
Sec. 8.
Minnesota Statutes 2020, section 256B.0625, subdivision 64, is amended to read:
Subd. 64.
Investigational drugs, biological products, devices, and clinical
trials.
Medical assistance and the early periodic screening, diagnosis, and treatment (EPSDT)
program do not cover deleted text begin the costs of any services that are incidental to, associated with, or
resulting from the use ofdeleted text end investigational drugs, biological products, or devices as defined
in section 151.375 or any other treatment that is part of an approved clinical trial as defined
in section 62Q.526. Participation of an enrollee in an approved clinical trial does not preclude
coverage of medically necessary services covered under this chapter that are not related to
the approved clinical trial.new text begin Any items or services that are provided solely to satisfy data
collection and analysis for a clinical trial, and not for direct clinical management of the
enrollee, are not covered.
new text end
Sec. 9.
new text begin
[256B.6903] OMBUDSPERSON FOR MANAGED CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given them.
new text end
new text begin
(b) "Adverse benefit determination" has the meaning provided in Code of Federal
Regulations, title 42, section 438.400, subpart (b).
new text end
new text begin
(c) "Appeal" means an oral or written request from an enrollee to the managed care
organization for review of an adverse benefit determination.
new text end
new text begin
(d) "Commissioner" means the commissioner of human services.
new text end
new text begin
(e) "Complaint" means an enrollee's informal expression of dissatisfaction about any
matter relating to the enrollee's prepaid health plan other than an adverse benefit
determination.
new text end
new text begin
(f) "Data analyst" means the person employed by the ombudsperson that uses research
methodologies to conduct research on data collected from prepaid health plans, including
but not limited to scientific theory; hypothesis testing; survey research techniques; data
collection; data manipulation; and statistical analysis interpretation, including multiple
regression techniques.
new text end
new text begin
(g) "Enrollee" means a person enrolled in a prepaid health plan under section 256B.69.
When applicable, an enrollee includes an enrollee's authorized representative.
new text end
new text begin
(h) "External review" means the process described under Code of Federal Regulations,
title 42, section 438.408, subpart (f); and section 62Q.73, subdivision 2.
new text end
new text begin
(i) "Grievance" means an enrollee's expression of dissatisfaction about any matter relating
to the enrollee's prepaid health plan other than an adverse benefit determination that follows
the procedures outlined in Code of Federal Regulations, title 42, part 438, subpart (f). A
grievance may include but is not limited to concerns relating to quality of care, services
provided, or failure to respect an enrollee's rights under a prepaid health plan.
new text end
new text begin
(j) "Managed care advocate" means a county or Tribal employee who works with
managed care enrollees when the enrollee has service, billing, or access problems with the
enrollee's prepaid health plan.
new text end
new text begin
(k) "Prepaid health plan" means a plan under contract with the commissioner according
to section 256B.69.
new text end
new text begin
(l) "State fair hearing" means the appeals process mandated under section 256.045,
subdivision 3a.
new text end
new text begin Subd. 2. new text end
new text begin Ombudsperson. new text end
new text begin
The commissioner must designate an ombudsperson to advocate
for enrollees. At the time of enrollment in a prepaid health plan, the local agency must
inform enrollees about the ombudsperson.
new text end
new text begin Subd. 3. new text end
new text begin Duties and cost. new text end
new text begin
(a) The ombudsperson must work to ensure enrollees receive
covered services as described in the enrollee's prepaid health plan by:
new text end
new text begin
(1) providing assistance and education to enrollees, when requested, regarding covered
health care benefits or services; billing and access; or the grievance, appeal, or state fair
hearing processes;
new text end
new text begin
(2) with the enrollee's permission and within the ombudsperson's discretion, using an
informal review process to assist an enrollee with a resolution involving the enrollee's
prepaid health plan's benefits;
new text end
new text begin
(3) assisting enrollees, when requested, with prepaid health plan grievances, appeals, or
the state fair hearing process;
new text end
new text begin
(4) overseeing, reviewing, and approving documents used by enrollees relating to prepaid
health plans' grievances, appeals, and state fair hearings;
new text end
new text begin
(5) reviewing all state fair hearings and requests by enrollees for external review;
overseeing entities under contract to provide external reviews, processes, and payments for
services; and utilizing aggregated results of external reviews to recommend health care
benefits policy changes; and
new text end
new text begin
(6) providing trainings to managed care advocates.
new text end
new text begin
(b) The ombudsperson must not charge an enrollee for the ombudsperson's services.
new text end
new text begin Subd. 4. new text end
new text begin Powers. new text end
new text begin
In exercising the ombudsperson's authority under this section, the
ombudsperson may:
new text end
new text begin
(1) gather information and evaluate any practice, policy, procedure, or action by a prepaid
health plan, state human services agency, county, or Tribe; and
new text end
new text begin
(2) prescribe the methods by which complaints are to be made, received, and acted upon.
The ombudsperson's authority under this clause includes but is not limited to:
new text end
new text begin
(i) determining the scope and manner of a complaint;
new text end
new text begin
(ii) holding a prepaid health plan accountable to address a complaint in a timely manner
as outlined in state and federal laws;
new text end
new text begin
(iii) requiring a prepaid health plan to respond in a timely manner to a request for data,
case details, and other information as needed to help resolve a complaint or to improve a
prepaid health plan's policy; and
new text end
new text begin
(iv) making recommendations for policy, administrative, or legislative changes regarding
prepaid health plans to the proper partners.
new text end
new text begin Subd. 5. new text end
new text begin Data. new text end
new text begin
(a) The data analyst must review and analyze prepaid health plan data
on denial, termination, and reduction notices (DTRs), grievances, appeals, and state fair
hearings by:
new text end
new text begin
(1) analyzing, reviewing, and reporting on DTRs, grievances, appeals, and state fair
hearings data collected from each prepaid health plan;
new text end
new text begin
(2) collaborating with the commissioner's partners and the Department of Health for the
Triennial Compliance Assessment under Code of Federal Regulations, title 42, section
438.358, subpart (b);
new text end
new text begin
(3) reviewing state fair hearing decisions for policy or coverage issues that may affect
enrollees; and
new text end
new text begin
(4) providing data required under Code of Federal Regulations, title 42, section 438.66
(2016), to the Centers for Medicare and Medicaid Services.
new text end
new text begin
(b) The data analyst must share the data analyst's data observations and trends under
this subdivision with the ombudsperson, prepaid health plans, and commissioner's partners.
new text end
new text begin Subd. 6. new text end
new text begin Collaboration and independence. new text end
new text begin
(a) The ombudsperson must work in
collaboration with the commissioner and the commissioner's partners when the
ombudsperson's collaboration does not otherwise interfere with the ombudsperson's duties
under this section.
new text end
new text begin
(b) The ombudsperson may act independently of the commissioner when:
new text end
new text begin
(1) providing information or testimony to the legislature; and
new text end
new text begin
(2) contacting and making reports to federal and state officials.
new text end
new text begin Subd. 7. new text end
new text begin Civil actions. new text end
new text begin
The ombudsperson is not civilly liable for actions taken under
this section if the action was taken in good faith, was within the scope of the ombudsperson's
authority, and did not constitute willful or reckless misconduct.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.77, subdivision 13, is amended to read:
Subd. 13.
Ombudsman.
Enrollees shall have access to ombudsman services established
in section deleted text begin 256B.69, subdivision 20deleted text end new text begin 256B.6903new text end , and advocacy services provided by the
ombudsman for mental health and developmental disabilities established in sections 245.91
to 245.97. The managed care ombudsman and the ombudsman for mental health and
developmental disabilities shall coordinate services provided to avoid duplication of services.
For purposes of the demonstration project, the powers and responsibilities of the Office of
Ombudsman for Mental Health and Developmental Disabilities, as provided in sections
245.91 to 245.97 are expanded to include all eligible individuals, health plan companies,
agencies, and providers participating in the demonstration project.
Sec. 11. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.057, subdivision 7,
new text end
new text begin
is repealed on July 1,
2022.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 256B.69, subdivision 20; 501C.0408, subdivision
4; and 501C.1206,
new text end
new text begin
are repealed the day following final enactment.
new text end
ARTICLE 5
HEALTH-RELATED LICENSING BOARDS
Section 1.
Minnesota Statutes 2020, section 148B.33, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Supervision requirement; postgraduate experience. new text end
new text begin
The board must allow
an applicant to satisfy the requirement for supervised postgraduate experience in marriage
and family therapy with all required hours of supervision provided through real-time,
two-way interactive audio and visual communication.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2021 Supplement, section 148B.5301, subdivision 2, is amended
to read:
Subd. 2.
Supervision.
(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).
(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional who is qualified according to section
245I.04, subdivision 2, or by a board-approved supervisor, who has at least two years of
postlicensure experience in the delivery of clinical services in the diagnosis and treatment
of mental illnesses and disorders. All supervisors must meet the supervisor requirements in
Minnesota Rules, part 2150.5010.
(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in personnew text begin or through real-time, two-way interactive audio and visual
communication, and the board must allow an applicant to satisfy this supervision requirement
with all required hours of supervision received through real-time, two-way interactive audio
and visual communicationnew text end . The remaining 25 percent of the required hours may be received
by telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.
(d) The supervised practice must include at least 1,800 hours of clinical client contact.
(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 3.
Minnesota Statutes 2020, section 148E.100, subdivision 3, is amended to read:
Subd. 3.
Types of supervision.
Of the 100 hours of supervision required under
subdivision 1:
(1) 50 hours must be provided through one-on-one supervisiondeleted text begin , including: (i) a minimum
of 25 hours of in-person supervision, and (ii) no more than 25 hours of supervisiondeleted text end new text begin . The
supervision must be provided either in person ornew text end via eye-to-eye electronic media, while
maintaining visual contactnew text begin . The board must allow a licensed social worker to satisfy the
supervision requirement of this clause with all required hours of supervision provided via
eye-to-eye electronic media, while maintaining visual contactnew text end ; and
(2) 50 hours must be provided through: (i) one-on-one supervision, or (ii) group
supervision. The supervision may be in person, by telephone, or via eye-to-eye electronic
media, while maintaining visual contact. The supervision must not be provided by e-mail.
Group supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 4.
Minnesota Statutes 2020, section 148E.105, subdivision 3, is amended to read:
Subd. 3.
Types of supervision.
Of the 100 hours of supervision required under
subdivision 1:
(1) 50 hours must be provided deleted text begin thoughdeleted text end new text begin throughnew text end one-on-one supervisiondeleted text begin , including: (i) a
minimum of 25 hours of in-person supervision, and (ii) no more than 25 hours of supervisiondeleted text end new text begin .
The supervision must be provided either in person ornew text end via eye-to-eye electronic media, while
maintaining visual contactnew text begin . The board must allow a licensed graduate social worker to satisfy
the supervision requirement of this clause with all required hours of supervision provided
via eye-to-eye electronic media, while maintaining visual contactnew text end ; and
(2) 50 hours must be provided through: (i) one-on-one supervision, or (ii) group
supervision. The supervision may be in person, by telephone, or via eye-to-eye electronic
media, while maintaining visual contact. The supervision must not be provided by e-mail.
Group supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 5.
Minnesota Statutes 2020, section 148E.106, subdivision 3, is amended to read:
Subd. 3.
Types of supervision.
Of the 200 hours of supervision required under
subdivision 1:
(1) 100 hours must be provided through one-on-one supervisiondeleted text begin , including: (i) a minimum
of 50 hours of in-person supervision, and (ii) no more than 50 hours of supervisiondeleted text end new text begin . The
supervision must be provided either in person ornew text end via eye-to-eye electronic media, while
maintaining visual contactnew text begin . The board must allow a licensed graduate social worker to satisfy
the supervision requirement of this clause with all required hours of supervision provided
via eye-to-eye electronic media, while maintaining visual contactnew text end ; and
(2) 100 hours must be provided through: (i) one-on-one supervision, or (ii) group
supervision. The supervision may be in person, by telephone, or via eye-to-eye electronic
media, while maintaining visual contact. The supervision must not be provided by e-mail.
Group supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 6.
Minnesota Statutes 2020, section 148E.110, subdivision 7, is amended to read:
Subd. 7.
Supervision; clinical social work practice after licensure as licensed
independent social worker.
Of the 200 hours of supervision required under subdivision
5:
(1) 100 hours must be provided through one-on-one supervisiondeleted text begin , including:deleted text end new text begin . The
supervision must be provided either in person or via eye-to-eye electronic media, while
maintaining visual contact. The board must allow a licensed independent social worker to
satisfy the supervision requirement of this clause with all required hours of supervision
provided via eye-to-eye electronic media, while maintaining visual contact; and
new text end
deleted text begin
(i) a minimum of 50 hours of in-person supervision; and
deleted text end
deleted text begin
(ii) no more than 50 hours of supervision via eye-to-eye electronic media, while
maintaining visual contact; and
deleted text end
(2) 100 hours must be provided through:
(i) one-on-one supervision; or
(ii) group supervision.
The supervision may be in person, by telephone, or via eye-to-eye electronic media, while
maintaining visual contact. The supervision must not be provided by e-mail. Group
supervision is limited to six supervisees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to supervision requirements in effect on or after that date.
new text end
Sec. 7.
Minnesota Statutes 2020, section 150A.06, subdivision 1c, is amended to read:
Subd. 1c.
Specialty dentists.
(a) The board may grant one or more specialty licenses in
the specialty areas of dentistry that are recognized by the Commission on Dental
Accreditation.
(b) An applicant for a specialty license shall:
(1) have successfully completed a postdoctoral specialty program accredited by the
Commission on Dental Accreditation, or have announced a limitation of practice before
1967;
(2) have been certified by a specialty board approved by the Minnesota Board of
Dentistry, or provide evidence of having passed a clinical examination for licensure required
for practice in any state or Canadian province, or in the case of oral and maxillofacial
surgeons only, have a Minnesota medical license in good standing;
(3) have been in active practice or a postdoctoral specialty education program or United
States government service at least 2,000 hours in the 36 months prior to applying for a
specialty license;
(4) if requested by the board, be interviewed by a committee of the board, which may
include the assistance of specialists in the evaluation process, and satisfactorily respond to
questions designed to determine the applicant's knowledge of dental subjects and ability to
practice;
(5) if requested by the board, present complete records on a sample of patients treated
by the applicant. The sample must be drawn from patients treated by the applicant during
the 36 months preceding the date of application. The number of records shall be established
by the board. The records shall be reasonably representative of the treatment typically
provided by the applicant for each specialty area;
(6) at board discretion, pass a board-approved English proficiency test if English is not
the applicant's primary language;
(7) pass all components of the National Board Dental Examinations;
(8) pass the Minnesota Board of Dentistry jurisprudence examination;
(9) abide by professional ethical conduct requirements; and
(10) meet all other requirements prescribed by the Board of Dentistry.
(c) The application must include:
(1) a completed application furnished by the board;
deleted text begin
(2) at least two character references from two different dentists for each specialty area,
one of whom must be a dentist practicing in the same specialty area, and the other from the
director of each specialty program attended;
deleted text end
deleted text begin
(3) a licensed physician's statement attesting to the applicant's physical and mental
condition;
deleted text end
deleted text begin
(4) a statement from a licensed ophthalmologist or optometrist attesting to the applicant's
visual acuity;
deleted text end
deleted text begin (5)deleted text end new text begin (2)new text end a nonrefundable fee; and
deleted text begin (6)deleted text end new text begin (3)new text end a deleted text begin notarized, unmounted passport-type photograph, three inches by three inches,
taken not more than six months before the date of applicationdeleted text end new text begin copy of the applicant's
government issued photo identification cardnew text end .
(d) A specialty dentist holding one or more specialty licenses is limited to practicing in
the dentist's designated specialty area or areas. The scope of practice must be defined by
each national specialty board recognized by the Commission on Dental Accreditation.
(e) A specialty dentist holding a general dental license is limited to practicing in the
dentist's designated specialty area or areas if the dentist has announced a limitation of
practice. The scope of practice must be defined by each national specialty board recognized
by the Commission on Dental Accreditation.
(f) All specialty dentists who have fulfilled the specialty dentist requirements and who
intend to limit their practice to a particular specialty area or areas may apply for one or more
specialty licenses.
Sec. 8.
Minnesota Statutes 2020, section 150A.06, subdivision 2c, is amended to read:
Subd. 2c.
Guest license.
(a) The board shall grant a guest license to practice as a dentist,
dental hygienist, or licensed dental assistant if the following conditions are met:
(1) the dentist, dental hygienist, or dental assistant is currently licensed in good standing
in another United States jurisdiction;
(2) the dentist, dental hygienist, or dental assistant is currently engaged in the practice
of that person's respective profession in another United States jurisdiction;
(3) the dentist, dental hygienist, or dental assistant will limit that person's practice to a
public health setting in Minnesota that (i) is approved by the board; (ii) was established by
a nonprofit organization that is tax exempt under chapter 501(c)(3) of the Internal Revenue
Code of 1986; and (iii) provides dental care to patients who have difficulty accessing dental
care;
(4) the dentist, dental hygienist, or dental assistant agrees to treat indigent patients who
meet the eligibility criteria established by the clinic; and
(5) the dentist, dental hygienist, or dental assistant has applied to the board for a guest
license and has paid a nonrefundable license fee to the board deleted text begin not to exceed $75deleted text end .
(b) A guest license must be renewed annually with the board and an annual renewal fee
deleted text begin not to exceed $75deleted text end must be paid to the board. Guest licenses expire on December 31 of each
year.
(c) A dentist, dental hygienist, or dental assistant practicing under a guest license under
this subdivision shall have the same obligations as a dentist, dental hygienist, or dental
assistant who is licensed in Minnesota and shall be subject to the laws and rules of Minnesota
and the regulatory authority of the board. If the board suspends or revokes the guest license
of, or otherwise disciplines, a dentist, dental hygienist, or dental assistant practicing under
this subdivision, the board shall promptly report such disciplinary action to the dentist's,
dental hygienist's, or dental assistant's regulatory board in the jurisdictions in which they
are licensed.
(d) The board may grant a guest license to a dentist, dental hygienist, or dental assistant
licensed in another United States jurisdiction to provide dental care to patients on a voluntary
basis without compensation for a limited period of time. The board shall not assess a fee
for the guest license for volunteer services issued under this paragraph.
new text begin (e) new text end The board shall issue a guest license for volunteer services if:
(1) the board determines that the applicant's services will provide dental care to patients
who have difficulty accessing dental care;
(2) the care will be provided without compensation; and
(3) the applicant provides adequate proof of the status of all licenses to practice in other
jurisdictions. The board may require such proof on an application form developed by the
board.
new text begin (f) new text end The guest license for volunteer services shall limit the licensee to providing dental
care services for a period of time not to exceed ten days in a calendar year. Guest licenses
expire on December 31 of each year.
new text begin (g) new text end The holder of a guest license for volunteer services shall be subject to state laws and
rules regarding dentistry and the regulatory authority of the board. The board may revoke
the license of a dentist, dental hygienist, or dental assistant practicing under this subdivision
or take other regulatory action against the dentist, dental hygienist, or dental assistant. If an
action is taken, the board shall report the action to the regulatory board of those jurisdictions
where an active license is held by the dentist, dental hygienist, or dental assistant.
Sec. 9.
Minnesota Statutes 2020, section 150A.06, subdivision 6, is amended to read:
Subd. 6.
Display of name and certificates.
(a) The renewal certificate of deleted text begin every dentist,
dental therapist, dental hygienist, or dental assistantdeleted text end new text begin every licensee or registrantnew text end must be
conspicuously displayed in plain sight of patients in every office in which that person
practices. Duplicate renewal certificates may be obtained from the board.
(b) Near or on the entrance door to every office where dentistry is practiced, the name
of each dentist practicing there, as inscribed on the current license certificate, must be
displayed in plain sight.
(c) The board must allow the display of a mini-license for guest license holders
performing volunteer dental services. There is no fee for the mini-license for guest volunteers.
Sec. 10.
Minnesota Statutes 2020, section 150A.06, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Licensure by credentials for dental therapy. new text end
new text begin
(a) Any dental therapist may,
upon application and payment of a fee established by the board, apply for licensure based
on an evaluation of the applicant's education, experience, and performance record. The
applicant may be interviewed by the board to determine if the applicant:
new text end
new text begin
(1) graduated with a baccalaureate or master's degree from a dental therapy program
accredited by the Commission on Dental Accreditation;
new text end
new text begin
(2) provided evidence of successfully completing the board's jurisprudence examination;
new text end
new text begin
(3) actively practiced at least 2,000 hours within 36 months of the application date or
passed a board-approved reentry program within 36 months of the application date;
new text end
new text begin
(4) either:
new text end
new text begin
(i) is currently licensed in another state or Canadian province and not subject to any
pending or final disciplinary action; or
new text end
new text begin
(ii) was previously licensed in another state or Canadian province in good standing and
not subject to any final or pending disciplinary action at the time of surrender;
new text end
new text begin
(5) passed a board-approved English proficiency test if English is not the applicant's
primary language required at the board's discretion; and
new text end
new text begin
(6) met all curriculum equivalency requirements regarding dental therapy scope of
practice in Minnesota.
new text end
new text begin
(b) The 2,000 practice hours required by clause (3) may count toward the 2,000 practice
hours required for consideration for advanced dental therapy certification, provided that all
other requirements of section 150A.106, subdivision 1, are met.
new text end
new text begin
(c) The board, at its discretion, may waive specific licensure requirements in paragraph
(a).
new text end
new text begin
(d) The board must license an applicant who fulfills the conditions of this subdivision
and demonstrates the minimum knowledge in dental subjects required for licensure under
subdivision 1d to practice the applicant's profession.
new text end
new text begin
(e) The board must deny the application if the applicant does not demonstrate the
minimum knowledge in dental subjects required for licensure under subdivision 1d. If
licensure is denied, the board may notify the applicant of any specific remedy the applicant
could take to qualify for licensure. A denial does not prohibit the applicant from applying
for licensure under subdivision 1d.
new text end
new text begin
(e) A candidate may appeal a denied application to the board according to subdivision
4a.
new text end
Sec. 11.
Minnesota Statutes 2020, section 150A.09, is amended to read:
150A.09 deleted text begin REGISTRATION OFdeleted text end LICENSES deleted text begin ANDdeleted text end new text begin ORnew text end REGISTRATION
CERTIFICATES.
Subdivision 1.
Registration information and procedure.
On or before the license
certificate expiration date every deleted text begin licensed dentist, dental therapist, dental hygienist, and
dental assistantdeleted text end new text begin licensee or registrantnew text end shall deleted text begin transmit to the executive secretary of the board,
pertinent informationdeleted text end new text begin submit the renewalnew text end required by the board, together with thenew text begin applicablenew text end
fee deleted text begin established by the boarddeleted text end new text begin under section 150A.091new text end . At least 30 days before a license
certificate expiration date, the board shall send a written notice stating the amount and due
date of the fee deleted text begin and the information to be provided to every licensed dentist, dental therapist,
dental hygienist, and dental assistantdeleted text end .
Subd. 3.
Current address, change of address.
Every deleted text begin dentist, dental therapist, dental
hygienist, and dental assistantdeleted text end new text begin licensee or registrantnew text end shall maintain with the board a correct
and current mailing address and electronic mail address. For dentists engaged in the practice
of dentistry, the postal address shall be that of the location of the primary dental practice.
Within 30 days after changing postal or electronic mail addresses, every deleted text begin dentist, dental
therapist, dental hygienist, and dental assistantdeleted text end new text begin licensee or registrantnew text end shall provide the board
deleted text begin writtendeleted text end notice deleted text begin of the new address either personally or by first class maildeleted text end .
Subd. 4.
Duplicate certificates.
Duplicate licenses or duplicate certificates of deleted text begin licensedeleted text end
renewal may be issued by the board upon satisfactory proof of the need for the duplicates
and upon payment of the fee established by the board.
Subd. 5.
Late fee.
A late fee established by the board shall be paid if the deleted text begin information
anddeleted text end fee required by subdivision 1 is not received by deleted text begin the executive secretary ofdeleted text end the board on
or before the registration or deleted text begin licensedeleted text end renewal date.
Sec. 12.
Minnesota Statutes 2020, section 150A.091, subdivision 2, is amended to read:
Subd. 2.
Applicationnew text begin and initial license or registrationnew text end fees.
Each applicant shall
submit with a license, advanced dental therapist certificate, or permit application a
nonrefundable fee in the following amounts in order to administratively process an
application:
(1) dentist, deleted text begin $140deleted text end new text begin $308new text end ;
(2) full faculty dentist, deleted text begin $140deleted text end new text begin $308new text end ;
(3) limited faculty dentist, $140;
(4) resident dentist or dental provider, $55;
(5) advanced dental therapist, $100;
(6) dental therapist, deleted text begin $100deleted text end new text begin $220new text end ;
(7) dental hygienist, deleted text begin $55deleted text end new text begin $115new text end ;
(8) licensed dental assistant, deleted text begin $55; anddeleted text end new text begin $115;
new text end
(9) dental assistant with deleted text begin a permitdeleted text end new text begin registrationnew text end as described in Minnesota Rules, part
3100.8500, subpart 3, deleted text begin $15.deleted text end new text begin $27; and
new text end
new text begin
(10) guest license, $50.
new text end
Sec. 13.
Minnesota Statutes 2020, section 150A.091, subdivision 5, is amended to read:
Subd. 5.
Biennial license or deleted text begin permitdeleted text end new text begin registration renewalnew text end fees.
Each of the following
applicants shall submit with a biennial license or permit renewal application a fee as
established by the board, not to exceed the following amounts:
(1) dentist or full faculty dentist, $475;
(2) dental therapist, $300;
(3) dental hygienist, $200;
(4) licensed dental assistant, $150; and
(5) dental assistant with a deleted text begin permitdeleted text end new text begin registrationnew text end as described in Minnesota Rules, part
3100.8500, subpart 3, $24.
Sec. 14.
Minnesota Statutes 2020, section 150A.091, subdivision 8, is amended to read:
Subd. 8.
Duplicate license or certificate fee.
Each applicant shall submit, with a request
for issuance of a duplicate of the original license, or of an annual or biennial renewal
certificate for a license or permit, a fee in the following amounts:
(1) original dentist, full faculty dentist, dental therapist, dental hygiene, or dental assistant
license, $35;new text begin and
new text end
(2) annual or biennial renewal certificates, $10deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(3) wallet-sized license and renewal certificate, $15.
deleted text end
Sec. 15.
Minnesota Statutes 2020, section 150A.091, subdivision 9, is amended to read:
Subd. 9.
Licensure by credentials.
Each applicant for licensure as a dentist, dental
hygienist, or dental assistant by credentials pursuant to section 150A.06, subdivisions 4 and
8, and Minnesota Rules, part 3100.1400, shall submit with the license application a fee in
the following amounts:
(1) dentist, deleted text begin $725deleted text end new text begin $893new text end ;
(2) dental hygienist, deleted text begin $175; anddeleted text end new text begin $235;
new text end
(3) dental assistant, deleted text begin $35.deleted text end new text begin $71; and
new text end
new text begin
(4) dental therapist, $340.
new text end
Sec. 16.
Minnesota Statutes 2020, section 150A.091, is amended by adding a subdivision
to read:
new text begin Subd. 21. new text end
new text begin Failure to practice with a current license. new text end
new text begin
(a) If a licensee practices without
a current license and pursues reinstatement, the board may take the following administrative
actions based on the length of time practicing without a current license:
new text end
new text begin
(1) for under one month, the board may not assess a penalty fee;
new text end
new text begin
(2) for one month to six months, the board may assess a penalty of $250;
new text end
new text begin
(3) for over six months, the board may assess a penalty of $500; and
new text end
new text begin
(4) for over 12 months, the board may assess a penalty of $1,000.
new text end
new text begin
(b) In addition to the penalty fee, the board shall initiate the complaint process against
the licensee for failure to practice with a current license for over 12 months.
new text end
Sec. 17.
Minnesota Statutes 2020, section 150A.091, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin
Delegating regulated procedures to an individual with a terminated
license.
new text end
new text begin
(a) If a dentist or dental therapist delegates regulated procedures to another dental
professional who had their license terminated, the board may take the following
administrative actions against the delegating dentist or dental therapist based on the length
of time they delegated regulated procedures:
new text end
new text begin
(1) for under one month, the board may not assess a penalty fee;
new text end
new text begin
(2) for one month to six months, the board may assess a penalty of $100;
new text end
new text begin
(3) for over six months, the board may assess a penalty of $250; and
new text end
new text begin
(4) for over 12 months, the board may assess a penalty of $500.
new text end
new text begin
(b) In addition to the penalty fee, the board shall initiate the complaint process against
a dentist or dental therapist who delegated regulated procedures to a dental professional
with a terminated license for over 12 months.
new text end
Sec. 18.
Minnesota Statutes 2020, section 151.01, subdivision 27, is amended to read:
Subd. 27.
Practice of pharmacy.
"Practice of pharmacy" means:
(1) interpretation and evaluation of prescription drug orders;
(2) compounding, labeling, and dispensing drugs and devices (except labeling by a
manufacturer or packager of nonprescription drugs or commercially packaged legend drugs
and devices);
(3) participation in clinical interpretations and monitoring of drug therapy for assurance
of safe and effective use of drugs, including the performance of laboratory tests that are
waived under the federal Clinical Laboratory Improvement Act of 1988, United States Code,
title 42, section 263a et seq., provided that a pharmacist may interpret the results of laboratory
tests but may modify drug therapy only pursuant to a protocol or collaborative practice
agreement;
(4) participation in drug and therapeutic device selection; drug administration for first
dosage and medical emergencies; intramuscular and subcutaneous new text begin drug new text end administration deleted text begin used
for the treatment of alcohol or opioid dependencedeleted text end new text begin under a prescription drug ordernew text end ; drug
regimen reviews; and drug or drug-related research;
(5) drug administration, through intramuscular and subcutaneous administration used
to treat mental illnesses as permitted under the following conditions:
(i) upon the order of a prescriber and the prescriber is notified after administration is
complete; or
(ii) pursuant to a protocol or collaborative practice agreement as defined by section
151.01, subdivisions 27b and 27c, and participation in the initiation, management,
modification, administration, and discontinuation of drug therapy is according to the protocol
or collaborative practice agreement between the pharmacist and a dentist, optometrist,
physician, podiatrist, or veterinarian, or an advanced practice registered nurse authorized
to prescribe, dispense, and administer under section 148.235. Any changes in drug therapy
or medication administration made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(6) participation in administration of influenza vaccines and vaccines approved by the
United States Food and Drug Administration related to COVID-19 or SARS-CoV-2 to all
eligible individuals six years of age and older and all other vaccines to patients 13 years of
age and older by written protocol with a physician licensed under chapter 147, a physician
assistant authorized to prescribe drugs under chapter 147A, or an advanced practice registered
nurse authorized to prescribe drugs under section 148.235, provided that:
(i) the protocol includes, at a minimum:
(A) the name, dose, and route of each vaccine that may be given;
(B) the patient population for whom the vaccine may be given;
(C) contraindications and precautions to the vaccine;
(D) the procedure for handling an adverse reaction;
(E) the name, signature, and address of the physician, physician assistant, or advanced
practice registered nurse;
(F) a telephone number at which the physician, physician assistant, or advanced practice
registered nurse can be contacted; and
(G) the date and time period for which the protocol is valid;
(ii) the pharmacist has successfully completed a program approved by the Accreditation
Council for Pharmacy Education specifically for the administration of immunizations or a
program approved by the board;
(iii) the pharmacist utilizes the Minnesota Immunization Information Connection to
assess the immunization status of individuals prior to the administration of vaccines, except
when administering influenza vaccines to individuals age nine and older;
(iv) the pharmacist reports the administration of the immunization to the Minnesota
Immunization Information Connection; and
(v) the pharmacist complies with guidelines for vaccines and immunizations established
by the federal Advisory Committee on Immunization Practices, except that a pharmacist
does not need to comply with those portions of the guidelines that establish immunization
schedules when administering a vaccine pursuant to a valid, patient-specific order issued
by a physician licensed under chapter 147, a physician assistant authorized to prescribe
drugs under chapter 147A, or an advanced practice registered nurse authorized to prescribe
drugs under section 148.235, provided that the order is consistent with the United States
Food and Drug Administration approved labeling of the vaccine;
(7) participation in the initiation, management, modification, and discontinuation of
drug therapy according to a written protocol or collaborative practice agreement between:
(i) one or more pharmacists and one or more dentists, optometrists, physicians, podiatrists,
or veterinarians; or (ii) one or more pharmacists and one or more physician assistants
authorized to prescribe, dispense, and administer under chapter 147A, or advanced practice
registered nurses authorized to prescribe, dispense, and administer under section 148.235.
Any changes in drug therapy made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(8) participation in the storage of drugs and the maintenance of records;
(9) patient counseling on therapeutic values, content, hazards, and uses of drugs and
devices;
(10) offering or performing those acts, services, operations, or transactions necessary
in the conduct, operation, management, and control of a pharmacy;
(11) participation in the initiation, management, modification, and discontinuation of
therapy with opiate antagonists, as defined in section 604A.04, subdivision 1, pursuant to:
(i) a written protocol as allowed under clause (7); or
(ii) a written protocol with a community health board medical consultant or a practitioner
designated by the commissioner of health, as allowed under section 151.37, subdivision 13;
deleted text begin and
deleted text end
(12) prescribing self-administered hormonal contraceptives; nicotine replacement
medications; and opiate antagonists for the treatment of an acute opiate overdose pursuant
to section 151.37, subdivision 14, 15, or 16deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(13) participation in the placement of drug monitoring devices according to a prescription,
protocol, or collaborative practice agreement.
new text end
Sec. 19.
Minnesota Statutes 2020, section 153.16, subdivision 1, is amended to read:
Subdivision 1.
License requirements.
The board shall issue a license to practice podiatric
medicine to a person who meets the following requirements:
(a) The applicant for a license shall file a written notarized application on forms provided
by the board, showing to the board's satisfaction that the applicant is of good moral character
and satisfies the requirements of this section.
(b) The applicant shall present evidence satisfactory to the board of being a graduate of
a podiatric medical school approved by the board based upon its faculty, curriculum, facilities,
accreditation by a recognized national accrediting organization approved by the board, and
other relevant factors.
(c) The applicant must have received a passing score on each part of the national board
examinations, parts one and two, prepared and graded by the National Board of Podiatric
Medical Examiners. The passing score for each part of the national board examinations,
parts one and two, is as defined by the National Board of Podiatric Medical Examiners.
(d) Applicants graduating after deleted text begin 1986deleted text end new text begin 1990new text end from a podiatric medical school shall present
evidence of successful completion of a residency program approved by a national accrediting
podiatric medicine organization.
(e) The applicant shall appear in person before the board or its designated representative
to show that the applicant satisfies the requirements of this section, including knowledge
of laws, rules, and ethics pertaining to the practice of podiatric medicine. The board may
establish as internal operating procedures the procedures or requirements for the applicant's
personal presentation. Upon completion of all other application requirements, a doctor of
podiatric medicine applying for a temporary military license has six months in which to
comply with this subdivision.
(f) The applicant shall pay a fee established by the board by rule. The fee shall not be
refunded.
(g) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee. If the applicant does not satisfy the requirements of this paragraph, the
board may refuse to issue a license unless it determines that the public will be protected
through issuance of a license with conditions and limitations the board considers appropriate.
(h) Upon payment of a fee as the board may require, an applicant who fails to pass an
examination and is refused a license is entitled to reexamination within one year of the
board's refusal to issue the license. No more than two reexaminations are allowed without
a new application for a license.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20. new text begin TEMPORARY REQUIREMENTS GOVERNING AMBULANCE SERVICE
OPERATIONS AND THE PROVISION OF EMERGENCY MEDICAL SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
Notwithstanding any law to the contrary in Minnesota
Statutes, chapter 144E, an ambulance service may operate according to this section, and
emergency medical technicians, advanced emergency medical technicians, and paramedics
may provide emergency medical services according to this section.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section.
new text end
new text begin
(b) "Advanced emergency medical technician" has the meaning given in Minnesota
Statutes, section 144E.001, subdivision 5d.
new text end
new text begin
(c) "Advanced life support" has the meaning given in Minnesota Statutes, section
144E.001, subdivision 1b.
new text end
new text begin
(d) "Ambulance" has the meaning given in Minnesota Statutes, section 144E.001,
subdivision 2.
new text end
new text begin
(e) "Ambulance service personnel" has the meaning given in Minnesota Statutes, section
144E.001, subdivision 3a.
new text end
new text begin
(f) "Basic life support" has the meaning given in Minnesota Statutes, section 144E.001,
subdivision 4b.
new text end
new text begin
(g) "Board" means the Emergency Medical Services Regulatory Board.
new text end
new text begin
(h) "Emergency medical technician" has the meaning given in Minnesota Statutes, section
144E.001, subdivision 5c.
new text end
new text begin
(i) "Paramedic" has the meaning given in Minnesota Statutes, section 144E.001,
subdivision 5e.
new text end
new text begin
(j) "Primary service area" means the area designated by the board according to Minnesota
Statutes, section 144E.06, to be served by an ambulance service.
new text end
new text begin Subd. 3. new text end
new text begin Staffing. new text end
new text begin
(a) For emergency ambulance calls and interfacility transfers in an
ambulance service's primary service area, an ambulance service must staff an ambulance
that provides basic life support with at least:
new text end
new text begin
(1) one emergency medical technician, who must be in the patient compartment when
a patient is being transported; and
new text end
new text begin
(2) one individual to drive the ambulance. The driver must hold a valid driver's license
from any state, must have attended an emergency vehicle driving course approved by the
ambulance service, and must have completed a course on cardiopulmonary resuscitation
approved by the ambulance service.
new text end
new text begin
(b) For emergency ambulance calls and interfacility transfers in an ambulance service's
primary service area, an ambulance service must staff an ambulance that provides advanced
life support with at least:
new text end
new text begin
(1) one paramedic; one registered nurse who meets the requirements in Minnesota
Statutes, section 144E.001, subdivision 3a, clause (2); or one physician assistant who meets
the requirements in Minnesota Statutes, section 144E.001, subdivision 3a, clause (3), and
who must be in the patient compartment when a patient is being transported; and
new text end
new text begin
(2) one individual to drive the ambulance. The driver must hold a valid driver's license
from any state, must have attended an emergency vehicle driving course approved by the
ambulance service, and must have completed a course on cardiopulmonary resuscitation
approved by the ambulance service.
new text end
new text begin
(c) The ambulance service director and medical director must approve the staffing of
an ambulance according to this subdivision.
new text end
new text begin
(d) An ambulance service staffing an ambulance according to this subdivision must
immediately notify the board in writing and in a manner prescribed by the board. The notice
must specify how the ambulance service is staffing its basic life support or advanced life
support ambulances and the time period the ambulance service plans to staff the ambulances
according to this subdivision. If an ambulance service continues to staff an ambulance
according to this subdivision after the date provided to the board in its initial notice, the
ambulance service must provide a new notice to the board in a manner that complies with
this paragraph.
new text end
new text begin
(e) If an individual serving as a driver under this subdivision commits an act listed in
Minnesota Statutes, section 144E.27, subdivision 5, paragraph (a), the board may temporarily
suspend or prohibit the individual from driving an ambulance or place conditions on the
individual's ability to drive an ambulance using the procedures and authority in Minnesota
Statutes, section 144E.27, subdivisions 5 and 6.
new text end
new text begin Subd. 4. new text end
new text begin Use of expired emergency medications and medical supplies. new text end
new text begin
(a) If an
ambulance service experiences a shortage of an emergency medication or medical supply,
ambulance service personnel may use an emergency medication or medical supply for up
to six months after the emergency medication's or medical supply's specified expiration
date, provided:
new text end
new text begin
(1) the ambulance service director and medical director approve the use of the expired
emergency medication or medical supply;
new text end
new text begin
(2) ambulance service personnel use an expired emergency medication or medical supply
only after depleting the ambulance service's supply of that emergency medication or medical
supply that is unexpired;
new text end
new text begin
(3) the ambulance service has stored and maintained the expired emergency medication
or medical supply according to the manufacturer's instructions;
new text end
new text begin
(4) if possible, ambulance service personnel obtain consent from the patient to use the
expired emergency medication or medical supply prior to its use; and
new text end
new text begin
(5) when the ambulance service obtains a supply of that emergency medication or medical
supply that is unexpired, ambulance service personnel cease use of the expired emergency
medication or medical supply and instead use the unexpired emergency medication or
medical supply.
new text end
new text begin
(b) Before approving the use of an expired emergency medication, an ambulance service
director and medical director must consult with the Board of Pharmacy regarding the safety
and efficacy of using the expired emergency medication.
new text end
new text begin
(c) An ambulance service must keep a record of all expired emergency medications and
all expired medical supplies used and must submit that record in writing to the board in a
time and manner specified by the board. The record must list the specific expired emergency
medications and medical supplies used and the time period during which ambulance service
personnel used the expired emergency medication or medical supply.
new text end
new text begin Subd. 5. new text end
new text begin Provision of emergency medical services after certification expires. new text end
new text begin
(a) At
the request of an emergency medical technician, advanced emergency medical technician,
or paramedic, and with the approval of the ambulance service director, an ambulance service
medical director may authorize the emergency medical technician, advanced emergency
medical technician, or paramedic to provide emergency medical services for the ambulance
service for up to three months after the certification of the emergency medical technician,
advanced emergency medical technician, or paramedic expires.
new text end
new text begin
(b) An ambulance service must immediately notify the board each time its medical
director issues an authorization under paragraph (a). The notice must be provided in writing
and in a manner prescribed by the board and must include information on the time period
each emergency medical technician, advanced emergency medical technician, or paramedic
will provide emergency medical services according to an authorization under this subdivision;
information on why the emergency medical technician, advanced emergency medical
technician, or paramedic needs the authorization; and an attestation from the medical director
that the authorization is necessary to help the ambulance service adequately staff its
ambulances.
new text end
new text begin Subd. 6. new text end
new text begin Reports. new text end
new text begin
The board must provide quarterly reports to the chairs and ranking
minority members of the legislative committees with jurisdiction over the board regarding
actions taken by ambulance services according to subdivisions 3, 4, and 5. The board must
submit reports by June 30, September 30, and December 31 of 2022; and by March 31, June
30, September 30, and December 31 of 2023. Each report must include the following
information:
new text end
new text begin
(1) for each ambulance service staffing basic life support or advanced life support
ambulances according to subdivision 3, the primary service area served by the ambulance
service, the number of ambulances staffed according to subdivision 3, and the time period
the ambulance service has staffed and plans to staff the ambulances according to subdivision
3;
new text end
new text begin
(2) for each ambulance service that authorized the use of an expired emergency
medication or medical supply according to subdivision 4, the expired emergency medications
and medical supplies authorized for use and the time period the ambulance service used
each expired emergency medication or medical supply; and
new text end
new text begin
(3) for each ambulance service that authorized the provision of emergency medical
services according to subdivision 5, the number of emergency medical technicians, advanced
emergency medical technicians, and paramedics providing emergency medical services
under an expired certification and the time period each emergency medical technician,
advanced emergency medical technician, or paramedic provided and will provide emergency
medical services under an expired certification.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
This section expires January 1, 2024.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 21. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 150A.091, subdivisions 3, 15, and 17,
new text end
new text begin
are repealed.
new text end
ARTICLE 6
PRESCRIPTION DRUGS
Section 1.
Minnesota Statutes 2020, section 62A.02, subdivision 1, is amended to read:
Subdivision 1.
Filing.
For purposes of this section, "health plan" means a health plan
as defined in section 62A.011 or a policy of accident and sickness insurance as defined in
section 62A.01. No health plan shall be issued or delivered to any person in this state, nor
shall any application, rider, or endorsement be used in connection with the health plan, until
a copy of its form and of the classification of risks and the premium rates pertaining to the
form have been filed with the commissioner. new text begin The filing must include the health plan's
prescription drug formulary. Proposed revisions to the health plan's prescription drug
formulary must be filed with the commissioner no later than August 1 of the application
year. new text end The filing for nongroup health plan forms shall include a statement of actuarial reasons
and data to support the rate. For health benefit plans as defined in section 62L.02, and for
health plans to be issued to individuals, the health carrier shall file with the commissioner
the information required in section 62L.08, subdivision 8. For group health plans for which
approval is sought for sales only outside of the small employer market as defined in section
62L.02, this section applies only to policies or contracts of accident and sickness insurance.
All forms intended for issuance in the individual or small employer market must be
accompanied by a statement as to the expected loss ratio for the form. Premium rates and
forms relating to specific insureds or proposed insureds, whether individuals or groups,
need not be filed, unless requested by the commissioner.
Sec. 2.
Minnesota Statutes 2021 Supplement, section 62J.497, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given.
(b) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision
30. Dispensing does not include the direct administering of a controlled substance to a
patient by a licensed health care professional.
(c) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.
(d) "Electronic media" has the meaning given under Code of Federal Regulations, title
45, part 160.103.
(e) "E-prescribing" means the transmission using electronic media of prescription or
prescription-related information between a prescriber, dispenser, pharmacy benefit manager,
or group purchaser, either directly or through an intermediary, including an e-prescribing
network. E-prescribing includes, but is not limited to, two-way transmissions between the
point of care and the dispenser and two-way transmissions related to eligibility, formulary,
and medication history information.
(f) "Electronic prescription drug program" means a program that provides for
e-prescribing.
(g) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
(h) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.
(i) "National Provider Identifier" or "NPI" means the identifier described under Code
of Federal Regulations, title 45, part 162.406.
(j) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
(k) "NCPDP Formulary and Benefits Standard" means the most recent version of the
National Council for Prescription Drug Programs Formulary and Benefits Standard or the
most recent standard adopted by the Centers for Medicare and Medicaid Services for
e-prescribing under Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social
Security Act and regulations adopted under it. The standards shall be implemented according
to the Centers for Medicare and Medicaid Services schedule for compliance.
new text begin
(l) "NCPDP Real-Time Prescription Benefit Standard" means the most recent National
Council for Prescription Drug Programs Real-Time Prescription Benefit Standard adopted
by the Centers for Medicare and Medicaid Services for e-prescribing under Medicare Part
D as required by section 1860D-4(e)(2) of the Social Security Act and regulations adopted
under it.
new text end
deleted text begin (l)deleted text end new text begin (m)new text end "NCPDP SCRIPT Standard" means the most recent version of the National
Council for Prescription Drug Programs SCRIPT Standard, or the most recent standard
adopted by the Centers for Medicare and Medicaid Services for e-prescribing under Medicare
Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and regulations
adopted under it. The standards shall be implemented according to the Centers for Medicare
and Medicaid Services schedule for compliance.
deleted text begin (m)deleted text end new text begin (n)new text end "Pharmacy" has the meaning given in section 151.01, subdivision 2.
new text begin
(o) "Pharmacy benefit manager" has the meaning given in section 62W.02, subdivision
15.
new text end
deleted text begin (n)deleted text end new text begin (p)new text end "Prescriber" means a licensed health care practitioner, other than a veterinarian,
as defined in section 151.01, subdivision 23.
deleted text begin (o)deleted text end new text begin (q)new text end "Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.
deleted text begin (p)deleted text end new text begin (r)new text end "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.
new text begin
(s) "Real-time prescription benefit tool" means a tool that is capable of being integrated
into a prescriber's e-prescribing system and that provides a prescriber with up-to-date and
patient-specific formulary and benefit information at the time the prescriber submits a
prescription.
new text end
Sec. 3.
Minnesota Statutes 2021 Supplement, section 62J.497, subdivision 3, is amended
to read:
Subd. 3.
Standards for electronic prescribing.
(a) Prescribers and dispensers must use
the NCPDP SCRIPT Standard for the communication of a prescription or prescription-related
information.
(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP SCRIPT
Standard for communicating and transmitting medication history information.
(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
Formulary and Benefits Standard for communicating and transmitting formulary and benefit
information.
(d) Providers, group purchasers, prescribers, and dispensers must use the national provider
identifier to identify a health care provider in e-prescribing or prescription-related transactions
when a health care provider's identifier is required.
(e) Providers, group purchasers, prescribers, and dispensers must communicate eligibility
information and conduct health care eligibility benefit inquiry and response transactions
according to the requirements of section 62J.536.
new text begin
(f) Group purchasers and pharmacy benefit managers must use a real-time prescription
benefit tool that complies with the NCPDP Real-Time Prescription Benefit Standard and
that, at a minimum, notifies a prescriber:
new text end
new text begin
(1) if a prescribed drug is covered by the patient's group purchaser or pharmacy benefit
manager;
new text end
new text begin
(2) if a prescribed drug is included on the formulary or preferred drug list of the patient's
group purchaser or pharmacy benefit manager;
new text end
new text begin
(3) of any patient cost-sharing for the prescribed drug;
new text end
new text begin
(4) if prior authorization is required for the prescribed drug; and
new text end
new text begin
(5) of a list of any available alternative drugs that are in the same class as the drug
originally prescribed and for which prior authorization is not required.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 4.
Minnesota Statutes 2020, section 62J.84, as amended by Laws 2021, chapter 30,
article 3, sections 5 to 9, is amended to read:
62J.84 PRESCRIPTION DRUG PRICE TRANSPARENCY.
Subdivision 1.
Short title.
This section may be cited as the "Prescription Drug Price
Transparency Act."
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics
license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) an original, new drug application approved under United States Code, title 21, section
355(c), except for a generic drug as defined under Code of Federal Regulations, title 42,
section 447.502; or
(2) a biologics license application approved under United States Code, title deleted text begin 45deleted text end new text begin 42new text end , section
262(a)(c).
(d) "Commissioner" means the commissioner of health.
new text begin
(e) "Course of treatment" means the total dosage of a single prescription for a prescription
drug recommended by the Food and Drug Administration (FDA)-approved prescribing
label. If the FDA-approved prescribing label includes more than one recommended dosage
for a single course of treatment, the course of treatment is the maximum recommended
dosage on the FDA-approved prescribing label.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21,
section 355(j);
(2) an authorized generic as defined under Code of Federal Regulations, title deleted text begin 45deleted text end new text begin 42new text end ,
section 447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed
under a new drug application.
deleted text begin (f)deleted text end new text begin (g)new text end "Manufacturer" means a drug manufacturer licensed under section 151.252.
new text begin
(h) "National Drug Code" means the three-segment code maintained by the FDA that
includes a labeler code, a product code, and a package code for a drug product and that has
been converted to an 11-digit format consisting of five digits in the first segment, four digits
in the second segment, and two digits in the third segment. A three-segment code shall be
considered converted to an 11-digit format when, as necessary, at least one "0" has been
added to the front of each segment containing less than the specified number of digits so
that each segment contains the specified number of digits.
new text end
deleted text begin (g)deleted text end new text begin (i)new text end "New prescription drug" or "new drug" means a prescription drug approved for
marketing by the United States Food and Drug Administration for which no previous
wholesale acquisition cost has been established for comparison.
deleted text begin (h)deleted text end new text begin (j)new text end "Patient assistance program" means a program that a manufacturer offers to the
public in which a consumer may reduce the consumer's out-of-pocket costs for prescription
drugs by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by
other means.
deleted text begin (i)deleted text end new text begin (k)new text end "Prescription drug" or "drug" has the meaning provided in section 151.441,
subdivision 8.
deleted text begin (j)deleted text end new text begin (l)new text end "Price" means the wholesale acquisition cost as defined in United States Code,
title 42, section 1395w-3a(c)(6)(B).
new text begin
(m) "Rebate" means a discount, chargeback, or other price concession that affects the
price of a prescription drug product, regardless of whether conferred through regular
aggregate payments, on a claim-by-claim basis at the point of sale, as part of retrospective
financial reconciliations including reconciliations that also reflect other contractual
arrangements, or by any other method. Rebate does not mean a bona fide service fee, as the
term is defined in Code of Federal Regulations, title 42, section 447.502.
new text end
new text begin
(n) "30-day supply" means the total daily dosage units of a prescription drug
recommended by the prescribing label approved by the FDA for 30 days. If the
FDA-approved prescribing label includes more than one recommended daily dosage, the
30-day supply is based on the maximum recommended daily dosage on the FDA-approved
prescribing label.
new text end
Subd. 3.
Prescription drug price increases reporting.
(a) Beginning January 1, 2022,
a drug manufacturer must submit to the commissioner the information described in paragraph
(b) for each prescription drug for which the price was $100 or greater for a 30-day supply
or for a course of treatment lasting less than 30 days and:
(1) for brand name drugs where there is an increase of ten percent or greater in the price
over the previous 12-month period or an increase of 16 percent or greater in the price over
the previous 24-month period; and
(2) for generic new text begin or biosimilar new text end drugs where there is an increase of 50 percent or greater in
the price over the previous 12-month period.
(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to
the commissioner no later than 60 days after the price increase goes into effect, in the form
and manner prescribed by the commissioner, the following information, if applicable:
(1) the namenew text begin , description,new text end and price of the drug and the net increase, expressed as a
percentagedeleted text begin ;deleted text end new text begin , with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
(2) the factors that contributed to the price increase;
(3) the name of any generic version of the prescription drug available on the market;
(4) the introductory price of the prescription drug new text begin when it was introduced for sale in the
United States and the price of the drug on the last day of each of the five calendar years
preceding the price increase new text end when it was approved for marketing by the Food and Drug
Administration and the net yearly increase, by calendar year, in the price of the prescription
drug during the previous five years;
(5) the direct costs incurred new text begin during the previous 12-month period new text end by the manufacturer
that are associated with the prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug;
new text begin
(6) the number of units of the prescription drug sold during the previous 12-month period;
new text end
new text begin
(7) the total rebate payable amount accrued for the prescription drug during the previous
12-month period;
new text end
deleted text begin (6)deleted text end new text begin (8)new text end the total sales revenue for the prescription drug during the previous 12-month
period;
deleted text begin (7)deleted text end new text begin (9)new text end the manufacturer's net profit attributable to the prescription drug during the
previous 12-month period;
deleted text begin (8)deleted text end new text begin (10)new text end the total amount of financial assistance the manufacturer has provided through
patient prescription assistance programsnew text begin during the previous 12-month periodnew text end , if applicable;
deleted text begin (9)deleted text end new text begin (11)new text end any agreement between a manufacturer and another entity contingent upon any
delay in offering to market a generic version of the prescription drug;
deleted text begin (10)deleted text end new text begin (12)new text end the patent expiration date of the prescription drug if it is under patent;
deleted text begin (11)deleted text end new text begin (13)new text end the name and location of the company that manufactured the drug; deleted text begin and
deleted text end
deleted text begin (12)deleted text end new text begin (14)new text end if a brand name prescription drug, the ten highest prices paid for the prescription
drug during the previous calendar year in deleted text begin any country other thandeleted text end new text begin the ten countries, excludingnew text end
the United Statesdeleted text begin .deleted text end new text begin , that charged the highest single price for the prescription drug; and
new text end
new text begin
(15) if the prescription drug was acquired by the manufacturer during the previous
12-month period, all of the following information:
new text end
new text begin
(i) price at acquisition;
new text end
new text begin
(ii) price in the calendar year prior to acquisition;
new text end
new text begin
(iii) name of the company from which the drug was acquired;
new text end
new text begin
(iv) date of acquisition; and
new text end
new text begin
(v) acquisition price.
new text end
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
Subd. 4.
New prescription drug price reporting.
(a) Beginning January 1, 2022, no
later than 60 days after a manufacturer introduces a new prescription drug for sale in the
United States that is a new brand name drug with a price that is greater than the tier threshold
established by the Centers for Medicare and Medicaid Services for specialty drugs in the
Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting less than
30 days new text end or a new generic or biosimilar drug with a price that is greater than the tier threshold
established by the Centers for Medicare and Medicaid Services for specialty drugs in the
Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting less than
30 days new text end and is not at least 15 percent lower than the referenced brand name drug when the
generic or biosimilar drug is launched, the manufacturer must submit to the commissioner,
in the form and manner prescribed by the commissioner, the following information, if
applicable:
new text begin
(1) the description of the drug, with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end the price of the prescription drug;
deleted text begin (2)deleted text end new text begin (3)new text end whether the Food and Drug Administration granted the new prescription drug a
breakthrough therapy designation or a priority review;
deleted text begin (3)deleted text end new text begin (4)new text end the direct costs incurred by the manufacturer that are associated with the
prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug; and
deleted text begin (4)deleted text end new text begin (5)new text end the patent expiration date of the drug if it is under patent.
(b) The manufacturer may submit documentation necessary to support the information
reported under this subdivision.
deleted text begin Subd. 5. deleted text end
deleted text begin Newly acquired prescription drug price reporting. deleted text end
deleted text begin
(a) Beginning January
1, 2022, the acquiring drug manufacturer must submit to the commissioner the information
described in paragraph (b) for each newly acquired prescription drug for which the price
was $100 or greater for a 30-day supply or for a course of treatment lasting less than 30
days and:
deleted text end
deleted text begin
(1) for a newly acquired brand name drug where there is an increase of ten percent or
greater in the price over the previous 12-month period or an increase of 16 percent or greater
in price over the previous 24-month period; and
deleted text end
deleted text begin
(2) for a newly acquired generic drug where there is an increase of 50 percent or greater
in the price over the previous 12-month period.
deleted text end
deleted text begin
(b) For each of the drugs described in paragraph (a), the acquiring manufacturer shall
submit to the commissioner no later than 60 days after the acquiring manufacturer begins
to sell the newly acquired drug, in the form and manner prescribed by the commissioner,
the following information, if applicable:
deleted text end
deleted text begin
(1) the price of the prescription drug at the time of acquisition and in the calendar year
prior to acquisition;
deleted text end
deleted text begin
(2) the name of the company from which the prescription drug was acquired, the date
acquired, and the purchase price;
deleted text end
deleted text begin
(3) the year the prescription drug was introduced to market and the price of the
prescription drug at the time of introduction;
deleted text end
deleted text begin
(4) the price of the prescription drug for the previous five years;
deleted text end
deleted text begin
(5) any agreement between a manufacturer and another entity contingent upon any delay
in offering to market a generic version of the manufacturer's drug; and
deleted text end
deleted text begin
(6) the patent expiration date of the drug if it is under patent.
deleted text end
deleted text begin
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
deleted text end
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, and 5, and the
manufacturers of those prescription drugs; and
(2) information reported to the commissioner under subdivisions 3, 4, and 5.
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
Subd. 7.
Consultation.
(a) The commissioner may consult with a private entity or
consortium that satisfies the standards of section 62U.04, subdivision 6, the University of
Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format
of the information reported under this section; in posting information pursuant to subdivision
6; and in taking any other action for the purpose of implementing this section.
(b) The commissioner may consult with representatives of the manufacturers to establish
a standard format for reporting information under this section and may use existing reporting
methodologies to establish a standard format to minimize administrative burdens to the state
and manufacturers.
Subd. 8.
Enforcement and penalties.
(a) A manufacturer may be subject to a civil
penalty, as provided in paragraph (b), for:
(1) failing to submit timely reports or notices as required by this section;
(2) failing to provide information required under this section; or
(3) providing inaccurate or incomplete information under this section.
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000
per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section as provided in
section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section upon terms
and conditions the commissioner considers proper and consistent with public health and
safety.
(e) Civil penalties collected under this section shall be deposited in the health care access
fund.
Subd. 9.
Legislative report.
(a) No later than May 15, 2022, and by January 15 of each
year thereafter, the commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over commerce and health and human services
policy and finance on the implementation of this section, including but not limited to the
effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the state and other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the state and other payers in the management of pharmaceutical costs.
(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, and 5.
Sec. 5.
Minnesota Statutes 2020, section 62J.84, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this sectionnew text begin and section 62J.841new text end , the terms
defined in this subdivision have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics
license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) an original, new drug application approved under United States Code, title 21, section
355(c), except for a generic drug as defined under Code of Federal Regulations, title 42,
section 447.502; or
(2) a biologics license application approved under United States Code, title 45, section
262(a)(c).
(d) "Commissioner" means the commissioner of health.
(e) "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21,
section 355(j);
(2) an authorized generic as defined under Code of Federal Regulations, title 45, section
447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed
under a new drug application.
(f) "Manufacturer" means a drug manufacturer licensed under section 151.252.
(g) "New prescription drug" or "new drug" means a prescription drug approved for
marketing by the United States Food and Drug Administration for which no previous
wholesale acquisition cost has been established for comparison.
(h) "Patient assistance program" means a program that a manufacturer offers to the public
in which a consumer may reduce the consumer's out-of-pocket costs for prescription drugs
by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by other
means.
(i) "Prescription drug" or "drug" has the meaning provided in section 151.441, subdivision
8.
(j) "Price" means the wholesale acquisition cost as defined in United States Code, title
42, section 1395w-3a(c)(6)(B).
Sec. 6.
Minnesota Statutes 2020, section 62J.84, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics
license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) an original, new drug application approved under United States Code, title 21, section
355(c), except for a generic drug as defined under Code of Federal Regulations, title 42,
section 447.502; or
(2) a biologics license application approved under United States Code, title 45, section
262(a)(c).
(d) "Commissioner" means the commissioner of health.
new text begin
(e) "Drug product family" means a group of one or more prescription drugs that share
a unique generic drug description or nontrade name and dosage form.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21,
section 355(j);
(2) an authorized generic as defined under Code of Federal Regulations, title 45, section
447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed
under a new drug application.
deleted text begin (f)deleted text end new text begin (g)new text end "Manufacturer" means a drug manufacturer licensed under section 151.252.
deleted text begin (g)deleted text end new text begin (h)new text end "New prescription drug" or "new drug" means a prescription drug approved for
marketing by the United States Food and Drug Administration for which no previous
wholesale acquisition cost has been established for comparison.
deleted text begin (h)deleted text end new text begin (i)new text end "Patient assistance program" means a program that a manufacturer offers to the
public in which a consumer may reduce the consumer's out-of-pocket costs for prescription
drugs by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by
other means.
new text begin
(j) "Pharmacy" or "pharmacy provider" means a place of business licensed by the Board
of Pharmacy under section 151.19 in which prescription drugs are prepared, compounded,
or dispensed under the supervision of a pharmacist.
new text end
new text begin
(k) "Pharmacy benefits manager (PBM)" means an entity licensed to act as a pharmacy
benefits manager under section 62W.03.
new text end
deleted text begin (i)deleted text end new text begin (l)new text end "Prescription drug" or "drug" has the meaning provided in section 151.441,
subdivision 8.
deleted text begin (j)deleted text end new text begin (m)new text end "Price" means the wholesale acquisition cost as defined in United States Code,
title 42, section 1395w-3a(c)(6)(B).
new text begin
(n) "Pricing Unit" means the smallest dispensable amount of a prescription drug product
that could be dispensed.
new text end
new text begin
(o) "Reporting entity" means any manufacturer, pharmacy, pharmacy benefits manager,
wholesale drug distributor, or any other entity required to submit data under this section.
new text end
new text begin
(p) "Wholesale drug distributor" or "wholesaler" means an entity that:
new text end
new text begin
(1) is licensed to act as a wholesale drug distributor under section 151.47; and
new text end
new text begin
(2) distributes prescription drugs, of which it is not the manufacturer, to persons or
entities other than a consumer or patient in the state.
new text end
Sec. 7.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 6, is amended
to read:
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, and 5, and the
manufacturers of those prescription drugs; deleted text begin and
deleted text end
(2) information reported to the commissioner under subdivisions 3, 4, and 5deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) information reported to the commissioner under section 62J.841, subdivision 2.
new text end
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b)new text begin , subject to section 62J.841,
subdivision 2, paragraph (e)new text end ; or is trade secret information pursuant to the Defend Trade
Secrets Act of 2016, United States Code, title 18, section 1836, as amendednew text begin , subject to
section 62J.841, subdivision 2, paragraph (e)new text end . If a manufacturer believes information should
be withheld from public disclosure pursuant to this paragraph, the manufacturer must clearly
and specifically identify that information and describe the legal basis in writing when the
manufacturer submits the information under this section. If the commissioner disagrees
with the manufacturer's request to withhold information from public disclosure, the
commissioner shall provide the manufacturer written notice that the information will be
publicly posted 30 days after the date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
Sec. 8.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 6, is amended
to read:
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, deleted text begin anddeleted text end 5,new text begin 11, 12, 13,
and 14new text end and the manufacturers of those prescription drugs; and
(2) information reported to the commissioner under subdivisions 3, 4, deleted text begin anddeleted text end 5new text begin , 11, 12, 13,
and 14new text end .
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
Sec. 9.
Minnesota Statutes 2020, section 62J.84, subdivision 7, is amended to read:
Subd. 7.
Consultation.
(a) The commissioner may consult with a private entity or
consortium that satisfies the standards of section 62U.04, subdivision 6, the University of
Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format
of the information reported under this sectionnew text begin and section 62J.841new text end ; in posting information
pursuant to subdivision 6; and in taking any other action for the purpose of implementing
this sectionnew text begin and section 62J.841new text end .
(b) The commissioner may consult with representatives of the manufacturers to establish
a standard format for reporting information under this section new text begin and section 62J.841 new text end and may
use existing reporting methodologies to establish a standard format to minimize
administrative burdens to the state and manufacturers.
Sec. 10.
Minnesota Statutes 2020, section 62J.84, subdivision 7, is amended to read:
Subd. 7.
Consultation.
(a) The commissioner may consult with a private entity or
consortium that satisfies the standards of section 62U.04, subdivision 6, the University of
Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format
of the information reported under this section; in posting information pursuant to subdivision
6; and in taking any other action for the purpose of implementing this section.
(b) The commissioner may consult with representatives of the deleted text begin manufacturersdeleted text end new text begin reporting
entitiesnew text end to establish a standard format for reporting information under this section and may
use existing reporting methodologies to establish a standard format to minimize
administrative burdens to the state and deleted text begin manufacturersdeleted text end new text begin reporting entitiesnew text end .
Sec. 11.
Minnesota Statutes 2020, section 62J.84, subdivision 8, is amended to read:
Subd. 8.
Enforcement and penalties.
(a) A manufacturer may be subject to a civil
penalty, as provided in paragraph (b), for:
(1) failing to submit timely reports or notices as required by this sectionnew text begin and section
62J.841new text end ;
(2) failing to provide information required under this sectionnew text begin and section 62J.841new text end ; deleted text begin or
deleted text end
(3) providing inaccurate or incomplete information under this sectionnew text begin and section 62J.841;
or
new text end
new text begin (4) failing to comply with section 62J.841, subdivisions 2, paragraph (e), and 4new text end .
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000
per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section new text begin and section 62J.841
new text end as provided in section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section new text begin and section
62J.481 new text end upon terms and conditions the commissioner considers proper and consistent with
public health and safety.
(e) Civil penalties collected under this section new text begin and section 62J.841 new text end shall be deposited in
the health care access fund.
Sec. 12.
Minnesota Statutes 2020, section 62J.84, subdivision 8, is amended to read:
Subd. 8.
Enforcement and penalties.
(a) A deleted text begin manufacturerdeleted text end new text begin reporting entitynew text end may be subject
to a civil penalty, as provided in paragraph (b), for:
new text begin
(1) failing to register under subdivision 15;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end failing to submit timely reports or notices as required by this section;
deleted text begin (2)deleted text end new text begin (3)new text end failing to provide information required under this section; or
deleted text begin (3)deleted text end new text begin (4)new text end providing inaccurate or incomplete information under this section.
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000
per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section as provided in
section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section upon terms
and conditions the commissioner considers proper and consistent with public health and
safety.
(e) Civil penalties collected under this section shall be deposited in the health care access
fund.
Sec. 13.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 9, is amended
to read:
Subd. 9.
Legislative report.
(a) No later than May 15, 2022, and by January 15 of each
year thereafter, the commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over commerce and health and human services
policy and finance on the implementation of this sectionnew text begin and section 62J.841new text end , including but
not limited to the effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the statenew text begin , health carriers,new text end and
other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the statenew text begin , health carriers,new text end and other payers in the management of
pharmaceutical costsnew text begin and limiting formulary changes due to prescription drug cost increases
during a coverage yearnew text end .
(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, and 5new text begin , and section 62J.841new text end .
Sec. 14.
Minnesota Statutes 2021 Supplement, section 62J.84, subdivision 9, is amended
to read:
Subd. 9.
Legislative report.
(a) No later than May 15, 2022, and by January 15 of each
year thereafter, the commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over commerce and health and human services
policy and finance on the implementation of this section, including but not limited to the
effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the state and other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the state and other payers in the management of pharmaceutical costs.
(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, deleted text begin anddeleted text end 5new text begin , 11, 12, 13, and 14new text end .
Sec. 15.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 10. new text end
new text begin Notice of prescription drugs of substantial public interest. new text end
new text begin
(a) No later than
January 31, 2023, and quarterly thereafter, the commissioner shall produce and post on the
department's website a list of prescription drugs that the department determines to represent
a substantial public interest and for which the department intends to request data under
subdivisions 11, 12, 13, and 14, subject to paragraph (c). The department shall base its
inclusion of prescription drugs on any information the department determines is relevant
to providing greater consumer awareness of the factors contributing to the cost of prescription
drugs in the state, and the department shall consider drug product families that include
prescription drugs:
new text end
new text begin
(1) that triggered reporting under subdivisions 3, 4, or 5 during the previous calendar
quarter;
new text end
new text begin
(2) for which average claims paid amounts exceeded 125 percent of the price as of the
claim incurred date during the most recent calendar quarter for which claims paid amounts
are available; or
new text end
new text begin
(3) that are identified by members of the public during a public comment period process.
new text end
new text begin
(b) No sooner than 30 days after publicly posting the list of prescription drugs under
paragraph (a), the department shall notify, via e-mail, reporting entities registered with the
department of the requirement to report under subdivisions 11, 12, 13, and 14.
new text end
new text begin
(c) No more than 500 prescription drugs may be designated as having a substantial public
interest in any one notice.
new text end
Sec. 16.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 11. new text end
new text begin Manufacturer prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2023, a manufacturer must submit to the commissioner the information
described in paragraph (b) for any prescription drug:
new text end
new text begin
(1) included in a notification to report issued to the manufacturer by the department
under subdivision 10;
new text end
new text begin
(2) which the manufacturer manufactures or repackages;
new text end
new text begin
(3) for which the manufacturer sets the wholesale acquisition cost; and
new text end
new text begin
(4) for which the manufacturer has not submitted data under subdivisions 3 or 5 during
the 120-day period prior to the date of the notification to report.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to
the commissioner no later than 60 days after the date of the notification to report, in the
form and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the price of the drug product on the later of:
new text end
new text begin
(i) the day one year prior to the date of the notification to report;
new text end
new text begin
(ii) the introduced to market date; or
new text end
new text begin
(iii) the acquisition date;
new text end
new text begin
(3) the price of the drug product on the date of the notification to report;
new text end
new text begin
(4) the introductory price of the prescription drug when it was introduced for sale in the
United States and the price of the drug on the last day of each of the five calendar years
preceding the date of the notification to report;
new text end
new text begin
(5) the direct costs incurred during the 12-month period prior to the date of the notification
to report by the manufacturer that are associated with the prescription drug, listed separately:
new text end
new text begin
(i) to manufacture the prescription drug;
new text end
new text begin
(ii) to market the prescription drug, including advertising costs; and
new text end
new text begin
(iii) to distribute the prescription drug;
new text end
new text begin
(6) the number of units of the prescription drug sold during the 12-month period prior
to the date of the notification to report;
new text end
new text begin
(7) the total sales revenue for the prescription drug during the 12-month period prior to
the date of the notification to report;
new text end
new text begin
(8) the total rebate payable amount accrued for the prescription drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(9) the manufacturer's net profit attributable to the prescription drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(10) the total amount of financial assistance the manufacturer has provided through
patient prescription assistance programs during the 12-month period prior to the date of the
notification to report, if applicable;
new text end
new text begin
(11) any agreement between a manufacturer and another entity contingent upon any
delay in offering to market a generic version of the prescription drug;
new text end
new text begin
(12) the patent expiration date of the prescription drug if it is under patent;
new text end
new text begin
(13) the name and location of the company that manufactured the drug;
new text end
new text begin
(14) if a brand name prescription drug, the ten countries other than the United States
that paid the highest prices for the prescription drug during the previous calendar year and
their prices; and
new text end
new text begin
(15) if the prescription drug was acquired by the manufacturer within the 12-month
period prior to the date of the notification to report, all of the following information:
new text end
new text begin
(i) price at acquisition;
new text end
new text begin
(ii) price in the calendar year prior to acquisition;
new text end
new text begin
(iii) name of the company from which the drug was acquired;
new text end
new text begin
(iv) date of acquisition; and
new text end
new text begin
(v) acquisition price.
new text end
new text begin
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 17.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 12. new text end
new text begin Pharmacy prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2023, a pharmacy must submit to the commissioner the information
described in paragraph (b) for any prescription drug included in a notification to report
issued to the pharmacy by the department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the pharmacy shall submit to the
commissioner no later than 60 days after the date of the notification to report in the form
and manner prescribed by the commissioner the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the number of units of the drug acquired during the 12-month period prior to the date
of the notification to report;
new text end
new text begin
(3) the total spent before rebates by the pharmacy to acquire the drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(4) the total rebate receivable amount accrued by the pharmacy for the drug during the
12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the number of pricing units of the drug dispensed by the pharmacy during the
12-month period prior to the date of the notification to report;
new text end
new text begin
(6) the total payment receivable by the pharmacy for dispensing the drug, including
ingredient cost, dispensing fee, and administrative fees, during the 12-month period prior
to the date of the notification to report;
new text end
new text begin
(7) the total rebate payable amount accrued by the pharmacy for the drug during the
12-month period prior to the date of the notification to report; and
new text end
new text begin
(8) the average cash price paid by consumers per pricing unit for prescriptions dispensed
where no claim was submitted to a health care service plan or health insurer during the
12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The pharmacy may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 18.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 13. new text end
new text begin
Pharmacy benefit manager (PBM) prescription drug substantial public
interest reporting.
new text end
new text begin
(a) Beginning January 1, 2023, a PBM as defined in section 62W.02,
subdivision 14, must submit to the commissioner the information described in paragraph
(b) for any prescription drug included in a notification to report issued to the PBM by the
department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the PBM shall submit to the
commissioner no later than 60 days after the date of the notification to report, in the form
and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the number of pricing units of the drug product filled for which the PBM administered
claims during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(3) the total reimbursement amount accrued and payable to pharmacies for pricing units
of the drug product filled for which the PBM administered claims during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(4) the total reimbursement or administrative fee amount or both accrued and receivable
from payers for pricing units of the drug product filled for which the PBM administered
claims during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the total rebate receivable amount accrued by the PBM for the drug product during
the 12-month period prior to the date of the notification to report; and
new text end
new text begin
(6) the total rebate payable amount accrued by the PBM for the drug product during the
12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The PBM may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 19.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 14. new text end
new text begin Wholesaler prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2023, a wholesaler must submit to the commissioner the information
described in paragraph (b) for any prescription drug included in a notification to report
issued to the wholesaler by the department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the wholesaler shall submit to the
commissioner no later than 60 days after the date of the notification to report, in the form
and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) National Drug Code;
new text end
new text begin
(ii) product name;
new text end
new text begin
(iii) dosage form;
new text end
new text begin
(iv) strength; and
new text end
new text begin
(v) package size;
new text end
new text begin
(2) the number of units of the drug product acquired by the wholesale drug distributor
during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(3) the total spent before rebates by the wholesale drug distributor to acquire the drug
product during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(4) the total rebate receivable amount accrued by the wholesale drug distributor for the
drug product during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the number of units of the drug product sold by the wholesale drug distributor during
the 12-month period prior to the date of the notification to report;
new text end
new text begin
(6) gross revenue from sales in the United States generated by the wholesale drug
distributor for the drug product during the 12-month period prior to the date of the notification
to report; and
new text end
new text begin
(7) total rebate payable amount accrued by the wholesale drug distributor for the drug
product during the 12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The wholesaler may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 20.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 15. new text end
new text begin Registration requirement. new text end
new text begin
Beginning January 1, 2023, a reporting entity
subject to this chapter shall register with the department in a form and manner prescribed
by the commissioner.
new text end
Sec. 21.
Minnesota Statutes 2020, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Rulemaking. new text end
new text begin
For the purposes of this section, the commissioner may use the
expedited rulemaking process under section 14.389.
new text end
Sec. 22.
new text begin
[62J.841] REPORTING PRESCRIPTION DRUG PRICES; FORMULARY
DEVELOPMENT AND PRICE STABILITY.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms in this subdivision
have the meanings given.
new text end
new text begin
(b) "Average wholesale price" means the customary reference price for sales by a drug
wholesaler to a retail pharmacy, as established and published by the manufacturer.
new text end
new text begin
(c) "National drug code" means the numerical code maintained by the United States
Food and Drug Administration and includes the label code, product code, and package code.
new text end
new text begin
(d) "Unit" has the meaning given in United States Code, title 42, section 1395w-3a(b)(2).
new text end
new text begin
(e) "Wholesale acquisition cost" has the meaning given in United States Code, title 42,
section 1395w-3a(c)(6)(B).
new text end
new text begin Subd. 2. new text end
new text begin Price reporting. new text end
new text begin
(a) Beginning July 31, 2023, and by July 31 each year
thereafter, a manufacturer must report to the commissioner the information in paragraph
(b) for every drug with a wholesale acquisition cost of $100 or more for a 30-day supply
or for a course of treatment lasting less than 30 days, as applicable to the next calendar year.
new text end
new text begin
(b) A manufacturer shall report a drug's:
new text end
new text begin
(1) national drug code, labeler code, and the manufacturer name associated with the
labeler code;
new text end
new text begin
(2) brand name, if applicable;
new text end
new text begin
(3) generic name, if applicable;
new text end
new text begin
(4) wholesale acquisition cost for one unit;
new text end
new text begin
(5) measure that constitutes a wholesale acquisition cost unit;
new text end
new text begin
(6) average wholesale price; and
new text end
new text begin
(7) status as brand name or generic.
new text end
new text begin
(c) The effective date of the information described in paragraph (b) must be included in
the report to the commissioner.
new text end
new text begin
(d) A manufacturer must report the information described in this subdivision in the form
and manner specified by the commissioner.
new text end
new text begin
(e) Information reported under this subdivision is classified as public data not on
individuals, as defined in section 13.02, subdivision 14, and must not be classified by the
manufacturer as trade secret information, as defined in section 13.37, subdivision 1, paragraph
(b).
new text end
new text begin
(f) A manufacturer's failure to report the information required by this subdivision is
grounds for disciplinary action under section 151.071, subdivision 2.
new text end
new text begin Subd. 3. new text end
new text begin Public posting of prescription drug price information. new text end
new text begin
By October 1 of each
year, beginning October 1, 2023, the commissioner must post the information reported
under subdivision 2 on the department website, as required by section 62J.84, subdivision
6.
new text end
new text begin Subd. 4. new text end
new text begin Price change. new text end
new text begin
(a) If a drug subject to price reporting under subdivision 2 is
included in the formulary of a health plan submitted to and approved by the commissioner
of commerce for the next calendar year under section 62A.02, subdivision 1, the manufacturer
may increase the wholesale acquisition cost of the drug for the next calendar year only after
providing the commissioner with at least 90 days' written notice.
new text end
new text begin
(b) A manufacturer's failure to meet the requirements of paragraph (a) is grounds for
disciplinary action under section 151.071, subdivision 2.
new text end
Sec. 23.
new text begin
[62J.841] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
For purposes of sections 62J.841 to 62J.845, the following
definitions apply.
new text end
new text begin Subd. 2. new text end
new text begin Consumer Price Index. new text end
new text begin
"Consumer Price Index" means the Consumer Price
Index, Annual Average, for All Urban Consumers, CPI-U: U.S. City Average, All Items,
reported by the United States Department of Labor, Bureau of Labor Statistics, or its
successor or, if the index is discontinued, an equivalent index reported by a federal authority
or, if no such index is reported, "Consumer Price Index" means a comparable index chosen
by the Bureau of Labor Statistics.
new text end
new text begin Subd. 3. new text end
new text begin Generic or off-patent drug. new text end
new text begin
"Generic or off-patent drug" means any prescription
drug for which any exclusive marketing rights granted under the Federal Food, Drug, and
Cosmetic Act; section 351 of the federal Public Health Service Act; and federal patent law
have expired, including any drug-device combination product for the delivery of a generic
drug.
new text end
new text begin Subd. 4. new text end
new text begin Manufacturer. new text end
new text begin
"Manufacturer" has the meaning provided in section 151.01,
subdivision 14a.
new text end
new text begin Subd. 5. new text end
new text begin Prescription drug. new text end
new text begin
"Prescription drug" means a drug for human use subject
to United States Code, title 21, section 353(b)(1).
new text end
new text begin Subd. 6. new text end
new text begin Wholesale acquisition cost. new text end
new text begin
"Wholesale acquisition cost" has the meaning
provided in United States Code, title 42, section 1395w-3a.
new text end
new text begin Subd. 7. new text end
new text begin Wholesale distributor. new text end
new text begin
"Wholesale distributor" has the meaning provided in
section 151.441, subdivision 14.
new text end
Sec. 24.
new text begin
[62J.842] EXCESSIVE PRICE INCREASES PROHIBITED.
new text end
new text begin Subdivision 1. new text end
new text begin Prohibition. new text end
new text begin
No manufacturer shall impose, or cause to be imposed, an
excessive price increase, whether directly or through a wholesale distributor, pharmacy, or
similar intermediary, on the sale of any generic or off-patent drug sold, dispensed, or
delivered to any consumer in the state.
new text end
new text begin Subd. 2. new text end
new text begin Excessive price increase. new text end
new text begin
A price increase is excessive for purposes of this
section when:
new text end
new text begin
(1) the price increase, adjusted for inflation utilizing the Consumer Price Index, exceeds:
new text end
new text begin
(i) 15 percent of the wholesale acquisition cost over the immediately preceding calendar
year; or
new text end
new text begin
(ii) 40 percent of the wholesale acquisition cost over the immediately preceding three
calendar years; and
new text end
new text begin
(2) the price increase, adjusted for inflation utilizing the Consumer Price Index, exceeds
$30 for:
new text end
new text begin
(i) a 30-day supply of the drug; or
new text end
new text begin
(ii) a course of treatment lasting less than 30 days.
new text end
new text begin Subd. 3. new text end
new text begin Exemption. new text end
new text begin
It is not a violation of this section for a wholesale distributor or
pharmacy to increase the price of a generic or off-patent drug if the price increase is directly
attributable to additional costs for the drug imposed on the wholesale distributor or pharmacy
by the manufacturer of the drug.
new text end
Sec. 25.
new text begin
[62J.843] REGISTERED AGENT AND OFFICE WITHIN THE STATE.
new text end
new text begin
Any manufacturer that sells, distributes, delivers, or offers for sale any generic or
off-patent drug in the state is required to maintain a registered agent and office within the
state.
new text end
Sec. 26.
new text begin
[62J.844] ENFORCEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Notification. new text end
new text begin
The commissioner of management and budget and any
other state agency that provides or purchases a pharmacy benefit, except the Department
of Human Services, and any entity under contract with a state agency to provide a pharmacy
benefit other than an entity under contract with the Department of Human Services, shall
notify the manufacturer of a generic or off-patent drug, the attorney general, and the Board
of Pharmacy of any price increase in violation of section 62J.842.
new text end
new text begin Subd. 2. new text end
new text begin
Submission of drug cost statement and other information by manufacturer;
investigation by attorney general.
new text end
new text begin
(a) Within 45 days of receiving a notice under subdivision
1, the manufacturer of the generic or off-patent drug shall submit a drug cost statement to
the attorney general. The statement must:
new text end
new text begin
(1) itemize the cost components related to production of the drug;
new text end
new text begin
(2) identify the circumstances and timing of any increase in materials or manufacturing
costs that caused any increase during the preceding calendar year, or preceding three calendar
years as applicable, in the price of the drug; and
new text end
new text begin
(3) provide any other information that the manufacturer believes to be relevant to a
determination of whether a violation of section 62J.842 has occurred.
new text end
new text begin
(b) The attorney general may investigate whether a violation of section 62J.842 has
occurred, is occurring, or is about to occur, in accordance with section 8.31, subdivision 2.
new text end
new text begin Subd. 3. new text end
new text begin Petition to court. new text end
new text begin
(a) On petition of the attorney general, a court may issue an
order:
new text end
new text begin
(1) compelling the manufacturer of a generic or off-patent drug to:
new text end
new text begin
(i) provide the drug cost statement required under subdivision 2, paragraph (a); and
new text end
new text begin
(ii) answer interrogatories, produce records or documents, or be examined under oath,
as required by the attorney general under subdivision 2, paragraph (b);
new text end
new text begin
(2) restraining or enjoining a violation of sections 62J.841 to 62J.845, including issuing
an order requiring that drug prices be restored to levels that comply with section 62J.842;
new text end
new text begin
(3) requiring the manufacturer to provide an accounting to the attorney general of all
revenues resulting from a violation of section 62J.842;
new text end
new text begin
(4) requiring the manufacturer to repay to all consumers, including any third-party payers,
any money acquired as a result of a price increase that violates section 62J.842;
new text end
new text begin
(5) notwithstanding section 16A.151, if a manufacturer is unable to determine the
individual transactions necessary to provide the repayments described in clause (4), requiring
that all revenues generated from a violation of section 62J.842 be remitted to the state and
deposited into a special fund to be used for initiatives to reduce the cost to consumers of
acquiring prescription drugs;
new text end
new text begin
(6) imposing a civil penalty of up to $10,000 per day for each violation of section 62J.842;
new text end
new text begin
(7) providing for the attorney general's recovery of its costs and disbursements incurred
in bringing an action against a manufacturer found in violation of section 62J.842, including
the costs of investigation and reasonable attorney's fees; and
new text end
new text begin
(8) providing any other appropriate relief, including any other equitable relief as
determined by the court.
new text end
new text begin
(b) For purposes of paragraph (a), clause (6), every individual transaction in violation
of section 62J.842 must be considered a separate violation.
new text end
new text begin Subd. 4. new text end
new text begin Private right of action. new text end
new text begin
Any action brought pursuant to section 8.31, subdivision
3a, by a person injured by a violation of this section is for the benefit of the public.
new text end
Sec. 27.
new text begin
[62J.845] PROHIBITION ON WITHDRAWAL OF GENERIC OR
OFF-PATENT DRUGS FOR SALE.
new text end
new text begin Subdivision 1. new text end
new text begin Prohibition. new text end
new text begin
A manufacturer of a generic or off-patent drug is prohibited
from withdrawing that drug from sale or distribution within this state for the purpose of
avoiding the prohibition on excessive price increases under section 62J.842.
new text end
new text begin Subd. 2. new text end
new text begin Notice to board and attorney general. new text end
new text begin
Any manufacturer that intends to
withdraw a generic or off-patent drug from sale or distribution within the state shall provide
a written notice of withdrawal to the Board of Pharmacy and the attorney general at least
180 days prior to the withdrawal.
new text end
new text begin Subd. 3. new text end
new text begin Financial penalty. new text end
new text begin
The attorney general shall assess a penalty of $500,000 on
any manufacturer of a generic or off-patent drug that it determines has failed to comply
with the requirements of this section.
new text end
Sec. 28.
new text begin
[62J.846] SEVERABILITY.
new text end
new text begin
If any provision of sections 62J.841 to 62J.845 or the application thereof to any person
or circumstance is held invalid for any reason in a court of competent jurisdiction, the
invalidity does not affect other provisions or any other application of sections 62J.841 to
62J.845 that can be given effect without the invalid provision or application.
new text end
Sec. 29.
new text begin
[62J.85] CITATION.
new text end
new text begin
Sections 62J.85 to 62J.95 may be cited as the "Prescription Drug Affordability Act."
new text end
Sec. 30.
new text begin
[62J.86] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
For the purposes of sections 62J.85 to 62J.95, the following
terms have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Advisory council. new text end
new text begin
"Advisory council" means the Prescription Drug Affordability
Advisory Council established under section 62J.88.
new text end
new text begin Subd. 3. new text end
new text begin Biologic. new text end
new text begin
"Biologic" means a drug that is produced or distributed in accordance
with a biologics license application approved under Code of Federal Regulations, title 42,
section 447.502.
new text end
new text begin Subd. 4. new text end
new text begin Biosimilar. new text end
new text begin
"Biosimilar" has the meaning provided in section 62J.84, subdivision
2, paragraph (b).
new text end
new text begin Subd. 5. new text end
new text begin Board. new text end
new text begin
"Board" means the Prescription Drug Affordability Board established
under section 62J.87.
new text end
new text begin Subd. 6. new text end
new text begin Brand name drug. new text end
new text begin
"Brand name drug" has the meaning provided in section
62J.84, subdivision 2, paragraph (c).
new text end
new text begin Subd. 7. new text end
new text begin Generic drug. new text end
new text begin
"Generic drug" has the meaning provided in section 62J.84,
subdivision 2, paragraph (e).
new text end
new text begin Subd. 8. new text end
new text begin Group purchaser. new text end
new text begin
"Group purchaser" has the meaning given in section 62J.03,
subdivision 6, and includes pharmacy benefit managers as defined in section 62W.02,
subdivision 15.
new text end
new text begin Subd. 9. new text end
new text begin Manufacturer. new text end
new text begin
"Manufacturer" means an entity that:
new text end
new text begin
(1) engages in the manufacture of a prescription drug product or enters into a lease with
another manufacturer to market and distribute a prescription drug product under the entity's
own name; and
new text end
new text begin
(2) sets or changes the wholesale acquisition cost of the prescription drug product it
manufacturers or markets.
new text end
new text begin Subd. 10. new text end
new text begin Prescription drug product. new text end
new text begin
"Prescription drug product" means a brand name
drug, a generic drug, a biologic, or a biosimilar.
new text end
new text begin Subd. 11. new text end
new text begin Wholesale acquisition cost or WAC. new text end
new text begin
"Wholesale acquisition cost" or "WAC"
has the meaning given in United States Code, title 42, section 1395W-3a(c)(6)(B).
new text end
Sec. 31.
new text begin
[62J.87] PRESCRIPTION DRUG AFFORDABILITY BOARD.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of commerce shall establish the
Prescription Drug Affordability Board, which shall be governed as a board under section
15.012, paragraph (a), to protect consumers, state and local governments, health plan
companies, providers, pharmacies, and other health care system stakeholders from
unaffordable costs of certain prescription drugs.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The Prescription Drug Affordability Board consists of nine
members appointed as follows:
new text end
new text begin
(1) seven voting members appointed by the governor;
new text end
new text begin
(2) one nonvoting member appointed by the majority leader of the senate; and
new text end
new text begin
(3) one nonvoting member appointed by the speaker of the house.
new text end
new text begin
(b) All members appointed must have knowledge and demonstrated expertise in
pharmaceutical economics and finance or health care economics and finance. A member
must not be an employee of, a board member of, or a consultant to a manufacturer or trade
association for manufacturers or a pharmacy benefit manager or trade association for
pharmacy benefit managers.
new text end
new text begin
(c) Initial appointments must be made by January 1, 2023.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) Board appointees shall serve four-year terms, except that initial
appointees shall serve staggered terms of two, three, or four years as determined by lot by
the secretary of state. A board member shall serve no more than two consecutive terms.
new text end
new text begin
(b) A board member may resign at any time by giving written notice to the board.
new text end
new text begin Subd. 4. new text end
new text begin Chair; other officers. new text end
new text begin
(a) The governor shall designate an acting chair from
the members appointed by the governor. The acting chair shall convene the first meeting
of the board.
new text end
new text begin
(b) The board shall elect a chair to replace the acting chair at the first meeting of the
board by a majority of the members. The chair shall serve for one year.
new text end
new text begin
(c) The board shall elect a vice-chair and other officers from its membership as it deems
necessary.
new text end
new text begin Subd. 5. new text end
new text begin Staff; technical assistance. new text end
new text begin
(a) The board shall hire an executive director and
other staff, who shall serve in the unclassified service. The executive director must have
knowledge and demonstrated expertise in pharmacoeconomics, pharmacology, health policy,
health services research, medicine, or a related field or discipline. The board may employ
or contract for professional and technical assistance as the board deems necessary to perform
the board's duties.
new text end
new text begin
(b) The attorney general shall provide legal services to the board.
new text end
new text begin Subd. 6. new text end
new text begin Compensation. new text end
new text begin
The board members shall not receive compensation but may
receive reimbursement for expenses as authorized under section 15.059, subdivision 3.
new text end
new text begin Subd. 7. new text end
new text begin Meetings. new text end
new text begin
(a) Meetings of the board are subject to chapter 13D. The board shall
meet publicly at least every three months to review prescription drug product information
submitted to the board under section 62J.90. If there are no pending submissions, the chair
of the board may cancel or postpone the required meeting. The board may meet in closed
session when reviewing proprietary information as determined under the standards developed
in accordance with section 62J.91, subdivision 4.
new text end
new text begin
(b) The board shall announce each public meeting at least two weeks prior to the
scheduled date of the meeting. Any materials for the meeting must be made public at least
one week prior to the scheduled date of the meeting.
new text end
new text begin
(c) At each public meeting, the board shall provide the opportunity for comments from
the public, including the opportunity for written comments to be submitted to the board
prior to a decision by the board.
new text end
Sec. 32.
new text begin
[62J.88] PRESCRIPTION DRUG AFFORDABILITY ADVISORY
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The governor shall appoint a 12-member stakeholder
advisory council to provide advice to the board on drug cost issues and to represent
stakeholders' views. The members of the advisory council shall be appointed based on their
knowledge and demonstrated expertise in one or more of the following areas: the
pharmaceutical business; practice of medicine; patient perspectives; health care cost trends
and drivers; clinical and health services research; and the health care marketplace.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
The council's membership shall consist of the following:
new text end
new text begin
(1) two members representing patients and health care consumers;
new text end
new text begin
(2) two members representing health care providers;
new text end
new text begin
(3) one member representing health plan companies;
new text end
new text begin
(4) two members representing employers, with one member representing large employers
and one member representing small employers;
new text end
new text begin
(5) one member representing government employee benefit plans;
new text end
new text begin
(6) one member representing pharmaceutical manufacturers;
new text end
new text begin
(7) one member who is a health services clinical researcher;
new text end
new text begin
(8) one member who is a pharmacologist; and
new text end
new text begin
(9) one member representing the commissioner of health with expertise in health
economics.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) The initial appointments to the advisory council must be made by
January 1, 2023. The initial appointed advisory council members shall serve staggered terms
of two, three, or four years determined by lot by the secretary of state. Following the initial
appointments, the advisory council members shall serve four-year terms.
new text end
new text begin
(b) Removal and vacancies of advisory council members are governed by section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Compensation. new text end
new text begin
Advisory council members may be compensated according to
section 15.059.
new text end
new text begin Subd. 5. new text end
new text begin Meetings. new text end
new text begin
Meetings of the advisory council are subject to chapter 13D. The
advisory council shall meet publicly at least every three months to advise the board on drug
cost issues related to the prescription drug product information submitted to the board under
section 62J.90.
new text end
new text begin Subd. 6. new text end
new text begin Exemption. new text end
new text begin
Notwithstanding section 15.059, the advisory council shall not
expire.
new text end
Sec. 33.
new text begin
[62J.89] CONFLICTS OF INTEREST.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
(a) For purposes of this section, "conflict of interest" means
a financial or personal association that has the potential to bias or have the appearance of
biasing a person's decisions in matters related to the board or the advisory council, or in the
conduct of the board's or council's activities.
new text end
new text begin
(b) A conflict of interest includes any instance in which a person or a person's immediate
family member has received or could receive a direct or indirect financial benefit of any
amount deriving from the result or findings of a decision or determination of the board.
new text end
new text begin
(c) For purposes of this section, a person's immediate family member includes a spouse,
parent, child, or other legal dependent, or an in-law of any of the preceding individuals.
new text end
new text begin
(d) For purposes of this section, a financial benefit includes honoraria, fees, stock, the
value of stock holdings, and any direct financial benefit deriving from the finding of a review
conducted under sections 62J.85 to 62J.95.
new text end
new text begin
(e) Ownership of securities is not a conflict of interest if the securities are: (1) part of a
diversified mutual or exchange traded fund; or (2) in a tax-deferred or tax-exempt retirement
account that is administered by an independent trustee.
new text end
new text begin Subd. 2. new text end
new text begin General. new text end
new text begin
(a) A board or advisory council member, board staff member, or
third-party contractor must disclose any conflicts of interest to the appointing authority or
the board prior to the acceptance of an appointment, an offer of employment, or a contractual
agreement. The information disclosed must include the type, nature, and magnitude of the
interests involved.
new text end
new text begin
(b) A board member, board staff member, or third-party contractor with a conflict of
interest relating to any prescription drug product under review must recuse themselves from
any discussion, review, decision, or determination made by the board relating to the
prescription drug product.
new text end
new text begin
(c) Any conflict of interest must be disclosed in advance of the first meeting after the
conflict is identified or within five days after the conflict is identified, whichever is earlier.
new text end
new text begin Subd. 3. new text end
new text begin Prohibitions. new text end
new text begin
Board members, board staff, or third-party contractors are
prohibited from accepting gifts, bequeaths, or donations of services or property that raise
the specter of a conflict of interest or have the appearance of injecting bias into the activities
of the board.
new text end
Sec. 34.
new text begin
[62J.90] PRESCRIPTION DRUG PRICE INFORMATION; DECISION
TO CONDUCT COST REVIEW.
new text end
new text begin Subdivision 1. new text end
new text begin
Drug price information from the commissioner of health and other
sources.
new text end
new text begin
(a) The commissioner of health shall provide to the board the information reported
to the commissioner by drug manufacturers under section 62J.84, subdivisions 3, 4, and 5.
The commissioner shall provide this information to the board within 30 days of the date the
information is received from drug manufacturers.
new text end
new text begin
(b) The board shall subscribe to one or more prescription drug pricing files, such as
Medispan or FirstDatabank, or as otherwise determined by the board.
new text end
new text begin Subd. 2. new text end
new text begin Identification of certain prescription drug products. new text end
new text begin
(a) The board, in
consultation with the advisory council, shall identify the following prescription drug products:
new text end
new text begin
(1) brand name drugs or biologics for which the WAC increases by more than ten percent
or by more than $10,000 during any 12-month period or course of treatment if less than 12
months, after adjusting for changes in the consumer price index (CPI);
new text end
new text begin
(2) brand name drugs or biologics introduced at a WAC of $30,000 or more per calendar
year or per course of treatment;
new text end
new text begin
(3) biosimilar drugs introduced at a WAC that is not at least 15 percent lower than the
referenced brand name biologic at the time the biosimilar is introduced; and
new text end
new text begin
(4) generic drugs for which the WAC:
new text end
new text begin
(i) is $100 or more, after adjusting for changes in the CPI, for:
new text end
new text begin
(A) a 30-day supply lasting a patient for a period of 30 consecutive days based on the
recommended dosage approved for labeling by the United States Food and Drug
Administration (FDA);
new text end
new text begin
(B) a supply lasting a patient for fewer than 30 days based on recommended dosage
approved for labeling by the FDA; or
new text end
new text begin
(C) one unit of the drug if the labeling approved by the FDA does not recommend a
finite dosage; and
new text end
new text begin
(ii) has increased by 200 percent or more during the immediate preceding 12-month
period, as determined by the difference between the resulting WAC and the average of the
WAC reported over the preceding 12 months, after adjusting for changes in the CPI.
new text end
new text begin
(b) The board, in consultation with the advisory council, shall identify prescription drug
products not described in paragraph (a) that may impose costs that create significant
affordability challenges for the state health care system or for patients, including but not
limited to drugs to address public health emergencies.
new text end
new text begin
(c) The board shall make available to the public the names and related price information
of the prescription drug products identified under this subdivision, with the exception of
information determined by the board to be proprietary under the standards developed by
the board under section 62J.91, subdivision 4.
new text end
new text begin Subd. 3. new text end
new text begin Determination to proceed with review. new text end
new text begin
(a) The board may initiate a cost
review of a prescription drug product identified by the board under this section.
new text end
new text begin
(b) The board shall consider requests by the public for the board to proceed with a cost
review of any prescription drug product identified under this section.
new text end
new text begin
(c) If there is no consensus among the members of the board on whether or not to initiate
a cost review of a prescription drug product, any member of the board may request a vote
to determine whether or not to review the cost of the prescription drug product.
new text end
Sec. 35.
new text begin
[62J.91] PRESCRIPTION DRUG PRODUCT REVIEWS.
new text end
new text begin Subdivision 1. new text end
new text begin General. new text end
new text begin
Once the board decides to proceed with a cost review of a
prescription drug product, the board shall conduct the review and make a determination as
to whether appropriate utilization of the prescription drug under review, based on utilization
that is consistent with the United States Food and Drug Administration (FDA) label or
standard medical practice, has led or will lead to affordability challenges for the state health
care system or for patients.
new text end
new text begin Subd. 2. new text end
new text begin Review considerations. new text end
new text begin
In reviewing the cost of a prescription drug product,
the board may consider the following factors:
new text end
new text begin
(1) the price at which the prescription drug product has been and will be sold in the state;
new text end
new text begin
(2) the average monetary price concession, discount, or rebate the manufacturer provides
to a group purchaser in this state as reported by the manufacturer and the group purchaser,
expressed as a percent of the WAC for the prescription drug product under review;
new text end
new text begin
(3) the price at which therapeutic alternatives have been or will be sold in the state;
new text end
new text begin
(4) the average monetary price concession, discount, or rebate the manufacturer provides
or is expected to provide to a group purchaser or group purchasers in the state for therapeutic
alternatives;
new text end
new text begin
(5) the cost to group purchasers based on patient access consistent with the FDA-labeled
indications;
new text end
new text begin
(6) the impact on patient access resulting from the cost of the prescription drug product
relative to insurance benefit design;
new text end
new text begin
(7) the current or expected dollar value of drug-specific patient access programs supported
by manufacturers;
new text end
new text begin
(8) the relative financial impacts to health, medical, or other social services costs that
can be quantified and compared to baseline effects of existing therapeutic alternatives;
new text end
new text begin
(9) the average patient co-pay or other cost-sharing for the prescription drug product in
the state;
new text end
new text begin
(10) any information a manufacturer chooses to provide; and
new text end
new text begin
(11) any other factors as determined by the board.
new text end
new text begin Subd. 3. new text end
new text begin Further review factors. new text end
new text begin
If, after considering the factors described in subdivision
2, the board is unable to determine whether a prescription drug product will produce or has
produced an affordability challenge, the board may consider:
new text end
new text begin
(1) manufacturer research and development costs, as indicated on the manufacturer's
federal tax filing for the most recent tax year, in proportion to the manufacturer's sales in
the state;
new text end
new text begin
(2) the portion of direct-to-consumer marketing costs eligible for favorable federal tax
treatment in the most recent tax year that is specific to the prescription drug product under
review, multiplied by the ratio of total manufacturer in-state sales to total manufacturer
sales in the United States for the product under review;
new text end
new text begin
(3) gross and net manufacturer revenues for the most recent tax year;
new text end
new text begin
(4) any information and research related to the manufacturer's selection of the introductory
price or price increase, including but not limited to:
new text end
new text begin
(i) life cycle management;
new text end
new text begin
(ii) market competition and context; and
new text end
new text begin
(iii) projected revenue; and
new text end
new text begin
(5) any additional factors determined by the board to be relevant.
new text end
new text begin Subd. 4. new text end
new text begin Public data; proprietary information. new text end
new text begin
(a) Any submission made to the board
related to a drug cost review must be made available to the public with the exception of
information determined by the board to be proprietary.
new text end
new text begin
(b) The board shall establish the standards for the information to be considered proprietary
under paragraph (a) and section 62J.90, subdivision 2, including standards for heightened
consideration of proprietary information for submissions for a cost review of a drug that is
not yet approved by the FDA.
new text end
new text begin
(c) Prior to the board establishing the standards under paragraph (b), the public must be
provided notice and the opportunity to submit comments.
new text end
Sec. 36.
new text begin
[62J.92] DETERMINATIONS; COMPLIANCE; REMEDIES.
new text end
new text begin Subdivision 1. new text end
new text begin Upper payment limit. new text end
new text begin
(a) In the event the board finds that the spending
on a prescription drug product reviewed under section 62J.91 creates an affordability
challenge for the state health care system or for patients, the board shall establish an upper
payment limit after considering:
new text end
new text begin
(1) the cost of administering the drug;
new text end
new text begin
(2) the cost of delivering the drug to consumers;
new text end
new text begin
(3) the range of prices at which the drug is sold in the United States according to one or
more pricing files accessed under section 62J.90, subdivision 1, and the range at which
pharmacies are reimbursed in Canada; and
new text end
new text begin
(4) any other relevant pricing and administrative cost information for the drug.
new text end
new text begin
(b) The upper payment limit must apply to all public and private purchases, payments,
and payer reimbursements for the prescription drug products received by an individual in
the state in person, by mail, or by other means.
new text end
new text begin Subd. 2. new text end
new text begin Noncompliance. new text end
new text begin
(a) The failure of an entity to comply with an upper payment
limit established by the board under this section shall be referred to the Office of the Attorney
General.
new text end
new text begin
(b) If the Office of the Attorney General finds that an entity was noncompliant with the
upper payment limit requirements, the attorney general may pursue remedies consistent
with chapter 8 or appropriate criminal charges if there is evidence of intentional profiteering.
new text end
new text begin
(c) An entity that obtains price concessions from a drug manufacturer that result in a
lower net cost to the stakeholder than the upper payment limit established by the board must
not be considered to be in noncompliance.
new text end
new text begin
(d) The Office of the Attorney General may provide guidance to stakeholders concerning
activities that could be considered noncompliant.
new text end
new text begin Subd. 3. new text end
new text begin Appeals. new text end
new text begin
(a) Persons affected by a decision of the board may request an appeal
of the board's decision within 30 days of the date of the decision. The board shall hear the
appeal and render a decision within 60 days of the hearing.
new text end
new text begin
(b) All appeal decisions are subject to judicial review in accordance with chapter 14.
new text end
Sec. 37.
new text begin
[62J.93] REPORTS.
new text end
new text begin
Beginning March 1, 2023, and each March 1 thereafter, the board shall submit a report
to the governor and legislature on general price trends for prescription drug products and
the number of prescription drug products that were subject to the board's cost review and
analysis, including the result of any analysis and the number and disposition of appeals and
judicial reviews.
new text end
Sec. 38.
new text begin
[62J.94] ERISA PLANS AND MEDICARE DRUG PLANS.
new text end
new text begin
(a) Nothing in sections 62J.85 to 62J.95 shall be construed to require ERISA plans or
Medicare Part D plans to comply with decisions of the board. ERISA plans or Medicare
Part D plans may choose to exceed the upper payment limit established by the board under
section 62J.92.
new text end
new text begin
(b) Providers who dispense and administer drugs in the state must bill all payers no more
than the upper payment limit without regard to whether or not an ERISA plan or Medicare
Part D plan chooses to reimburse the provider in an amount greater than the upper payment
limit established by the board.
new text end
new text begin
(c) For purposes of this section, an ERISA plan or group health plan is an employee
welfare benefit plan established or maintained by an employer or an employee organization,
or both, that provides employer sponsored health coverage to employees and the employee's
dependents and is subject to the Employee Retirement Income Security Act of 1974 (ERISA).
new text end
Sec. 39.
new text begin
[62J.95] SEVERABILITY.
new text end
new text begin
If any provision of sections 62J.85 to 62J.94 or the application thereof to any person or
circumstance is held invalid for any reason in a court of competent jurisdiction, the invalidity
does not affect other provisions or any other application of sections 62J.85 to 62J.94 that
can be given effect without the invalid provision or application.
new text end
Sec. 40.
new text begin
[62Q.1842] PROHIBITION ON USE OF STEP THERAPY FOR
ANTIRETROVIRAL DRUGS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following definitions
apply.
new text end
new text begin
(b) "Health plan" has the meaning given in section 62Q.01, subdivision 3, and includes
health coverage provided by a managed care plan or a county-based purchasing plan
participating in a public program under chapter 256B or 256L or an integrated health
partnership under section 256B.0755.
new text end
new text begin
(c) "Step therapy protocol" has the meaning given in section 62Q.184.
new text end
new text begin Subd. 2. new text end
new text begin Prohibition on use of step therapy protocols. new text end
new text begin
A health plan that covers
antiretroviral drugs that are medically necessary for the prevention of HIV/AIDS, including
preexposure prophylaxis and postexposure prophylaxis, must not limit or exclude coverage
for the antiretroviral drugs by requiring prior authorization or by requiring an enrollee to
follow a step therapy protocol.
new text end
Sec. 41.
new text begin
[62Q.481] COST-SHARING FOR PRESCRIPTION DRUGS AND RELATED
MEDICAL SUPPLIES TO TREAT CHRONIC DISEASE.
new text end
new text begin Subdivision 1. new text end
new text begin Cost-sharing limits. new text end
new text begin
(a) A health plan must limit the amount of any
enrollee cost-sharing for prescription drugs prescribed to treat a chronic disease to no more
than $25 per one-month supply for each prescription drug and to no more than $50 per
month in total for all related medical supplies. Coverage under this section must not be
subject to any deductible.
new text end
new text begin
(b) If application of this section before an enrollee has met their plan's deductible would
result in health savings account ineligibility under United States Code, title 26, section 223,
then this section must apply to that specific prescription drug or related medical supply only
after the enrollee has met their plan's deductible.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Chronic disease" means diabetes, asthma, and allergies requiring the use of
epinephrine auto-injectors.
new text end
new text begin
(c) "Cost-sharing" means co-payments and coinsurance.
new text end
new text begin
(d) "Related medical supplies" means syringes, insulin pens, insulin pumps, epinephrine
auto-injectors, test strips, glucometers, continuous glucose monitors, and other medical
supply items necessary to effectively and appropriately administer a prescription drug
prescribed to treat a chronic disease.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 42.
new text begin
[62Q.524] COVERAGE FOR DRUGS TO PREVENT THE ACQUISITION
OF HUMAN IMMUNODEFICIENCY VIRUS.
new text end
new text begin
(a) A health plan that provides prescription drug coverage must provide coverage in
accordance with this section for:
new text end
new text begin
(1) any antiretroviral drug approved by the United States Food and Drug Administration
(FDA) for preventing the acquisition of human immunodeficiency virus (HIV) that is
prescribed, dispensed, or administered by a pharmacist who meets the requirements described
in section 151.37, subdivision 17; and
new text end
new text begin
(2) any laboratory testing necessary for therapy that uses the drugs described in clause
(1) that is ordered, performed, and interpreted by a pharmacist who meets the requirements
described in section 151.37, subdivision 17.
new text end
new text begin
(b) A health plan must provide the same terms of prescription drug coverage for drugs
to prevent the acquisition of HIV that are prescribed or administered by a pharmacist if the
pharmacist meets the requirements described in section 151.37, subdivision 17, as would
apply had the drug been prescribed or administered by a physician, physician assistant, or
advanced practice registered nurse. The health plan may require pharmacists or pharmacies
to meet reasonable medical management requirements when providing the services described
in paragraph (a) if other providers are required to meet the same requirements.
new text end
new text begin
(c) A health plan must reimburse an in-network pharmacist or pharmacy for the drugs
and testing described in paragraph (a) at a rate equal to the rate of reimbursement provided
to a physician, physician assistant, or advanced practice registered nurse if providing similar
services.
new text end
new text begin
(d) A health plan is not required to cover the drugs and testing described in paragraph
(a) if provided by a pharmacist or pharmacy that is out-of-network unless the health plan
covers similar services provided by out-of-network providers. A health plan must ensure
that the health plan's provider network includes in-network pharmacies that provide the
services described in paragraph (a).
new text end
Sec. 43.
new text begin
[62Q.83] PRESCRIPTION DRUG BENEFIT TRANSPARENCY AND
MANAGEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Drug" has the meaning given in section 151.01, subdivision 5.
new text end
new text begin
(c) "Enrollee contract term" means the 12-month term during which benefits associated
with health plan company products are in effect. For managed care plans and county-based
purchasing plans under section 256B.69 and chapter 256L, enrollee contract term means a
single calendar quarter.
new text end
new text begin
(d) "Formulary" means a list of prescription drugs developed by clinical and pharmacy
experts that represents the health plan company's medically appropriate and cost-effective
prescription drugs approved for use.
new text end
new text begin
(e) "Health plan company" has the meaning given in section 62Q.01, subdivision 4, and
includes an entity that performs pharmacy benefits management for the health plan company.
For purposes of this paragraph, "pharmacy benefits management" means the administration
or management of prescription drug benefits provided by the health plan company for the
benefit of the plan's enrollees and may include but is not limited to procurement of
prescription drugs, clinical formulary development and management services, claims
processing, and rebate contracting and administration.
new text end
new text begin
(f) "Prescription" has the meaning given in section 151.01, subdivision 16a.
new text end
new text begin Subd. 2. new text end
new text begin Prescription drug benefit disclosure. new text end
new text begin
(a) A health plan company that provides
prescription drug benefit coverage and uses a formulary must make the plan's formulary
and related benefit information available by electronic means and, upon request, in writing
at least 30 days before annual renewal dates.
new text end
new text begin
(b) Formularies must be organized and disclosed consistent with the most recent version
of the United States Pharmacopeia's (USP) Model Guidelines.
new text end
new text begin
(c) For each item or category of items on the formulary, the specific enrollee benefit
terms must be identified, including enrollee cost-sharing and expected out-of-pocket costs.
new text end
new text begin Subd. 3. new text end
new text begin Formulary changes. new text end
new text begin
(a) Once a formulary has been established, a health plan
company may, at any time during the enrollee's contract term:
new text end
new text begin
(1) expand its formulary by adding drugs to the formulary;
new text end
new text begin
(2) reduce co-payments or coinsurance; or
new text end
new text begin
(3) move a drug to a benefit category that reduces an enrollee's cost.
new text end
new text begin
(b) A health plan company may remove a brand name drug from the plan's formulary
or place a brand name drug in a benefit category that increases an enrollee's cost only upon
the addition to the formulary of a generic or multisource brand name drug rated as
therapeutically equivalent according to the FDA Orange Book or a biologic drug rated as
interchangeable according to the FDA Purple Book at a lower cost to the enrollee, and upon
at least a 60-day notice to prescribers, pharmacists, and affected enrollees.
new text end
new text begin
(c) A health plan company may change utilization review requirements or move drugs
to a benefit category that increases an enrollee's cost during the enrollee's contract term
upon at least a 60-day notice to prescribers, pharmacists, and affected enrollees, provided
that these changes do not apply to enrollees who are currently taking the drugs affected by
these changes for the duration of the enrollee's contract term.
new text end
new text begin
(d) A health plan company may remove any drugs from the plan's formulary that have
been deemed unsafe by the Food and Drug Administration; that have been withdrawn by
either the Food and Drug Administration or the product manufacturer; or when an
independent source of research, clinical guidelines, or evidence-based standards has issued
drug-specific warnings or recommended changes in drug usage.
new text end
new text begin
(e) The state employee group insurance program and coverage offered through that
program are exempt from the requirements of this subdivision.
new text end
new text begin Subd. 4. new text end
new text begin Not severable. new text end
new text begin
(a) The provisions of this section are not severable from the
amendments and enactments in this act to sections 62A.02, subdivision 1; 62J.84,
subdivisions 2, 6, 7, 8, and 9; 62J.841; and 151.071, subdivision 2.
new text end
new text begin
(b) If any amendment or enactment listed in paragraph (a) or its application to any
individual, entity, or circumstance is found to be void for any reason, this section is also
void.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end
Sec. 44.
new text begin
[62W.0751] ALTERNATIVE BIOLOGICAL PRODUCTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Biological product" has the meaning given in section 151.01, subdivision 40.
new text end
new text begin
(c) "Biosimilar" or "biosimilar product" has the meaning given in section 151.01,
subdivision 43.
new text end
new text begin
(d) "Interchangeable biological product" has the meaning given in section 151.01,
subdivision 41.
new text end
new text begin
(e) "Reference biological product" has the meaning given in section 151.01, subdivision
44.
new text end
new text begin Subd. 2. new text end
new text begin
Pharmacy and provider choice related to dispensing reference biological
products, interchangeable biological products, or biosimilar products.
new text end
new text begin
(a) Except as
provided in paragraphs (b) and (c), a pharmacy benefit manager or health carrier must not
require or demonstrate a preference for a reference biological product administered to a
patient by a physician or health care provider or any product that is biosimilar or
interchangeable to the reference biological product administered to a patient by a physician
or health care provider.
new text end
new text begin
(b) If a pharmacy benefit manager or health carrier elects coverage of a product listed
in paragraph (a), and there are two or less biosimilar or interchangeable biological products
available relative to the reference product, the pharmacy benefit manager or health carrier
must elect equivalent coverage for all of the products that are biosimilar or interchangeable
to the reference biological product.
new text end
new text begin
(c) If a pharmacy benefit manager or health carrier elects coverage of a product listed
in paragraph (a), and there are greater than two biosimilar or interchangeable biological
products available relative to the reference product, the pharmacy benefit manager or health
carrier must elect preferential coverage for all of the products that are biosimilar or
interchangeable to the reference biological product.
new text end
new text begin
(d) A pharmacy benefit manager or health carrier must not impose limits on access to a
product required to be covered under paragraph (b) that are more restrictive than limits
imposed on access to a product listed in paragraph (a), or that otherwise have the same
effect as giving preferred status to a product listed in paragraph (a) over the product required
to be covered under paragraph (b).
new text end
new text begin
(e) This section only applies to new administrations of a reference biological product.
Nothing in this section requires switching from a prescribed reference biological product
for a patient on an active course of treatment.
new text end
new text begin Subd. 3. new text end
new text begin Exemption. new text end
new text begin
The state employee group insurance program, and coverage offered
through that program, are exempt from the requirements of this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 45.
new text begin
[62W.15] CLINICIAN-ADMINISTERED DRUGS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Affiliated pharmacy" means a pharmacy in which a pharmacy benefit manager or
health carrier has an ownership interest either directly or indirectly, or through an affiliate
or subsidiary.
new text end
new text begin
(c) "Clinician-administered drug" means an outpatient prescription drug other than a
vaccine that:
new text end
new text begin
(1) cannot reasonably be self-administered by the patient to whom the drug is prescribed
or by an individual assisting the patient with self-administration; and
new text end
new text begin
(2) is typically administered:
new text end
new text begin
(i) by a health care provider authorized to administer the drug, including when acting
under a physician's delegation and supervision; and
new text end
new text begin
(ii) in a physician's office, hospital outpatient infusion center, or other clinical setting.
new text end
new text begin Subd. 2. new text end
new text begin Prohibition on requiring coverage as a pharmacy benefit. new text end
new text begin
A pharmacy
benefit manager or health carrier shall not require that a clinician-administered drug or the
administration of a clinician-administered drug be covered as a pharmacy benefit.
new text end
new text begin Subd. 3. new text end
new text begin Enrollee choice. new text end
new text begin
A pharmacy benefit manager or health carrier:
new text end
new text begin
(1) shall permit an enrollee to obtain a clinician-administered drug from a health care
provider authorized to administer the drug, or a pharmacy;
new text end
new text begin
(2) shall not interfere with the enrollee's right to obtain a clinician-administered drug
from their provider or pharmacy of choice, and shall not offer financial or other incentives
to influence the enrollee's choice of a provider or pharmacy;
new text end
new text begin
(3) shall not require clinician-administered drugs to be dispensed by a pharmacy selected
by the pharmacy benefit manager or health carrier; and
new text end
new text begin
(4) shall not limit or exclude coverage for a clinician-administered drug when it is not
dispensed by a pharmacy selected by the pharmacy benefit manager or health carrier, if the
drug would otherwise be covered.
new text end
new text begin Subd. 4. new text end
new text begin Cost-sharing and reimbursement. new text end
new text begin
A pharmacy benefit manager or health
carrier:
new text end
new text begin
(1) may impose coverage or benefit limitations on an enrollee who obtains a
clinician-administered drug from a health care provider authorized to administer the drug,
or a pharmacy, only if these limitations would also be imposed were the drug to be obtained
from an affiliated pharmacy or a pharmacy selected by the pharmacy benefit manager or
health carrier; and
new text end
new text begin
(2) may impose cost-sharing requirements on an enrollee who obtains a
clinician-administered drug from a health care provider authorized to administer the drug,
or a pharmacy, only if these requirements would also be imposed were the drug to be obtained
from an affiliated pharmacy or a pharmacy selected by the pharmacy benefit manager or
health carrier.
new text end
new text begin Subd. 5. new text end
new text begin Other requirements. new text end
new text begin
A pharmacy benefit manager or health carrier:
new text end
new text begin
(1) shall not require or encourage the dispensing of a clinician-administered drug to an
enrollee in a manner that is inconsistent with the supply chain security controls and chain
of distribution set by the federal Drug Supply Chain Security Act, United States Code, title
21, section 360eee, et seq.;
new text end
new text begin
(2) shall not require a specialty pharmacy to dispense a clinician-administered medication
directly to a patient with the intention that the patient will transport the medication to a
health care provider for administration; and
new text end
new text begin
(3) may offer, but shall not require:
new text end
new text begin
(i) the use of a home infusion pharmacy to dispense or administer clinician-administered
drugs to enrollees; and
new text end
new text begin
(ii) the use of an infusion site external to the enrollee's provider office or clinic.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 46.
Minnesota Statutes 2020, section 151.01, subdivision 23, is amended to read:
Subd. 23.
Practitioner.
"Practitioner" means a licensed doctor of medicine, licensed
doctor of osteopathic medicine duly licensed to practice medicine, licensed doctor of
dentistry, licensed doctor of optometry, licensed podiatrist, licensed veterinarian, licensed
advanced practice registered nurse, or licensed physician assistant. For purposes of sections
151.15, subdivision 4; 151.211, subdivision 3; 151.252, subdivision 3; 151.37, subdivision
2, paragraph (b); and 151.461, "practitioner" also means a dental therapist authorized to
dispense and administer under chapter 150A. For purposes of sections 151.252, subdivision
3, and 151.461, "practitioner" also means a pharmacist authorized to prescribe
self-administered hormonal contraceptives, nicotine replacement medications, or opiate
antagonists under section 151.37, subdivision 14, 15, or 16new text begin , or authorized to prescribe drugs
to prevent the acquisition of human immunodeficiency virus (HIV) under section 151.37,
subdivision 17new text end .
Sec. 47.
Minnesota Statutes 2020, section 151.01, subdivision 27, is amended to read:
Subd. 27.
Practice of pharmacy.
"Practice of pharmacy" means:
(1) interpretation and evaluation of prescription drug orders;
(2) compounding, labeling, and dispensing drugs and devices (except labeling by a
manufacturer or packager of nonprescription drugs or commercially packaged legend drugs
and devices);
(3) participation in clinical interpretations and monitoring of drug therapy for assurance
of safe and effective use of drugs, including the performance of laboratory tests that are
waived under the federal Clinical Laboratory Improvement Act of 1988, United States Code,
title 42, section 263a et seq., provided that a pharmacist may interpret the results of laboratory
tests but may modify drug therapy only pursuant to a protocol or collaborative practice
agreement;
(4) participation in drug and therapeutic device selection; drug administration for first
dosage and medical emergencies; intramuscular and subcutaneous administration used for
the treatment of alcohol or opioid dependence; drug regimen reviews; and drug or
drug-related research;
(5) drug administration, through intramuscular and subcutaneous administration used
to treat mental illnesses as permitted under the following conditions:
(i) upon the order of a prescriber and the prescriber is notified after administration is
complete; or
(ii) pursuant to a protocol or collaborative practice agreement as defined by section
151.01, subdivisions 27b and 27c, and participation in the initiation, management,
modification, administration, and discontinuation of drug therapy is according to the protocol
or collaborative practice agreement between the pharmacist and a dentist, optometrist,
physician, podiatrist, or veterinarian, or an advanced practice registered nurse authorized
to prescribe, dispense, and administer under section 148.235. Any changes in drug therapy
or medication administration made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(6) participation in administration of influenza vaccines and vaccines approved by the
United States Food and Drug Administration related to COVID-19 or SARS-CoV-2 to all
eligible individuals six years of age and older and all other vaccines to patients 13 years of
age and older by written protocol with a physician licensed under chapter 147, a physician
assistant authorized to prescribe drugs under chapter 147A, or an advanced practice registered
nurse authorized to prescribe drugs under section 148.235, provided that:
(i) the protocol includes, at a minimum:
(A) the name, dose, and route of each vaccine that may be given;
(B) the patient population for whom the vaccine may be given;
(C) contraindications and precautions to the vaccine;
(D) the procedure for handling an adverse reaction;
(E) the name, signature, and address of the physician, physician assistant, or advanced
practice registered nurse;
(F) a telephone number at which the physician, physician assistant, or advanced practice
registered nurse can be contacted; and
(G) the date and time period for which the protocol is valid;
(ii) the pharmacist has successfully completed a program approved by the Accreditation
Council for Pharmacy Education specifically for the administration of immunizations or a
program approved by the board;
(iii) the pharmacist utilizes the Minnesota Immunization Information Connection to
assess the immunization status of individuals prior to the administration of vaccines, except
when administering influenza vaccines to individuals age nine and older;
(iv) the pharmacist reports the administration of the immunization to the Minnesota
Immunization Information Connection; and
(v) the pharmacist complies with guidelines for vaccines and immunizations established
by the federal Advisory Committee on Immunization Practices, except that a pharmacist
does not need to comply with those portions of the guidelines that establish immunization
schedules when administering a vaccine pursuant to a valid, patient-specific order issued
by a physician licensed under chapter 147, a physician assistant authorized to prescribe
drugs under chapter 147A, or an advanced practice registered nurse authorized to prescribe
drugs under section 148.235, provided that the order is consistent with the United States
Food and Drug Administration approved labeling of the vaccine;
(7) participation in the initiation, management, modification, and discontinuation of
drug therapy according to a written protocol or collaborative practice agreement between:
(i) one or more pharmacists and one or more dentists, optometrists, physicians, podiatrists,
or veterinarians; or (ii) one or more pharmacists and one or more physician assistants
authorized to prescribe, dispense, and administer under chapter 147A, or advanced practice
registered nurses authorized to prescribe, dispense, and administer under section 148.235.
Any changes in drug therapy made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(8) participation in the storage of drugs and the maintenance of records;
(9) patient counseling on therapeutic values, content, hazards, and uses of drugs and
devices;
(10) offering or performing those acts, services, operations, or transactions necessary
in the conduct, operation, management, and control of a pharmacy;
(11) participation in the initiation, management, modification, and discontinuation of
therapy with opiate antagonists, as defined in section 604A.04, subdivision 1, pursuant to:
(i) a written protocol as allowed under clause (7); or
(ii) a written protocol with a community health board medical consultant or a practitioner
designated by the commissioner of health, as allowed under section 151.37, subdivision 13;
deleted text begin and
deleted text end
(12) prescribing self-administered hormonal contraceptives; nicotine replacement
medications; and opiate antagonists for the treatment of an acute opiate overdose pursuant
to section 151.37, subdivision 14, 15, or 16deleted text begin .deleted text end new text begin ;
new text end
new text begin
(13) prescribing, dispensing, and administering drugs for preventing the acquisition of
human immunodeficiency virus (HIV) if the pharmacist meets the requirements under
section 151.37, subdivision 17; and
new text end
new text begin
(14) ordering, conducting, and interpreting laboratory tests necessary for therapies that
use drugs for preventing the acquisition of HIV, if the pharmacist meets the requirements
under section 151.37, subdivision 17.
new text end
Sec. 48.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 43. new text end
new text begin Biosimilar product. new text end
new text begin
"Biosimilar product" or "interchangeable biologic product"
means a biological product that the United States Food and Drug Administration has licensed
and determined to be biosimilar under United States Code, title 42, section 262(i)(2).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 49.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 44. new text end
new text begin Reference biological product. new text end
new text begin
"Reference biological product" means the
single biological product for which the United States Food and Drug Administration has
approved an initial biological product license application, against which other biological
products are evaluated for licensure as biosimilar products or interchangeable biological
products.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 50.
Minnesota Statutes 2020, section 151.071, subdivision 1, is amended to read:
Subdivision 1.
Forms of disciplinary action.
When the board finds that a licensee,
registrant, or applicant has engaged in conduct prohibited under subdivision 2, it may do
one or more of the following:
(1) deny the issuance of a license or registration;
(2) refuse to renew a license or registration;
(3) revoke the license or registration;
(4) suspend the license or registration;
(5) impose limitations, conditions, or both on the license or registration, including but
not limited to: the limitation of practice to designated settings; the limitation of the scope
of practice within designated settings; the imposition of retraining or rehabilitation
requirements; the requirement of practice under supervision; the requirement of participation
in a diversion program such as that established pursuant to section 214.31 or the conditioning
of continued practice on demonstration of knowledge or skills by appropriate examination
or other review of skill and competence;
(6) impose a civil penalty not exceeding $10,000 for each separate violation,new text begin except that
a civil penalty not exceeding $25,000 may be imposed for each separate violation of section
62J.842,new text end the amount of the civil penalty to be fixed so as to deprive a licensee or registrant
of any economic advantage gained by reason of the violation, to discourage similar violations
by the licensee or registrant or any other licensee or registrant, or to reimburse the board
for the cost of the investigation and proceeding, including but not limited to, fees paid for
services provided by the Office of Administrative Hearings, legal and investigative services
provided by the Office of the Attorney General, court reporters, witnesses, reproduction of
records, board members' per diem compensation, board staff time, and travel costs and
expenses incurred by board staff and board members; and
(7) reprimand the licensee or registrant.
Sec. 51.
Minnesota Statutes 2020, section 151.071, subdivision 2, is amended to read:
Subd. 2.
Grounds for disciplinary action.
The following conduct is prohibited and is
grounds for disciplinary action:
(1) failure to demonstrate the qualifications or satisfy the requirements for a license or
registration contained in this chapter or the rules of the board. The burden of proof is on
the applicant to demonstrate such qualifications or satisfaction of such requirements;
(2) obtaining a license by fraud or by misleading the board in any way during the
application process or obtaining a license by cheating, or attempting to subvert the licensing
examination process. Conduct that subverts or attempts to subvert the licensing examination
process includes, but is not limited to: (i) conduct that violates the security of the examination
materials, such as removing examination materials from the examination room or having
unauthorized possession of any portion of a future, current, or previously administered
licensing examination; (ii) conduct that violates the standard of test administration, such as
communicating with another examinee during administration of the examination, copying
another examinee's answers, permitting another examinee to copy one's answers, or
possessing unauthorized materials; or (iii) impersonating an examinee or permitting an
impersonator to take the examination on one's own behalf;
(3) for a pharmacist, pharmacy technician, pharmacist intern, applicant for a pharmacist
or pharmacy license, or applicant for a pharmacy technician or pharmacist intern registration,
conviction of a felony reasonably related to the practice of pharmacy. Conviction as used
in this subdivision includes a conviction of an offense that if committed in this state would
be deemed a felony without regard to its designation elsewhere, or a criminal proceeding
where a finding or verdict of guilt is made or returned but the adjudication of guilt is either
withheld or not entered thereon. The board may delay the issuance of a new license or
registration if the applicant has been charged with a felony until the matter has been
adjudicated;
(4) for a facility, other than a pharmacy, licensed or registered by the board, if an owner
or applicant is convicted of a felony reasonably related to the operation of the facility. The
board may delay the issuance of a new license or registration if the owner or applicant has
been charged with a felony until the matter has been adjudicated;
(5) for a controlled substance researcher, conviction of a felony reasonably related to
controlled substances or to the practice of the researcher's profession. The board may delay
the issuance of a registration if the applicant has been charged with a felony until the matter
has been adjudicated;
(6) disciplinary action taken by another state or by one of this state's health licensing
agencies:
(i) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration in another state or jurisdiction, failure to report to the board that
charges or allegations regarding the person's license or registration have been brought in
another state or jurisdiction, or having been refused a license or registration by any other
state or jurisdiction. The board may delay the issuance of a new license or registration if an
investigation or disciplinary action is pending in another state or jurisdiction until the
investigation or action has been dismissed or otherwise resolved; and
(ii) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration issued by another of this state's health licensing agencies, failure to
report to the board that charges regarding the person's license or registration have been
brought by another of this state's health licensing agencies, or having been refused a license
or registration by another of this state's health licensing agencies. The board may delay the
issuance of a new license or registration if a disciplinary action is pending before another
of this state's health licensing agencies until the action has been dismissed or otherwise
resolved;
(7) for a pharmacist, pharmacy, pharmacy technician, or pharmacist intern, violation of
any order of the board, of any of the provisions of this chapter or any rules of the board or
violation of any federal, state, or local law or rule reasonably pertaining to the practice of
pharmacy;
(8) for a facility, other than a pharmacy, licensed by the board, violations of any order
of the board, of any of the provisions of this chapter or the rules of the board or violation
of any federal, state, or local law relating to the operation of the facility;
(9) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or pharmacy practice that is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof of
actual injury need not be established;
(10) aiding or abetting an unlicensed person in the practice of pharmacy, except that it
is not a violation of this clause for a pharmacist to supervise a properly registered pharmacy
technician or pharmacist intern if that person is performing duties allowed by this chapter
or the rules of the board;
(11) for an individual licensed or registered by the board, adjudication as mentally ill
or developmentally disabled, or as a chemically dependent person, a person dangerous to
the public, a sexually dangerous person, or a person who has a sexual psychopathic
personality, by a court of competent jurisdiction, within or without this state. Such
adjudication shall automatically suspend a license for the duration thereof unless the board
orders otherwise;
(12) for a pharmacist or pharmacy intern, engaging in unprofessional conduct as specified
in the board's rules. In the case of a pharmacy technician, engaging in conduct specified in
board rules that would be unprofessional if it were engaged in by a pharmacist or pharmacist
intern or performing duties specifically reserved for pharmacists under this chapter or the
rules of the board;
(13) for a pharmacy, operation of the pharmacy without a pharmacist present and on
duty except as allowed by a variance approved by the board;
(14) for a pharmacist, the inability to practice pharmacy with reasonable skill and safety
to patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills. In the case of registered pharmacy technicians,
pharmacist interns, or controlled substance researchers, the inability to carry out duties
allowed under this chapter or the rules of the board with reasonable skill and safety to
patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills;
(15) for a pharmacist, pharmacy, pharmacist intern, pharmacy technician, medical gas
dispenser, or controlled substance researcher, revealing a privileged communication from
or relating to a patient except when otherwise required or permitted by law;
(16) for a pharmacist or pharmacy, improper management of patient records, including
failure to maintain adequate patient records, to comply with a patient's request made pursuant
to sections 144.291 to 144.298, or to furnish a patient record or report required by law;
(17) fee splitting, including without limitation:
(i) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
kickback, or other form of remuneration, directly or indirectly, for the referral of patients;
(ii) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the licensee or registrant has a financial or economic interest as defined
in section 144.6521, subdivision 3, unless the licensee or registrant has disclosed the
licensee's or registrant's financial or economic interest in accordance with section 144.6521;
and
(iii) any arrangement through which a pharmacy, in which the prescribing practitioner
does not have a significant ownership interest, fills a prescription drug order and the
prescribing practitioner is involved in any manner, directly or indirectly, in setting the price
for the filled prescription that is charged to the patient, the patient's insurer or pharmacy
benefit manager, or other person paying for the prescription or, in the case of veterinary
patients, the price for the filled prescription that is charged to the client or other person
paying for the prescription, except that a veterinarian and a pharmacy may enter into such
an arrangement provided that the client or other person paying for the prescription is notified,
in writing and with each prescription dispensed, about the arrangement, unless such
arrangement involves pharmacy services provided for livestock, poultry, and agricultural
production systems, in which case client notification would not be required;
(18) engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws or rules;
(19) engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient;
(20) failure to make reports as required by section 151.072 or to cooperate with an
investigation of the board as required by section 151.074;
(21) knowingly providing false or misleading information that is directly related to the
care of a patient unless done for an accepted therapeutic purpose such as the dispensing and
administration of a placebo;
(22) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board must investigate any complaint of a violation of section 609.215, subdivision 1
or 2;
(23) for a pharmacist, practice of pharmacy under a lapsed or nonrenewed license. For
a pharmacist intern, pharmacy technician, or controlled substance researcher, performing
duties permitted to such individuals by this chapter or the rules of the board under a lapsed
or nonrenewed registration. For a facility required to be licensed under this chapter, operation
of the facility under a lapsed or nonrenewed license or registration; deleted text begin and
deleted text end
(24) for a pharmacist, pharmacist intern, or pharmacy technician, termination or discharge
from the health professionals services program for reasons other than the satisfactory
completion of the programnew text begin ; and
new text end
new text begin (25) for a drug manufacturer, failure to comply with section 62J.841new text end .
Sec. 52.
Minnesota Statutes 2020, section 151.071, subdivision 2, is amended to read:
Subd. 2.
Grounds for disciplinary action.
The following conduct is prohibited and is
grounds for disciplinary action:
(1) failure to demonstrate the qualifications or satisfy the requirements for a license or
registration contained in this chapter or the rules of the board. The burden of proof is on
the applicant to demonstrate such qualifications or satisfaction of such requirements;
(2) obtaining a license by fraud or by misleading the board in any way during the
application process or obtaining a license by cheating, or attempting to subvert the licensing
examination process. Conduct that subverts or attempts to subvert the licensing examination
process includes, but is not limited to: (i) conduct that violates the security of the examination
materials, such as removing examination materials from the examination room or having
unauthorized possession of any portion of a future, current, or previously administered
licensing examination; (ii) conduct that violates the standard of test administration, such as
communicating with another examinee during administration of the examination, copying
another examinee's answers, permitting another examinee to copy one's answers, or
possessing unauthorized materials; or (iii) impersonating an examinee or permitting an
impersonator to take the examination on one's own behalf;
(3) for a pharmacist, pharmacy technician, pharmacist intern, applicant for a pharmacist
or pharmacy license, or applicant for a pharmacy technician or pharmacist intern registration,
conviction of a felony reasonably related to the practice of pharmacy. Conviction as used
in this subdivision includes a conviction of an offense that if committed in this state would
be deemed a felony without regard to its designation elsewhere, or a criminal proceeding
where a finding or verdict of guilt is made or returned but the adjudication of guilt is either
withheld or not entered thereon. The board may delay the issuance of a new license or
registration if the applicant has been charged with a felony until the matter has been
adjudicated;
(4) for a facility, other than a pharmacy, licensed or registered by the board, if an owner
or applicant is convicted of a felony reasonably related to the operation of the facility. The
board may delay the issuance of a new license or registration if the owner or applicant has
been charged with a felony until the matter has been adjudicated;
(5) for a controlled substance researcher, conviction of a felony reasonably related to
controlled substances or to the practice of the researcher's profession. The board may delay
the issuance of a registration if the applicant has been charged with a felony until the matter
has been adjudicated;
(6) disciplinary action taken by another state or by one of this state's health licensing
agencies:
(i) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration in another state or jurisdiction, failure to report to the board that
charges or allegations regarding the person's license or registration have been brought in
another state or jurisdiction, or having been refused a license or registration by any other
state or jurisdiction. The board may delay the issuance of a new license or registration if an
investigation or disciplinary action is pending in another state or jurisdiction until the
investigation or action has been dismissed or otherwise resolved; and
(ii) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration issued by another of this state's health licensing agencies, failure to
report to the board that charges regarding the person's license or registration have been
brought by another of this state's health licensing agencies, or having been refused a license
or registration by another of this state's health licensing agencies. The board may delay the
issuance of a new license or registration if a disciplinary action is pending before another
of this state's health licensing agencies until the action has been dismissed or otherwise
resolved;
(7) for a pharmacist, pharmacy, pharmacy technician, or pharmacist intern, violation of
any order of the board, of any of the provisions of this chapter or any rules of the board or
violation of any federal, state, or local law or rule reasonably pertaining to the practice of
pharmacy;
(8) for a facility, other than a pharmacy, licensed by the board, violations of any order
of the board, of any of the provisions of this chapter or the rules of the board or violation
of any federal, state, or local law relating to the operation of the facility;
(9) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or pharmacy practice that is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof of
actual injury need not be established;
(10) aiding or abetting an unlicensed person in the practice of pharmacy, except that it
is not a violation of this clause for a pharmacist to supervise a properly registered pharmacy
technician or pharmacist intern if that person is performing duties allowed by this chapter
or the rules of the board;
(11) for an individual licensed or registered by the board, adjudication as mentally ill
or developmentally disabled, or as a chemically dependent person, a person dangerous to
the public, a sexually dangerous person, or a person who has a sexual psychopathic
personality, by a court of competent jurisdiction, within or without this state. Such
adjudication shall automatically suspend a license for the duration thereof unless the board
orders otherwise;
(12) for a pharmacist or pharmacy intern, engaging in unprofessional conduct as specified
in the board's rules. In the case of a pharmacy technician, engaging in conduct specified in
board rules that would be unprofessional if it were engaged in by a pharmacist or pharmacist
intern or performing duties specifically reserved for pharmacists under this chapter or the
rules of the board;
(13) for a pharmacy, operation of the pharmacy without a pharmacist present and on
duty except as allowed by a variance approved by the board;
(14) for a pharmacist, the inability to practice pharmacy with reasonable skill and safety
to patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills. In the case of registered pharmacy technicians,
pharmacist interns, or controlled substance researchers, the inability to carry out duties
allowed under this chapter or the rules of the board with reasonable skill and safety to
patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills;
(15) for a pharmacist, pharmacy, pharmacist intern, pharmacy technician, medical gas
dispenser, or controlled substance researcher, revealing a privileged communication from
or relating to a patient except when otherwise required or permitted by law;
(16) for a pharmacist or pharmacy, improper management of patient records, including
failure to maintain adequate patient records, to comply with a patient's request made pursuant
to sections 144.291 to 144.298, or to furnish a patient record or report required by law;
(17) fee splitting, including without limitation:
(i) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
kickback, or other form of remuneration, directly or indirectly, for the referral of patients;
(ii) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the licensee or registrant has a financial or economic interest as defined
in section 144.6521, subdivision 3, unless the licensee or registrant has disclosed the
licensee's or registrant's financial or economic interest in accordance with section 144.6521;
and
(iii) any arrangement through which a pharmacy, in which the prescribing practitioner
does not have a significant ownership interest, fills a prescription drug order and the
prescribing practitioner is involved in any manner, directly or indirectly, in setting the price
for the filled prescription that is charged to the patient, the patient's insurer or pharmacy
benefit manager, or other person paying for the prescription or, in the case of veterinary
patients, the price for the filled prescription that is charged to the client or other person
paying for the prescription, except that a veterinarian and a pharmacy may enter into such
an arrangement provided that the client or other person paying for the prescription is notified,
in writing and with each prescription dispensed, about the arrangement, unless such
arrangement involves pharmacy services provided for livestock, poultry, and agricultural
production systems, in which case client notification would not be required;
(18) engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws or rules;
(19) engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient;
(20) failure to make reports as required by section 151.072 or to cooperate with an
investigation of the board as required by section 151.074;
(21) knowingly providing false or misleading information that is directly related to the
care of a patient unless done for an accepted therapeutic purpose such as the dispensing and
administration of a placebo;
(22) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board must investigate any complaint of a violation of section 609.215, subdivision 1
or 2;
(23) for a pharmacist, practice of pharmacy under a lapsed or nonrenewed license. For
a pharmacist intern, pharmacy technician, or controlled substance researcher, performing
duties permitted to such individuals by this chapter or the rules of the board under a lapsed
or nonrenewed registration. For a facility required to be licensed under this chapter, operation
of the facility under a lapsed or nonrenewed license or registration; deleted text begin and
deleted text end
(24) for a pharmacist, pharmacist intern, or pharmacy technician, termination or discharge
from the health professionals services program for reasons other than the satisfactory
completion of the programdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(25) for a manufacturer, a violation of section 62J.842 or 62J.845.
new text end
Sec. 53.
Minnesota Statutes 2021 Supplement, section 151.335, is amended to read:
151.335 DELIVERY THROUGH COMMON CARRIER; COMPLIANCE WITH
TEMPERATURE REQUIREMENTS.
In addition to complying with the requirements of Minnesota Rules, part 6800.3000, a
mail order or specialty pharmacy that employs the United States Postal Service or other
common carrier to deliver a filled prescription directly to a patient must ensure that the drug
is delivered in compliance with temperature requirements established by the manufacturer
of the drug. new text begin The methods used to ensure compliance must include but are not limited to
enclosing in each medication's packaging a device recognized by the United States
Pharmacopeia by which the patient can easily detect improper storage or temperature
variations. new text end The pharmacy must develop written policies and procedures that are consistent
with United States Pharmacopeia, chapters 1079 and 1118, and with nationally recognized
standards issued by standard-setting or accreditation organizations recognized by the board
through guidance. The policies and procedures must be provided to the board upon request.
Sec. 54.
Minnesota Statutes 2020, section 151.37, is amended by adding a subdivision to
read:
new text begin Subd. 17. new text end
new text begin Drugs for preventing the acquisition of HIV. new text end
new text begin
(a) A pharmacist is authorized
to prescribe and administer drugs to prevent the acquisition of human immunodeficiency
virus (HIV) in accordance with this subdivision.
new text end
new text begin
(b) By January 1, 2023, the board of pharmacy shall develop a standardized protocol
for a pharmacist to follow in prescribing the drugs described in paragraph (a). In developing
the protocol, the board may consult with community health advocacy groups, the board of
medical practice, the board of nursing, the commissioner of health, professional pharmacy
associations, and professional associations for physicians, physician assistants, and advanced
practice registered nurses.
new text end
new text begin
(c) Before a pharmacist is authorized to prescribe a drug described in paragraph (a), the
pharmacist must successfully complete a training program specifically developed for
prescribing drugs for preventing the acquisition of HIV that is offered by a college of
pharmacy, a continuing education provider that is accredited by the Accreditation Council
for Pharmacy Education, or a program approved by the board. To maintain authorization
to prescribe, the pharmacist shall complete continuing education requirements as specified
by the board.
new text end
new text begin
(d) Before prescribing a drug described in paragraph (a), the pharmacist shall follow the
appropriate standardized protocol developed under paragraph (b) and, if appropriate, may
dispense to a patient a drug described in paragraph (a).
new text end
new text begin
(e) Before dispensing a drug described under paragraph (a) that is prescribed by the
pharmacist, the pharmacist must provide counseling to the patient on the use of the drugs
and must provide the patient with a fact sheet that includes the indications and
contraindications for the use of these drugs, the appropriate method for using these drugs,
the need for medical follow up, and any other additional information listed in Minnesota
Rules, part 6800.0910, subpart 2, that is required to be provided to a patient during the
counseling process.
new text end
new text begin
(f) A pharmacist is prohibited from delegating the prescribing authority provided under
this subdivision to any other person. A pharmacist intern registered under section 151.101
may prepare the prescription, but before the prescription is processed or dispensed, a
pharmacist authorized to prescribe under this subdivision must review, approve, and sign
the prescription.
new text end
new text begin
(g) Nothing in this subdivision prohibits a pharmacist from participating in the initiation,
management, modification, and discontinuation of drug therapy according to a protocol as
authorized in this section and in section 151.01, subdivision 27.
new text end
Sec. 55.
Minnesota Statutes 2020, section 151.555, as amended by Laws 2021, chapter
30, article 5, sections 2 to 5, is amended to read:
151.555 deleted text begin PRESCRIPTION DRUGdeleted text end new text begin MEDICATIONnew text end REPOSITORY PROGRAM.
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Central repository" means a wholesale distributor that meets the requirements under
subdivision 3 and enters into a contract with the Board of Pharmacy in accordance with this
section.
(c) "Distribute" means to deliver, other than by administering or dispensing.
(d) "Donor" means:
(1) a health care facility as defined in this subdivision;
(2) a skilled nursing facility licensed under chapter 144A;
(3) an assisted living facility licensed under chapter 144G;
(4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
(5) a drug wholesaler licensed under section 151.47;
(6) a drug manufacturer licensed under section 151.252; or
(7) an individual at least 18 years of age, provided that the drug or medical supply that
is donated was obtained legally and meets the requirements of this section for donation.
(e) "Drug" means any prescription drug that has been approved for medical use in the
United States, is listed in the United States Pharmacopoeia or National Formulary, and
meets the criteria established under this section for donation; or any over-the-counter
medication that meets the criteria established under this section for donation. This definition
includes cancer drugs and antirejection drugs, but does not include controlled substances,
as defined in section 152.01, subdivision 4, or a prescription drug that can only be dispensed
to a patient registered with the drug's manufacturer in accordance with federal Food and
Drug Administration requirements.
(f) "Health care facility" means:
(1) a physician's office or health care clinic where licensed practitioners provide health
care to patients;
(2) a hospital licensed under section 144.50;
(3) a pharmacy licensed under section 151.19 and located in Minnesota; or
(4) a nonprofit community clinic, including a federally qualified health center; a rural
health clinic; public health clinic; or other community clinic that provides health care utilizing
a sliding fee scale to patients who are low-income, uninsured, or underinsured.
(g) "Local repository" means a health care facility that elects to accept donated drugs
and medical supplies and meets the requirements of subdivision 4.
(h) "Medical supplies" or "supplies" means any prescription deleted text begin anddeleted text end new text begin ornew text end nonprescription
medical supplies needed to administer a deleted text begin prescriptiondeleted text end drug.
(i) "Original, sealed, unopened, tamper-evident packaging" means packaging that is
sealed, unopened, and tamper-evident, including a manufacturer's original unit dose or
unit-of-use container, a repackager's original unit dose or unit-of-use container, or unit-dose
packaging prepared by a licensed pharmacy according to the standards of Minnesota Rules,
part 6800.3750.
(j) "Practitioner" has the meaning given in section 151.01, subdivision 23, except that
it does not include a veterinarian.
Subd. 2.
Establishmentnew text begin ; contract and oversightnew text end .
new text begin (a) new text end By January 1, 2020, the Board of
Pharmacy shall establish a deleted text begin drugdeleted text end new text begin medicationnew text end repository program, through which donors may
donate a drug or medical supply for use by an individual who meets the eligibility criteria
specified under subdivision 5.
new text begin (b)new text end The board shall contract with a central repository that meets the requirements of
subdivision 3 to implement and administer the deleted text begin prescription drugdeleted text end new text begin medicationnew text end repository
program.new text begin The contract must:
new text end
new text begin
(1) require the board to transfer to the central repository any money appropriated by the
legislature for the purpose of operating the medication repository program and require the
central repository to spend any money transferred only for purposes specified in the contract;
new text end
new text begin
(2) require the central repository to report the following performance measures to the
board:
new text end
new text begin
(i) the number of individuals served and the types of medications these individuals
received;
new text end
new text begin
(ii) the number of clinics, pharmacies, and long-term care facilities with which the central
repository partnered;
new text end
new text begin
(iii) the number and cost of medications accepted for inventory, disposed of, and
dispensed to individuals in need; and
new text end
new text begin
(iv) locations within the state to which medications are shipped or delivered; and
new text end
new text begin
(3) require the board to annually audit the expenditure by the central repository of any
funds appropriated by the legislature and transferred by the board to ensure that this funding
is used only for purposes specified in the contract.
new text end
Subd. 3.
Central repository requirements.
(a) The board may publish a request for
proposal for participants who meet the requirements of this subdivision and are interested
in acting as the central repository for the deleted text begin drugdeleted text end new text begin medicationnew text end repository program. If the board
publishes a request for proposal, it shall follow all applicable state procurement procedures
in the selection process. The board may also work directly with the University of Minnesota
to establish a central repository.
(b) To be eligible to act as the central repository, the participant must be a wholesale
drug distributor located in Minnesota, licensed pursuant to section 151.47, and in compliance
with all applicable federal and state statutes, rules, and regulations.
(c) The central repository shall be subject to inspection by the board pursuant to section
151.06, subdivision 1.
(d) The central repository shall comply with all applicable federal and state laws, rules,
and regulations pertaining to the deleted text begin drugdeleted text end new text begin medicationnew text end repository program, drug storage, and
dispensing. The facility must maintain in good standing any state license or registration that
applies to the facility.
Subd. 4.
Local repository requirements.
(a) To be eligible for participation in the deleted text begin drugdeleted text end new text begin
medicationnew text end repository program, a health care facility must agree to comply with all applicable
federal and state laws, rules, and regulations pertaining to the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program, drug storage, and dispensing. The facility must also agree to maintain in good
standing any required state license or registration that may apply to the facility.
(b) A local repository may elect to participate in the program by submitting the following
information to the central repository on a form developed by the board and made available
on the board's website:
(1) the name, street address, and telephone number of the health care facility and any
state-issued license or registration number issued to the facility, including the issuing state
agency;
(2) the name and telephone number of a responsible pharmacist or practitioner who is
employed by or under contract with the health care facility; and
(3) a statement signed and dated by the responsible pharmacist or practitioner indicating
that the health care facility meets the eligibility requirements under this section and agrees
to comply with this section.
(c) Participation in the deleted text begin drugdeleted text end new text begin medicationnew text end repository program is voluntary. A local
repository may withdraw from participation in the deleted text begin drugdeleted text end new text begin medicationnew text end repository program at
any time by providing written notice to the central repository on a form developed by the
board and made available on the board's website. The central repository shall provide the
board with a copy of the withdrawal notice within ten business days from the date of receipt
of the withdrawal notice.
Subd. 5.
Individual eligibility and application requirements.
(a) To be eligible for
the deleted text begin drugdeleted text end new text begin medicationnew text end repository program, an individual must submit to a local repository an
intake application form that is signed by the individual and attests that the individual:
(1) is a resident of Minnesota;
(2) is uninsured and is not enrolled in the medical assistance program under chapter
256B or the MinnesotaCare program under chapter 256L, has no prescription drug coverage,
or is underinsured;
(3) acknowledges that the drugs or medical supplies to be received through the program
may have been donated; and
(4) consents to a waiver of the child-resistant packaging requirements of the federal
Poison Prevention Packaging Act.
(b) Upon determining that an individual is eligible for the program, the local repository
shall furnish the individual with an identification card. The card shall be valid for one year
from the date of issuance and may be used at any local repository. A new identification card
may be issued upon expiration once the individual submits a new application form.
(c) The local repository shall send a copy of the intake application form to the central
repository by regular mail, facsimile, or secured e-mail within ten days from the date the
application is approved by the local repository.
(d) The board shall develop and make available on the board's website an application
form and the format for the identification card.
Subd. 6.
Standards and procedures for accepting donations of drugs and supplies.
(a)
A donor may donate deleted text begin prescriptiondeleted text end drugs or medical supplies to the central repository or a
local repository if the drug or supply meets the requirements of this section as determined
by a pharmacist or practitioner who is employed by or under contract with the central
repository or a local repository.
(b) A deleted text begin prescriptiondeleted text end drug is eligible for donation under the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program if the following requirements are met:
(1) the donation is accompanied by a deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described
under paragraph (d) that is signed by an individual who is authorized by the donor to attest
to the donor's knowledge in accordance with paragraph (d);
(2) the drug's expiration date is at least six months after the date the drug was donated.
If a donated drug bears an expiration date that is less than six months from the donation
date, the drug may be accepted and distributed if the drug is in high demand and can be
dispensed for use by a patient before the drug's expiration date;
(3) the drug is in its original, sealed, unopened, tamper-evident packaging that includes
the expiration date. Single-unit-dose drugs may be accepted if the single-unit-dose packaging
is unopened;
(4) the drug or the packaging does not have any physical signs of tampering, misbranding,
deterioration, compromised integrity, or adulteration;
(5) the drug does not require storage temperatures other than normal room temperature
as specified by the manufacturer or United States Pharmacopoeia, unless the drug is being
donated directly by its manufacturer, a wholesale drug distributor, or a pharmacy located
in Minnesota; and
(6) the deleted text begin prescriptiondeleted text end drug is not a controlled substance.
(c) A medical supply is eligible for donation under the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program if the following requirements are met:
(1) the supply has no physical signs of tampering, misbranding, or alteration and there
is no reason to believe it has been adulterated, tampered with, or misbranded;
(2) the supply is in its original, unopened, sealed packaging;
(3) the donation is accompanied by a deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described
under paragraph (d) that is signed by an individual who is authorized by the donor to attest
to the donor's knowledge in accordance with paragraph (d); and
(4) if the supply bears an expiration date, the date is at least six months later than the
date the supply was donated. If the donated supply bears an expiration date that is less than
six months from the date the supply was donated, the supply may be accepted and distributed
if the supply is in high demand and can be dispensed for use by a patient before the supply's
expiration date.
(d) The board shall develop the deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form and make it
available on the board's website. The form must state that to the best of the donor's knowledge
the donated drug or supply has been properly stored under appropriate temperature and
humidity conditions and that the drug or supply has never been opened, used, tampered
with, adulterated, or misbranded.
(e) Donated drugs and supplies may be shipped or delivered to the premises of the central
repository or a local repository, and shall be inspected by a pharmacist or an authorized
practitioner who is employed by or under contract with the repository and who has been
designated by the repository to accept donations. A drop box must not be used to deliver
or accept donations.
(f) The central repository and local repository shall inventory all drugs and supplies
donated to the repository. For each drug, the inventory must include the drug's name, strength,
quantity, manufacturer, expiration date, and the date the drug was donated. For each medical
supply, the inventory must include a description of the supply, its manufacturer, the date
the supply was donated, and, if applicable, the supply's brand name and expiration date.
Subd. 7.
Standards and procedures for inspecting and storing donated deleted text begin prescriptiondeleted text end
drugs and supplies.
(a) A pharmacist or authorized practitioner who is employed by or
under contract with the central repository or a local repository shall inspect all donated
deleted text begin prescriptiondeleted text end drugs and supplies before the drug or supply is dispensed to determine, to the
extent reasonably possible in the professional judgment of the pharmacist or practitioner,
that the drug or supply is not adulterated or misbranded, has not been tampered with, is safe
and suitable for dispensing, has not been subject to a recall, and meets the requirements for
donation. The pharmacist or practitioner who inspects the drugs or supplies shall sign an
inspection record stating that the requirements for donation have been met. If a local
repository receives drugs and supplies from the central repository, the local repository does
not need to reinspect the drugs and supplies.
(b) The central repository and local repositories shall store donated drugs and supplies
in a secure storage area under environmental conditions appropriate for the drug or supply
being stored. Donated drugs and supplies may not be stored with nondonated inventory.
(c) The central repository and local repositories shall dispose of all deleted text begin prescriptiondeleted text end drugs
and medical supplies that are not suitable for donation in compliance with applicable federal
and state statutes, regulations, and rules concerning hazardous waste.
(d) In the event that controlled substances or deleted text begin prescriptiondeleted text end drugs that can only be dispensed
to a patient registered with the drug's manufacturer are shipped or delivered to a central or
local repository for donation, the shipment delivery must be documented by the repository
and returned immediately to the donor or the donor's representative that provided the drugs.
(e) Each repository must develop drug and medical supply recall policies and procedures.
If a repository receives a recall notification, the repository shall destroy all of the drug or
medical supply in its inventory that is the subject of the recall and complete a record of
destruction form in accordance with paragraph (f). If a drug or medical supply that is the
subject of a Class I or Class II recall has been dispensed, the repository shall immediately
notify the recipient of the recalled drug or medical supply. A drug that potentially is subject
to a recall need not be destroyed if its packaging bears a lot number and that lot of the drug
is not subject to the recall. If no lot number is on the drug's packaging, it must be destroyed.
(f) A record of destruction of donated drugs and supplies that are not dispensed under
subdivision 8, are subject to a recall under paragraph (e), or are not suitable for donation
shall be maintained by the repository for at least two years. For each drug or supply destroyed,
the record shall include the following information:
(1) the date of destruction;
(2) the name, strength, and quantity of the drug destroyed; and
(3) the name of the person or firm that destroyed the drug.
Subd. 8.
Dispensing requirements.
(a) Donated drugs and supplies may be dispensed
if the drugs or supplies are prescribed by a practitioner for use by an eligible individual and
are dispensed by a pharmacist or practitioner. A repository shall dispense drugs and supplies
to eligible individuals in the following priority order: (1) individuals who are uninsured;
(2) individuals with no prescription drug coverage; and (3) individuals who are underinsured.
A repository shall dispense donated deleted text begin prescriptiondeleted text end drugs in compliance with applicable federal
and state laws and regulations for dispensing deleted text begin prescriptiondeleted text end drugs, including all requirements
relating to packaging, labeling, record keeping, drug utilization review, and patient
counseling.
(b) Before dispensing or administering a drug or supply, the pharmacist or practitioner
shall visually inspect the drug or supply for adulteration, misbranding, tampering, and date
of expiration. Drugs or supplies that have expired or appear upon visual inspection to be
adulterated, misbranded, or tampered with in any way must not be dispensed or administered.
(c) Before a drug or supply is dispensed or administered to an individual, the individual
must sign a drug repository recipient form acknowledging that the individual understands
the information stated on the form. The board shall develop the form and make it available
on the board's website. The form must include the following information:
(1) that the drug or supply being dispensed or administered has been donated and may
have been previously dispensed;
(2) that a visual inspection has been conducted by the pharmacist or practitioner to ensure
that the drug or supply has not expired, has not been adulterated or misbranded, and is in
its original, unopened packaging; and
(3) that the dispensing pharmacist, the dispensing or administering practitioner, the
central repository or local repository, the Board of Pharmacy, and any other participant of
the deleted text begin drugdeleted text end new text begin medicationnew text end repository program cannot guarantee the safety of the drug or medical
supply being dispensed or administered and that the pharmacist or practitioner has determined
that the drug or supply is safe to dispense or administer based on the accuracy of the donor's
form submitted with the donated drug or medical supply and the visual inspection required
to be performed by the pharmacist or practitioner before dispensing or administering.
Subd. 9.
Handling fees.
(a) The central or local repository may charge the individual
receiving a drug or supply a handling fee of no more than 250 percent of the medical
assistance program dispensing fee for each drug or medical supply dispensed or administered
by that repository.
(b) A repository that dispenses or administers a drug or medical supply through the drug
repository program shall not receive reimbursement under the medical assistance program
or the MinnesotaCare program for that dispensed or administered drug or supply.
Subd. 10.
Distribution of donated drugs and supplies.
(a) The central repository and
local repositories may distribute drugs and supplies donated under the drug repository
program to other participating repositories for use pursuant to this program.
(b) A local repository that elects not to dispense donated drugs or supplies must transfer
all donated drugs and supplies to the central repository. A copy of the donor form that was
completed by the original donor under subdivision 6 must be provided to the central
repository at the time of transfer.
Subd. 11.
Forms and record-keeping requirements.
(a) The following forms developed
for the administration of this program shall be utilized by the participants of the program
and shall be available on the board's website:
(1) intake application form described under subdivision 5;
(2) local repository participation form described under subdivision 4;
(3) local repository withdrawal form described under subdivision 4;
(4) deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described under subdivision 6;
(5) record of destruction form described under subdivision 7; and
(6) deleted text begin drugdeleted text end new text begin medicationnew text end repository recipient form described under subdivision 8.
(b) All records, including drug inventory, inspection, and disposal of donated deleted text begin prescriptiondeleted text end
drugs and medical supplies, must be maintained by a repository for a minimum of two years.
Records required as part of this program must be maintained pursuant to all applicable
practice acts.
(c) Data collected by the deleted text begin drugdeleted text end new text begin medicationnew text end repository program from all local repositories
shall be submitted quarterly or upon request to the central repository. Data collected may
consist of the information, records, and forms required to be collected under this section.
(d) The central repository shall submit reports to the board as required by the contract
or upon request of the board.
Subd. 12.
Liability.
(a) The manufacturer of a drug or supply is not subject to criminal
or civil liability for injury, death, or loss to a person or to property for causes of action
described in clauses (1) and (2). A manufacturer is not liable for:
(1) the intentional or unintentional alteration of the drug or supply by a party not under
the control of the manufacturer; or
(2) the failure of a party not under the control of the manufacturer to transfer or
communicate product or consumer information or the expiration date of the donated drug
or supply.
(b) A health care facility participating in the program, a pharmacist dispensing a drug
or supply pursuant to the program, a practitioner dispensing or administering a drug or
supply pursuant to the program, or a donor of a drug or medical supply is immune from
civil liability for an act or omission that causes injury to or the death of an individual to
whom the drug or supply is dispensed and no disciplinary action by a health-related licensing
board shall be taken against a pharmacist or practitioner so long as the drug or supply is
donated, accepted, distributed, and dispensed according to the requirements of this section.
This immunity does not apply if the act or omission involves reckless, wanton, or intentional
misconduct, or malpractice unrelated to the quality of the drug or medical supply.
Subd. 13.
Drug returned for credit.
Nothing in this section allows a long-term care
facility to donate a drug to a central or local repository when federal or state law requires
the drug to be returned to the pharmacy that initially dispensed it, so that the pharmacy can
credit the payer for the amount of the drug returned.
Subd. 14.
Cooperation.
The central repository, as approved by the Board of Pharmacy,
may enter into an agreement with another state that has an established drug repository or
drug donation program if the other state's program includes regulations to ensure the purity,
integrity, and safety of the drugs and supplies donated, to permit the central repository to
offer to another state program inventory that is not needed by a Minnesota resident and to
accept inventory from another state program to be distributed to local repositories and
dispensed to Minnesota residents in accordance with this program.
new text begin Subd. 15. new text end
new text begin Funding. new text end
new text begin
The central repository may seek grants and other funds from nonprofit
charitable organizations, the federal government, and other sources to fund the ongoing
operations of the medication repository program.
new text end
Sec. 56.
Minnesota Statutes 2020, section 152.125, is amended to read:
152.125 INTRACTABLE PAIN.
Subdivision 1.
deleted text begin Definitiondeleted text end new text begin Definitionsnew text end .
new text begin (a) new text end For purposes of this section, new text begin the terms in this
subdivision have the meanings given.
new text end
new text begin
(b) "Drug diversion" means the unlawful transfer of prescription drugs from their licit
medical purpose to the illicit marketplace.
new text end
new text begin (c) new text end "Intractable pain" means a pain state in which the cause of the pain cannot be removed
or otherwise treated with the consent of the patient and in which, in the generally accepted
course of medical practice, no relief or cure of the cause of the pain is possible, or none has
been found after reasonable efforts. new text begin Examples of conditions associated with intractable pain
sometimes but do not always include cancer and the recovery period, sickle cell disease,
noncancer pain, rare diseases, orphan diseases, severe injuries, and health conditions requiring
the provision of palliative care or hospice care. new text end Reasonable efforts for relieving or curing
the cause of the pain may be determined on the basis of, but are not limited to, the following:
(1) when treating a nonterminally ill patient for intractable pain, new text begin an new text end evaluation new text begin conducted
new text end by the attending physician and one or more physicians specializing in pain medicine or the
treatment of the area, system, or organ of the body new text begin confirmed or new text end perceived as the source of
the new text begin intractable new text end pain; or
(2) when treating a terminally ill patient, new text begin an new text end evaluation new text begin conducted new text end by the attending
physician who does so in accordance with new text begin the standard of care and new text end the level of care, skill,
and treatment that would be recognized by a reasonably prudent physician under similar
conditions and circumstances.
new text begin
(d) "Palliative care" has the meaning provided in section 144A.75, subdivision 12.
new text end
new text begin
(e) "Rare disease" means a disease, disorder, or condition that affects fewer than 200,000
individuals in the United States and is chronic, serious, life altering, or life threatening.
new text end
new text begin Subd. 1a. new text end
new text begin Criteria for the evaluation and treatment of intractable pain. new text end
new text begin
The evaluation
and treatment of intractable pain when treating a nonterminally ill patient is governed by
the following criteria:
new text end
new text begin
(1) a diagnosis of intractable pain by the treating physician and either by a physician
specializing in pain medicine or a physician treating the area, system, or organ of the body
that is the source of the pain is sufficient to meet the definition of intractable pain; and
new text end
new text begin
(2) the cause of the diagnosis of intractable pain must not interfere with medically
necessary treatment including but not limited to prescribing or administering a controlled
substance in Schedules II to V of section 152.02.
new text end
Subd. 2.
Prescription and administration of controlled substances for intractable
pain.
new text begin (a) new text end Notwithstanding any other provision of this chapter, a physiciannew text begin , advanced practice
registered nurse, or physician assistantnew text end may prescribe or administer a controlled substance
in Schedules II to V of section 152.02 to deleted text begin an individualdeleted text end new text begin a patientnew text end in the course of the
physician'snew text begin , advanced practice registered nurse's, or physician assistant'snew text end treatment of the
deleted text begin individualdeleted text end new text begin patientnew text end for a diagnosed condition causing intractable pain. No physiciannew text begin , advanced
practice registered nurse, or physician assistantnew text end shall be subject to disciplinary action by
the Board of Medical Practice new text begin or Board of Nursing new text end for appropriately prescribing or
administering a controlled substance in Schedules II to V of section 152.02 in the course
of treatment of deleted text begin an individualdeleted text end new text begin a patientnew text end for intractable pain, provided the physiciannew text begin , advanced
practice registered nurse, or physician assistant:
new text end
new text begin (1) new text end keeps accurate records of the purpose, use, prescription, and disposal of controlled
substances, writes accurate prescriptions, and prescribes medications in conformance with
chapter 147deleted text begin .deleted text end new text begin or 148 or in accordance with the current standard of care; and
new text end
new text begin
(2) enters into a patient-provider agreement that meets the criteria in subdivision 5.
new text end
new text begin
(b) No physician, advanced practice registered nurse, or physician assistant, acting in
good faith and based on the needs of the patient, shall be subject to any civil or criminal
action or investigation, disenrollment, or termination by the commissioner of health or
human services solely for prescribing a dosage that equates to an upward deviation from
morphine milligram equivalent dosage recommendations or thresholds specified in state or
federal opioid prescribing guidelines or policies, including but not limited to the Guideline
for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and
Prevention, Minnesota opioid prescribing guidelines, the Minnesota opioid prescribing
improvement program, and the Minnesota quality improvement program established under
section 256B.0638.
new text end
new text begin
(c) A physician, advanced practice registered nurse, or physician assistant treating
intractable pain by prescribing, dispensing, or administering a controlled substance in
Schedules II to V of section 152.02 that includes but is not opioid analgesics must not taper
a patient's medication dosage solely to meet a predetermined morphine milligram equivalent
dosage recommendation or threshold if the patient is stable and compliant with the treatment
plan, is experiencing no serious harm from the level of medication currently being prescribed
or previously prescribed, and is in compliance with the patient-provider agreement as
described in subdivision 5.
new text end
new text begin
(d) A physician's, advanced practice registered nurse's, or physician assistant's decision
to taper a patient's medication dosage must be based on factors other than a morphine
milligram equivalent recommendation or threshold.
new text end
new text begin
(e) No pharmacist, health plan company, or pharmacy benefit manager shall refuse to
fill a prescription for an opiate issued by a licensed practitioner with the authority to prescribe
opiates solely based on the prescription exceeding a predetermined morphine milligram
equivalent dosage recommendation or threshold. Health plan companies that participate in
Minnesota health care programs under chapters 256B and 256L, and pharmacy benefit
managers under contract with these health plan companies, must comply with section 1004
of the federal SUPPORT Act, Public Law 115-271, when providing services to medical
assistance and MinnesotaCare enrollees.
new text end
Subd. 3.
Limits on applicability.
This section does not apply to:
(1) a physician'snew text begin , advanced practice registered nurse's, or physician assistant'snew text end treatment
of deleted text begin an individualdeleted text end new text begin a patientnew text end for chemical dependency resulting from the use of controlled
substances in Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to deleted text begin an individualdeleted text end new text begin a patientnew text end whom the physiciannew text begin , advanced practice registered
nurse, or physician assistantnew text end knows to be using the controlled substances for nontherapeutic
new text begin or drug diversion new text end purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of deleted text begin an individualdeleted text end new text begin a patientnew text end having
intractable pain; or
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain relief.
Subd. 4.
Notice of risks.
Prior to treating deleted text begin an individualdeleted text end new text begin a patientnew text end for intractable pain in
accordance with subdivision 2, a physiciannew text begin , advanced practice registered nurse, or physician
assistantnew text end shall discuss with the deleted text begin individualdeleted text end new text begin patient or the patient's legal guardian, if applicable,new text end
the risks associated with the controlled substances in Schedules II to V of section 152.02
to be prescribed or administered in the course of the physician'snew text begin , advanced practice registered
nurse's, or physician assistant'snew text end treatment of deleted text begin an individualdeleted text end new text begin a patientnew text end , and document the
discussion in the deleted text begin individual'sdeleted text end new text begin patient'snew text end recordnew text begin as required in the patient-provider agreement
described in subdivision 5new text end .
new text begin Subd. 5. new text end
new text begin Patient-provider agreement. new text end
new text begin
(a) Before treating a patient for intractable pain,
a physician, advanced practice registered nurse, or physician assistant and the patient or the
patient's legal guardian, if applicable, must mutually agree to the treatment and enter into
a provider-patient agreement. The agreement must include a description of the prescriber's
and the patient's expectations, responsibilities, and rights according to best practices and
current standards of care.
new text end
new text begin
(b) The agreement must be signed by the patient or the patient's legal guardian, if
applicable, and the physician, advanced practice registered nurse, or physician assistant and
included in the patient's medical records. A copy of the signed agreement must be provided
to the patient.
new text end
new text begin
(c) The agreement must be reviewed by the patient and the physician, advanced practice
registered nurse, or physician assistant annually. If there is a change in the patient's treatment
plan, the agreement must be updated and a revised agreement must be signed by the patient
or the patient's legal guardian. A copy of the revised agreement must be included in the
patient's medical record and a copy must be provided to the patient.
new text end
new text begin
(d) A patient-provider agreement is not required in an emergency or inpatient hospital
setting.
new text end
Sec. 57.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 13, is
amended to read:
Subd. 13.
Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner or the drug appears on the 90-day supply list published
by the commissioner. The 90-day supply list shall be published by the commissioner on the
department's website. The commissioner may add to, delete from, and otherwise modify
the 90-day supply list after providing public notice and the opportunity for a 15-day public
comment period. The 90-day supply list may include cost-effective generic drugs and shall
not include controlled substances.
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.
new text begin
(h) Medical assistance coverage of, and reimbursement for, antiretroviral drugs to prevent
the acquisition of human immunodeficiency virus (HIV) and any laboratory testing necessary
for therapy that uses these drugs must meet the requirements that would otherwise apply to
a health plan under section 62Q.524.
new text end
Sec. 58.
Minnesota Statutes 2020, section 256B.0625, subdivision 13f, is amended to read:
Subd. 13f.
Prior authorization.
(a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to review
each brand-name drug for which a generically equivalent drug is available.
(b) Prior authorization may be required by the commissioner before certain formulary
drugs are eligible for payment. The Formulary Committee may recommend drugs for prior
authorization directly to the commissioner. The commissioner may also request that the
Formulary Committee review a drug for prior authorization. Before the commissioner may
require prior authorization for a drug:
(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;
(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and
(3) the Formulary Committee must hold a public forum and receive public comment for
an additional 15 days.
The commissioner must provide a 15-day notice period before implementing the prior
authorization.
(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness
if:
(1) there is no generically equivalent drug available; and
(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
(3) the drug is part of the recipient's current course of treatment.
This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of mental
illness within 60 days of when a generically equivalent drug becomes available, provided
that the brand name drug was part of the recipient's course of treatment at the time the
generically equivalent drug became available.
(d) The commissioner may require prior authorization for brand name drugs whenever
a generically equivalent product is available, even if the prescriber specifically indicates
"dispense as written-brand necessary" on the prescription as required by section 151.21,
subdivision 2.
(e) Notwithstanding this subdivision, the commissioner may automatically require prior
authorization, for a period not to exceed 180 days, for any drug that is approved by the
United States Food and Drug Administration on or after July 1, 2005. The 180-day period
begins no later than the first day that a drug is available for shipment to pharmacies within
the state. The Formulary Committee shall recommend to the commissioner general criteria
to be used for the prior authorization of the drugs, but the committee is not required to
review each individual drug. In order to continue prior authorizations for a drug after the
180-day period has expired, the commissioner must follow the provisions of this subdivision.
(f) Prior authorization under this subdivision shall comply with deleted text begin sectiondeleted text end new text begin sectionsnew text end 62Q.184new text begin
and 62Q.1842new text end .
(g) Any step therapy protocol requirements established by the commissioner must comply
with deleted text begin sectiondeleted text end new text begin sectionsnew text end 62Q.1841new text begin and 62Q.1842new text end .
Sec. 59. new text begin STUDY OF PHARMACY AND PROVIDER CHOICE OF BIOLOGICAL
PRODUCTS.
new text end
new text begin
The commissioner of health, within the limits of existing resources, shall analyze the
effect of Minnesota Statutes, section 62W.0751, on the net price for different payors of
biological products, interchangeable biological products, and biosimilar products. The
commissioner of health shall report findings to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services finance and
policy and insurance by December 15, 2024.
new text end
ARTICLE 7
HEALTH INSURANCE
Section 1.
Minnesota Statutes 2020, section 62A.25, subdivision 2, is amended to read:
Subd. 2.
Required coverage.
(a) Every policy, plan, certificate or contract to which this
section applies shall provide benefits for reconstructive surgery when such service is
incidental to or follows surgery resulting from injury, sickness or other diseases of the
involved part or when such service is performed on a covered dependent child because of
congenital disease or anomaly which has resulted in a functional defect as determined by
the attending physician.
(b) The coverage limitations on reconstructive surgery in paragraph (a) do not apply to
reconstructive breast surgerynew text begin : (1)new text end following mastectomiesnew text begin ; or (2) if the patient has been
diagnosed with ectodermal dysplasia and has congenitally absent breast tissue or nipplesnew text end .
deleted text begin In these cases,deleted text end deleted text begin Coverage for reconstructive surgery must be provided if the mastectomy is
medically necessary as determined by the attending physician.
deleted text end
(c) Reconstructive surgery benefits include all stages of reconstruction deleted text begin of the breast on
which the mastectomy has been performeddeleted text end ,new text begin includingnew text end surgery and reconstruction of the
other breast to produce a symmetrical appearance, and prosthesis and physical complications
at all stages deleted text begin of a mastectomydeleted text end , including lymphedemas, in a manner determined in consultation
with the attending physician and patient. Coverage may be subject to annual deductible,
co-payment, and coinsurance provisions as may be deemed appropriate and as are consistent
with those established for other benefits under the plan or coverage. Coverage may not:
(1) deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage
under the terms of the plan, solely for the purpose of avoiding the requirements of this
section; and
(2) penalize or otherwise reduce or limit the reimbursement of an attending provider, or
provide monetary or other incentives to an attending provider to induce the provider to
provide care to an individual participant or beneficiary in a manner inconsistent with this
section.
Written notice of the availability of the coverage must be delivered to the participant upon
enrollment and annually thereafter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 2.
new text begin
[62A.255] COVERAGE OF LYMPHEDEMA TREATMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Scope of coverage. new text end
new text begin
This section applies to all health plans that are sold,
issued, or renewed to a Minnesota resident.
new text end
new text begin Subd. 2. new text end
new text begin Required coverage. new text end
new text begin
(a) Each health plan must provide coverage for lymphedema
treatment, including coverage for compression treatment items, complex decongestive
therapy, and outpatient self-management training and education during lymphedema treatment
if prescribed by a licensed health care professional. Lymphedema compression treatment
items include: (1) compression garments, stockings, and sleeves; (2) compression devices;
and (3) bandaging systems, components, and supplies that are primarily and customarily
used in the treatment of lymphedema.
new text end
new text begin
(b) If applicable to the enrollee's health plan, a health carrier may require the prescribing
health care professional to be within the enrollee's health plan provider network if the
provider network meets network adequacy requirements under section 62K.10.
new text end
new text begin
(c) A health plan must not apply any cost-sharing requirements, benefit limitations, or
service limitations for lymphedema treatment and compression treatment items that place
a greater financial burden on the enrollee or are more restrictive than cost-sharing
requirements or limitations applied by the health plan to other similar services or benefits.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to any health
plan issued, sold, or renewed on or after that date.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62A.28, subdivision 2, is amended to read:
Subd. 2.
Required coverage.
Every policy, plan, certificate, or contract referred to in
subdivision 1 deleted text begin issued or renewed after August 1, 1987,deleted text end must provide coverage for scalp hair
prostheses worn for hair loss suffered as a result of alopecia areatanew text begin or ectodermal dysplasiasnew text end .
The coverage required by this section is subject to the co-payment, coinsurance,
deductible, and other enrollee cost-sharing requirements that apply to similar types of items
under the policy, plan, certificate, or contract and may be limited to one prosthesis per
benefit year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 4.
Minnesota Statutes 2020, section 62A.30, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Mammogram; diagnostic services and testing. new text end
new text begin
If a health care provider
determines an enrollee requires additional diagnostic services or testing after a mammogram,
a health plan must provide coverage for the additional diagnostic services or testing with
no cost sharing, including co-pay, deductible, or coinsurance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 5.
new text begin
[62A.3096] COVERAGE FOR ECTODERMAL DYSPLASIAS.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
For purposes of this chapter, "ectodermal dysplasias" means
a genetic disorder involving the absence or deficiency of tissues and structures derived from
the embryonic ectoderm.
new text end
new text begin Subd. 2. new text end
new text begin Coverage. new text end
new text begin
A health plan must provide coverage for the treatment of ectodermal
dysplasias.
new text end
new text begin Subd. 3. new text end
new text begin Dental coverage. new text end
new text begin
(a) A health plan must provide coverage for dental treatments
related to ectodermal dysplasias. Covered dental treatments must include but are not limited
to bone grafts, dental implants, orthodontia, dental prosthodontics, and dental maintenance.
new text end
new text begin
(b) If a dental treatment is eligible for coverage under a dental insurance plan or other
health plan, the coverage under this subdivision is secondary.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 6.
new text begin
[62Q.451] UNRESTRICTED ACCESS TO SERVICES FOR THE
DIAGNOSIS, MONITORING, AND TREATMENT OF RARE DISEASES.
new text end
new text begin
(a) No health plan company may restrict the choice of an enrollee as to where the enrollee
receives services from a licensed health care provider related to the diagnosis, monitoring,
and treatment of a rare disease or condition. Except as provided in paragraph (b), for purposes
of this section, "rare disease or condition" means any disease or condition:
new text end
new text begin
(1) that affects fewer than 200,000 persons in the United States and is chronic, serious,
life-altering, or life-threatening;
new text end
new text begin
(2) that affects more than 200,000 persons in the United States and a drug for treatment
has been designated as such pursuant to United States Code, title 21, section 360bb;
new text end
new text begin
(3) that is labeled as a rare disease or condition on the Genetic and Rare Diseases
Information Center list created by the National Institutes of Health; or
new text end
new text begin
(4) for which a pediatric patient:
new text end
new text begin
(i) has received two or more clinical consultations from a primary care provider or
specialty provider;
new text end
new text begin
(ii) has a delay in skill acquisition and development, regression in skill acquisition,
failure to thrive, or multisystemic involvement; and
new text end
new text begin
(iii) had laboratory or clinical testing that failed to provide a definitive diagnosis or
resulted in conflicting diagnoses.
new text end
new text begin
(b) A rare disease or condition does not include an infectious disease that has widely
available and known protocols for diagnosis and treatment and that is commonly treated in
a primary care setting, even if it affects less than 200,000 persons in the United States.
new text end
new text begin
(c) Cost-sharing requirements and benefit or services limitations for the diagnosis and
treatment of a rare disease or condition must not place a greater financial burden on the
enrollee or be more restrictive than those requirements for in-network medical treatment.
new text end
new text begin
(d) This section does not apply to health plan coverage provided through the State
Employee Group Insurance Program (SEGIP) under chapter 43A.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 68. new text end
new text begin
Services for the diagnosis, monitoring, and treatment of rare
diseases.
new text end
new text begin
Medical assistance coverage for services related to the diagnosis, monitoring, and
treatment of a rare disease or condition must meet the requirements in section 62Q.451.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 69. new text end
new text begin Ectodermal dysplasias. new text end
new text begin
Medical assistance and MinnesotaCare cover treatment
for ectodermal dysplasias. Coverage must meet the requirements of sections 62A.25, 62A.28,
and 62A.3096.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
ARTICLE 8
COMMUNITY SUPPORTS AND BEHAVIORAL HEALTH POLICY
Section 1.
Minnesota Statutes 2021 Supplement, section 62A.673, subdivision 2, is
amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
(b) "Distant site" means a site at which a health care provider is located while providing
health care services or consultations by means of telehealth.
(c) "Health care provider" means a health care professional who is licensed or registered
by the state to perform health care services within the provider's scope of practice and in
accordance with state law. A health care provider includes a mental health professional deleted text begin as
defineddeleted text end under section deleted text begin 245.462, subdivision 18, or 245.4871, subdivision 27deleted text end new text begin 245I.04,
subdivision 2new text end ; a mental health practitioner deleted text begin as defineddeleted text end under section deleted text begin 245.462, subdivision
17, or 245.4871, subdivision 26deleted text end new text begin 245I.04, subdivision 4; a clinical trainee under section
245I.04, subdivision 6new text end ; a treatment coordinator under section 245G.11, subdivision 7; an
alcohol and drug counselor under section 245G.11, subdivision 5; and a recovery peer under
section 245G.11, subdivision 8.
(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.
(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan
includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental
plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed
to pay benefits directly to the policy holder.
(f) "Originating site" means a site at which a patient is located at the time health care
services are provided to the patient by means of telehealth. For purposes of store-and-forward
technology, the originating site also means the location at which a health care provider
transfers or transmits information to the distant site.
(g) "Store-and-forward technology" means the asynchronous electronic transfer or
transmission of a patient's medical information or data from an originating site to a distant
site for the purposes of diagnostic and therapeutic assistance in the care of a patient.
(h) "Telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual communications to provide or support
health care delivery and facilitate the assessment, diagnosis, consultation, treatment,
education, and care management of a patient's health care. Telehealth includes the application
of secure video conferencing, store-and-forward technology, and synchronous interactions
between a patient located at an originating site and a health care provider located at a distant
site. Until July 1, 2023, telehealth also includes audio-only communication between a health
care provider and a patient in accordance with subdivision 6, paragraph (b). Telehealth does
not include communication between health care providers that consists solely of a telephone
conversation, e-mail, or facsimile transmission. Telehealth does not include communication
between a health care provider and a patient that consists solely of an e-mail or facsimile
transmission. Telehealth does not include telemonitoring services as defined in paragraph
(i).
(i) "Telemonitoring services" means the remote monitoring of clinical data related to
the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits
the data electronically to a health care provider for analysis. Telemonitoring is intended to
collect an enrollee's health-related data for the purpose of assisting a health care provider
in assessing and monitoring the enrollee's medical condition or status.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 2.
Minnesota Statutes 2021 Supplement, section 148F.11, subdivision 1, is amended
to read:
Subdivision 1.
Other professionals.
(a) Nothing in this chapter prevents members of
other professions or occupations from performing functions for which they are qualified or
licensed. This exception includes, but is not limited to: licensed physicians; registered nurses;
licensed practical nurses; licensed psychologists and licensed psychological practitioners;
members of the clergy provided such services are provided within the scope of regular
ministries; American Indian medicine men and women; licensed attorneys; probation officers;
licensed marriage and family therapists; licensed social workers; social workers employed
by city, county, or state agencies; licensed professional counselors; licensed professional
clinical counselors; licensed school counselors; registered occupational therapists or
occupational therapy assistants; Upper Midwest Indian Council on Addictive Disorders
(UMICAD) certified counselors when providing services to Native American people; city,
county, or state employees when providing assessments or case management under Minnesota
Rules, chapter 9530; and deleted text begin individuals defined in section 256B.0623, subdivision 5, clauses
(1) to (6),deleted text end new text begin staff personsnew text end providing co-occurring substance use disorder treatment in adult
mental health rehabilitative programs certified or licensed by the Department of Human
Services under section 245I.23, 256B.0622, or 256B.0623.
(b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.
(c) Any person who is exempt from licensure under this section must not use a title
incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold himself or herself out to the public by any title or description
stating or implying that he or she is engaged in the practice of alcohol and drug counseling,
or that he or she is licensed to engage in the practice of alcohol and drug counseling, unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the practice
of alcohol and drug counseling are not exempt from the board's jurisdiction solely by the
use of one of the titles in paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 3.
Minnesota Statutes 2020, section 245.462, subdivision 4, is amended to read:
Subd. 4.
Case management service provider.
(a) "Case management service provider"
means a case manager or case manager associate employed by the county or other entity
authorized by the county board to provide case management services specified in section
245.4711.
(b) A case manager must:
(1) be skilled in the process of identifying and assessing a wide range of client needs;
(2) be knowledgeable about local community resources and how to use those resources
for the benefit of the client;
(3) new text begin be a mental health practitioner as defined in section 245I.04, subdivision 4, or new text end have
a bachelor's degree in one of the behavioral sciences or related fields including, but not
limited to, social work, psychology, or nursing from an accredited college or university deleted text begin ordeleted text end new text begin .
A case manager who is not a mental health practitioner and who does not have a bachelor's
degree in one of the behavioral sciences or related fields mustnew text end meet the requirements of
paragraph (c); and
(4) meet the supervision and continuing education requirements described in paragraphs
(d), (e), and (f), as applicable.
(c) Case managers without a bachelor's degree must meet one of the requirements in
clauses (1) to (3):
(1) have three or four years of experience as a case manager associate as defined in this
section;
(2) be a registered nurse without a bachelor's degree and have a combination of
specialized training in psychiatry and work experience consisting of community interaction
and involvement or community discharge planning in a mental health setting totaling three
years; or
(3) be a person who qualified as a case manager under the 1998 Department of Human
Service waiver provision and meet the continuing education and mentoring requirements
in this section.
(d) A case manager with at least 2,000 hours of supervised experience in the delivery
of services to adults with mental illness must receive regular ongoing supervision and clinical
supervision totaling 38 hours per year of which at least one hour per month must be clinical
supervision regarding individual service delivery with a case management supervisor. The
remaining 26 hours of supervision may be provided by a case manager with two years of
experience. Group supervision may not constitute more than one-half of the required
supervision hours. Clinical supervision must be documented in the client record.
(e) A case manager without 2,000 hours of supervised experience in the delivery of
services to adults with mental illness must:
(1) receive clinical supervision regarding individual service delivery from a mental
health professional at least one hour per week until the requirement of 2,000 hours of
experience is met; and
(2) complete 40 hours of training approved by the commissioner in case management
skills and the characteristics and needs of adults with serious and persistent mental illness.
(f) A case manager who is not licensed, registered, or certified by a health-related
licensing board must receive 30 hours of continuing education and training in mental illness
and mental health services every two years.
(g) A case manager associate (CMA) must:
(1) work under the direction of a case manager or case management supervisor;
(2) be at least 21 years of age;
(3) have at least a high school diploma or its equivalent; and
(4) meet one of the following criteria:
(i) have an associate of arts degree in one of the behavioral sciences or human services;
(ii) be a certified peer specialist under section 256B.0615;
(iii) be a registered nurse without a bachelor's degree;
(iv) within the previous ten years, have three years of life experience with serious and
persistent mental illness as defined in subdivision 20; or as a child had severe emotional
disturbance as defined in section 245.4871, subdivision 6; or have three years life experience
as a primary caregiver to an adult with serious and persistent mental illness within the
previous ten years;
(v) have 6,000 hours work experience as a nondegreed state hospital technician; or
(vi) have at least 6,000 hours of supervised experience in the delivery of services to
persons with mental illness.
Individuals meeting one of the criteria in items (i) to (v) may qualify as a case manager
after four years of supervised work experience as a case manager associate. Individuals
meeting the criteria in item (vi) may qualify as a case manager after three years of supervised
experience as a case manager associate.
(h) A case management associate must meet the following supervision, mentoring, and
continuing education requirements:
(1) have 40 hours of preservice training described under paragraph (e), clause (2);
(2) receive at least 40 hours of continuing education in mental illness and mental health
services annually; and
(3) receive at least five hours of mentoring per week from a case management mentor.
A "case management mentor" means a qualified, practicing case manager or case management
supervisor who teaches or advises and provides intensive training and clinical supervision
to one or more case manager associates. Mentoring may occur while providing direct services
to consumers in the office or in the field and may be provided to individuals or groups of
case manager associates. At least two mentoring hours per week must be individual and
face-to-face.
(i) A case management supervisor must meet the criteria for mental health professionals,
as specified in subdivision 18.
(j) An immigrant who does not have the qualifications specified in this subdivision may
provide case management services to adult immigrants with serious and persistent mental
illness who are members of the same ethnic group as the case manager if the person:
(1) is currently enrolled in and is actively pursuing credits toward the completion of a
bachelor's degree in one of the behavioral sciences or a related field including, but not
limited to, social work, psychology, or nursing from an accredited college or university;
(2) completes 40 hours of training as specified in this subdivision; and
(3) receives clinical supervision at least once a week until the requirements of this
subdivision are met.
Sec. 4.
Minnesota Statutes 2021 Supplement, section 245.467, subdivision 2, is amended
to read:
Subd. 2.
Diagnostic assessment.
deleted text begin Providersdeleted text end new text begin A providernew text end of services governed by this
section must complete a diagnostic assessment new text begin of a client new text end according to the standards of
section 245I.10deleted text begin , subdivisions 4 to 6deleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 5.
Minnesota Statutes 2021 Supplement, section 245.467, subdivision 3, is amended
to read:
Subd. 3.
Individual treatment plans.
deleted text begin Providersdeleted text end new text begin A providernew text end of services governed by
this section must complete an individual treatment plan new text begin for a client new text end according to the standards
of section 245I.10, subdivisions 7 and 8.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 6.
Minnesota Statutes 2021 Supplement, section 245.4871, subdivision 21, is amended
to read:
Subd. 21.
Individual treatment plan.
new text begin (a) new text end "Individual treatment plan" means the
formulation of planned services that are responsive to the needs and goals of a client. An
individual treatment plan must be completed according to section 245I.10, subdivisions 7
and 8.
new text begin
(b) A children's residential facility licensed under Minnesota Rules, chapter 2960, is
exempt from the requirements of section 245I.10, subdivisions 7 and 8. Instead, the individual
treatment plan must:
new text end
new text begin
(1) include a written plan of intervention, treatment, and services for a child with an
emotional disturbance that the service provider develops under the clinical supervision of
a mental health professional on the basis of a diagnostic assessment;
new text end
new text begin
(2) be developed in conjunction with the family unless clinically inappropriate; and
new text end
new text begin
(3) identify goals and objectives of treatment, treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment to the child with an emotional disturbance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 7.
Minnesota Statutes 2021 Supplement, section 245.4876, subdivision 2, is amended
to read:
Subd. 2.
Diagnostic assessment.
deleted text begin Providersdeleted text end new text begin A providernew text end of services governed by this
section deleted text begin shalldeleted text end new text begin mustnew text end complete a diagnostic assessment new text begin of a client new text end according to the standards
of section 245I.10deleted text begin , subdivisions 4 to 6deleted text end .new text begin Notwithstanding the required timelines for completing
a diagnostic assessment in section 245I.10, a children's residential facility licensed under
Minnesota Rules, chapter 2960, that provides mental health services to children must, within
ten days of the client's admission: (1) complete the client's diagnostic assessment; or (2)
review and update the client's diagnostic assessment with a summary of the child's current
mental health status and service needs if a diagnostic assessment is available that was
completed within 180 days preceding admission and the client's mental health status has
not changed markedly since the diagnostic assessment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 8.
Minnesota Statutes 2021 Supplement, section 245.4876, subdivision 3, is amended
to read:
Subd. 3.
Individual treatment plans.
deleted text begin Providersdeleted text end new text begin A providernew text end of services governed by
this section deleted text begin shalldeleted text end new text begin mustnew text end complete an individual treatment plan new text begin for a client new text end according to the
standards of section 245I.10, subdivisions 7 and 8.new text begin A children's residential facility licensed
according to Minnesota Rules, chapter 2960, is exempt from the requirements in section
245I.10, subdivisions 7 and 8. Instead, the facility must involve the child and the child's
family in all phases of developing and implementing the individual treatment plan to the
extent appropriate and must review the individual treatment plan every 90 days after intake.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 9.
Minnesota Statutes 2021 Supplement, section 245.735, subdivision 3, is amended
to read:
Subd. 3.
Certified community behavioral health clinics.
(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs) that satisfy all federal requirements necessary for CCBHCs certified under this
section to be eligible for reimbursement under medical assistance, without service area
limits based on geographic area or region. The commissioner shall consult with CCBHC
stakeholders before establishing and implementing changes in the certification process and
requirements. Entities that choose to be CCBHCs must:
(1) comply with state licensing requirements and other requirements issued by the
commissioner;
(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;
(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;
(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;
(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;
(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization services through existing
mobile crisis services; screening, assessment, and diagnosis services, including risk
assessments and level of care determinations; person- and family-centered treatment planning;
outpatient mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veterans. CCBHCs must directly provide the majority
of these services to enrollees, but may coordinate some services with another entity through
a collaboration or agreement, pursuant to paragraph (b);
(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:
(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and
(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;
(8) be certified as new text begin a new text end mental health deleted text begin clinicsdeleted text end new text begin clinicnew text end under section deleted text begin 245.69, subdivision 2deleted text end new text begin
245I.20new text end ;
(9) comply with standards established by the commissioner relating to CCBHC
screenings, assessments, and evaluations;
(10) be licensed to provide substance use disorder treatment under chapter 245G;
(11) be certified to provide children's therapeutic services and supports under section
256B.0943;
(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;
(13) be enrolled to provide mental health crisis response services under deleted text begin sectionsdeleted text end new text begin sectionnew text end
256B.0624 deleted text begin and 256B.0944deleted text end ;
(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;
(16) provide services that comply with the evidence-based practices described in
paragraph (e); and
(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
(b) If a certified CCBHC is unable to provide one or more of the services listed in
paragraph (a), clauses (6) to (17), the CCBHC may contract with another entity that has the
required authority to provide that service and that meets the following criteria as a designated
collaborating organization:
(1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under paragraph (a), clause (6);
(2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
(4) the entity meets any additional requirements issued by the commissioner.
(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.
(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements
for services reimbursed under medical assistance. If standards overlap, the commissioner
may substitute all or a part of a licensure or certification that is substantially the same as
another licensure or certification. The commissioner shall consult with stakeholders, as
described in subdivision 4, before granting variances under this provision. For the CCBHC
that is certified but not approved for prospective payment under section 256B.0625,
subdivision 5m, the commissioner may grant a variance under this paragraph if the variance
does not increase the state share of costs.
(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.
(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 10.
Minnesota Statutes 2021 Supplement, section 245A.03, subdivision 7, is amended
to read:
Subd. 7.
Licensing moratorium.
(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a family child foster care home or family adult foster care home
license is issued during this moratorium, and the license holder changes the license holder's
primary residence away from the physical location of the foster care license, the
commissioner shall revoke the license according to section 245A.07. The commissioner
shall not issue an initial license for a community residential setting licensed under chapter
245D. When approving an exception under this paragraph, the commissioner shall consider
the resource need determination process in paragraph (h), the availability of foster care
licensed beds in the geographic area in which the licensee seeks to operate, the results of a
person's choices during their annual assessment and service plan review, and the
recommendation of the local county board. The determination by the commissioner is final
and not subject to appeal. Exceptions to the moratorium include:
(1) foster care settings where at least 80 percent of the residents are 55 years of age or
older;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);
(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;
(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;new text begin
or
new text end
deleted text begin
(5) new foster care licenses or community residential setting licenses for people receiving
services under chapter
deleted text end
deleted text begin
245D
deleted text end
deleted text begin
and residing in an unlicensed setting before May 1, 2017, and
for which a license is required. This exception does not apply to people living in their own
home. For purposes of this clause, there is a presumption that a foster care or community
residential setting license is required for services provided to three or more people in a
dwelling unit when the setting is controlled by the provider. A license holder subject to this
exception may rebut the presumption that a license is required by seeking a reconsideration
of the commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter
deleted text end
deleted text begin
14
deleted text end
deleted text begin
. The exception is available
until June 30, 2018. This exception is available when:
deleted text end
deleted text begin
(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
deleted text end
deleted text begin
(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agency; or
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end new foster care licenses or community residential setting licenses for people
receiving customized living or 24-hour customized living services under the brain injury
or community access for disability inclusion waiver plans under section 256B.49 and residing
in the customized living setting before July 1, 2022, for which a license is required. A
customized living service provider subject to this exception may rebut the presumption that
a license is required by seeking a reconsideration of the commissioner's determination. The
commissioner's disposition of a request for reconsideration is final and not subject to appeal
under chapter 14. The exception is available until June 30, 2023. This exception is available
when:
(i) the person's customized living services are provided in a customized living service
setting serving four or fewer people under the brain injury or community access for disability
inclusion waiver plans under section 256B.49 in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;
(ii) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
(iii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the customized
living setting as determined by the lead agency.
(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.
(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department may decrease
the statewide licensed capacity for adult foster care settings.
(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.
(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity determined under section 256B.493 will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet the
informed decisions of those people who want to move out of corporate foster care or
community residential settings, long-term service needs within budgetary limits, including
seeking proposals from service providers or lead agencies to change service type, capacity,
or location to improve services, increase the independence of residents, and better meet
needs identified by the long-term services and supports reports and statewide data and
information.
(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.
(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human
services licensing division that the license holder provides or intends to provide these
waiver-funded services.
(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493. Annually, by August 1, the commissioner shall provide
information and data on capacity of licensed long-term services and supports, actions taken
under the subdivision to manage statewide long-term services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over the
health and human services budget.
(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2020, section 245D.12, is amended to read:
245D.12 INTEGRATED COMMUNITY SUPPORTS; SETTING CAPACITY
REPORT.
(a) The license holder providing integrated community support, as defined in section
245D.03, subdivision 1, paragraph (c), clause (8), must submit a setting capacity report to
the commissioner to ensure the identified location of service delivery meets the criteria of
the home and community-based service requirements as specified in section 256B.492.
(b) The license holder shall provide the setting capacity report on the forms and in the
manner prescribed by the commissioner. The report must include:
(1) the address of the multifamily housing building where the license holder delivers
integrated community supports and owns, leases, or has a direct or indirect financial
relationship with the property owner;
(2) the total number of living units in the multifamily housing building described in
clause (1) where integrated community supports are delivered;
(3) the total number of living units in the multifamily housing building described in
clause (1), including the living units identified in clause (2); deleted text begin and
deleted text end
new text begin
(4) the total number of people who could reside in the living units in the multifamily
housing building described in clause (2) and receive integrated community supports; and
new text end
deleted text begin (4)deleted text end new text begin (5)new text end the percentage of living units that are controlled by the license holder in the
multifamily housing building by dividing clause (2) by clause (3).
(c) Only one license holder may deliver integrated community supports at the address
of the multifamily housing building.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2021 Supplement, section 245I.02, subdivision 19, is amended
to read:
Subd. 19.
Level of care assessment.
"Level of care assessment" means the level of care
decision support tool appropriate to the client's age. For a client five years of age or younger,
a level of care assessment is the Early Childhood Service Intensity Instrument (ESCII). For
a client six to 17 years of age, a level of care assessment is the Child and Adolescent Service
Intensity Instrument (CASII). For a client 18 years of age or older, a level of care assessment
is the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS)new text begin
or another tool authorized by the commissionernew text end .
Sec. 13.
Minnesota Statutes 2021 Supplement, section 245I.02, subdivision 36, is amended
to read:
Subd. 36.
Staff person.
"Staff person" means an individual who works under a license
holder's direction or under a contract with a license holder. Staff person includes an intern,
consultant, contractor, individual who works part-time, and an individual who does not
provide direct contact services to clientsnew text begin but does have physical access to clientsnew text end . Staff
person includes a volunteer who provides treatment services to a client or a volunteer whom
the license holder regards as a staff person for the purpose of meeting staffing or service
delivery requirements. A staff person must be 18 years of age or older.
Sec. 14.
Minnesota Statutes 2021 Supplement, section 245I.03, subdivision 9, is amended
to read:
Subd. 9.
Volunteers.
deleted text begin Adeleted text end new text begin If a license holder uses volunteers, thenew text end license holder must have
policies and procedures for using volunteers, including when deleted text begin adeleted text end new text begin thenew text end license holder must
submit a background study for a volunteer, and the specific tasks that a volunteer may
perform.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 15.
Minnesota Statutes 2021 Supplement, section 245I.04, subdivision 4, is amended
to read:
Subd. 4.
Mental health practitioner qualifications.
(a) An individual who is qualified
in at least one of the ways described in paragraph (b) to (d) may serve as a mental health
practitioner.
(b) An individual is qualified as a mental health practitioner through relevant coursework
if the individual completes at least 30 semester hours or 45 quarter hours in behavioral
sciences or related fields and:
(1) has at least 2,000 hours of experience providing services to individuals with:
(i) a mental illness or a substance use disorder; or
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to a client;
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the individual's clients belong, and completes the additional training described in section
245I.05, subdivision 3, paragraph (c), before providing direct contact services to a client;
(3) is working in a day treatment program under section 256B.0671, subdivision 3, or
256B.0943; deleted text begin or
deleted text end
(4) has completed a practicum or internship that (i) required direct interaction with adult
clients or child clients, and (ii) was focused on behavioral sciences or related fieldsdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) is in the process of completing a practicum or internship as part of a formal
undergraduate or graduate training program in social work, psychology, or counseling.
new text end
(c) An individual is qualified as a mental health practitioner through work experience
if the individual:
(1) has at least 4,000 hours of experience in the delivery of services to individuals with:
(i) a mental illness or a substance use disorder; or
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients; or
(2) receives treatment supervision at least once per week until meeting the requirement
in clause (1) of 4,000 hours of experience and has at least 2,000 hours of experience providing
services to individuals with:
(i) a mental illness or a substance use disorder; or
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients.
(d) An individual is qualified as a mental health practitioner if the individual has a
master's or other graduate degree in behavioral sciences or related fields.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 16.
Minnesota Statutes 2021 Supplement, section 245I.05, subdivision 3, is amended
to read:
Subd. 3.
Initial training.
(a) A staff person must receive training about:
(1) vulnerable adult maltreatment under section 245A.65, subdivision 3; and
(2) the maltreatment of minor reporting requirements and definitions in chapter 260E
within 72 hours of first providing direct contact services to a client.
(b) Before providing direct contact services to a client, a staff person must receive training
about:
(1) client rights and protections under section 245I.12;
(2) the Minnesota Health Records Act, including client confidentiality, family engagement
under section 144.294, and client privacy;
(3) emergency procedures that the staff person must follow when responding to a fire,
inclement weather, a report of a missing person, and a behavioral or medical emergency;
(4) specific activities and job functions for which the staff person is responsible, including
the license holder's program policies and procedures applicable to the staff person's position;
(5) professional boundaries that the staff person must maintain; and
(6) specific needs of each client to whom the staff person will be providing direct contact
services, including each client's developmental status, cognitive functioning, and physical
and mental abilities.
(c) Before providing direct contact services to a client, a mental health rehabilitation
worker, mental health behavioral aide, or mental health practitioner deleted text begin qualified underdeleted text end new text begin required
to receive the training according tonew text end section 245I.04, subdivision 4, must receive 30 hours
of training about:
(1) mental illnesses;
(2) client recovery and resiliency;
(3) mental health de-escalation techniques;
(4) co-occurring mental illness and substance use disorders; and
(5) psychotropic medications and medication side effects.
(d) Within 90 days of first providing direct contact services to an adult client, a clinical
trainee, mental health practitioner, mental health certified peer specialist, or mental health
rehabilitation worker must receive training about:
(1) trauma-informed care and secondary trauma;
(2) person-centered individual treatment plans, including seeking partnerships with
family and other natural supports;
(3) co-occurring substance use disorders; and
(4) culturally responsive treatment practices.
(e) Within 90 days of first providing direct contact services to a child client, a clinical
trainee, mental health practitioner, mental health certified family peer specialist, mental
health certified peer specialist, or mental health behavioral aide must receive training about
the topics in clauses (1) to (5). This training must address the developmental characteristics
of each child served by the license holder and address the needs of each child in the context
of the child's family, support system, and culture. Training topics must include:
(1) trauma-informed care and secondary trauma, including adverse childhood experiences
(ACEs);
(2) family-centered treatment plan development, including seeking partnership with a
child client's family and other natural supports;
(3) mental illness and co-occurring substance use disorders in family systems;
(4) culturally responsive treatment practices; and
(5) child development, including cognitive functioning, and physical and mental abilities.
(f) For a mental health behavioral aide, the training under paragraph (e) must include
parent team training using a curriculum approved by the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 17.
Minnesota Statutes 2021 Supplement, section 245I.08, subdivision 4, is amended
to read:
Subd. 4.
Progress notes.
A license holder must use a progress note to document each
occurrence of a mental health service that a staff person provides to a client. A progress
note must include the following:
(1) the type of service;
(2) the date of service;
(3) the start and stop time of the service unless the license holder is licensed as a
residential program;
(4) the location of the service;
(5) the scope of the service, including: (i) the targeted goal and objective; (ii) the
intervention that the staff person provided to the client and the methods that the staff person
used; (iii) the client's response to the intervention; (iv) the staff person's plan to take future
actions, including changes in treatment that the staff person will implement if the intervention
was ineffective; and (v) the service modality;
(6) the signaturedeleted text begin , printed name,deleted text end and credentials of the staff person who provided the
service to the client;
(7) the mental health provider travel documentation required by section 256B.0625, if
applicable; and
(8) significant observations by the staff person, if applicable, including: (i) the client's
current risk factors; (ii) emergency interventions by staff persons; (iii) consultations with
or referrals to other professionals, family, or significant others; and (iv) changes in the
client's mental or physical symptoms.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 18.
Minnesota Statutes 2021 Supplement, section 245I.09, subdivision 2, is amended
to read:
Subd. 2.
Record retention.
A license holder must retain client records of a discharged
client for a minimum of five years from the date of the client's discharge. A license holder
who deleted text begin ceases to provide treatment services to a clientdeleted text end new text begin closes a programnew text end must retain deleted text begin thedeleted text end new text begin anew text end
client's records for a minimum of five years from the date that the license holder stopped
providing services to the client and must notify the commissioner of the location of the
client records and the name of the individual responsible for storing and maintaining the
client records.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 19.
Minnesota Statutes 2021 Supplement, section 245I.10, subdivision 2, is amended
to read:
Subd. 2.
Generally.
(a) A license holder must use a client's diagnostic assessment or
crisis assessment to determine a client's eligibility for mental health services, except as
provided in this section.
(b) Prior to completing a client's initial diagnostic assessment, a license holder may
provide a client with the following services:
(1) an explanation of findings;
(2) neuropsychological testing, neuropsychological assessment, and psychological
testing;
(3) any combination of psychotherapy sessions, family psychotherapy sessions, and
family psychoeducation sessions not to exceed three sessions;
(4) crisis assessment services according to section 256B.0624; and
(5) ten days of intensive residential treatment services according to the assessment and
treatment planning standards in section deleted text begin 245.23deleted text end new text begin 245I.23new text end , subdivision 7.
(c) Based on the client's needs that a crisis assessment identifies under section 256B.0624,
a license holder may provide a client with the following services:
(1) crisis intervention and stabilization services under section 245I.23 or 256B.0624;
and
(2) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization.
(d) Based on the client's needs in the client's brief diagnostic assessment, a license holder
may provide a client with any combination of psychotherapy sessions, group psychotherapy
sessions, family psychotherapy sessions, and family psychoeducation sessions not to exceed
ten sessions within a 12-month period without prior authorization for any new client or for
an existing client who the license holder projects will need fewer than ten sessions during
the next 12 months.
(e) Based on the client's needs that a hospital's medical history and presentation
examination identifies, a license holder may provide a client with:
(1) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization for any new client or for an existing
client who the license holder projects will need fewer than ten sessions during the next 12
months; and
(2) up to five days of day treatment services or partial hospitalization.
(f) A license holder must complete a new standard diagnostic assessment of a client:
(1) when the client requires services of a greater number or intensity than the services
that paragraphs (b) to (e) describe;
(2) at least annually following the client's initial diagnostic assessment if the client needs
additional mental health services and the client does not meet the criteria for a brief
assessment;
(3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; or
(4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis.
(g) For an existing client, the license holder must ensure that a new standard diagnostic
assessment includes a written update containing all significant new or changed information
about the client, and an update regarding what information has not significantly changed,
including a discussion with the client about changes in the client's life situation, functioning,
presenting problems, and progress with achieving treatment goals since the client's last
diagnostic assessment was completed.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2021 Supplement, section 245I.10, subdivision 6, is amended
to read:
Subd. 6.
Standard diagnostic assessment; required elements.
(a) Only a mental health
professional or a clinical trainee may complete a standard diagnostic assessment of a client.
A standard diagnostic assessment of a client must include a face-to-face interview with a
client and a written evaluation of the client. The assessor must complete a client's standard
diagnostic assessment within the client's cultural context.
(b) When completing a standard diagnostic assessment of a client, the assessor must
gather and document information about the client's current life situation, including the
following information:
(1) the client's age;
(2) the client's current living situation, including the client's housing status and household
members;
(3) the status of the client's basic needs;
(4) the client's education level and employment status;
(5) the client's current medications;
(6) any immediate risks to the client's health and safety;
(7) the client's perceptions of the client's condition;
(8) the client's description of the client's symptoms, including the reason for the client's
referral;
(9) the client's history of mental health treatment; and
(10) cultural influences on the client.
(c) If the assessor cannot obtain the information that this deleted text begin subdivisiondeleted text end new text begin paragraphnew text end requires
without retraumatizing the client or harming the client's willingness to engage in treatment,
the assessor must identify which topics will require further assessment during the course
of the client's treatment. The assessor must gather and document information related to the
following topics:
(1) the client's relationship with the client's family and other significant personal
relationships, including the client's evaluation of the quality of each relationship;
(2) the client's strengths and resources, including the extent and quality of the client's
social networks;
(3) important developmental incidents in the client's life;
(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;
(5) the client's history of or exposure to alcohol and drug usage and treatment; and
(6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.
(d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.
(1) When completing a standard diagnostic assessment of a client who is five years of
age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood
published by Zero to Three.
(2) When completing a standard diagnostic assessment of a client who is six years of
age or older, the assessor must use the current edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.
(3) When completing a standard diagnostic assessment of a client who is five years of
age or younger, an assessor must administer the Early Childhood Service Intensity Instrument
(ECSII) to the client and include the results in the client's assessment.
(4) When completing a standard diagnostic assessment of a client who is six to 17 years
of age, an assessor must administer the Child and Adolescent Service Intensity Instrument
(CASII) to the client and include the results in the client's assessment.
(5) When completing a standard diagnostic assessment of a client who is 18 years of
age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the criteria
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association to screen and assess the client for a
substance use disorder.
(e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:
(1) the client's mental status examination;
(2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources;
vulnerabilities; safety needs, including client information that supports the assessor's findings
after applying a recognized diagnostic framework from paragraph (d); and any differential
diagnosis of the client;
(3) an explanation of: (i) how the assessor diagnosed the client using the information
from the client's interview, assessment, psychological testing, and collateral information
about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths;
and (v) the client's responsivity factors.
(f) When completing a standard diagnostic assessment of a client, the assessor must
consult the client and the client's family about which services that the client and the family
prefer to treat the client. The assessor must make referrals for the client as to services required
by law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 21.
Minnesota Statutes 2021 Supplement, section 245I.20, subdivision 5, is amended
to read:
Subd. 5.
Treatment supervision specified.
(a) A mental health professional must remain
responsible for each client's case. The certification holder must document the name of the
mental health professional responsible for each case and the dates that the mental health
professional is responsible for the client's case from beginning date to end date. The
certification holder must assign each client's case for assessment, diagnosis, and treatment
services to a treatment team member who is competent in the assigned clinical service, the
recommended treatment strategy, and in treating the client's characteristics.
(b) Treatment supervision of mental health practitioners and clinical trainees required
by section 245I.06 must include case reviews as described in this paragraph. Every two
months, a mental health professional must completenew text begin and documentnew text end a case review of each
client assigned to the mental health professional when the client is receiving clinical services
from a mental health practitioner or clinical trainee. The case review must include a
consultation process that thoroughly examines the client's condition and treatment, including:
(1) a review of the client's reason for seeking treatment, diagnoses and assessments, and
the individual treatment plan; (2) a review of the appropriateness, duration, and outcome
of treatment provided to the client; and (3) treatment recommendations.
Sec. 22.
Minnesota Statutes 2021 Supplement, section 245I.23, subdivision 22, is amended
to read:
Subd. 22.
Additional policy and procedure requirements.
(a) In addition to the policies
and procedures in section 245I.03, the license holder must establish, enforce, and maintain
the policies and procedures in this subdivision.
(b) The license holder must have policies and procedures for receiving referrals and
making admissions determinations about referred persons under subdivisions deleted text begin 14 to 16deleted text end new text begin 15
to 17new text end .
(c) The license holder must have policies and procedures for discharging clients under
subdivision deleted text begin 17deleted text end new text begin 18new text end . In the policies and procedures, the license holder must identify the staff
persons who are authorized to discharge clients from the program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 23.
Minnesota Statutes 2021 Supplement, section 254B.05, subdivision 5, is amended
to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific or culturally responsive programs as defined in section 254B.01,
subdivision 4a;
(3) disability responsive programs as defined in section 254B.01, subdivision 4b;
(4) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; or
(5) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionalsdeleted text begin , as defined
in section 245.462, subdivision 18, clauses (1) to (6)deleted text end new text begin under section 245I.04, subdivision 2new text end ,
or are students or licensing candidates under the supervision of a licensed alcohol and drug
counselor supervisor and deleted text begin licenseddeleted text end mental health professionalnew text begin under section 245I.04,
subdivision 2new text end , except that no more than 50 percent of the mental health staff may be students
or licensing candidates with time documented to be directly related to provisions of
co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, substance use disorder services that are otherwise covered
as direct face-to-face services may be provided via telehealth as defined in section 256B.0625,
subdivision 3b. The use of telehealth to deliver services must be medically appropriate to
the condition and needs of the person being served. Reimbursement shall be at the same
rates and under the same conditions that would otherwise apply to direct face-to-face services.
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
(h) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 24.
Minnesota Statutes 2021 Supplement, section 256B.0622, subdivision 2, is
amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them.
(b) "ACT team" means the group of interdisciplinary mental health staff who work as
a team to provide assertive community treatment.
(c) "Assertive community treatment" means intensive nonresidential treatment and
rehabilitative mental health services provided according to the assertive community treatment
model. Assertive community treatment provides a single, fixed point of responsibility for
treatment, rehabilitation, and support needs for clients. Services are offered 24 hours per
day, seven days per week, in a community-based setting.
(d) "Individual treatment plan" means a plan described by section 245I.10, subdivisions
7 and 8.
(e) "Crisis assessment and intervention" means deleted text begin mental healthdeleted text end new text begin mobilenew text end crisis response
services deleted text begin as defined indeleted text end new text begin undernew text end section 256B.0624deleted text begin , subdivision 2deleted text end .
(f) "Individual treatment team" means a minimum of three members of the ACT team
who are responsible for consistently carrying out most of a client's assertive community
treatment services.
(g) "Primary team member" means the person who leads and coordinates the activities
of the individual treatment team and is the individual treatment team member who has
primary responsibility for establishing and maintaining a therapeutic relationship with the
client on a continuing basis.
(h) "Certified rehabilitation specialist" means a staff person who is qualified according
to section 245I.04, subdivision 8.
(i) "Clinical trainee" means a staff person who is qualified according to section 245I.04,
subdivision 6.
(j) "Mental health certified peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 10.
(k) "Mental health practitioner" means a staff person who is qualified according to section
245I.04, subdivision 4.
(l) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
(m) "Mental health rehabilitation worker" means a staff person who is qualified according
to section 245I.04, subdivision 14.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 25.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 3b, is
amended to read:
Subd. 3b.
Telehealth services.
(a) Medical assistance covers medically necessary services
and consultations delivered by a health care provider through telehealth in the same manner
as if the service or consultation was delivered through in-person contact. Services or
consultations delivered through telehealth shall be paid at the full allowable rate.
(b) The commissioner may establish criteria that a health care provider must attest to in
order to demonstrate the safety or efficacy of delivering a particular service through
telehealth. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
through telehealth;
(2) has written policies and procedures specific to services delivered through telehealth
that are regularly reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the service is delivered through telehealth;
(4) has established protocols addressing how and when to discontinue telehealth services;
and
(5) has an established quality assurance process related to delivering services through
telehealth.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service delivered through telehealth to a medical assistance enrollee.
Health care service records for services delivered through telehealth must meet the
requirements set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must
document:
(1) the type of service delivered through telehealth;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the health care provider's basis for determining that telehealth is an appropriate and
effective means for delivering the service to the enrollee;
(4) the mode of transmission used to deliver the service through telehealth and records
evidencing that a particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's consultation with another physician
through telehealth, the written opinion from the consulting physician providing the telehealth
consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) Telehealth visitsdeleted text begin ,deleted text end as described in this subdivision provided through audio and visual
communicationdeleted text begin ,deleted text end new text begin or accessible video-based platformsnew text end may deleted text begin be used todeleted text end satisfy the face-to-face
requirement for reimbursement under the payment methods that apply to a federally qualified
health center, rural health clinic, Indian health service, 638 tribal clinic, and certified
community behavioral health clinic, if the service would have otherwise qualified for
payment if performed in person.new text begin Beginning July 1, 2021, visits provided through telephone
may satisfy the face-to-face requirement for reimbursement under these payment methods
if the service would have otherwise qualified for payment if performed in person until the
COVID-19 federal public health emergency ends or July 1, 2023, whichever is earlier.
new text end
deleted text begin
(e) For mental health services or assessments delivered through telehealth that are based
on an individual treatment plan, the provider may document the client's verbal approval or
electronic written approval of the treatment plan or change in the treatment plan in lieu of
the client's signature in accordance with Minnesota Rules, part 9505.0371.
deleted text end
deleted text begin (f)deleted text end new text begin (e)new text end For purposes of this subdivision, unless otherwise covered under this chapter:
(1) "telehealth" means the delivery of health care services or consultations through the
use of real-time two-way interactive audio and visual communication to provide or support
health care delivery and facilitate the assessment, diagnosis, consultation, treatment,
education, and care management of a patient's health care. Telehealth includes the application
of secure video conferencing, store-and-forward technology, and synchronous interactions
between a patient located at an originating site and a health care provider located at a distant
site. Telehealth does not include communication between health care providers, or between
a health care provider and a patient that consists solely of an audio-only communication,
e-mail, or facsimile transmission or as specified by law;
(2) "health care provider" means a health care provider as defined under section 62A.673,
a community paramedic as defined under section 144E.001, subdivision 5f, a community
health worker who meets the criteria under subdivision 49, paragraph (a), a mental health
certified peer specialist under section deleted text begin 256B.0615, subdivision 5deleted text end new text begin 245I.04, subdivision 10new text end , a
mental health certified family peer specialist under section deleted text begin 256B.0616, subdivision 5deleted text end new text begin 245I.04,
subdivision 12new text end , a mental health rehabilitation worker under section deleted text begin 256B.0623, subdivision
5, paragraph (a), clause (4), and paragraph (b)deleted text end new text begin 245I.04, subdivision 14new text end , a mental health
behavioral aide under section deleted text begin 256B.0943, subdivision 7, paragraph (b), clause (3)deleted text end new text begin 245I.04,
subdivision 16new text end , a treatment coordinator under section 245G.11, subdivision 7, an alcohol
and drug counselor under section 245G.11, subdivision 5,new text begin ornew text end a recovery peer under section
245G.11, subdivision 8; and
(3) "originating site," "distant site," and "store-and-forward technology" have the
meanings given in section 62A.673, subdivision 2.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later, except that the amendment to paragraph (d) is effective retroactively
from July 1, 2021, and expires when the COVID-19 federal public health emergency ends
or July 1, 2023, whichever is earlier. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained and when the amendments to paragraph
(d) expire.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256B.0659, subdivision 19, is amended to read:
Subd. 19.
Personal care assistance choice option; qualifications; duties.
(a) Under
personal care assistance choice, the recipient or responsible party shall:
(1) recruit, hire, schedule, and terminate personal care assistants according to the terms
of the written agreement required under subdivision 20, paragraph (a);
(2) develop a personal care assistance care plan based on the assessed needs and
addressing the health and safety of the recipient with the assistance of a qualified professional
as needed;
(3) orient and train the personal care assistant with assistance as needed from the qualified
professional;
(4) deleted text begin effective January 1, 2010,deleted text end supervise and evaluate the personal care assistant with the
qualified professional, who is required to visit the recipient at least every 180 days;
(5) monitor and verify in writing and report to the personal care assistance choice agency
the number of hours worked by the personal care assistant and the qualified professional;
(6) engage in an annual deleted text begin face-to-facedeleted text end reassessmentnew text begin as required in subdivision 3anew text end to
determine continuing eligibility and service authorization; and
(7) use the same personal care assistance choice provider agency if shared personal
assistance care is being used.
(b) The personal care assistance choice provider agency shall:
(1) meet all personal care assistance provider agency standards;
(2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;
(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal
care assistant; and
(4) ensure arm's-length transactions without undue influence or coercion with the recipient
and personal care assistant.
(c) The duties of the personal care assistance choice provider agency are to:
(1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation includingdeleted text begin ,deleted text end but not
limited todeleted text begin ,deleted text end workers' compensation, unemployment insurance, and labor market data required
under section 256B.4912, subdivision 1a;
(2) bill the medical assistance program for personal care assistance services and qualified
professional services;
(3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;
(4) pay the personal care assistant and qualified professional based on actual hours of
services provided;
(5) withhold and pay all applicable federal and state taxes;
(6) verify and keep records of hours worked by the personal care assistant and qualified
professional;
(7) make the arrangements and pay taxes and other benefits, if any, and comply with
any legal requirements for a Minnesota employer;
(8) enroll in the medical assistance program as a personal care assistance choice agency;
and
(9) enter into a written agreement as specified in subdivision 20 before services are
provided.
Sec. 27.
Minnesota Statutes 2021 Supplement, section 256B.0671, subdivision 6, is
amended to read:
Subd. 6.
Dialectical behavior therapy.
(a) Subject to federal approval, medical assistance
covers intensive mental health outpatient treatment for dialectical behavior therapy for
adults. A dialectical behavior therapy provider must make reasonable and good faith efforts
to report individual client outcomes to the commissioner using instruments and protocols
that are approved by the commissioner.
(b) "Dialectical behavior therapy" means an evidence-based treatment approach that a
mental health professional or clinical trainee provides to a client or a group of clients in an
intensive outpatient treatment program using a combination of individualized rehabilitative
and psychotherapeutic interventions. A dialectical behavior therapy program involves:
individual dialectical behavior therapy, group skills training, telephone coaching, and team
consultation meetings.
(c) To be eligible for dialectical behavior therapy, a client must:
deleted text begin
(1) be 18 years of age or older;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end have mental health needs that available community-based services cannot meet
or that the client must receive concurrently with other community-based services;
deleted text begin (3)deleted text end new text begin (2)new text end have either:
(i) a diagnosis of borderline personality disorder; or
(ii) multiple mental health diagnoses, exhibit behaviors characterized by impulsivity or
intentional self-harm, and be at significant risk of death, morbidity, disability, or severe
dysfunction in multiple areas of the client's life;
deleted text begin (4)deleted text end new text begin (3)new text end be cognitively capable of participating in dialectical behavior therapy as an
intensive therapy program and be able and willing to follow program policies and rules to
ensure the safety of the client and others; and
deleted text begin (5)deleted text end new text begin (4)new text end be at significant risk of one or more of the following if the client does not receive
dialectical behavior therapy:
(i) having a mental health crisis;
(ii) requiring a more restrictive setting such as hospitalization;
(iii) decompensating; or
(iv) engaging in intentional self-harm behavior.
(d) Individual dialectical behavior therapy combines individualized rehabilitative and
psychotherapeutic interventions to treat a client's suicidal and other dysfunctional behaviors
and to reinforce a client's use of adaptive skillful behaviors. A mental health professional
or clinical trainee must provide individual dialectical behavior therapy to a client. A mental
health professional or clinical trainee providing dialectical behavior therapy to a client must:
(1) identify, prioritize, and sequence the client's behavioral targets;
(2) treat the client's behavioral targets;
(3) assist the client in applying dialectical behavior therapy skills to the client's natural
environment through telephone coaching outside of treatment sessions;
(4) measure the client's progress toward dialectical behavior therapy targets;
(5) help the client manage mental health crises and life-threatening behaviors; and
(6) help the client learn and apply effective behaviors when working with other treatment
providers.
(e) Group skills training combines individualized psychotherapeutic and psychiatric
rehabilitative interventions conducted in a group setting to reduce the client's suicidal and
other dysfunctional coping behaviors and restore function. Group skills training must teach
the client adaptive skills in the following areas: (1) mindfulness; (2) interpersonal
effectiveness; (3) emotional regulation; and (4) distress tolerance.
(f) Group skills training must be provided by two mental health professionals or by a
mental health professional co-facilitating with a clinical trainee or a mental health practitioner.
Individual skills training must be provided by a mental health professional, a clinical trainee,
or a mental health practitioner.
(g) Before a program provides dialectical behavior therapy to a client, the commissioner
must certify the program as a dialectical behavior therapy provider. To qualify for
certification as a dialectical behavior therapy provider, a provider must:
(1) allow the commissioner to inspect the provider's program;
(2) provide evidence to the commissioner that the program's policies, procedures, and
practices meet the requirements of this subdivision and chapter 245I;
(3) be enrolled as a MHCP provider; and
(4) have a manual that outlines the program's policies, procedures, and practices that
meet the requirements of this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 28.
Minnesota Statutes 2021 Supplement, section 256B.0911, subdivision 3a, is
amended to read:
Subd. 3a.
Assessment and support planning.
(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment deleted text begin in orderdeleted text end to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services. The commissioner shall provide at least a
90-day notice to lead agencies prior to the effective date of this requirement. Assessments
must be conducted according to paragraphs (b) to (r).
(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.
(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, conversation-based, person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a person-centered community support
plan that meets the individual's needs and preferences.
(d) Except as provided in paragraph (r), the assessment must be conducted by a certified
assessor in a face-to-face conversational interview with the person being assessed. The
person's legal representative must provide input during the assessment process and may do
so remotely if requested. At the request of the person, other individuals may participate in
the assessment to provide information on the needs, strengths, and preferences of the person
necessary to develop a community support plan that ensures the person's health and safety.
Except for legal representatives or family members invited by the person, persons
participating in the assessment may not be a provider of service or have any financial interest
in the provision of services. For persons who are to be assessed for elderly waiver customized
living or adult day services under chapter 256S, with the permission of the person being
assessed or the person's designated or legal representative, the client's current or proposed
provider of services may submit a copy of the provider's nursing assessment or written
report outlining its recommendations regarding the client's care needs. The person conducting
the assessment must notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment prior
to the assessment. For a person who is to be assessed for waiver services under section
256B.092 or 256B.49, with the permission of the person being assessed or the person's
designated legal representative, the person's current provider of services may submit a
written report outlining recommendations regarding the person's care needs the person
completed in consultation with someone who is known to the person and has interaction
with the person on a regular basis. The provider must submit the report at least 60 days
before the end of the person's current service agreement. The certified assessor must consider
the content of the submitted report prior to finalizing the person's assessment or reassessment.
(e) The certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit. The
person or the person's legal representative must be provided with a written community
support plan within the timelines established by the commissioner, regardless of whether
the person is eligible for Minnesota health care programs.
(f) For a person being assessed for elderly waiver services under chapter 256S, a provider
who submitted information under paragraph (d) shall receive the final written community
support plan when available and the Residential Services Workbook.
(g) The written community support plan must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including:
(i) all available options for case management services and providers;
(ii) all available options for employment services, settings, and providers;
(iii) all available options for living arrangements;
(iv) all available options for self-directed services and supports, including self-directed
budget options; and
(v) service provided in a non-disability-specific setting;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.
(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.
(i) The person has the right to make the final decision:
(1) between institutional placement and community placement after the recommendations
have been provided, except as provided in section 256.975, subdivision 7a, paragraph (d);
(2) between community placement in a setting controlled by a provider and living
independently in a setting not controlled by a provider;
(3) between day services and employment services; and
(4) regarding available options for self-directed services and supports, including
self-directed funding options.
(j) The lead agency must give the person receiving long-term care consultation services
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
(1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
chapter 256S or section 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;
(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);
(5) information about Minnesota health care programs;
(6) the person's freedom to accept or reject the recommendations of the team;
(7) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;
(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b);
(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. The certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated;
and
(10) documentation that available options for employment services, independent living,
and self-directed services and supports were described to the individual.
(k) An assessment that is completed as part of an eligibility determination for multiple
programs for the alternative care, elderly waiver, developmental disabilities, community
access for disability inclusion, community alternative care, and brain injury waiver programs
under chapter 256S and sections 256B.0913, 256B.092, and 256B.49 is valid to establish
service eligibility for no more than 60 calendar days after the date of the assessment.
(l) The effective eligibility start date for programs in paragraph (k) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.
(m) If an eligibility update is completed within 90 days of the previous assessment and
documented in the department's Medicaid Management Information System (MMIS), the
effective date of eligibility for programs included in paragraph (k) is the date of the previous
face-to-face assessment when all other eligibility requirements are met.
(n) If a person who receives home and community-based waiver services under section
256B.0913, 256B.092, or 256B.49 or chapter 256S temporarily enters for 121 days or fewer
a hospital, institution of mental disease, nursing facility, intensive residential treatment
services program, transitional care unit, or inpatient substance use disorder treatment setting,
the person may return to the community with home and community-based waiver services
under the same waiver, without requiring an assessment or reassessment under this section,
unless the person's annual reassessment is otherwise due. Nothing in this paragraph shall
change annual long-term care consultation reassessment requirements, payment for
institutional or treatment services, medical assistance financial eligibility, or any other law.
(o) At the time of reassessment, the certified assessor shall assess each person receiving
waiver residential supports and services currently residing in a community residential setting,
licensed adult foster care home that is either not the primary residence of the license holder
or in which the license holder is not the primary caregiver, family adult foster care residence,
customized living setting, or supervised living facility to determine if that person would
prefer to be served in a community-living setting as defined in section 256B.49, subdivision
23, in a setting not controlled by a provider, or to receive integrated community supports
as described in section 245D.03, subdivision 1, paragraph (c), clause (8). The certified
assessor shall offer the person, through a person-centered planning process, the option to
receive alternative housing and service options.
(p) At the time of reassessment, the certified assessor shall assess each person receiving
waiver day services to determine if that person would prefer to receive employment services
as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7). The certified
assessor shall describe to the person through a person-centered planning process the option
to receive employment services.
(q) At the time of reassessment, the certified assessor shall assess each person receiving
non-self-directed waiver services to determine if that person would prefer an available
service and setting option that would permit self-directed services and supports. The certified
assessor shall describe to the person through a person-centered planning process the option
to receive self-directed services and supports.
(r) All assessments performed according to this subdivision must be face-to-face unless
the assessment is a reassessment meeting the requirements of this paragraph. Remote
reassessments conducted by interactive video or telephone may substitute for face-to-face
reassessments. For services provided by the developmental disabilities waiver under section
256B.092, and the community access for disability inclusion, community alternative care,
and brain injury waiver programs under section 256B.49, remote reassessments may be
substituted for two consecutive reassessments if followed by a face-to-face reassessment.
For services provided by alternative care under section 256B.0913, essential community
supports under section 256B.0922, and the elderly waiver under chapter 256S, remote
reassessments may be substituted for one reassessment if followed by a face-to-face
reassessment. A remote reassessment is permitted only if the person being reassesseddeleted text begin , or
the person's legal representative, and the lead agency case manager both agree that there is
no change in the person's condition, there is no need for a change in service, and that a
remote reassessment is appropriatedeleted text end new text begin or the person's legal representative provide informed
choice for a remote assessmentnew text end . The person being reassessed, or the person's legal
representative, has the right to refuse a remote reassessment at any time. During a remote
reassessment, if the certified assessor determines a face-to-face reassessment is necessary
deleted text begin in orderdeleted text end to complete the assessment, the lead agency shall schedule a face-to-face
reassessment. All other requirements of a face-to-face reassessment shall apply to a remote
reassessment, including updates to a person's support plan.
Sec. 29.
Minnesota Statutes 2021 Supplement, section 256B.0946, subdivision 1, is
amended to read:
Subdivision 1.
Required covered service components.
(a) Subject to federal approval,
medical assistance covers medically necessary intensive treatment services when the services
are provided by a provider entity certified under and meeting the standards in this section.
The provider entity must make reasonable and good faith efforts to report individual client
outcomes to the commissioner, using instruments and protocols approved by the
commissioner.
(b) Intensive treatment services to children with mental illness residing in foster family
settings that comprise specific required service components provided in clauses (1) to (6)
are reimbursed by medical assistance when they meet the following standards:
(1) psychotherapy provided by a mental health professional or a clinical trainee;
(2) crisis planning;
(3) individual, family, and group psychoeducation services provided by a mental health
professional or a clinical trainee;
(4) clinical care consultation provided by a mental health professional or a clinical
trainee;
(5) individual treatment plan development as defined in deleted text begin Minnesota Rules, part 9505.0371,
subpart 7deleted text end new text begin section 245I.10, subdivisions 7 and 8new text end ; and
(6) service delivery payment requirements as provided under subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 30.
Minnesota Statutes 2021 Supplement, section 256B.0947, subdivision 2, is
amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Intensive nonresidential rehabilitative mental health services" means child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
who are eight years of age or older and under 26 years of age who require intensive services
to prevent admission to an inpatient psychiatric hospital or placement in a residential
treatment facility or who require intensive services to step down from inpatient or residential
care to community-based care.
(b) "Co-occurring mental illness and substance use disorder" means a dual diagnosis of
at least one form of mental illness and at least one substance use disorder. Substance use
disorders include alcohol or drug abuse or dependence, excluding nicotine use.
(c) "Standard diagnostic assessment" means the assessment described in section 245I.10,
subdivision 6.
(d) "Medication education services" means services provided individually or in groups,
which focus on:
(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;
(2) the role and effects of medications in treating symptoms of mental illness; and
(3) the side effects of medications.
Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
(e) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
(f) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
(g) "Substance use disorders" means one or more of the disorders defined in the diagnostic
and statistical manual of mental disorders, current edition.
(h) "Transition services" means:
(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;
(2) providing the client with knowledge and skills needed posttransition;
(3) establishing communication between sending and receiving entities;
(4) supporting a client's request for service authorization and enrollment; and
(5) establishing and enforcing procedures and schedules.
deleted text begin
A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.
deleted text end
(i) "Treatment team" means all staff who provide services to recipients under this section.
(j) "Family peer specialist" means a staff person who is qualified under section
256B.0616.
Sec. 31.
Minnesota Statutes 2021 Supplement, section 256B.0947, subdivision 6, is
amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The level of care assessment as defined in section 245I.02, subdivision 19, and
functional assessment as defined in section 245I.02, subdivision 17, must be updated at
least every deleted text begin 90 daysdeleted text end new text begin six monthsnew text end or prior to discharge from the service, whichever comes
first.
(e) The treatment team must complete an individual treatment plan for each client,
according to section 245I.10, subdivisions 7 and 8, and the individual treatment plan must:
(1) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(2) if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment;
(ii) develop a schedule for accomplishing substance use disorder treatment goals and
objectives; and
(iii) identify the individuals responsible for providing substance use disorder treatment
services and supports;new text begin and
new text end
(3) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" servicesdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) notwithstanding section 245I.10, subdivision 8, be reviewed at least every 90 days
and revised to document treatment progress or, if progress is not documented, to document
changes in treatment.
deleted text end
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 32.
Minnesota Statutes 2021 Supplement, section 256B.0949, subdivision 2, is
amended to read:
Subd. 2.
Definitions.
(a) The terms used in this section have the meanings given in this
subdivision.
(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.
(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:
(1) is severe and chronic;
(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;
(3) requires treatment or services similar to those required for a person with ASD; and
(4) results in substantial functional limitations in three core developmental deficits of
ASD: social or interpersonal interaction; functional communication, including nonverbal
or social communication; and restrictive or repetitive behaviors or hyperreactivity or
hyporeactivity to sensory input; and may include deficits or a high level of support in one
or more of the following domains:
(i) behavioral challenges and self-regulation;
(ii) cognition;
(iii) learning and play;
(iv) self-care; or
(v) safety.
(d) "Person" means a person under 21 years of age.
(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.
(f) "Commissioner" means the commissioner of human services, unless otherwise
specified.
(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.
(h) "Department" means the Department of Human Services, unless otherwise specified.
(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means a variety of individualized, intensive treatment modalities approved and
published by the commissioner that are based in behavioral and developmental science
consistent with best practices on effectiveness.
(j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and people, and in different environments includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end clinics, homes,
schools, and the community.
(k) "Incident" means when any of the following occur:
(1) an illness, accident, or injury that requires first aid treatment;
(2) a bump or blow to the head; or
(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.
(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.
(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.
(n) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.
(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.
new text begin
(q) "Advanced certification" means a person who has completed advanced certification
in an approved modality under subdivision 13, paragraph (b).
new text end
Sec. 33.
Minnesota Statutes 2021 Supplement, section 256B.0949, subdivision 13, is
amended to read:
Subd. 13.
Covered services.
(a) The services described in paragraphs (b) to (l) are
eligible for reimbursement by medical assistance under this section. Services must be
provided by a qualified EIDBI provider and supervised by a QSP. An EIDBI service must
address the person's medically necessary treatment goals and must be targeted to develop,
enhance, or maintain the individual developmental skills of a person with ASD or a related
condition to improve functional communication, including nonverbal or social
communication, social or interpersonal interaction, restrictive or repetitive behaviors,
hyperreactivity or hyporeactivity to sensory input, behavioral challenges and self-regulation,
cognition, learning and play, self-care, and safety.
(b) EIDBI treatment must be delivered consistent with the standards of an approved
modality, as published by the commissioner. EIDBI modalities include:
(1) applied behavior analysis (ABA);
(2) developmental individual-difference relationship-based model (DIR/Floortime);
(3) early start Denver model (ESDM);
(4) PLAY project;
(5) relationship development intervention (RDI); or
(6) additional modalities not listed in clauses (1) to (5) upon approval by the
commissioner.
(c) An EIDBI provider may use one or more of the EIDBI modalities in paragraph (b),
clauses (1) to (5), as the primary modality for treatment as a covered service, or several
EIDBI modalities in combination as the primary modality of treatment, as approved by the
commissioner. An EIDBI provider that identifies and provides assurance of qualifications
for a single specific treatment modalitynew text begin , including an EIDBI provider with advanced
certification overseeing implementation,new text end must document the required qualifications to meet
fidelity to the specific modelnew text begin in a manner determined by the commissionernew text end .
(d) Each qualified EIDBI provider must identify and provide assurance of qualifications
for professional licensure certification, or training in evidence-based treatment methods,
and must document the required qualifications outlined in subdivision 15 in a manner
determined by the commissioner.
(e) CMDE is a comprehensive evaluation of the person's developmental status to
determine medical necessity for EIDBI services and meets the requirements of subdivision
5. The services must be provided by a qualified CMDE provider.
(f) EIDBI intervention observation and direction is the clinical direction and oversight
of EIDBI services by the QSP, level I treatment provider, or level II treatment provider,
including developmental and behavioral techniques, progress measurement, data collection,
function of behaviors, and generalization of acquired skills for the direct benefit of a person.
EIDBI intervention observation and direction informs any modification of the current
treatment protocol to support the outcomes outlined in the ITP.
(g) Intervention is medically necessary direct treatment provided to a person with ASD
or a related condition as outlined in their ITP. All intervention services must be provided
under the direction of a QSP. Intervention may take place across multiple settings. The
frequency and intensity of intervention services are provided based on the number of
treatment goals, person and family or caregiver preferences, and other factors. Intervention
services may be provided individually or in a group. Intervention with a higher provider
ratio may occur when deemed medically necessary through the person's ITP.
(1) Individual intervention is treatment by protocol administered by a single qualified
EIDBI provider delivered to one person.
(2) Group intervention is treatment by protocol provided by one or more qualified EIDBI
providers, delivered to at least two people who receive EIDBI services.
new text begin
(3) Higher provider ratio intervention is treatment with protocol modification provided
by two or more qualified EIDBI providers delivered to one person in an environment that
meets the person's needs and under the direction of the QSP or level I provider.
new text end
(h) ITP development and ITP progress monitoring is development of the initial, annual,
and progress monitoring of an ITP. ITP development and ITP progress monitoring documents
provide oversight and ongoing evaluation of a person's treatment and progress on targeted
goals and objectives and integrate and coordinate the person's and the person's legal
representative's information from the CMDE and ITP progress monitoring. This service
must be reviewed and completed by the QSP, and may include input from a level I provider
or a level II provider.
(i) Family caregiver training and counseling is specialized training and education for a
family or primary caregiver to understand the person's developmental status and help with
the person's needs and development. This service must be provided by the QSP, level I
provider, or level II provider.
(j) A coordinated care conference is a voluntary meeting with the person and the person's
family to review the CMDE or ITP progress monitoring and to integrate and coordinate
services across providers and service-delivery systems to develop the ITP. This service
deleted text begin must be provided by the QSP anddeleted text end may include the CMDE provider deleted text begin ordeleted text end new text begin , QSP,new text end a level I
providernew text begin ,new text end or a level II provider.
(k) Travel time is allowable billing for traveling to and from the person's home, school,
a community setting, or place of service outside of an EIDBI center, clinic, or office from
a specified location to provide in-person EIDBI intervention, observation and direction, or
family caregiver training and counseling. The person's ITP must specify the reasons the
provider must travel to the person.
(l) Medical assistance covers medically necessary EIDBI services and consultations
delivered deleted text begin by a licensed health care providerdeleted text end via telehealth, as defined under section
256B.0625, subdivision 3b, in the same manner as if the service or consultation was delivered
in person.
Sec. 34.
Minnesota Statutes 2020, section 256K.26, subdivision 2, is amended to read:
Subd. 2.
Implementation.
The commissioner, in consultation with the commissioners
of the Department of Corrections and the Minnesota Housing Finance Agency, counties,
new text begin Tribes, new text end providersnew text begin ,new text end and funders of supportive housing and services, shall develop application
requirements and make funds available according to this section, with the goal of providing
maximum flexibility in program design.
Sec. 35.
Minnesota Statutes 2020, section 256K.26, subdivision 6, is amended to read:
Subd. 6.
Outcomes.
Projects will be selected to further the following outcomes:
(1) reduce the number of Minnesota individuals and families that experience long-term
homelessness;
(2) increase the number of housing opportunities with supportive services;
(3) develop integrated, cost-effective service models that address the multiple barriers
to obtaining housing stability faced by people experiencing long-term homelessness,
including abuse, neglect, chemical dependency, disability, chronic health problems, or other
factors including ethnicity and race that may result in poor outcomes or service disparities;
(4) encourage partnerships among counties, new text begin Tribes, new text end community agencies, schools, and
other providers so that the service delivery system is seamless for people experiencing
long-term homelessness;
(5) increase employability, self-sufficiency, and other social outcomes for individuals
and families experiencing long-term homelessness; and
(6) reduce inappropriate use of emergency health care, shelter, deleted text begin chemical dependencydeleted text end new text begin
substance use disorder treatmentnew text end , foster care, child protection, corrections, and similar
services used by people experiencing long-term homelessness.
Sec. 36.
Minnesota Statutes 2020, section 256K.26, subdivision 7, is amended to read:
Subd. 7.
Eligible services.
Services eligible for funding under this section are all services
needed to maintain households in permanent supportive housing, as determined by the
deleted text begin county ordeleted text end countiesnew text begin or Tribesnew text end administering the project or projects.
Sec. 37.
Minnesota Statutes 2021 Supplement, section 256P.01, subdivision 6a, is amended
to read:
Subd. 6a.
Qualified professional.
(a) For illness, injury, or incapacity, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, physical therapist, occupational therapist, or licensed chiropractor, according to their
scope of practice.
(b) For developmental disability, learning disability, and intelligence testing, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, licensed independent clinical social worker, licensed psychologist, certified school
psychologist, or certified psychometrist working under the supervision of a licensed
psychologist.
(c) For mental health, a "qualified professional" means a licensed physician, advanced
practice registered nurse, or qualified mental health professional under section 245I.04,
subdivision 2.
(d) For substance use disorder, a "qualified professional" means a licensed physician, a
qualified mental health professional under section deleted text begin 245.462, subdivision 18, clauses (1) to
(6)deleted text end new text begin 245I.04, subdivision 2new text end , or an individual as defined in section 245G.11, subdivision 3,
4, or 5.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 38.
Minnesota Statutes 2020, section 256Q.06, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Account creation. new text end
new text begin
If an eligible individual is unable to establish the eligible
individual's own ABLE account, an ABLE account may be established on behalf of the
eligible individual by the eligible individual's agent under a power of attorney or, if none,
by the eligible individual's conservator or legal guardian, spouse, parent, sibling, or
grandparent or a representative payee appointed for the eligible individual by the Social
Security Administration, in that order.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 39.
Laws 2020, First Special Session chapter 7, section 1, subdivision 1, as amended
by Laws 2021, First Special Session chapter 7, article 2, section 71, is amended to read:
Subdivision 1.
Waivers and modifications; federal funding extension.
When the
peacetime emergency declared by the governor in response to the COVID-19 outbreak
expires, is terminated, or is rescinded by the proper authority, the following waivers and
modifications to human services programs issued by the commissioner of human services
pursuant to Executive Orders 20-11 and 20-12 deleted text begin that are required to comply with federal lawdeleted text end
may remain in effect for the time period set out in applicable federal law or for the time
period set out in any applicable federally approved waiver or state plan amendment,
whichever is later:
(1) CV15: allowing telephone or video visits for waiver programs;
(2) CV17: preserving health care coverage for Medical Assistance and MinnesotaCare;
(3) CV18: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(4) CV20: eliminating cost-sharing for COVID-19 diagnosis and treatment;
(5) CV24: allowing telephone or video use for targeted case management visits;
(6) CV30: expanding telemedicine in health care, mental health, and substance use
disorder settings;
(7) CV37: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(8) CV39: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(9) CV42: implementation of federal changes to the Supplemental Nutrition Assistance
Program;
(10) CV43: expanding remote home and community-based waiver services;
(11) CV44: allowing remote delivery of adult day services;
(12) CV59: modifying eligibility period for the federally funded Refugee Cash Assistance
Program;
(13) CV60: modifying eligibility period for the federally funded Refugee Social Services
Program; and
(14) CV109: providing 15 percent increase for Minnesota Food Assistance Program and
Minnesota Family Investment Program maximum food benefits.
Sec. 40. new text begin REVISOR INSTRUCTION.
new text end
new text begin
In Minnesota Statutes and Minnesota Rules, the revisor of statutes shall change the term
"chemical dependency" or similar terms to "substance use disorder." The revisor may make
grammatical changes related to the term change.
new text end
Sec. 41. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 254A.04; and 254B.14, subdivisions 1, 2, 3, 4,
and 6,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2021 Supplement, section 254B.14, subdivision 5,
new text end
new text begin
is repealed.
new text end
ARTICLE 9
COMMUNITY SUPPORTS
Section 1.
Minnesota Statutes 2020, section 245A.04, is amended by adding a subdivision
to read:
new text begin Subd. 15b. new text end
new text begin Additional community residential setting closure requirements. new text end
new text begin
(a) In
addition to the requirements in subdivision 15a, in the event that a license holder elects to
voluntarily close a community residential setting, the license holder must notify the
commissioner, the Office of Ombudsman for Mental Health and Developmental Disabilities,
and the Office of Ombudsman for Long-Term Care in writing by submitting notification at
least 60 days prior to closure. The closure notification must include:
new text end
new text begin
(1) assurance that the license holder notified or will notify residents and their expanded
support teams, if applicable, of the closure and comply with the conditions for service
terminations under section 245D.10, subdivision 3a;
new text end
new text begin
(2) procedures and actions the license holder will implement to maintain compliance
with this subdivision and subdivision 15a; and
new text end
new text begin
(3) assurance that the license holder will meet with the case manager and each resident's
expanded support team, as defined in section 245D.02, subdivision 8b, within ten working
days of delivering any service terminations to develop a person-centered relocation plan
with each individual impacted by the change in service. The license holder must complete
a relocation plan for each impacted individual 45 days prior to the service termination or
closure date, whichever is sooner.
new text end
new text begin
(b) The commissioner may require the license holder to work with a transitional team
that includes department staff, staff of the Office of Ombudsman for Mental Health and
Developmental Disabilities, staff of the Office of Ombudsman for Long-Term Care, and
other professionals the commissioner deems necessary to assist in the proper relocation of
residents.
new text end
new text begin
(c) The commissioner may eliminate a closure rate adjustment under section 256B.493
for violations of this subdivision.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245D.10, subdivision 3a, is amended to read:
Subd. 3a.
Service termination.
(a) The license holder must establish policies and
procedures for service termination that promote continuity of care and service coordination
with the person and the case manager and with other licensed caregivers, if any, who also
provide support to the person. The policy must include the requirements specified in
paragraphs (b) to (f).
(b) The license holder must permit each person to remain in the programnew text begin or to continue
receiving servicesnew text end and must not terminate services unless:
(1) the termination is necessary for the person's welfare and the deleted text begin facilitydeleted text end new text begin license holdernew text end
cannot meet the person's needs;
(2) the safety of the person deleted text begin ordeleted text end new text begin ,new text end others in the programnew text begin , or staffnew text end is endangered and positive
support strategies were attempted and have not achieved and effectively maintained safety
for the person or others;
(3) the health of the person deleted text begin ordeleted text end new text begin ,new text end others in the programnew text begin , or staffnew text end would otherwise be
endangered;
(4) the deleted text begin programdeleted text end new text begin license holdernew text end has not been paid for services;
(5) the programnew text begin or license holdernew text end ceases to operate;
(6) the person has been terminated by the lead agency from waiver eligibility; or
(7) for state-operated community-based services, the person no longer demonstrates
complex behavioral needs that cannot be met by private community-based providers
identified in section 252.50, subdivision 5, paragraph (a), clause (1).
(c) Prior to giving notice of service termination, the license holder must document actions
taken to minimize or eliminate the need for termination. Action taken by the license holder
must include, at a minimum:
(1) consultation with the person's support team or expanded support team to identify
and resolve issues leading to issuance of the termination notice;
(2) a request to the case manager for intervention services identified in section 245D.03,
subdivision 1, paragraph (c), clause (1), or other professional consultation or intervention
services to support the person in the program. This requirement does not apply to notices
of service termination issued under paragraph (b), clauses (4) and (7); and
(3) for state-operated community-based services terminating services under paragraph
(b), clause (7), the state-operated community-based services must engage in consultation
with the person's support team or expanded support team to:
(i) identify that the person no longer demonstrates complex behavioral needs that cannot
be met by private community-based providers identified in section 252.50, subdivision 5,
paragraph (a), clause (1);
(ii) provide notice of intent to issue a termination of services to the lead agency when a
finding has been made that a person no longer demonstrates complex behavioral needs that
cannot be met by private community-based providers identified in section 252.50, subdivision
5, paragraph (a), clause (1);
(iii) assist the lead agency and case manager in developing a person-centered transition
plan to a private community-based provider to ensure continuity of care; and
(iv) coordinate with the lead agency to ensure the private community-based service
provider is able to meet the person's needs and criteria established in a person's
person-centered transition plan.
If, based on the best interests of the person, the circumstances at the time of the notice were
such that the license holder was unable to take the action specified in clauses (1) and (2),
the license holder must document the specific circumstances and the reason for being unable
to do so.
(d) The notice of service termination must meet the following requirements:
(1) the license holder must notify the person or the person's legal representative and the
case manager in writing of the intended service termination. If the service termination is
from residential supports and services as defined in section 245D.03, subdivision 1, paragraph
(c), clause (3), the license holder must also notify the commissioner in writing; and
(2) the notice must include:
(i) the reason for the action;
(ii) except for a service termination under paragraph (b), clause (5), a summary of actions
taken to minimize or eliminate the need for service termination or temporary service
suspension as required under paragraph (c), and why these measures failed to prevent the
termination or suspension;
(iii) the person's right to appeal the termination of services under section 256.045,
subdivision 3, paragraph (a); and
(iv) the person's right to seek a temporary order staying the termination of services
according to the procedures in section 256.045, subdivision 4a or 6, paragraph (c).
(e) Notice of the proposed termination of service, including those situations that began
with a temporary service suspension, must be given at least 90 days prior to termination of
services under paragraph (b), clause (7), 60 days prior to termination when a license holder
is providing intensive supports and services identified in section 245D.03, subdivision 1,
paragraph (c), and 30 days prior to termination for all other services licensed under this
chapter. This notice may be given in conjunction with a notice of temporary service
suspension under subdivision 3.
(f) During the service termination notice period, the license holder must:
(1) work with the support team or expanded support team to develop reasonable
alternatives to protect the person and others and to support continuity of care;
(2) provide information requested by the person or case manager; and
(3) maintain information about the service termination, including the written notice of
intended service termination, in the service recipient record.
(g) For notices issued under paragraph (b), clause (7), the lead agency shall provide
notice to the commissioner and state-operated services at least 30 days before the conclusion
of the 90-day termination period, if an appropriate alternative provider cannot be secured.
Upon receipt of this notice, the commissioner and state-operated services shall reassess
whether a private community-based service can meet the person's needs. If the commissioner
determines that a private provider can meet the person's needs, state-operated services shall,
if necessary, extend notice of service termination until placement can be made. If the
commissioner determines that a private provider cannot meet the person's needs,
state-operated services shall rescind the notice of service termination and re-engage with
the lead agency in service planning for the person.
(h) For state-operated community-based services, the license holder shall prioritize the
capacity created within the existing service site by the termination of services under paragraph
(b), clause (7), to serve persons described in section 252.50, subdivision 5, paragraph (a),
clause (1).
Sec. 3.
Minnesota Statutes 2020, section 256.01, is amended by adding a subdivision to
read:
new text begin Subd. 12b. new text end
new text begin Department of Human Services systemic critical incident review team. new text end
new text begin
(a)
The commissioner may establish a Department of Human Services systemic critical incident
review team to review required critical incident reports under section 626.557 for which
the Department of Human Services is responsible under section 626.5572, subdivision 13;
chapter 245D; or Minnesota Rules, chapter 9544. When reviewing a critical incident, the
systemic critical incident review team must identify systemic influences to the incident
rather than determining the culpability of any actors involved in the incident. The systemic
critical incident review may assess the entire critical incident process from the point of an
entity reporting the critical incident through the ongoing case management process.
Department staff must lead and conduct the reviews and may utilize county staff as reviewers.
The systemic critical incident review process may include but is not limited to:
new text end
new text begin
(1) data collection about the incident and actors involved. Data may include the critical
incident report under review; previous incident reports pertaining to the person receiving
services; the service provider's policies and procedures applicable to the incident; the
coordinated service and support plan as defined in section 245D.02, subdivision 4b, for the
person receiving services; or an interview of an actor involved in the critical incident or the
review of the critical incident. Actors may include:
new text end
new text begin
(i) staff of the provider agency;
new text end
new text begin
(ii) lead agency staff administering home and community-based services delivered by
the provider;
new text end
new text begin
(iii) Department of Human Services staff with oversight of home and community-based
services;
new text end
new text begin
(iv) Department of Health staff with oversight of home and community-based services;
new text end
new text begin
(v) members of the community including advocates, legal representatives, health care
providers, pharmacy staff, or others with knowledge of the incident or the actors in the
incident; and
new text end
new text begin
(vi) staff from the Office of the Ombudsman for Mental Health and Developmental
Disabilities;
new text end
new text begin
(2) systemic mapping of the critical incident. The team conducting the systemic mapping
of the incident may include any actors identified in clause (1), designated representatives
of other provider agencies, regional teams, and representatives of the local regional quality
council identified in section 256B.097; and
new text end
new text begin
(3) analysis of the case for systemic influences.
new text end
new text begin
(b) The critical incident review team must aggregate data collected and provide the
aggregated data to regional teams, participating regional quality councils, and the
commissioner. The regional teams and quality councils must analyze the data and make
recommendations to the commissioner regarding systemic changes that would decrease the
number and severity of critical incidents in the future or improve the quality of the home
and community-based service system.
new text end
new text begin
(c) A selection committee must select cases for the systemic critical incident review
process from among the following critical incident categories:
new text end
new text begin
(1) cases of caregiver neglect identified in section 626.5572, subdivision 17;
new text end
new text begin
(2) cases involving financial exploitation identified in section 626.5572, subdivision 9;
new text end
new text begin
(3) incidents identified in section 245D.02, subdivision 11;
new text end
new text begin
(4) incidents identified in Minnesota Rules, part 9544.0110; and
new text end
new text begin
(5) service terminations reported to the department in accordance with section 245D.10,
subdivision 3a.
new text end
new text begin
(d) The systemic critical incident review under this section must not replace the process
for screening or investigating cases of alleged maltreatment of an adult under section 626.557.
The department, under the jurisdiction of the commissioner, may select for systemic critical
incident review cases reported for suspected maltreatment and closed following initial or
final disposition.
new text end
new text begin
(e) The proceedings and records of the review team are confidential data on individuals
or protected nonpublic data as defined in section 13.02, subdivisions 3 and 13. Data that
document a person's opinions formed as a result of the review are not subject to discovery
or introduction into evidence in a civil or criminal action against a professional, the state,
or a county agency arising out of the matters that the team is reviewing. Information,
documents, and records otherwise available from other sources are not immune from
discovery or use in a civil or criminal action solely because the information, documents,
and records were assessed or presented during review team proceedings. A person who
presented information before the systemic critical incident review team or who is a member
of the team must not be prevented from testifying about matters within the person's
knowledge. In a civil or criminal proceeding, a person must not be questioned about opinions
formed by the person as a result of the review.
new text end
new text begin
(f) By October 1 of each year, the commissioner shall prepare an annual public report
containing the following information:
new text end
new text begin
(1) the number of cases reviewed under each critical incident category identified in
paragraph (b) and a geographical description of where cases under each category originated;
new text end
new text begin
(2) an aggregate summary of the systemic themes from the critical incidents examined
by the critical incident review team during the previous year;
new text end
new text begin
(3) a synopsis of the conclusions, incident analyses, or exploratory activities taken in
regard to the critical incidents examined by the critical incident review team; and
new text end
new text begin
(4) recommendations made to the commissioner regarding systemic changes that could
decrease the number and severity of critical incidents in the future or improve the quality
of the home and community-based service system.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256.045, subdivision 3, is amended to read:
Subd. 3.
State agency hearings.
(a) State agency hearings are available for the following:
(1) any person applying for, receiving or having received public assistance, medical
care, or a program of social services granted by the state agency or a county agency or the
federal Food and Nutrition Act whose application for assistance is denied, not acted upon
with reasonable promptness, or whose assistance is suspended, reduced, terminated, or
claimed to have been incorrectly paid;
(2) any patient or relative aggrieved by an order of the commissioner under section
252.27;
(3) a party aggrieved by a ruling of a prepaid health plan;
(4) except as provided under chapter 245C, any individual or facility determined by a
lead investigative agency to have maltreated a vulnerable adult under section 626.557 after
they have exercised their right to administrative reconsideration under section 626.557;
(5) any person whose claim for foster care payment according to a placement of the
child resulting from a child protection assessment under chapter 260E is denied or not acted
upon with reasonable promptness, regardless of funding source;
(6) any person to whom a right of appeal according to this section is given by other
provision of law;
(7) an applicant aggrieved by an adverse decision to an application for a hardship waiver
under section 256B.15;
(8) an applicant aggrieved by an adverse decision to an application or redetermination
for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;
(9) except as provided under chapter 245A, an individual or facility determined to have
maltreated a minor under chapter 260E, after the individual or facility has exercised the
right to administrative reconsideration under chapter 260E;
(10) except as provided under chapter 245C, an individual disqualified under sections
245C.14 and 245C.15, following a reconsideration decision issued under section 245C.23,
on the basis of serious or recurring maltreatment; a preponderance of the evidence that the
individual has committed an act or acts that meet the definition of any of the crimes listed
in section 245C.15, subdivisions 1 to 4; or for failing to make reports required under section
260E.06, subdivision 1, or 626.557, subdivision 3. Hearings regarding a maltreatment
determination under clause (4) or (9) and a disqualification under this clause in which the
basis for a disqualification is serious or recurring maltreatment, shall be consolidated into
a single fair hearing. In such cases, the scope of review by the human services judge shall
include both the maltreatment determination and the disqualification. The failure to exercise
the right to an administrative reconsideration shall not be a bar to a hearing under this section
if federal law provides an individual the right to a hearing to dispute a finding of
maltreatment;
(11) any person with an outstanding debt resulting from receipt of public assistance,
medical care, or the federal Food and Nutrition Act who is contesting a setoff claim by the
Department of Human Services or a county agency. The scope of the appeal is the validity
of the claimant agency's intention to request a setoff of a refund under chapter 270A against
the debt;
(12) a person issued a notice of service termination under section 245D.10, subdivision
3a, deleted text begin fromdeleted text end new text begin by a licensed provider of anynew text end residential supports deleted text begin anddeleted text end new text begin ornew text end services deleted text begin as defineddeleted text end new text begin listednew text end
in section 245D.03, subdivision 1, deleted text begin paragraphdeleted text end new text begin paragraphs (b) andnew text end (c), deleted text begin clause (3),deleted text end that is not
otherwise subject to appeal under subdivision 4a;
(13) an individual disability waiver recipient based on a denial of a request for a rate
exception under section 256B.4914; or
(14) a person issued a notice of service termination under section 245A.11, subdivision
11, that is not otherwise subject to appeal under subdivision 4a.
(b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or (10),
is the only administrative appeal to the final agency determination specifically, including
a challenge to the accuracy and completeness of data under section 13.04. Hearings requested
under paragraph (a), clause (4), apply only to incidents of maltreatment that occur on or
after October 1, 1995. Hearings requested by nursing assistants in nursing homes alleged
to have maltreated a resident prior to October 1, 1995, shall be held as a contested case
proceeding under the provisions of chapter 14. Hearings requested under paragraph (a),
clause (9), apply only to incidents of maltreatment that occur on or after July 1, 1997. A
hearing for an individual or facility under paragraph (a), clauses (4), (9), and (10), is only
available when there is no district court action pending. If such action is filed in district
court while an administrative review is pending that arises out of some or all of the events
or circumstances on which the appeal is based, the administrative review must be suspended
until the judicial actions are completed. If the district court proceedings are completed,
dismissed, or overturned, the matter may be considered in an administrative hearing.
(c) For purposes of this section, bargaining unit grievance procedures are not an
administrative appeal.
(d) The scope of hearings involving claims to foster care payments under paragraph (a),
clause (5), shall be limited to the issue of whether the county is legally responsible for a
child's placement under court order or voluntary placement agreement and, if so, the correct
amount of foster care payment to be made on the child's behalf and shall not include review
of the propriety of the county's child protection determination or child placement decision.
(e) The scope of hearings under paragraph (a), clauses (12) and (14), shall be limited to
whether the proposed termination of services is authorized under section 245D.10,
subdivision 3a, paragraph (b), or 245A.11, subdivision 11, and whether the requirements
of section 245D.10, subdivision 3a, paragraphs (c) to (e), or 245A.11, subdivision 2a,
paragraphs (d) to (f), were met. If the appeal includes a request for a temporary stay of
termination of services, the scope of the hearing shall also include whether the case
management provider has finalized arrangements for a residential facility, a program, or
services that will meet the assessed needs of the recipient by the effective date of the service
termination.
(f) A vendor of medical care as defined in section 256B.02, subdivision 7, or a vendor
under contract with a county agency to provide social services is not a party and may not
request a hearing under this section, except if assisting a recipient as provided in subdivision
4.
(g) An applicant or recipient is not entitled to receive social services beyond the services
prescribed under chapter 256M or other social services the person is eligible for under state
law.
(h) The commissioner may summarily affirm the county or state agency's proposed
action without a hearing when the sole issue is an automatic change due to a change in state
or federal law.
(i) Unless federal or Minnesota law specifies a different time frame in which to file an
appeal, an individual or organization specified in this section may contest the specified
action, decision, or final disposition before the state agency by submitting a written request
for a hearing to the state agency within 30 days after receiving written notice of the action,
decision, or final disposition, or within 90 days of such written notice if the applicant,
recipient, patient, or relative shows good cause, as defined in section 256.0451, subdivision
13, why the request was not submitted within the 30-day time limit. The individual filing
the appeal has the burden of proving good cause by a preponderance of the evidence.
Sec. 5.
Minnesota Statutes 2020, section 256B.0651, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of sections 256B.0651 to 256B.0654
and 256B.0659, the terms in paragraphs (b) to deleted text begin (g)deleted text end new text begin (i)new text end have the meanings given.
(b) "Activities of daily living" has the meaning given in section 256B.0659, subdivision
1, paragraph (b).
(c) "Assessment" means a review and evaluation of a recipient's need for home care
services conducted in person.
new text begin
(d) "Care coordination" means a service performed by a licensed professional to
coordinate both skilled and unskilled home care services, except personal care assistance,
for a recipient, and may include documentation and coordination activities not carried out
in conjunction with a care evaluation visit.
new text end
new text begin
(e) "Care evaluation" means a start-of-care visit, a resumption-of-care visit, or a
recertification visit that is a face-to-face assessment of a person by a licensed professional
to develop, update, or review the service plan for both skilled and unskilled home care
services, except personal care assistance.
new text end
deleted text begin (d)deleted text end new text begin (f)new text end "Home care services" means medical assistance covered services that are home
health agency services, including skilled nurse visits; home health aide visits; physical
therapy, occupational therapy, respiratory therapy, and language-speech pathology therapy;
home care nursing; and personal care assistance.
deleted text begin (e)deleted text end new text begin (g)new text end "Home residence," effective January 1, 2010, means a residence owned or rented
by the recipient either alone, with roommates of the recipient's choosing, or with an unpaid
responsible party or legal representative; or a family foster home where the license holder
lives with the recipient and is not paid to provide home care services for the recipient except
as allowed under sections 256B.0652, subdivision 10, and 256B.0654, subdivision 4.
deleted text begin (f)deleted text end new text begin (h)new text end "Medically necessary" has the meaning given in Minnesota Rules, parts 9505.0170
to 9505.0475.
deleted text begin (g)deleted text end new text begin (i)new text end "Ventilator-dependent" means an individual who receives mechanical ventilation
for life support at least six hours per day and is expected to be or has been dependent on a
ventilator for at least 30 consecutive days.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 6.
Minnesota Statutes 2020, section 256B.0651, subdivision 2, is amended to read:
Subd. 2.
Services covered.
Home care services covered under this section and sections
256B.0652 to 256B.0654 and 256B.0659 include:
new text begin
(1) care coordination services under subdivision 1, paragraph (d);
new text end
new text begin
(2) care evaluation services under subdivision 1, paragraph (e);
new text end
deleted text begin (1)deleted text end new text begin (3)new text end nursing services under sections 256B.0625, subdivision 6a, and 256B.0653;
deleted text begin (2)deleted text end new text begin (4)new text end home care nursing services under sections 256B.0625, subdivision 7, and
256B.0654;
deleted text begin (3)deleted text end new text begin (5)new text end home health services under sections 256B.0625, subdivision 6a, and 256B.0653;
deleted text begin (4)deleted text end new text begin (6)new text end personal care assistance services under sections 256B.0625, subdivision 19a, and
256B.0659;
deleted text begin (5)deleted text end new text begin (7)new text end supervision of personal care assistance services provided by a qualified
professional under sections 256B.0625, subdivision 19a, and 256B.0659;
deleted text begin (6)deleted text end new text begin (8)new text end face-to-face assessments by county public health nurses for services under sections
256B.0625, subdivision 19a, and 256B.0659; and
deleted text begin (7)deleted text end new text begin (9)new text end service updates and review of temporary increases for personal care assistance
services by the county public health nurse for services under sections 256B.0625, subdivision
19a, and 256B.0659.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256B.0652, subdivision 11, is amended to read:
Subd. 11.
Limits on services without authorization.
A recipient may receive the
following home care services during a calendar year:
(1) up to two face-to-face assessments to determine a recipient's need for personal care
assistance services;
(2) one service update done to determine a recipient's need for personal care assistance
services; deleted text begin and
deleted text end
(3) up to nine face-to-facenew text begin visits that may include bothnew text end skilled nurse visitsdeleted text begin .deleted text end new text begin and care
evaluations; and
new text end
new text begin
(4) up to four 15-minute units of care coordination per episode of care to coordinate
home health services for a recipient.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0653, subdivision 6, is amended to read:
Subd. 6.
Noncovered home health agency services.
The following are not eligible for
payment under medical assistance as a home health agency service:
(1) telehomecare skilled nurses services that is communication between the home care
nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
mail, or a consultation between two health care practitioners;
(2) the following skilled nurse visits:
(i) for the purpose of monitoring medication compliance with an established medication
program for a recipient;
(ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient or a family member is physically and mentally able to
self-administer or prefill a medication;
(iii) services done for the sole purpose of supervision of the home health aide or personal
care assistant;
(iv) services done for the sole purpose to train other home health agency workers;
(v) services done for the sole purpose of blood samples or lab draw when the recipient
is able to access these services outside the home; and
(vi) Medicare evaluation or administrative nursing visits required by Medicarenew text begin , with the
exception of care evaluation as defined in section 256B.0651, subdivision 1, paragraph (e)new text end ;
(3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education;
(4) home care therapies provided in other settings such as a clinic or as an inpatient or
when the recipient can access therapy outside of the recipient's residence; and
(5) home health agency services without qualifying documentation of a face-to-face
encounter as specified in subdivision 7.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.0659, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in
paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
positioning, eating, and toileting.
(c) "Behavior," effective January 1, 2010, means a category to determine the home care
rating and is based on the criteria found in this section. "Level I behavior" means physical
aggression deleted text begin towardsdeleted text end new text begin towardnew text end self, others, or destruction of property that requires the immediate
response of another person.
(d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.
(e) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.
(f) "Dependency in activities of daily living" means a person requires assistance to begin
and complete one or more of the activities of daily living.
(g) "Extended personal care assistance service" means personal care assistance services
included in a service plan under one of the home and community-based services waivers
authorized under chapter 256S and sections 256B.092, subdivision 5, and 256B.49, which
exceed the amount, duration, and frequency of the state plan personal care assistance services
for participants who:
(1) need assistance provided periodically during a week, but less than daily will not be
able to remain in their homes without the assistance, and other replacement services are
more expensive or are not available when personal care assistance services are to be reduced;
or
(2) need additional personal care assistance services beyond the amount authorized by
the state plan personal care assistance assessment in order to ensure that their safety, health,
and welfare are provided for in their homes.
(h) "Health-related procedures and tasks" means procedures and tasks that can be
delegated or assigned by a licensed health care professional under state law to be performed
by a personal care assistant.
(i) "Instrumental activities of daily living" means activities to include meal planning and
preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance services;
communication by telephone and other media; and traveling, including to medical
appointments and to participate in the community.new text begin For purposes of this paragraph, traveling
includes driving and accompanying the recipient in the recipient's chosen mode of
transportation and according to the recipient's personal care assistance care plan.
new text end
(j) "Managing employee" has the same definition as Code of Federal Regulations, title
42, section 455.
(k) "Qualified professional" means a professional providing supervision of personal care
assistance services and staff as defined in section 256B.0625, subdivision 19c.
(l) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and includes
a personal care assistance provider organization, personal care assistance choice agency,
class A licensed nursing agency, and Medicare-certified home health agency.
(m) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.
(n) "Personal care assistance care plan" means a written description of personal care
assistance services developed by the personal care assistance provider according to the
service plan.
(o) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.
(p) "Self-administered medication" means medication taken orally, by injection, nebulizer,
or insertion, or applied topically without the need for assistance.
(q) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.
(r) "Wages and benefits" means wages and salaries, the employer's share of FICA taxes,
Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
reimbursement, health and dental insurance, life insurance, disability insurance, long-term
care insurance, uniform allowance, and contributions to employee retirement accounts.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective within 90 days following federal approval.
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.0659, subdivision 12, is amended to read:
Subd. 12.
Documentation of personal care assistance services provided.
(a) Personal
care assistance services for a recipient must be documented daily by each personal care
assistant, on a time sheet form approved by the commissioner. All documentation may be
web-based, electronic, or paper documentation. The completed form must be submitted on
a monthly basis to the provider and kept in the recipient's health record.
(b) The activity documentation must correspond to the personal care assistance care plan
and be reviewed by the qualified professional.
(c) The personal care assistant time sheet must be on a form approved by the
commissioner documenting time the personal care assistant provides services in the home.
The following criteria must be included in the time sheet:
(1) full name of personal care assistant and individual provider number;
(2) provider name and telephone numbers;
(3) full name of recipient and either the recipient's medical assistance identification
number or date of birth;
(4) consecutive dates, including month, day, and year, and arrival and departure times
with a.m. or p.m. notations;
(5) signatures of recipient or the responsible party;
(6) personal signature of the personal care assistant;
(7) any shared care provided, if applicable;
(8) a statement that it is a federal crime to provide false information on personal care
service billings for medical assistance payments; deleted text begin and
deleted text end
(9) dates and location of recipient stays in a hospital, care facility, or incarcerationnew text begin ; and
new text end
new text begin (10) any time spent traveling, as described in subdivision 1, paragraph (i), including
start and stop times with a.m. and p.m. designations, the origination site, and the destination
sitenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective within 90 days following federal approval.
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.0659, subdivision 19, is amended to read:
Subd. 19.
Personal care assistance choice option; qualifications; duties.
(a) Under
personal care assistance choice, the recipient or responsible party shall:
(1) recruit, hire, schedule, and terminate personal care assistants according to the terms
of the written agreement required under subdivision 20, paragraph (a);
(2) develop a personal care assistance care plan based on the assessed needs and
addressing the health and safety of the recipient with the assistance of a qualified professional
as needed;
(3) orient and train the personal care assistant with assistance as needed from the qualified
professional;
(4) deleted text begin effective January 1, 2010,deleted text end supervise and evaluate the personal care assistant with the
qualified professional, who is required to visit the recipient at least every 180 days;
(5) monitor and verify in writing and report to the personal care assistance choice agency
the number of hours worked by the personal care assistant and the qualified professional;
(6) engage in an annual face-to-face reassessment to determine continuing eligibility
and service authorization; deleted text begin and
deleted text end
(7) use the same personal care assistance choice provider agency if shared personal
assistance care is being usednew text begin ; and
new text end
new text begin (8) ensure that a personal care assistant driving the recipient under subdivision 1,
paragraph (i), has a valid driver's license and the vehicle used is registered and insured
according to Minnesota lawnew text end .
(b) The personal care assistance choice provider agency shall:
(1) meet all personal care assistance provider agency standards;
(2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;
(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal
care assistant; and
(4) ensure arm's-length transactions without undue influence or coercion with the recipient
and personal care assistant.
(c) The duties of the personal care assistance choice provider agency are to:
(1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including, but not limited to, purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including, but not
limited to, workers' compensation, unemployment insurance, and labor market data required
under section 256B.4912, subdivision 1a;
(2) bill the medical assistance program for personal care assistance services and qualified
professional services;
(3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;
(4) pay the personal care assistant and qualified professional based on actual hours of
services provided;
(5) withhold and pay all applicable federal and state taxes;
(6) verify and keep records of hours worked by the personal care assistant and qualified
professional;
(7) make the arrangements and pay taxes and other benefits, if any, and comply with
any legal requirements for a Minnesota employer;
(8) enroll in the medical assistance program as a personal care assistance choice agency;
and
(9) enter into a written agreement as specified in subdivision 20 before services are
provided.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective within 90 days following federal approval.
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0659, subdivision 24, is amended to read:
Subd. 24.
Personal care assistance provider agency; general duties.
A personal care
assistance provider agency shall:
(1) enroll as a Medicaid provider meeting all provider standards, including completion
of the required provider training;
(2) comply with general medical assistance coverage requirements;
(3) demonstrate compliance with law and policies of the personal care assistance program
to be determined by the commissioner;
(4) comply with background study requirements;
(5) verify and keep records of hours worked by the personal care assistant and qualified
professional;
(6) not engage in any agency-initiated direct contact or marketing in person, by phone,
or other electronic means to potential recipients, guardians, or family members;
(7) pay the personal care assistant and qualified professional based on actual hours of
services provided;
(8) withhold and pay all applicable federal and state taxes;
(9) document that the agency uses a minimum of 72.5 percent of the revenue generated
by the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits. The revenue generated by the qualified professional and
the reasonable costs associated with the qualified professional shall not be used in making
this calculation;
(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
(11) enter into a written agreement under subdivision 20 before services are provided;
(12) report suspected neglect and abuse to the common entry point according to section
256B.0651;
(13) provide the recipient with a copy of the home care bill of rights at start of service;
(14) request reassessments at least 60 days prior to the end of the current authorization
for personal care assistance services, on forms provided by the commissioner;
(15) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a; deleted text begin and
deleted text end
(16) document that the agency uses the additional revenue due to the enhanced rate under
subdivision 17a for the wages and benefits of the PCAs whose services meet the requirements
under subdivision 11, paragraph (d)new text begin ; and
new text end
new text begin (17) ensure that a personal care assistant driving a recipient under subdivision 1,
paragraph (i), has a valid driver's license and the vehicle used is registered and insured
according to Minnesota lawnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective within 90 days following federal approval.
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.092, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin Community residential setting notice of closure; planning process. new text end
new text begin
(a) The
lead agency shall, within five working days of receiving initial notice of a community
residential setting's intent to terminate services of a person due to closure pursuant to section
245A.04, subdivision 15b, provide the license holder and the expanded support team with
the contact information of those persons responsible for coordinating county and state social
services agency efforts in the planning process.
new text end
new text begin
(b) Within ten working days of receipt of the notice of closure and proposed closure
plan, the county social services agency and license holder shall meet to develop a
person-centered relocation plan with each individual impacted by the closure. The license
holder shall inform the commissioner, the Office of Ombudsman for Mental Health and
Developmental Disabilities, and the Office of Ombudsman for Long-Term Care of the date,
time, and location of the meeting so that their representatives may attend.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision
to read:
new text begin Subd. 30. new text end
new text begin Community residential setting notice of closure; planning process. new text end
new text begin
(a) The
lead agency shall, within five working days of receiving initial notice of a community
residential setting's intent to terminate services of a person due to closure pursuant to section
245A.04, subdivision 15b, provide the license holder and the expanded support team with
the contact information of those persons responsible for coordinating county and state social
services agency efforts in the planning process.
new text end
new text begin
(b) Within ten working days of receipt of the notice of closure and proposed closure
plan, the county social services agency and license holder shall meet to develop a
person-centered relocation plan with each individual impacted by the closure. The license
holder shall inform the commissioner, the Office of Ombudsman for Mental Health and
Developmental Disabilities, and the Office of Ombudsman for Long-Term Care of the date,
time, and location of the meeting so that their representatives may attend.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256B.4911, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Services provided by parents and spouses. new text end
new text begin
(a) Upon federal approval, this
subdivision limits medical assistance payments under the consumer-directed community
supports option for personal assistance services provided by a parent to the parent's minor
child or by a spouse. This subdivision applies to the consumer-directed community supports
option available under all of the following:
new text end
new text begin
(1) alternative care program;
new text end
new text begin
(2) brain injury waiver;
new text end
new text begin
(3) community alternative care waiver;
new text end
new text begin
(4) community access for disability inclusion waiver;
new text end
new text begin
(5) developmental disabilities waiver;
new text end
new text begin
(6) elderly waiver; and
new text end
new text begin
(7) Minnesota senior health option.
new text end
new text begin
(b) For the purposes of this subdivision, "parent" means a parent, stepparent, or legal
guardian of a minor.
new text end
new text begin
(c) If multiple parents are providing personal assistance services to their minor child or
children, each parent may provide up to 40 hours of personal assistance services in any
seven-day period regardless of the number of children served. The total number of hours
of personal assistance services provided by all of the parents must not exceed 80 hours in
a seven-day period regardless of the number of children served.
new text end
new text begin
(d) If only one parent is providing personal assistance services to a minor child or
children, the parent may provide up to 60 hours of personal assistance services in a seven-day
period regardless of the number of children served.
new text end
new text begin
(e) If a spouse is providing personal assistance services, the spouse may provide up to
60 hours of personal assistance services in a seven-day period.
new text end
new text begin
(f) This subdivision must not be construed to permit an increase in the total authorized
consumer-directed community supports budget for an individual.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.4914, subdivision 8, as amended by Laws
2022, chapter 33, section 1, is amended to read:
Subd. 8.
Unit-based services with programming; component values and calculation
of payment rates.
(a) For the purpose of this section, unit-based services with programming
include employment exploration services, employment development services, employment
support services, individualized home supports with family training, individualized home
supports with training, and positive support services provided to an individual outside of
any service plan for a day program or residential support service.
(b) Component values for unit-based services with programming are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 15.5 percent;
(6) client programming and support ratio: 4.7 percent, updated as specified in subdivision
5b;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 6.1 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
(c) A unit of service for unit-based services with programming is 15 minutes.
(d) Payments for unit-based services with programming must be calculated as follows,
unless the services are reimbursed separately as part of a residential support services or day
program payment rate:
(1) determine the number of units of service to meet a recipient's needs;
(2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 and 5a;
(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staffing hours by the appropriate staff wage;
(6) multiply the number of direct staffing hours by the product of the supervisory span
of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;
(11) this is the subtotal rate;
(12) sum the standard general administrative support ratio, the program-related expense
ratio, and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for services provided in a shared manner, divide the total payment in clause (13)
as follows:
(i) for employment exploration services, divide by the number of service recipients, not
to exceed five;
(ii) for employment support services, divide by the number of service recipients, not to
exceed six; and
(iii) for individualized home supports with training and individualized home supports
with family training, divide by the number of service recipients, not to exceed deleted text begin twodeleted text end new text begin threenew text end ;
and
(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.4914, subdivision 9, as amended by Laws
2022, chapter 33, section 1, is amended to read:
Subd. 9.
Unit-based services without programming; component values and
calculation of payment rates.
(a) For the purposes of this section, unit-based services
without programming include individualized home supports without training and night
supervision provided to an individual outside of any service plan for a day program or
residential support service. Unit-based services without programming do not include respite.
(b) Component values for unit-based services without programming are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 7.0 percent;
(6) client programming and support ratio: 2.3 percent, updated as specified in subdivision
5b;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 2.9 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
(c) A unit of service for unit-based services without programming is 15 minutes.
(d) Payments for unit-based services without programming must be calculated as follows
unless the services are reimbursed separately as part of a residential support services or day
program payment rate:
(1) determine the number of units of service to meet a recipient's needs;
(2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 to 5a;
(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staffing hours by the appropriate staff wage;
(6) multiply the number of direct staffing hours by the product of the supervisory span
of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;
(11) this is the subtotal rate;
(12) sum the standard general administrative support ratio, the program-related expense
ratio, and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for individualized home supports without training provided in a shared manner,
divide the total payment amount in clause (13) by the number of service recipients, not to
exceed deleted text begin twodeleted text end new text begin threenew text end ; and
(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end
Sec. 18.
Minnesota Statutes 2021 Supplement, section 256B.85, subdivision 7, is amended
to read:
Subd. 7.
Community first services and supports; covered services.
Services and
supports covered under CFSS include:
(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and health-related procedures and tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task;
(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
accomplish activities of daily living, instrumental activities of daily living, or health-related
tasks;
(3) expenditures for items, services, supports, environmental modifications, or goods,
including assistive technology. These expenditures must:
(i) relate to a need identified in a participant's CFSS service delivery plan; and
(ii) increase independence or substitute for human assistance, to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;
(4) observation and redirection for behavior or symptoms where there is a need for
assistance;
(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
to ensure continuity of the participant's services and supports;
(6) services provided by a consultation services provider as defined under subdivision
17, that is under contract with the department and enrolled as a Minnesota health care
program provider;
(7) services provided by an FMS provider as defined under subdivision 13a, that is an
enrolled provider with the department;
(8) CFSS services provided by a support worker who is a parent, stepparent, or legal
guardian of a participant under age 18, or who is the participant's spouse. deleted text begin These support
workers shall not:deleted text end new text begin Covered services under this clause are subject to the limitations described
in subdivision 7b; and
new text end
deleted text begin
(i) provide any medical assistance home and community-based services in excess of 40
hours per seven-day period regardless of the number of parents providing services,
combination of parents and spouses providing services, or number of children who receive
medical assistance services; and
deleted text end
deleted text begin
(ii) have a wage that exceeds the current rate for a CFSS support worker including the
wage, benefits, and payroll taxes; and
deleted text end
(9) worker training and development services as described in subdivision 18a.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 7b. new text end
new text begin Services provided by parents and spouses. new text end
new text begin
(a) This subdivision applies to
services and supports described in subdivision 7, clause (8).
new text end
new text begin
(b) If multiple parents are support workers providing CFSS services to their minor child
or children, each parent may provide up to 40 hours of medical assistance home and
community-based services in any seven-day period regardless of the number of children
served. The total number of hours of medical assistance home and community-based services
provided by all of the parents must not exceed 80 hours in a seven-day period regardless of
the number of children served.
new text end
new text begin
(c) If only one parent is a support worker providing CFSS services to the parent's minor
child or children, the parent may provide up to 60 hours of medical assistance home and
community-based services in a seven-day period regardless of the number of children served.
new text end
new text begin
(d) If a spouse is a support worker providing CFSS services, the spouse may provide up
to 60 hours of medical assistance home and community-based services in a seven-day period.
new text end
new text begin
(e) Paragraphs (b) to (d) must not be construed to permit an increase in either the total
authorized service budget for an individual or the total number of authorized service units.
new text end
new text begin
(f) A parent or spouse must not receive a wage that exceeds the current rate for a CFSS
support worker, including the wage, benefits, and payroll taxes.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2021 Supplement, section 256B.85, subdivision 8, is amended
to read:
Subd. 8.
Determination of CFSS service authorization amount.
(a) All community
first services and supports must be authorized by the commissioner or the commissioner's
designee before services begin. The authorization for CFSS must be completed as soon as
possible following an assessment but no later than 40 calendar days from the date of the
assessment.
(b) The amount of CFSS authorized must be based on the participant's home care rating
described in paragraphs (d) and (e) and any additional service units for which the participant
qualifies as described in paragraph (f).
(c) The home care rating shall be determined by the commissioner or the commissioner's
designee based on information submitted to the commissioner identifying the following for
a participant:
(1) the total number of dependencies of activities of daily living;
(2) the presence of complex health-related needs; and
(3) the presence of Level I behavior.
(d) The methodology to determine the total service units for CFSS for each home care
rating is based on the median paid units per day for each home care rating from fiscal year
2007 data for the PCA program.
(e) Each home care rating is designated by the letters P through Z and EN and has the
following base number of service units assigned:
(1) P home care rating requires Level I behavior or one to three dependencies in ADLs
and qualifies the person for five service units;
(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs
and qualifies the person for six service units;
(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies the person for seven service units;
(4) S home care rating requires four to six dependencies in ADLs and qualifies the person
for ten service units;
(5) T home care rating requires four to six dependencies in ADLs and Level I behavior
and qualifies the person for 11 service units;
(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies the person for 14 service units;
(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
person for 17 service units;
(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies the person for 20 service units;
(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies the person for 30 service units; and
(10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
subdivision 1, paragraph deleted text begin (g)deleted text end new text begin (i)new text end . A person who meets the definition of ventilator-dependent
and the EN home care rating and utilize a combination of CFSS and home care nursing
services is limited to a total of 96 service units per day for those services in combination.
Additional units may be authorized when a person's assessment indicates a need for two
staff to perform activities. Additional time is limited to 16 service units per day.
(f) Additional service units are provided through the assessment and identification of
the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily
living;
(2) 30 additional minutes per day for each complex health-related need; and
(3) 30 additional minutes per day for each behavior under this clause that requires
assistance at least four times per week:
(i) level I behavior that requires the immediate response of another person;
(ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior;
or
(iii) increased need for assistance for participants who are verbally aggressive or resistive
to care so that the time needed to perform activities of daily living is increased.
(g) The service budget for budget model participants shall be based on:
(1) assessed units as determined by the home care rating; and
(2) an adjustment needed for administrative expenses.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 21.
Minnesota Statutes 2021 Supplement, section 256B.851, subdivision 5, is amended
to read:
Subd. 5.
Payment rates; component values.
(a) The commissioner must use the
following component values:
(1) employee vacation, sick, and training factor, 8.71 percent;
(2) employer taxes and workers' compensation factor, 11.56 percent;
(3) employee benefits factor, 12.04 percent;
(4) client programming and supports factor, 2.30 percent;
(5) program plan support factor, 7.00 percent;
(6) general business and administrative expenses factor, 13.25 percent;
(7) program administration expenses factor, 2.90 percent; and
(8) absence and utilization factor, 3.90 percent.
(b) For purposes of implementation, the commissioner shall use the following
implementation components:
(1) personal care assistance services and CFSS: deleted text begin 75.45deleted text end new text begin 79.5new text end percent;
(2) enhanced rate personal care assistance services and enhanced rate CFSS: deleted text begin 75.45deleted text end new text begin 79.5new text end
percent; and
(3) qualified professional services and CFSS worker training and development: deleted text begin 75.45deleted text end new text begin
79.5new text end percent.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or 60 days following
federal approval, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256I.04, subdivision 3, is amended to read:
Subd. 3.
Moratorium on development of housing support beds.
(a) Agencies shall
not enter into agreements for new housing support beds with total rates in excess of the
MSA equivalent rate except:
(1) for establishments licensed under chapter 245D provided the facility is needed to
meet the census reduction targets for persons with developmental disabilities at regional
treatment centers;
(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a, paragraph (b);
(3) notwithstanding the provisions of subdivision 2a, for up to deleted text begin 226deleted text end new text begin 500new text end supportive
housing units in Anoka, new text begin Carver, new text end Dakota, Hennepin, deleted text begin ordeleted text end Ramseynew text begin , Scott, or Washingtonnew text end County
for homeless adults with anew text begin disability, including but not limited tonew text end mental illness, a history
of substance abuse, or human immunodeficiency virus or acquired immunodeficiency
syndrome. For purposes of this deleted text begin sectiondeleted text end new text begin clausenew text end , "homeless adult" means a person who isnew text begin : (i)new text end
living on the street or in a shelternew text begin ;new text end ornew text begin (ii)new text end discharged from a regional treatment center,
community hospital, or residential treatment program and has no appropriate housing
available and lacks the resources and support necessary to access appropriate housing. deleted text begin At
least 70 percent of the supportive housing units must serve homeless adults with mental
illness, substance abuse problems, or human immunodeficiency virus or acquired
immunodeficiency syndrome who are about to be or, within the previous six months, have
been discharged from a regional treatment center, or a state-contracted psychiatric bed in
a community hospital, or a residential mental health or chemical dependency treatment
program.deleted text end If a person meets the requirements of subdivision 1, paragraph (a)new text begin or (b)new text end , and
receives a federal or state housing subsidy, the housing support rate for that person is limited
to the supplementary rate under section 256I.05, subdivision 1adeleted text begin , and is determined by
subtracting the amount of the person's countable income that exceeds the MSA equivalent
rate from the housing support supplementary service ratedeleted text end . A resident in a demonstration
project site who no longer participates in the demonstration program shall retain eligibility
for a housing support payment in an amount determined under section 256I.06, subdivision
8, using the MSA equivalent ratedeleted text begin . Service funding under section 256I.05, subdivision 1a,
will end June 30, 1997, if federal matching funds are available and the services can be
provided through a managed care entity. If federal matching funds are not available, then
service funding will continue under section 256I.05, subdivision 1adeleted text end ;
(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a housing support contract with the county and has been licensed as a board and lodge
facility with special services since 1980;
(5) for a housing support provider located in the city of St. Cloud, or a county contiguous
to the city of St. Cloud, that operates a 40-bed facility, that received financing through the
Minnesota Housing Finance Agency Ending Long-Term Homelessness Initiative and serves
chemically dependent clientele, providing 24-hour-a-day supervision;
(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a housing support provider that currently operates a 304-bed facility
in Minneapolis, and a 44-bed facility in Duluth;
(7) for a housing support provider that operates two ten-bed facilities, one located in
Hennepin County and one located in Ramsey County, that provide community support and
24-hour-a-day supervision to serve the mental health needs of individuals who have
chronically lived unsheltered; and
(8) for a facility authorized for recipients of housing support in Hennepin County with
a capacity of up to 48 beds that has been licensed since 1978 as a board and lodging facility
and that until August 1, 2007, operated as a licensed chemical dependency treatment program.
(b) An agency may enter into a housing support agreement for beds with rates in excess
of the MSA equivalent rate in addition to those currently covered under a housing support
agreement if the additional beds are only a replacement of beds with rates in excess of the
MSA equivalent rate which have been made available due to closure of a setting, a change
of licensure or certification which removes the beds from housing support payment, or as
a result of the downsizing of a setting authorized for recipients of housing support. The
transfer of available beds from one agency to another can only occur by the agreement of
both agencies.
new text begin
(c) The appropriation for this subdivision must include administrative funding equal to
the cost of two full-time equivalent employees to process eligibility. The commissioner
must disburse administrative funding to the fiscal agent for the counties under this
subdivision.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256S.16, is amended to read:
256S.16 AUTHORIZATION OF ELDERLY WAIVER SERVICES AND SERVICE
RATES.
new text begin Subdivision 1. new text end
new text begin Service rates; generally. new text end
A lead agency must use the service rates and
service rate limits published by the commissioner to authorize services.
new text begin Subd. 2. new text end
new text begin Shared services; rates. new text end
new text begin
The commissioner shall provide a rate system for
shared homemaker services and shared chore services, based on homemaker rates for a
single individual under section 256S.215, subdivisions 9 to 11, and the chore rate for a
single individual under section 256S.215, subdivision 7. For two persons sharing services,
the rate paid to a provider must not exceed 1-1/2 times the rate paid for serving a single
individual, and for three persons sharing services, the rate paid to a provider must not exceed
two times the rate paid for serving a single individual. These rates apply only when all of
the criteria for the shared service have been met.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256S.18, subdivision 1, is amended to read:
Subdivision 1.
Case mix classifications.
(a) The elderly waiver case mix classifications
A to K shall be the resident classes A to K established under Minnesota Rules, parts
9549.0058 and 9549.0059.
(b) A participant assigned to elderly waiver case mix classification A must be reassigned
to elderly waiver case mix classification L if an assessment or reassessment performed
under section 256B.0911 determines that the participant has:
(1) no dependencies in activities of daily living; or
(2) up to two dependencies in bathing, dressing, grooming, walking, or eating when the
dependency score in eating is three or greater.
(c) A participant must be assigned to elderly waiver case mix classification V if the
participant meets the definition of ventilator-dependent in section 256B.0651, subdivision
1, paragraph deleted text begin (g)deleted text end new text begin (i)new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 25.
Laws 2021, First Special Session chapter 7, article 17, section 14, subdivision 3,
is amended to read:
Subd. 3.
Membership.
(a) The task force consists of deleted text begin 16deleted text end new text begin 20new text end members, appointed as
follows:
(1) the commissioner of human services or a designee;
(2) the commissioner of labor and industry or a designee;
(3) the commissioner of education or a designee;
(4) the commissioner of employment and economic development or a designee;
(5) a representative of the Department of Employment and Economic Development's
Vocational Rehabilitation Services Division appointed by the commissioner of employment
and economic development;
(6) one member appointed by the Minnesota Disability Law Center;
(7) one member appointed by The Arc of Minnesota;
(8) deleted text begin threedeleted text end new text begin fournew text end members who are persons with disabilities appointed by the commissioner
of human services, at least one of whom deleted text begin must bedeleted text end new text begin isnew text end neurodiverse, deleted text begin anddeleted text end at least one of whom
deleted text begin must havedeleted text end new text begin hasnew text end a significant physical disabilitynew text begin , and at least one of whom at the time of the
appointment is being paid a subminimum wagenew text end ;
(9) two representatives of employers authorized to pay subminimum wage and one
representative of an employer who successfully transitioned away from payment of
subminimum wages to people with disabilities, appointed by the commissioner of human
services;
(10) one member appointed by the Minnesota Organization for Habilitation and
Rehabilitation;
(11) one member appointed by ARRM; deleted text begin and
deleted text end
(12) one member appointed by the State Rehabilitation Councilnew text begin ; and
new text end
new text begin (13) three members who are parents or guardians of persons with disabilities appointed
by the commissioner of human services, at least one of whom is a parent or guardian of a
person who is neurodiverse, at least one of whom is a parent or guardian of a person with
a significant physical disability, and at least one of whom is a parent or guardian of a person
being paid a subminimum wage as of the date of the appointmentnew text end .
(b) To the extent possible, membership on the task force under paragraph (a) shall reflect
geographic parity throughout the state and representation from Black, Indigenous, and
communities of color.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment. The
commissioner of human services must make the additional appointments required under
this section within 30 days following final enactment.
new text end
Sec. 26.
Laws 2022, chapter 33, section 1, subdivision 5a, is amended to read:
Subd. 5a.
Base wage index; calculations.
The base wage index must be calculated as
follows:
(1) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialist, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);
(2) for registered nurse staff, 100 percent of the median wage for registered nurses (SOC
code 29-1141);
(3) for licensed practical nurse staff, 100 percent of the median wage for licensed practical
nurses (SOC code 29-2061);
(4) for residential asleep-overnight staff, the minimum wage in Minnesota for large
employers, with the exception of asleep-overnight staff for family residential services, which
is 36 percent of the minimum wage in Minnesota for large employers;
(5) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 30 percent of the median wage for nursing assistant
(SOC code 31-1131); and 20 percent of the median wage for social and human services
aide (SOC code 21-1093); and
(ii) 85 percent of the subtotal of 40 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 20 percent of the median wage for social and human services aide (SOC code
21-1093);
(6) for adult day services staff, 70 percent of the median wage for nursing assistant (SOC
code 31-1131); and 30 percent of the median wage for home health and personal care aide
(SOC code 31-1120);
(7) for day support services staff and prevocational services staff, 20 percent of the
median wage for nursing assistant (SOC code 31-1131); 20 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093);
(8) for positive supports analyst staff, 100 percent of the median wage for substance
abuse, behavioral disorder, and mental health counselor (SOC code 21-1018);
(9) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(10) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(11) for individualized home supports with family training staff, 20 percent of the median
wage for nursing aide (SOC code 31-1131); 30 percent of the median wage for community
social service specialist (SOC code 21-1099); 40 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
(12) for individualized home supports with training services staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(14) for employment exploration services staff, 50 percent of the median wage for
deleted text begin rehabilitation counselor (SOC code 21-1015)deleted text end new text begin education, guidance, school, and vocational
counselors (SOC code 21-1012)new text end ; and 50 percent of the median wage for community and
social services specialist (SOC code 21-1099);
(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);
(16) for individualized home support without training staff, 50 percent of the median
wage for home health and personal care aide (SOC code 31-1120); and 50 percent of the
median wage for nursing assistant (SOC code 31-1131);
(17) for night supervision staff, 40 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
(SOC code 31-1131); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 20 percent of the median wage for social and human services aide (SOC code
21-1093); and
(18) for respite staff, 50 percent of the median wage for home health and personal care
aide (SOC code 31-1131); and 50 percent of the median wage for nursing assistant (SOC
code 31-1014).deleted text begin .
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 27.
Laws 2022, chapter 33, section 1, subdivision 9a, is amended to read:
Subd. 9a.
Respite services; component values and calculation of payment rates.
(a)
For the purposes of this section, respite services include respite services provided to an
individual outside of any service plan for a day program or residential support service.
(b) Component values for respite services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 2.9 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
(c) A unit of service for respite services is 15 minutes.
(d) Payments for respite services must be calculated as follows unless the service is
reimbursed separately as part of a residential support services or day program payment rate:
(1) determine the number of units of service to meet an individual's needs;
(2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 and 5a;
(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the
product of one plus the competitive workforce factor;
(4) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (3);
(5) multiply the number of direct staffing hours by the appropriate staff wage;
(6) multiply the number of direct staffing hours by the product of the supervisory span
of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
rate;
(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio;
(9) this is the subtotal rate;
(10) sum the standard general administrative support ratio, the program-related expense
ratio, and the absence and utilization factor ratio;
(11) divide the result of clause (9) by one minus the result of clause (10). This is the
total payment amount;
(12) for respite services provided in a shared manner, divide the total payment amount
in clause (11) by the number of service recipients, not to exceed three; deleted text begin and
deleted text end
new text begin
(13) for night supervision provided in a shared manner, divide the total payment amount
in clause (11) by the number of service recipients, not to exceed two; and
new text end
deleted text begin (13)deleted text end new text begin (14)new text end adjust the result of deleted text begin clausedeleted text end new text begin clausesnew text end (12)new text begin and (13)new text end by a factor to be determined
by the commissioner to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever occurs later. The commissioner of human services shall notify the revisor of
statutes when federal approval is obtained.
new text end
Sec. 28.
Laws 2022, chapter 40, section 7, is amended to read:
Sec. 7. APPROPRIATION; TEMPORARY STAFFING POOL.
deleted text begin $1,029,000deleted text end new text begin $3,181,000new text end in fiscal year 2022 is appropriated from the general fund to the
commissioner of human services for the temporary staffing pool described in this act. This
is a onetime appropriation and is available until deleted text begin June 30, 2022deleted text end new text begin September 30, 2023new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 29. new text begin WORKFORCE INCENTIVE FUND GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program established. new text end
new text begin
The commissioner of human services shall
establish grants for behavioral health, housing, disability, and home and community-based
older adult providers to assist with recruiting and retaining direct support and frontline
workers.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services.
new text end
new text begin
(c) "Eligible employer" means an organization enrolled in a Minnesota health care
program or providing housing services that is:
new text end
new text begin
(1) a provider of home and community-based services under Minnesota Statutes, chapter
245D;
new text end
new text begin
(2) an agency provider or financial management service provider under Minnesota
Statutes, section 256B.85;
new text end
new text begin
(3) a home care provider licensed under Minnesota Statutes, sections 144A.43 to
144A.482;
new text end
new text begin
(4) a facility certified as an intermediate care facility for persons with developmental
disabilities;
new text end
new text begin
(5) a provider of home care services as defined in Minnesota Statutes, section 256B.0651,
subdivision 1, paragraph (d);
new text end
new text begin
(6) an agency as defined in Minnesota Statutes, section 256B.0949, subdivision 2;
new text end
new text begin
(7) a provider of mental health day treatment services for children or adults;
new text end
new text begin
(8) a provider of emergency services as defined in Minnesota Statutes, section 256E.36;
new text end
new text begin
(9) a provider of housing support as defined in Minnesota Statutes, chapter 256I;
new text end
new text begin
(10) a provider of housing stabilization services as defined in Minnesota Statutes, section
256B.051;
new text end
new text begin
(11) a provider of transitional housing programs as defined in Minnesota Statutes, section
256E.33;
new text end
new text begin
(12) a provider of substance use disorder services as defined in Minnesota Statutes,
chapter 245G;
new text end
new text begin
(13) an eligible financial management service provider serving people through
consumer-directed community supports under Minnesota Statutes, sections 256B.092 and
256B.49, and chapter 256S, and consumer support grants under Minnesota Statutes, section
256.476;
new text end
new text begin
(14) a provider of customized living services as defined in Minnesota Statutes, section
256S.02, subdivision 12; or
new text end
new text begin
(15) a provider who serves children with an emotional disorder or adults with mental
illness under Minnesota Statutes, section 245I.011 or 256B.0671, providing services,
including:
new text end
new text begin
(i) assertive community treatment;
new text end
new text begin
(ii) intensive residential treatment services;
new text end
new text begin
(iii) adult rehabilitative mental health services;
new text end
new text begin
(iv) mobile crisis services;
new text end
new text begin
(v) children's therapeutic services and supports;
new text end
new text begin
(vi) children's residential services;
new text end
new text begin
(vii) psychiatric residential treatment services;
new text end
new text begin
(viii) outpatient mental health treatment provided by mental health professionals,
community mental health center services, or certified community behavioral health clinics;
and
new text end
new text begin
(ix) intensive mental health outpatient treatment services.
new text end
new text begin
(d) "Eligible worker" means a worker who earns $30 per hour or less and has worked
in an eligible profession for at least six months. Eligible workers may receive up to $5,000
annually in payments from the workforce incentive fund.
new text end
new text begin Subd. 3. new text end
new text begin Allowable uses of grant money. new text end
new text begin
(a) Grantees must use money awarded to
provide payments to eligible workers for the following purposes:
new text end
new text begin
(1) retention and incentive payments;
new text end
new text begin
(2) postsecondary loan and tuition payments;
new text end
new text begin
(3) child care costs;
new text end
new text begin
(4) transportation-related costs; and
new text end
new text begin
(5) other costs associated with retaining and recruiting workers, as approved by the
commissioner.
new text end
new text begin
(b) The commissioner must develop a grant cycle distribution plan that allows for
equitable distribution of funding among eligible employer types. The commissioner's
determination of the grant awards and amounts is final and is not subject to appeal.
new text end
new text begin
(c) The commissioner must make efforts to prioritize eligible employers owned by
persons who are Black, Indigenous, and people of color and small- to mid-sized eligible
employers.
new text end
new text begin Subd. 4. new text end
new text begin Attestation. new text end
new text begin
As a condition of obtaining grant payments under this section, an
eligible employer must attest and agree to the following:
new text end
new text begin
(1) the employer is an eligible employer;
new text end
new text begin
(2) the total number of eligible employees;
new text end
new text begin
(3) the employer will distribute the entire value of the grant to eligible employees, as
allowed under this section;
new text end
new text begin
(4) the employer will create and maintain records under subdivision 6;
new text end
new text begin
(5) the employer will not use the money appropriated under this section for any purpose
other than the purposes permitted under this section; and
new text end
new text begin
(6) the entire value of any grant amounts must be distributed to eligible employees
identified by the provider.
new text end
new text begin Subd. 5. new text end
new text begin Audits and recoupment. new text end
new text begin
(a) The commissioner may perform an audit under
this section up to six years after the grant is awarded to ensure:
new text end
new text begin
(1) the grantee used the money solely for the purposes stated in subdivision 3;
new text end
new text begin
(2) the grantee was truthful when making attestations under subdivision 5; and
new text end
new text begin
(3) the grantee complied with the conditions of receiving a grant under this section.
new text end
new text begin
(b) If the commissioner determines that a grantee used awarded money for purposes not
authorized under this section, the commissioner must treat any amount used for a purpose
not authorized under this section as an overpayment. The commissioner must recover any
overpayment.
new text end
new text begin Subd. 6. new text end
new text begin Self-directed services workforce. new text end
new text begin
Grants paid to eligible employees providing
services within the covered programs defined in Minnesota Statutes, section 256B.0711,
do not constitute a change in a term or condition for individual providers in covered programs
and are not subject to the state's obligation to meet and negotiate under Minnesota Statutes,
chapter 179A.
new text end
new text begin Subd. 7. new text end
new text begin Grants not to be considered income. new text end
new text begin
(a) For the purposes of this subdivision,
"subtraction" has the meaning given in Minnesota Statutes, section 290.0132, subdivision
1, paragraph (a), and the rules in that subdivision apply for this subdivision. The definitions
in Minnesota Statutes, section 290.01, apply to this subdivision.
new text end
new text begin
(b) The amount of grant awards received under this section is a subtraction.
new text end
new text begin
(c) Grant awards under this section are excluded from income, as defined in Minnesota
Statutes, sections 290.0674, subdivision 2a, and 290A.03, subdivision 3.
new text end
new text begin
(d) Notwithstanding any law to the contrary, grant awards under this section must not
be considered income, assets, or personal property for purposes of determining eligibility
or recertifying eligibility for:
new text end
new text begin
(1) child care assistance programs under Minnesota Statutes, chapter 119B;
new text end
new text begin
(2) general assistance, Minnesota supplemental aid, and food support under Minnesota
Statutes, chapter 256D;
new text end
new text begin
(3) housing support under Minnesota Statutes, chapter 256I;
new text end
new text begin
(4) Minnesota family investment program and diversionary work program under
Minnesota Statutes, chapter 256J; and
new text end
new text begin
(5) economic assistance programs under Minnesota Statutes, chapter 256P.
new text end
new text begin
(e) The commissioner of human services must not consider grant awards under this
section as income or assets under Minnesota Statutes, section 256B.056, subdivision 1a,
paragraph (a); 3; or 3c, or for persons with eligibility determined under Minnesota Statutes,
section 256B.057, subdivision 3, 3a, or 3b.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 30. new text begin DIRECT CARE SERVICE CORPS PILOT PROJECT.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
HealthForce Minnesota at Winona State University must
develop a pilot project establishing the Minnesota Direct Care Service Corps. The pilot
program must utilize financial incentives to attract postsecondary students to work as personal
care assistants or direct support professionals. HealthForce Minnesota must establish the
financial incentives and minimum work requirements to be eligible for incentive payments.
The financial incentive must increase with each semester that the student participates in the
Minnesota Direct Care Service Corps.
new text end
new text begin Subd. 2. new text end
new text begin Pilot sites. new text end
new text begin
(a) Pilot sites must include one postsecondary institution in the
seven-county metropolitan area and at least one postsecondary institution outside of the
seven-county metropolitan area. If more than one postsecondary institution outside the
metropolitan area is selected, one must be located in northern Minnesota and the other must
be located in southern Minnesota.
new text end
new text begin
(b) After satisfactorily completing the work requirements for a semester, the pilot site
or its fiscal agent must pay students the financial incentive developed for the pilot project.
new text end
new text begin Subd. 3. new text end
new text begin Evaluation and report. new text end
new text begin
(a) HealthForce Minnesota must contract with a third
party to evaluate the pilot project's impact on health care costs, retention of personal care
assistants, and patients' and providers' satisfaction of care. The evaluation must include the
number of participants, the hours of care provided by participants, and the retention of
participants from semester to semester.
new text end
new text begin
(b) By January 4, 2024, HealthForce Minnesota must report the findings under paragraph
(a) to the chairs and ranking members of the legislative committees with jurisdiction over
human services policy and finance.
new text end
Sec. 31. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
LIFE-SHARING SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Recommendations required. new text end
new text begin
The commissioner of human services shall
develop recommendations for establishing life sharing as a covered medical assistance
waiver service.
new text end
new text begin Subd. 2. new text end
new text begin Definition. new text end
new text begin
For the purposes of this section, "life sharing" means a
relationship-based living arrangement between an adult with a disability and an individual
or family in which they share their lives and experiences while the adult with a disability
receives support from the individual or family using person-centered practices.
new text end
new text begin Subd. 3. new text end
new text begin Stakeholder engagement and consultation. new text end
new text begin
(a) The commissioner must
proactively solicit participation in the development of the life-sharing medical assistance
service through a robust stakeholder engagement process that results in the inclusion of a
racially, culturally, and geographically diverse group of interested stakeholders from each
of the following groups:
new text end
new text begin
(1) providers currently providing or interested in providing life-sharing services;
new text end
new text begin
(2) people with disabilities accessing or interested in accessing life-sharing services;
new text end
new text begin
(3) disability advocacy organizations; and
new text end
new text begin
(4) lead agencies.
new text end
new text begin
(b) The commissioner must proactively seek input into and assistance with the
development of recommendations for establishing the life-sharing service from interested
stakeholders.
new text end
new text begin
(c) The commissioner must provide a method for the commissioner and interested
stakeholders to cofacilitate public meetings. The first meeting must occur before January
31, 2023. The commissioner must host the cofacilitated meetings at least monthly through
October 31, 2023. All meetings must be accessible to all interested stakeholders, recorded,
and posted online within one week of the meeting date.
new text end
new text begin Subd. 4. new text end
new text begin
Required topics to be discussed during development of the
recommendations.
new text end
new text begin
The commissioner and the interested stakeholders must discuss the
following topics:
new text end
new text begin
(1) the distinction between life sharing and adult family foster care;
new text end
new text begin
(2) successful life-sharing models used in other states;
new text end
new text begin
(3) services and supports that could be included in a life-sharing service;
new text end
new text begin
(4) potential barriers to providing or accessing life-sharing services;
new text end
new text begin
(5) solutions to remove identified barriers to providing or accessing life-sharing services;
new text end
new text begin
(6) potential medical assistance payment methodologies for life-sharing services;
new text end
new text begin
(7) expanding awareness of the life-sharing model; and
new text end
new text begin
(8) draft language for legislation necessary to define and implement life-sharing services.
new text end
new text begin Subd. 5. new text end
new text begin Report to the legislature. new text end
new text begin
By December 31, 2023, the commissioner must
provide to the chairs and ranking minority members of the house of representatives and
senate committees and divisions with jurisdiction over direct care services a report
summarizing the discussions between the commissioner and the interested stakeholders and
the commissioner's recommendations. The report must also include any draft legislation
necessary to define and implement life-sharing services.
new text end
Sec. 32. new text begin TASK FORCE ON DISABILITY SERVICES ACCESSIBILITY.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The Task Force on Disability Services
Accessibility is established to evaluate the accessibility of current state and county disability
services and to develop and evaluate plans to address barriers to accessibility.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms in this subdivision have
the meanings given.
new text end
new text begin
(b) "Accessible" means that a service or program is easily navigated without
accommodation or assistance, or, if reasonable accommodations are needed to navigate a
service or program, accommodations are chosen by the participant and effectively
implemented without excessive burden to the participant. Accessible communication means
communication that a person understands, with appropriate accommodations as needed,
including language or other interpretation.
new text end
new text begin
(c) "Commissioner" means the commissioner of the Department of Human Services.
new text end
new text begin
(d) "Disability services" means services provided through Medicaid, including personal
care assistance, home care, other home and community-based services, waivers, and other
home and community-based disability services provided through lead agencies.
new text end
new text begin
(e) "Lead agency" means a county, Tribe, or health plan under contract with the
commissioner to administer disability services.
new text end
new text begin
(f) "Task force" means the Task Force on Disability Services Accessibility.
new text end
new text begin Subd. 3. new text end
new text begin Membership. new text end
new text begin
(a) The task force consists of 24 members as follows:
new text end
new text begin
(1) the commissioner of human services or a designee;
new text end
new text begin
(2) one member appointed by the Minnesota Council on Disability;
new text end
new text begin
(3) the ombudsman for mental health and developmental disabilities or a designee;
new text end
new text begin
(4) two representatives of counties or Tribal agencies appointed by the commissioner
of human services;
new text end
new text begin
(5) one member appointed by the Minnesota Association of County Social Service
Administrators;
new text end
new text begin
(6) one member appointed by the Minnesota Disability Law Center;
new text end
new text begin
(7) one member appointed by the Arc of Minnesota;
new text end
new text begin
(8) one member appointed by the Autism Society of Minnesota;
new text end
new text begin
(9) one member appointed by the Service Employees International Union;
new text end
new text begin
(10) five members appointed by the commissioner of human services who are people
with disabilities, including at least one individual who has been denied services from the
state or county and two individuals who use different types of disability services;
new text end
new text begin
(11) three members appointed by the commissioner of human services who are parents
of children with disabilities who use different types of disability services;
new text end
new text begin
(12) one member appointed by the Association of Residential Resources in Minnesota;
new text end
new text begin
(13) one member appointed by the Minnesota First Provider Alliance;
new text end
new text begin
(14) one member appointed by the Minnesota Commission of the Deaf, DeafBlind and
Hard of Hearing;
new text end
new text begin
(15) one member appointed by the Minnesota Organization for Habilitation and
Rehabilitation; and
new text end
new text begin
(16) two members appointed by the commissioner of human services who are direct
service professionals.
new text end
new text begin
(b) To the extent possible, membership on the task force under paragraph (a) shall reflect
geographic parity throughout the state and representation from Black and Indigenous
communities and communities of color.
new text end
new text begin
(c) The membership terms, compensation, expense reimbursement, and removal and
filling of vacancies of task force members are as provided in section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Appointment deadline; first meeting; chair. new text end
new text begin
Appointing authorities must
complete member selections by August 1, 2022. The commissioner shall convene the first
meeting of the task force by September 15, 2022. The task force shall select a chair from
among its members at its first meeting. The chair shall convene all subsequent meetings.
new text end
new text begin Subd. 5. new text end
new text begin Goals. new text end
new text begin
The goals of the task force include:
new text end
new text begin
(1) developing plans and executing methods to investigate accessibility of disability
services, including consideration of the following inquiries:
new text end
new text begin
(i) how accessible is the program or service without assistance or accommodation,
including what accessibility options exist, how the accessibility options are communicated,
what communication options are available, what trainings are provided to ensure accessibility
options are implemented, and available processes for filing consumer accessibility complaints
and correcting administrative errors;
new text end
new text begin
(ii) the impact of accessibility barriers on individuals' access to services, including
information about service denials or reductions due to accessibility issues, and aggregate
information about reductions and denials related to disability or support need types and
reasons for reductions and denials; and
new text end
new text begin
(iii) what areas of discrepancy exist between declared state and county disability policy
goals and enumerated state and federal laws and the experiences of people who have
disabilities in accessing services;
new text end
new text begin
(2) identifying areas of inaccessibility creating inefficiencies that financially impact the
state and counties, including:
new text end
new text begin
(i) the number and cost of appeals, including the number of appeals of service denials
or reductions that are ultimately overturned;
new text end
new text begin
(ii) the cost of crisis intervention because of service failure; and
new text end
new text begin
(iii) the cost of redoing work that was not done correctly initially; and
new text end
new text begin
(3) assessing the efficacy of possible solutions.
new text end
new text begin Subd. 6. new text end
new text begin Duties; plan and recommendations. new text end
new text begin
(a) The task force shall work with the
commissioner to identify investigative areas and to develop a plan to conduct an accessibility
assessment of disability services provided by lead agencies and the Department of Human
Services. The assessment shall:
new text end
new text begin
(1) identify accessibility barriers and impediments created by current policies, procedures,
and implementation;
new text end
new text begin
(2) identify and analyze accessibility barrier and impediment impacts on different
demographics;
new text end
new text begin
(3) gather information from:
new text end
new text begin
(i) the Department of Human Services;
new text end
new text begin
(ii) relevant state agencies and staff;
new text end
new text begin
(iii) counties and relevant staff;
new text end
new text begin
(iv) people who use disability services;
new text end
new text begin
(v) disability advocates; and
new text end
new text begin
(vi) family members and other support people for individuals who use disability services;
new text end
new text begin
(4) identify barriers to accessibility improvements in state and county services; and
new text end
new text begin
(5) identify benefits to the state and counties in improving accessibility of disability
services.
new text end
new text begin
(b) For the purposes of the assessment, disability services include:
new text end
new text begin
(1) access to services;
new text end
new text begin
(2) explanation of services;
new text end
new text begin
(3) maintenance of services;
new text end
new text begin
(4) application of services;
new text end
new text begin
(5) services participant understanding of rights and responsibilities;
new text end
new text begin
(6) communication regarding services;
new text end
new text begin
(7) requests for accommodations;
new text end
new text begin
(8) processes for filing complaints or grievances; and
new text end
new text begin
(9) processes for appealing decisions denying or reducing services or eligibility.
new text end
new text begin
(c) The task force shall collaborate with stakeholders, counties, and state agencies to
develop recommendations from the findings of the assessment and to create sustainable and
accessible changes to county and state services to improve outcomes for people with
disabilities. The recommendations shall include:
new text end
new text begin
(1) recommendations to eliminate barriers identified in the assessment, including but
not limited to recommendations for state legislative action, state policy action, and lead
agency changes;
new text end
new text begin
(2) benchmarks for measuring annual progress toward increasing accessibility in county
and state disability services to be annually evaluated by the commissioner and the Minnesota
Council on Disability;
new text end
new text begin
(3) a proposed method for monitoring and tracking accessibility in disability services;
new text end
new text begin
(4) proposed initiatives, training, and services designed to improve accessibility and
effectiveness of county and state disability services, including recommendations for needed
electronic or other communication changes in order to facilitate accessible communication
for participants; and
new text end
new text begin
(5) recommendations for sustainable financial support and resources for improving
accessibility.
new text end
new text begin
(d) The task force shall oversee preparation of a report outlining the findings from the
accessibility assessment in paragraph (a) and the recommendations developed pursuant to
paragraph (b) according to subdivision 7.
new text end
new text begin Subd. 7. new text end
new text begin Report. new text end
new text begin
By September 30, 2023, the task force shall submit a report with
recommendations to the chairs and ranking minority members of the committees and divisions
in the senate and house of representatives with jurisdiction over health and human services.
This report must comply with subdivision 6, paragraph (d), include any changes to statutes,
laws, or rules required to implement the recommendations of the task force, and include a
recommendation concerning continuing the task force beyond its scheduled expiration.
new text end
new text begin Subd. 8. new text end
new text begin Administrative support. new text end
new text begin
The commissioner of human services shall provide
meeting space and administrative services to the task force.
new text end
new text begin Subd. 9. new text end
new text begin Expiration. new text end
new text begin
The task force expires on June 30, 2023.
new text end
Sec. 33. new text begin DIRECTION TO COMMISSIONER; SHARED SERVICES.
new text end
new text begin
(a) By December 1, 2022, the commissioner of human services shall seek any necessary
changes to home and community-based services waiver plans regarding sharing services in
order to:
new text end
new text begin
(1) permit shared services for more services, including chore, homemaker, and night
supervision;
new text end
new text begin
(2) permit shared services for some services for higher ratios, including individualized
home supports without training, individualized home supports with training, and
individualized home supports with family training for a ratio of one staff person to three
recipients;
new text end
new text begin
(3) ensure that individuals who are seeking to share services permitted under the waiver
plans in an own-home setting are not required to live in a licensed setting in order to share
services so long as all other requirements are met; and
new text end
new text begin
(4) issue guidance for shared services, including:
new text end
new text begin
(i) informed choice for all individuals sharing the services;
new text end
new text begin
(ii) guidance for when multiple shared services by different providers occur in one home
and how lead agencies and individuals shall determine that shared service is appropriate to
meet the needs, health, and safety of each individual for whom the lead agency provides
case management or care coordination; and
new text end
new text begin
(iii) guidance clarifying that an individual's decision to share services does not reduce
any determination of the individual's overall or assessed needs for services.
new text end
new text begin
(b) The commissioner shall develop or provide guidance outlining:
new text end
new text begin
(1) instructions for shared services support planning;
new text end
new text begin
(2) person-centered approaches and informed choice in shared services support planning;
and
new text end
new text begin
(3) required contents of shared services agreements.
new text end
new text begin
(c) The commissioner shall seek and utilize stakeholder input for any proposed changes
to waiver plans and any shared services guidance.
new text end
Sec. 34. new text begin DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED
SERVICES RATES.
new text end
new text begin
The commissioner of human services shall provide a rate system for shared homemaker
services and shared chore services provided under Minnesota Statutes, sections 256B.092
and 256B.49. For two persons sharing services, the rate paid to a provider must not exceed
1-1/2 times the rate paid for serving a single individual, and for three persons sharing
services, the rate paid to a provider must not exceed two times the rate paid for serving a
single individual. These rates apply only when all of the criteria for the shared service have
been met.
new text end
Sec. 35. new text begin DIRECTION TO COMMISSIONER; CONSUMER-DIRECTED
COMMUNITY SUPPORTS.
new text end
new text begin
The commissioner of human services shall increase individual budgets for people
receiving consumer-directed community supports available under programs established
pursuant to home and community-based service waivers authorized under section 1915(c)
of the federal Social Security Act and Minnesota Statutes, sections 256B.092 and 256B.49,
by 2.8 percent.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 36. new text begin DIRECTION TO COMMISSIONER; DIRECT SUPPORT SERVICES
WORKFORCE COLLECTIVE BARGAINING.
new text end
new text begin
Notwithstanding Minnesota Statutes, section 256B.851, subdivision 11, or any other
law to the contrary, the commissioner of management and budget shall meet and negotiate
in good faith with the exclusive representative of individual providers under Minnesota
Statutes, section 179A.54, for an amendment to the current contract covering individual
providers to establish a mutually acceptable increase in wages and benefits made possible
by the funds provided by the rate increase in this act. Any such amendment agreed upon
between the state and the exclusive representative of individual providers must be submitted
for acceptance or rejection in accordance with Minnesota Statutes, section 179A.54,
subdivision 5, and is subject to an appropriation by the legislature.
new text end
Sec. 37. new text begin DIRECTION TO COMMISSIONER; INTERMEDIATE CARE FACILITIES
FOR PERSONS WITH DISABILITIES RATE STUDY.
new text end
new text begin
The commissioner of human services shall study medical assistance payment rates for
intermediate care facilities for persons with disabilities under Minnesota Statutes, sections
256B.5011 to 256B.5015; make recommendations on establishing a new payment rate
methodology for these facilities; and submit a report to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services finance by
February 15, 2023, that includes the recommendations and any draft legislation necessary
to implement the recommendations.
new text end
ARTICLE 10
BEHAVIORAL HEALTH
Section 1.
Minnesota Statutes 2020, section 62N.25, subdivision 5, is amended to read:
Subd. 5.
Benefits.
Community integrated service networks must offer the health
maintenance organization benefit set, as defined in chapter 62D, and other laws applicable
to entities regulated under chapter 62D. Community networks and chemical dependency
facilities under contract with a community network shall use the assessment criteria in
deleted text begin Minnesota Rules, parts 9530.6600 to 9530.6655,deleted text end new text begin section 245G.05new text end when assessing enrollees
for chemical dependency treatment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 2.
Minnesota Statutes 2020, section 62Q.1055, is amended to read:
62Q.1055 CHEMICAL DEPENDENCY.
All health plan companies shall use the assessment criteria in deleted text begin Minnesota Rules, parts
9530.6600 to 9530.6655,deleted text end new text begin section 245G.05new text end when assessing and deleted text begin placingdeleted text end new text begin treatingnew text end enrollees
for chemical dependency treatment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62Q.47, is amended to read:
62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY
SERVICES.
(a) All health plans, as defined in section 62Q.01, that provide coverage for alcoholism,
mental health, or chemical dependency services, must comply with the requirements of this
section.
(b) Cost-sharing requirements and benefit or service limitations for outpatient mental
health and outpatient chemical dependency and alcoholism services, except for persons
deleted text begin placed indeleted text end new text begin seekingnew text end chemical dependency services under deleted text begin Minnesota Rules, parts 9530.6600
to 9530.6655deleted text end new text begin section 245G.05new text end , must not place a greater financial burden on the insured or
enrollee, or be more restrictive than those requirements and limitations for outpatient medical
services.
(c) Cost-sharing requirements and benefit or service limitations for inpatient hospital
mental health and inpatient hospital and residential chemical dependency and alcoholism
services, except for persons deleted text begin placed indeleted text end new text begin seekingnew text end chemical dependency services under deleted text begin Minnesota
Rules, parts 9530.6600 to 9530.6655deleted text end new text begin section 245G.05new text end , must not place a greater financial
burden on the insured or enrollee, or be more restrictive than those requirements and
limitations for inpatient hospital medical services.
(d) A health plan company must not impose an NQTL with respect to mental health and
substance use disorders in any classification of benefits unless, under the terms of the health
plan as written and in operation, any processes, strategies, evidentiary standards, or other
factors used in applying the NQTL to mental health and substance use disorders in the
classification are comparable to, and are applied no more stringently than, the processes,
strategies, evidentiary standards, or other factors used in applying the NQTL with respect
to medical and surgical benefits in the same classification.
(e) All health plans must meet the requirements of the federal Mental Health Parity Act
of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008; the Affordable Care Act; and any amendments to, and federal
guidance or regulations issued under, those acts.
(f) The commissioner may require information from health plan companies to confirm
that mental health parity is being implemented by the health plan company. Information
required may include comparisons between mental health and substance use disorder
treatment and other medical conditions, including a comparison of prior authorization
requirements, drug formulary design, claim denials, rehabilitation services, and other
information the commissioner deems appropriate.
(g) Regardless of the health care provider's professional license, if the service provided
is consistent with the provider's scope of practice and the health plan company's credentialing
and contracting provisions, mental health therapy visits and medication maintenance visits
shall be considered primary care visits for the purpose of applying any enrollee cost-sharing
requirements imposed under the enrollee's health plan.
(h) By June 1 of each year, beginning June 1, 2021, the commissioner of commerce, in
consultation with the commissioner of health, shall submit a report on compliance and
oversight to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and commerce. The report must:
(1) describe the commissioner's process for reviewing health plan company compliance
with United States Code, title 42, section 18031(j), any federal regulations or guidance
relating to compliance and oversight, and compliance with this section and section 62Q.53;
(2) identify any enforcement actions taken by either commissioner during the preceding
12-month period regarding compliance with parity for mental health and substance use
disorders benefits under state and federal law, summarizing the results of any market conduct
examinations. The summary must include: (i) the number of formal enforcement actions
taken; (ii) the benefit classifications examined in each enforcement action; and (iii) the
subject matter of each enforcement action, including quantitative and nonquantitative
treatment limitations;
(3) detail any corrective action taken by either commissioner to ensure health plan
company compliance with this section, section 62Q.53, and United States Code, title 42,
section 18031(j); and
(4) describe the information provided by either commissioner to the public about
alcoholism, mental health, or chemical dependency parity protections under state and federal
law.
The report must be written in nontechnical, readily understandable language and must be
made available to the public by, among other means as the commissioners find appropriate,
posting the report on department websites. Individually identifiable information must be
excluded from the report, consistent with state and federal privacy protections.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 4.
Minnesota Statutes 2020, section 169A.70, subdivision 3, is amended to read:
Subd. 3.
Assessment report.
(a) The assessment report must be on a form prescribed
by the commissioner and shall contain an evaluation of the convicted defendant concerning
the defendant's prior traffic and criminal record, characteristics and history of alcohol and
chemical use problems, and amenability to rehabilitation through the alcohol safety program.
The report is classified as private data on individuals as defined in section 13.02, subdivision
12.
(b) The assessment report must include:
(1) a diagnosis of the nature of the offender's chemical and alcohol involvement;
(2) an assessment of the severity level of the involvement;
(3) a recommended level of care for the offender in accordance with the criteria contained
in deleted text begin rules adopted by the commissioner of human services under section 254A.03, subdivision
3 (chemical dependency treatment rules)deleted text end new text begin section 245G.05new text end ;
(4) an assessment of the offender's placement needs;
(5) recommendations for other appropriate remedial action or care, including aftercare
services in section 254B.01, subdivision 3, that may consist of educational programs,
one-on-one counseling, a program or type of treatment that addresses mental health concerns,
or a combination of them; and
(6) a specific explanation why no level of care or action was recommended, if applicable.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 5.
Minnesota Statutes 2020, section 169A.70, subdivision 4, is amended to read:
Subd. 4.
Assessor standards; rules; assessment time limits.
A chemical use assessment
required by this section must be conducted by an assessor appointed by the court. The
assessor must meet the training and qualification requirements of deleted text begin rules adopted by the
commissioner of human services under section 254A.03, subdivision 3 (chemical dependency
treatment rules)deleted text end new text begin section 245G.11, subdivisions 1 and 5new text end . Notwithstanding section 13.82 (law
enforcement data), the assessor shall have access to any police reports, laboratory test results,
and other law enforcement data relating to the current offense or previous offenses that are
necessary to complete the evaluation. deleted text begin An assessor providing an assessment under this section
may not have any direct or shared financial interest or referral relationship resulting in
shared financial gain with a treatment provider, except as authorized under section 254A.19,
subdivision 3. If an independent assessor is not available, the court may use the services of
an assessor authorized to perform assessments for the county social services agency under
a variance granted under rules adopted by the commissioner of human services under section
254A.03, subdivision 3.deleted text end An appointment for the defendant to undergo the assessment must
be made by the court, a court services probation officer, or the court administrator as soon
as possible but in no case more than one week after the defendant's court appearance. The
assessment must be completed no later than three weeks after the defendant's court
appearance. If the assessment is not performed within this time limit, the county where the
defendant is to be sentenced shall perform the assessment. The county of financial
responsibility must be determined under chapter 256G.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 6.
new text begin
[245.4866] CHILDREN'S MENTAL HEALTH COMMUNITY OF
PRACTICE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of human services, in
consultation with children's mental health subject matter experts, shall establish a children's
mental health community of practice. The purposes of the community of practice are to
improve treatment outcomes for children and adolescents with mental illness and reduce
disparities. The community of practice shall use evidence-based and best practices through
peer-to-peer and person-to-provider sharing.
new text end
new text begin Subd. 2. new text end
new text begin Participants; meetings. new text end
new text begin
(a) The community of practice must include the
following participants:
new text end
new text begin
(1) researchers or members of the academic community who are children's mental health
subject matter experts who do not have financial relationships with treatment providers;
new text end
new text begin
(2) children's mental health treatment providers;
new text end
new text begin
(3) a representative from a mental health advocacy organization;
new text end
new text begin
(4) a representative from the Department of Human Services;
new text end
new text begin
(5) a representative from the Department of Health;
new text end
new text begin
(6) a representative from the Department of Education;
new text end
new text begin
(7) representatives from county social services agencies;
new text end
new text begin
(8) representatives from Tribal nations or Tribal social services providers; and
new text end
new text begin
(9) representatives from managed care organizations.
new text end
new text begin
(b) The community of practice must include, to the extent possible, individuals and
family members who have used mental health treatment services and must highlight the
voices and experiences of individuals who are Black, Indigenous, people of color, and
people from other communities that are disproportionately impacted by mental illness.
new text end
new text begin
(c) The community of practice must meet regularly and must hold its first meeting before
January 1, 2023.
new text end
new text begin
(d) Compensation and reimbursement for expenses for participants in paragraph (b) are
governed by section 15.059, subdivision 3.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
(a) The community of practice must:
new text end
new text begin
(1) identify gaps in children's mental health treatment services;
new text end
new text begin
(2) enhance collective knowledge of issues related to children's mental health;
new text end
new text begin
(3) understand evidence-based practices, best practices, and promising approaches to
address children's mental health;
new text end
new text begin
(4) use knowledge gathered through the community of practice to develop strategic plans
to improve outcomes for children who participate in mental health treatment and related
services in Minnesota;
new text end
new text begin
(5) increase knowledge about the challenges and opportunities learned by implementing
strategies; and
new text end
new text begin
(6) develop capacity for community advocacy.
new text end
new text begin
(b) The commissioner, in collaboration with subject matter experts and other participants,
may issue reports and recommendations to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services policy and finance
and to local and regional governments.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245.4882, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Assessment requirements. new text end
new text begin
(a) A residential treatment service provider must
complete a diagnostic assessment of a child within ten calendar days of the child's admission.
If a diagnostic assessment has been completed by a mental health professional within the
past 180 days, a new diagnostic assessment need not be completed unless in the opinion of
the current treating mental health professional the child's mental health status has changed
markedly since the assessment was completed.
new text end
new text begin
(b) The service provider must complete the screenings required by Minnesota Rules,
part 2960.0070, subpart 5, within ten calendar days.
new text end
Sec. 8.
Minnesota Statutes 2020, section 245.4882, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Crisis admissions and stabilization. new text end
new text begin
(a) A child may be referred for residential
treatment services under this section for the purpose of crisis stabilization by:
new text end
new text begin
(1) a mental health professional as defined in section 245I.04, subdivision 2;
new text end
new text begin
(2) a physician licensed under chapter 147 who is assessing a child in an emergency
department; or
new text end
new text begin
(3) a member of a mobile crisis team who meets the qualifications under section
256B.0624, subdivision 5
new text end
new text begin
.
new text end
new text begin
(b) A provider making a referral under paragraph (a) must conduct an assessment of the
child's mental health needs and make a determination that the child is experiencing a mental
health crisis and is in need of residential treatment services under this section.
new text end
new text begin
(c) A child may receive services under this subdivision for up to 30 days and must be
subject to the screening and admissions criteria and processes under section 245.4885
thereafter
new text end
new text begin
.
new text end
Sec. 9.
Minnesota Statutes 2021 Supplement, section 245.4885, subdivision 1, is amended
to read:
Subdivision 1.
Admission criteria.
(a) Prior to admission or placement, except in the
case of an emergency, all children referred for treatment of severe emotional disturbance
in a treatment foster care setting, residential treatment facility, or informally admitted to a
regional treatment center shall undergo an assessment to determine the appropriate level of
care if county funds are used to pay for the child's services.new text begin An emergency includes when
a child is in need of and has been referred for crisis stabilization services under section
245.4882, subdivision 6. A child who has been referred to residential treatment for crisis
stabilization services in a residential treatment center is not required to undergo an assessment
under this section.
new text end
(b) The county board shall determine the appropriate level of care for a child when
county-controlled funds are used to pay for the child's residential treatment under this
chapter, including residential treatment provided in a qualified residential treatment program
as defined in section 260C.007, subdivision 26d. When a county board does not have
responsibility for a child's placement and the child is enrolled in a prepaid health program
under section 256B.69, the enrolled child's contracted health plan must determine the
appropriate level of care for the child. When Indian Health Services funds or funds of a
tribally owned facility funded under the Indian Self-Determination and Education Assistance
Act, Public Law 93-638, are used for the child, the Indian Health Services or 638 tribal
health facility must determine the appropriate level of care for the child. When more than
one entity bears responsibility for a child's coverage, the entities shall coordinate level of
care determination activities for the child to the extent possible.
(c) The child's level of care determination shall determine whether the proposed treatment:
(1) is necessary;
(2) is appropriate to the child's individual treatment needs;
(3) cannot be effectively provided in the child's home; and
(4) provides a length of stay as short as possible consistent with the individual child's
needs.
(d) When a level of care determination is conducted, the county board or other entity
may not determine that a screening of a child, referral, or admission to a residential treatment
facility is not appropriate solely because services were not first provided to the child in a
less restrictive setting and the child failed to make progress toward or meet treatment goals
in the less restrictive setting. The level of care determination must be based on a diagnostic
assessment of a child that evaluates the child's family, school, and community living
situations; and an assessment of the child's need for care out of the home using a validated
tool which assesses a child's functional status and assigns an appropriate level of care to the
child. The validated tool must be approved by the commissioner of human services and
may be the validated tool approved for the child's assessment under section 260C.704 if the
juvenile treatment screening team recommended placement of the child in a qualified
residential treatment program. If a diagnostic assessment has been completed by a mental
health professional within the past 180 days, a new diagnostic assessment need not be
completed unless in the opinion of the current treating mental health professional the child's
mental health status has changed markedly since the assessment was completed. The child's
parent shall be notified if an assessment will not be completed and of the reasons. A copy
of the notice shall be placed in the child's file. Recommendations developed as part of the
level of care determination process shall include specific community services needed by
the child and, if appropriate, the child's family, and shall indicate whether these services
are available and accessible to the child and the child's family. The child and the child's
family must be invited to any meeting where the level of care determination is discussed
and decisions regarding residential treatment are made. The child and the child's family
may invite other relatives, friends, or advocates to attend these meetings.
(e) During the level of care determination process, the child, child's family, or child's
legal representative, as appropriate, must be informed of the child's eligibility for case
management services and family community support services and that an individual family
community support plan is being developed by the case manager, if assigned.
(f) The level of care determination, placement decision, and recommendations for mental
health services must be documented in the child's record and made available to the child's
family, as appropriate.
Sec. 10.
Minnesota Statutes 2021 Supplement, section 245.4889, subdivision 1, is amended
to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; deleted text begin or
deleted text end
(4) mental health service providersdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) school districts and charter schools.
new text end
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with emotional disturbances or severe emotional
disturbances who are at risk of out-of-home placementnew text begin or already in out-of-home placement
and at risk of change in placement or a higher level of care. Allowable activities and expenses
for respite care services are defined under subdivision 4new text end . A child is not required to have
case management services to receive respite care services;
(4) children's mental health crisis services;
(5) mental health services for people from cultural and ethnic minorities, including
supervision of clinical trainees who are Black, indigenous, or people of color;
(6) children's mental health screening and follow-up diagnostic assessment and treatment;
(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(8) school-linked mental health services under section 245.4901;
(9) building evidence-based mental health intervention capacity for children birth to age
five;
(10) suicide prevention and counseling services that use text messaging statewide;
(11) mental health first aid training;
(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;
(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(14) early childhood mental health consultation;
(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;
(16) psychiatric consultation for primary care practitioners; deleted text begin and
deleted text end
(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grantsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(18) intensive developmentally appropriate and culturally informed interventions for
youth who are at risk of developing a mood disorder or experiencing a first episode of a
mood disorder and a public awareness campaign on the signs and symptoms of mood
disorders in youth.
new text end
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.
(d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
Sec. 11.
Minnesota Statutes 2020, section 245.4889, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Covered respite care services. new text end
new text begin
Respite care services under subdivision 1,
paragraph (b), clause (3), include hourly or overnight stays at a licensed foster home or with
a qualified and approved family member or friend and may occur at a child's or a provider's
home. Respite care services may also include the following activities and expenses:
new text end
new text begin
(1) recreational, sport, and nonsport extracurricular activities and programs for the child
such as camps, clubs, activities, lessons, group outings, sports, or other activities and
programs;
new text end
new text begin
(2) family activities, camps, and retreats that the whole family does together that provide
a break from the family's circumstances;
new text end
new text begin
(3) cultural programs and activities for the child and family designed to address the
unique needs of individuals who share a common language or racial, ethnic, or social
background; and
new text end
new text begin
(4) costs of transportation, food, supplies, and equipment directly associated with
approved respite care services and expenses necessary for the child and family to access
and participate in respite care services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 12.
new text begin
[245.4903] CULTURAL AND ETHNIC MINORITY INFRASTRUCTURE
GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of human services shall establish a
cultural and ethnic minority infrastructure grant program to ensure that mental health and
substance use disorder treatment supports and services are culturally specific and culturally
responsive to meet the cultural needs of the communities served.
new text end
new text begin Subd. 2. new text end
new text begin Eligible applicants. new text end
new text begin
An eligible applicant is a licensed entity or provider from
a cultural or ethnic minority population who:
new text end
new text begin
(1) provides mental health or substance use disorder treatment services and supports to
individuals from cultural and ethnic minority populations, including individuals who are
lesbian, gay, bisexual, transgender, or queer, from cultural and ethnic minority populations;
new text end
new text begin
(2) provides or is qualified and has the capacity to provide clinical supervision and
support to members of culturally diverse and ethnic minority communities to qualify as
mental health and substance use disorder treatment providers; or
new text end
new text begin
(3) has the capacity and experience to provide training for mental health and substance
use disorder treatment providers on cultural competency and cultural humility.
new text end
new text begin Subd. 3. new text end
new text begin Allowable grant activities. new text end
new text begin
(a) The cultural and ethnic minority infrastructure
grant program grantees must engage in activities and provide supportive services to ensure
and increase equitable access to culturally specific and responsive care and to build
organizational and professional capacity for licensure and certification for the communities
served. Allowable grant activities include but are not limited to:
new text end
new text begin
(1) workforce development activities focused on recruiting, supporting, training, and
supervision activities for mental health and substance use disorder practitioners and
professionals from diverse racial, cultural, and ethnic communities;
new text end
new text begin
(2) supporting members of culturally diverse and ethnic minority communities to qualify
as mental health and substance use disorder professionals, practitioners, clinical supervisors,
recovery peer specialists, mental health certified peer specialists, and mental health certified
family peer specialists;
new text end
new text begin
(3) culturally specific outreach, early intervention, trauma-informed services, and recovery
support in mental health and substance use disorder services;
new text end
new text begin
(4) provision of trauma-informed, culturally responsive mental health and substance use
disorder supports and services for children and families, youth, or adults who are from
cultural and ethnic minority backgrounds and are uninsured or underinsured;
new text end
new text begin
(5) mental health and substance use disorder service expansion and infrastructure
improvement activities, particularly in greater Minnesota;
new text end
new text begin
(6) training for mental health and substance use disorder treatment providers on cultural
competency and cultural humility; and
new text end
new text begin
(7) activities to increase the availability of culturally responsive mental health and
substance use disorder services for children and families, youth, or adults or to increase the
availability of substance use disorder services for individuals from cultural and ethnic
minorities in the state.
new text end
new text begin
(b) The commissioner must assist grantees with meeting third-party credentialing
requirements, and grantees must obtain all available third-party reimbursement sources as
a condition of receiving grant funds. Grantees must serve individuals from cultural and
ethnic minority communities regardless of health coverage status or ability to pay.
new text end
new text begin Subd. 4. new text end
new text begin Data collection and outcomes. new text end
new text begin
Grantees must provide regular data summaries
to the commissioner for purposes of evaluating the effectiveness of the cultural and ethnic
minority infrastructure grant program. The commissioner must use identified culturally
appropriate outcome measures instruments to evaluate outcomes and must evaluate program
activities by analyzing whether the program:
new text end
new text begin
(1) increased access to culturally specific services for individuals from cultural and
ethnic minority communities across the state;
new text end
new text begin
(2) increased number of individuals from cultural and ethnic minority communities
served by grantees;
new text end
new text begin
(3) increased cultural responsiveness and cultural competency of mental health and
substance use disorder treatment providers;
new text end
new text begin
(4) increased number of mental health and substance use disorder treatment providers
and clinical supervisors from cultural and ethnic minority communities;
new text end
new text begin
(5) increased number of mental health and substance use disorder treatment organizations
owned, managed, or led by individuals who are Black, Indigenous, or people of color;
new text end
new text begin
(6) reduced in health disparities through improved clinical and functional outcomes for
those accessing services; and
new text end
new text begin
(7) led to an overall increase in culturally specific mental health and substance use
disorder service availability.
new text end
Sec. 13.
new text begin
[245.4904] EMERGING MOOD DISORDER GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Creation. new text end
new text begin
(a) The emerging mood disorder grant program is established
in the Department of Human Services to fund:
new text end
new text begin
(1) evidence-informed interventions for youth and young adults who are at risk of
developing a mood disorder or are experiencing an emerging mood disorder, including
major depression and bipolar disorders; and
new text end
new text begin
(2) a public awareness campaign on the signs and symptoms of mood disorders in youth
and young adults.
new text end
new text begin
(b) Emerging mood disorder services are eligible for children's mental health grants as
specified in section 245.4889, subdivision 1, paragraph (b), clause (18).
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
(a) All emerging mood disorder grant programs must:
new text end
new text begin
(1) provide intensive treatment and support to adolescents and young adults experiencing
or at risk of experiencing an emerging mood disorder. Intensive treatment and support
includes medication management, psychoeducation for the individual and the individual's
family, case management, employment support, education support, cognitive behavioral
approaches, social skills training, peer support, crisis planning, and stress management;
new text end
new text begin
(2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinicians, on early symptoms of mood
disorders, screening tools, and best practices;
new text end
new text begin
(3) ensure access for individuals to emerging mood disorder services under this section,
including ensuring access for individuals who live in rural areas; and
new text end
new text begin
(4) use all available funding streams.
new text end
new text begin
(b) Grant money may also be used to pay for housing or travel expenses for individuals
receiving services or to address other barriers preventing individuals and their families from
participating in emerging mood disorder services.
new text end
new text begin
(c) Grant money may be used by the grantee to evaluate the efficacy of providing
intensive services and supports to people with emerging mood disorders.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
Program activities must be provided to youth and young adults with
early signs of an emerging mood disorder.
new text end
new text begin Subd. 4. new text end
new text begin Outcomes. new text end
new text begin
Evaluation of program activities must utilize evidence-based
practices and must include the following outcome evaluation criteria:
new text end
new text begin
(1) whether individuals experience a reduction in mood disorder symptoms; and
new text end
new text begin
(2) whether individuals experience a decrease in inpatient mental health hospitalizations.
new text end
Sec. 14.
new text begin
[245.4905] FIRST EPISODE OF PSYCHOSIS GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Creation. new text end
new text begin
The first episode of psychosis grant program is established in
the Department of Human Services to fund evidence-based interventions for youth at risk
of developing or experiencing a first episode of psychosis and a public awareness campaign
on the signs and symptoms of psychosis. First episode of psychosis services are eligible for
children's mental health grants as specified in section 245.4889, subdivision 1, paragraph
(b), clause (15).
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
(a) All first episode of psychosis grant programs must:
new text end
new text begin
(1) provide intensive treatment and support for adolescents and adults experiencing or
at risk of experiencing a first psychotic episode. Intensive treatment and support includes
medication management, psychoeducation for an individual and an individual's family, case
management, employment support, education support, cognitive behavioral approaches,
social skills training, peer support, crisis planning, and stress management;
new text end
new text begin
(2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinicians, on early psychosis symptoms,
screening tools, and best practices;
new text end
new text begin
(3) ensure access for individuals to first psychotic episode services under this section,
including access for individuals who live in rural areas; and
new text end
new text begin
(4) use all available funding streams.
new text end
new text begin
(b) Grant money may also be used to pay for housing or travel expenses for individuals
receiving services or to address other barriers preventing individuals and their families from
participating in first psychotic episode services.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
Program activities must be provided to people 15 to 40 years old
with early signs of psychosis.
new text end
new text begin Subd. 4. new text end
new text begin Outcomes. new text end
new text begin
Evaluation of program activities must utilize evidence-based
practices and must include the following outcome evaluation criteria:
new text end
new text begin
(1) whether individuals experience a reduction in psychotic symptoms;
new text end
new text begin
(2) whether individuals experience a decrease in inpatient mental health hospitalizations;
and
new text end
new text begin
(3) whether individuals experience an increase in educational attainment.
new text end
new text begin Subd. 5. new text end
new text begin Federal aid or grants. new text end
new text begin
The commissioner of human services must comply with
all conditions and requirements necessary to receive federal aid or grants.
new text end
Sec. 15.
Minnesota Statutes 2020, section 245.713, subdivision 2, is amended to read:
Subd. 2.
Total funds available; allocation.
Funds granted to the state by the federal
government under United States Code, title 42, sections 300X to 300X-9 each federal fiscal
year for mental health services must be allocated as follows:
(a) Any amount set aside by the commissioner of human services for American Indian
organizations within the state, which funds shall not duplicate any direct federal funding of
American Indian organizations and which funds shall be at least 25 percent of the total
federal allocation to the state for mental health servicesdeleted text begin ; provided that sufficient applications
for funding are received by the commissioner which meet the specifications contained in
requests for proposalsdeleted text end . Money from this source may be used for special committees to advise
the commissioner on mental health programs and services for American Indians and other
minorities or underserved groups. For purposes of this subdivision, "American Indian
organization" means an American Indian tribe or band or an organization providing mental
health services that is legally incorporated as a nonprofit organization registered with the
secretary of state and governed by a board of directors having at least a majority of American
Indian directors.
(b) An amount not to exceed five percent of the federal block grant allocation for mental
health services to be retained by the commissioner for administration.
(c) Any amount permitted under federal law which the commissioner approves for
demonstration or research projects for severely disturbed children and adolescents, the
underserved, special populations or multiply disabled mentally ill persons. The groups to
be served, the extent and nature of services to be provided, the amount and duration of any
grant awards are to be based on criteria set forth in the Alcohol, Drug Abuse and Mental
Health Block Grant Law, United States Code, title 42, sections 300X to 300X-9, and on
state policies and procedures determined necessary by the commissioner. Grant recipients
must comply with applicable state and federal requirements and demonstrate fiscal and
program management capabilities that will result in provision of quality, cost-effective
services.
(d) The amount required under federal law, for federally mandated expenditures.
(e) An amount not to exceed 15 percent of the federal block grant allocation for mental
health services to be retained by the commissioner for planning and evaluation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 16.
new text begin
[245.991] PROJECTS FOR ASSISTANCE IN TRANSITION FROM
HOMELESSNESS PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Creation. new text end
new text begin
The projects for assistance in transition from homelessness
program is established in the Department of Human Services to prevent or end homelessness
for people with serious mental illness and substance use disorders and ensure the
commissioner may achieve the goals of the housing mission statement in section 245.461,
subdivision 4.
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
All projects for assistance in transition from homelessness must
provide homeless outreach and case management services. Projects may provide clinical
assessment, habilitation and rehabilitation services, community mental health services,
substance use disorder treatment, housing transition and sustaining services, direct assistance
funding, and other activities as determined by the commissioner.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
Program activities must be provided to people with serious mental
illness or a substance use disorder who meet homeless criteria determined by the
commissioner. People receiving homeless outreach may be presumed eligible until a serious
mental illness or a substance use disorder can be verified.
new text end
new text begin Subd. 4. new text end
new text begin Outcomes. new text end
new text begin
Evaluation of each project must include the following outcome
evaluation criteria:
new text end
new text begin
(1) whether people are contacted through homeless outreach services;
new text end
new text begin
(2) whether people are enrolled in case management services;
new text end
new text begin
(3) whether people access behavioral health services; and
new text end
new text begin
(4) whether people transition from homelessness to housing.
new text end
new text begin Subd. 5. new text end
new text begin Federal aid or grants. new text end
new text begin
The commissioner of human services must comply with
all conditions and requirements necessary to receive federal aid or grants with respect to
homeless services or programs as specified in section 245.70.
new text end
Sec. 17.
new text begin
[245.992] HOUSING WITH SUPPORT FOR BEHAVIORAL HEALTH.
new text end
new text begin Subdivision 1. new text end
new text begin Creation. new text end
new text begin
The housing with support for behavioral health program is
established in the Department of Human Services to prevent or end homelessness for people
with serious mental illness and substance use disorders, increase the availability of housing
with support, and ensure the commissioner may achieve the goals of the housing mission
statement in section 245.461, subdivision 4.
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
The housing with support for behavioral health program may provide
a range of activities and supportive services to ensure that people obtain and retain permanent
supportive housing. Program activities may include case management, site-based housing
services, housing transition and sustaining services, outreach services, community support
services, direct assistance funding, and other activities as determined by the commissioner.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
Program activities must be provided to people with a serious mental
illness or a substance use disorder who meet homeless criteria determined by the
commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Outcomes. new text end
new text begin
Evaluation of program activities must utilize evidence-based
practices and must include the following outcome evaluation criteria:
new text end
new text begin
(1) whether housing and activities utilize evidence-based practices;
new text end
new text begin
(2) whether people transition from homelessness to housing;
new text end
new text begin
(3) whether people retain housing; and
new text end
new text begin
(4) whether people are satisfied with their current housing.
new text end
Sec. 18.
Minnesota Statutes 2021 Supplement, section 245A.043, subdivision 3, is amended
to read:
Subd. 3.
Change of ownership process.
(a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of sections 245G.03, subdivision 2, paragraph (b), and
254B.03, subdivision 2, paragraphs deleted text begin (d)deleted text end new text begin (c)new text end and deleted text begin (e)deleted text end new text begin (d)new text end .
(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
(d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.
(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.
(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
Sec. 19.
new text begin
[245A.26] CHILDREN'S RESIDENTIAL FACILITY CRISIS
STABILIZATION SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end
new text begin
(b) "Clinical trainee" means a staff person who is qualified under section 245I.04,
subdivision 6.
new text end
new text begin
(c) "License holder" means an individual, organization, or government entity that was
issued a license by the commissioner of human services under this chapter for residential
mental health treatment for children with emotional disturbance according to Minnesota
Rules, parts 2960.0010 to 2960.0220 and 2960.0580 to 2960.0700, or shelter care services
according to Minnesota Rules, parts 2960.0010 to 2960.0120 and 2960.0510 to 2960.0530.
new text end
new text begin
(d) "Mental health professional" means an individual who is qualified under section
245I.04, subdivision 2.
new text end
new text begin Subd. 2. new text end
new text begin Scope and applicability. new text end
new text begin
(a) This section establishes additional licensing
requirements for a children's residential facility to provide children's residential crisis
stabilization services to a child who is experiencing a mental health crisis and is in need of
residential treatment services.
new text end
new text begin
(b) A children's residential facility may provide residential crisis stabilization services
only if the facility is licensed to provide:
new text end
new text begin
(1) residential mental health treatment for children with emotional disturbance according
to Minnesota Rules, parts 2960.0010 to 2960.0220 and 2960.0580 to 2960.0700; or
new text end
new text begin
(2) shelter care services according to Minnesota Rules, parts 2960.0010 to 2960.0120
and 2960.0510 to 2960.0530.
new text end
new text begin
(c) If a child receives residential crisis stabilization services for 35 days or fewer in a
facility licensed according to paragraph (b), clause (1), the facility is not required to complete
a diagnostic assessment or treatment plan under Minnesota Rules, part 2960.0180, subpart
2, and part 2960.0600.
new text end
new text begin
(d) If a child receives residential crisis stabilization services for 35 days or fewer in a
facility licensed according to paragraph (b), clause (2), the facility is not required to develop
a plan for meeting the child's immediate needs under Minnesota Rules, part 2960.0520,
subpart 3.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility for services. new text end
new text begin
An individual is eligible for children's residential crisis
stabilization services if the individual is under 19 years of age and meets the eligibility
criteria for crisis services under section 256B.0624, subdivision 3.
new text end
new text begin Subd. 4. new text end
new text begin Required services; providers. new text end
new text begin
(a) A license holder providing residential crisis
stabilization services must continually follow a child's individual crisis treatment plan to
improve the child's functioning.
new text end
new text begin
(b) The license holder must offer and have the capacity to directly provide the following
treatment services to a child:
new text end
new text begin
(1) crisis stabilization services as described in section 256B.0624, subdivision 7;
new text end
new text begin
(2) mental health services as specified in the child's individual crisis treatment plan,
according to the child's treatment needs;
new text end
new text begin
(3) health services and medication administration, if applicable; and
new text end
new text begin
(4) referrals for the child to community-based treatment providers and support services
for the child's transition from residential crisis stabilization to another treatment setting.
new text end
new text begin
(c) Children's residential crisis stabilization services must be provided by a qualified
staff person listed in section 256B.0624, subdivision 8, according to the scope of practice
for the individual staff person's position.
new text end
new text begin Subd. 5. new text end
new text begin Assessment and treatment planning. new text end
new text begin
(a) Within 24 hours of a child's admission
for residential crisis stabilization, the license holder must assess the child and document the
child's immediate needs, including the child's:
new text end
new text begin
(1) health and safety, including the need for crisis assistance; and
new text end
new text begin
(2) need for connection to family and other natural supports.
new text end
new text begin
(b) Within 24 hours of a child's admission for residential crisis stabilization, the license
holder must complete a crisis treatment plan for the child, according to the requirements
for a crisis treatment plan under section 256B.0624, subdivision 11. The license holder must
base the child's crisis treatment plan on the child's referral information and the assessment
of the child's immediate needs under paragraph (a). A mental health professional or a clinical
trainee under the supervision of a mental health professional must complete the crisis
treatment plan. A crisis treatment plan completed by a clinical trainee must contain
documentation of approval, as defined in section 245I.02, subdivision 2, by a mental health
professional within five business days of initial completion by the clinical trainee.
new text end
new text begin
(c) A mental health professional must review a child's crisis treatment plan each week
and document the weekly reviews in the child's client file.
new text end
new text begin
(d) For a client receiving children's residential crisis stabilization services who is 18
years of age or older, the license holder must complete an individual abuse prevention plan
for the client, pursuant to section 245A.65, subdivision 2, as part of the client's crisis
treatment plan.
new text end
new text begin Subd. 6. new text end
new text begin Staffing requirements. new text end
new text begin
Staff members of facilities providing services under
this section must have access to a mental health professional or clinical trainee within 30
minutes, either in person or by telephone. The license holder must maintain a current schedule
of available mental health professionals or clinical trainees and include contact information
for each mental health professional or clinical trainee. The schedule must be readily available
to all staff members.
new text end
Sec. 20.
Minnesota Statutes 2020, section 245F.03, is amended to read:
245F.03 APPLICATION.
(a) This chapter establishes minimum standards for withdrawal management programs
licensed by the commissioner that serve one or more unrelated persons.
(b) This chapter does not apply to a withdrawal management program licensed as a
hospital under sections 144.50 to 144.581. A withdrawal management program located in
a hospital licensed under sections 144.50 to 144.581 that chooses to be licensed under this
chapter is deemed to be in compliance with section 245F.13.
deleted text begin
(c) Minnesota Rules, parts 9530.6600 to 9530.6655, do not apply to withdrawal
management programs licensed under this chapter.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 21.
Minnesota Statutes 2020, section 245G.05, subdivision 2, is amended to read:
Subd. 2.
Assessment summary.
(a) An alcohol and drug counselor must complete an
assessment summary within three calendar days from the day of service initiation for a
residential program and within three calendar days on which a treatment session has been
provided from the day of service initiation for a client in a nonresidential program. The
comprehensive assessment summary is complete upon a qualified staff member's dated
signature. If the comprehensive assessment is used to authorize the treatment service, the
alcohol and drug counselor must prepare an assessment summary on the same date the
comprehensive assessment is completed. If the comprehensive assessment and assessment
summary are to authorize treatment services, the assessor must determine appropriatenew text begin level
of care andnew text end services for the client using the deleted text begin dimensions in Minnesota Rules, part 9530.6622deleted text end new text begin
criteria established in section 254B.04, subdivision 4new text end , and document the recommendations.
(b) An assessment summary must include:
(1) a risk description according to section 245G.05 for each dimension listed in paragraph
(c);
(2) a narrative summary supporting the risk descriptions; and
(3) a determination of whether the client has a substance use disorder.
(c) An assessment summary must contain information relevant to treatment service
planning and recorded in the dimensions in clauses (1) to (6). The license holder must
consider:
(1) Dimension 1, acute intoxication/withdrawal potential; the client's ability to cope with
withdrawal symptoms and current state of intoxication;
(2) Dimension 2, biomedical conditions and complications; the degree to which any
physical disorder of the client would interfere with treatment for substance use, and the
client's ability to tolerate any related discomfort. The license holder must determine the
impact of continued substance use on the unborn child, if the client is pregnant;
(3) Dimension 3, emotional, behavioral, and cognitive conditions and complications;
the degree to which any condition or complication is likely to interfere with treatment for
substance use or with functioning in significant life areas and the likelihood of harm to self
or others;
(4) Dimension 4, readiness for change; the support necessary to keep the client involved
in treatment service;
(5) Dimension 5, relapse, continued use, and continued problem potential; the degree
to which the client recognizes relapse issues and has the skills to prevent relapse of either
substance use or mental health problems; and
(6) Dimension 6, recovery environment; whether the areas of the client's life are
supportive of or antagonistic to treatment participation and recovery.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 22.
Minnesota Statutes 2020, section 245G.22, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given them.
(b) "Diversion" means the use of a medication for the treatment of opioid addiction being
diverted from intended use of the medication.
(c) "Guest dose" means administration of a medication used for the treatment of opioid
addiction to a person who is not a client of the program that is administering or dispensing
the medication.
(d) "Medical director" means a practitioner licensed to practice medicine in the
jurisdiction that the opioid treatment program is located who assumes responsibility for
administering all medical services performed by the program, either by performing the
services directly or by delegating specific responsibility to a practitioner of the opioid
treatment program.
(e) "Medication used for the treatment of opioid use disorder" means a medication
approved by the Food and Drug Administration for the treatment of opioid use disorder.
(f) "Minnesota health care programs" has the meaning given in section 256B.0636.
(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations,
title 42, section 8.12, and includes programs licensed under this chapter.
deleted text begin
(h) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605,
subpart 21a.
deleted text end
deleted text begin (i)deleted text end new text begin (h)new text end "Practitioner" means a staff member holding a current, unrestricted license to
practice medicine issued by the Board of Medical Practice or nursing issued by the Board
of Nursing and is currently registered with the Drug Enforcement Administration to order
or dispense controlled substances in Schedules II to V under the Controlled Substances Act,
United States Code, title 21, part B, section 821. Practitioner includes an advanced practice
registered nurse and physician assistant if the staff member receives a variance by the state
opioid treatment authority under section 254A.03 and the federal Substance Abuse and
Mental Health Services Administration.
deleted text begin (j)deleted text end new text begin (i)new text end "Unsupervised use" means the use of a medication for the treatment of opioid use
disorder dispensed for use by a client outside of the program setting.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 23.
Minnesota Statutes 2020, section 245G.22, subdivision 15, is amended to read:
Subd. 15.
Nonmedication treatment services; documentation.
deleted text begin
(a) The program must
offer at least 50 consecutive minutes of individual or group therapy treatment services as
defined in section 245G.07, subdivision 1, paragraph (a), clause (1), per week, for the first
ten weeks following the day of service initiation, and at least 50 consecutive minutes per
month thereafter. As clinically appropriate, the program may offer these services cumulatively
and not consecutively in increments of no less than 15 minutes over the required time period,
and for a total of 60 minutes of treatment services over the time period, and must document
the reason for providing services cumulatively in the client's record. The program may offer
additional levels of service when deemed clinically necessary.
deleted text end
new text begin
(a) The program must meet the requirements in section 245G.07, subdivision 1, paragraph
(a), and must document each occurrence when the program offered the client an individual
or group counseling service. If the program offered an individual or group counseling service
but did not provide the service to the client, the program must document the reason the
service was not provided. If the service is provided, the program must ensure that the staff
member who provides the treatment service documents in the client record the date, type,
and amount of the treatment service and the client's response to the treatment service within
seven days of providing the treatment service.
new text end
(b) Notwithstanding the requirements of comprehensive assessments in section 245G.05,
the assessment must be completed within 21 days from the day of service initiation.
(c) Notwithstanding the requirements of individual treatment plans set forth in section
245G.06:
(1) treatment plan contents for a maintenance client are not required to include goals
the client must reach to complete treatment and have services terminated;
(2) treatment plans for a client in a taper or detox status must include goals the client
must reach to complete treatment and have services terminated; and
(3) for the ten weeks following the day of service initiation for all new admissions,
readmissions, and transfers, a weekly treatment plan review must be documented once the
treatment plan is completed. Subsequently, the counselor must document treatment plan
reviews in the six dimensions at least once monthly or, when clinical need warrants, more
frequently.
Sec. 24.
Minnesota Statutes 2021 Supplement, section 245I.23, is amended by adding a
subdivision to read:
new text begin Subd. 19a. new text end
new text begin Additional requirements for locked program facility. new text end
new text begin
(a) A license holder
that prohibits clients from leaving the facility by locking exit doors or other permissible
methods must meet the additional requirements of this subdivision.
new text end
new text begin
(b) The license holder must meet all applicable building and fire codes to operate a
building with locked exit doors. The license holder must have the appropriate license from
the Department of Health, as determined by the Department of Health, for operating a
program with locked exit doors.
new text end
new text begin
(c) The license holder's policies and procedures must clearly describe the types of court
orders that authorize the license holder to prohibit clients from leaving the facility.
new text end
new text begin
(d) For each client present in the facility under a court order, the license holder must
maintain documentation of the court order authorizing the license holder to prohibit the
client from leaving the facility.
new text end
new text begin
(e) Upon a client's admission to a locked program facility, the license holder must
document in the client file that the client was informed:
new text end
new text begin
(1) that the client has the right to leave the facility according to the client's rights under
section 144.651, subdivision 12, if the client is not subject to a court order authorizing the
license holder to prohibit the client from leaving the facility; or
new text end
new text begin
(2) that the client cannot leave the facility due to a court order authorizing the license
holder to prohibit the client from leaving the facility.
new text end
new text begin
(f) If the license holder prohibits a client from leaving the facility, the client's treatment
plan must reflect this restriction.
new text end
Sec. 25.
Minnesota Statutes 2021 Supplement, section 254A.03, subdivision 3, is amended
to read:
Subd. 3.
Rules for substance use disorder care.
(a) deleted text begin The commissioner of human
services shall establish by rule criteria to be used in determining the appropriate level of
chemical dependency care for each recipient of public assistance seeking treatment for
substance misuse or substance use disorder. Upon federal approval of a comprehensive
assessment as a Medicaid benefit, or on July 1, 2018, whichever is later, and notwithstanding
the criteria in Minnesota Rules, parts 9530.6600 to 9530.6655,deleted text end An eligible vendor of
comprehensive assessments under section 254B.05 may determine deleted text begin and approvedeleted text end the
appropriate level of substance use disorder treatment for a recipient of public assistance.
deleted text begin The process for determining an individual's financial eligibility for the behavioral health
deleted text end deleted text begin fund or determining an individual's enrollment in or eligibility for a publicly subsidized
deleted text end deleted text begin health plan is not affected by the individual's choice to access a comprehensive assessment
deleted text end deleted text begin for placement.
deleted text end
(b) The commissioner shall develop and implement a utilization review process for
publicly funded treatment placements to monitor and review the clinical appropriateness
and timeliness of all publicly funded placements in treatment.
(c) If a screen result is positive for alcohol or substance misuse, a brief screening for
alcohol or substance use disorder that is provided to a recipient of public assistance within
a primary care clinic, hospital, or other medical setting or school setting establishes medical
necessity and approval for an initial set of substance use disorder services identified in
section 254B.05, subdivision 5. The initial set of services approved for a recipient whose
screen result is positive may include any combination of up to four hours of individual or
group substance use disorder treatment, two hours of substance use disorder treatment
coordination, or two hours of substance use disorder peer support services provided by a
qualified individual according to chapter 245G. A recipient must obtain an assessment
pursuant to paragraph (a) to be approved for additional treatment services. deleted text begin Minnesota Rules,
parts 9530.6600 to 9530.6655, anddeleted text end A comprehensive assessment pursuant to section 245G.05
deleted text begin are not applicabledeleted text end new text begin is not requirednew text end tonew text begin receivenew text end the initial set of services allowed under this
subdivision. A positive screen result establishes eligibility for the initial set of services
allowed under this subdivision.
(d) deleted text begin Notwithstanding Minnesota Rules, parts 9530.6600 to 9530.6655,deleted text end An individual
may choose to obtain a comprehensive assessment as provided in section 245G.05.
Individuals obtaining a comprehensive assessment may access any enrolled provider that
is licensed to provide the level of service authorized pursuant to section 254A.19, subdivision
3deleted text begin , paragraph (d)deleted text end . If the individual is enrolled in a prepaid health plan, the individual must
comply with any provider network requirements or limitations. deleted text begin This paragraph expires July
1, 2022.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 26.
Minnesota Statutes 2020, section 254A.19, subdivision 1, is amended to read:
Subdivision 1.
Persons arrested outside of deleted text begin home countydeleted text end new text begin county of residencenew text end .
When
a chemical use assessment is required deleted text begin under Minnesota Rules, parts 9530.6600 to 9530.6655,deleted text end
for a person who is arrested and taken into custody by a peace officer outside of the person's
county of residence, the deleted text begin assessment must be completed by the person's county of residence
no later than three weeks after the assessment is initially requested. If the assessment is not
performed within this time limit, the county where the person is to be sentenced shall perform
the assessmentdeleted text end new text begin county where the person is detained must facilitate access to an assessor
qualified under subdivision 3new text end . The county of financial responsibility is determined under
chapter 256G.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 27.
Minnesota Statutes 2020, section 254A.19, subdivision 3, is amended to read:
Subd. 3.
deleted text begin Financial conflicts of interestdeleted text end new text begin Comprehensive assessmentsnew text end .
deleted text begin
(a) Except as
provided in paragraph (b), (c), or (d), an assessor conducting a chemical use assessment
under Minnesota Rules, parts 9530.6600 to 9530.6655, may not have any direct or shared
financial interest or referral relationship resulting in shared financial gain with a treatment
provider.
deleted text end
deleted text begin
(b) A county may contract with an assessor having a conflict described in paragraph (a)
if the county documents that:
deleted text end
deleted text begin
(1) the assessor is employed by a culturally specific service provider or a service provider
with a program designed to treat individuals of a specific age, sex, or sexual preference;
deleted text end
deleted text begin
(2) the county does not employ a sufficient number of qualified assessors and the only
qualified assessors available in the county have a direct or shared financial interest or a
referral relationship resulting in shared financial gain with a treatment provider; or
deleted text end
deleted text begin
(3) the county social service agency has an existing relationship with an assessor or
service provider and elects to enter into a contract with that assessor to provide both
assessment and treatment under circumstances specified in the county's contract, provided
the county retains responsibility for making placement decisions.
deleted text end
deleted text begin
(c) The county may contract with a hospital to conduct chemical assessments if the
requirements in subdivision 1a are met.
deleted text end
deleted text begin
An assessor under this paragraph may not place clients in treatment. The assessor shall
gather required information and provide it to the county along with any required
documentation. The county shall make all placement decisions for clients assessed by
assessors under this paragraph.
deleted text end
deleted text begin (d)deleted text end An eligible vendor under section 254B.05 conducting a comprehensive assessment
for an individual seeking treatment shall approve the nature, intensity level, and duration
of treatment service if a need for services is indicated, but the individual assessed can access
any enrolled provider that is licensed to provide the level of service authorized, including
the provider or program that completed the assessment. If an individual is enrolled in a
prepaid health plan, the individual must comply with any provider network requirements
or limitations. new text begin An eligible vendor of a comprehensive assessment must provide information,
in a format provided by the commissioner, on medical assistance and the behavioral health
fund to individuals seeking an assessment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 28.
Minnesota Statutes 2021 Supplement, section 254A.19, subdivision 4, is amended
to read:
Subd. 4.
Civil commitments.
deleted text begin A Rule 25 assessment, under Minnesota Rules, part
9530.6615,deleted text end new text begin For the purposes of determining level of care, a comprehensive assessmentnew text end does
not need to be completed for an individual being committed as a chemically dependent
person, as defined in section 253B.02, and for the duration of a civil commitment under
section deleted text begin 253B.065,deleted text end 253B.09deleted text begin ,deleted text end or 253B.095 in order for a county to access the behavioral
health fund under section 254B.04. The county must determine if the individual meets the
financial eligibility requirements for the behavioral health fund under section 254B.04.
deleted text begin Nothing in this subdivision prohibits placement in a treatment facility or treatment program
governed under this chapter or Minnesota Rules, parts 9530.6600 to 9530.6655.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 29.
Minnesota Statutes 2020, section 254A.19, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Assessments for detoxification programs. new text end
new text begin
For detoxification programs licensed
under chapter 245A according to Minnesota Rules, parts 9530.6510 to 9530.6590, a
"chemical use assessment" means a comprehensive assessment and assessment summary
completed according to section 245G.05 and a "chemical dependency assessor" or "assessor"
means an individual who meets the qualifications of section 245G.11, subdivisions 1 and
5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 30.
Minnesota Statutes 2020, section 254A.19, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Assessments for children's residential facilities. new text end
new text begin
For children's residential
facilities licensed under chapter 245A according to Minnesota Rules, parts 2960.0010 to
2960.0220 and 2960.0430 to 2960.0490, a "chemical use assessment" means a comprehensive
assessment and assessment summary completed according to section 245G.05 by an
individual who meets the qualifications of section 245G.11, subdivisions 1 and 5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 31.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Behavioral health fund. new text end
new text begin
"Behavioral health fund" means money allocated
for payment of treatment services under this chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 32.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Client. new text end
new text begin
"Client" means an individual who has requested substance use disorder
services, or for whom substance use disorder services have been requested.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 33.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 2c. new text end
new text begin Co-payment. new text end
new text begin
"Co-payment" means the amount an insured person is obligated
to pay before the person's third-party payment source is obligated to make a payment, or
the amount an insured person is obligated to pay in addition to the amount the person's
third-party payment source is obligated to pay.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 34.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 4c. new text end
new text begin Department. new text end
new text begin
"Department" means the Department of Human Services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 35.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 4d. new text end
new text begin Drug and alcohol abuse normative evaluation system or DAANES. new text end
new text begin
"Drug
and alcohol abuse normative evaluation system" or "DAANES" means the reporting system
used to collect substance use disorder treatment data across all levels of care and providers.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 36.
Minnesota Statutes 2020, section 254B.01, subdivision 5, is amended to read:
Subd. 5.
Local agency.
"Local agency" means the agency designated by a board of
county commissioners, a local social services agency, or a human services board deleted text begin to make
placements and submit state invoices according to Laws 1986, chapter 394, sections 8 to
20deleted text end new text begin authorized under section 254B.03, subdivision 1, to determine financial eligibility for
the behavioral health fundnew text end .
Sec. 37.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Minor child. new text end
new text begin
"Minor child" means an individual under the age of 18 years.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 38.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 6b. new text end
new text begin Policy holder. new text end
new text begin
"Policy holder" means a person who has a third-party payment
policy under which a third-party payment source has an obligation to pay all or part of a
client's treatment costs.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 39.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Responsible relative. new text end
new text begin
"Responsible relative" means a person who is a member
of the client's household and is a client's spouse or the parent of a minor child who is a
client.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 40.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Third-party payment source. new text end
new text begin
"Third-party payment source" means a person,
entity, or public or private agency other than medical assistance or general assistance medical
care that has a probable obligation to pay all or part of the costs of a client's substance use
disorder treatment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 41.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Vendor. new text end
new text begin
"Vendor" means a provider of substance use disorder treatment
services that meets the criteria established in section 254B.05 and that has applied to
participate as a provider in the medical assistance program according to Minnesota Rules,
part 9505.0195.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 42.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin
American Society of Addiction Medicine criteria or ASAM
criteria.
new text end
new text begin
"American Society of Addiction Medicine criteria" or "ASAM criteria" means the
clinical guidelines for purposes of the assessment, treatment, placement, and transfer or
discharge of individuals with substance use disorders. The ASAM criteria are contained in
the current edition of the ASAM Criteria: Treatment Criteria for Addictive,
Substance-Related, and Co-Occurring Conditions.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 43.
Minnesota Statutes 2020, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 13. new text end
new text begin Skilled treatment services. new text end
new text begin
"Skilled treatment services" means the "treatment
services" described by section 245G.07, subdivisions 1, paragraph (a), clauses (1) to (4);
and 2, clauses (1) to (6). Skilled treatment services must be provided by qualified
professionals as identified in section 245G.07, subdivision 3.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 44.
Minnesota Statutes 2020, section 254B.03, subdivision 1, is amended to read:
Subdivision 1.
Local agency duties.
(a) Every local agency deleted text begin shalldeleted text end new text begin must determine financial
eligibility for substance use disorder services andnew text end provide deleted text begin chemical dependencydeleted text end new text begin substance
use disordernew text end services to persons residing within its jurisdiction who meet criteria established
by the commissioner deleted text begin for placement in a chemical dependency residential or nonresidential
treatment servicedeleted text end . Chemical dependency money must be administered by the local agencies
according to law and rules adopted by the commissioner under sections 14.001 to 14.69.
(b) In order to contain costs, the commissioner of human services shall select eligible
vendors of chemical dependency services who can provide economical and appropriate
treatment. Unless the local agency is a social services department directly administered by
a county or human services board, the local agency shall not be an eligible vendor under
section 254B.05. The commissioner may approve proposals from county boards to provide
services in an economical manner or to control utilization, with safeguards to ensure that
necessary services are provided. If a county implements a demonstration or experimental
medical services funding plan, the commissioner shall transfer the money as appropriate.
deleted text begin
(c) A culturally specific vendor that provides assessments under a variance under
Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to persons
not covered by the variance.
deleted text end
deleted text begin (d) Notwithstanding Minnesota Rules, parts 9530.6600 to 9530.6655,deleted text end new text begin (c) new text end An individual
may choose to obtain a comprehensive assessment as provided in section 245G.05.
Individuals obtaining a comprehensive assessment may access any enrolled provider that
is licensed to provide the level of service authorized pursuant to section 254A.19, subdivision
3deleted text begin , paragraph (d)deleted text end . If the individual is enrolled in a prepaid health plan, the individual must
comply with any provider network requirements or limitations.
deleted text begin (e)deleted text end new text begin (d)new text end Beginning July 1, 2022, local agencies shall not make placement location
determinations.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 45.
Minnesota Statutes 2021 Supplement, section 254B.03, subdivision 2, is amended
to read:
Subd. 2.
Behavioral health fund payment.
(a) Payment from the behavioral health
fund is limited to payments for services identified in section 254B.05, other than
detoxification licensed under Minnesota Rules, parts 9530.6510 to 9530.6590, and
detoxification provided in another state that would be required to be licensed as a chemical
dependency program if the program were in the state. Out of state vendors must also provide
the commissioner with assurances that the program complies substantially with state licensing
requirements and possesses all licenses and certifications required by the host state to provide
chemical dependency treatment. Vendors receiving payments from the behavioral health
fund must not require co-payment from a recipient of benefits for services provided under
this subdivision. The vendor is prohibited from using the client's public benefits to offset
the cost of services paid under this section. The vendor shall not require the client to use
public benefits for room or board costs. This includes but is not limited to cash assistance
benefits under chapters 119B, 256D, and 256J, or SNAP benefits. Retention of SNAP
benefits is a right of a client receiving services through the behavioral health fund or through
state contracted managed care entities. Payment from the behavioral health fund shall be
made for necessary room and board costs provided by vendors meeting the criteria under
section 254B.05, subdivision 1a, or in a community hospital licensed by the commissioner
of health according to sections 144.50 to 144.56 to a client who is:
(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and
(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the behavioral health fund.
deleted text begin
(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.
deleted text begin (d)deleted text end new text begin (c)new text end At least 60 days prior to submitting an application for new licensure under chapter
245G, the applicant must notify the county human services director in writing of the
applicant's intent to open a new treatment program. The written notification must include,
at a minimum:
(1) a description of the proposed treatment program; and
(2) a description of the target population to be served by the treatment program.
deleted text begin (e)deleted text end new text begin (d)new text end The county human services director may submit a written statement to the
commissioner, within 60 days of receiving notice from the applicant, regarding the county's
support of or opposition to the opening of the new treatment program. The written statement
must include documentation of the rationale for the county's determination. The commissioner
shall consider the county's written statement when determining whether there is a need for
the treatment program as required by paragraph deleted text begin (c)deleted text end new text begin (b)new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 46.
Minnesota Statutes 2020, section 254B.03, subdivision 4, is amended to read:
Subd. 4.
Division of costs.
(a) Except for services provided by a county under section
254B.09, subdivision 1, or services provided under section 256B.69, the county shall, out
of local money, pay the state for 22.95 percent of the cost of chemical dependency services,
except for those services provided to persons enrolled in medical assistance under chapter
256B and room and board services under section 254B.05, subdivision 5, paragraph (b),
clause deleted text begin (12)deleted text end new text begin (11)new text end . Counties may use the indigent hospitalization levy for treatment and hospital
payments made under this section.
(b) 22.95 percent of any state collections from private or third-party pay, less 15 percent
for the cost of payment and collections, must be distributed to the county that paid for a
portion of the treatment under this section.
Sec. 47.
Minnesota Statutes 2020, section 254B.03, subdivision 5, is amended to read:
Subd. 5.
Rules; appeal.
The commissioner shall adopt rules as necessary to implement
this chapter. deleted text begin The commissioner shall establish an appeals process for use by recipients when
services certified by the county are disputed. The commissioner shall adopt rules and
standards for the appeal process to assure adequate redress for persons referred to
inappropriate services.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 48.
Minnesota Statutes 2021 Supplement, section 254B.04, subdivision 1, is amended
to read:
Subdivision 1.
new text begin Client new text end eligibility.
(a) Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, who meet the income standards of section 256B.056,
subdivision 4, and are not enrolled in medical assistance, are entitled to behavioral health
fund services. State money appropriated for this paragraph must be placed in a separate
account established for this purpose.
(b) Persons with dependent children who are determined to be in need of chemical
dependency treatment pursuant to an assessment under section 260E.20, subdivision 1, or
a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
local agency to access needed treatment services. Treatment services must be appropriate
for the individual or family, which may include long-term care treatment or treatment in a
facility that allows the dependent children to stay in the treatment facility. The county shall
pay for out-of-home placement costs, if applicable.
(c) Notwithstanding paragraph (a), persons enrolled in medical assistance are eligible
for room and board services under section 254B.05, subdivision 5, paragraph (b), clause
deleted text begin (12)deleted text end new text begin (11)new text end .
new text begin
(d) A client is eligible to have substance use disorder treatment paid for with funds from
the behavioral health fund if:
new text end
new text begin
(1) the client is eligible for MFIP as determined under chapter 256J;
new text end
new text begin
(2) the client is eligible for medical assistance as determined under Minnesota Rules,
parts 9505.0010 to 9505.0150;
new text end
new text begin
(3) the client is eligible for general assistance, general assistance medical care, or work
readiness as determined under Minnesota Rules, parts 9500.1200 to 9500.1272; or
new text end
new text begin
(4) the client's income is within current household size and income guidelines for entitled
persons, as defined in this subdivision and subdivision 7.
new text end
new text begin
(e) Clients who meet the financial eligibility requirement in paragraph (a) and who have
a third-party payment source are eligible for the behavioral health fund if the third-party
payment source pays less than 100 percent of the cost of treatment services for eligible
clients.
new text end
new text begin
(f) A client is ineligible to have substance use disorder treatment services paid for by
the behavioral health fund if the client:
new text end
new text begin
(1) has an income that exceeds current household size and income guidelines for entitled
persons, as defined in this subdivision and subdivision 7; or
new text end
new text begin
(2) has an available third-party payment source that will pay the total cost of the client's
treatment.
new text end
new text begin
(g) A client who is disenrolled from a state prepaid health plan during a treatment episode
is eligible for continued treatment service paid for by the behavioral health fund until the
treatment episode is completed or the client is re-enrolled in a state prepaid health plan if
the client:
new text end
new text begin
(1) continues to be enrolled in MinnesotaCare, medical assistance, or general assistance
medical care; or
new text end
new text begin
(2) is eligible according to paragraphs (a) and (b) and is determined eligible by a local
agency under this section.
new text end
new text begin
(h) If a county commits a client under chapter 253B to a regional treatment center for
substance use disorder services and the client is ineligible for the behavioral health fund,
the county is responsible for payment to the regional treatment center according to section
254B.05, subdivision 4.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 49.
Minnesota Statutes 2020, section 254B.04, subdivision 2a, is amended to read:
Subd. 2a.
Eligibility for deleted text begin treatment in residential settingsdeleted text end new text begin room and board services
for persons in outpatient substance use disorder treatmentnew text end .
deleted text begin Notwithstanding provisions
of Minnesota Rules, part 9530.6622, subparts 5 and 6, related to an assessor's discretion in
making placements to residential treatment settings,deleted text end A person eligible fornew text begin room and boardnew text end
services under deleted text begin thisdeleted text end sectionnew text begin 254B.05, subdivision 5, paragraph (b), clause (12),new text end must score
at level 4 on assessment dimensions related tonew text begin readiness to change,new text end relapse, continued use,
or recovery environment deleted text begin in orderdeleted text end to be assigned to services with a room and board component
reimbursed under this section. Whether a treatment facility has been designated an institution
for mental diseases under United States Code, title 42, section 1396d, shall not be a factor
in making placements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 50.
Minnesota Statutes 2020, section 254B.04, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Assessment criteria and risk descriptions. new text end
new text begin
(a) The level of care determination
must follow criteria approved by the commissioner.
new text end
new text begin
(b) Dimension 1: the vendor must use the criteria in Dimension 1 to determine a client's
acute intoxication and withdrawal potential.
new text end
new text begin
(1) "0" The client displays full functioning with good ability to tolerate and cope with
withdrawal discomfort. The client displays no signs or symptoms of intoxication or
withdrawal or diminishing signs or symptoms.
new text end
new text begin
(2) "1" The client can tolerate and cope with withdrawal discomfort. The client displays
mild to moderate intoxication or signs and symptoms interfering with daily functioning but
does not immediately endanger self or others. The client poses minimal risk of severe
withdrawal.
new text end
new text begin
(3) "2" The client has some difficulty tolerating and coping with withdrawal discomfort.
The client's intoxication may be severe, but the client responds to support and treatment
such that the client does not immediately endanger self or others. The client displays moderate
signs and symptoms with moderate risk of severe withdrawal.
new text end
new text begin
(4) "3" The client tolerates and copes with withdrawal discomfort poorly. The client has
severe intoxication, such that the client endangers self or others, or has intoxication that has
not abated with less intensive services. The client displays severe signs and symptoms, risk
of severe but manageable withdrawal, or worsening withdrawal despite detoxification at a
less intensive level.
new text end
new text begin
(5) "4" The client is incapacitated with severe signs and symptoms. The client displays
severe withdrawal and is a danger to self or others.
new text end
new text begin
(c) Dimension 2: the vendor must use the criteria in Dimension 2 to determine a client's
biomedical conditions and complications.
new text end
new text begin
(1) "0" The client displays full functioning with good ability to cope with physical
discomfort.
new text end
new text begin
(2) "1" The client tolerates and copes with physical discomfort and is able to get the
services that the client needs.
new text end
new text begin
(3) "2" The client has difficulty tolerating and coping with physical problems or has
other biomedical problems that interfere with recovery and treatment. The client neglects
or does not seek care for serious biomedical problems.
new text end
new text begin
(4) "3" The client tolerates and copes poorly with physical problems or has poor general
health. The client neglects the client's medical problems without active assistance.
new text end
new text begin
(5) "4" The client is unable to participate in substance use disorder treatment and has
severe medical problems, has a condition that requires immediate intervention, or is
incapacitated.
new text end
new text begin
(d) Dimension 3: the vendor must use the criteria in Dimension 3 to determine a client's
emotional, behavioral, and cognitive conditions and complications.
new text end
new text begin
(1) "0" The client has good impulse control and coping skills and presents no risk of
harm to self or others. The client functions in all life areas and displays no emotional,
behavioral, or cognitive problems or the problems are stable.
new text end
new text begin
(2) "1" The client has impulse control and coping skills. The client presents a mild to
moderate risk of harm to self or others or displays symptoms of emotional, behavioral, or
cognitive problems. The client has a mental health diagnosis and is stable. The client
functions adequately in significant life areas.
new text end
new text begin
(3) "2" The client has difficulty with impulse control and lacks coping skills. The client
has thoughts of suicide or harm to others without means; however, the thoughts may interfere
with participation in some activities. The client has difficulty functioning in significant life
areas. The client has moderate symptoms of emotional, behavioral, or cognitive problems.
The client is able to participate in most treatment activities.
new text end
new text begin
(4) "3" The client has a severe lack of impulse control and coping skills. The client also
has frequent thoughts of suicide or harm to others, including a plan and the means to carry
out the plan. In addition, the client is severely impaired in significant life areas and has
severe symptoms of emotional, behavioral, or cognitive problems that interfere with the
client's participation in treatment activities.
new text end
new text begin
(5) "4" The client has severe emotional or behavioral symptoms that place the client or
others at acute risk of harm. The client also has intrusive thoughts of harming self or others.
The client is unable to participate in treatment activities.
new text end
new text begin
(e) Dimension 4: the vendor must use the criteria in Dimension 4 to determine a client's
readiness for change.
new text end
new text begin
(1) "0" The client admits to problems and is cooperative, motivated, ready to change,
committed to change, and engaged in treatment as a responsible participant.
new text end
new text begin
(2) "1" The client is motivated with active reinforcement to explore treatment and
strategies for change but ambivalent about the client's illness or need for change.
new text end
new text begin
(3) "2" The client displays verbal compliance but lacks consistent behaviors, has low
motivation for change, and is passively involved in treatment.
new text end
new text begin
(4) "3" The client displays inconsistent compliance, has minimal awareness of either
the client's addiction or mental disorder, and is minimally cooperative.
new text end
new text begin
(5) "4" The client is:
new text end
new text begin
(i) noncompliant with treatment and has no awareness of addiction or mental disorder
and does not want or is unwilling to explore change or is in total denial of the client's illness
and its implications; or
new text end
new text begin
(ii) dangerously oppositional to the extent that the client is a threat of imminent harm
to self and others.
new text end
new text begin
(f) Dimension 5: the vendor must use the criteria in Dimension 5 to determine a client's
relapse, continued substance use, and continued problem potential.
new text end
new text begin
(1) "0" The client recognizes risk well and is able to manage potential problems.
new text end
new text begin
(2) "1" The client recognizes relapse issues and prevention strategies, but displays some
vulnerability for further substance use or mental health problems.
new text end
new text begin
(3) "2" The client has minimal recognition and understanding of relapse and recidivism
issues and displays moderate vulnerability for further substance use or mental health
problems. The client has some coping skills inconsistently applied.
new text end
new text begin
(4) "3" The client has poor recognition and understanding of relapse and recidivism
issues and displays moderately high vulnerability for further substance use or mental health
problems. The client has few coping skills and rarely applies coping skills.
new text end
new text begin
(5) "4" The client has no coping skills to arrest mental health or addiction illnesses or
to prevent relapse. The client has no recognition or understanding of relapse and recidivism
issues and displays high vulnerability for further substance use or mental health problems.
new text end
new text begin
(g) Dimension 6: the vendor must use the criteria in Dimension 6 to determine a client's
recovery environment.
new text end
new text begin
(1) "0" The client is engaged in structured, meaningful activity and has a supportive
significant other, family, and living environment.
new text end
new text begin
(2) "1" The client has passive social network support or the client's family and significant
other are not interested in the client's recovery. The client is engaged in structured, meaningful
activity.
new text end
new text begin
(3) "2" The client is engaged in structured, meaningful activity, but the client's peers,
family, significant other, and living environment are unsupportive, or there is criminal
justice system involvement by the client or among the client's peers or significant other or
in the client's living environment.
new text end
new text begin
(4) "3" The client is not engaged in structured, meaningful activity and the client's peers,
family, significant other, and living environment are unsupportive, or there is significant
criminal justice system involvement.
new text end
new text begin
(5) "4" The client has:
new text end
new text begin
(i) a chronically antagonistic significant other, living environment, family, or peer group
or long-term criminal justice system involvement that is harmful to the client's recovery or
treatment progress; or
new text end
new text begin
(ii) an actively antagonistic significant other, family, work, or living environment, with
an immediate threat to the client's safety and well-being.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 51.
Minnesota Statutes 2020, section 254B.04, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Scope and applicability. new text end
new text begin
This section governs administration of the behavioral
health fund, establishes the criteria to be applied by local agencies to determine a client's
financial eligibility under the behavioral health fund, and determines a client's obligation
to pay for substance use disorder treatment services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 52.
Minnesota Statutes 2020, section 254B.04, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Local agency responsibility to provide services. new text end
new text begin
The local agency may employ
individuals to conduct administrative activities and facilitate access to substance use disorder
treatment services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 53.
Minnesota Statutes 2020, section 254B.04, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Local agency to determine client financial eligibility. new text end
new text begin
(a) The local agency
shall determine a client's financial eligibility for the behavioral health fund according to
subdivision 1 with the income calculated prospectively for one year from the date of
comprehensive assessment. The local agency shall pay for eligible clients according to
chapter 256G. The local agency shall enter the financial eligibility span within ten calendar
days of request. Client eligibility must be determined using forms prescribed by the
commissioner. The local agency must determine a client's eligibility as follows:
new text end
new text begin
(1) The local agency must determine the client's income. A client who is a minor child
must not be deemed to have income available to pay for substance use disorder treatment,
unless the minor child is responsible for payment under section 144.347 for substance use
disorder treatment services sought under section 144.343, subdivision 1.
new text end
new text begin
(2) The local agency must determine the client's household size according to the
following:
new text end
new text begin
(i) If the client is a minor child, the household size includes the following persons living
in the same dwelling unit:
new text end
new text begin
(A) the client;
new text end
new text begin
(B) the client's birth or adoptive parents; and
new text end
new text begin
(C) the client's siblings who are minors.
new text end
new text begin
(ii) If the client is an adult, the household size includes the following persons living in
the same dwelling unit:
new text end
new text begin
(A) the client;
new text end
new text begin
(B) the client's spouse;
new text end
new text begin
(C) the client's minor children; and
new text end
new text begin
(D) the client's spouse's minor children.
new text end
new text begin
(iii) Household size includes a person listed in items (i) and (ii) who is in out-of-home
placement if a person listed in item (i) or (ii) is contributing to the cost of care of the person
in out-of-home placement.
new text end
new text begin
(3) The local agency must determine the client's current prepaid health plan enrollment
and the availability of a third-party payment source, including the availability of total or
partial payment and the amount of co-payment.
new text end
new text begin
(4) The local agency must provide the required eligibility information to the commissioner
in the manner specified by the commissioner.
new text end
new text begin
(5) The local agency must require the client and policyholder to conditionally assign to
the department the client's and policyholder's rights and the rights of minor children to
benefits or services provided to the client if the commissioner is required to collect from a
third-party payment source.
new text end
new text begin
(b) The local agency must redetermine a client's eligibility for the behavioral health fund
every 12 months.
new text end
new text begin
(c) A client, responsible relative, and policyholder must provide income or wage
verification and household size verification under paragraph (a), clause (3), and must make
an assignment of third-party payment rights under paragraph (a), clause (5). If a client,
responsible relative, or policyholder does not comply with this subdivision, the client is
ineligible for behavioral health fund payment for substance use disorder treatment, and the
client and responsible relative are obligated to pay the full cost of substance use disorder
treatment services provided to the client.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 54.
Minnesota Statutes 2020, section 254B.04, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Client fees. new text end
new text begin
A client whose household income is within current household size
and income guidelines for entitled persons as defined in subdivision 1 must pay no fee.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 55.
Minnesota Statutes 2020, section 254B.04, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Vendor must participate in DAANES. new text end
new text begin
To be eligible for payment under the
behavioral health fund, a vendor must participate in DAANES or submit to the commissioner
the information required in DAANES in the format specified by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 56.
Minnesota Statutes 2021 Supplement, section 254B.05, subdivision 1a, is amended
to read:
Subd. 1a.
Room and board provider requirements.
(a) Effective January 1, 2000,
vendors of room and board are eligible for behavioral health fund payment if the vendor:
(1) has rules prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of those rules;
(2) is determined to meet applicable health and safety requirements;
(3) is not a jail or prison;
(4) is not concurrently receiving funds under chapter 256I for the recipient;
(5) admits individuals who are 18 years of age or older;
(6) is registered as a board and lodging or lodging establishment according to section
157.17;
(7) has awake staff on site 24 hours per day;
(8) has staff who are at least 18 years of age and meet the requirements of section
245G.11, subdivision 1, paragraph (b);
(9) has emergency behavioral procedures that meet the requirements of section 245G.16;
(10) meets the requirements of section 245G.08, subdivision 5, if administering
medications to clients;
(11) meets the abuse prevention requirements of section 245A.65, including a policy on
fraternization and the mandatory reporting requirements of section 626.557;
(12) documents coordination with the treatment provider to ensure compliance with
section 254B.03, subdivision 2;
(13) protects client funds and ensures freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;
(14) has a grievance procedure that meets the requirements of section 245G.15,
subdivision 2; and
(15) has sleeping and bathroom facilities for men and women separated by a door that
is locked, has an alarm, or is supervised by awake staff.
(b) Programs licensed according to Minnesota Rules, chapter 2960, are exempt from
paragraph (a), clauses (5) to (15).
new text begin
(c) Programs providing children's mental health crisis admissions and stabilization under
section 245.4882, subdivision 6, are eligible vendors of room and board.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end Licensed programs providing intensive residential treatment services or residential
crisis stabilization services pursuant to section 256B.0622 or 256B.0624 are eligible vendors
of room and board and are exempt from paragraph (a), clauses (6) to (15).
Sec. 57.
Minnesota Statutes 2021 Supplement, section 254B.05, subdivision 4, is amended
to read:
Subd. 4.
Regional treatment centers.
Regional treatment center chemical dependency
treatment units are eligible vendors. The commissioner may expand the capacity of chemical
dependency treatment units beyond the capacity funded by direct legislative appropriation
to serve individuals who are referred for treatment by counties and whose treatment will be
paid for by funding under this chapter or other funding sources. Notwithstanding the
provisions of sections 254B.03 to deleted text begin 254B.041deleted text end new text begin 254B.04new text end , payment for any person committed
at county request to a regional treatment center under chapter 253B for chemical dependency
treatment and determined to be ineligible under the behavioral health fund, shall become
the responsibility of the county.
Sec. 58.
Minnesota Statutes 2021 Supplement, section 254B.05, subdivision 5, is amended
to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
deleted text begin
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
deleted text end
new text begin
(1) outpatient treatment services licensed according to sections 245G.01 to 245G.17, or
applicable Tribal license, including:
new text end
new text begin
(i) ASAM 1.0 Outpatient: zero to eight hours per week of skilled treatment services for
adults and zero to five hours per week for adolescents. Peer recovery and treatment
coordination may be provided beyond the skilled treatment service hours allowable per
week; and
new text end
new text begin
(ii) ASAM 2.1 Intensive Outpatient: nine or more hours per week of skilled treatment
services for adults and six or more hours per week for adolescents in accordance with the
limitations in paragraph (h). Peer recovery and treatment coordination may be provided
beyond the skilled treatment service hours allowable per week;
new text end
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) deleted text begin medication-assisted therapy services that aredeleted text end new text begin substance use disorder treatment with
medication for opioid use disorders provided in an opioid treatment program that isnew text end licensed
according to sections 245G.01 to 245G.17 and 245G.22, or applicable tribal license;
deleted text begin
(7) medication-assisted therapy plus enhanced treatment services that meet the
deleted text end
deleted text begin
requirements of clause (6) and provide nine hours of clinical services each week;
deleted text end
deleted text begin (8)deleted text end new text begin (7)new text end high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
deleted text begin (9)deleted text end new text begin (8)new text end hospital-based treatment services that are licensed according to sections 245G.01
to 245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
deleted text begin (10)deleted text end new text begin (9)new text end adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
deleted text begin (11)deleted text end new text begin (10)new text end high-intensity residential treatment services that are licensed according to
sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30
hours of clinical services each week provided by a state-operated vendor or to clients who
have been civilly committed to the commissioner, present the most complex and difficult
care needs, and are a potential threat to the community; and
deleted text begin (12)deleted text end new text begin (11)new text end room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific or culturally responsive programs as defined in section 254B.01,
subdivision 4a;
(3) disability responsive programs as defined in section 254B.01, subdivision 4b;
(4) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; or
(5) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, substance use disorder services that are otherwise covered
as direct face-to-face services may be provided via telehealth as defined in section 256B.0625,
subdivision 3b. The use of telehealth to deliver services must be medically appropriate to
the condition and needs of the person being served. Reimbursement shall be at the same
rates and under the same conditions that would otherwise apply to direct face-to-face services.
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
(h) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 59.
Minnesota Statutes 2020, section 256.042, subdivision 1, is amended to read:
Subdivision 1.
Establishment of the advisory council.
(a) The Opiate Epidemic
Response Advisory Council is established to develop and implement a comprehensive and
effective statewide effort to address the opioid addiction and overdose epidemic in Minnesota.
The council shall focus on:
(1) prevention and education, including public education and awareness for adults and
youth, prescriber education, the development and sustainability of opioid overdose prevention
and education programs, the role of adult protective services in prevention and response,
and providing financial support to local law enforcement agencies for opiate antagonist
programs;
(2) training on the treatment of opioid addiction, including the use of all Food and Drug
Administration approved opioid addiction medications, detoxification, relapse prevention,
patient assessment, individual treatment planning, counseling, recovery supports, diversion
control, and other best practices;
(3) the expansion and enhancement of a continuum of care for opioid-related substance
use disorders, including primary prevention, early intervention, treatment, recovery, and
aftercare services; and
(4) the development of measures to assess and protect the ability of cancer patients and
survivors, persons battling life-threatening illnesses, persons suffering from severe chronic
pain, and persons at the end stages of life, who legitimately need prescription pain
medications, to maintain their quality of life by accessing these pain medications without
facing unnecessary barriers. The measures must also address the needs of individuals
described in this clause who are elderly or who reside in underserved or rural areas of the
state.
(b) The council shall:
(1) review local, state, and federal initiatives and activities related to education,
prevention, treatment, and services for individuals and families experiencing and affected
by opioid use disorder;
(2) establish priorities to address the state's opioid epidemic, for the purpose of
recommending initiatives to fund;
(3) recommend to the commissioner of human services specific projects and initiatives
to be funded;
(4) ensure that available funding is allocated to align with other state and federal funding,
to achieve the greatest impact and ensure a coordinated state effort;
(5) consult with the commissioners of human services, health, and management and
budget to develop measurable outcomes to determine the effectiveness of funds allocated;
deleted text begin and
deleted text end
(6) develop recommendations for an administrative and organizational framework for
the allocation, on a sustainable and ongoing basis, of any money deposited into the separate
account under section 16A.151, subdivision 2, paragraph (f), in order to address the opioid
abuse and overdose epidemic in Minnesota and the areas of focus specified in paragraph
(a)deleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) review reports, data, and performance measures submitted by municipalities, as
defined in section 466.01, subdivision 1, in receipt of direct payments from settlement
agreements, as described in section 256.043, subdivision 4; and
new text end
new text begin
(8) consult with relevant stakeholders, including lead agencies and municipalities, to
review and provide recommendations for necessary revisions to required reporting to ensure
the reporting reflects measures of progress in addressing the harms of the opioid epidemic.
new text end
(c) The council, in consultation with the commissioner of management and budget, and
within available appropriations, shall select from the awarded grants projects new text begin or may select
municipality projects funded by settlement monies as described in section 256.043,
subdivision 4, new text end that include promising practices or theory-based activities for which the
commissioner of management and budget shall conduct evaluations using experimental or
quasi-experimental design. Grants awarded to proposals new text begin or municipality projects funded by
settlement monies new text end that include promising practices or theory-based activities and that are
selected for an evaluation shall be administered to support the experimental or
quasi-experimental evaluation and require grantees new text begin and municipality projects new text end to collect and
report information that is needed to complete the evaluation. The commissioner of
management and budget, under section 15.08, may obtain additional relevant data to support
the experimental or quasi-experimental evaluation studies.new text begin For the purposes of this paragraph,
"municipality" has the meaning given in section 466.01, subdivision 1.
new text end
(d) The council, in consultation with the commissioners of human services, health, public
safety, and management and budget, shall establish goals related to addressing the opioid
epidemic and determine a baseline against which progress shall be monitored and set
measurable outcomes, including benchmarks. The goals established must include goals for
prevention and public health, access to treatment, and multigenerational impacts. The council
shall use existing measures and data collection systems to determine baseline data against
which progress shall be measured. The council shall include the proposed goals, the
measurable outcomes, and proposed benchmarks to meet these goals in its initial report to
the legislature under subdivision 5, paragraph (a), due January 31, 2021.
Sec. 60.
Minnesota Statutes 2020, section 256.042, subdivision 2, is amended to read:
Subd. 2.
Membership.
(a) The council shall consist of the following deleted text begin 19deleted text end new text begin 30new text end voting
members, appointed by the commissioner of human services except as otherwise specified,
and three nonvoting members:
(1) two members of the house of representatives, appointed in the following sequence:
the first from the majority party appointed by the speaker of the house and the second from
the minority party appointed by the minority leader. Of these two members, one member
must represent a district outside of the seven-county metropolitan area, and one member
must represent a district that includes the seven-county metropolitan area. The appointment
by the minority leader must ensure that this requirement for geographic diversity in
appointments is met;
(2) two members of the senate, appointed in the following sequence: the first from the
majority party appointed by the senate majority leader and the second from the minority
party appointed by the senate minority leader. Of these two members, one member must
represent a district outside of the seven-county metropolitan area and one member must
represent a district that includes the seven-county metropolitan area. The appointment by
the minority leader must ensure that this requirement for geographic diversity in appointments
is met;
(3) one member appointed by the Board of Pharmacy;
(4) one member who is a physician appointed by the Minnesota Medical Association;
(5) one member representing opioid treatment programs, sober living programs, or
substance use disorder programs licensed under chapter 245G;
(6) one member appointed by the Minnesota Society of Addiction Medicine who is an
addiction psychiatrist;
(7) one member representing professionals providing alternative pain management
therapies, including, but not limited to, acupuncture, chiropractic, or massage therapy;
(8) one member representing nonprofit organizations conducting initiatives to address
the opioid epidemic, with the commissioner's initial appointment being a member
representing the Steve Rummler Hope Network, and subsequent appointments representing
this or other organizations;
(9) one member appointed by the Minnesota Ambulance Association who is serving
with an ambulance service as an emergency medical technician, advanced emergency
medical technician, or paramedic;
(10) one member representing the Minnesota courts who is a judge or law enforcement
officer;
(11) one public member who is a Minnesota resident and who is in opioid addiction
recovery;
(12) deleted text begin twodeleted text end new text begin 11new text end members representing Indian tribes, one representing deleted text begin the Ojibwe tribes and
one representing the Dakota tribesdeleted text end new text begin each of Minnesota's Tribal Nationsnew text end ;
new text begin
(13) two members representing the urban American Indian population;
new text end
deleted text begin (13)deleted text end new text begin (14)new text end one public member who is a Minnesota resident and who is suffering from
chronic pain, intractable pain, or a rare disease or condition;
deleted text begin (14)deleted text end new text begin (15)new text end one mental health advocate representing persons with mental illness;
deleted text begin (15)deleted text end new text begin (16)new text end one member appointed by the Minnesota Hospital Association;
deleted text begin (16)deleted text end new text begin (17)new text end one member representing a local health department; and
deleted text begin (17)deleted text end new text begin (18)new text end the commissioners of human services, health, and corrections, or their designees,
who shall be ex officio nonvoting members of the council.
(b) The commissioner of human services shall coordinate the commissioner's
appointments to provide geographic, racial, and gender diversity, and shall ensure that at
least one-half of council members appointed by the commissioner reside outside of the
seven-county metropolitan area new text begin and that at least one-half of the members have lived
experience with opiate addictionnew text end . Of the members appointed by the commissioner, to the
extent practicable, at least one member must represent a community of color
disproportionately affected by the opioid epidemic.
(c) The council is governed by section 15.059, except that members of the council shall
serve three-year terms and shall receive no compensation other than reimbursement for
expenses. Notwithstanding section 15.059, subdivision 6, the council shall not expire.
(d) The chair shall convene the council at least quarterly, and may convene other meetings
as necessary. The chair shall convene meetings at different locations in the state to provide
geographic access, and shall ensure that at least one-half of the meetings are held at locations
outside of the seven-county metropolitan area.
(e) The commissioner of human services shall provide staff and administrative services
for the advisory council.
(f) The council is subject to chapter 13D.
Sec. 61.
Minnesota Statutes 2021 Supplement, section 256.042, subdivision 4, is amended
to read:
Subd. 4.
Grants.
(a) The commissioner of human services shall submit a report of the
grants proposed by the advisory council to be awarded for the upcoming calendar year to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services policy and finance, by December 1 of each year, beginning
March 1, 2020.
(b) The grants shall be awarded to proposals selected by the advisory council that address
the priorities in subdivision 1, paragraph (a), clauses (1) to (4), unless otherwise appropriated
by the legislature. The advisory council shall determine grant awards and funding amounts
based on the funds appropriated to the commissioner under section 256.043, subdivision 3,
paragraph (e). The commissioner shall award the grants from the opiate epidemic response
fund and administer the grants in compliance with section 16B.97. No more than ten percent
of the grant amount may be used by a grantee for administration.new text begin The commissioner must
award at least 40 percent of grants to projects that include a focus on addressing the opiate
crisis in Black and Indigenous communities and communities of color.
new text end
Sec. 62.
Minnesota Statutes 2020, section 256.042, subdivision 5, is amended to read:
Subd. 5.
Reports.
(a) The advisory council shall report annually to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance by January 31 of each yeardeleted text begin , beginning January 31, 2021deleted text end . The
report shall include information about the individual projects that receive grantsnew text begin , the
municipality projects funded by settlement monies as described in section 256.043,
subdivision 4,new text end and the overall role of the deleted text begin projectdeleted text end new text begin projectsnew text end in addressing the opioid addiction
and overdose epidemic in Minnesota. The report must describe the grantees and the activities
implemented, along with measurable outcomes as determined by the council in consultation
with the commissioner of human services and the commissioner of management and budget.
At a minimum, the report must include information about the number of individuals who
received information or treatment, the outcomes the individuals achieved, and demographic
information about the individuals participating in the project; an assessment of the progress
toward achieving statewide access to qualified providers and comprehensive treatment and
recovery services; and an update on the evaluations implemented by the commissioner of
management and budget for the promising practices and theory-based projects that receive
funding.
(b) The commissioner of management and budget, in consultation with the Opiate
Epidemic Response Advisory Council, shall report to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance when an evaluation study described in subdivision 1, paragraph (c), is
complete on the promising practices or theory-based projects that are selected for evaluation
activities. The report shall include demographic information; outcome information for the
individuals in the program; the results for the program in promoting recovery, employment,
family reunification, and reducing involvement with the criminal justice system; and other
relevant outcomes determined by the commissioner of management and budget that are
specific to the projects that are evaluated. The report shall include information about the
ability of grant programs to be scaled to achieve the statewide results that the grant project
demonstrated.
(c) The advisory council, in its annual report to the legislature under paragraph (a) due
by January 31, 2024, shall include recommendations on whether the appropriations to the
specified entities under Laws 2019, chapter 63, should be continued, adjusted, or
discontinued; whether funding should be appropriated for other purposes related to opioid
abuse prevention, education, and treatment; and on the appropriate level of funding for
existing and new uses.
new text begin
(d) Municipalities receiving direct payments for settlement agreements as described in
section 256.043, subdivision 4, must annually report to the commissioner on how the funds
were used on opioid remediation. The report must be submitted in a format prescribed by
the commissioner. The report must include data and measurable outcomes on expenditures
funded with opioid settlement funds, as identified by the commissioner, including details
on services drawn from the categories of approved uses, as identified in agreements between
the state of Minnesota, the Association of Minnesota Counties, and the League of Minnesota
Cities. Minimum reporting requirements must include:
new text end
new text begin
(1) contact information;
new text end
new text begin
(2) information on funded services and programs; and
new text end
new text begin
(3) target populations for each funded service and program.
new text end
new text begin
(e) In reporting data and outcomes under paragraph (d), municipalities should include
information on the use of evidence-based and culturally relevant services, to the extent
feasible.
new text end
new text begin
(f) Reporting requirements for municipal projects using $25,000 or more of settlement
funds in a calendar year must also include:
new text end
new text begin
(1) a brief qualitative description of successes or challenges; and
new text end
new text begin
(2) results using process and quality measures.
new text end
new text begin
(g) For the purposes of this subdivision, "municipality" or "municipalities" has the
meaning given in section 466.01, subdivision 1.
new text end
Sec. 63.
Minnesota Statutes 2021 Supplement, section 256B.0625, subdivision 5m, is
amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers new text begin services provided by a not-for-profit new text end certified community behavioral health
clinic (CCBHC) deleted text begin servicesdeleted text end that deleted text begin meetdeleted text end new text begin meetsnew text end the requirements of section 245.735, subdivision
3.
(b) The commissioner shall reimburse CCBHCs on a deleted text begin per-visitdeleted text end new text begin per-daynew text end basis deleted text begin under the
prospective paymentdeleted text end new text begin for each day that an eligible service is delivered using the CCBHC
daily bundled ratenew text end system for medical assistance payments as described in paragraph (c).
The commissioner shall include a quality incentive payment in the deleted text begin prospective paymentdeleted text end
new text begin CCBHC daily bundled rate new text end system as described in paragraph (e). There is no county share
for medical assistance services when reimbursed through the CCBHC deleted text begin prospective paymentdeleted text end new text begin
daily bundled ratenew text end system.
(c) The commissioner shall ensure that the deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundled
ratenew text end system for CCBHC payments under medical assistance meets the following requirements:
(1) the deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundlednew text end rate shall be a provider-specific rate
calculated for each CCBHC, based on the daily cost of providing CCBHC services and the
total annual allowable new text begin CCBHC new text end costs deleted text begin for CCBHCsdeleted text end divided by the total annual number of
CCBHC visits. For calculating the payment rate, total annual visits include visits covered
by medical assistance and visits not covered by medical assistance. Allowable costs include
but are not limited to the salaries and benefits of medical assistance providers; the cost of
CCBHC services provided under section 245.735, subdivision 3, paragraph (a), clauses (6)
and (7); and other costs such as insurance or supplies needed to provide CCBHC services;
(2) payment shall be limited to one payment per day per medical assistance enrollee deleted text begin for
eachdeleted text end new text begin when an eligiblenew text end CCBHC deleted text begin visit eligible for reimbursementdeleted text end new text begin service is providednew text end . A
CCBHC visit is eligible for reimbursement if at least one of the CCBHC services listed
under section 245.735, subdivision 3, paragraph (a), clause (6), is furnished to a medical
assistance enrollee by a health care practitioner or licensed agency employed by or under
contract with a CCBHC;
(3) deleted text begin new paymentdeleted text end new text begin initial CCBHC daily bundlednew text end rates deleted text begin set by the commissionerdeleted text end for newly
certified CCBHCs under section 245.735, subdivision 3, shall be deleted text begin based on rates for
established CCBHCs with a similar scope of services. If no comparable CCBHC exists, the
commissioner shall establish a clinic-specific rate using audited historical cost report data
adjusted for the estimated cost of delivering CCBHC services, including the estimated cost
of providing the full scope of services and the projected change in visits resulting from the
change in scopedeleted text end new text begin established by the commissioner using a provider-specific rate based on
the newly certified CCBHC's audited historical cost report data adjusted for the expected
cost of delivering CCBHC services. Estimates are subject to review by the commissioner
and must include the expected cost of providing the full scope of CCBHC services and the
expected number of visits for the rate periodnew text end ;
(4) the commissioner shall rebase CCBHC rates once every three yearsnew text begin following the
last rebasingnew text end and no less than 12 months following an initial rate or a rate change due to a
change in the scope of services;
(5) the commissioner shall provide for a 60-day appeals process after notice of the results
of the rebasing;
(6) the deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundlednew text end rate under this section does not apply
to services rendered by CCBHCs to individuals who are dually eligible for Medicare and
medical assistance when Medicare is the primary payer for the service. An entity that receives
a deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundled rate new text end system deleted text begin ratedeleted text end that overlaps with the CCBHC
rate is not eligible for the CCBHC rate;
(7) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments. The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundled rate new text end system in the Medicaid Management
Information System (MMIS), for CCBHCs reimbursed under this chapter, with a final
settlement of payments due made payable to CCBHCs no later than 18 months thereafter;
(8) the deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundlednew text end rate for each CCBHC shall be updated
by trending each provider-specific rate by the Medicare Economic Index for primary care
services. This update shall occur each year in between rebasing periods determined by the
commissioner in accordance with clause (4). CCBHCs must provide data on costs and visits
to the state annually using the CCBHC cost report established by the commissioner; and
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. new text begin Estimated costs are subject to review by the commissioner. new text end Rate
adjustments for changes in scope shall occur no more than once per year in between rebasing
periods per CCBHC and are effective on the date of the annual CCBHC rate update.
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundlednew text end rate. The commissioner shall
monitor the effect of this requirement on the rate of access to the services delivered by
CCBHC providers. If, for any contract year, federal approval is not received for this
paragraph, the commissioner must adjust the capitation rates paid to managed care plans
and county-based purchasing plans for that contract year to reflect the removal of this
provision. Contracts between managed care plans and county-based purchasing plans and
providers to whom this paragraph applies must allow recovery of payments from those
providers if capitation rates are adjusted in accordance with this paragraph. Payment
recoveries must not exceed the amount equal to any increase in rates that results from this
provision. This paragraph expires if federal approval is not received for this paragraph at
any time.
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the deleted text begin prospective paymentdeleted text end new text begin CCBHC daily bundled
ratenew text end system described in paragraph (c);
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
Sec. 64.
Minnesota Statutes 2020, section 256B.0757, subdivision 5, is amended to read:
Subd. 5.
Payments.
The commissioner shall deleted text begin make payments to each designated provider
for the provision ofdeleted text end new text begin establish a single statewide reimbursement rate fornew text end health home services
deleted text begin described in subdivision 3 to each eligible individual under subdivision 2 that selects the
health home as a providerdeleted text end new text begin under this sectionnew text end .new text begin In setting this rate, the commissioner must
include input from stakeholders, including providers of the services. The statewide
reimbursement rate shall be adjusted annually to match the growth in the Medicare Economic
Index.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 65.
Minnesota Statutes 2021 Supplement, section 256B.0759, subdivision 4, is
amended to read:
Subd. 4.
Provider payment rates.
(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirements and provide evidence
of formal referral arrangements with providers delivering step-up or step-down levels of
care. Providers that have enrolled in the demonstration project but have not met the provider
standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase under
this subdivision until the date that the provider meets the provider standards in subdivision
3. Services provided from July 1, 2022, to the date that the provider meets the provider
standards under subdivision 3 shall be reimbursed at rates according to section 254B.05,
subdivision 5, paragraph (b). Rate increases paid under this subdivision to a provider for
services provided between July 1, 2021, and July 1, 2022, are not subject to recoupment
when the provider is taking meaningful steps to meet demonstration project requirements
that are not otherwise required by law, and the provider provides documentation to the
commissioner, upon request, of the steps being taken.
(b) The commissioner may temporarily suspend payments to the provider according to
section 256B.04, subdivision 21, paragraph (d), if the provider does not meet the requirements
in paragraph (a). Payments withheld from the provider must be made once the commissioner
determines that the requirements in paragraph (a) are met.
(c) For substance use disorder services under section 254B.05, subdivision 5, paragraph
(b), clause deleted text begin (8)deleted text end new text begin (7)new text end , provided on or after July 1, 2020, payment rates must be increased by
25 percent over the rates in effect on December 31, 2019.
(d) For substance use disorder services under section 254B.05, subdivision 5, paragraph
(b), clauses (1)deleted text begin ,deleted text end new text begin andnew text end (6), deleted text begin and (7),deleted text end and adolescent treatment programs that are licensed as
outpatient treatment programs according to sections 245G.01 to 245G.18, provided on or
after January 1, 2021, payment rates must be increased by 20 percent over the rates in effect
on December 31, 2020.
(e) Effective January 1, 2021, and contingent on annual federal approval, managed care
plans and county-based purchasing plans must reimburse providers of the substance use
disorder services meeting the criteria described in paragraph (a) who are employed by or
under contract with the plan an amount that is at least equal to the fee-for-service base rate
payment for the substance use disorder services described in paragraphs (c) and (d). The
commissioner must monitor the effect of this requirement on the rate of access to substance
use disorder services and residential substance use disorder rates. Capitation rates paid to
managed care organizations and county-based purchasing plans must reflect the impact of
this requirement. This paragraph expires if federal approval is not received at any time as
required under this paragraph.
(f) Effective July 1, 2021, contracts between managed care plans and county-based
purchasing plans and providers to whom paragraph (e) applies must allow recovery of
payments from those providers if, for any contract year, federal approval for the provisions
of paragraph (e) is not received, and capitation rates are adjusted as a result. Payment
recoveries must not exceed the amount equal to any decrease in rates that results from this
provision.
Sec. 66.
Minnesota Statutes 2020, section 256B.0941, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Sleeping hours. new text end
new text begin
During normal sleeping hours, a psychiatric residential
treatment facility provider must provide at least one staff person for every six residents
present within a living unit. A provider must adjust sleeping-hour staffing levels based on
the clinical needs of the residents in the facility.
new text end
Sec. 67.
Minnesota Statutes 2020, section 256B.0941, subdivision 3, is amended to read:
Subd. 3.
Per diem rate.
(a) The commissioner must establish one per diem rate per
provider for psychiatric residential treatment facility services for individuals 21 years of
age or younger. The rate for a provider must not exceed the rate charged by that provider
for the same service to other payers. Payment must not be made to more than one entity for
each individual for services provided under this section on a given day. The commissioner
must set rates prospectively for the annual rate period. The commissioner must require
providers to submit annual cost reports on a uniform cost reporting form and must use
submitted cost reports to inform the rate-setting process. The cost reporting must be done
according to federal requirements for Medicare cost reports.
(b) The following are included in the rate:
(1) costs necessary for licensure and accreditation, meeting all staffing standards for
participation, meeting all service standards for participation, meeting all requirements for
active treatment, maintaining medical records, conducting utilization review, meeting
inspection of care, and discharge planning. The direct services costs must be determined
using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff
and service-related transportation; and
(2) payment for room and board provided by facilities meeting all accreditation and
licensing requirements for participation.
(c) A facility may submit a claim for payment outside of the per diem for professional
services arranged by and provided at the facility by an appropriately licensed professional
who is enrolled as a provider with Minnesota health care programs. Arranged services may
be billed by either the facility or the licensed professional. These services must be included
in the individual plan of care and are subject to prior authorization.
(d) Medicaid must reimburse for concurrent services as approved by the commissioner
to support continuity of care and successful discharge from the facility. "Concurrent services"
means services provided by another entity or provider while the individual is admitted to a
psychiatric residential treatment facility. Payment for concurrent services may be limited
and these services are subject to prior authorization by the state's medical review agent.
Concurrent services may include targeted case management, assertive community treatment,
clinical care consultation, team consultation, and treatment planning.
(e) Payment rates under this subdivision must not include the costs of providing the
following services:
(1) educational services;
(2) acute medical care or specialty services for other medical conditions;
(3) dental services; and
(4) pharmacy drug costs.
(f) For purposes of this section, "actual cost" means costs that are allowable, allocable,
reasonable, and consistent with federal reimbursement requirements in Code of Federal
Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of
Management and Budget Circular Number A-122, relating to nonprofit entities.
new text begin
(g) The commissioner shall consult with providers and stakeholders to develop an
assessment tool that identifies when a child with a medical necessity for psychiatric
residential treatment facility level of care will require specialized care planning, including
but not limited to a one-on-one staffing ratio in a living environment. The commissioner
must develop the tool based on clinical and safety review and recommend best uses of the
protocols to align with reimbursement structures.
new text end
Sec. 68.
Minnesota Statutes 2020, section 256B.0941, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Start-up grants. new text end
new text begin
Start-up grants to prospective psychiatric residential treatment
facility sites may be used for:
new text end
new text begin
(1) administrative expenses;
new text end
new text begin
(2) consulting services;
new text end
new text begin
(3) Health Insurance Portability and Accountability Act of 1996 compliance;
new text end
new text begin
(4) therapeutic resources including evidence-based, culturally appropriate curriculums,
and training programs for staff and clients;
new text end
new text begin
(5) allowable physical renovations to the property; and
new text end
new text begin
(6) emergency workforce shortage uses, as determined by the commissioner.
new text end
Sec. 69.
Minnesota Statutes 2021 Supplement, section 256B.0946, subdivision 1, is
amended to read:
Subdivision 1.
Required covered service components.
(a) Subject to federal approval,
medical assistance covers medically necessary intensive new text begin behavioral healthnew text end treatment services
when the services are provided by a provider entity certified under and meeting the standards
in this section. The provider entity must make reasonable and good faith efforts to report
individual client outcomes to the commissioner, using instruments and protocols approved
by the commissioner.
(b) Intensive new text begin behavioral healthnew text end treatment services to children with mental illness residing
in foster family settings new text begin or with legal guardians new text end that comprise specific required service
components provided in clauses (1) to (6) are reimbursed by medical assistance when they
meet the following standards:
(1) psychotherapy provided by a mental health professional or a clinical trainee;
(2) crisis planning;
(3) individual, family, and group psychoeducation services provided by a mental health
professional or a clinical trainee;
(4) clinical care consultation provided by a mental health professional or a clinical
trainee;
(5) individual treatment plan development as defined in Minnesota Rules, part 9505.0371,
subpart 7; and
(6) service delivery payment requirements as provided under subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 70.
Minnesota Statutes 2021 Supplement, section 256B.0946, subdivision 1a, is
amended to read:
Subd. 1a.
Definitions.
For the purposes of this section, the following terms have the
meanings given them.
new text begin
(a) "At risk of out-of-home placement" means the child has participated in
community-based therapeutic or behavioral services including psychotherapy within the
past 30 days and has experienced severe difficulty in managing mental health and behavior
in multiple settings and has one of the following:
new text end
new text begin
(1) has previously been in out-of-home placement for mental health issues within the
past six months;
new text end
new text begin
(2) has a history of threatening harm to self or others and has actively engaged in
self-harming or threatening behavior in the past 30 days;
new text end
new text begin
(3) demonstrates extremely inappropriate or dangerous social behavior in home,
community, and school settings;
new text end
new text begin
(4) has a history of repeated intervention from mental health programs, social services,
mobile crisis programs, or law enforcement to maintain safety in the home, community, or
school within the past 60 days; or
new text end
new text begin
(5) whose parent is unable to safely manage the child's mental health, behavioral, or
emotional problems in the home and has been actively seeking placement for at least two
weeks.
new text end
deleted text begin (a)deleted text end new text begin (b)new text end "Clinical care consultation" means communication from a treating clinician to
other providers working with the same client to inform, inquire, and instruct regarding the
client's symptoms, strategies for effective engagement, care and intervention needs, and
treatment expectations across service settings, including but not limited to the client's school,
social services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.
deleted text begin (b)deleted text end new text begin (c)new text end "Clinical trainee" means a staff person who is qualified according to section
245I.04, subdivision 6.
deleted text begin (c)deleted text end new text begin (d)new text end "Crisis planning" has the meaning given in section 245.4871, subdivision 9a.
deleted text begin (d)deleted text end new text begin (e)new text end "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influences into interventions as a way to maximize resiliency
factors and utilize cultural strengths and resources to promote overall wellness.
deleted text begin (e)deleted text end new text begin (f)new text end "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.
deleted text begin (f)deleted text end new text begin (g)new text end "Standard diagnostic assessment" means the assessment described in section
245I.10, subdivision 6.
deleted text begin (g)deleted text end new text begin (h)new text end "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.
deleted text begin (h)deleted text end new text begin (i)new text end "Foster care" has the meaning given in section 260C.007, subdivision 18.
deleted text begin (i)deleted text end new text begin (j)new text end "Foster family setting" means the foster home in which the license holder resides.
deleted text begin (j)deleted text end new text begin (k)new text end "Individual treatment plan" means the plan described in section 245I.10,
subdivisions 7 and 8.
deleted text begin (k)deleted text end new text begin (l)new text end "Mental health certified family peer specialist" means a staff person who is
qualified according to section 245I.04, subdivision 12.
deleted text begin (l)deleted text end new text begin (m)new text end "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
deleted text begin (m)deleted text end new text begin (n)new text end "Mental illness" has the meaning given in section 245I.02, subdivision 29.
deleted text begin (n)deleted text end new text begin (o)new text end "Parent" has the meaning given in section 260C.007, subdivision 25.
deleted text begin (o)deleted text end new text begin (p)new text end "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.
deleted text begin (p)deleted text end new text begin (q)new text end "Psychotherapy" means the treatment described in section 256B.0671, subdivision
11.
deleted text begin (q)deleted text end new text begin (r)new text end "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.
deleted text begin (r)deleted text end new text begin (s)new text end "Trauma" has the meaning given in section 245I.02, subdivision 38.
deleted text begin (s)deleted text end new text begin (t)new text end "Treatment supervision" means the supervision described under section 245I.06.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 71.
Minnesota Statutes 2021 Supplement, section 256B.0946, subdivision 2, is
amended to read:
Subd. 2.
Determination of client eligibility.
An eligible recipient is an individual, from
birth through age 20, who is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, or placed in a foster home licensed under the
regulations established by a federally recognized Minnesota Tribe, new text begin or who is residing in the
legal guardian's home and is at risk of out-of-home placement, new text end and has received: (1) a
standard diagnostic assessment within 180 days before the start of service that documents
that intensive new text begin behavioral healthnew text end treatment services are medically necessary deleted text begin within a foster
family settingdeleted text end to ameliorate identified symptoms and functional impairments; and (2) a level
of care assessment as defined in section 245I.02, subdivision 19, that demonstrates that the
individual requires intensive intervention without 24-hour medical monitoring, and a
functional assessment as defined in section 245I.02, subdivision 17. The level of care
assessment and the functional assessment must include information gathered from the
placing county, Tribe, or case manager.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 72.
Minnesota Statutes 2021 Supplement, section 256B.0946, subdivision 3, is
amended to read:
Subd. 3.
Eligible mental health services providers.
(a) Eligible providers for new text begin children'snew text end
intensive deleted text begin children's mental healthdeleted text end new text begin behavioral healthnew text end services deleted text begin in a foster family settingdeleted text end must
be certified by the state deleted text begin and have a service provision contract with a county board or a
reservation tribal councildeleted text end and must be able to demonstrate the ability to provide all of the
services required in this section and meet the standards in chapter 245I, as required in section
245I.011, subdivision 5.
(b) For purposes of this section, a provider agency must be:
(1) a county-operated entity certified by the state;
(2) an Indian Health Services facility operated by a Tribe or Tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
(3) a noncounty entity.
(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.
(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional or a clinical trainee.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 73.
Minnesota Statutes 2021 Supplement, section 256B.0946, subdivision 4, is
amended to read:
Subd. 4.
Service delivery payment requirements.
(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
new text begin children'snew text end intensive deleted text begin treatment in foster caredeleted text end new text begin behavioral health servicesnew text end , consistent with
subdivision 1, paragraph (b), and comply with the following requirements in paragraphs
(b) to (n).
(b) Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
standard diagnostic assessment and team consultation and treatment planning review process.
(c) Each client receiving treatment must be assessed for a trauma history, and the client's
treatment plan must document how the results of the assessment will be incorporated into
treatment.
(d) The level of care assessment as defined in section 245I.02, subdivision 19, and
functional assessment as defined in section 245I.02, subdivision 17, must be updated at
least every 90 days or prior to discharge from the service, whichever comes first.
(e) Each client receiving treatment services must have an individual treatment plan that
is reviewed, evaluated, and approved every 90 days using the team consultation and treatment
planning process.
(f) Clinical care consultation must be provided in accordance with the client's individual
treatment plan.
(g) Each client must have a crisis plan within ten days of initiating services and must
have access to clinical phone support 24 hours per day, seven days per week, during the
course of treatment. The crisis plan must demonstrate coordination with the local or regional
mobile crisis intervention team.
(h) Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week. If the mental health professional, client, and family
agree, service units may be temporarily reduced for a period of no more than 60 days in
order to meet the needs of the client and family, or as part of transition or on a discharge
plan to another service or level of care. The reasons for service reduction must be identified,
documented, and included in the treatment plan. Billing and payment are prohibited for
days on which no services are delivered and documented.
(i) Location of service delivery must be in the client's home, day care setting, school, or
other community-based setting that is specified on the client's individualized treatment plan.
(j) Treatment must be developmentally and culturally appropriate for the client.
(k) Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the service team must be aware
of the medication regimen and potential side effects.
(l) Parents, siblings, foster parents, new text begin legal guardians, new text end and members of the child's
permanency plan must be involved in treatment and service delivery unless otherwise noted
in the treatment plan.
(m) Transition planning for deleted text begin thedeleted text end new text begin anew text end child new text begin in foster care new text end must be conducted starting with
the first treatment plan and must be addressed throughout treatment to support the child's
permanency plan and postdischarge mental health service needs.
(n) In order for a provider to receive the daily per-client encounter rate, at least one of
the services listed in subdivision 1, paragraph (b), clauses (1) to (3), must be provided. The
services listed in subdivision 1, paragraph (b), clauses (4) and (5), may be included as part
of the daily per-client encounter rate.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 74.
Minnesota Statutes 2021 Supplement, section 256B.0946, subdivision 6, is
amended to read:
Subd. 6.
Excluded services.
(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of new text begin children's
new text end intensive deleted text begin treatment in foster caredeleted text end new text begin behavioral healthnew text end services, but may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) mental health targeted case management;
(3) partial hospitalization;
(4) medication management;
(5) children's mental health day treatment services;
(6) crisis response services under section 256B.0624;
(7) transportation; and
(8) mental health certified family peer specialist services under section 256B.0616.
(b) Children receiving intensive deleted text begin treatment in foster caredeleted text end new text begin behavioral healthnew text end services are
not eligible for medical assistance reimbursement for the following services while receiving
new text begin children's new text end intensive deleted text begin treatment in foster caredeleted text end new text begin behavioral health servicesnew text end :
(1) psychotherapy and skills training components of children's therapeutic services and
supports under section 256B.0943;
(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph (l);
(3) home and community-based waiver services;
(4) mental health residential treatment; and
(5) room and board costs as defined in section 256I.03, subdivision 6.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 75.
Minnesota Statutes 2020, section 256B.0946, subdivision 7, is amended to read:
Subd. 7.
Medical assistance payment and rate setting.
The commissioner shall establish
a single daily per-client encounter rate for new text begin children's new text end intensive deleted text begin treatment in foster caredeleted text end new text begin
behavioral healthnew text end services. The rate must be constructed to cover only eligible services
delivered to an eligible recipient by an eligible provider, as prescribed in subdivision 1,
paragraph (b).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 76.
Minnesota Statutes 2021 Supplement, section 256B.0947, subdivision 2, is
amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Intensive nonresidential rehabilitative mental health services" means child
rehabilitative mental health services as defined in section 256B.0943, except that these
services are provided by a multidisciplinary staff using a total team approach consistent
with assertive community treatment, as adapted for youth, and are directed to recipients
who are eight years of age or older and under deleted text begin 26deleted text end new text begin 21new text end years of age who require intensive
services to prevent admission to an inpatient psychiatric hospital or placement in a residential
treatment facility or who require intensive services to step down from inpatient or residential
care to community-based care.
(b) "Co-occurring mental illness and substance use disorder" means a dual diagnosis of
at least one form of mental illness and at least one substance use disorder. Substance use
disorders include alcohol or drug abuse or dependence, excluding nicotine use.
(c) "Standard diagnostic assessment" means the assessment described in section 245I.10,
subdivision 6.
(d) "Medication education services" means services provided individually or in groups,
which focus on:
(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;
(2) the role and effects of medications in treating symptoms of mental illness; and
(3) the side effects of medications.
Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
(e) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
(f) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
(g) "Substance use disorders" means one or more of the disorders defined in the diagnostic
and statistical manual of mental disorders, current edition.
(h) "Transition services" means:
(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;
(2) providing the client with knowledge and skills needed posttransition;
(3) establishing communication between sending and receiving entities;
(4) supporting a client's request for service authorization and enrollment; and
(5) establishing and enforcing procedures and schedules.
A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.
(i) "Treatment team" means all staff who provide services to recipients under this section.
(j) "Family peer specialist" means a staff person who is qualified under section
256B.0616.
Sec. 77.
Minnesota Statutes 2021 Supplement, section 256B.0947, subdivision 3, is
amended to read:
Subd. 3.
Client eligibility.
An eligible recipient is an individual who:
(1) is eight years of age or older and under deleted text begin 26deleted text end new text begin 21new text end years of age;
(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
use disorder, for which intensive nonresidential rehabilitative mental health services are
needed;
(3) has received a level of care assessment as defined in section 245I.02, subdivision
19, that indicates a need for intensive integrated intervention without 24-hour medical
monitoring and a need for extensive collaboration among multiple providers;
(4) has received a functional assessment as defined in section 245I.02, subdivision 17,
that indicates functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system during adulthood; and
(5) has had a recent standard diagnostic assessment that documents that intensive
nonresidential rehabilitative mental health services are medically necessary to ameliorate
identified symptoms and functional impairments and to achieve individual transition goals.
Sec. 78.
Minnesota Statutes 2021 Supplement, section 256B.0947, subdivision 5, is
amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must meet the standards in this section and chapter 245I as required in section 245I.011,
subdivision 5.
(b) The treatment team must have specialized training in providing services to the specific
age group of youth that the team serves. An individual treatment team must serve youth
who are: (1) at least eight years of age or older and under 16 years of age, or (2) at least 14
years of age or older and under deleted text begin 26deleted text end new text begin 21new text end years of age.
(c) The treatment team for intensive nonresidential rehabilitative mental health services
comprises both permanently employed core team members and client-specific team members
as follows:
(1) Based on professional qualifications and client needs, clinically qualified core team
members are assigned on a rotating basis as the client's lead worker to coordinate a client's
care. The core team must comprise at least four full-time equivalent direct care staff and
must minimally include:
(i) a mental health professional who serves as team leader to provide administrative
direction and treatment supervision to the team;
(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;
(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
(iv) a mental health certified peer specialist who is qualified according to section 245I.04,
subdivision 10, and is also a former children's mental health consumer.
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialist with knowledge and experience working with youth
regarding special education requirements and goals, special education plans, and coordination
of educational activities with health care activities;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v) a clinical trainee qualified according to section 245I.04, subdivision 6;
(vi) a mental health practitioner qualified according to section 245I.04, subdivision 4;
(vii) a case management service provider, as defined in section 245.4871, subdivision
4;
(viii) a housing access specialist; and
(ix) a family peer specialist as defined in subdivision 2, paragraph (j).
(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:
(i) the mental health professional treating the client prior to placement with the treatment
team;
(ii) the client's current substance use counselor, if applicable;
(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;
(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;
(v) the client's probation officer or other juvenile justice representative, if applicable;
and
(vi) the client's current vocational or employment counselor, if applicable.
(d) The treatment supervisor shall be an active member of the treatment team and shall
function as a practicing clinician at least on a part-time basis. The treatment team shall meet
with the treatment supervisor at least weekly to discuss recipients' progress and make rapid
adjustments to meet recipients' needs. The team meeting must include client-specific case
reviews and general treatment discussions among team members. Client-specific case
reviews and planning must be documented in the individual client's treatment record.
(e) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
(f) The treatment team shall serve no more than 80 clients at any one time. Should local
demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.
(g) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitioner, clinical trainee, or mental health professional. The provider shall have
the capacity to promptly and appropriately respond to emergent needs and make any
necessary staffing adjustments to ensure the health and safety of clients.
(h) The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.
(i) A regional treatment team may serve multiple counties.
Sec. 79.
Minnesota Statutes 2020, section 256B.0949, subdivision 15, is amended to read:
Subd. 15.
EIDBI provider qualifications.
(a) A QSP must be employed by an agency
and be:
(1) a licensed mental health professional who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
ASD diagnostics, ASD developmental and behavioral treatment strategies, and typical child
development; or
(2) a developmental or behavioral pediatrician who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
the areas of ASD diagnostics, ASD developmental and behavioral treatment strategies, and
typical child development.
(b) A level I treatment provider must be employed by an agency and:
(1) have at least 2,000 hours of supervised clinical experience or training in examining
or treating people with ASD or a related condition or equivalent documented coursework
at the graduate level by an accredited university in ASD diagnostics, ASD developmental
and behavioral treatment strategies, and typical child development or an equivalent
combination of documented coursework or hours of experience; and
(2) have or be at least one of the following:
(i) a master's degree in behavioral health or child development or related fields including,
but not limited to, mental health, special education, social work, psychology, speech
pathology, or occupational therapy from an accredited college or university;
(ii) a bachelor's degree in a behavioral health, child development, or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy, from an accredited college or university, and
advanced certification in a treatment modality recognized by the department;
(iii) a board-certified behavior analyst; or
(iv) a board-certified assistant behavior analyst with 4,000 hours of supervised clinical
experience that meets all registration, supervision, and continuing education requirements
of the certification.
(c) A level II treatment provider must be employed by an agency and must be:
(1) a person who has a bachelor's degree from an accredited college or university in a
behavioral or child development science or related field including, but not limited to, mental
health, special education, social work, psychology, speech pathology, or occupational
therapy; and meets at least one of the following:
(i) has at least 1,000 hours of supervised clinical experience or training in examining or
treating people with ASD or a related condition or equivalent documented coursework at
the graduate level by an accredited university in ASD diagnostics, ASD developmental and
behavioral treatment strategies, and typical child development or a combination of
coursework or hours of experience;
(ii) has certification as a board-certified assistant behavior analyst from the Behavior
Analyst Certification Board;
(iii) is a registered behavior technician as defined by the Behavior Analyst Certification
Board; or
(iv) is certified in one of the other treatment modalities recognized by the department;
or
(2) a person who has:
(i) an associate's degree in a behavioral or child development science or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy from an accredited college or university; and
(ii) at least 2,000 hours of supervised clinical experience in delivering treatment to people
with ASD or a related condition. Hours worked as a mental health behavioral aide or level
III treatment provider may be included in the required hours of experience; or
(3) a person who has at least 4,000 hours of supervised clinical experience in delivering
treatment to people with ASD or a related condition. Hours worked as a mental health
behavioral aide or level III treatment provider may be included in the required hours of
experience; or
(4) a person who is a graduate student in a behavioral science, child development science,
or related field and is receiving clinical supervision by a QSP affiliated with an agency to
meet the clinical training requirements for experience and training with people with ASD
or a related condition; or
(5) a person who is at least 18 years of age and who:
(i) is fluent in a non-English languagenew text begin or an individual certified by a Tribal Nationnew text end ;
(ii) completed the level III EIDBI training requirements; and
(iii) receives observation and direction from a QSP or level I treatment provider at least
once a week until the person meets 1,000 hours of supervised clinical experience.
(d) A level III treatment provider must be employed by an agency, have completed the
level III training requirement, be at least 18 years of age, and have at least one of the
following:
(1) a high school diploma or commissioner of education-selected high school equivalency
certification;
(2) fluency in a non-English languagenew text begin or certification by a Tribal Nationnew text end ;
(3) one year of experience as a primary personal care assistant, community health worker,
waiver service provider, or special education assistant to a person with ASD or a related
condition within the previous five years; or
(4) completion of all required EIDBI training within six months of employment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 80.
Minnesota Statutes 2020, section 256D.09, subdivision 2a, is amended to read:
Subd. 2a.
Vendor payments for drug dependent persons.
If, at the time of application
or at any other time, there is a reasonable basis for questioning whether a person applying
for or receiving financial assistance is drug dependent, as defined in section 254A.02,
subdivision 5, the person shall be referred for a chemical health assessment, and only
emergency assistance payments or general assistance vendor payments may be provided
until the assessment is complete and the results of the assessment made available to the
county agency. A reasonable basis for referring an individual for an assessment exists when:
(1) the person has required detoxification two or more times in the past 12 months;
(2) the person appears intoxicated at the county agency as indicated by two or more of
the following:
(i) the odor of alcohol;
(ii) slurred speech;
(iii) disconjugate gaze;
(iv) impaired balance;
(v) difficulty remaining awake;
(vi) consumption of alcohol;
(vii) responding to sights or sounds that are not actually present;
(viii) extreme restlessness, fast speech, or unusual belligerence;
(3) the person has been involuntarily committed for drug dependency at least once in
the past 12 months; or
(4) the person has received treatment, including domiciliary care, for drug abuse or
dependency at least twice in the past 12 months.
The assessment and determination of drug dependency, if any, must be made by an
assessor qualified under deleted text begin Minnesota Rules, part 9530.6615, subpart 2deleted text end new text begin section 245G.11,
subdivisions 1 and 5new text end , to perform an assessment of chemical use. The county shall only
provide emergency general assistance or vendor payments to an otherwise eligible applicant
or recipient who is determined to be drug dependent, except up to 15 percent of the grant
amount the person would otherwise receive may be paid in cash. Notwithstanding subdivision
1, the commissioner of human services shall also require county agencies to provide
assistance only in the form of vendor payments to all eligible recipients who assert chemical
dependency as a basis for eligibility under section 256D.05, subdivision 1, paragraph (a),
clauses (1) and (5).
The determination of drug dependency shall be reviewed at least every 12 months. If
the county determines a recipient is no longer drug dependent, the county may cease vendor
payments and provide the recipient payments in cash.
Sec. 81.
Minnesota Statutes 2021 Supplement, section 256L.03, subdivision 2, is amended
to read:
Subd. 2.
Alcohol and drug dependency.
Beginning July 1, 1993, covered health services
shall include individual outpatient treatment of alcohol or drug dependency by a qualified
health professional or outpatient program.
Persons who may need chemical dependency services under the provisions of this chapter
deleted text begin shall be assessed by a local agencydeleted text end new text begin must be offered access by a local agency to a
comprehensive assessmentnew text end as defined under section deleted text begin 254B.01deleted text end new text begin 245G.05new text end , and under the
assessment provisions of section 254A.03, subdivision 3. A local agency or managed care
plan under contract with the Department of Human Services must deleted text begin placedeleted text end new text begin offer services tonew text end a
person in need of chemical dependency services deleted text begin as provided in Minnesota Rules, parts
9530.6600 to 9530.6655deleted text end new text begin based on the recommendations of section 245G.05new text end . Persons who
are recipients of medical benefits under the provisions of this chapter and who are financially
eligible for behavioral health fund services provided under the provisions of chapter 254B
shall receive chemical dependency treatment services under the provisions of chapter 254B
only if:
(1) they have exhausted the chemical dependency benefits offered under this chapter;
or
(2) an assessment indicates that they need a level of care not provided under the provisions
of this chapter.
Recipients of covered health services under the children's health plan, as provided in
Minnesota Statutes 1990, section 256.936, and as amended by Laws 1991, chapter 292,
article 4, section 17, and recipients of covered health services enrolled in the children's
health plan or the MinnesotaCare program after October 1, 1992, pursuant to Laws 1992,
chapter 549, article 4, sections 5 and 17, are eligible to receive alcohol and drug dependency
benefits under this subdivision.
Sec. 82.
Minnesota Statutes 2020, section 256L.12, subdivision 8, is amended to read:
Subd. 8.
Chemical dependency assessments.
The managed care plan shall be responsible
for assessing the need and deleted text begin placement fordeleted text end new text begin provision ofnew text end chemical dependency services
according to criteria set forth in deleted text begin Minnesota Rules, parts 9530.6600 to 9530.6655deleted text end new text begin section
245G.05new text end .
Sec. 83.
Minnesota Statutes 2020, section 260B.157, subdivision 1, is amended to read:
Subdivision 1.
Investigation.
Upon request of the court the local social services agency
or probation officer shall investigate the personal and family history and environment of
any minor coming within the jurisdiction of the court under section 260B.101 and shall
report its findings to the court. The court may order any minor coming within its jurisdiction
to be examined by a duly qualified physician, psychiatrist, or psychologist appointed by the
court.
The court shall order a chemical use assessment conducted when a child is (1) found to
be delinquent for violating a provision of chapter 152, or for committing a felony-level
violation of a provision of chapter 609 if the probation officer determines that alcohol or
drug use was a contributing factor in the commission of the offense, or (2) alleged to be
delinquent for violating a provision of chapter 152, if the child is being held in custody
under a detention order. The assessor's qualifications new text begin must comply with section 245G.11,
subdivisions 1 and 5, new text end and the assessment criteria deleted text begin shalldeleted text end new text begin mustnew text end comply with deleted text begin Minnesota Rules,
parts 9530.6600 to 9530.6655deleted text end new text begin section 245G.05new text end . If funds under chapter 254B are to be used
to pay for the recommended treatment, the assessment deleted text begin and placementdeleted text end must comply with all
provisions of deleted text begin Minnesota Rules, parts 9530.6600 to 9530.6655 and 9530.7000 to 9530.7030deleted text end new text begin
sections 245G.05 and 254B.04new text end . The commissioner of human services shall reimburse the
court for the cost of the chemical use assessment, up to a maximum of $100.
The court shall order a children's mental health screening conducted when a child is
found to be delinquent. The screening shall be conducted with a screening instrument
approved by the commissioner of human services and shall be conducted by a mental health
practitioner as defined in section 245.4871, subdivision 26, or a probation officer who is
trained in the use of the screening instrument. If the screening indicates a need for assessment,
the local social services agency, in consultation with the child's family, shall have a diagnostic
assessment conducted, including a functional assessment, as defined in section 245.4871.
With the consent of the commissioner of corrections and agreement of the county to pay
the costs thereof, the court may, by order, place a minor coming within its jurisdiction in
an institution maintained by the commissioner for the detention, diagnosis, custody and
treatment of persons adjudicated to be delinquent, in order that the condition of the minor
be given due consideration in the disposition of the case. Any funds received under the
provisions of this subdivision shall not cancel until the end of the fiscal year immediately
following the fiscal year in which the funds were received. The funds are available for use
by the commissioner of corrections during that period and are hereby appropriated annually
to the commissioner of corrections as reimbursement of the costs of providing these services
to the juvenile courts.
Sec. 84.
Minnesota Statutes 2020, section 260B.157, subdivision 3, is amended to read:
Subd. 3.
Juvenile treatment screening team.
(a) The local social services agency shall
establish a juvenile treatment screening team to conduct screenings and prepare case plans
under this subdivision. The team, which may be the team constituted under section 245.4885
or 256B.092 or deleted text begin Minnesota Rules, parts 9530.6600 to 9530.6655deleted text end new text begin chapter 254Bnew text end , shall consist
of social workers, juvenile justice professionals, and persons with expertise in the treatment
of juveniles who are emotionally disabled, chemically dependent, or have a developmental
disability. The team shall involve parents or guardians in the screening process as appropriate.
The team may be the same team as defined in section 260C.157, subdivision 3.
(b) If the court, prior to, or as part of, a final disposition, proposes to place a child:
(1) for the primary purpose of treatment for an emotional disturbance, and residential
placement is consistent with section 260.012, a developmental disability, or chemical
dependency in a residential treatment facility out of state or in one which is within the state
and licensed by the commissioner of human services under chapter 245A; or
(2) in any out-of-home setting potentially exceeding 30 days in duration, including a
post-dispositional placement in a facility licensed by the commissioner of corrections or
human services, the court shall notify the county welfare agency. The county's juvenile
treatment screening team must either:
(i) screen and evaluate the child and file its recommendations with the court within 14
days of receipt of the notice; or
(ii) elect not to screen a given case, and notify the court of that decision within three
working days.
(c) If the screening team has elected to screen and evaluate the child, the child may not
be placed for the primary purpose of treatment for an emotional disturbance, a developmental
disability, or chemical dependency, in a residential treatment facility out of state nor in a
residential treatment facility within the state that is licensed under chapter 245A, unless one
of the following conditions applies:
(1) a treatment professional certifies that an emergency requires the placement of the
child in a facility within the state;
(2) the screening team has evaluated the child and recommended that a residential
placement is necessary to meet the child's treatment needs and the safety needs of the
community, that it is a cost-effective means of meeting the treatment needs, and that it will
be of therapeutic value to the child; or
(3) the court, having reviewed a screening team recommendation against placement,
determines to the contrary that a residential placement is necessary. The court shall state
the reasons for its determination in writing, on the record, and shall respond specifically to
the findings and recommendation of the screening team in explaining why the
recommendation was rejected. The attorney representing the child and the prosecuting
attorney shall be afforded an opportunity to be heard on the matter.
Sec. 85.
Minnesota Statutes 2021 Supplement, section 260C.157, subdivision 3, is amended
to read:
Subd. 3.
Juvenile treatment screening team.
(a) The responsible social services agency
shall establish a juvenile treatment screening team to conduct screenings under this chapter
and chapter 260D, for a child to receive treatment for an emotional disturbance, a
developmental disability, or related condition in a residential treatment facility licensed by
the commissioner of human services under chapter 245A, or licensed or approved by a
Tribe. A screening team is not required for a child to be in: (1) a residential facility
specializing in prenatal, postpartum, or parenting support; (2) a facility specializing in
high-quality residential care and supportive services to children and youth who have been
or are at risk of becoming victims of sex trafficking or commercial sexual exploitation; (3)
supervised settings for youth who are 18 years of age or older and living independently; or
(4) a licensed residential family-based treatment facility for substance abuse consistent with
section 260C.190. Screenings are also not required when a child must be placed in a facility
due to an emotional crisis or other mental health emergency.
(b) The responsible social services agency shall conduct screenings within 15 days of a
request for a screening, unless the screening is for the purpose of residential treatment and
the child is enrolled in a prepaid health program under section 256B.69, in which case the
agency shall conduct the screening within ten working days of a request. The responsible
social services agency shall convene the juvenile treatment screening team, which may be
constituted under section 245.4885 deleted text begin ordeleted text end new text begin , 254B.05, ornew text end 256B.092 deleted text begin or Minnesota Rules, parts
9530.6600 to 9530.6655deleted text end . The team shall consist of social workers; persons with expertise
in the treatment of juveniles who are emotionally disturbed, chemically dependent, or have
a developmental disability; and the child's parent, guardian, or permanent legal custodian.
The team may include the child's relatives as defined in section 260C.007, subdivisions 26b
and 27, the child's foster care provider, and professionals who are a resource to the child's
family such as teachers, medical or mental health providers, and clergy, as appropriate,
consistent with the family and permanency team as defined in section 260C.007, subdivision
16a. Prior to forming the team, the responsible social services agency must consult with the
child's parents, the child if the child is age 14 or older, and, if applicable, the child's Tribe
to obtain recommendations regarding which individuals to include on the team and to ensure
that the team is family-centered and will act in the child's best interests. If the child, child's
parents, or legal guardians raise concerns about specific relatives or professionals, the team
should not include those individuals. This provision does not apply to paragraph (c).
(c) If the agency provides notice to Tribes under section 260.761, and the child screened
is an Indian child, the responsible social services agency must make a rigorous and concerted
effort to include a designated representative of the Indian child's Tribe on the juvenile
treatment screening team, unless the child's Tribal authority declines to appoint a
representative. The Indian child's Tribe may delegate its authority to represent the child to
any other federally recognized Indian Tribe, as defined in section 260.755, subdivision 12.
The provisions of the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, and the Minnesota Indian Family Preservation Act, sections 260.751 to
260.835, apply to this section.
(d) If the court, prior to, or as part of, a final disposition or other court order, proposes
to place a child with an emotional disturbance or developmental disability or related condition
in residential treatment, the responsible social services agency must conduct a screening.
If the team recommends treating the child in a qualified residential treatment program, the
agency must follow the requirements of sections 260C.70 to 260C.714.
The court shall ascertain whether the child is an Indian child and shall notify the
responsible social services agency and, if the child is an Indian child, shall notify the Indian
child's Tribe as paragraph (c) requires.
(e) When the responsible social services agency is responsible for placing and caring
for the child and the screening team recommends placing a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the agency must: (1)
begin the assessment and processes required in section 260C.704 without delay; and (2)
conduct a relative search according to section 260C.221 to assemble the child's family and
permanency team under section 260C.706. Prior to notifying relatives regarding the family
and permanency team, the responsible social services agency must consult with the child's
parent or legal guardian, the child if the child is age 14 or older, and, if applicable, the child's
Tribe to ensure that the agency is providing notice to individuals who will act in the child's
best interests. The child and the child's parents may identify a culturally competent qualified
individual to complete the child's assessment. The agency shall make efforts to refer the
assessment to the identified qualified individual. The assessment may not be delayed for
the purpose of having the assessment completed by a specific qualified individual.
(f) When a screening team determines that a child does not need treatment in a qualified
residential treatment program, the screening team must:
(1) document the services and supports that will prevent the child's foster care placement
and will support the child remaining at home;
(2) document the services and supports that the agency will arrange to place the child
in a family foster home; or
(3) document the services and supports that the agency has provided in any other setting.
(g) When the Indian child's Tribe or Tribal health care services provider or Indian Health
Services provider proposes to place a child for the primary purpose of treatment for an
emotional disturbance, a developmental disability, or co-occurring emotional disturbance
and chemical dependency, the Indian child's Tribe or the Tribe delegated by the child's Tribe
shall submit necessary documentation to the county juvenile treatment screening team,
which must invite the Indian child's Tribe to designate a representative to the screening
team.
(h) The responsible social services agency must conduct and document the screening in
a format approved by the commissioner of human services.
Sec. 86.
Minnesota Statutes 2020, section 260E.20, subdivision 1, is amended to read:
Subdivision 1.
General duties.
(a) The local welfare agency shall offer services to
prevent future maltreatment, safeguarding and enhancing the welfare of the maltreated child,
and supporting and preserving family life whenever possible.
(b) If the report alleges a violation of a criminal statute involving maltreatment or child
endangerment under section 609.378, the local law enforcement agency and local welfare
agency shall coordinate the planning and execution of their respective investigation and
assessment efforts to avoid a duplication of fact-finding efforts and multiple interviews.
Each agency shall prepare a separate report of the results of the agency's investigation or
assessment.
(c) In cases of alleged child maltreatment resulting in death, the local agency may rely
on the fact-finding efforts of a law enforcement investigation to make a determination of
whether or not maltreatment occurred.
(d) When necessary, the local welfare agency shall seek authority to remove the child
from the custody of a parent, guardian, or adult with whom the child is living.
(e) In performing any of these duties, the local welfare agency shall maintain an
appropriate record.
(f) In conducting a family assessment or investigation, the local welfare agency shall
gather information on the existence of substance abuse and domestic violence.
(g) If the family assessment or investigation indicates there is a potential for abuse of
alcohol or other drugs by the parent, guardian, or person responsible for the child's care,
the local welfare agency deleted text begin shall conduct a chemical usedeleted text end new text begin must coordinate a comprehensivenew text end
assessment pursuant to deleted text begin Minnesota Rules, part 9530.6615deleted text end new text begin section 245G.05new text end .
(h) The agency may use either a family assessment or investigation to determine whether
the child is safe when responding to a report resulting from birth match data under section
260E.03, subdivision 23, paragraph (c). If the child subject of birth match data is determined
to be safe, the agency shall consult with the county attorney to determine the appropriateness
of filing a petition alleging the child is in need of protection or services under section
260C.007, subdivision 6, clause (16), in order to deliver needed services. If the child is
determined not to be safe, the agency and the county attorney shall take appropriate action
as required under section 260C.503, subdivision 2.
Sec. 87.
Minnesota Statutes 2020, section 299A.299, subdivision 1, is amended to read:
Subdivision 1.
Establishment of team.
A county, a multicounty organization of counties
formed by an agreement under section 471.59, or a city with a population of no more than
50,000, may establish a multidisciplinary chemical abuse prevention team. The chemical
abuse prevention team may include, but not be limited to, representatives of health, mental
health, public health, law enforcement, educational, social service, court service, community
education, religious, and other appropriate agencies, and parent and youth groups. For
purposes of this section, "chemical abuse" has the meaning given in deleted text begin Minnesota Rules, part
9530.6605, subpart 6deleted text end new text begin section 254A.02, subdivision 6anew text end . When possible the team must
coordinate its activities with existing local groups, organizations, and teams dealing with
the same issues the team is addressing.
Sec. 88.
Laws 2021, First Special Session chapter 7, article 17, section 1, subdivision 2,
is amended to read:
Subd. 2.
Eligibility.
An individual is eligible for the transition to community initiative
if the individual does not meet eligibility criteria for the medical assistance program under
section 256B.056 or 256B.057, but who meets at least one of the following criteria:
(1) the person otherwise meets the criteria under section 256B.092, subdivision 13, or
256B.49, subdivision 24;
(2) the person has met treatment objectives and no longer requires a hospital-level care
or a secure treatment setting, but the person's discharge from the Anoka Metro Regional
Treatment Center, the Minnesota Security Hospital, or a community behavioral health
hospital would be substantially delayed without additional resources available through the
transitions to community initiative;
(3) the person is in a community hospital deleted text begin and on the waiting list for the Anoka Metro
Regional Treatment Centerdeleted text end , but alternative community living options would be appropriate
for the persondeleted text begin , and the person has received approval from the commissionerdeleted text end ; or
(4)(i) the person is receiving customized living services reimbursed under section
256B.4914, 24-hour customized living services reimbursed under section 256B.4914, or
community residential services reimbursed under section 256B.4914; (ii) the person expresses
a desire to move; and (iii) the person has received approval from the commissioner.
Sec. 89.
Laws 2021, First Special Session chapter 7, article 17, section 11, is amended to
read:
Sec. 11. EXPAND MOBILE CRISIS.
deleted text begin (a)deleted text end This act includes $8,000,000 in fiscal year 2022 and $8,000,000 in fiscal year 2023
for additional funding for grants for adult mobile crisis services under Minnesota Statutes,
section 245.4661, subdivision 9, paragraph (b), clause (15)new text begin and children's mobile crisis
services under Minnesota Statutes, section 256B.0944new text end . The general fund base in this act for
this purpose is deleted text begin $4,000,000deleted text end new text begin $8,000,000new text end in fiscal year 2024 and deleted text begin $0deleted text end new text begin $8,000,000new text end in fiscal year
2025.
deleted text begin
(b) Beginning April 1, 2024, counties may fund and continue conducting activities
funded under this section.
deleted text end
deleted text begin
(c) All grant activities must be completed by March 31, 2024.
deleted text end
deleted text begin
(d) This section expires June 30, 2024.
deleted text end
Sec. 90.
Laws 2021, First Special Session chapter 7, article 17, section 12, is amended to
read:
Sec. 12. deleted text begin PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY AND CHILD
AND ADOLESCENTdeleted text end new text begin ADULT AND CHILDREN'Snew text end MOBILE TRANSITION deleted text begin UNITdeleted text end new text begin
UNITSnew text end .
(a) This act includes $2,500,000 in fiscal year 2022 and $2,500,000 in fiscal year 2023
for the commissioner of human services to create new text begin adult and new text end children's mental health transition
and support teams to facilitate transition back to the community deleted text begin of childrendeleted text end new text begin or to the least
restrictive level of carenew text end from new text begin inpatient new text end psychiatric new text begin settings, emergency departments, new text end residential
treatment facilities, and child and adolescent behavioral health hospitals. The general fund
base included in this act for this purpose is $1,875,000 in fiscal year 2024 and $0 in fiscal
year 2025.
(b) Beginning April 1, 2024, counties may fund and continue conducting activities
funded under this section.
(c) This section expires March 31, 2024.
Sec. 91. new text begin RATE INCREASE FOR MENTAL HEALTH ADULT DAY TREATMENT.
new text end
new text begin
The commissioner of human services must increase the reimbursement rate for adult
day treatment by 50 percent over the reimbursement rate in effect as of June 30, 2022.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or 60 days following
federal approval, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end
Sec. 92. new text begin DIRECTION TO COMMISSIONER.
new text end
new text begin
The commissioner must update the behavioral health fund room and board rate schedule
to include programs providing children's mental health crisis admissions and stabilization
under Minnesota Statutes, section 245.4882, subdivision 6. The commissioner must establish
room and board rates commensurate with current room and board rates for adolescent
programs licensed under Minnesota Statutes, section 245G.18.
new text end
Sec. 93. new text begin DIRECTION TO COMMISSIONER; BEHAVIORAL HEALTH FUND
ALLOCATION.
new text end
new text begin
The commissioner of human services, in consultation with counties and Tribal Nations,
must make recommendations on an updated allocation to local agencies from funds allocated
under Minnesota Statutes, section 254B.02, subdivision 5. The commissioner must submit
the recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services finance and policy by January
1, 2024.
new text end
Sec. 94. new text begin DIRECTION TO COMMISSIONER; MEDICATION-ASSISTED THERAPY
SERVICES PAYMENT METHODOLOGY.
new text end
new text begin
The commissioner of human services shall revise the payment methodology for
medication-assisted therapy services under Minnesota Statutes, section 254B.05, subdivision
5, paragraph (b), clause (6). The revised payment methodology must only allow payment
if the provider renders the service or services billed on the specified date of service or, in
the case of drugs and drug-related services, within a week of the specified date of service,
as defined by the commissioner. The revised payment methodology must include a weekly
bundled rate, based on the Medicare rate, that includes the costs of drugs; drug administration
and observation; drug packaging and preparation; and nursing time. The commissioner shall
seek all necessary waivers, state plan amendments, and federal authorizations required to
implement the revised payment methodology.
new text end
Sec. 95. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall change the terms "medication-assisted treatment" and
"medication-assisted therapy" or similar terms to "substance use disorder treatment with
medications for opioid use disorder" whenever the terms appear in Minnesota Statutes and
Minnesota Rules. The revisor may make technical and other necessary grammatical changes
related to the term change.
new text end
new text begin
(b) The revisor of statutes shall change the term "intensive treatment in foster care" or
similar terms to "children's intensive behavioral health services" wherever they appear in
Minnesota Statutes and Minnesota Rules when referring to those providers and services
regulated under Minnesota Statutes, section 256B.0946. The revisor shall make technical
and grammatical changes related to the changes in terms.
new text end
Sec. 96. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 169A.70, subdivision 6; 245G.22, subdivision 19;
254A.02, subdivision 8a; 254A.16, subdivision 6; 254A.19, subdivisions 1a and 2; 254B.04,
subdivisions 2b and 2c; and 254B.041, subdivision 2,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2021 Supplement, section 254A.19, subdivision 5,
new text end
new text begin
is repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Rules, parts 9530.7000, subparts 1, 2, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 17a,
19, 20, and 21; 9530.7005; 9530.7010; 9530.7012; 9530.7015, subparts 1, 2a, 4, 5, and 6;
9530.7020, subparts 1, 1a, and 2; 9530.7021; 9530.7022, subpart 1; 9530.7025; and
9530.7030, subpart 1,
new text end
new text begin
are repealed.
new text end
ARTICLE 11
CONTINUING CARE FOR OLDER ADULTS POLICY
Section 1.
Minnesota Statutes 2020, section 245A.14, subdivision 14, is amended to read:
Subd. 14.
Attendance records for publicly funded services.
(a) A child care center
licensed under this chapter and according to Minnesota Rules, chapter 9503, must maintain
documentation of actual attendance for each child receiving care for which the license holder
is reimbursed by a governmental program. The records must be accessible to the
commissioner during the program's hours of operation, they must be completed on the actual
day of attendance, and they must include:
(1) the first and last name of the child;
(2) the time of day that the child was dropped off; and
(3) the time of day that the child was picked up.
(b) A family child care provider licensed under this chapter and according to Minnesota
Rules, chapter 9502, must maintain documentation of actual attendance for each child
receiving care for which the license holder is reimbursed for the care of that child by a
governmental program. The records must be accessible to the commissioner during the
program's hours of operation, they must be completed on the actual day of attendance, and
they must include:
(1) the first and last name of the child;
(2) the time of day that the child was dropped off; and
(3) the time of day that the child was picked up.
(c) An adult day services program licensed under this chapter and according to Minnesota
Rules, parts 9555.5105 to 9555.6265, must maintain documentation of actual attendance
for each adult day service recipient for which the license holder is reimbursed by a
governmental program. The records must be accessible to the commissioner during the
program's hours of operation, they must be completed on the actual day of attendance, and
they must include:
(1) the first, middle, and last name of the recipient;
(2) the time of day that the recipient was dropped off; and
(3) the time of day that the recipient was picked up.
(d) deleted text begin The commissioner shall not issue a correction for attendance record errors that occur
before August 1, 2013.deleted text end new text begin Adult day services programs licensed under this chapter that are
designated for remote adult day services must maintain documentation of actual participation
for each adult day service recipient for whom the license holder is reimbursed by a
governmental program. The records must be accessible to the commissioner during the
program's hours of operation, must be completed on the actual day service is provided, and
must include the:
new text end
new text begin
(1) first, middle, and last name of the recipient;
new text end
new text begin
(2) time of day the remote services started;
new text end
new text begin
(3) time of day that the remote services ended; and
new text end
new text begin
(4) means by which the remote services were provided, through audio remote services
or through audio and video remote services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 2.
new text begin
[245A.70] REMOTE ADULT DAY SERVICES.
new text end
new text begin
(a) For the purposes of sections 245A.70 to 245A.75, the following terms have the
meanings given.
new text end
new text begin
(b) "Adult day care" and "adult day services" have the meanings given in section 245A.02,
subdivision 2a.
new text end
new text begin
(c) "Remote adult day services" means an individualized and coordinated set of services
provided via live two-way communication by an adult day care or adult day services center.
new text end
new text begin
(d) "Live two-way communication" means real-time audio or audio and video
transmission of information between a participant and an actively involved staff member.
new text end
Sec. 3.
new text begin
[245A.71] APPLICABILITY AND SCOPE.
new text end
new text begin Subdivision 1. new text end
new text begin Licensing requirements. new text end
new text begin
Adult day care centers or adult day services
centers that provide remote adult day services must be licensed under this chapter and
comply with the requirements set forth in this section.
new text end
new text begin Subd. 2. new text end
new text begin Standards for licensure. new text end
new text begin
License holders seeking to provide remote adult day
services must submit a request in the manner prescribed by the commissioner. Remote adult
day services must not be delivered until approved by the commissioner. The designation to
provide remote services is voluntary for license holders. Upon approval, the designation of
approval for remote adult day services must be printed on the center's license, and identified
on the commissioner's public website.
new text end
new text begin Subd. 3. new text end
new text begin Federal requirements. new text end
new text begin
Adult day care centers or adult day services centers
that provide remote adult day services to participants receiving alternative care under section
256B.0913, essential community supports under section 256B.0922, or home and
community-based services waivers under chapter 256S or section 256B.092 or 256B.49
must comply with federally approved waiver plans.
new text end
new text begin Subd. 4. new text end
new text begin Service limitations. new text end
new text begin
Remote adult day services must be provided during the
days and hours of in-person services specified on the license of the adult day care center or
adult day services center.
new text end
Sec. 4.
new text begin
[245A.72] RECORD REQUIREMENTS.
new text end
new text begin
Adult day care centers and adult day services centers providing remote adult day services
must comply with participant record requirements set forth in Minnesota Rules, part
9555.9660. The center must document how remote services will help a participant reach
the short- and long-term objectives in the participant's plan of care.
new text end
Sec. 5.
new text begin
[245A.73] REMOTE ADULT DAY SERVICES STAFF.
new text end
new text begin Subdivision 1. new text end
new text begin Staff ratios. new text end
new text begin
(a) A staff person who provides remote adult day services
without two-way interactive video must only provide services to one participant at a time.
new text end
new text begin
(b) A staff person who provides remote adult day services through two-way interactive
video must not provide services to more than eight participants at one time.
new text end
new text begin Subd. 2. new text end
new text begin Staff training. new text end
new text begin
A center licensed under section 245A.71 must document training
provided to each staff person regarding the provision of remote services in the staff person's
record. The training must be provided prior to a staff person delivering remote adult day
services without supervision. The training must include:
new text end
new text begin
(1) how to use the equipment, technology, and devices required to provide remote adult
day services via live two-way communication;
new text end
new text begin
(2) orientation and training on each participant's plan of care as directly related to remote
adult day services; and
new text end
new text begin
(3) direct observation by a manager or supervisor of the staff person while providing
supervised remote service delivery sufficient to assess staff competency.
new text end
Sec. 6.
new text begin
[245A.74] INDIVIDUAL SERVICE PLANNING.
new text end
new text begin Subdivision 1. new text end
new text begin Eligibility. new text end
new text begin
(a) A person must be eligible for and receiving in-person
adult day services to receive remote adult day services from the same provider. The same
provider must deliver both in-person adult day services and remote adult day services to a
participant.
new text end
new text begin
(b) The license holder must update the participant's plan of care according to Minnesota
Rules, part 9555.9700.
new text end
new text begin
(c) For a participant who chooses to receive remote adult day services, the license holder
must document in the participant's plan of care the participant's proposed schedule and
frequency for receiving both in-person and remote services. The license holder must also
document in the participant's plan of care that remote services:
new text end
new text begin
(1) are chosen as a service delivery method by the participant or the participant's legal
representative;
new text end
new text begin
(2) will meet the participant's assessed needs;
new text end
new text begin
(3) are provided within the scope of adult day services; and
new text end
new text begin
(4) will help the participant achieve identified short and long-term objectives specific
to the provision of remote adult day services.
new text end
new text begin Subd. 2. new text end
new text begin Participant daily service limitations. new text end
new text begin
In a 24-hour period, a participant may
receive:
new text end
new text begin
(1) a combination of in-person adult day services and remote adult day services on the
same day but not at the same time;
new text end
new text begin
(2) a combination of in-person and remote adult day services that does not exceed 12
hours in total; and
new text end
new text begin
(3) up to six hours of remote adult day services.
new text end
new text begin Subd. 3. new text end
new text begin Minimum in-person requirement. new text end
new text begin
A participant who receives remote services
must receive services in-person as assigned in the participant's plan of care at least quarterly.
new text end
Sec. 7.
new text begin
[245A.75] SERVICE AND PROGRAM REQUIREMENTS.
new text end
new text begin
Remote adult day services must be in the scope of adult day services provided in
Minnesota Rules, part 9555.9710, subparts 3 to 7.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256R.02, subdivision 4, is amended to read:
Subd. 4.
Administrative costs.
"Administrative costs" means the identifiable costs for
administering the overall activities of the nursing home. These costs include salaries and
wages of the administrator, assistant administrator, business office employees, security
guards, new text begin purchasing and inventory employees, new text end and associated fringe benefits and payroll
taxes, fees, contracts, or purchases related to business office functions, licenses, permits
except as provided in the external fixed costs category, employee recognition, travel including
meals and lodging, all training except as specified in subdivision 17, voice and data
communication or transmission, office supplies, property and liability insurance and other
forms of insurance except insurance that is a fringe benefit under subdivision 22, personnel
recruitment, legal services, accounting services, management or business consultants, data
processing, information technology, website, central or home office costs, business meetings
and seminars, postage, fees for professional organizations, subscriptions, security services,
new text begin nonpromotional new text end advertising, board of directors fees, working capital interest expense, bad
debts, bad debt collection fees, and costs incurred for travel and deleted text begin housingdeleted text end new text begin lodgingnew text end for persons
employed by a new text begin Minnesota-registered new text end supplemental nursing services agency as defined in
section 144A.70, subdivision 6.
Sec. 9.
Minnesota Statutes 2020, section 256R.02, subdivision 17, is amended to read:
Subd. 17.
Direct care costs.
"Direct care costs" means costs for the wages of nursing
administration, direct care registered nurses, licensed practical nurses, certified nursing
assistants, trained medication aides, employees conducting training in resident care topics
and associated fringe benefits and payroll taxes; services from a new text begin Minnesota-registered
new text end supplemental nursing services agencynew text begin up to the maximum allowable charges under section
144A.74, excluding associated lodging and travel costsnew text end ; supplies that are stocked at nursing
stations or on the floor and distributed or used individually, including, but not limited to:
new text begin rubbing new text end alcoholnew text begin or alcohol swabsnew text end , applicators, cotton balls, incontinence pads, disposable
ice bags, dressings, bandages, water pitchers, tongue depressors, disposable gloves, enemas,
enema equipment, new text begin personal hygiene new text end soap, medication cups, diapers, deleted text begin plastic waste bags,deleted text end
sanitary products, new text begin disposable new text end thermometers, hypodermic needles and syringes, deleted text begin clinical
reagents or similar diagnostic agents,deleted text end drugs deleted text begin that are not paiddeleted text end new text begin not payablenew text end on a separate fee
schedule by the medical assistance program or any other payer, and deleted text begin technology relateddeleted text end new text begin
clinical software costs specificnew text end to the provision of nursing care to residents, such as electronic
charting systems; costs of materials used for resident care training, and training courses
outside of the facility attended by direct care staff on resident care topics; and costs for
nurse consultants, pharmacy consultants, and medical directors. Salaries and payroll taxes
for nurse consultants who work out of a central office must be allocated proportionately by
total resident days or by direct identification to the nursing facilities served by those
consultants.
Sec. 10.
Minnesota Statutes 2020, section 256R.02, subdivision 18, is amended to read:
Subd. 18.
Employer health insurance costs.
"Employer health insurance costs" means
premium expenses for group coveragedeleted text begin ;deleted text end new text begin andnew text end actual expenses incurred for self-insured plans,
including deleted text begin reinsurance;deleted text end new text begin actual claims paid, stop-loss premiums, plan fees,new text end and employer
contributions to employee health reimbursement and health savings accounts. new text begin Actual costs
of self-insurance plans must not include any allowance for future funding unless the plan
meets the Medicare requirements for reporting on a premium basis when the Medicare
regulations define the actual costs. new text end Premium and expense costs and contributions are
allowable for (1) all employees and (2) the spouse and dependents of those employees who
are employed on average at least 30 hours per week.
Sec. 11.
Minnesota Statutes 2020, section 256R.02, subdivision 19, is amended to read:
Subd. 19.
External fixed costs.
"External fixed costs" means costs related to the nursing
home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
family advisory council fee under section 144A.33; scholarships under section 256R.37;
planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41; property taxes, special assessments, and
payments in lieu of taxes; employer health insurance costs; quality improvement incentive
payment rate adjustments under section 256R.39; performance-based incentive payments
under section 256R.38; special dietary needs under section 256R.51; deleted text begin rate adjustments for
compensation-related costs for minimum wage changes under section 256R.49 provided
on or after January 1, 2018;deleted text end Public Employees Retirement Association employer costs; and
border city rate adjustments under section 256R.481.
Sec. 12.
Minnesota Statutes 2020, section 256R.02, subdivision 22, is amended to read:
Subd. 22.
Fringe benefit costs.
"Fringe benefit costs" means the costs for group life,
dental, workers' compensation, short- and long-term disability, long-term care insurance,
accident insurance, supplemental insurance, legal assistance insurance, profit sharing,new text begin child
care costs,new text end health insurance costs not covered under subdivision 18, including costs associated
with part-time employee family members or retirees, and pension and retirement plan
contributions, except for the Public Employees Retirement Association costs.
Sec. 13.
Minnesota Statutes 2020, section 256R.02, subdivision 29, is amended to read:
Subd. 29.
Maintenance and plant operations costs.
"Maintenance and plant operations
costs" means the costs for the salaries and wages of the maintenance supervisor, engineers,
heating-plant employees, and other maintenance employees and associated fringe benefits
and payroll taxes. It also includes identifiable costs for maintenance and operation of the
building and grounds, including, but not limited to, fuel, electricity, new text begin plastic waste bags,
new text end medical waste and garbage removal, water, sewer, supplies, tools, deleted text begin anddeleted text end repairsnew text begin , and minor
equipment not requiring capitalization under Medicare guidelinesnew text end .
Sec. 14.
Minnesota Statutes 2020, section 256R.02, is amended by adding a subdivision
to read:
new text begin Subd. 32a. new text end
new text begin Minor equipment. new text end
new text begin
"Minor equipment" means equipment that does not qualify
as either fixed equipment or depreciable movable equipment as defined in section 256R.261.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256R.02, subdivision 42a, is amended to read:
Subd. 42a.
Real estate taxes.
"Real estate taxes" means the real estate tax liability shown
on the annual property tax deleted text begin statementdeleted text end new text begin statementsnew text end of the nursing facility for the reporting
period. The term does not include personnel costs or fees for late payment.
Sec. 16.
Minnesota Statutes 2020, section 256R.02, subdivision 48a, is amended to read:
Subd. 48a.
Special assessments.
"Special assessments" means the actual special
assessments and related interest paid during the reporting periodnew text begin that are not voluntary costsnew text end .
The term does not include personnel costs deleted text begin ordeleted text end new text begin ,new text end fees for late paymentnew text begin , or special assessments
for projects that are reimbursed in the property ratenew text end .
Sec. 17.
Minnesota Statutes 2020, section 256R.02, is amended by adding a subdivision
to read:
new text begin Subd. 53. new text end
new text begin Vested. new text end
new text begin
"Vested" means the existence of a legally fixed unconditional right
to a present or future benefit.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256R.07, subdivision 1, is amended to read:
Subdivision 1.
Criteria.
A nursing facility deleted text begin shalldeleted text end new text begin mustnew text end keep adequate documentation. In
order to be adequate, documentation must:
(1) be maintained in orderly, well-organized files;
(2) not include documentation of more than one nursing facility in one set of files unless
transactions may be traced by the commissioner to the nursing facility's annual cost report;
(3) include a paid invoice or copy of a paid invoice with date of purchase, vendor name
and address, purchaser name and delivery destination address, listing of items or services
purchased, cost of items purchased, account number to which the cost is posted, and a
breakdown of any allocation of costs between accounts or nursing facilities. If any of the
information is not available, the nursing facility deleted text begin shalldeleted text end new text begin mustnew text end document its good faith attempt
to obtain the information;
(4) include contracts, agreements, amortization schedules, mortgages, other debt
instruments, and all other documents necessary to explain the nursing facility's costs or
revenues; deleted text begin and
deleted text end
(5) new text begin include signed and dated position descriptions; and
new text end
new text begin (6) new text end be retained by the nursing facility to support the five most recent annual cost reports.
The commissioner may extend the period of retention if the field audit was postponed
because of inadequate record keeping or accounting practices as in section 256R.13,
subdivisions 2 and 4, the records are necessary to resolve a pending appeal, or the records
are required for the enforcement of sections 256R.04; 256R.05, subdivision 2; 256R.06,
subdivisions 2, 6, and 7; 256R.08, subdivisions 1 deleted text begin todeleted text end new text begin andnew text end 3; and 256R.09, subdivisions 3 and
4.
Sec. 19.
Minnesota Statutes 2020, section 256R.07, subdivision 2, is amended to read:
Subd. 2.
Documentation of compensation.
Compensation for personal services,
regardless of whether treated as identifiable costs or costs that are not identifiable, must be
documented on payroll records. Payrolls must be supported by time and attendance or
equivalent records for individual employees. Salaries and wages of employees which are
allocated to more than one cost category must be supported by time distribution records.
deleted text begin The method used must produce a proportional distribution of actual time spent, or an accurate
estimate of time spent performing assigned duties. The nursing facility that chooses to
estimate time spent must use a statistically valid method. The compensation must reflect
an amount proportionate to a full-time basis if the services are rendered on less than a
full-time basis.deleted text end new text begin Salary allocations are allowable using the Medicare-approved allocation
basis and methodology only if the salary costs cannot be directly determined, including
when employees provide shared services to noncovered operations.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256R.07, subdivision 3, is amended to read:
Subd. 3.
Adequate documentation supporting nursing facility payrolls.
Payroll
records supporting compensation costs claimed by nursing facilities must be supported by
affirmative time and attendance records prepared by each individual at intervals of not more
than one month. The requirements of this subdivision are met when documentation is
provided under either clause (1) or (2) deleted text begin as followsdeleted text end :
(1) the affirmative time and attendance record must identify the individual's name; the
days worked during each pay period; the number of hours worked each day; and the number
of hours taken each day by the individual for vacation, sick, and other leave. The affirmative
time and attendance record must include a signed verification by the individual and the
individual's supervisor, if any, that the entries reported on the record are correct; or
(2) if the affirmative time and attendance records identifying the individual's name, the
days worked each pay period, the number of hours worked each day, and the number of
hours taken each day by the individual for vacation, sick, and other leave are deleted text begin placed on
microfilmdeleted text end new text begin stored electronicallynew text end , equipment must be made available for viewing and printing
deleted text begin them, or if the records are stored as automated data, summary data must be available for
viewing and printingdeleted text end new text begin the recordsnew text end .
Sec. 21.
Minnesota Statutes 2020, section 256R.08, subdivision 1, is amended to read:
Subdivision 1.
Reporting of financial statements.
(a) No later than February 1 of each
year, a nursing facility deleted text begin shalldeleted text end new text begin mustnew text end :
(1) provide the state agency with a copy of its audited financial statements or its working
trial balance;
(2) provide the state agency with a statement of ownership for the facility;
(3) provide the state agency with separate, audited financial statements or working trial
balances for every other facility owned in whole or in part by an individual or entity that
has an ownership interest in the facility;
(4) upon request, provide the state agency with separate, audited financial statements or
working trial balances for every organization with which the facility conducts business and
which is owned in whole or in part by an individual or entity which has an ownership interest
in the facility;
(5) provide the state agency with copies of leases, purchase agreements, and other
documents related to the lease or purchase of the nursing facility; and
(6) upon request, provide the state agency with copies of leases, purchase agreements,
and other documents related to the acquisition of equipment, goods, and services which are
claimed as allowable costs.
(b) Audited financial statements submitted under paragraph (a) must include a balance
sheet, income statement, statement of the rate or rates charged to private paying residents,
statement of retained earnings, statement of cash flows, notes to the financial statements,
audited applicable supplemental information, and the public accountant's report. Public
accountants must conduct audits in accordance with chapter 326A. The cost of an audit
deleted text begin shalldeleted text end new text begin mustnew text end not be an allowable cost unless the nursing facility submits its audited financial
statements in the manner otherwise specified in this subdivision. A nursing facility must
permit access by the state agency to the public accountant's audit work papers that support
the audited financial statements submitted under paragraph (a).
(c) Documents or information provided to the state agency pursuant to this subdivision
deleted text begin shalldeleted text end new text begin mustnew text end be publicnew text begin unless prohibited by the Health Insurance Portability and Accountability
Act or any other federal or state regulation. Data, notes, and preliminary drafts of reports
created, collected, and maintained by the audit offices of government entities, or persons
performing audits for government entities, and relating to an audit or investigation are
confidential data on individuals or protected nonpublic data until the final report has been
published or the audit or investigation is no longer being pursued actively, except that the
data must be disclosed as required to comply with section 6.67 or 609.456new text end .
(d) If the requirements of paragraphs (a) and (b) are not met, the reimbursement rate
may be reduced to 80 percent of the rate in effect on the first day of the fourth calendar
month after the close of the reporting period and the reduction deleted text begin shalldeleted text end new text begin mustnew text end continue until the
requirements are met.
Sec. 22.
Minnesota Statutes 2020, section 256R.09, subdivision 2, is amended to read:
Subd. 2.
Reporting of statistical and cost information.
All nursing facilities deleted text begin shalldeleted text end new text begin mustnew text end
provide information annually to the commissioner on a form and in a manner determined
by the commissioner. The commissioner may separately require facilities to submit in a
manner specified by the commissioner documentation of statistical and cost information
included in the report to ensure accuracy in establishing payment rates and to perform audit
and appeal review functions under this chapter. The commissioner may also require nursing
facilities to provide statistical and cost information for a subset of the items in the annual
report on a semiannual basis. Nursing facilities deleted text begin shalldeleted text end new text begin mustnew text end report only costs directly related
to the operation of the nursing facility. The facility deleted text begin shalldeleted text end new text begin mustnew text end not include costs which are
separately reimbursed new text begin or reimbursable new text end by residents, medical assistance, or other payors.
Allocations of costs from central, affiliated, or corporate office and related organization
transactions shall be reported according to sections 256R.07, subdivision 3, and 256R.12,
subdivisions 1 to 7. The commissioner shall not grant facilities extensions to the filing
deadline.
Sec. 23.
Minnesota Statutes 2020, section 256R.09, subdivision 5, is amended to read:
Subd. 5.
Method of accounting.
The accrual method of accounting in accordance with
generally accepted accounting principles is the only method acceptable for purposes of
satisfying the reporting requirements of this chapter. If a governmentally owned nursing
facility demonstrates that the accrual method of accounting is not applicable to its accounts
and that a cash or modified accrual method of accounting more accurately reports the nursing
facility's financial operations, the commissioner shall permit the governmentally owned
nursing facility to use a cash or modified accrual method of accounting.new text begin For reimbursement
purposes, the accrued expense must be paid by the providers within 180 days following the
end of the reporting period. An expense disallowed by the commissioner under this section
in any cost report period must not be claimed by a provider on a subsequent cost report.
Specific exemptions to the 180-day rule may be granted by the commissioner for documented
contractual arrangements such as receivership, property tax installment payments, and
pension contributions.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256R.13, subdivision 4, is amended to read:
Subd. 4.
Extended record retention requirements.
The commissioner shall extend the
period for retention of records under section 256R.09, subdivision 3, for purposes of
performing field audits as necessary to enforce sections 256R.04; 256R.05, subdivision 2;
256R.06, subdivisions 2, 6, and 7; 256R.08, subdivisions 1 deleted text begin todeleted text end new text begin andnew text end 3; and 256R.09,
subdivisions 3 and 4, with written notice to the facility postmarked no later than 90 days
prior to the expiration of the record retention requirement.
Sec. 25.
Minnesota Statutes 2020, section 256R.16, subdivision 1, is amended to read:
Subdivision 1.
Calculation of a quality score.
(a) The commissioner shall determine
a quality score for each nursing facility using quality measures established in section
256B.439, according to methods determined by the commissioner in consultation with
stakeholders and experts, and using the most recently available data as provided in the
Minnesota Nursing Home Report Card. These methods deleted text begin shalldeleted text end new text begin mustnew text end be exempt from the
rulemaking requirements under chapter 14.
(b) For each quality measure, a score deleted text begin shalldeleted text end new text begin mustnew text end be determined with the number of points
assigned as determined by the commissioner using the methodology established according
to this subdivision. The determination of the quality measures to be used and the methods
of calculating scores may be revised annually by the commissioner.
(c) The quality score deleted text begin shalldeleted text end new text begin mustnew text end include up to 50 points related to the Minnesota quality
indicators score derived from the minimum data set, up to 40 points related to the resident
quality of life score derived from the consumer survey conducted under section 256B.439,
subdivision 3, and up to ten points related to the state inspection results score.
(d) The commissioner, in cooperation with the commissioner of health, may adjust the
formula in paragraph (c), or the methodology for computing the total quality score, deleted text begin effective
July 1 of any year,deleted text end with five months advance public notice. In changing the formula, the
commissioner shall consider quality measure priorities registered by report card users, advice
of stakeholders, and available research.
Sec. 26.
Minnesota Statutes 2020, section 256R.17, subdivision 3, is amended to read:
Subd. 3.
Resident assessment schedule.
(a) Nursing facilities deleted text begin shalldeleted text end new text begin mustnew text end conduct and
submit case mix classification assessments according to the schedule established by the
commissioner of health under section 144.0724, subdivisions 4 and 5.
(b) The case mix classifications established under section 144.0724, subdivision 3a,
deleted text begin shall bedeleted text end new text begin arenew text end effective the day of admission for new admission assessments. The effective
date for significant change assessments deleted text begin shall bedeleted text end new text begin isnew text end the assessment reference date. The
effective date for annual and quarterly assessments deleted text begin shall bedeleted text end new text begin and significant corrections
assessments isnew text end the first day of the month following assessment reference date.
Sec. 27.
Minnesota Statutes 2020, section 256R.26, subdivision 1, is amended to read:
Subdivision 1.
Determination of limited undepreciated replacement cost.
A facility's
limited URC is the lesser of:
(1) the facility's new text begin recognized new text end URC from the appraisal; or
(2) the product of (i) the number of the facility's licensed beds three months prior to the
beginning of the rate year, (ii) the construction cost per square foot value, and (iii) 1,000
square feet.
Sec. 28.
Minnesota Statutes 2020, section 256R.261, subdivision 13, is amended to read:
Subd. 13.
Equipment allowance per bed value.
The equipment allowance per bed
value is $10,000 adjusted annually for rate years beginning on or after January 1, 2021, by
the percentage change indicated by the urban consumer price index for Minneapolis-St.
Paul, as published by the Bureau of Labor Statistics (series deleted text begin 1967=100deleted text end new text begin 1982-84=100new text end ) for
the two previous Julys. The computation for this annual adjustment is based on the data that
is publicly available on November 1 immediately preceding the start of the rate year.
Sec. 29.
Minnesota Statutes 2020, section 256R.37, is amended to read:
256R.37 SCHOLARSHIPS.
deleted text begin
(a) For the 27-month period beginning October 1, 2015, through December 31, 2017,
the commissioner shall allow a scholarship per diem of up to 25 cents for each nursing
facility with no scholarship per diem that is requesting a scholarship per diem to be added
to the external fixed payment rate to be used:
deleted text end
deleted text begin
(1) for employee scholarships that satisfy the following requirements:
deleted text end
deleted text begin
(i) scholarships are available to all employees who work an average of at least ten hours
per week at the facility except the administrator, and to reimburse student loan expenses
for newly hired registered nurses and licensed practical nurses, and training expenses for
nursing assistants as specified in section 144A.611, subdivisions 2 and 4, who are newly
hired; and
deleted text end
deleted text begin
(ii) the course of study is expected to lead to career advancement with the facility or in
long-term care, including medical care interpreter services and social work; and
deleted text end
deleted text begin
(2) to provide job-related training in English as a second language.
deleted text end
deleted text begin
(b) All facilities may annually request a rate adjustment under this section by submitting
information to the commissioner on a schedule and in a form supplied by the commissioner.
The commissioner shall allow a scholarship payment rate equal to the reported and allowable
costs divided by resident days.
deleted text end
deleted text begin
(c) In calculating the per diem under paragraph (b), the commissioner shall allow costs
related to tuition, direct educational expenses, and reasonable costs as defined by the
commissioner for child care costs and transportation expenses related to direct educational
expenses.
deleted text end
deleted text begin
(d) The rate increase under this section is an optional rate add-on that the facility must
request from the commissioner in a manner prescribed by the commissioner. The rate
increase must be used for scholarships as specified in this section.
deleted text end
deleted text begin
(e) For instances in which a rate adjustment will be 15 cents or greater, nursing facilities
that close beds during a rate year may request to have their scholarship adjustment under
paragraph (b) recalculated by the commissioner for the remainder of the rate year to reflect
the reduction in resident days compared to the cost report year.
deleted text end
new text begin
(a) The commissioner shall provide a scholarship per diem rate calculated using the
criteria in paragraphs (b) to (d). The per diem rate must be based on the allowable costs the
facility paid for employee scholarships for any eligible employee, except the facility
administrator, who works an average of at least ten hours per week in the licensed nursing
facility building when the facility has paid expenses related to:
new text end
new text begin
(1) an employee's course of study that is expected to lead to career advancement with
the facility or in the field of long-term care;
new text end
new text begin
(2) an employee's job-related training in English as a second language;
new text end
new text begin
(3) the reimbursement of student loan expenses for newly hired registered nurses and
licensed practical nurses; and
new text end
new text begin
(4) the reimbursement of training, testing, and associated expenses for newly hired
nursing assistants as specified in section 144A.611, subdivisions 2 and 4. The reimbursement
of nursing assistant expenses under this clause is not subject to the ten-hour minimum work
requirement under this paragraph.
new text end
new text begin
(b) Allowable scholarship costs include: tuition, student loan reimbursement, other direct
educational expenses, and reasonable costs for child care and transportation expenses directly
related to education, as defined by the commissioner.
new text end
new text begin
(c) The commissioner shall provide a scholarship per diem rate equal to the allowable
scholarship costs divided by resident days. The commissioner shall compute the scholarship
per diem rate annually and include the scholarship per diem rate in the external fixed costs
payment rate.
new text end
new text begin
(d) When the resulting scholarship per diem rate is 15 cents or more, nursing facilities
that close beds during a rate year may request to have the scholarship rate recalculated. This
recalculation is effective from the date of the bed closure through the remainder of the rate
year and reflects the estimated reduction in resident days compared to the previous cost
report year.
new text end
new text begin
(e) Facilities seeking to have the facility's scholarship expenses recognized for the
payment rate computation in section 256R.25 may apply annually by submitting information
to the commissioner on a schedule and in a form supplied by the commissioner.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256R.39, is amended to read:
256R.39 QUALITY IMPROVEMENT INCENTIVE PROGRAM.
The commissioner shall develop a quality improvement incentive program in consultation
with stakeholders. The annual funding pool available for quality improvement incentive
payments deleted text begin shalldeleted text end new text begin mustnew text end be equal to 0.8 percent of all operating payments, not including any
rate components resulting from equitable cost-sharing for publicly owned nursing facility
program participation under section 256R.48, critical access nursing facility program
participation under section 256R.47, or performance-based incentive payment program
participation under section 256R.38. deleted text begin For the period from October 1, 2015, to December 31,
2016, rate adjustments provided under this section shall be effective for 15 months. Beginning
January 1, 2017,deleted text end new text begin Annew text end annual rate deleted text begin adjustmentsdeleted text end new text begin adjustmentnew text end provided under this section deleted text begin shalldeleted text end new text begin
mustnew text end be effective for one rate year.
Sec. 31. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, sections 245A.03, subdivision 5; 256R.08, subdivision 2; and
256R.49,
new text end
new text begin
and
new text end
new text begin
Minnesota Rules, part 9555.6255,
new text end
new text begin
are repealed.
new text end
ARTICLE 12
CONTINUING CARE FOR OLDER ADULTS
Section 1.
Minnesota Statutes 2020, section 177.27, subdivision 4, is amended to read:
Subd. 4.
Compliance orders.
The commissioner may issue an order requiring an
employer to comply with sections 177.21 to 177.435, 181.02, 181.03, 181.031, 181.032,
181.101, 181.11, 181.13, 181.14, 181.145, 181.15, 181.172, paragraph (a) or (d), new text begin 181.214
to 181.217, new text end 181.275, subdivision 2a, 181.722, 181.79, and 181.939 to 181.943, or with any
rule promulgated under section 177.28new text begin or 181.213new text end . The commissioner shall issue an order
requiring an employer to comply with sections 177.41 to 177.435 if the violation is repeated.
For purposes of this subdivision only, a violation is repeated if at any time during the two
years that preceded the date of violation, the commissioner issued an order to the employer
for violation of sections 177.41 to 177.435 and the order is final or the commissioner and
the employer have entered into a settlement agreement that required the employer to pay
back wages that were required by sections 177.41 to 177.435. The department shall serve
the order upon the employer or the employer's authorized representative in person or by
certified mail at the employer's place of business. An employer who wishes to contest the
order must file written notice of objection to the order with the commissioner within 15
calendar days after being served with the order. A contested case proceeding must then be
held in accordance with sections 14.57 to 14.69. If, within 15 calendar days after being
served with the order, the employer fails to file a written notice of objection with the
commissioner, the order becomes a final order of the commissioner.
Sec. 2.
Minnesota Statutes 2020, section 177.27, subdivision 7, is amended to read:
Subd. 7.
Employer liability.
If an employer is found by the commissioner to have
violated a section identified in subdivision 4, or any rule adopted under section 177.28new text begin or
181.213new text end , and the commissioner issues an order to comply, the commissioner shall order the
employer to cease and desist from engaging in the violative practice and to take such
affirmative steps that in the judgment of the commissioner will effectuate the purposes of
the section or rule violated. The commissioner shall order the employer to pay to the
aggrieved parties back pay, gratuities, and compensatory damages, less any amount actually
paid to the employee by the employer, and for an additional equal amount as liquidated
damages. Any employer who is found by the commissioner to have repeatedly or willfully
violated a section or sections identified in subdivision 4 shall be subject to a civil penalty
of up to $1,000 for each violation for each employee. In determining the amount of a civil
penalty under this subdivision, the appropriateness of such penalty to the size of the
employer's business and the gravity of the violation shall be considered. In addition, the
commissioner may order the employer to reimburse the department and the attorney general
for all appropriate litigation and hearing costs expended in preparation for and in conducting
the contested case proceeding, unless payment of costs would impose extreme financial
hardship on the employer. If the employer is able to establish extreme financial hardship,
then the commissioner may order the employer to pay a percentage of the total costs that
will not cause extreme financial hardship. Costs include but are not limited to the costs of
services rendered by the attorney general, private attorneys if engaged by the department,
administrative law judges, court reporters, and expert witnesses as well as the cost of
transcripts. Interest shall accrue on, and be added to, the unpaid balance of a commissioner's
order from the date the order is signed by the commissioner until it is paid, at an annual rate
provided in section 549.09, subdivision 1, paragraph (c). The commissioner may establish
escrow accounts for purposes of distributing damages.
Sec. 3.
new text begin
[181.211] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Application. new text end
new text begin
The terms defined in this section apply to sections 181.211
to 181.217.
new text end
new text begin Subd. 2. new text end
new text begin Board. new text end
new text begin
"Board" means the Minnesota Nursing Home Workforce Standards
Board established under section 181.212.
new text end
new text begin Subd. 3. new text end
new text begin Certified worker organization. new text end
new text begin
"Certified worker organization" means a
worker organization that is certified by the board to conduct nursing home worker trainings
under section 181.214.
new text end
new text begin Subd. 4. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of labor and industry.
new text end
new text begin Subd. 5. new text end
new text begin Employer organization. new text end
new text begin
"Employer organization" means:
new text end
new text begin
(1) an organization that is exempt from federal income taxation under section 501(c)(6)
of the Internal Revenue Code and that represents nursing home employers; or
new text end
new text begin
(2) an entity that employers, who together employ a majority of nursing home workers
in Minnesota, have selected as a representative.
new text end
new text begin Subd. 6. new text end
new text begin Nursing home. new text end
new text begin
"Nursing home" means a nursing home licensed under chapter
144A, or a boarding care home licensed under sections 144.50 to 144.56.
new text end
new text begin Subd. 7. new text end
new text begin Nursing home employer. new text end
new text begin
"Nursing home employer" means an employer of
nursing home workers.
new text end
new text begin Subd. 8. new text end
new text begin Nursing home worker. new text end
new text begin
"Nursing home worker" means any worker who provides
services in a nursing home in Minnesota, including direct care staff, administrative staff,
and contractors.
new text end
new text begin Subd. 9. new text end
new text begin Retaliatory personnel action. new text end
new text begin
"Retaliatory personnel action" means any form
of intimidation, threat, reprisal, harassment, discrimination, or adverse employment action,
including discipline, discharge, suspension, transfer, or reassignment to a lesser position in
terms of job classification, job security, or other condition of employment; reduction in pay
or hours or denial of additional hours; informing another employer that a nursing home
worker has engaged in activities protected under sections 181.211 to 181.217; or reporting
or threatening to report the actual or suspected citizenship or immigration status of a nursing
home worker, former nursing home worker, or family member of a nursing home worker
to a federal, state, or local agency.
new text end
new text begin Subd. 10. new text end
new text begin Worker organization. new text end
new text begin
"Worker organization" means an organization that is
exempt from federal income taxation under section 501(c)(3), 501(c)(4), or 501(c)(5) of
the Internal Revenue Code, that is not dominated or controlled by any nursing home employer
within the meaning of United States Code, title 29, section 158a(2), and that has at least
five years of demonstrated experience engaging with and advocating for nursing home
workers.
new text end
Sec. 4.
new text begin
[181.212] MINNESOTA NURSING HOME WORKFORCE STANDARDS
BOARD; ESTABLISHMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Board established; membership. new text end
new text begin
The Minnesota Nursing Home
Workforce Standards Board is created with the powers and duties established by law. The
board is composed of the following members:
new text end
new text begin
(1) the commissioner of human services or a designee;
new text end
new text begin
(2) the commissioner of health or a designee;
new text end
new text begin
(3) the commissioner of labor and industry or a designee;
new text end
new text begin
(4) three members who represent nursing home employers or employer organizations,
appointed by the governor; and
new text end
new text begin
(5) three members who represent nursing home workers or worker organizations,
appointed by the governor.
new text end
new text begin Subd. 2. new text end
new text begin Terms; vacancies. new text end
new text begin
(a) Board members appointed under subdivision 1, clause
(4) or (5), shall serve four-year terms following the initial staggered-lot determination. The
initial terms of members appointed under subdivision 1, clauses (4) and (5), shall be
determined by lot by the secretary of state and shall be as follows:
new text end
new text begin
(1) one member appointed under each of subdivision 1, clauses (4) and (5), shall serve
a two-year term;
new text end
new text begin
(2) one member appointed under each of subdivision 1, clauses (4) and (5), shall serve
a three-year term; and
new text end
new text begin
(3) one member appointed under each of subdivision 1, clauses (4) and (5), shall serve
a four-year term.
new text end
new text begin
(b) For members appointed under subdivision 1, clause (4) or (5), the governor shall fill
vacancies occurring prior to the expiration of a member's term by appointment for the
unexpired term. A member appointed under subdivision 1, clause (4) or (5), must not be
appointed to more than two consecutive four-year terms.
new text end
new text begin Subd. 3. new text end
new text begin Chairperson. new text end
new text begin
The board shall elect a member by majority vote to serve as its
chairperson and shall determine the term to be served by the chairperson.
new text end
new text begin Subd. 4. new text end
new text begin Staffing. new text end
new text begin
The board may employ an executive director and other personnel to
carry out duties of the board under sections 181.211 to 181.217.
new text end
new text begin Subd. 5. new text end
new text begin Compensation. new text end
new text begin
Compensation of board members is governed by section
15.0575.
new text end
new text begin Subd. 6. new text end
new text begin Application of other laws. new text end
new text begin
Meetings of the board are subject to chapter 13D.
The board is subject to chapter 13.
new text end
new text begin Subd. 7. new text end
new text begin Voting. new text end
new text begin
The affirmative vote of five board members is required for the board
to take any action, including action to establish minimum nursing home employment
standards under section 181.213.
new text end
new text begin Subd. 8. new text end
new text begin Hearings and investigations. new text end
new text begin
To carry out its duties, the board shall hold public
hearings on, and conduct investigations into, working conditions in the nursing home
industry.
new text end
Sec. 5.
new text begin
[181.213] DUTIES OF THE BOARD; MINIMUM NURSING HOME
EMPLOYMENT STANDARDS.
new text end
new text begin Subdivision 1. new text end
new text begin
Authority to establish minimum nursing home employment
standards.
new text end
new text begin
(a) The board must adopt rules establishing minimum nursing home employment
standards that are reasonably necessary and appropriate to protect the health and welfare
of nursing home workers, to ensure that nursing home workers are properly trained and
fully informed of their rights under sections 181.211 to 181.217, and to otherwise satisfy
the purposes of sections 181.211 to 181.217. Standards established by the board must
include, as appropriate, standards on compensation, working hours, and other working
conditions for nursing home workers. Any standards established by the board under this
section must be at least as protective of or beneficial to nursing home workers as any other
applicable statute or rule or any standard previously established by the board. In establishing
standards under this section, the board may establish statewide standards, standards that
apply to specific nursing home occupations, standards that apply to specific geographic
areas within the state, or any combination thereof.
new text end
new text begin
(b) The board must adopt rules establishing initial standards for wages and working
hours for nursing home workers no later than August 1, 2023. The board may use the
authority in section 14.389 to adopt rules under this paragraph.
new text end
new text begin
(c) To the extent that any minimum standards that the board finds are reasonably
necessary and appropriate to protect the health and welfare of nursing home workers fall
within the jurisdiction of chapter 182, the board shall not adopt rules establishing the
standards but shall instead recommend the standards to the commissioner of labor and
industry. The commissioner of labor and industry shall adopt nursing home health and safety
standards under section 182.655 as recommended by the board, unless the commissioner
determines that the recommended standard is outside the statutory authority of the
commissioner or is otherwise unlawful and issues a written explanation of this determination.
new text end
new text begin Subd. 2. new text end
new text begin Investigation of market conditions. new text end
new text begin
The board must investigate market
conditions and the existing wages, benefits, and working conditions of nursing home workers
for specific geographic areas of the state and specific nursing home occupations. Based on
this information, the board must seek to adopt minimum nursing home employment standards
that meet or exceed existing industry conditions for a majority of nursing home workers in
the relevant geographic area and nursing home occupation. The board must consider the
following types of information in making wage rate determinations that are reasonably
necessary to protect the health and welfare of nursing home workers:
new text end
new text begin
(1) wage rate and benefit data collected by or submitted to the board for nursing home
workers in the relevant geographic area and nursing home occupations;
new text end
new text begin
(2) statements showing wage rates and benefits paid to nursing home workers in the
relevant geographic area and nursing home occupations;
new text end
new text begin
(3) signed collective bargaining agreements applicable to nursing home workers in the
relevant geographic area and nursing home occupations;
new text end
new text begin
(4) testimony and information from current and former nursing home workers, worker
organizations, nursing home employers, and employer organizations;
new text end
new text begin
(5) local minimum nursing home employment standards;
new text end
new text begin
(6) information submitted by or obtained from state and local government entities; and
new text end
new text begin
(7) any other information pertinent to establishing minimum nursing home employment
standards.
new text end
new text begin Subd. 3. new text end
new text begin Review of standards. new text end
new text begin
At least once every two years, the board shall:
new text end
new text begin
(1) conduct a full review of the adequacy of the minimum nursing home employment
standards previously established by the board; and
new text end
new text begin
(2) following that review, adopt new rules, amend or repeal existing rules, or make
recommendations to adopt new rules or amend or repeal existing rules, as appropriate to
meet the purposes of sections 181.211 to 181.217.
new text end
new text begin Subd. 4. new text end
new text begin Conflict. new text end
new text begin
In the event of a conflict between a standard established by the board
in rule and a rule adopted by another state agency, the rule adopted by the board shall apply
to nursing home workers and nursing home employers, except where the conflicting rule
is issued after the board's standard, and the rule issued by the other state agency is more
protective or more beneficial, then the subsequent more protective or more beneficial rule
must apply to nursing home workers and nursing home employers.
new text end
new text begin Subd. 5. new text end
new text begin Effect on other agreements. new text end
new text begin
Nothing in sections 181.211 to 181.217 shall be
construed to:
new text end
new text begin
(1) limit the rights of parties to a collective bargaining agreement to bargain and agree
with respect to nursing home employment standards; or
new text end
new text begin
(2) diminish the obligation of a nursing home employer to comply with any contract,
collective bargaining agreement, or employment benefit program or plan that meets or
exceeds, and does not conflict with, the minimum standards and requirements in sections
181.211 to 181.217 or established by the board.
new text end
Sec. 6.
new text begin
[181.214] DUTIES OF THE BOARD; TRAINING FOR NURSING HOME
WORKERS.
new text end
new text begin Subdivision 1. new text end
new text begin Certification of worker organizations. new text end
new text begin
The board shall certify worker
organizations that it finds are qualified to provide training to nursing home workers according
to this section. The board shall by rule establish certification criteria that a worker
organization must meet in order to be certified. In adopting rules to establish initial
certification criteria under this subdivision, the board may use the authority in section 14.389.
The criteria must ensure that a worker organization, if certified, is able to provide:
new text end
new text begin
(1) effective, interactive training on the information required by this section; and
new text end
new text begin
(2) follow-up written materials and responses to inquiries from nursing home workers
in the languages in which nursing home workers are proficient.
new text end
new text begin Subd. 2. new text end
new text begin Curriculum. new text end
new text begin
(a) The board shall establish requirements for the curriculum for
the nursing home worker training required by this section. A curriculum must at least provide
the following information to nursing home workers:
new text end
new text begin
(1) the applicable compensation, working hours, and working conditions in the minimum
standards or local minimum standards established by the board;
new text end
new text begin
(2) the antiretaliation protections established in section 181.216;
new text end
new text begin
(3) information on how to enforce sections 181.211 to 181.217 and on how to report
violations of sections 181.211 to 181.217 or of standards established by the board, including
contact information for the Department of Labor and Industry, the board, and any local
enforcement agencies, and information on the remedies available for violations;
new text end
new text begin
(4) the purposes and functions of the board and information on upcoming hearings,
investigations, or other opportunities for nursing home workers to become involved in board
proceedings;
new text end
new text begin
(5) other rights, duties, and obligations under sections 181.211 to 181.217;
new text end
new text begin
(6) any updates or changes to the information provided according to clauses (1) to (5)
since the most recent training session;
new text end
new text begin
(7) any other information the board deems appropriate to facilitate compliance with
sections 181.211 to 181.217; and
new text end
new text begin
(8) information on other applicable local, state, and federal laws, rules, and ordinances
regarding nursing home working conditions or nursing home worker health and safety.
new text end
new text begin
(b) Before establishing initial curriculum requirements, the board must hold at least one
public hearing to solicit input on the requirements.
new text end
new text begin Subd. 3. new text end
new text begin Topics covered in training session. new text end
new text begin
A certified worker organization is not
required to cover all of the topics listed in subdivision 2 in a single training session. A
curriculum used by a certified worker organization may provide instruction on each topic
listed in subdivision 2 over the course of up to three training sessions.
new text end
new text begin Subd. 4. new text end
new text begin Annual review of curriculum requirements. new text end
new text begin
The board must review the
adequacy of its curriculum requirements at least annually and must revise the requirements
as appropriate to meet the purposes of sections 181.211 to 181.217. As part of each annual
review of the curriculum requirements, the board must hold at least one public hearing to
solicit input on the requirements.
new text end
new text begin Subd. 5. new text end
new text begin Duties of certified worker organizations. new text end
new text begin
A certified worker organization:
new text end
new text begin
(1) must use a curriculum for its training sessions that meets requirements established
by the board;
new text end
new text begin
(2) must provide trainings that are interactive and conducted in the languages in which
the attending nursing home workers are proficient;
new text end
new text begin
(3) must, at the end of each training session, provide attending nursing home workers
with follow-up written or electronic materials on the topics covered in the training session,
in order to fully inform nursing home workers of their rights and opportunities under sections
181.211 to 181.217 and other applicable laws, rules, and ordinances governing nursing
home working conditions or worker health and safety;
new text end
new text begin
(4) must make itself reasonably available to respond to inquiries from nursing home
workers during and after training sessions; and
new text end
new text begin
(5) may conduct surveys of nursing home workers who attend a training session to assess
the effectiveness of the training session and industry compliance with sections 181.211 to
181.217 and other applicable laws, rules, and ordinances governing nursing home working
conditions or worker health and safety.
new text end
new text begin Subd. 6. new text end
new text begin Nursing home employer duties regarding training. new text end
new text begin
(a) A nursing home
employer must ensure, and must provide proof to the commissioner of labor and industry,
that every six months each of its nursing home workers completes one hour of training that
meets the requirements of this section and is provided by a certified worker organization.
A nursing home employer may, but is not required to, host training sessions on the premises
of the nursing home.
new text end
new text begin
(b) If requested by a certified worker organization, a nursing home employer must, after
a training session provided by the certified worker organization, provide the certified worker
organization with the names and contact information of the nursing home workers who
attended the training session, unless a nursing home worker opts out according to paragraph
(c).
new text end
new text begin
(c) A nursing home worker may opt out of having the worker's nursing home employer
provide the worker's name and contact information to a certified worker organization that
provided a training session attended by the worker by submitting a written statement to that
effect to the nursing home employer.
new text end
new text begin Subd. 7. new text end
new text begin Compensation. new text end
new text begin
A nursing home employer must compensate its nursing home
workers at their regular hourly rate of wages and benefits for each hour of training completed
as required by this section.
new text end
Sec. 7.
new text begin
[181.215] REQUIRED NOTICES.
new text end
new text begin Subdivision 1. new text end
new text begin Provision of notice. new text end
new text begin
(a) Nursing home employers must provide notices
informing nursing home workers of the rights and obligations provided under sections
181.211 to 181.217 of applicable minimum nursing home employment standards or local
minimum standards and that for assistance and information, nursing home workers should
contact the Department of Labor and Industry. A nursing home employer must provide
notice using the same means that the nursing home employer uses to provide other
work-related notices to nursing home workers. Provision of notice must be at least as
conspicuous as:
new text end
new text begin
(1) posting a copy of the notice at each work site where nursing home workers work
and where the notice may be readily observed and reviewed by all nursing home workers
working at the site; or
new text end
new text begin
(2) providing a paper or electronic copy of the notice to all nursing home workers and
applicants for employment as a nursing home worker.
new text end
new text begin
(b) The notice required by this subdivision must include text provided by the board that
informs nursing home workers that they may request the notice to be provided in a particular
language. The nursing home employer must provide the notice in the language requested
by the nursing home worker. The board must assist nursing home employers in translating
the notice in the languages requested by their nursing home workers.
new text end
new text begin Subd. 2. new text end
new text begin Minimum content and posting requirements. new text end
new text begin
The board must adopt rules
specifying the minimum content and posting requirements for the notices required in
subdivision 1. The board must make available to nursing home employers a template or
sample notice that satisfies the requirements of this section and rules adopted under this
section.
new text end
Sec. 8.
new text begin
[181.216] RETALIATION ON CERTAIN GROUNDS PROHIBITED.
new text end
new text begin
A nursing home employer must not retaliate against a nursing home worker, including
taking retaliatory personnel action, for:
new text end
new text begin
(1) exercising any right afforded to the nursing home worker under sections 181.211 to
181.217;
new text end
new text begin
(2) participating in any process or proceeding under sections 181.211 to 181.217,
including but not limited to board hearings, investigations, or other proceedings; or
new text end
new text begin
(3) attending or participating in the training required by section 181.214.
new text end
Sec. 9.
new text begin
[181.217] ENFORCEMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Minimum nursing home employment standards. new text end
new text begin
The minimum wages,
maximum hours of work, and other working conditions established by the board in rule as
minimum nursing home employment standards shall be the minimum wages, maximum
hours of work, and standard conditions of labor for nursing home workers or a subgroup
of nursing home workers as a matter of state law. It shall be unlawful for a nursing home
employer to employ a nursing home worker for lower wages or for longer hours than those
established as the minimum nursing home employment standards or under any other working
conditions that violate the minimum nursing home employment standards.
new text end
new text begin Subd. 2. new text end
new text begin Investigations. new text end
new text begin
The commissioner may investigate possible violations of sections
181.214 to 181.217 or of the minimum nursing home employment standards established by
the board whenever it has cause to believe that a violation has occurred, either on the basis
of a report of a suspected violation or on the basis of any other credible information, including
violations found during the course of an investigation.
new text end
new text begin Subd. 3. new text end
new text begin Enforcement authority. new text end
new text begin
The Department of Labor and Industry shall enforce
sections 181.214 to 181.217 and compliance with the minimum nursing home employment
standards established by the board according to the authority in section 177.27, subdivisions
4 and 7.
new text end
new text begin Subd. 4. new text end
new text begin Civil action by nursing home worker. new text end
new text begin
(a) One or more nursing home workers
may bring a civil action in district court seeking redress for violations of sections 181.211
to 181.217 or of any applicable minimum nursing home employment standards or local
minimum nursing home employment standards. Such an action may be filed in the district
court of the county where a violation or violations are alleged to have been committed or
where the nursing home employer resides, or in any other court of competent jurisdiction,
and may represent a class of similarly situated nursing home workers.
new text end
new text begin
(b) Upon a finding of one or more violations, a nursing home employer shall be liable
to each nursing home worker for the full amount of the wages, benefits, and overtime
compensation, less any amount the nursing home employer is able to establish was actually
paid to each nursing home worker and for an additional equal amount as liquidated damages.
In an action under this subdivision, nursing home workers may seek damages and other
appropriate relief provided by section 177.27, subdivision 7, or otherwise provided by law,
including reasonable costs, disbursements, witness fees, and attorney fees. A court may also
issue an order requiring compliance with sections 181.211 to 181.217 or with the applicable
minimum nursing home employment standards or local minimum nursing home employment
standards. A nursing home worker found to have experienced a retaliatory personnel action
in violation of section 181.216 shall be entitled to reinstatement to the worker's previous
position, wages, benefits, hours, and other conditions of employment.
new text end
new text begin
(c) An agreement between a nursing home employer and nursing home worker or labor
union that fails to meet the minimum standards and requirements in sections 181.211 to
181.217 or established by the board is not a defense to an action brought under this
subdivision.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.0913, subdivision 4, is amended to read:
Subd. 4.
Eligibility for funding for services for nonmedical assistance recipients.
(a)
Funding for services under the alternative care program is available to persons who meet
the following criteria:
(1) the person is a citizen of the United States or a United States national;
(2) the person has been determined by a community assessment under section 256B.0911
to be a person who would require the level of care provided in a nursing facility, as
determined under section 256B.0911, subdivision 4e, but for the provision of services under
the alternative care program;
(3) the person is age 65 or older;
(4) the person would be eligible for medical assistance within 135 days of admission to
a nursing facility;
(5) the person is not ineligible for the payment of long-term care services by the medical
assistance program due to an asset transfer penalty under section 256B.0595 or equity
interest in the home exceeding $500,000 as stated in section 256B.056;
(6) the person needs long-term care services that are not funded through other state or
federal funding, or other health insurance or other third-party insurance such as long-term
care insurance;
(7) except for individuals described in clause (8), the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256S.18. This monthly limit does not prohibit the
alternative care client from payment for additional services, but in no case may the cost of
additional services purchased under this section exceed the difference between the client's
monthly service limit defined under section 256S.04, and the alternative care program
monthly service limit defined in this paragraph. If care-related supplies and equipment or
environmental modifications and adaptations are or will be purchased for an alternative
care services recipient, the costs may be prorated on a monthly basis for up to 12 consecutive
months beginning with the month of purchase. If the monthly cost of a recipient's other
alternative care services exceeds the monthly limit established in this paragraph, the annual
cost of the alternative care services deleted text begin shalldeleted text end new text begin mustnew text end be determined. In this event, the annual cost
of alternative care services deleted text begin shalldeleted text end new text begin mustnew text end not exceed 12 times the monthly limit described in
this paragraph;
(8) for individuals assigned a case mix classification A as described under section
256S.18, with (i) no dependencies in activities of daily living, or (ii) up to two dependencies
in bathing, dressing, grooming, walking, and eating when the dependency score in eating
is three or greater as determined by an assessment performed under section 256B.0911, the
monthly cost of alternative care services funded by the program cannot exceed $593 per
month for all new participants enrolled in the program on or after July 1, 2011. This monthly
limit shall be applied to all other participants who meet this criteria at reassessment. This
monthly limit deleted text begin shalldeleted text end new text begin mustnew text end be increased annually as described in section 256S.18. This monthly
limit does not prohibit the alternative care client from payment for additional services, but
in no case may the cost of additional services purchased exceed the difference between the
client's monthly service limit defined in this clause and the limit described in clause (7) for
case mix classification A; deleted text begin and
deleted text end
(9) the person is making timely payments of the assessed monthly feedeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(10) for a person participating in consumer-directed community supports, the person's
monthly service limit must be equal to the monthly service limits in clause (7), except that
a person assigned a case mix classification L must receive the monthly service limit for
case mix classification A.
new text end
A person is ineligible if payment of the fee is over 60 days past due, unless the person agrees
to:
(i) the appointment of a representative payee;
(ii) automatic payment from a financial account;
(iii) the establishment of greater family involvement in the financial management of
payments; or
(iv) another method acceptable to the lead agency to ensure prompt fee payments.
The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility deleted text begin shalldeleted text end new text begin mustnew text end not be
reinstated for a period of 30 days.
(b) Alternative care funding under this subdivision is not available for a person who is
a medical assistance recipient or who would be eligible for medical assistance without a
spenddown or waiver obligation. A person whose initial application for medical assistance
and the elderly waiver program is being processed may be served under the alternative care
program for a period up to 60 days. If the individual is found to be eligible for medical
assistance, medical assistance must be billed for services payable under the federally
approved elderly waiver plan and delivered from the date the individual was found eligible
for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
care funds may not be used to pay for any service the cost of which: (i) is payable by medical
assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to pay a
medical assistance income spenddown for a person who is eligible to participate in the
federally approved elderly waiver program under the special income standard provision.
(c) Alternative care funding is not available for a person who resides in a licensed nursing
home, certified boarding care home, hospital, or intermediate care facility, except for case
management services which are provided in support of the discharge planning process for
a nursing home resident or certified boarding care home resident to assist with a relocation
process to a community-based setting.
(d) Alternative care funding is not available for a person whose income is greater than
the maintenance needs allowance under section 256S.05, but equal to or less than 120 percent
of the federal poverty guideline effective July 1 in the fiscal year for which alternative care
eligibility is determined, who would be eligible for the elderly waiver with a waiver
obligation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.0913, subdivision 5, is amended to read:
Subd. 5.
Services covered under alternative care.
Alternative care funding may be
used for payment of costs of:
(1) adult day services and adult day services bath;
(2) home care;
(3) homemaker services;
(4) personal care;
(5) case management and conversion case management;
(6) respite care;
(7) specialized supplies and equipment;
(8) home-delivered meals;
(9) nonmedical transportation;
(10) nursing services;
(11) chore services;
(12) companion services;
(13) nutrition services;
(14) family caregiver training and education;
(15) coaching and counseling;
(16) telehome care to provide services in their own homes in conjunction with in-home
visits;
(17) consumer-directed community supports deleted text begin under the alternative care programs which
are available statewide and limited to the average monthly expenditures representative of
all alternative care program participants for the same case mix resident class assigned in
the most recent fiscal year for which complete expenditure data is availabledeleted text end ;
(18) environmental accessibility and adaptations; and
(19) discretionary services, for which lead agencies may make payment from their
alternative care program allocation for services not otherwise defined in this section or
section 256B.0625, following approval by the commissioner.
Total annual payments for discretionary services for all clients served by a lead agency
must not exceed 25 percent of that lead agency's annual alternative care program base
allocation, except that when alternative care services receive federal financial participation
under the 1115 waiver demonstration, funding shall be allocated in accordance with
subdivision 17.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256S.15, subdivision 2, is amended to read:
Subd. 2.
Foster care limit.
The elderly waiver payment for the foster care service in
combination with the payment for all other elderly waiver services, including case
management, must not exceed the monthly case mix budget cap for the participant as
specified in sections 256S.18, subdivision 3, and 256S.19, deleted text begin subdivisionsdeleted text end new text begin subdivisionnew text end 3 deleted text begin and
4deleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256S.18, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin
Monthly case mix budget caps for consumer-directed community
supports.
new text end
new text begin
The monthly case mix budget caps for each case mix classification for
consumer-directed community supports must be equal to the monthly case mix budget caps
in subdivision 3.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256S.19, subdivision 3, is amended to read:
Subd. 3.
Calculation of monthly conversion budget deleted text begin cap without consumer-directed
community supportsdeleted text end new text begin capsnew text end .
(a) The elderly waiver monthly conversion budget cap for the
cost of elderly waiver services deleted text begin without consumer-directed community supportsdeleted text end must be
based on the nursing facility case mix adjusted total payment rate of the nursing facility
where the elderly waiver applicant currently resides for the applicant's case mix classification
as determined according to section 256R.17.
(b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver
services deleted text begin without consumer-directed community supports shalldeleted text end new text begin mustnew text end be calculated by
multiplying the applicable nursing facility case mix adjusted total payment rate by 365,
dividing by 12, and subtracting the participant's maintenance needs allowance.
(c) A participant's initially approved monthly conversion budget cap for elderly waiver
services deleted text begin without consumer-directed community supports shalldeleted text end new text begin mustnew text end be adjusted at least
annually as described in section 256S.18, subdivision 5.
new text begin
(d) Conversion budget caps for individuals participating in consumer-directed community
supports are also set as described in paragraphs (a) to (c).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 15.
Minnesota Statutes 2021 Supplement, section 256S.21, is amended to read:
256S.21 RATE SETTING; APPLICATION.
The payment methodologies in sections 256S.2101 to 256S.215 apply tonew text begin :
new text end
new text begin (1)new text end elderly waiver, elderly waiver customized living, and elderly waiver foster care under
this chapter;
new text begin (2)new text end alternative care under section 256B.0913;
new text begin (3)new text end essential community supports under section 256B.0922; deleted text begin and
deleted text end
new text begin
(4) homemaker services under the developmental disability waiver under section
256B.092 and community alternative care, community access for disability inclusion, and
brain injury waiver under section 256B.49; and
new text end
new text begin (5)new text end community access for disability inclusion customized living and brain injury
customized living under section 256B.49.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 16.
Minnesota Statutes 2021 Supplement, section 256S.2101, subdivision 2, is
amended to read:
Subd. 2.
Phase-in for elderly waiver rates.
Except for home-delivered meals deleted text begin as
described in section 256S.215, subdivision 15deleted text end , all rates and rate components for elderly
waiver, elderly waiver customized living, and elderly waiver foster care under this chapter;
alternative care under section 256B.0913; and essential community supports under section
256B.0922 deleted text begin shalldeleted text end new text begin mustnew text end be the sum of deleted text begin 18.8deleted text end new text begin 21.6new text end percent of the rates calculated under sections
256S.211 to 256S.215, and deleted text begin 81.2deleted text end new text begin 78.4new text end percent of the rates calculated using the rate
methodology in effect as of June 30, 2017. deleted text begin The rate for home-delivered meals shall be the
sum of the service rate in effect as of January 1, 2019, and the increases described in section
256S.215, subdivision 15.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
Minnesota Statutes 2021 Supplement, section 256S.2101, is amended by adding
a subdivision to read:
new text begin Subd. 3. new text end
new text begin Phase-in for home-delivered meals rate. new text end
new text begin
The home-delivered meals rate for
elderly waiver under this chapter; alternative care under section 256B.0913; and essential
community supports under section 256B.0922 must be the sum of 65 percent of the rate in
section 256S.215, subdivision 15, and 35 percent of the rate calculated using the rate
methodology in effect as of June 30, 2017.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256S.211, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Updating homemaker services rates. new text end
new text begin
On January 1, 2023, and every two
years thereafter, the commissioner shall recalculate rates for homemaker services as directed
by section 256S.215, subdivisions 9 to 11. Prior to recalculating the rates, the commissioner
shall:
new text end
new text begin
(1) update the base wage index for homemaker services in section 256S.212, subdivisions
8 to 10, based on the most recently available Bureau of Labor Statistics Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA data;
new text end
new text begin
(2) update the payroll taxes and benefits factor in section 256S.213, subdivision 1, and
the general and administrative factor in section 256S.213, subdivision 2, based on the most
recently available nursing facility cost report data;
new text end
new text begin
(3) update the registered nurse management and supervision wage component in section
256S.213, subdivision 4, based on the most recently available Bureau of Labor Statistics
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA data; and
new text end
new text begin
(4) update the adjusted base wage for homemaker services as directed in section 256S.214.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256S.211, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Updating the home-delivered meals rate. new text end
new text begin
On July 1 of each year, the
commissioner shall update the home-delivered meals rate in section 256S.215, subdivision
15, by the percent increase in the nursing facility dietary per diem using the two most recent
and available nursing facility cost reports.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256S.212, is amended to read:
256S.212 RATE SETTING; BASE WAGE INDEX.
Subdivision 1.
Updating SOC codes.
If any of the SOC codes and positions used in
this section are no longer available, the commissioner shall, in consultation with stakeholders,
select a new SOC code and position that is the closest match to the previously used SOC
position.
Subd. 2.
Home management and support services base wage.
For customized livingdeleted text begin ,deleted text end new text begin
andnew text end foster caredeleted text begin , and residential caredeleted text end component services, the home management and support
services base wage equals 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for new text begin home health and new text end personal deleted text begin and homedeleted text end care deleted text begin aidedeleted text end new text begin aidesnew text end (SOC code
deleted text begin 39-9021deleted text end new text begin 31-1120new text end ); 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for food preparation workers (SOC code 35-2021); and 33.34 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
housekeeping cleaners (SOC code 37-2012).
Subd. 3.
Home care aide base wage.
For customized livingdeleted text begin ,deleted text end new text begin andnew text end foster caredeleted text begin , and
residential caredeleted text end component services, the home care aide base wage equals deleted text begin 50deleted text end new text begin 75new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health
new text begin and personal care new text end aides (SOC code deleted text begin 31-1011deleted text end new text begin 31-1120new text end ); and deleted text begin 50deleted text end new text begin 25new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end ).
Subd. 4.
Home health aide base wage.
For customized livingdeleted text begin ,deleted text end new text begin andnew text end foster caredeleted text begin , and
residential caredeleted text end component services, the home health aide base wage equals deleted text begin 20deleted text end new text begin 33.33new text end percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed
practical and licensed vocational nurses (SOC code 29-2061); deleted text begin and 80deleted text end new text begin 33.33new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end )new text begin ; and 33.34 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for home health and personal care aides (SOC code
31-1120)new text end .
Subd. 5.
Medication setups by licensed nurse base wage.
For customized livingdeleted text begin ,deleted text end new text begin andnew text end
foster caredeleted text begin , and residential caredeleted text end component services, the medication setups by licensed nurse
base wage equals deleted text begin tendeleted text end new text begin 25new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for licensed practical and licensed vocational nurses (SOC code 29-2061);
and deleted text begin 90deleted text end new text begin 75new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
wage for registered nurses (SOC code 29-1141).
Subd. 6.
Chore services base wage.
The chore services base wage equals deleted text begin 100deleted text end new text begin 50new text end percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for landscaping
and groundskeeping workers (SOC code 37-3011)new text begin ; and 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for maids and housekeeping cleaners
(SOC code 37-2012)new text end .
Subd. 7.
Companion services base wage.
The companion services base wage equals
deleted text begin 50deleted text end new text begin 80new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage
for new text begin home health and new text end personal deleted text begin and homedeleted text end care aides (SOC code deleted text begin 39-9021deleted text end new text begin 31-1120new text end ); and deleted text begin 50deleted text end new text begin
20new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
maids and housekeeping cleaners (SOC code 37-2012).
Subd. 8.
Homemaker services and assistance with personal care base wage.
The
homemaker services and assistance with personal care base wage equals deleted text begin 60deleted text end new text begin 50new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for new text begin home health
and new text end personal deleted text begin and homedeleted text end care deleted text begin aidedeleted text end new text begin aidesnew text end (SOC code deleted text begin 39-9021deleted text end new text begin 31-1120new text end ); deleted text begin 20deleted text end new text begin and 50new text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end )deleted text begin ; and 20 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012)deleted text end .
Subd. 9.
Homemaker services and cleaning base wage.
The homemaker services and
cleaning base wage equals deleted text begin 60 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for personal and home care aide (SOC code 39-9021); 20 percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing
assistants (SOC code 31-1014); and 20deleted text end new text begin 100new text end percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).
Subd. 10.
Homemaker services and home management base wage.
The homemaker
services and home management base wage equals deleted text begin 60deleted text end new text begin 50new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for new text begin home health and new text end personal deleted text begin and homedeleted text end
care deleted text begin aidedeleted text end new text begin aidesnew text end (SOC code deleted text begin 39-9021deleted text end new text begin 31-1120new text end ); deleted text begin 20deleted text end new text begin and 50new text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
deleted text begin 31-1014deleted text end new text begin 31-1131new text end )deleted text begin ; and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012)deleted text end .
Subd. 11.
In-home respite care services base wage.
The in-home respite care services
base wage equals deleted text begin fivedeleted text end new text begin 15new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for registered nurses (SOC code 29-1141); 75 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for deleted text begin nursing assistantsdeleted text end new text begin home health and
personal care aidesnew text end (SOC code deleted text begin 31-1014deleted text end new text begin 31-1120new text end ); and deleted text begin 20deleted text end new text begin tennew text end percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061).
Subd. 12.
Out-of-home respite care services base wage.
The out-of-home respite care
services base wage equals deleted text begin fivedeleted text end new text begin 15new text end percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for registered nurses (SOC code 29-1141); 75 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for deleted text begin nursing assistantsdeleted text end new text begin
home health and personal care aidesnew text end (SOC code deleted text begin 31-1014deleted text end new text begin 31-1120new text end ); and deleted text begin 20deleted text end new text begin tennew text end percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061).
Subd. 13.
Individual community living support base wage.
The individual community
living support base wage equals deleted text begin 20deleted text end new text begin 60new text end percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for deleted text begin licensed practical and licensed vocational nursesdeleted text end new text begin social
and human services aidesnew text end (SOC code deleted text begin 29-2061deleted text end new text begin 21-1093new text end ); and deleted text begin 80deleted text end new text begin 40new text end percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code deleted text begin 31-1014deleted text end new text begin 31-1131new text end ).
Subd. 14.
Registered nurse base wage.
The registered nurse base wage equals 100
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
registered nurses (SOC code 29-1141).
Subd. 15.
deleted text begin Social workerdeleted text end new text begin Unlicensed supervisornew text end base wage.
The deleted text begin social workerdeleted text end new text begin
unlicensed supervisornew text end base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for deleted text begin medical and public health socialdeleted text end new text begin
first-line supervisors of personal servicenew text end workers (SOC code deleted text begin 21-1022deleted text end new text begin 39-1098new text end ).
new text begin Subd. 16. new text end
new text begin Adult day services base wage. new text end
new text begin
The adult day services base wage equals 75
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home
health and personal care aides (SOC code 31-1120); and 25 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1131).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256S.213, is amended to read:
256S.213 RATE SETTING; FACTORSnew text begin AND SUPERVISION WAGE
COMPONENTSnew text end .
Subdivision 1.
Payroll taxes and benefits factor.
The payroll taxes and benefits factor
is the sum of net payroll taxes and benefits, divided by the sum of all salaries for all nursing
facilities on the most recent and available cost report.
Subd. 2.
General and administrative factor.
The general and administrative factor is
deleted text begin the difference of net general and administrative expenses and administrative salaries, divided
by total operating expenses for all nursing facilities on the most recent and available cost
reportdeleted text end new text begin 14.4 percentnew text end .
Subd. 3.
Program plan support factor.
new text begin (a) new text end The program plan support factor is deleted text begin 12.8deleted text end new text begin tennew text end
percentnew text begin for the following servicesnew text end to cover the cost of direct service staff needed to provide
support for deleted text begin home and community-baseddeleted text end new text begin thenew text end service when not engaged in direct contact with
participantsdeleted text begin .deleted text end new text begin :
new text end
new text begin
(1) adult day services;
new text end
new text begin
(2) customized living; and
new text end
new text begin
(3) foster care.
new text end
new text begin
(b) The program plan support factor is 15.5 percent for the following services to cover
the cost of direct service staff needed to provide support for the service when not engaged
in direct contact with participants:
new text end
new text begin
(1) chore services;
new text end
new text begin
(2) companion services;
new text end
new text begin
(3) homemaker services and assistance with personal care;
new text end
new text begin
(4) homemaker services and cleaning;
new text end
new text begin
(5) homemaker services and home management;
new text end
new text begin
(6) in-home respite care;
new text end
new text begin
(7) individual community living support; and
new text end
new text begin
(8) out-of-home respite care.
new text end
Subd. 4.
Registered nurse management and supervision deleted text begin factordeleted text end new text begin wage componentnew text end .
The
registered nurse management and supervision deleted text begin factordeleted text end new text begin wage componentnew text end equals 15 percent of
the registered nurse adjusted base wage as defined in section 256S.214.
Subd. 5.
deleted text begin Social workerdeleted text end new text begin Unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage
componentnew text end .
The deleted text begin social workerdeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end
equals 15 percent of the deleted text begin social workerdeleted text end new text begin unlicensed supervisornew text end adjusted base wage as defined
in section 256S.214.
new text begin Subd. 6. new text end
new text begin Facility and equipment factor. new text end
new text begin
The facility and equipment factor for adult
day services is 16.2 percent.
new text end
new text begin Subd. 7. new text end
new text begin Food, supplies, and transportation factor. new text end
new text begin
The food, supplies, and
transportation factor for adult day services is 24 percent.
new text end
new text begin Subd. 8. new text end
new text begin Supplies and transportation factor. new text end
new text begin
The supplies and transportation factor
for the following services is 1.56 percent:
new text end
new text begin
(1) chore services;
new text end
new text begin
(2) companion services;
new text end
new text begin
(3) homemaker services and assistance with personal care;
new text end
new text begin
(4) homemaker services and cleaning;
new text end
new text begin
(5) homemaker services and home management;
new text end
new text begin
(6) in-home respite care;
new text end
new text begin
(7) individual community living support; and
new text end
new text begin
(8) out-of-home respite care.
new text end
new text begin Subd. 9. new text end
new text begin Absence factor. new text end
new text begin
The absence factor for the following services is 4.5 percent:
new text end
new text begin
(1) adult day services;
new text end
new text begin
(2) chore services;
new text end
new text begin
(3) companion services;
new text end
new text begin
(4) homemaker services and assistance with personal care;
new text end
new text begin
(5) homemaker services and cleaning;
new text end
new text begin
(6) homemaker services and home management;
new text end
new text begin
(7) in-home respite care;
new text end
new text begin
(8) individual community living support; and
new text end
new text begin
(9) out-of-home respite care.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256S.214, is amended to read:
256S.214 RATE SETTING; ADJUSTED BASE WAGE.
For the purposes of section 256S.215, the adjusted base wage for each position equals
the position's base wage under section 256S.212 plus:
(1) the position's base wage multiplied by the payroll taxes and benefits factor under
section 256S.213, subdivision 1;
deleted text begin
(2) the position's base wage multiplied by the general and administrative factor under
section 256S.213, subdivision 2; and
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end the position's base wage multiplied by the new text begin applicable new text end program plan support factor
under section 256S.213, subdivision 3deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) the position's base wage multiplied by the absence factor under section 256S.213,
subdivision 9, if applicable.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256S.215, is amended to read:
256S.215 RATE SETTING; COMPONENT RATES.
Subdivision 1.
Medication setups by licensed nurse component rate.
The component
rate for medication setups by a licensed nurse equals the medication setups by licensed
nurse adjusted base wage.
Subd. 2.
Home management and support services component rate.
The component
rate for home management and support services is new text begin calculated as follows:
new text end
new text begin (1) sum new text end the home management and support services adjusted base wage deleted text begin plusdeleted text end new text begin andnew text end the
registered nurse management and supervision deleted text begin factor.deleted text end new text begin wage component;
new text end
new text begin
(2) multiply the result of clause (1) by the general and administrative factor; and
new text end
new text begin
(3) sum the results of clauses (1) and (2).
new text end
Subd. 3.
Home care aide services component rate.
The component rate for home care
aide services isnew text begin calculated as follows:
new text end
new text begin (1) sumnew text end the home health aide services adjusted base wage deleted text begin plusdeleted text end new text begin andnew text end the registered nurse
management and supervision deleted text begin factor.deleted text end new text begin wage component;
new text end
new text begin
(2) multiply clause (1) by the general and administrative factor; and
new text end
new text begin
(3) sum the results of clauses (1) and (2).
new text end
Subd. 4.
Home health aide services component rate.
The component rate for home
health aide services is new text begin calculated as follows:
new text end
new text begin (1) sum new text end the home health aide services adjusted base wage deleted text begin plusdeleted text end new text begin andnew text end the registered nurse
management and supervision deleted text begin factor.deleted text end new text begin wage component;
new text end
new text begin
(2) multiply the result of clause (1) by the general and administrative factor; and
new text end
new text begin
(3) sum the results of clauses (1) and (2).
new text end
Subd. 5.
Socialization component rate.
The component rate under elderly waiver
customized living for one-to-one socialization equals the home management and support
services component rate.
Subd. 6.
Transportation component rate.
The component rate under elderly waiver
customized living for one-to-one transportation equals the home management and support
services component rate.
Subd. 7.
Chore services rate.
The 15-minute unit rate for chore services is calculated
as follows:
(1) sum the chore services adjusted base wage and the deleted text begin social workerdeleted text end new text begin unlicensed supervisornew text end
supervision deleted text begin factordeleted text end new text begin wage componentnew text end ; deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
Subd. 8.
Companion services rate.
The 15-minute unit rate for companion services is
calculated as follows:
(1) sum the companion services adjusted base wage and the deleted text begin social workerdeleted text end new text begin unlicensed
supervisornew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end ; deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
Subd. 9.
Homemaker services and assistance with personal care rate.
The 15-minute
unit rate for homemaker services and assistance with personal care is calculated as follows:
(1) sum the homemaker services and assistance with personal care adjusted base wage
and the deleted text begin registered nurse management anddeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage
componentnew text end ; deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
Subd. 10.
Homemaker services and cleaning rate.
The 15-minute unit rate for
homemaker services and cleaning is calculated as follows:
(1) sum the homemaker services and cleaning adjusted base wage and the deleted text begin registered
nurse management anddeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin base wagenew text end ; deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
Subd. 11.
Homemaker services and home management rate.
The 15-minute unit rate
for homemaker services and home management is calculated as follows:
(1) sum the homemaker services and home management adjusted base wage and the
deleted text begin registered nurse management anddeleted text end new text begin unlicensed supervisornew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end ;
deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
Subd. 12.
In-home respite care services rates.
(a) The 15-minute unit rate for in-home
respite care services is calculated as follows:
(1) sum the in-home respite care services adjusted base wage and the registered nurse
management and supervision deleted text begin factordeleted text end new text begin wage componentnew text end ; deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
(b) The in-home respite care services daily rate equals the in-home respite care services
15-minute unit rate multiplied by 18.
Subd. 13.
Out-of-home respite care services rates.
(a) The 15-minute unit rate for
out-of-home respite care is calculated as follows:
(1) sum the out-of-home respite care services adjusted base wage and the registered
nurse management and supervision deleted text begin factordeleted text end new text begin wage componentnew text end ; deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
(b) The out-of-home respite care services daily rate equals the 15-minute unit rate for
out-of-home respite care services multiplied by 18.
Subd. 14.
Individual community living support rate.
The individual community living
support rate is calculated as follows:
(1) sum the deleted text begin home care aidedeleted text end new text begin individual community living supportnew text end adjusted base wage
and the deleted text begin social workerdeleted text end new text begin registered nurse management andnew text end supervision deleted text begin factordeleted text end new text begin wage componentnew text end ;
deleted text begin and
deleted text end
(2)new text begin multiply the result of clause (1) by the general and administrative factor;
new text end
new text begin
(3) multiply the result of clause (1) by the supplies and transportation factor; and
new text end
new text begin (4) sum the results of clauses (1) to (3) andnew text end divide the result deleted text begin of clause (1)deleted text end by four.
Subd. 15.
Home-delivered meals rate.
The home-delivered meals rate equals deleted text begin $9.30deleted text end new text begin
$8.17new text end . deleted text begin The commissioner shall increase the home delivered meals rate every July 1 by the
percent increase in the nursing facility dietary per diem using the two most recent and
available nursing facility cost reports.
deleted text end
Subd. 16.
Adult day services rate.
The 15-minute unit rate for adult day servicesdeleted text begin , with
an assumed staffing ratio of one staff person to four participants, is the sum ofdeleted text end new text begin is calculated
as followsnew text end :
(1) deleted text begin one-sixteenth of the home care aidedeleted text end new text begin divide the adult daynew text end services adjusted base wagedeleted text begin ,
except that the general and administrative factor used to determine the home care aide
services adjusted base wage is 20 percentdeleted text end new text begin by five to reflect an assumed staffing ratio of one
to fivenew text end ;
(2) deleted text begin one-fourth of the registered nurse management and supervision factordeleted text end new text begin sum the result
of clause (1) and the registered nurse management and supervision wage componentnew text end ; deleted text begin and
deleted text end
(3) deleted text begin $0.63 to cover the cost of meals.deleted text end new text begin multiply the result of clause (2) by the general and
administrative factor;
new text end
new text begin
(4) multiply the result of clause (2) by the facility and equipment factor;
new text end
new text begin
(5) multiply the result of clause (2) by the food, supplies, and transportation factor; and
new text end
new text begin
(6) sum the results of clauses (2) to (5) and divide the result by four.
new text end
Subd. 17.
Adult day services bath rate.
The 15-minute unit rate for adult day services
bath is deleted text begin the sum ofdeleted text end new text begin calculated as followsnew text end :
(1) deleted text begin one-fourth of the home care aidedeleted text end new text begin sum the adult daynew text end services adjusted base wagedeleted text begin ,
except that the general and administrative factor used to determine the home care aide
services adjusted base wage is 20 percentdeleted text end new text begin and the nurse management and supervision wage
componentnew text end ;
(2) deleted text begin one-fourth of the registered nurse management and supervision factordeleted text end new text begin multiply the
result of clause (1) by the general and administrative factornew text end ; deleted text begin and
deleted text end
(3) deleted text begin $0.63 to cover the cost of meals.deleted text end new text begin multiply the result of clause (1) by the facility and
equipment factor;
new text end
new text begin
(4) multiply the result of clause (1) by the food, supplies, and transportation factor; and
new text end
new text begin
(5) sum the results of clauses (1) to (4) and divide the result by four.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24. new text begin DIRECTION TO COMMISSIONER; INITIAL PACE IMPLEMENTATION
FUNDING.
new text end
new text begin
The commissioner of human services must work with stakeholders to develop
recommendations for financing mechanisms to complete the actuarial work and cover the
administrative costs of a program of all-inclusive care for the elderly (PACE). The
commissioner must recommend a financing mechanism that could begin July 1, 2024. By
December 15, 2023, the commissioner shall inform the chairs and ranking minority members
of the legislative committees with jurisdiction over health care funding on the commissioner's
progress toward developing a recommended financing mechanism.
new text end
Sec. 25. new text begin TITLE.
new text end
new text begin
Sections 181.212 to 181.217 shall be known as the "Minnesota Nursing Home Workforce
Standards Board Act."
new text end
Sec. 26. new text begin INITIAL APPOINTMENTS.
new text end
new text begin
The governor shall make initial appointments to the Minnesota Nursing Home Workforce
Standards Board under Minnesota Statutes, section 181.212, no later than August 1, 2022.
new text end
Sec. 27. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) In Minnesota Statutes, chapter 256S, the revisor of statutes shall change the following
terms:
new text end
new text begin
(1) "homemaker services and assistance with personal care" to "homemaker assistance
with personal care services";
new text end
new text begin
(2) "homemaker services and cleaning" to "homemaker cleaning services"; and
new text end
new text begin
(3) "homemaker services and home management" to "homemaker home management
services" wherever the terms appear.
new text end
new text begin
(b) The revisor shall also make necessary grammatical changes related to the changes
in terms.
new text end
Sec. 28. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 256S.19, subdivision 4,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
ARTICLE 13
CHILD AND VULNERABLE ADULT PROTECTION POLICY
Section 1.
Minnesota Statutes 2020, section 260.012, is amended to read:
260.012 DUTY TO ENSURE PLACEMENT PREVENTION AND FAMILY
REUNIFICATION; REASONABLE EFFORTS.
(a) Once a child alleged to be in need of protection or services is under the court's
jurisdiction, the court shall ensure that reasonable efforts, including culturally appropriate
servicesnew text begin and practicesnew text end , by the social services agency are made to prevent placement or to
eliminate the need for removal and to reunite the child with the child's family at the earliest
possible time, and the court must ensure that the responsible social services agency makes
reasonable efforts to finalize an alternative permanent plan for the child as provided in
paragraph (e). In determining reasonable efforts to be made with respect to a child and in
making those reasonable efforts, the child's best interests, health, and safety must be of
paramount concern. Reasonable efforts to prevent placement and for rehabilitation and
reunification are always required except upon a determination by the court that a petition
has been filed stating a prima facie case that:
(1) the parent has subjected a child to egregious harm as defined in section 260C.007,
subdivision 14;
(2) the parental rights of the parent to another child have been terminated involuntarily;
(3) the child is an abandoned infant under section 260C.301, subdivision 2, paragraph
(a), clause (2);
(4) the parent's custodial rights to another child have been involuntarily transferred to a
relative under Minnesota Statutes 2010, section 260C.201, subdivision 11, paragraph (d),
clause (1), section 260C.515, subdivision 4, or a similar law of another jurisdiction;
(5) the parent has committed sexual abuse as defined in section 260E.03, against the
child or another child of the parent;
(6) the parent has committed an offense that requires registration as a predatory offender
under section 243.166, subdivision 1b, paragraph (a) or (b); or
(7) the provision of services or further services for the purpose of reunification is futile
and therefore unreasonable under the circumstances.
(b) When the court makes one of the prima facie determinations under paragraph (a),
either permanency pleadings under section 260C.505, or a termination of parental rights
petition under sections 260C.141 and 260C.301 must be filed. A permanency hearing under
sections 260C.503 to 260C.521 must be held within 30 days of this determination.
(c) In the case of an Indian child, in proceedings under sections 260B.178, 260C.178,
260C.201, 260C.202, 260C.204, 260C.301, or 260C.503 to 260C.521, the juvenile court
must make findings and conclusions consistent with the Indian Child Welfare Act of 1978,
United States Code, title 25, section 1901 et seq., as to the provision of active efforts. In
cases governed by the Indian Child Welfare Act of 1978, United States Code, title 25, section
1901, the responsible social services agency must provide active efforts as required under
United States Code, title 25, section 1911(d).
(d) "Reasonable efforts to prevent placement" means:
(1) the agency has made reasonable efforts to prevent the placement of the child in foster
care by working with the family to develop and implement a safety plannew text begin that is individualized
to the needs of the child and the child's family and may include support persons from the
child's extended family, kin network, and communitynew text end ; or
(2) new text begin the agency has demonstrated to the court that, new text end given the particular circumstances of
the child and family at the time of the child's removal, there are no services or efforts
available deleted text begin whichdeleted text end new text begin thatnew text end could allow the child to safely remain in the home.
(e) "Reasonable efforts to finalize a permanent plan for the child" means due diligence
by the responsible social services agency to:
(1) reunify the child with the parent or guardian from whom the child was removed;
(2) assess a noncustodial parent's ability to provide day-to-day care for the child and,
where appropriate, provide services necessary to enable the noncustodial parent to safely
provide the care, as required by section 260C.219;
(3) conduct a relative search to identify and provide notice to adult relativesnew text begin , and engage
relatives in case planning and permanency planning,new text end as required under section 260C.221;
new text begin
(4) consider placing the child with relatives in the order specified in section 260C.212,
subdivision 2, paragraph (a);
new text end
deleted text begin (4)deleted text end new text begin (5)new text end place siblings removed from their home in the same home for foster care or
adoption, or transfer permanent legal and physical custody to a relative. Visitation between
siblings who are not in the same foster care, adoption, or custodial placement or facility
shall be consistent with section 260C.212, subdivision 2; and
deleted text begin (5)deleted text end new text begin (6)new text end when the child cannot return to the parent or guardian from whom the child was
removed, to plan for and finalize a safe and legally permanent alternative home for the child,
and considers permanent alternative homes for the child inside or outside of the state,
preferably new text begin with a relative in the order specified in section 260C.212, subdivision 2, paragraph
(a), new text end through adoption or transfer of permanent legal and physical custody of the child.
(f) Reasonable efforts are made upon the exercise of due diligence by the responsible
social services agency to use culturally appropriate and available services to meet the
new text begin individualized new text end needs of the child and the child's family. Services may include those provided
by the responsible social services agency and other culturally appropriate services available
in the community. new text begin The responsible social services agency must select services for a child
and the child's family by collaborating with the child's family and, if appropriate, the child.
new text end At each stage of the proceedings deleted text begin wheredeleted text end new text begin whennew text end the court is required to review the
appropriateness of the responsible social services agency's reasonable efforts as described
in paragraphs (a), (d), and (e), the social services agency has the burden of demonstrating
that:
(1) deleted text begin itdeleted text end new text begin the agency new text end has made reasonable efforts to prevent placement of the child in foster
carenew text begin , including that the agency considered or established a safety plan according to paragraph
(d), clause (1)new text end ;
(2) deleted text begin itdeleted text end new text begin the agencynew text end has made reasonable efforts to eliminate the need for removal of the
child from the child's home and to reunify the child with the child's family at the earliest
possible time;
new text begin
(3) the agency has made reasonable efforts to finalize a permanent plan for the child
pursuant to paragraph (e);
new text end
deleted text begin (3) itdeleted text end new text begin (4) the agency new text end has made reasonable efforts to finalize an alternative permanent
home for the child, and deleted text begin considersdeleted text end new text begin considerednew text end permanent alternative homes for the child
deleted text begin inside or outsidedeleted text end new text begin in or outnew text end of the statenew text begin , preferably with a relative in the order specified in
section 260C.212, subdivision 2, paragraph (a)new text end ; or
deleted text begin (4)deleted text end new text begin (5)new text end reasonable efforts to prevent placement and to reunify the child with the parent
or guardian are not required. The agency may meet this burden by stating facts in a sworn
petition filed under section 260C.141, by filing an affidavit summarizing the agency's
reasonable efforts or factsnew text begin thatnew text end the agency believes demonstrate new text begin that new text end there is no need for
reasonable efforts to reunify the parent and child, or through testimony or a certified report
required under juvenile court rules.
(g) Once the court determines that reasonable efforts for reunification are not required
because the court has made one of the prima facie determinations under paragraph (a), the
court may only require new text begin the agency to make new text end reasonable efforts for reunification after a hearing
according to section 260C.163, deleted text begin wheredeleted text end new text begin ifnew text end the court findsnew text begin thatnew text end there is not clear and convincing
evidence of the facts upon which the court based deleted text begin itsdeleted text end new text begin the court'snew text end prima facie determination.
deleted text begin In this case whendeleted text end new text begin Ifnew text end there is clear and convincing evidence that the child is in need of
protection or services, the court may find the child in need of protection or services and
order any of the dispositions available under section 260C.201, subdivision 1. Reunification
of a child with a parent is not required if the parent has been convicted of:
(1) a violation of, or an attempt or conspiracy to commit a violation of, sections 609.185
to 609.20; 609.222, subdivision 2; or 609.223 in regard to another child of the parent;
(2) a violation of section 609.222, subdivision 2; or 609.223, in regard to the child;
(3) a violation of, or an attempt or conspiracy to commit a violation of, United States
Code, title 18, section 1111(a) or 1112(a), in regard to another child of the parent;
(4) committing sexual abuse as defined in section 260E.03, against the child or another
child of the parent; or
(5) an offense that requires registration as a predatory offender under section 243.166,
subdivision 1b, paragraph (a) or (b).
(h) The juvenile court, in proceedings under sections 260B.178, 260C.178, 260C.201,
260C.202, 260C.204, 260C.301, or 260C.503 to 260C.521, shall make findings and
conclusions as to the provision of reasonable efforts. When determining whether reasonable
efforts have been madenew text begin by the agencynew text end , the court shall consider whether services to the child
and family were:
new text begin
(1) selected in collaboration with the child's family and, if appropriate, the child;
new text end
new text begin
(2) tailored to the individualized needs of the child and child's family;
new text end
deleted text begin (1)deleted text end new text begin (3)new text end relevant to the safety deleted text begin anddeleted text end new text begin ,new text end protectionnew text begin , and well-beingnew text end of the child;
deleted text begin (2)deleted text end new text begin (4)new text end adequate to meet the new text begin individualized new text end needs of the child and family;
deleted text begin (3)deleted text end new text begin (5)new text end culturally appropriate;
deleted text begin (4)deleted text end new text begin (6)new text end available and accessible;
deleted text begin (5)deleted text end new text begin (7)new text end consistent and timely; and
deleted text begin (6)deleted text end new text begin (8)new text end realistic under the circumstances.
In the alternative, the court may determine that new text begin the new text end provision of services or further services
for the purpose of rehabilitation is futile and therefore unreasonable under the circumstances
or that reasonable efforts are not required as provided in paragraph (a).
(i) This section does not prevent out-of-home placement for new text begin the new text end treatment of a child with
a mental disability when it is determined to be medically necessary as a result of the child's
diagnostic assessment or new text begin the child's new text end individual treatment plan indicates that appropriate and
necessary treatment cannot be effectively provided outside of a residential or inpatient
treatment program and the level or intensity of supervision and treatment cannot be
effectively and safely provided in the child's home or community and it is determined that
a residential treatment setting is the least restrictive setting that is appropriate to the needs
of the child.
(j) If continuation of reasonable efforts to prevent placement or reunify the child with
the parent or guardian from whom the child was removed is determined by the court to be
inconsistent with the permanent plan for the child or upon the court making one of the prima
facie determinations under paragraph (a), reasonable efforts must be made to place the child
in a timely manner in a safe and permanent home and to complete whatever steps are
necessary to legally finalize the permanent placement of the child.
(k) Reasonable efforts to place a child for adoption or in another permanent placement
may be made concurrently with reasonable efforts to prevent placement or to reunify the
child with the parent or guardian from whom the child was removed. When the responsible
social services agency decides to concurrently make reasonable efforts for both reunification
and permanent placement away from the parent under paragraph (a), the agency shall disclose
deleted text begin itsdeleted text end new text begin the agency'snew text end decision and both plans for concurrent reasonable efforts to all parties and
the court. When the agency discloses deleted text begin itsdeleted text end new text begin the agency'snew text end decision to proceed deleted text begin ondeleted text end new text begin withnew text end both plans
for reunification and permanent placement away from the parent, the court's review of the
agency's reasonable efforts shall include the agency's efforts under both plans.
Sec. 2.
Minnesota Statutes 2020, section 260C.001, subdivision 3, is amended to read:
Subd. 3.
Permanency, termination of parental rights, and adoption.
The purpose of
the laws relating to permanency, termination of parental rights, and children who come
under the guardianship of the commissioner of human services is to ensure that:
(1) when required and appropriate, reasonable efforts have been made by the social
services agency to reunite the child with the child's parents in a home that is safe and
permanent;
(2) if placement with the parents is not reasonably foreseeable, to secure for the child a
safe and permanent placement according to the requirements of section 260C.212, subdivision
2, preferably deleted text begin with adoptive parentsdeleted text end new text begin with a relative through an adoption or a transfer of
permanent legal and physical custodynew text end or, if that is not possible or in the best interests of the
child, deleted text begin a fit and willing relative through transfer of permanent legal and physical custody to
that relativedeleted text end new text begin with a nonrelative caregiver through adoptionnew text end ; and
(3) when a child is under the guardianship of the commissioner of human services,
reasonable efforts are made to finalize an adoptive home for the child in a timely manner.
Nothing in this section requires reasonable efforts to prevent placement or to reunify
the child with the parent or guardian to be made in circumstances where the court has
determined that the child has been subjected to egregious harm, when the child is an
abandoned infant, the parent has involuntarily lost custody of another child through a
proceeding under section 260C.515, subdivision 4, or similar law of another state, the
parental rights of the parent to a sibling have been involuntarily terminated, or the court has
determined that reasonable efforts or further reasonable efforts to reunify the child with the
parent or guardian would be futile.
The paramount consideration in all proceedings for permanent placement of the child
under sections 260C.503 to 260C.521, or the termination of parental rights is the best interests
of the child. In proceedings involving an American Indian child, as defined in section
260.755, subdivision 8, the best interests of the child must be determined consistent with
the Indian Child Welfare Act of 1978, United States Code, title 25, section 1901, et seq.
Sec. 3.
Minnesota Statutes 2020, section 260C.007, subdivision 27, is amended to read:
Subd. 27.
Relative.
"Relative" means a person related to the child by blood, marriage,
or adoption; the legal parent, guardian, or custodian of the child's siblings; or an individual
who is an important friend new text begin of the child or of the child's parent or custodian, including an
individual new text end with whom the child has resided or had significant contactnew text begin or who has a significant
relationship to the child or the child's parent or custodiannew text end .
Sec. 4.
Minnesota Statutes 2020, section 260C.151, subdivision 6, is amended to read:
Subd. 6.
Immediate custody.
If the court makes individualized, explicit findings, based
on the notarized petition or sworn affidavit, that there are reasonable grounds to believe
new text begin that new text end the child is in surroundings or conditions deleted text begin whichdeleted text end new text begin thatnew text end endanger the child's health, safety,
or welfare that require that responsibility for the child's care and custody be immediately
assumed by the responsible social services agency and that continuation of the child in the
custody of the parent or guardian is contrary to the child's welfare, the court may order that
the officer serving the summons take the child into immediate custody for placement of the
child in foster carenew text begin , preferably with a relativenew text end . In ordering that responsibility for the care,
custody, and control of the child be assumed by the responsible social services agency, the
court is ordering emergency protective care as that term is defined in the juvenile court
rules.
Sec. 5.
Minnesota Statutes 2020, section 260C.152, subdivision 5, is amended to read:
Subd. 5.
Notice to foster parents and preadoptive parents and relatives.
The foster
parents, if any, of a child and any preadoptive parent or relative providing care for the child
must be provided notice of and a right to be heard in any review or hearing to be held with
respect to the child. Any other relative may also request, and must be granted, a notice and
the deleted text begin opportunitydeleted text end new text begin rightnew text end to be heard under this section. This subdivision does not require that
a foster parent, preadoptive parent, or new text begin anynew text end relative providing care for the child be made a
party to a review or hearing solely on the basis of the notice and right to be heard.
Sec. 6.
Minnesota Statutes 2020, section 260C.175, subdivision 2, is amended to read:
Subd. 2.
Notice to parent or custodiannew text begin and child; emergency placement with
relativenew text end .
deleted text begin Wheneverdeleted text end new text begin (a) At the time thatnew text end a peace officer takes a child into custody fornew text begin relative
placement ornew text end shelter care deleted text begin or relative placementdeleted text end pursuant to subdivision 1, section 260C.151,
subdivision 5, or section 260C.154, the officer shall notify the new text begin child's new text end parent or custodiannew text begin
and the child, if the child is ten years of age or older,new text end that under section 260C.181, subdivision
2, the parent or custodiannew text begin or the childnew text end may request deleted text begin thatdeleted text end new text begin to placenew text end the child deleted text begin be placeddeleted text end with a
relative deleted text begin or a designated caregiver underdeleted text end new text begin as defined in section 260C.007, subdivision 27,new text end
deleted text begin chapter 257Adeleted text end instead of in a shelter care facility.new text begin When a child who is not alleged to be
delinquent is taken into custody pursuant to subdivision 1, clause (1) or (2), item (ii), and
placement with an identified relative is requested, the peace officer shall coordinate with
the responsible social services agency to ensure the child's safety and well-being, and comply
with section 260C.181, subdivision 2.
new text end
new text begin (c) new text end The officer also shall give the parent or custodian of the child a list of names,
addresses, and telephone numbers of social services agencies that offer child welfare services.
If the parent or custodian was not present when the child was removed from the residence,
the list shall be left with an adult on the premises or left in a conspicuous place on the
premises if no adult is present. If the officer has reason to believe the parent or custodian
is not able to read and understand English, the officer must provide a list that is written in
the language of the parent or custodian. The list shall be prepared by the commissioner of
human services. The commissioner shall prepare lists for each county and provide each
county with copies of the list without charge. The list shall be reviewed annually by the
commissioner and updated if it is no longer accurate. Neither the commissioner nor any
peace officer or the officer's employer shall be liable to any person for mistakes or omissions
in the list. The list does not constitute a promise that any agency listed will deleted text begin in factdeleted text end assist the
parent or custodian.
Sec. 7.
Minnesota Statutes 2020, section 260C.176, subdivision 2, is amended to read:
Subd. 2.
Reasons for detention.
(a) If the child is not released as provided in subdivision
1, the person taking the child into custody shall notify the court as soon as possible of the
detention of the child and the reasons for detention.
(b) No child taken into custody and placed in anew text begin relative's home ornew text end shelter care facility
deleted text begin or relative's homedeleted text end by a peace officer pursuant to section 260C.175, subdivision 1, clause
(1) or (2), item (ii), may be held in custody longer than 72 hours, excluding Saturdays,
Sundays and holidays, unless a petition has been filed and the judge or referee determines
pursuant to section 260C.178 that the child shall remain in custody or unless the court has
made a finding of domestic abuse perpetrated by a minor after a hearing under Laws 1997,
chapter 239, article 10, sections 2 to 26, in which case the court may extend the period of
detention for an additional seven days, within which time the social services agency shall
conduct an assessment and shall provide recommendations to the court regarding voluntary
services or file a child in need of protection or services petition.
Sec. 8.
Minnesota Statutes 2020, section 260C.178, subdivision 1, is amended to read:
Subdivision 1.
Hearing and release requirements.
(a) If a child was taken into custody
under section 260C.175, subdivision 1, clause (1) or (2), item (ii), the court shall hold a
hearing within 72 hours of the timenew text begin thatnew text end the child was taken into custody, excluding
Saturdays, Sundays, and holidays, to determine whether the child should continuenew text begin to benew text end in
custody.
(b) Unless there is reason to believe that the child would endanger self or others or not
return for a court hearing, or that the child's health or welfare would be immediately
endangered, the child shall be released to the custody of a parent, guardian, custodian, or
other suitable person, subject to reasonable conditions of release including, but not limited
to, a requirement that the child undergo a chemical use assessment as provided in section
260C.157, subdivision 1.
(c) If the court determines new text begin that new text end there is reason to believe that the child would endanger
self or others or not return for a court hearing, or that the child's health or welfare would be
immediately endangered if returned to the care of the parent or guardian who has custody
and from whom the child was removed, the court shall order the childnew text begin :
new text end
new text begin
(1) into the care of the child's noncustodial parent and order the noncustodial parent to
comply with any conditions that the court determines appropriate to ensure the safety and
care of the child, including requiring the noncustodial parent to cooperate with paternity
establishment proceedings if the noncustodial parent has not been adjudicated the child's
father; or
new text end
new text begin (2)new text end into foster care as defined in section 260C.007, subdivision 18, under the legal
responsibility of the responsible social services agency or responsible probation or corrections
agency for the purposes of protective care as that term is used in the juvenile court rules deleted text begin or
into the home of a noncustodial parent and order the noncustodial parent to comply with
any conditions the court determines to be appropriate to the safety and care of the child,
including cooperating with paternity establishment proceedings in the case of a man who
has not been adjudicated the child's fatherdeleted text end . The court shall not give the responsible social
services legal custody and order a trial home visit at any time prior to adjudication and
disposition under section 260C.201, subdivision 1, paragraph (a), clause (3), but may order
the child returned to the care of the parent or guardian who has custody and from whom the
child was removed and order the parent or guardian to comply with any conditions the court
determines to be appropriate to meet the safety, health, and welfare of the child.
(d) In determining whether the child's health or welfare would be immediately
endangered, the court shall consider whether the child would reside with a perpetrator of
domestic child abuse.
(e) The court, before determining whether a child should be placed in or continue in
foster care under the protective care of the responsible agency, shall also make a
determination, consistent with section 260.012 as to whether reasonable efforts were made
to prevent placement or whether reasonable efforts to prevent placement are not required.
In the case of an Indian child, the court shall determine whether active efforts, according
to section 260.762 and the Indian Child Welfare Act of 1978, United States Code, title 25,
section 1912(d), were made to prevent placement. The court shall enter a finding that the
responsible social services agency has made reasonable efforts to prevent placement when
the agency establishes either:
(1) that deleted text begin itdeleted text end new text begin the agency new text end has actually provided services or made efforts in an attempt to
prevent the child's removal but that such services or efforts have not proven sufficient to
permit the child to safely remain in the home; or
(2) that there are no services or other efforts that could be made at the time of the hearing
that could safely permit the child to remain home or to return home. new text begin The court shall not
make a reasonable efforts determination under this clause unless the court is satisfied that
the agency has sufficiently demonstrated to the court that there were no services or other
efforts that the agency was able to provide at the time of the hearing enabling the child to
safely remain home or to safely return home. new text end When reasonable efforts to prevent placement
are required and there are services or other efforts that could be ordered deleted text begin whichdeleted text end new text begin thatnew text end would
permit the child to safely return home, the court shall order the child returned to the care of
the parent or guardian and the services or efforts put in place to ensure the child's safety.
When the court makes a prima facie determination that one of the circumstances under
paragraph (g) exists, the court shall determine that reasonable efforts to prevent placement
and to return the child to the care of the parent or guardian are not required.
new text begin (f) new text end If the court finds the social services agency's preventive or reunification efforts have
not been reasonable but further preventive or reunification efforts could not permit the child
to safely remain at home, the court may nevertheless authorize or continue the removal of
the child.
deleted text begin (f)deleted text end new text begin (g)new text end The court may not order or continue the foster care placement of the child unless
the court makes explicit, individualized findings that continued custody of the child by the
parent or guardian would be contrary to the welfare of the child and that placement is in the
best interest of the child.
deleted text begin (g)deleted text end new text begin (h)new text end At the emergency removal hearing, or at any time during the course of the
proceeding, and upon notice and request of the county attorney, the court shall determine
whether a petition has been filed stating a prima facie case that:
(1) the parent has subjected a child to egregious harm as defined in section 260C.007,
subdivision 14;
(2) the parental rights of the parent to another child have been involuntarily terminated;
(3) the child is an abandoned infant under section 260C.301, subdivision 2, paragraph
(a), clause (2);
(4) the parents' custodial rights to another child have been involuntarily transferred to a
relative under Minnesota Statutes 2010, section 260C.201, subdivision 11, paragraph (e),
clause (1); section 260C.515, subdivision 4; or a similar law of another jurisdiction;
(5) the parent has committed sexual abuse as defined in section 260E.03, against the
child or another child of the parent;
(6) the parent has committed an offense that requires registration as a predatory offender
under section 243.166, subdivision 1b, paragraph (a) or (b); or
(7) the provision of services or further services for the purpose of reunification is futile
and therefore unreasonable.
deleted text begin (h)deleted text end new text begin (i)new text end When a petition to terminate parental rights is required under section 260C.301,
subdivision 4, or 260C.503, subdivision 2, but the county attorney has determined not to
proceed with a termination of parental rights petition, and has instead filed a petition to
transfer permanent legal and physical custody to a relative under section 260C.507, the
court shall schedule a permanency hearing within 30 days of the filing of the petition.
deleted text begin (i)deleted text end new text begin (j)new text end If the county attorney has filed a petition under section 260C.307, the court shall
schedule a trial under section 260C.163 within 90 days of the filing of the petition except
when the county attorney determines that the criminal case shall proceed to trial first under
section 260C.503, subdivision 2, paragraph (c).
deleted text begin (j)deleted text end new text begin (k)new text end If the court determines the child should be ordered into foster care and the child's
parent refuses to give information to the responsible social services agency regarding the
child's father or relatives of the child, the court may order the parent to disclose the names,
addresses, telephone numbers, and other identifying information to the responsible social
services agency for the purpose of complying with sectionsnew text begin 260C.150,new text end 260C.151, 260C.212,
260C.215, new text begin 260C.219, new text end and 260C.221.
deleted text begin (k)deleted text end new text begin (l)new text end If a child ordered into foster care has siblings, whether full, half, or step, who are
also ordered into foster care, the court shall inquire of the responsible social services agency
of the efforts to place the children together as required by section 260C.212, subdivision 2,
paragraph (d), if placement together is in each child's best interests, unless a child is in
placement for treatment or a child is placed with a previously noncustodial parent who is
not a parent to all siblings. If the children are not placed together at the time of the hearing,
the court shall inquire at each subsequent hearing of the agency's reasonable efforts to place
the siblings together, as required under section 260.012. If any sibling is not placed with
another sibling or siblings, the agency must develop a plan to facilitate visitation or ongoing
contact among the siblings as required under section 260C.212, subdivision 1, unless it is
contrary to the safety or well-being of any of the siblings to do so.
deleted text begin (l)deleted text end new text begin (m)new text end When the court has ordered the child into new text begin the care of a noncustodial parent or in
new text end foster care deleted text begin or into the home of a noncustodial parentdeleted text end , the court may order a chemical
dependency evaluation, mental health evaluation, medical examination, and parenting
assessment for the parent as necessary to support the development of a plan for reunification
required under subdivision 7 and section 260C.212, subdivision 1, or the child protective
services plan under section 260E.26, and Minnesota Rules, part 9560.0228.
Sec. 9.
Minnesota Statutes 2020, section 260C.181, subdivision 2, is amended to read:
Subd. 2.
Least restrictive setting.
Notwithstanding the provisions of subdivision 1, if
the child had been taken into custody pursuant to section 260C.175, subdivision 1, clause
(1) or (2), item (ii), and is not alleged to be delinquent, the child shall be detained in the
least restrictive setting consistent with the child's health and welfare and in closest proximity
to the child's family as possible. Placement may be with a child's relativedeleted text begin , a designateddeleted text end
deleted text begin caregiver under chapter 257A,deleted text end ornew text begin ,new text end new text begin if no placement is available with a relative,new text end in a shelter
care facility. The placing officer shall comply with this section and shall document why a
less restrictive setting will or will not be in the best interests of the child for placement
purposes.
Sec. 10.
Minnesota Statutes 2020, section 260C.193, subdivision 3, is amended to read:
Subd. 3.
Best interests of the child.
(a) The policy of the state is to ensure that the best
interests of children in foster care, who experience new text begin a new text end transfer of permanent legal and physical
custody to a relative under section 260C.515, subdivision 4, or adoption under this chapter,
are met bynew text begin :
new text end
new text begin
(1) considering placement of a child with relatives in the order specified in section
260C.212, subdivision 2, paragraph (a); and
new text end
new text begin (2)new text end requiring individualized determinations under section 260C.212, subdivision 2,
paragraph (b), of the needs of the child and of how the selected home will serve the needs
of the child.
(b) No later than three months after a child is ordered new text begin to be new text end removed from the care of a
parent in the hearing required under section 260C.202, the court shall review and enter
findings regarding whether the responsible social services agency deleted text begin madedeleted text end :
(1) deleted text begin diligent effortsdeleted text end new text begin exercised due diligencenew text end to identify deleted text begin anddeleted text end new text begin ,new text end search fornew text begin , notify, and engagenew text end
relatives as required under section 260C.221; and
(2) new text begin made a placement consistent with section 260C.212, subdivision 2, that is based on
new text end an individualized determination deleted text begin as required under section 260C.212, subdivision 2,deleted text end new text begin of the
child's needs new text end to select a home that meets the needs of the child.
(c) If the court finds new text begin that new text end the agency has not deleted text begin made effortsdeleted text end new text begin exercised due diligencenew text end as
required under section 260C.221, deleted text begin anddeleted text end new text begin the court shall order the agency to make reasonable
efforts. If new text end there is a relative who qualifies to be licensed to provide family foster care under
chapter 245A, the court may order the child new text begin to be new text end placed with the relative consistent with
the child's best interests.
(d) If the agency's efforts under section 260C.221 are found new text begin by the court new text end to be sufficient,
the court shall order the agency to continue to appropriately engage relatives who responded
to the notice under section 260C.221 in placement and case planning decisions and to
appropriately engage relatives who subsequently come to the agency's attention.new text begin A court's
finding that the agency has made reasonable efforts under this paragraph does not relieve
the agency of the duty to continue notifying relatives who come to the agency's attention
and engaging and considering relatives who respond to the notice under section 260C.221
in child placement and case planning decisions.
new text end
(e) If the child's birth parent deleted text begin or parentsdeleted text end explicitly deleted text begin requestdeleted text end new text begin requestsnew text end that a new text begin specific new text end relative
deleted text begin or important frienddeleted text end not be considerednew text begin for placement of the childnew text end , the court shall honor that
request if it is consistent with the best interests of the child and consistent with the
requirements of section 260C.221.new text begin The court shall not waive relative search, notice, and
consideration requirements, unless section 260C.139 applies.new text end If the child's birth parent deleted text begin or
parents expressdeleted text end new text begin expressesnew text end a preference for placing the child in a foster or adoptive home of
the same or a similar religious background deleted text begin todeleted text end new text begin asnew text end that of the birth parent or parents, the court
shall order placement of the child with an individual who meets the birth parent's religious
preference.
(f) Placement of a child deleted text begin cannotdeleted text end new text begin must notnew text end be delayed or denied based on race, color, or
national origin of the foster parent or the child.
(g) Whenever possible, siblings requiring foster care placement deleted text begin shoulddeleted text end new text begin shallnew text end be placed
together unless it is determined not to be in the best interests ofnew text begin one or more of thenew text end siblings
after weighing the benefits of separate placement against the benefits of sibling connections
for each sibling. new text begin The agency shall consider section 260C.008 when making this determination.
new text end If siblings were not placed together according to section 260C.212, subdivision 2, paragraph
(d), the responsible social services agency shall report to the court the efforts made to place
the siblings together and why the efforts were not successful. If the court is not satisfied
that the agency has made reasonable efforts to place siblings together, the court must order
the agency to make further reasonable efforts. If siblings are not placed together, the court
shall order the responsible social services agency to implement the plan for visitation among
siblings required as part of the out-of-home placement plan under section 260C.212.
(h) This subdivision does not affect the Indian Child Welfare Act, United States Code,
title 25, sections 1901 to 1923, and the Minnesota Indian Family Preservation Act, sections
260.751 to 260.835.
Sec. 11.
Minnesota Statutes 2020, section 260C.201, subdivision 1, is amended to read:
Subdivision 1.
Dispositions.
(a) If the court finds that the child is in need of protection
or services or neglected and in foster care, deleted text begin itdeleted text end new text begin the courtnew text end shall enter an order making any of
the following dispositions of the case:
(1) place the child under the protective supervision of the responsible social services
agency or child-placing agency in the home of a parent of the child under conditions
prescribed by the court directed to the correction of the child's need for protection or services:
(i) the court may order the child into the home of a parent who does not otherwise have
legal custody of the child, however, an order under this section does not confer legal custody
on that parent;
(ii) if the court orders the child into the home of a father who is not adjudicated, the
father must cooperate with paternity establishment proceedings regarding the child in the
appropriate jurisdiction as one of the conditions prescribed by the court for the child to
continue in the father's home; and
(iii) the court may order the child into the home of a noncustodial parent with conditions
and may also order both the noncustodial and the custodial parent to comply with the
requirements of a case plan under subdivision 2; or
(2) transfer legal custody to one of the following:
(i) a child-placing agency; or
(ii) the responsible social services agency. In making a foster care placement deleted text begin fordeleted text end new text begin ofnew text end a
child whose custody has been transferred under this subdivision, the agency shall make an
individualized determination of how the placement is in the child's best interests using thenew text begin
placementnew text end considerationnew text begin ordernew text end for relativesdeleted text begin ,deleted text end new text begin andnew text end the best interest factors in section 260C.212,
subdivision 2deleted text begin , paragraph (b)deleted text end , and may include a child colocated with a parent in a licensed
residential family-based substance use disorder treatment program under section 260C.190;
or
(3) order a trial home visit without modifying the transfer of legal custody to the
responsible social services agency under clause (2). Trial home visit means the child is
returned to the care of the parent or guardian from whom the child was removed for a period
not to exceed six months. During the period of the trial home visit, the responsible social
services agency:
(i) shall continue to have legal custody of the child, which means new text begin that new text end the agency may
see the child in the parent's home, at school, in a child care facility, or other setting as the
agency deems necessary and appropriate;
(ii) shall continue to have the ability to access information under section 260C.208;
(iii) shall continue to provide appropriate services to both the parent and the child during
the period of the trial home visit;
(iv) without previous court order or authorization, may terminate the trial home visit in
order to protect the child's health, safety, or welfare and may remove the child to foster care;
(v) shall advise the court and parties within three days of the termination of the trial
home visit when a visit is terminated by the responsible social services agency without a
court order; and
(vi) shall prepare a report for the court when the trial home visit is terminated whether
by the agency or court order deleted text begin whichdeleted text end new text begin thatnew text end describes the child's circumstances during the trial
home visit and recommends appropriate orders, if any, for the court to enter to provide for
the child's safety and stability. In the event a trial home visit is terminated by the agency
by removing the child to foster care without prior court order or authorization, the court
shall conduct a hearing within ten days of receiving notice of the termination of the trial
home visit by the agency and shall order disposition under this subdivision or commence
permanency proceedings under sections 260C.503 to 260C.515. The time period for the
hearing may be extended by the court for good cause shown and if it is in the best interests
of the child as long as the total time the child spends in foster care without a permanency
hearing does not exceed 12 months;
(4) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a physical or mental
disability or emotional disturbance as defined in section 245.4871, subdivision 15, the court
may order the child's parent, guardian, or custodian to provide it. The court may order the
child's health plan company to provide mental health services to the child. Section 62Q.535
applies to an order for mental health services directed to the child's health plan company.
If the health plan, parent, guardian, or custodian fails or is unable to provide this treatment
or care, the court may order it provided. Absent specific written findings by the court that
the child's disability is the result of abuse or neglect by the child's parent or guardian, the
court shall not transfer legal custody of the child for the purpose of obtaining special
treatment or care solely because the parent is unable to provide the treatment or care. If the
court's order for mental health treatment is based on a diagnosis made by a treatment
professional, the court may order that the diagnosing professional not provide the treatment
to the child if it finds that such an order is in the child's best interests; or
(5) if the court believes that the child has sufficient maturity and judgment and that it is
in the best interests of the child, the court may order a child 16 years old or older to be
allowed to live independently, either alone or with others as approved by the court under
supervision the court considers appropriate, if the county board, after consultation with the
court, has specifically authorized this dispositional alternative for a child.
(b) If the child was adjudicated in need of protection or services because the child is a
runaway or habitual truant, the court may order any of the following dispositions in addition
to or as alternatives to the dispositions authorized under paragraph (a):
(1) counsel the child or the child's parents, guardian, or custodian;
(2) place the child under the supervision of a probation officer or other suitable person
in the child's own home under conditions prescribed by the court, including reasonable rules
for the child's conduct and the conduct of the parents, guardian, or custodian, designed for
the physical, mental, and moral well-being and behavior of the child;
(3) subject to the court's supervision, transfer legal custody of the child to one of the
following:
(i) a reputable person of good moral character. No person may receive custody of two
or more unrelated children unless licensed to operate a residential program under sections
245A.01 to 245A.16; or
(ii) a county probation officer for placement in a group foster home established under
the direction of the juvenile court and licensed pursuant to section 241.021;
(4) require the child to pay a fine of up to $100. The court shall order payment of the
fine in a manner that will not impose undue financial hardship upon the child;
(5) require the child to participate in a community service project;
(6) order the child to undergo a chemical dependency evaluation and, if warranted by
the evaluation, order participation by the child in a drug awareness program or an inpatient
or outpatient chemical dependency treatment program;
(7) if the court believes that it is in the best interests of the child or of public safety that
the child's driver's license or instruction permit be canceled, the court may order the
commissioner of public safety to cancel the child's license or permit for any period up to
the child's 18th birthday. If the child does not have a driver's license or permit, the court
may order a denial of driving privileges for any period up to the child's 18th birthday. The
court shall forward an order issued under this clause to the commissioner, who shall cancel
the license or permit or deny driving privileges without a hearing for the period specified
by the court. At any time before the expiration of the period of cancellation or denial, the
court may, for good cause, order the commissioner of public safety to allow the child to
apply for a license or permit, and the commissioner shall so authorize;
(8) order that the child's parent or legal guardian deliver the child to school at the
beginning of each school day for a period of time specified by the court; or
(9) require the child to perform any other activities or participate in any other treatment
programs deemed appropriate by the court.
To the extent practicable, the court shall enter a disposition order the same day it makes
a finding that a child is in need of protection or services or neglected and in foster care, but
in no event more than 15 days after the finding unless the court finds that the best interests
of the child will be served by granting a delay. If the child was under eight years of age at
the time the petition was filed, the disposition order must be entered within ten days of the
finding and the court may not grant a delay unless good cause is shown and the court finds
the best interests of the child will be served by the delay.
(c) If a child who is 14 years of age or older is adjudicated in need of protection or
services because the child is a habitual truant and truancy procedures involving the child
were previously dealt with by a school attendance review board or county attorney mediation
program under section 260A.06 or 260A.07, the court shall order a cancellation or denial
of driving privileges under paragraph (b), clause (7), for any period up to the child's 18th
birthday.
(d) In the case of a child adjudicated in need of protection or services because the child
has committed domestic abuse and been ordered excluded from the child's parent's home,
the court shall dismiss jurisdiction if the court, at any time, finds the parent is able or willing
to provide an alternative safe living arrangement for the child, as defined in Laws 1997,
chapter 239, article 10, section 2.
(e) When a parent has complied with a case plan ordered under subdivision 6 and the
child is in the care of the parent, the court may order the responsible social services agency
to monitor the parent's continued ability to maintain the child safely in the home under such
terms and conditions as the court determines appropriate under the circumstances.
Sec. 12.
Minnesota Statutes 2020, section 260C.201, subdivision 2, is amended to read:
Subd. 2.
Written findings.
(a) Any order for a disposition authorized under this section
shall contain written findings of fact to support the disposition and case plan ordered and
shall also set forth in writing the following information:
(1) why the best interests and safety of the child are served by the disposition and case
plan ordered;
(2) what alternative dispositions or services under the case plan were considered by the
court and why such dispositions or services were not appropriate in the instant case;
(3) when legal custody of the child is transferred, the appropriateness of the particular
placement made or to be made by the placing agency using thenew text begin relative and sibling placement
considerations and best interestnew text end factors in section 260C.212, subdivision 2deleted text begin , paragraph (b)deleted text end ,
or the appropriateness of a child colocated with a parent in a licensed residential family-based
substance use disorder treatment program under section 260C.190;
(4) whether reasonable efforts to finalize the permanent plan for the child consistent
with section 260.012 were made including reasonable efforts:
(i) to prevent the child's placement and to reunify the child with the parent or guardian
from whom the child was removed at the earliest time consistent with the child's safety.
The court's findings must include a brief description of what preventive and reunification
efforts were made and why further efforts could not have prevented or eliminated the
necessity of removal or that reasonable efforts were not required under section 260.012 or
260C.178, subdivision 1;
(ii) to identify and locate any noncustodial or nonresident parent of the child and to
assess such parent's ability to provide day-to-day care of the child, and, where appropriate,
provide services necessary to enable the noncustodial or nonresident parent to safely provide
day-to-day care of the child as required under section 260C.219, unless such services are
not required under section 260.012 or 260C.178, subdivision 1deleted text begin ;deleted text end new text begin . The court's findings must
include a description of the agency's efforts to:
new text end
new text begin
(A) identify and locate the child's noncustodial or nonresident parent;
new text end
new text begin
(B) assess the noncustodial or nonresident parent's ability to provide day-to-day care of
the child; and
new text end
new text begin
(C) if appropriate, provide services necessary to enable the noncustodial or nonresident
parent to safely provide the child's day-to-day care, including efforts to engage the
noncustodial or nonresident parent in assuming care and responsibility of the child;
new text end
(iii) to make the diligent search for relatives and provide the notices required under
section 260C.221; a finding made pursuant to a hearing under section 260C.202 that the
agency has made diligent efforts to conduct a relative search and has appropriately engaged
relatives who responded to the notice under section 260C.221 and other relatives, who came
to the attention of the agency after notice under section 260C.221 was sent, in placement
and case planning decisions fulfills the requirement of this item;
(iv) to identify and make a foster care placement new text begin of the child, considering the order in
section 260C.212, subdivision 2, paragraph (a), new text end in the home of an unlicensed relative,
according to the requirements of section 245A.035, a licensed relative, or other licensed
foster care providernew text begin ,new text end who will commit to being the permanent legal parent or custodian for
the child in the event reunification cannot occur, but who will actively support the
reunification plan for the childnew text begin . If the court finds that the agency has not appropriately
considered relatives for placement of the child, the court shall order the agency to comply
with section 260C.212, subdivision 2, paragraph (a). The court may order the agency to
continue considering relatives for placement of the child regardless of the child's current
placement settingnew text end ; and
(v) to place siblings together in the same home or to ensure visitation is occurring when
siblings are separated in foster care placement and visitation is in the siblings' best interests
under section 260C.212, subdivision 2, paragraph (d); and
(5) if the child has been adjudicated as a child in need of protection or services because
the child is in need of special services or care to treat or ameliorate a mental disability or
emotional disturbance as defined in section 245.4871, subdivision 15, the written findings
shall also set forth:
(i) whether the child has mental health needs that must be addressed by the case plan;
(ii) what consideration was given to the diagnostic and functional assessments performed
by the child's mental health professional and to health and mental health care professionals'
treatment recommendations;
(iii) what consideration was given to the requests or preferences of the child's parent or
guardian with regard to the child's interventions, services, or treatment; and
(iv) what consideration was given to the cultural appropriateness of the child's treatment
or services.
(b) If the court finds that the social services agency's preventive or reunification efforts
have not been reasonable but that further preventive or reunification efforts could not permit
the child to safely remain at home, the court may nevertheless authorize or continue the
removal of the child.
(c) If the child has been identified by the responsible social services agency as the subject
of concurrent permanency planning, the court shall review the reasonable efforts of the
agency to develop a permanency plan for the child that includes a primary plan deleted text begin whichdeleted text end new text begin thatnew text end
is for reunification with the child's parent or guardian and a secondary plan deleted text begin whichdeleted text end new text begin thatnew text end is
for an alternative, legally permanent home for the child in the event reunification cannot
be achieved in a timely manner.
Sec. 13.
Minnesota Statutes 2020, section 260C.202, is amended to read:
260C.202 COURT REVIEW OF FOSTER CARE.
(a) If the court orders a child placed in foster care, the court shall review the out-of-home
placement plan and the child's placement at least every 90 days as required in juvenile court
rules to determine whether continued out-of-home placement is necessary and appropriate
or whether the child should be returned home. This review is not required if the court has
returned the child home, ordered the child permanently placed away from the parent under
sections 260C.503 to 260C.521, or terminated rights under section 260C.301. Court review
for a child permanently placed away from a parent, including where the child is under
guardianship of the commissioner, shall be governed by section 260C.607. When a child
is placed in a qualified residential treatment program setting as defined in section 260C.007,
subdivision 26d, the responsible social services agency must submit evidence to the court
as specified in section 260C.712.
(b) No later than three months after the child's placement in foster care, the court shall
review agency efforts new text begin to search for and notify relatives new text end pursuant to section 260C.221, and
order that the new text begin agency's new text end efforts new text begin begin immediately, or new text end continuenew text begin ,new text end if the agency has failed to
performnew text begin , or has not adequately performed,new text end the duties under that section. The court must
order the agency to continue to appropriately engage relatives who responded to the notice
under section 260C.221 in placement and case planning decisions and to new text begin consider relatives
for foster care placement consistent with section 260C.221. Notwithstanding a court's finding
that the agency has made reasonable efforts to search for and notify relatives under section
260C.221, the court may order the agency to continue making reasonable efforts to search
for, notify, new text end engage deleted text begin otherdeleted text end new text begin , and considernew text end relatives who came to the agency's attention after
new text begin sending the initial new text end notice under section 260C.221 deleted text begin was sentdeleted text end .
(c) The court shall review the out-of-home placement plan and may modify the plan as
provided under section 260C.201, subdivisions 6 and 7.
(d) When the court deleted text begin orders transfer ofdeleted text end new text begin transfers thenew text end custodynew text begin of a childnew text end to a responsible
social services agency resulting in foster care or protective supervision with a noncustodial
parent under subdivision 1, the court shall notify the parents of the provisions of sections
260C.204 and 260C.503 to 260C.521, as required under juvenile court rules.
(e) When a child remains in or returns to foster care pursuant to section 260C.451 and
the court has jurisdiction pursuant to section 260C.193, subdivision 6, paragraph (c), the
court shall at least annually conduct the review required under section 260C.203.
Sec. 14.
Minnesota Statutes 2020, section 260C.203, is amended to read:
260C.203 ADMINISTRATIVE OR COURT REVIEW OF PLACEMENTS.
(a) Unless the court is conducting the reviews required under section 260C.202, there
shall be an administrative review of the out-of-home placement plan of each child placed
in foster care no later than 180 days after the initial placement of the child in foster care
and at least every six months thereafter if the child is not returned to the home of the parent
or parents within that time. The out-of-home placement plan must be monitored and updated
new text begin by the responsible social services agency new text end at each administrative review. The administrative
review shall be conducted by the responsible social services agency using a panel of
appropriate persons at least one of whom is not responsible for the case management of, or
the delivery of services to, either the child or the parents who are the subject of the review.
The administrative review shall be open to participation by the parent or guardian of the
child and the child, as appropriate.
(b) As an alternative to the administrative review required in paragraph (a), the court
may, as part of any hearing required under the Minnesota Rules of Juvenile Protection
Procedure, conduct a hearing to monitor and update the out-of-home placement plan pursuant
to the procedure and standard in section 260C.201, subdivision 6, paragraph (d). The party
requesting review of the out-of-home placement plan shall give parties to the proceeding
notice of the request to review and update the out-of-home placement plan. A court review
conducted pursuant to section 260C.141, subdivision 2; 260C.193; 260C.201, subdivision
1; 260C.202; 260C.204; 260C.317; or 260D.06 shall satisfy the requirement for the review
so long as the other requirements of this section are met.
(c) As appropriate to the stage of the proceedings and relevant court orders, the
responsible social services agency or the court shall review:
(1) the safety, permanency needs, and well-being of the child;
(2) the continuing necessity for and appropriateness of the placementnew text begin , including whether
the placement is consistent with the child's best interests and other placement considerations,
including relative and sibling placement considerations under section 260C.212, subdivision
2new text end ;
(3) the extent of compliance with the out-of-home placement plannew text begin required under section
260C.212, subdivisions 1 and 1a, including services and resources that the agency has
provided to the child and child's parents, services and resources that other agencies and
individuals have provided to the child and child's parents, and whether the out-of-home
placement plan is individualized to the needs of the child and child's parentsnew text end ;
(4) the extent of progress that has been made toward alleviating or mitigating the causes
necessitating placement in foster care;
(5) the projected date by which the child may be returned to and safely maintained in
the home or placed permanently away from the care of the parent or parents or guardian;
and
(6) the appropriateness of the services provided to the child.
(d) When a child is age 14 or older:
(1) in addition to any administrative review conducted by the responsible social services
agency, at the in-court review required under section 260C.317, subdivision 3, clause (3),
or 260C.515, subdivision 5 or 6, the court shall review the independent living plan required
under section 260C.212, subdivision 1, paragraph (c), clause (12), and the provision of
services to the child related to the well-being of the child as the child prepares to leave foster
care. The review shall include the actual plans related to each item in the plan necessary to
the child's future safety and well-being when the child is no longer in foster care; and
(2) consistent with the requirements of the independent living plan, the court shall review
progress toward or accomplishment of the following goals:
(i) the child has obtained a high school diploma or its equivalent;
(ii) the child has completed a driver's education course or has demonstrated the ability
to use public transportation in the child's community;
(iii) the child is employed or enrolled in postsecondary education;
(iv) the child has applied for and obtained postsecondary education financial aid for
which the child is eligible;
(v) the child has health care coverage and health care providers to meet the child's
physical and mental health needs;
(vi) the child has applied for and obtained disability income assistance for which the
child is eligible;
(vii) the child has obtained affordable housing with necessary supports, which does not
include a homeless shelter;
(viii) the child has saved sufficient funds to pay for the first month's rent and a damage
deposit;
(ix) the child has an alternative affordable housing plan, which does not include a
homeless shelter, if the original housing plan is unworkable;
(x) the child, if male, has registered for the Selective Service; and
(xi) the child has a permanent connection to a caring adult.
Sec. 15.
Minnesota Statutes 2020, section 260C.204, is amended to read:
260C.204 PERMANENCY PROGRESS REVIEW FOR CHILDREN IN FOSTER
CARE FOR SIX MONTHS.
(a) When a child continues in placement out of the home of the parent or guardian from
whom the child was removed, no later than six months after the child's placement the court
shall conduct a permanency progress hearing to review:
(1) the progress of the case, the parent's progress on the case plan or out-of-home
placement plan, whichever is applicable;
(2) the agency's reasonable, or in the case of an Indian child, active efforts for
reunification and its provision of services;
(3) the agency's reasonable efforts to finalize the permanent plan for the child under
section 260.012, paragraph (e), and to make a placement as required under section 260C.212,
subdivision 2, in a home that will commit to being the legally permanent family for the
child in the event the child cannot return home according to the timelines in this section;
and
(4) in the case of an Indian child, active efforts to prevent the breakup of the Indian
family and to make a placement according to the placement preferences under United States
Code, title 25, chapter 21, section 1915.
(b) When a child is placed in a qualified residential treatment program setting as defined
in section 260C.007, subdivision 26d, the responsible social services agency must submit
evidence to the court as specified in section 260C.712.
(c) The court shall ensure that notice of the hearing is sent to any relative who:
(1) responded to the agency's notice provided under section 260C.221, indicating an
interest in participating in planning for the child or being a permanency resource for the
child and who has kept the court apprised of the relative's address; or
(2) asked to be notified of court proceedings regarding the child as is permitted in section
260C.152, subdivision 5.
(d)(1) If the parent or guardian has maintained contact with the child and is complying
with the court-ordered out-of-home placement plan, and if the child would benefit from
reunification with the parent, the court may either:
(i) return the child home, if the conditions deleted text begin whichdeleted text end new text begin thatnew text end led to the out-of-home placement
have been sufficiently mitigated that it is safe and in the child's best interests to return home;
or
(ii) continue the matter up to a total of six additional months. If the child has not returned
home by the end of the additional six months, the court must conduct a hearing according
to sections 260C.503 to 260C.521.
(2) If the court determines that the parent or guardian is not complyingnew text begin , is not making
progress with or engagingnew text end with new text begin services in new text end the out-of-home placement plannew text begin ,new text end or is not
maintaining regular contact with the child as outlined in the visitation plan required as part
of the out-of-home placement plan under section 260C.212, the court may order the
responsible social services agency:
(i) to develop a plan for legally permanent placement of the child away from the parent;
(ii) to consider, identify, recruit, and support one or more permanency resources from
the child's relatives and foster parentnew text begin , consistent with section 260C.212, subdivision 2,
paragraph (a),new text end to be the legally permanent home in the event the child cannot be returned
to the parent. Any relative or the child's foster parent may ask the court to order the agency
to consider them for permanent placement of the child in the event the child cannot be
returned to the parent. A relative or foster parent who wants to be considered under this
item shall cooperate with the background study required under section 245C.08, if the
individual has not already done so, and with the home study process required under chapter
245A for providing child foster care and for adoption under section 259.41. The home study
referred to in this item shall be a single-home study in the form required by the commissioner
of human services or similar study required by the individual's state of residence when the
subject of the study is not a resident of Minnesota. The court may order the responsible
social services agency to make a referral under the Interstate Compact on the Placement of
Children when necessary to obtain a home study for an individual who wants to be considered
for transfer of permanent legal and physical custody or adoption of the child; and
(iii) to file a petition to support an order for the legally permanent placement plan.
(e) Following the review under this section:
(1) if the court has either returned the child home or continued the matter up to a total
of six additional months, the agency shall continue to provide services to support the child's
return home or to make reasonable efforts to achieve reunification of the child and the parent
as ordered by the court under an approved case plan;
(2) if the court orders the agency to develop a plan for the transfer of permanent legal
and physical custody of the child to a relative, a petition supporting the plan shall be filed
in juvenile court within 30 days of the hearing required under this section and a trial on the
petition held within 60 days of the filing of the pleadings; or
(3) if the court orders the agency to file a termination of parental rights, unless the county
attorney can show cause why a termination of parental rights petition should not be filed,
a petition for termination of parental rights shall be filed in juvenile court within 30 days
of the hearing required under this section and a trial on the petition held within 60 days of
the filing of the petition.
Sec. 16.
Minnesota Statutes 2021 Supplement, section 260C.212, subdivision 1, is amended
to read:
Subdivision 1.
Out-of-home placement; plan.
(a) An out-of-home placement plan shall
be prepared within 30 days after any child is placed in foster care by court order or a
voluntary placement agreement between the responsible social services agency and the
child's parent pursuant to section 260C.227 or chapter 260D.
(b) An out-of-home placement plan means a written document deleted text begin whichdeleted text end new text begin individualized to
the needs of the child and the child's parents or guardians thatnew text end is prepared by the responsible
social services agency jointly with deleted text begin the parent or parents or guardian of the childdeleted text end new text begin the child's
parents or guardiansnew text end and in consultation with the child's guardian ad litemdeleted text begin ,deleted text end new text begin ;new text end the child's tribe,
if the child is an Indian childdeleted text begin ,deleted text end new text begin ;new text end the child's foster parent or representative of the foster care
facilitydeleted text begin ,deleted text end new text begin ;new text end and, deleted text begin wheredeleted text end new text begin whennew text end appropriate, the child. When a child is age 14 or older, the child
may include two other individuals on the team preparing the child's out-of-home placement
plan. The child may select one member of the case planning team to be designated as the
child's advisor and to advocate with respect to the application of the reasonable and prudent
parenting standards. The responsible social services agency may reject an individual selected
by the child if the agency has good cause to believe that the individual would not act in the
best interest of the child. For a child in voluntary foster care for treatment under chapter
260D, preparation of the out-of-home placement plan shall additionally include the child's
mental health treatment provider. For a child 18 years of age or older, the responsible social
services agency shall involve the child and the child's parents as appropriate. As appropriate,
the plan shall be:
(1) submitted to the court for approval under section 260C.178, subdivision 7;
(2) ordered by the court, either as presented or modified after hearing, under section
260C.178, subdivision 7, or 260C.201, subdivision 6; and
(3) signed by the parent or parents or guardian of the child, the child's guardian ad litem,
a representative of the child's tribe, the responsible social services agency, and, if possible,
the child.
(c) The out-of-home placement plan shall be explained new text begin by the responsible social services
agency new text end to all persons involved in deleted text begin itsdeleted text end new text begin the plan'snew text end implementation, including the child who has
signed the plan, and shall set forth:
(1) a description of the foster care home or facility selected, including how the
out-of-home placement plan is designed to achieve a safe placement for the child in the
least restrictive, most family-likedeleted text begin ,deleted text end setting available deleted text begin whichdeleted text end new text begin thatnew text end is in close proximity to the
home of the deleted text begin parent ordeleted text end new text begin child'snew text end parents or deleted text begin guardian of the childdeleted text end new text begin guardiansnew text end when the case plan
goal is reunificationdeleted text begin ,deleted text end new text begin ;new text end and how the placement is consistent with the best interests and special
needs of the child according to the factors under subdivision 2, paragraph (b);
(2) the specific reasons for the placement of the child in foster care, and when
reunification is the plan, a description of the problems or conditions in the home of the
parent or parents deleted text begin whichdeleted text end new text begin thatnew text end necessitated removal of the child from home and the changes
the parent or parents must make for the child to safely return home;
(3) a description of the services offered and provided to prevent removal of the child
from the home and to reunify the family including:
(i) the specific actions to be taken by the parent or parents of the child to eliminate or
correct the problems or conditions identified in clause (2), and the time period during which
the actions are to be taken; and
(ii) the reasonable efforts, or in the case of an Indian child, active efforts to be made to
achieve a safe and stable home for the child including social and other supportive services
to be provided or offered to the parent or parents or guardian of the child, the child, and the
residential facility during the period the child is in the residential facility;
(4) a description of any services or resources that were requested by the child or the
child's parent, guardian, foster parent, or custodian since the date of the child's placement
in the residential facility, and whether those services or resources were provided and if not,
the basis for the denial of the services or resources;
(5) the visitation plan for the parent or parents or guardian, other relatives as defined in
section 260C.007, subdivision 26b or 27, and siblings of the child if the siblings are not
placed together in foster care, and whether visitation is consistent with the best interest of
the child, during the period the child is in foster care;
(6) when a child cannot return to or be in the care of either parent, documentation of
steps to finalize adoption as the permanency plan for the child through reasonable efforts
to place the child for adoptionnew text begin pursuant to section 260C.605new text end . At a minimum, the
documentation must include consideration of whether adoption is in the best interests of
the childdeleted text begin ,deleted text end new text begin andnew text end child-specific recruitment efforts such as new text begin a new text end relative searchnew text begin , consideration of
relatives for adoptive placement,new text end and the use of state, regional, and national adoption
exchanges to facilitate orderly and timely placements in and outside of the state. A copy of
this documentation shall be provided to the court in the review required under section
260C.317, subdivision 3, paragraph (b);
(7) when a child cannot return to or be in the care of either parent, documentation of
steps to finalize the transfer of permanent legal and physical custody to a relative as the
permanency plan for the child. This documentation must support the requirements of the
kinship placement agreement under section 256N.22 and must include the reasonable efforts
used to determine that it is not appropriate for the child to return home or be adopted, and
reasons why permanent placement with a relative through a Northstar kinship assistance
arrangement is in the child's best interest; how the child meets the eligibility requirements
for Northstar kinship assistance payments; agency efforts to discuss adoption with the child's
relative foster parent and reasons why the relative foster parent chose not to pursue adoption,
if applicable; and agency efforts to discuss with the child's parent or parents the permanent
transfer of permanent legal and physical custody or the reasons why these efforts were not
made;
(8) efforts to ensure the child's educational stability while in foster care for a child who
attained the minimum age for compulsory school attendance under state law and is enrolled
full time in elementary or secondary school, or instructed in elementary or secondary
education at home, or instructed in an independent study elementary or secondary program,
or incapable of attending school on a full-time basis due to a medical condition that is
documented and supported by regularly updated information in the child's case plan.
Educational stability efforts include:
(i) efforts to ensure that the child remains in the same school in which the child was
enrolled prior to placement or upon the child's move from one placement to another, including
efforts to work with the local education authorities to ensure the child's educational stability
and attendance; or
(ii) if it is not in the child's best interest to remain in the same school that the child was
enrolled in prior to placement or move from one placement to another, efforts to ensure
immediate and appropriate enrollment for the child in a new school;
(9) the educational records of the child including the most recent information available
regarding:
(i) the names and addresses of the child's educational providers;
(ii) the child's grade level performance;
(iii) the child's school record;
(iv) a statement about how the child's placement in foster care takes into account
proximity to the school in which the child is enrolled at the time of placement; and
(v) any other relevant educational information;
(10) the efforts by the responsible social services agency to ensure the oversight and
continuity of health care services for the foster child, including:
(i) the plan to schedule the child's initial health screens;
(ii) how the child's known medical problems and identified needs from the screens,
including any known communicable diseases, as defined in section 144.4172, subdivision
2, shall be monitored and treated while the child is in foster care;
(iii) how the child's medical information shall be updated and shared, including the
child's immunizations;
(iv) who is responsible to coordinate and respond to the child's health care needs,
including the role of the parent, the agency, and the foster parent;
(v) who is responsible for oversight of the child's prescription medications;
(vi) how physicians or other appropriate medical and nonmedical professionals shall be
consulted and involved in assessing the health and well-being of the child and determine
the appropriate medical treatment for the child; and
(vii) the responsibility to ensure that the child has access to medical care through either
medical insurance or medical assistance;
(11) the health records of the child including information available regarding:
(i) the names and addresses of the child's health care and dental care providers;
(ii) a record of the child's immunizations;
(iii) the child's known medical problems, including any known communicable diseases
as defined in section 144.4172, subdivision 2;
(iv) the child's medications; and
(v) any other relevant health care information such as the child's eligibility for medical
insurance or medical assistance;
(12) an independent living plan for a child 14 years of age or older, developed in
consultation with the child. The child may select one member of the case planning team to
be designated as the child's advisor and to advocate with respect to the application of the
reasonable and prudent parenting standards in subdivision 14. The plan should include, but
not be limited to, the following objectives:
(i) educational, vocational, or employment planning;
(ii) health care planning and medical coverage;
(iii) transportation including, where appropriate, assisting the child in obtaining a driver's
license;
(iv) money management, including the responsibility of the responsible social services
agency to ensure that the child annually receives, at no cost to the child, a consumer report
as defined under section 13C.001 and assistance in interpreting and resolving any inaccuracies
in the report;
(v) planning for housing;
(vi) social and recreational skills;
(vii) establishing and maintaining connections with the child's family and community;
and
(viii) regular opportunities to engage in age-appropriate or developmentally appropriate
activities typical for the child's age group, taking into consideration the capacities of the
individual child;
(13) for a child in voluntary foster care for treatment under chapter 260D, diagnostic
and assessment information, specific services relating to meeting the mental health care
needs of the child, and treatment outcomes;
(14) for a child 14 years of age or older, a signed acknowledgment that describes the
child's rights regarding education, health care, visitation, safety and protection from
exploitation, and court participation; receipt of the documents identified in section 260C.452;
and receipt of an annual credit report. The acknowledgment shall state that the rights were
explained in an age-appropriate manner to the child; and
(15) for a child placed in a qualified residential treatment program, the plan must include
the requirements in section 260C.708.
(d) The parent or parents or guardian and the child each shall have the right to legal
counsel in the preparation of the case plan and shall be informed of the right at the time of
placement of the child. The child shall also have the right to a guardian ad litem. If unable
to employ counsel from their own resources, the court shall appoint counsel upon the request
of the parent or parents or the child or the child's legal guardian. The parent or parents may
also receive assistance from any person or social services agency in preparation of the case
plan.
new text begin (e) new text end After the plan has been agreed upon by the parties involved or approved or ordered
by the court, the foster parents shall be fully informed of the provisions of the case plan and
shall be provided a copy of the plan.
new text begin (f) new text end Upon the child's discharge from foster care, the responsible social services agency
must provide the child's parent, adoptive parent, or permanent legal and physical custodian,
and the child, if the child is 14 years of age or older, with a current copy of the child's health
and education record. If a child meets the conditions in subdivision 15, paragraph (b), the
agency must also provide the child with the child's social and medical history. The responsible
social services agency may give a copy of the child's health and education record and social
and medical history to a child who is younger than 14 years of age, if it is appropriate and
if subdivision 15, paragraph (b), applies.
Sec. 17.
Minnesota Statutes 2021 Supplement, section 260C.212, subdivision 2, is amended
to read:
Subd. 2.
Placement decisions based on best interests of the child.
(a) The policy of
the state of Minnesota is to ensure that the child's best interests are met by requiring an
individualized determination of the needs of the child new text begin in consideration of paragraphs (a) to
(f), new text end and of how the selected placement will serve the new text begin current and future new text end needs of the child
being placed. The authorized child-placing agency shall place a child, released by court
order or by voluntary release by the parent or parents, in a family foster home selected by
considering placement with relatives deleted text begin and important friendsdeleted text end in the following order:
(1) with an individual who is related to the child by blood, marriage, or adoption,
including the legal parent, guardian, or custodian of the child's deleted text begin siblingsdeleted text end new text begin siblingnew text end ; or
new text begin
(2) with an individual who is an important friend of the child or of the child's parent or
custodian, including an individual with whom the child has resided or had significant contact
or who has a significant relationship to the child or the child's parent or custodian.
new text end
deleted text begin
(2)
deleted text end
deleted text begin
with an individual who is an important friend with whom the child has resided
deleted text end
deleted text begin
or
had significant contact.
deleted text end
For an Indian child, the agency shall follow the order of placement preferences in the Indian
Child Welfare Act of 1978, United States Code, title 25, section 1915.
(b) Among the factors the agency shall consider in determining the new text begin current and future
new text end needs of the child are the following:
(1) the child's current functioning and behaviors;
(2) the medical needs of the child;
(3) the educational needs of the child;
(4) the developmental needs of the child;
(5) the child's history and past experience;
(6) the child's religious and cultural needs;
(7) the child's connection with a community, school, and faith community;
(8) the child's interests and talents;
(9) the child's deleted text begin relationship to current caretakers,deleted text end new text begin current and long-term needs regarding
relationships withnew text end parents, siblings, deleted text begin anddeleted text end relativesnew text begin , and other caretakersnew text end ;
(10) the reasonable preference of the child, if the court, or the child-placing agency in
the case of a voluntary placement, deems the child to be of sufficient age to express
preferences; and
(11) for an Indian child, the best interests of an Indian child as defined in section 260.755,
subdivision 2a.
new text begin
When placing a child in foster care or in a permanent placement based on an individualized
determination of the child's needs, the agency must not use one factor in this paragraph to
the exclusion of all others, and the agency shall consider that the factors in paragraph (b)
may be interrelated.
new text end
(c) Placement of a child cannot be delayed or denied based on race, color, or national
origin of the foster parent or the child.
(d) Siblings should be placed together for foster care and adoption at the earliest possible
time unless it is documented that a joint placement would be contrary to the safety or
well-being of any of the siblings or unless it is not possible after reasonable efforts by the
responsible social services agency. In cases where siblings cannot be placed together, the
agency is required to provide frequent visitation or other ongoing interaction between
siblings unless the agency documents that the interaction would be contrary to the safety
or well-being of any of the siblings.
(e) Except for emergency placement as provided for in section 245A.035, the following
requirements must be satisfied before the approval of a foster or adoptive placement in a
related or unrelated home: (1) a completed background study under section 245C.08; and
(2) a completed review of the written home study required under section 260C.215,
subdivision 4, clause (5), or 260C.611, to assess the capacity of the prospective foster or
adoptive parent to ensure the placement will meet the needs of the individual child.
(f) The agency must determine whether colocation with a parent who is receiving services
in a licensed residential family-based substance use disorder treatment program is in the
child's best interests according to paragraph (b) and include that determination in the child's
case plan under subdivision 1. The agency may consider additional factors not identified
in paragraph (b). The agency's determination must be documented in the child's case plan
before the child is colocated with a parent.
(g) The agency must establish a juvenile treatment screening team under section 260C.157
to determine whether it is necessary and appropriate to recommend placing a child in a
qualified residential treatment program, as defined in section 260C.007, subdivision 26d.
Sec. 18.
Minnesota Statutes 2020, section 260C.221, is amended to read:
260C.221 RELATIVE SEARCHnew text begin AND ENGAGEMENT; PLACEMENT
CONSIDERATIONnew text end .
new text begin Subdivision 1. new text end
new text begin Relative search requirements. new text end
(a) The responsible social services agency
shall exercise due diligence to identify and notify adult relatives new text begin and current caregivers of
a child's sibling, new text end prior to placement or within 30 days after the child's removal from the
parentnew text begin , regardless of whether a child is placed in a relative's home, as required under
subdivision 2new text end . deleted text begin The county agency shall consider placement with a relative under this section
without delay and whenever the child must move from or be returned to foster care.deleted text end The
relative search required by this section shall be comprehensive in scope. deleted text begin After a finding
that the agency has made reasonable efforts to conduct the relative search under this
paragraph, the agency has the continuing responsibility to appropriately involve relatives,
who have responded to the notice required under this paragraph, in planning for the child
and to continue to consider relatives according to the requirements of section 260C.212,
subdivision 2. At any time during the course of juvenile protection proceedings, the court
may order the agency to reopen its search for relatives when it is in the child's best interest
to do so.
deleted text end
(b) The relative search required by this section shall include both maternal and paternal
adult relatives of the child; all adult grandparents; all legal parents, guardians, or custodians
of the child's siblings; and any other adult relatives suggested by the child's parents, subject
to the exceptions due to family violence in new text begin subdivision 5, new text end paragraph deleted text begin (c)deleted text end new text begin (b)new text end . The search shall
also include getting information from the child in an age-appropriate manner about who the
child considers to be family members and important friends with whom the child has resided
or had significant contact. The relative search required under this section must fulfill the
agency's duties under the Indian Child Welfare Act regarding active efforts to prevent the
breakup of the Indian family under United States Code, title 25, section 1912(d), and to
meet placement preferences under United States Code, title 25, section 1915.
new text begin
(c) The responsible social services agency has a continuing responsibility to search for
and identify relatives of a child and send the notice to relatives that is required under
subdivision 2, unless the court has relieved the agency of this duty under subdivision 5,
paragraph (e).
new text end
new text begin Subd. 2. new text end
new text begin Relative notice requirements. new text end
new text begin (a) The agency may provide oral or written
notice to a child's relatives. In the child's case record, the agency must document providing
the required notice to each of the child's relatives. new text end Thenew text begin responsible social services agency
must notifynew text end relatives deleted text begin must be notifieddeleted text end :
(1) of the need for a foster home for the child, the option to become a placement resource
for the child, new text begin the order of placement that the agency will consider under section 260C.212,
subdivision 2, paragraph (a), new text end and the possibility of the need for a permanent placement for
the child;
(2) of their responsibility to keep the responsible social services agency and the court
informed of their current address in order to receive notice in the event that a permanent
placement is sought for the child and to receive notice of the permanency progress review
hearing under section 260C.204. A relative who fails to provide a current address to the
responsible social services agency and the court forfeits the right to receive notice of the
possibility of permanent placement and of the permanency progress review hearing under
section 260C.204new text begin , until the relative provides a current address to the responsible social
services agency and the courtnew text end . A decision by a relative not to be identified as a potential
permanent placement resource or participate in planning for the child deleted text begin at the beginning of
the casedeleted text end shall not affect whether the relative is considered for placement ofnew text begin , or as a
permanency resource for,new text end the child with that relative deleted text begin laterdeleted text end new text begin at any time in the case, and shall
not be the sole basis for the court to rule out the relative as the child's placement or
permanency resourcenew text end ;
(3) that the relative may participate in the care and planning for the child, new text begin as specified
in subdivision 3, new text end including that the opportunity for such participation may be lost by failing
to respond to the notice sent under this subdivisiondeleted text begin . "Participate in the care and planning"
includes, but is not limited to, participation in case planning for the parent and child,
identifying the strengths and needs of the parent and child, supervising visits, providing
respite and vacation visits for the child, providing transportation to appointments, suggesting
other relatives who might be able to help support the case plan, and to the extent possible,
helping to maintain the child's familiar and regular activities and contact with friends and
relativesdeleted text end ;
(4) of the family foster care licensing new text begin and adoption home study new text end requirements, including
how to complete an application and how to request a variance from licensing standards that
do not present a safety or health risk to the child in the home under section 245A.04 and
supports that are available for relatives and children who reside in a family foster home;
deleted text begin and
deleted text end
(5) of the relatives' right to ask to be notified of any court proceedings regarding the
child, to attend the hearings, and of a relative's right deleted text begin or opportunitydeleted text end to be heard by the court
as required under section 260C.152, subdivision 5deleted text begin .deleted text end new text begin ;
new text end
new text begin
(6) that regardless of the relative's response to the notice sent under this subdivision, the
agency is required to establish permanency for a child, including planning for alternative
permanency options if the agency's reunification efforts fail or are not required; and
new text end
new text begin
(7) that by responding to the notice, a relative may receive information about participating
in a child's family and permanency team if the child is placed in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d.
new text end
new text begin
(b) The responsible social services agency shall send the notice required under paragraph
(a) to relatives who become known to the responsible social services agency, except for
relatives that the agency does not contact due to safety reasons under subdivision 5, paragraph
(b). The responsible social services agency shall continue to send notice to relatives
notwithstanding a court's finding that the agency has made reasonable efforts to conduct a
relative search.
new text end
new text begin
(c) The responsible social services agency is not required to send the notice under
paragraph (a) to a relative who becomes known to the agency after an adoption placement
agreement has been fully executed under section 260C.613, subdivision 1. If the relative
wishes to be considered for adoptive placement of the child, the agency shall inform the
relative of the relative's ability to file a motion for an order for adoptive placement under
section 260C.607, subdivision 6.
new text end
new text begin Subd. 3. new text end
new text begin Relative engagement requirements. new text end
new text begin
(a) A relative who responds to the notice
under subdivision 2 has the opportunity to participate in care and planning for a child, which
must not be limited based solely on the relative's prior inconsistent participation or
nonparticipation in care and planning for the child. Care and planning for a child may include
but is not limited to:
new text end
new text begin
(1) participating in case planning for the child and child's parent, including identifying
services and resources that meet the individualized needs of the child and child's parent. A
relative's participation in case planning may be in person, via phone call, or by electronic
means;
new text end
new text begin
(2) identifying the strengths and needs of the child and child's parent;
new text end
new text begin
(3) asking the responsible social services agency to consider the relative for placement
of the child according to subdivision 4;
new text end
new text begin
(4) acting as a support person for the child, the child's parents, and the child's current
caregiver;
new text end
new text begin
(5) supervising visits;
new text end
new text begin
(6) providing respite care for the child and having vacation visits with the child;
new text end
new text begin
(7) providing transportation;
new text end
new text begin
(8) suggesting other relatives who may be able to participate in the case plan or that the
agency may consider for placement of the child. The agency shall send a notice to each
relative identified by other relatives according to subdivision 2, paragraph (b), unless a
relative received this notice earlier in the case;
new text end
new text begin
(9) helping to maintain the child's familiar and regular activities and contact with the
child's friends and relatives, including providing supervision of the child at family gatherings
and events; and
new text end
new text begin
(10) participating in the child's family and permanency team if the child is placed in a
qualified residential treatment program as defined in section 260C.007, subdivision 26d.
new text end
new text begin
(b) The responsible social services agency shall make reasonable efforts to contact and
engage relatives who respond to the notice required under this section. Upon a request by
a relative or party to the proceeding, the court may conduct a review of the agency's
reasonable efforts to contact and engage relatives who respond to the notice. If the court
finds that the agency did not make reasonable efforts to contact and engage relatives who
respond to the notice, the court may order the agency to make reasonable efforts to contact
and engage relatives who respond to the notice in care and planning for the child.
new text end
new text begin Subd. 4. new text end
new text begin Placement considerations. new text end
new text begin
(a) The responsible social services agency shall
consider placing a child with a relative under this section without delay and when the child:
new text end
new text begin
(1) enters foster care;
new text end
new text begin
(2) must be moved from the child's current foster setting;
new text end
new text begin
(3) must be permanently placed away from the child's parent; or
new text end
new text begin
(4) returns to foster care after permanency has been achieved for the child.
new text end
new text begin
(b) The agency shall consider placing a child with relatives:
new text end
new text begin
(1) in the order specified in section 260C.212, subdivision 2, paragraph (a); and
new text end
new text begin
(2) based on the child's best interests using the factors in section 260C.212, subdivision
2.
new text end
new text begin
(c) The agency shall document how the agency considered relatives in the child's case
record.
new text end
new text begin
(d) Any relative who requests to be a placement option for a child in foster care has the
right to be considered for placement of the child according to section 260C.212, subdivision
2, paragraph (a), unless the court finds that placing the child with a specific relative would
endanger the child, sibling, parent, guardian, or any other family member under subdivision
5, paragraph (b).
new text end
new text begin
(e) When adoption is the responsible social services agency's permanency goal for the
child, the agency shall consider adoptive placement of the child with a relative in the order
specified under section 260C.212, subdivision 2, paragraph (a).
new text end
new text begin Subd. 5. new text end
new text begin Data disclosure; court review. new text end
deleted text begin (c)deleted text end new text begin (a)new text end A responsible social services agency
may disclose private data, as defined in section 13.02 and chapter 260E, to relatives of the
child for the purpose of locating and assessing a suitable placement and may use any
reasonable means of identifying and locating relatives including the Internet or other
electronic means of conducting a search. The agency shall disclose data that is necessary
to facilitate possible placement with relatives and to ensure that the relative is informed of
the needs of the child so the relative can participate in planning for the child and be supportive
of services to the child and family.
new text begin (b) new text end If the child's parent refuses to give the responsible social services agency information
sufficient to identify the maternal and paternal relatives of the child, the agency shall ask
the juvenile court to order the parent to provide the necessary informationnew text begin and shall use
other resources to identify the child's maternal and paternal relativesnew text end . If a parent makes an
explicit request that a specific relative not be contacted or considered for placement due to
safety reasonsnew text begin ,new text end including past family or domestic violence, the agency shall bring the parent's
request to the attention of the court to determine whether the parent's request is consistent
with the best interests of the child deleted text begin anddeleted text end new text begin .new text end The agency shall not contact the specific relative
when the juvenile court finds that contacting new text begin or placing the child with new text end the specific relative
would endanger the parent, guardian, child, sibling, or any family member. new text begin Unless section
260C.139 applies to the child's case, a court shall not waive or relieve the responsible social
services agency of reasonable efforts to:
new text end
new text begin
(1) conduct a relative search;
new text end
new text begin
(2) notify relatives;
new text end
new text begin
(3) contact and engage relatives in case planning; and
new text end
new text begin
(4) consider relatives for placement of the child.
new text end
new text begin
(c) Notwithstanding chapter 13, the agency shall disclose data to the court about particular
relatives that the agency has identified, contacted, or considered for the child's placement
for the court to review the agency's due diligence.
new text end
(d) At a regularly scheduled hearing not later than three months after the child's placement
in foster care and as required in deleted text begin sectiondeleted text end new text begin sections 260C.193 andnew text end 260C.202, the agency shall
report to the court:
(1) deleted text begin itsdeleted text end new text begin the agency'snew text end efforts to identify maternal and paternal relatives of the child and to
engage the relatives in providing support for the child and family, and document that the
relatives have been provided the notice required under deleted text begin paragraph (a)deleted text end new text begin subdivision 2new text end ; and
(2) deleted text begin itsdeleted text end new text begin the agency'snew text end decision regarding placing the child with a relative as required under
section 260C.212, subdivision 2deleted text begin , and to askdeleted text end new text begin . If the responsible social services agency decides
that relative placement is not in the child's best interests at the time of the hearing, the agency
shall inform the court of the agency's decision, including:
new text end
new text begin
(i) why the agency decided against relative placement of the child; and
new text end
new text begin (ii) the agency's efforts to engagenew text end relatives deleted text begin to visit or maintain contact with the child in
orderdeleted text end new text begin as required under subdivision 3new text end to support family connections for the childdeleted text begin , when
placement with a relative is not possible or appropriatedeleted text end .
deleted text begin
(e) Notwithstanding chapter
deleted text end
deleted text begin
13
deleted text end
deleted text begin
, the agency shall disclose data about particular relatives
identified, searched for, and contacted for the purposes of the court's review of the agency's
due diligence.
deleted text end
deleted text begin (f)deleted text end new text begin (e)new text end When the court is satisfied that the agency has exercised due diligence to identify
relatives and provide the notice required in deleted text begin paragraph (a)deleted text end new text begin subdivision 2new text end , the court may find
that new text begin the agency made new text end reasonable efforts deleted text begin have been madedeleted text end to conduct a relative search to
identify and provide notice to adult relatives as required under section 260.012, paragraph
(e), clause (3). new text begin A finding under this paragraph does not relieve the responsible social services
agency of the ongoing duty to contact, engage, and consider relatives under this section nor
is it a basis for the court to rule out any relative from being a foster care or permanent
placement option for the child. The agency has the continuing responsibility to:
new text end
new text begin
(1) involve relatives who respond to the notice in planning for the child; and
new text end
new text begin
(2) continue considering relatives for the child's placement while taking the child's short-
and long-term permanency goals into consideration, according to the requirements of section
260C.212, subdivision 2.
new text end
new text begin
(f) At any time during the course of juvenile protection proceedings, the court may order
the agency to reopen the search for relatives when it is in the child's best interests.
new text end
new text begin (g) new text end If the court is not satisfied that the agency has exercised due diligence to identify
relatives and provide the notice required in deleted text begin paragraph (a)deleted text end new text begin subdivision 2new text end , the court may order
the agency to continue its search and notice efforts and to report back to the court.
deleted text begin
(g) When the placing agency determines that permanent placement proceedings are
necessary because there is a likelihood that the child will not return to a parent's care, the
agency must send the notice provided in paragraph (h), may ask the court to modify the
duty of the agency to send the notice required in paragraph (h), or may ask the court to
completely relieve the agency of the requirements of paragraph (h). The relative notification
requirements of paragraph (h) do not apply when the child is placed with an appropriate
relative or a foster home that has committed to adopting the child or taking permanent legal
and physical custody of the child and the agency approves of that foster home for permanent
placement of the child. The actions ordered by the court under this section must be consistent
with the best interests, safety, permanency, and welfare of the child.
deleted text end
(h) deleted text begin Unless required under the Indian Child Welfare Act or relieved of this duty by the
court under paragraph (f),deleted text end When the agency determines that it is necessary to prepare for
permanent placement determination proceedings, or in anticipation of filing a termination
of parental rights petition, the agency shall send notice to deleted text begin thedeleted text end relativesnew text begin who responded to a
notice under this section sent at any time during the casenew text end , any adult with whom the child is
currently residing, any adult with whom the child has resided for one year or longer in the
past, and any adults who have maintained a relationship or exercised visitation with the
child as identified in the agency case plan. The notice must state that a permanent home is
sought for the child and that the individuals receiving the notice may indicate to the agency
their interest in providing a permanent home. The notice must state that within 30 days of
receipt of the notice an individual receiving the notice must indicate to the agency the
individual's interest in providing a permanent home for the child or that the individual may
lose the opportunity to be considered for a permanent placement.new text begin A relative's failure to
respond or timely respond to the notice is not a basis for ruling out the relative from being
a permanent placement option for the child, should the relative request to be considered for
permanent placement at a later date.
new text end
Sec. 19.
Minnesota Statutes 2020, section 260C.513, is amended to read:
260C.513 PERMANENCY DISPOSITIONS WHEN CHILD CANNOT RETURN
HOME.
(a) deleted text begin Termination of parental rights and adoption, or guardianship to the commissioner of
human services through a consent to adopt, are preferred permanency options for a child
who cannot return home. If the court finds that termination of parental rights and guardianship
to the commissioner is not in the child's best interests, the court may transfer permanent
legal and physical custody of the child to a relative when that order is in the child's best
interests.deleted text end new text begin For a child who cannot return home, a permanency placement with a relative is
preferred. A permanency placement with a relative includes termination of parental rights
and adoption by a relative, guardianship to the commissioner of human services through a
consent to adopt with a relative, or a transfer of permanent legal and physical custody to a
relative. The court must consider the best interests of the child and section 260C.212,
subdivision 2, paragraph (a), when making a permanency determination.
new text end
(b) When the court has determined that permanent placement of the child away from
the parent is necessary, the court shall consider permanent alternative homes that are available
both inside and outside the state.
Sec. 20.
Minnesota Statutes 2021 Supplement, section 260C.605, subdivision 1, is amended
to read:
Subdivision 1.
Requirements.
(a) Reasonable efforts to finalize the adoption of a child
under the guardianship of the commissioner shall be made by the responsible social services
agency responsible for permanency planning for the child.
(b) Reasonable efforts to make a placement in a home according to the placement
considerations under section 260C.212, subdivision 2, with a relative or foster parent who
will commit to being the permanent resource for the child in the event the child cannot be
reunified with a parent are required under section 260.012 and may be made concurrently
with reasonable, or if the child is an Indian child, active efforts to reunify the child with the
parent.
(c) Reasonable efforts under paragraph (b) must begin as soon as possible when the
child is in foster care under this chapter, but not later than the hearing required under section
260C.204.
(d) Reasonable efforts to finalize the adoption of the child include:
new text begin
(1) considering the child's preference for an adoptive family;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end using age-appropriate engagement strategies to plan for adoption with the child;
deleted text begin (2)deleted text end new text begin (3)new text end identifying an appropriate prospective adoptive parent for the child by updating
the child's identified needs using the factors in section 260C.212, subdivision 2;
deleted text begin (3)deleted text end new text begin (4)new text end making an adoptive placement that meets the child's needs by:
(i) completing or updating the relative search required under section 260C.221 and giving
notice of the need for an adoptive home for the child to:
(A) relatives who have kept the agency or the court apprised of their whereabouts deleted text begin and
who have indicated an interest in adopting the childdeleted text end ; or
(B) relatives of the child who are located in an updated search;
(ii) an updated search is required whenever:
(A) there is no identified prospective adoptive placement for the child notwithstanding
a finding by the court that the agency made diligent efforts under section 260C.221, in a
hearing required under section 260C.202;
(B) the child is removed from the home of an adopting parent; or
(C) the court determines new text begin that new text end a relative search by the agency is in the best interests of
the child;
(iii) engaging the child's new text begin relatives or current or former new text end foster deleted text begin parent and the child's
relatives identified as an adoptive resource during the search conducted under section
260C.221,deleted text end new text begin parentsnew text end to commit to being the prospective adoptive parent of the childnew text begin , and
considering the child's relatives for adoptive placement of the child in the order specified
under section 260C.212, subdivision 2, paragraph (a)new text end ; or
(iv) when there is no identified prospective adoptive parent:
(A) registering the child on the state adoption exchange as required in section 259.75
unless the agency documents to the court an exception to placing the child on the state
adoption exchange reported to the commissioner;
(B) reviewing all families with approved adoption home studies associated with the
responsible social services agency;
(C) presenting the child to adoption agencies and adoption personnel who may assist
with finding an adoptive home for the child;
(D) using newspapers and other media to promote the particular child;
(E) using a private agency under grant contract with the commissioner to provide adoption
services for intensive child-specific recruitment efforts; and
(F) making any other efforts or using any other resources reasonably calculated to identify
a prospective adoption parent for the child;
deleted text begin (4)deleted text end new text begin (5)new text end updating and completing the social and medical history required under sections
260C.212, subdivision 15, and 260C.609;
deleted text begin (5)deleted text end new text begin (6)new text end making, and keeping updated, appropriate referrals required by section 260.851,
the Interstate Compact on the Placement of Children;
deleted text begin (6)deleted text end new text begin (7)new text end giving notice regarding the responsibilities of an adoptive parent to any prospective
adoptive parent as required under section 259.35;
deleted text begin (7)deleted text end new text begin (8)new text end offering the adopting parent the opportunity to apply for or decline adoption
assistance under chapter 256N;
deleted text begin (8)deleted text end new text begin (9)new text end certifying the child for adoption assistance, assessing the amount of adoption
assistance, and ascertaining the status of the commissioner's decision on the level of payment
if the adopting parent has applied for adoption assistance;
deleted text begin (9)deleted text end new text begin (10)new text end placing the child with siblings. If the child is not placed with siblings, the agency
must document reasonable efforts to place the siblings together, as well as the reason for
separation. The agency may not cease reasonable efforts to place siblings together for final
adoption until the court finds further reasonable efforts would be futile or that placement
together for purposes of adoption is not in the best interests of one of the siblings; and
deleted text begin (10)deleted text end new text begin (11)new text end working with the adopting parent to file a petition to adopt the child and with
the court administrator to obtain a timely hearing to finalize the adoption.
Sec. 21.
Minnesota Statutes 2020, section 260C.607, subdivision 2, is amended to read:
Subd. 2.
Notice.
Notice of review hearings shall be given by the court to:
(1) the responsible social services agency;
(2) the child, if the child is age ten and older;
(3) the child's guardian ad litem;
(4) counsel appointed for the child pursuant to section 260C.163, subdivision 3;
(5) relatives of the child who have kept the court informed of their whereabouts as
required in section 260C.221 and who have responded to the agency's notice under section
260C.221, deleted text begin indicating a willingness to provide an adoptive home for the childdeleted text end unless the
relative has been previously ruled out by the court as a suitable deleted text begin foster parent ordeleted text end permanency
resource for the child;
(6) the current foster or adopting parent of the child;
(7) any foster or adopting parents of siblings of the child; and
(8) the Indian child's tribe.
Sec. 22.
Minnesota Statutes 2020, section 260C.607, subdivision 5, is amended to read:
Subd. 5.
Required placement by responsible social services agency.
(a) No petition
for adoption shall be filed for a child under the guardianship of the commissioner unless
the child sought to be adopted has been placed for adoption with the adopting parent by the
responsible social services agencynew text begin as required under section 260C.613, subdivision 1new text end . The
court may order the agency to make an adoptive placement using standards and procedures
under subdivision 6.
(b) Any relative or the child's foster parent who believes the responsible agency has not
reasonably considered the relative's or foster parent's request to be considered for adoptive
placement as required under section 260C.212, subdivision 2, and who wants to be considered
for adoptive placement of the child shall bring a request for consideration to the attention
of the court during a review required under this section. The child's guardian ad litem and
the child may also bring a request for a relative or the child's foster parent to be considered
for adoptive placement. After hearing from the agency, the court may order the agency to
take appropriate action regarding the relative's or foster parent's request for consideration
under section 260C.212, subdivision 2, paragraph (b).
Sec. 23.
Minnesota Statutes 2021 Supplement, section 260C.607, subdivision 6, is amended
to read:
Subd. 6.
Motion and hearing to order adoptive placement.
(a) At any time after the
district court orders the child under the guardianship of the commissioner of human services,
but not later than 30 days after receiving notice required under section 260C.613, subdivision
1, paragraph (c), that the agency has made an adoptive placement, a relative or the child's
foster parent may file a motion for an order for adoptive placement of a child who is under
the guardianship of the commissioner if the relative or the child's foster parent:
(1) has an adoption home study under section 259.41 approving the relative or foster
parent for adoption deleted text begin and hasdeleted text end new text begin . If the relative or foster parent does not have an adoption home
study, an affidavit attesting to efforts to complete an adoption home study may be filed with
the motion instead. The affidavit must be signed by the relative or foster parent and the
responsible social services agency or licensed child-placing agency completing the adoption
home study. The relative or foster parent must also havenew text end been a resident of Minnesota for
at least six months before filing the motion; the court may waive the residency requirement
for the moving party if there is a reasonable basis to do so; or
(2) is not a resident of Minnesota, but has an approved adoption home study by an agency
licensed or approved to complete an adoption home study in the state of the individual's
residence and the study is filed with the motion for adoptive placement. new text begin If the relative or
foster parent does not have an adoption home study in the relative's or foster parent's state
of residence, an affidavit attesting to efforts to complete an adoption home study may be
filed with the motion instead. The affidavit must be signed by the relative or foster parent
and the agency completing the adoption home study.
new text end
(b) The motion shall be filed with the court conducting reviews of the child's progress
toward adoption under this section. The motion and supporting documents must make a
prima facie showing that the agency has been unreasonable in failing to make the requested
adoptive placement. The motion must be served according to the requirements for motions
under the Minnesota Rules of Juvenile Protection Procedure and shall be made on all
individuals and entities listed in subdivision 2.
(c) If the motion and supporting documents do not make a prima facie showing for the
court to determine whether the agency has been unreasonable in failing to make the requested
adoptive placement, the court shall dismiss the motion. If the court determines a prima facie
basis is made, the court shall set the matter for evidentiary hearing.
(d) At the evidentiary hearing, the responsible social services agency shall proceed first
with evidence about the reason for not making the adoptive placement proposed by the
moving party. new text begin When the agency presents evidence regarding the child's current relationship
with the identified adoptive placement resource, the court must consider the agency's efforts
to support the child's relationship with the moving party consistent with section 260C.221.
new text end The moving party then has the burden of proving by a preponderance of the evidence that
the agency has been unreasonable in failing to make the adoptive placement.
new text begin
(e) The court shall review and enter findings regarding whether, in making an adoptive
placement decision for the child, the agency:
new text end
new text begin
(1) considered relatives for adoptive placement in the order specified under section
260C.212, subdivision 2, paragraph (a); and
new text end
new text begin
(2) assessed how the identified adoptive placement resource and the moving party are
each able to meet the child's current and future needs based on an individualized
determination of the child's needs, as required under sections 260C.612, subdivision 2, and
260C.613, subdivision 1, paragraph (b).
new text end
deleted text begin (e)deleted text end new text begin (f)new text end At the conclusion of the evidentiary hearing, if the court finds that the agency has
been unreasonable in failing to make the adoptive placement and that the deleted text begin relative or the
child's foster parentdeleted text end new text begin moving partynew text end is the most suitable adoptive home to meet the child's
needs using the factors in section 260C.212, subdivision 2, paragraph (b), the court maynew text begin :
new text end
new text begin (1)new text end order the responsible social services agency to make an adoptive placement in the
home of the deleted text begin relative or the child's foster parent.deleted text end new text begin moving party if the moving party has an
approved adoption home study; or
new text end
new text begin
(2) order the responsible social services agency to place the child in the home of the
moving party upon approval of an adoption home study. The agency must promote and
support the child's ongoing visitation and contact with the moving party until the child is
placed in the moving party's home. The agency must provide an update to the court after
90 days, including progress and any barriers encountered. If the moving party does not have
an approved adoption home study within 180 days, the moving party and the agency must
inform the court of any barriers to obtaining the approved adoption home study during a
review hearing under this section. If the court finds that the moving party is unable to obtain
an approved adoption home study, the court must dismiss the order for adoptive placement
under this subdivision and order the agency to continue making reasonable efforts to finalize
the adoption of the child as required under section 260C.605.
new text end
deleted text begin (f)deleted text end new text begin (g)new text end If, in order to ensure that a timely adoption may occur, the court orders the
responsible social services agency to make an adoptive placement under this subdivision,
the agency shall:
(1) make reasonable efforts to obtain a fully executed adoption placement agreementnew text begin ,
including assisting the moving party with the adoption home study processnew text end ;
(2) work with the moving party regarding eligibility for adoption assistance as required
under chapter 256N; and
(3) if the moving party is not a resident of Minnesota, timely refer the matter for approval
of the adoptive placement through the Interstate Compact on the Placement of Children.
deleted text begin (g)deleted text end new text begin (h)new text end Denial or granting of a motion for an order for adoptive placement after an
evidentiary hearing is an order which may be appealed by the responsible social services
agency, the moving party, the child, when age ten or over, the child's guardian ad litem,
and any individual who had a fully executed adoption placement agreement regarding the
child at the time the motion was filed if the court's order has the effect of terminating the
adoption placement agreement. An appeal shall be conducted according to the requirements
of the Rules of Juvenile Protection Procedure.
Sec. 24.
Minnesota Statutes 2020, section 260C.613, subdivision 1, is amended to read:
Subdivision 1.
Adoptive placement decisions.
(a) The responsible social services agency
has exclusive authority to make an adoptive placement of a child under the guardianship of
the commissioner. The child shall be considered placed for adoption when the adopting
parent, the agency, and the commissioner have fully executed an adoption placement
agreement on the form prescribed by the commissioner.
(b) The responsible social services agency shall use an individualized determination of
the child's currentnew text begin and futurenew text end needsnew text begin ,new text end pursuant to section 260C.212, subdivision 2, paragraph
(b), to determine the most suitable adopting parent for the child in the child's best interests.new text begin
The responsible social services agency must consider adoptive placement of the child with
relatives in the order specified in section 260C.212, subdivision 2, paragraph (a).
new text end
(c) The responsible social services agency shall notify the court and parties entitled to
notice under section 260C.607, subdivision 2, when there is a fully executed adoption
placement agreement for the child.
(d) In the event an adoption placement agreement terminates, the responsible social
services agency shall notify the court, the parties entitled to notice under section 260C.607,
subdivision 2, and the commissioner that the agreement and the adoptive placement have
terminated.
Sec. 25.
Minnesota Statutes 2020, section 260C.613, subdivision 5, is amended to read:
Subd. 5.
Required record keeping.
The responsible social services agency shall
document, in the records required to be kept under section 259.79, the reasons for the
adoptive placement decision regarding the child, including the individualized determination
of the child's needs based on the factors in section 260C.212, subdivision 2, paragraph (b)deleted text begin ,deleted text end new text begin ;
the agency's consideration of relatives in the order specified in section 260C.212, subdivision
2, paragraph (a);new text end and the assessment of how the selected adoptive placement meets the
identified needs of the child. The responsible social services agency shall retain in the
records required to be kept under section 259.79, copies of all out-of-home placement plans
made since the child was ordered under guardianship of the commissioner and all court
orders from reviews conducted pursuant to section 260C.607.
Sec. 26.
Minnesota Statutes 2021 Supplement, section 260E.20, subdivision 2, is amended
to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall conduct a face-to-face contact with the child reported to be maltreated and
with the child's primary caregiver sufficient to complete a safety assessment and ensure the
immediate safety of the child.new text begin If the report alleges substantial child endangerment or sexual
abuse, the local welfare agency or agency responsible for assessing or investigating the
report is not required to provide notice before conducting the initial face-to-face contact
with the child and the child's primary caregiver.
new text end
(b) The face-to-face contact with the child and primary caregiver shall occur immediately
if sexual abuse or substantial child endangerment is alleged and within five calendar days
for all other reports. If the alleged offender was not already interviewed as the primary
caregiver, the local welfare agency shall also conduct a face-to-face interview with the
alleged offender in the early stages of the assessment or investigation. Face-to-face contact
with the child and primary caregiver in response to a report alleging sexual abuse or
substantial child endangerment may be postponed for no more than five calendar days if
the child is residing in a location that is confirmed to restrict contact with the alleged offender
as established in guidelines issued by the commissioner, or if the local welfare agency is
pursuing a court order for the child's caregiver to produce the child for questioning under
section 260E.22, subdivision 5.
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statement. The
alleged offender may submit supporting documentation relevant to the assessment or
investigation.
Sec. 27.
Minnesota Statutes 2020, section 260E.22, subdivision 2, is amended to read:
Subd. 2.
Child interview procedure.
(a) The interview may take place at school or at
any facility or other place where the alleged victim or other children might be found or the
child may be transported to, and the interview may be conducted at a place appropriate for
the interview of a child designated by the local welfare agency or law enforcement agency.
(b)new text begin When appropriate,new text end the interview deleted text begin maydeleted text end new text begin mustnew text end take place outside the presence of the
alleged offender or parent, legal custodian, guardian, or school officialdeleted text begin .deleted text end new text begin and may take place
prior to any interviews of the alleged offender or parent, legal custodian, guardian, foster
parent, or school official.
new text end
deleted text begin
(c) For a family assessment, it is the preferred practice to request a parent or guardian's
permission to interview the child before conducting the child interview, unless doing so
would compromise the safety assessment.
deleted text end
Sec. 28.
Minnesota Statutes 2020, section 260E.24, subdivision 2, is amended to read:
Subd. 2.
Determination after family assessment.
After conducting a family assessment,
the local welfare agency shall determine whether child protective services are needed to
address the safety of the child and other family members and the risk of subsequent
maltreatment.new text begin The local welfare agency must document the information collected under
section 260E.20, subdivision 3, related to the completed family assessment in the child's or
family's case notes.
new text end
Sec. 29.
Minnesota Statutes 2020, section 260E.34, is amended to read:
260E.34 IMMUNITY.
(a) The following personsnew text begin , including persons under the age of 18,new text end are immune from any
civil or criminal liability that otherwise might result from the person's actions if the person
is acting in good faith:
(1) a person making a voluntary or mandated report under this chapter or assisting in an
assessment under this chapter;
(2) a person with responsibility for performing duties under this section or supervisor
employed by a local welfare agency, the commissioner of an agency responsible for operating
or supervising a licensed or unlicensed day care facility, residential facility, agency, hospital,
sanitarium, or other facility or institution required to be licensed or certified under sections
144.50 to 144.58; 241.021; 245A.01 to 245A.16; or chapter 245B or 245H; or a school as
defined in section 120A.05, subdivisions 9, 11, and 13; and chapter 124E; or a nonlicensed
personal care provider organization as defined in section 256B.0625, subdivision 19a,
complying with sections 260E.23, subdivisions 2 and 3, and 260E.30; and
(3) a public or private school, facility as defined in section 260E.03, or the employee of
any public or private school or facility who permits access by a local welfare agency, the
Department of Education, or a local law enforcement agency and assists in an investigation
or assessment pursuant to this chapter.
(b) A person who is a supervisor or person with responsibility for performing duties
under this chapter employed by a local welfare agency, the commissioner of human services,
or the commissioner of education complying with this chapter or any related rule or provision
of law is immune from any civil or criminal liability that might otherwise result from the
person's actions if the person is (1) acting in good faith and exercising due care, or (2) acting
in good faith and following the information collection procedures established under section
260E.20, subdivision 3.
(c) Any physician or other medical personnel administering a toxicology test under
section 260E.32 to determine the presence of a controlled substance in a pregnant woman,
in a woman within eight hours after delivery, or in a child at birth or during the first month
of life is immune from civil or criminal liability arising from administration of the test if
the physician ordering the test believes in good faith that the test is required under this
section and the test is administered in accordance with an established protocol and reasonable
medical practice.
(d) This section does not provide immunity to any person for failure to make a required
report or for committing maltreatment.
(e) If a person who makes a voluntary or mandatory report under section 260E.06 prevails
in a civil action from which the person has been granted immunity under this section, the
court may award the person attorney fees and costs.
Sec. 30.
Minnesota Statutes 2020, section 626.557, subdivision 4, is amended to read:
Subd. 4.
Reporting.
(a) Except as provided in paragraph (b), a mandated reporter shall
immediately make deleted text begin an oraldeleted text end new text begin anew text end report to the common entry point. deleted text begin The common entry point
may accept electronic reports submitted through a web-based reporting system established
by the commissioner. Use of a telecommunications device for the deaf or other similar
device shall be considered an oral report. The common entry point may not require written
reports.deleted text end To the extent possible, the report must be of sufficient content to identify the
vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment, any
evidence of previous maltreatment, the name and address of the reporter, the time, date,
and location of the incident, and any other information that the reporter believes might be
helpful in investigating the suspected maltreatment. A mandated reporter may disclose not
public data, as defined in section 13.02, and medical records under sections 144.291 to
144.298, to the extent necessary to comply with this subdivision.
(b) A boarding care home that is licensed under sections 144.50 to 144.58 and certified
under Title 19 of the Social Security Act, a nursing home that is licensed under section
144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a hospital
that is licensed under sections 144.50 to 144.58 and has swing beds certified under Code
of Federal Regulations, title 42, section 482.66, may submit a report electronically to the
common entry point instead of submitting an oral report. The report may be a duplicate of
the initial report the facility submits electronically to the commissioner of health to comply
with the reporting requirements under Code of Federal Regulations, title 42, section 483.12.
The commissioner of health may modify these reporting requirements to include items
required under paragraph (a) that are not currently included in the electronic reporting form.
Sec. 31.
Minnesota Statutes 2020, section 626.557, subdivision 9, is amended to read:
Subd. 9.
Common entry point designation.
(a) deleted text begin Each county board shall designate a
common entry point for reports of suspected maltreatment, for use until the commissioner
of human services establishes a common entry point. Two or more county boards may
jointly designate a single common entry point.deleted text end The commissioner of human services shall
establish a common entry point deleted text begin effective July 1, 2015deleted text end . The common entry point is the unit
responsible for receiving the report of suspected maltreatment under this section.
(b) The common entry point must be available 24 hours per day to take calls from
reporters of suspected maltreatment. The common entry point shall use a standard intake
form that includes:
(1) the time and date of the report;
(2)new text begin the name, relationship, and identifying and contact information for the person believed
to be a vulnerable adult and the individual or facility alleged responsible for maltreatment;
new text end
new text begin (3)new text end the name, deleted text begin address, and telephone number of the person reporting;deleted text end new text begin relationship, and
contact information for the:
new text end
new text begin
(i) reporter;
new text end
new text begin
(ii) initial reporter, witnesses, and persons who may have knowledge about the
maltreatment; and
new text end
new text begin
(iii) legal surrogate and persons who may provide support to the vulnerable adult;
new text end
new text begin
(4) the basis of vulnerability for the vulnerable adult;
new text end
deleted text begin (3)deleted text end new text begin (5)new text end the time, date, and location of the incident;
deleted text begin
(4) the names of the persons involved, including but not limited to, perpetrators, alleged
victims, and witnesses;
deleted text end
deleted text begin
(5) whether there was a risk of imminent danger to the alleged victim;
deleted text end
new text begin
(6) the immediate safety risk to the vulnerable adult;
new text end
deleted text begin (6)deleted text end new text begin (7)new text end a description of the suspected maltreatment;
deleted text begin
(7) the disability, if any, of the alleged victim;
deleted text end
deleted text begin
(8) the relationship of the alleged perpetrator to the alleged victim;
deleted text end
new text begin
(8) the impact of the suspected maltreatment on the vulnerable adult;
new text end
(9) whether a facility was involved and, if so, which agency licenses the facility;
deleted text begin
(10) any action taken by the common entry point;
deleted text end
deleted text begin
(11) whether law enforcement has been notified;
deleted text end
new text begin
(10) the actions taken to protect the vulnerable adult;
new text end
new text begin
(11) the required notifications and referrals made by the common entry point; and
new text end
(12) whether the reporter wishes to receive notification of the deleted text begin initial and final reports;
anddeleted text end new text begin disposition.
new text end
deleted text begin
(13) if the report is from a facility with an internal reporting procedure, the name, mailing
address, and telephone number of the person who initiated the report internally.
deleted text end
(c) The common entry point is not required to complete each item on the form prior to
dispatching the report to the appropriate lead investigative agency.
(d) The common entry point shall immediately report to a law enforcement agency any
incident in which there is reason to believe a crime has been committed.
(e) If a report is initially made to a law enforcement agency or a lead investigative agency,
those agencies shall take the report on the appropriate common entry point intake forms
and immediately forward a copy to the common entry point.
(f) The common entry point staff must receive training on how to screen and dispatch
reports efficiently and in accordance with this section.
(g) The commissioner of human services shall maintain a centralized database for the
collection of common entry point data, lead investigative agency data including maltreatment
report disposition, and appeals data. The common entry point shall have access to the
centralized database and must log the reports into the database deleted text begin and immediately identify
and locate prior reports of abuse, neglect, or exploitationdeleted text end .
(h) When appropriate, the common entry point staff must refer calls that do not allege
the abuse, neglect, or exploitation of a vulnerable adult to other organizations that might
resolve the reporter's concerns.
(i) A common entry point must be operated in a manner that enables the commissioner
of human services to:
(1) track critical steps in the reporting, evaluation, referral, response, disposition, and
investigative process to ensure compliance with all requirements for all reports;
(2) maintain data to facilitate the production of aggregate statistical reports for monitoring
patterns of abuse, neglect, or exploitation;
(3) serve as a resource for the evaluation, management, and planning of preventative
and remedial services for vulnerable adults who have been subject to abuse, neglect, or
exploitation;
(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
of the common entry point; and
(5) track and manage consumer complaints related to the common entry point.
(j) The commissioners of human services and health shall collaborate on the creation of
a system for referring reports to the lead investigative agencies. This system shall enable
the commissioner of human services to track critical steps in the reporting, evaluation,
referral, response, disposition, investigation, notification, determination, and appeal processes.
Sec. 32.
Minnesota Statutes 2020, section 626.557, subdivision 9b, is amended to read:
Subd. 9b.
Response to reports.
Law enforcement is the primary agency to conduct
investigations of any incident in which there is reason to believe a crime has been committed.
Law enforcement shall initiate a response immediately. If the common entry point notified
a county agency for emergency adult protective services, law enforcement shall cooperate
with that county agency when both agencies are involved and shall exchange data to the
extent authorized in subdivision 12b, paragraph (g). County adult protection shall initiate
a response immediately. Each lead investigative agency shall complete the investigative
process for reports within its jurisdiction. A lead investigative agency, county, adult protective
agency, licensed facility, or law enforcement agency shall cooperate with other agencies in
the provision of protective services, coordinating its investigations, and assisting another
agency within the limits of its resources and expertise and shall exchange data to the extent
authorized in subdivision 12b, paragraph (g). The lead investigative agency shall obtain the
results of any investigation conducted by law enforcement officials. The lead investigative
agency has the right to enter facilities and inspect and copy records as part of investigations.
The lead investigative agency has access to not public data, as defined in section 13.02, and
medical records under sections 144.291 to 144.298, that are maintained by facilities to the
extent necessary to conduct its investigation. Each lead investigative agency shall develop
guidelines for prioritizing reports for investigation.new text begin When a county acts as a lead investigative
agency, the county shall make guidelines available to the public regarding which reports
the county prioritizes for investigation and adult protective services.
new text end
Sec. 33.
Minnesota Statutes 2020, section 626.557, subdivision 9c, is amended to read:
Subd. 9c.
Lead investigative agency; notifications, dispositions, determinations.
(a)
Upon request of the reporter, the lead investigative agency shall notify the reporter that it
has received the report, and provide information on the initial disposition of the report within
five business days of receipt of the report, provided that the notification will not endanger
the vulnerable adult or hamper the investigation.
new text begin
(b) In making the initial disposition of a report alleging maltreatment of a vulnerable
adult, the lead investigative agency may consider previous reports of suspected maltreatment
and may request and consider public information, records maintained by a lead investigative
agency or licensed providers, and information from any person who may have knowledge
regarding the alleged maltreatment and the basis for the adult's vulnerability.
new text end
new text begin
(c) Unless the lead investigative agency believes that: (1) the information would endanger
the well-being of the vulnerable adult; or (2) it would not be in the best interests of the
vulnerable adult, the lead investigative agency shall inform the vulnerable adult, or vulnerable
adult's guardian or health care agent, if known and when applicable to the authority of the
vulnerable adult's guardian or health care agent, of all reports accepted by the agency for
investigation, including the maltreatment allegation, investigation guidelines, time frame,
and evidence standards that the agency uses for determinations. If the allegation is applicable
to the guardian or health care agent, the lead investigative agency must also inform the
vulnerable adult's guardian or health care agent of all reports accepted for investigation by
the agency, including the maltreatment allegation, investigation guidelines, time frame, and
evidence standards that the agency uses for determinations.
new text end
new text begin
(d) When the county social service agency does not accept a report for adult protective
services or investigation, the agency may offer assistance to the reporter or the person who
was the subject of the report.
new text end
new text begin
(e) When the county is the lead investigative agency or the agency responsible for adult
protective services, the agency may coordinate and share data with the Native American
Tribes and case management agencies as allowed under chapter 13 to support a vulnerable
adult's health, safety, or comfort or to prevent, stop, or remediate maltreatment. The identity
of the reporter shall not be disclosed, except as provided in subdivision 12b.
new text end
new text begin
(f) While investigating reports and providing adult protective services, the lead
investigative agency may coordinate with entities identified under subdivision 12b, paragraph
(g), and may coordinate with support persons to safeguard the welfare of the vulnerable
adult and prevent further maltreatment of the vulnerable adult.
new text end
deleted text begin (b)deleted text end new text begin (g)new text end Upon conclusion of every investigation it conducts, the lead investigative agency
shall make a final disposition as defined in section 626.5572, subdivision 8.
deleted text begin (c)deleted text end new text begin (h)new text end When determining whether the facility or individual is the responsible party for
substantiated maltreatment or whether both the facility and the individual are responsible
for substantiated maltreatment, the lead investigative agency shall consider at least the
following mitigating factors:
(1) whether the actions of the facility or the individual caregivers were in accordance
with, and followed the terms of, an erroneous physician order, prescription, resident care
plan, or directive. This is not a mitigating factor when the facility or caregiver is responsible
for the issuance of the erroneous order, prescription, plan, or directive or knows or should
have known of the errors and took no reasonable measures to correct the defect before
administering care;
(2) the comparative responsibility between the facility, other caregivers, and requirements
placed upon the employee, including but not limited to, the facility's compliance with related
regulatory standards and factors such as the adequacy of facility policies and procedures,
the adequacy of facility training, the adequacy of an individual's participation in the training,
the adequacy of caregiver supervision, the adequacy of facility staffing levels, and a
consideration of the scope of the individual employee's authority; and
(3) whether the facility or individual followed professional standards in exercising
professional judgment.
deleted text begin (d)deleted text end new text begin (i)new text end When substantiated maltreatment is determined to have been committed by an
individual who is also the facility license holder, both the individual and the facility must
be determined responsible for the maltreatment, and both the background study
disqualification standards under section 245C.15, subdivision 4, and the licensing actions
under section 245A.06 or 245A.07 apply.
deleted text begin (e)deleted text end new text begin (j)new text end The lead investigative agency shall complete its final disposition within 60 calendar
days. If the lead investigative agency is unable to complete its final disposition within 60
calendar days, the lead investigative agency shall notify the following persons provided
that the notification will not endanger the vulnerable adult or hamper the investigation: (1)
the vulnerable adult or the vulnerable adult's guardian or health care agent, when known,
if the lead investigative agency knows them to be aware of the investigation; and (2) the
facility, where applicable. The notice shall contain the reason for the delay and the projected
completion date. If the lead investigative agency is unable to complete its final disposition
by a subsequent projected completion date, the lead investigative agency shall again notify
the vulnerable adult or the vulnerable adult's guardian or health care agent, when known if
the lead investigative agency knows them to be aware of the investigation, and the facility,
where applicable, of the reason for the delay and the revised projected completion date
provided that the notification will not endanger the vulnerable adult or hamper the
investigation. The lead investigative agency must notify the health care agent of the
vulnerable adult only if the health care agent's authority to make health care decisions for
the vulnerable adult is currently effective under section 145C.06 and not suspended under
section 524.5-310 and the investigation relates to a duty assigned to the health care agent
by the principal. A lead investigative agency's inability to complete the final disposition
within 60 calendar days or by any projected completion date does not invalidate the final
disposition.
deleted text begin (f) Within ten calendar days of completing the final dispositiondeleted text end new text begin (k) When the lead
investigative agency is the Department of Health or the Department of Human Servicesnew text end ,
the lead investigative agency shall provide a copy of the public investigation memorandum
under subdivision 12b, paragraph (b), clause (1), deleted text begin when required to be completed under this
section,deleted text end new text begin within ten calendar days of completing the final dispositionnew text end to the following persons:
(1) the vulnerable adult, or the vulnerable adult's guardian or health care agent, if known,
unless the lead investigative agency knows that the notification would endanger the
well-being of the vulnerable adult;
(2) the reporter, if the reporter requested notification when making the report, provided
this notification would not endanger the well-being of the vulnerable adult;
(3) the deleted text begin alleged perpetratordeleted text end new text begin person or facility alleged responsible for maltreatmentnew text end , if
known;
(4) the facility; and
(5) the ombudsman for long-term care, or the ombudsman for mental health and
developmental disabilities, as appropriate.
new text begin
(l) When the lead investigative agency is a county agency, within ten calendar days of
completing the final disposition, the lead investigative agency shall provide notification of
the final disposition to the following persons:
new text end
new text begin
(1) the vulnerable adult, or the vulnerable adult's guardian or health care agent, if known,
when the allegation is applicable to the authority of the vulnerable adult's guardian or health
care agent, unless the agency knows that the notification would endanger the well-being of
the vulnerable adult;
new text end
new text begin
(2) the individual determined responsible for maltreatment, if known; and
new text end
new text begin
(3) when the alleged incident involves a personal care assistant or provider agency, the
personal care provider organization under section 256B.0659. Upon implementation of
Community First Services and Supports (CFSS), this notification requirement applies to
the CFSS support worker or CFSS agency under section 256B.85.
new text end
deleted text begin (g)deleted text end new text begin (m)new text end If, as a result of a reconsideration, review, or hearing, the lead investigative
agency changes the final disposition, or if a final disposition is changed on appeal, the lead
investigative agency shall notify the parties specified in paragraph deleted text begin (f)deleted text end new text begin (k)new text end .
deleted text begin (h)deleted text end new text begin (n)new text end The lead investigative agency shall notify the vulnerable adult who is the subject
of the report or the vulnerable adult's guardian or health care agent, if known, and any person
or facility determined to have maltreated a vulnerable adult, of their appeal or review rights
under this section or section 256.021.
deleted text begin (i)deleted text end new text begin (o)new text end The lead investigative agency shall routinely provide investigation memoranda
for substantiated reports to the appropriate licensing boards. These reports must include the
names of substantiated perpetrators. The lead investigative agency may not provide
investigative memoranda for inconclusive or false reports to the appropriate licensing boards
unless the lead investigative agency's investigation gives reason to believe that there may
have been a violation of the applicable professional practice laws. If the investigation
memorandum is provided to a licensing board, the subject of the investigation memorandum
shall be notified and receive a summary of the investigative findings.
deleted text begin (j)deleted text end new text begin (p)new text end In order to avoid duplication, licensing boards shall consider the findings of the
lead investigative agency in their investigations if they choose to investigate. This does not
preclude licensing boards from considering other information.
deleted text begin (k)deleted text end new text begin (q)new text end The lead investigative agency must provide to the commissioner of human services
its final dispositions, including the names of all substantiated perpetrators. The commissioner
of human services shall establish records to retain the names of substantiated perpetrators.
Sec. 34.
Minnesota Statutes 2020, section 626.557, subdivision 9d, is amended to read:
Subd. 9d.
Administrative reconsideration; review panel.
(a) Except as provided under
paragraph (e), any individual or facility which a lead investigative agency determines has
maltreated a vulnerable adult, or the vulnerable adult or an interested person acting on behalf
of the vulnerable adult, regardless of the lead investigative agency's determination, who
contests the lead investigative agency's final disposition of an allegation of maltreatment,
may request the lead investigative agency to reconsider its final disposition. The request
for reconsideration must be submitted in writing to the lead investigative agency within 15
calendar days after receipt of notice of final disposition or, if the request is made by an
interested person who is not entitled to notice, within 15 days after receipt of the notice by
the vulnerable adult or the vulnerable adult's guardian or health care agent. If mailed, the
request for reconsideration must be postmarked and sent to the lead investigative agency
within 15 calendar days of the individual's or facility's receipt of the final disposition. If the
request for reconsideration is made by personal service, it must be received by the lead
investigative agency within 15 calendar days of the individual's or facility's receipt of the
final disposition. An individual who was determined to have maltreated a vulnerable adult
under this section and who was disqualified on the basis of serious or recurring maltreatment
under sections 245C.14 and 245C.15, may request reconsideration of the maltreatment
determination and the disqualification. The request for reconsideration of the maltreatment
determination and the disqualification must be submitted in writing within 30 calendar days
of the individual's receipt of the notice of disqualification under sections 245C.16 and
245C.17. If mailed, the request for reconsideration of the maltreatment determination and
the disqualification must be postmarked and sent to the lead investigative agency within 30
calendar days of the individual's receipt of the notice of disqualification. If the request for
reconsideration is made by personal service, it must be received by the lead investigative
agency within 30 calendar days after the individual's receipt of the notice of disqualification.
(b) Except as provided under paragraphs (e) and (f), if the lead investigative agency
denies the request or fails to act upon the request within 15 working days after receiving
the request for reconsideration, the person or facility entitled to a fair hearing under section
256.045, may submit to the commissioner of human services a written request for a hearing
under that statute. The vulnerable adult, or an interested person acting on behalf of the
vulnerable adult, may request a review by the Vulnerable Adult Maltreatment Review Panel
under section 256.021 if the lead investigative agency denies the request or fails to act upon
the request, or if the vulnerable adult or interested person contests a reconsidered disposition.new text begin
The Vulnerable Adult Maltreatment Review Panel shall not conduct a review if the interested
person making the request on behalf of the vulnerable adult is also the individual or facility
alleged responsible for the maltreatment of the vulnerable adult.new text end The lead investigative
agency shall notify persons who request reconsideration of their rights under this paragraph.
The request must be submitted in writing to the review panel and a copy sent to the lead
investigative agency within 30 calendar days of receipt of notice of a denial of a request for
reconsideration or of a reconsidered disposition. The request must specifically identify the
aspects of the lead investigative agency determination with which the person is dissatisfied.
(c) If, as a result of a reconsideration or review, the lead investigative agency changes
the final disposition, it shall notify the parties specified in subdivision 9c, paragraph deleted text begin (f)deleted text end new text begin (i)new text end .
(d) For purposes of this subdivision, "interested person acting on behalf of the vulnerable
adult" means a person designated in writing by the vulnerable adult to act on behalf of the
vulnerable adult, or a legal guardian or conservator or other legal representative, a proxy
or health care agent appointed under chapter 145B or 145C, or an individual who is related
to the vulnerable adult, as defined in section 245A.02, subdivision 13.
(e) If an individual was disqualified under sections 245C.14 and 245C.15, on the basis
of a determination of maltreatment, which was serious or recurring, and the individual has
requested reconsideration of the maltreatment determination under paragraph (a) and
reconsideration of the disqualification under sections 245C.21 to 245C.27, reconsideration
of the maltreatment determination and requested reconsideration of the disqualification
shall be consolidated into a single reconsideration. If reconsideration of the maltreatment
determination is denied and the individual remains disqualified following a reconsideration
decision, the individual may request a fair hearing under section 256.045. If an individual
requests a fair hearing on the maltreatment determination and the disqualification, the scope
of the fair hearing shall include both the maltreatment determination and the disqualification.
(f) If a maltreatment determination or a disqualification based on serious or recurring
maltreatment is the basis for a denial of a license under section 245A.05 or a licensing
sanction under section 245A.07, the license holder has the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. As provided for
under section 245A.08, the scope of the contested case hearing must include the maltreatment
determination, disqualification, and licensing sanction or denial of a license. In such cases,
a fair hearing must not be conducted under section 256.045. Except for family child care
and child foster care, reconsideration of a maltreatment determination under this subdivision,
and reconsideration of a disqualification under section 245C.22, must not be conducted
when:
(1) a denial of a license under section 245A.05, or a licensing sanction under section
245A.07, is based on a determination that the license holder is responsible for maltreatment
or the disqualification of a license holder based on serious or recurring maltreatment;
(2) the denial of a license or licensing sanction is issued at the same time as the
maltreatment determination or disqualification; and
(3) the license holder appeals the maltreatment determination or disqualification, and
denial of a license or licensing sanction.
Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
determination or disqualification, but does not appeal the denial of a license or a licensing
sanction, reconsideration of the maltreatment determination shall be conducted under sections
260E.33 and 626.557, subdivision 9d, and reconsideration of the disqualification shall be
conducted under section 245C.22. In such cases, a fair hearing shall also be conducted as
provided under sections 245C.27, 260E.33, and 626.557, subdivision 9d.
If the disqualified subject is an individual other than the license holder and upon whom
a background study must be conducted under chapter 245C, the hearings of all parties may
be consolidated into a single contested case hearing upon consent of all parties and the
administrative law judge.
(g) Until August 1, 2002, an individual or facility that was determined by the
commissioner of human services or the commissioner of health to be responsible for neglect
under section 626.5572, subdivision 17, after October 1, 1995, and before August 1, 2001,
that believes that the finding of neglect does not meet an amended definition of neglect may
request a reconsideration of the determination of neglect. The commissioner of human
services or the commissioner of health shall mail a notice to the last known address of
individuals who are eligible to seek this reconsideration. The request for reconsideration
must state how the established findings no longer meet the elements of the definition of
neglect. The commissioner shall review the request for reconsideration and make a
determination within 15 calendar days. The commissioner's decision on this reconsideration
is the final agency action.
(1) For purposes of compliance with the data destruction schedule under subdivision
12b, paragraph (d), when a finding of substantiated maltreatment has been changed as a
result of a reconsideration under this paragraph, the date of the original finding of a
substantiated maltreatment must be used to calculate the destruction date.
(2) For purposes of any background studies under chapter 245C, when a determination
of substantiated maltreatment has been changed as a result of a reconsideration under this
paragraph, any prior disqualification of the individual under chapter 245C that was based
on this determination of maltreatment shall be rescinded, and for future background studies
under chapter 245C the commissioner must not use the previous determination of
substantiated maltreatment as a basis for disqualification or as a basis for referring the
individual's maltreatment history to a health-related licensing board under section 245C.31.
Sec. 35.
Minnesota Statutes 2020, section 626.557, subdivision 10, is amended to read:
Subd. 10.
Duties of county social service agency.
(a) When the common entry point
refers a report to the county social service agency as the lead investigative agency or makes
a referral to the county social service agency for emergency adult protective services, or
when another lead investigative agency requests assistance from the county social service
agency for adult protective services, the county social service agency shall immediately
assess and offer emergency and continuing protective social services for purposes of
preventing further maltreatment and for safeguarding the welfare of the maltreated vulnerable
adult. The county shall use deleted text begin adeleted text end standardized deleted text begin tooldeleted text end new text begin tools and the data systemnew text end made available by
the commissioner. The information entered by the county into the standardized tool must
be accessible to the Department of Human Services. In cases of suspected sexual abuse, the
county social service agency shall immediately arrange for and make available to the
vulnerable adult appropriate medical examination and treatment. When necessary in order
to protect the vulnerable adult from further harm, the county social service agency shall
seek authority to remove the vulnerable adult from the situation in which the maltreatment
occurred. The county social service agency may also investigate to determine whether the
conditions which resulted in the reported maltreatment place other vulnerable adults in
jeopardy of being maltreated and offer protective social services that are called for by its
determination.
new text begin
(b) Within five business days of receipt of a report screened in by the county social
service agency for investigation, the county social service agency shall determine whether,
in addition to an assessment and services for the vulnerable adult, to also conduct an
investigation for final disposition of the individual or facility alleged to have maltreated the
vulnerable adult.
new text end
new text begin
(c) The county social service agency must investigate for a final disposition the individual
or facility alleged to have maltreated a vulnerable adult for each report accepted as lead
investigative agency involving an allegation of abuse, caregiver neglect that resulted in
harm to the vulnerable adult, financial exploitation that may be criminal, or an allegation
against a caregiver under chapter 256B.
new text end
new text begin
(d) An investigating county social service agency must make a final disposition for any
allegation when the county social service agency determines that a final disposition may
safeguard a vulnerable adult or may prevent further maltreatment.
new text end
new text begin
(e) If the county social service agency learns of an allegation listed in paragraph (c) after
the determination in paragraph (a), the county social service agency must change the initial
determination and conduct an investigation for final disposition of the individual or facility
alleged to have maltreated the vulnerable adult.
new text end
deleted text begin (b)deleted text end new text begin (f)new text end County social service agencies may enter facilities and inspect and copy records
as part of an investigation. The county social service agency has access to not public data,
as defined in section 13.02, and medical records under sections 144.291 to 144.298, that
are maintained by facilities to the extent necessary to conduct its investigation. The inquiry
is not limited to the written records of the facility, but may include every other available
source of information.
deleted text begin (c)deleted text end new text begin (g)new text end When necessary in order to protect a vulnerable adult from serious harm, the
county social service agency shall immediately intervene on behalf of that adult to help the
family, vulnerable adult, or other interested person by seeking any of the following:
(1) a restraining order or a court order for removal of the perpetrator from the residence
of the vulnerable adult pursuant to section 518B.01;
(2) the appointment of a guardian or conservator pursuant to sections 524.5-101 to
524.5-502, or guardianship or conservatorship pursuant to chapter 252A;
(3) replacement of a guardian or conservator suspected of maltreatment and appointment
of a suitable person as guardian or conservator, pursuant to sections 524.5-101 to 524.5-502;
or
(4) a referral to the prosecuting attorney for possible criminal prosecution of the
perpetrator under chapter 609.
The expenses of legal intervention must be paid by the county in the case of indigent
persons, under section 524.5-502 and chapter 563.
In proceedings under sections 524.5-101 to 524.5-502, if a suitable relative or other
person is not available to petition for guardianship or conservatorship, a county employee
shall present the petition with representation by the county attorney. The county shall contract
with or arrange for a suitable person or organization to provide ongoing guardianship
services. If the county presents evidence to the court exercising probate jurisdiction that it
has made a diligent effort and no other suitable person can be found, a county employee
may serve as guardian or conservator. The county shall not retaliate against the employee
for any action taken on behalf of the deleted text begin ward or protecteddeleted text end person new text begin subject to guardianship or
conservatorship, new text end even if the action is adverse to the county's interest. Any person retaliated
against in violation of this subdivision shall have a cause of action against the county and
shall be entitled to reasonable attorney fees and costs of the action if the action is upheld
by the court.
Sec. 36.
Minnesota Statutes 2020, section 626.557, subdivision 10b, is amended to read:
Subd. 10b.
Investigations; guidelines.
new text begin (a) new text end Each lead investigative agency shall develop
guidelines for prioritizing reports for investigation.
new text begin (b)new text end When investigating a report, the lead investigative agency shall conduct the following
activitiesdeleted text begin ,deleted text end as appropriate:
(1) interview of the deleted text begin alleged victimdeleted text end new text begin vulnerable adultnew text end ;
(2) interview of the reporter and others who may have relevant information;
(3) interview of the deleted text begin alleged perpetratordeleted text end new text begin individual or facility alleged responsible for
maltreatmentnew text end ;new text begin and
new text end
deleted text begin
(4) examination of the environment surrounding the alleged incident;
deleted text end
deleted text begin (5)deleted text end new text begin (4)new text end review ofnew text begin records andnew text end pertinent documentation of the alleged incidentdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(6) consultation with professionals.
deleted text end
new text begin
(c) The lead investigative agency shall conduct the following activities as appropriate
to further the investigation, to prevent further maltreatment, or to safeguard the vulnerable
adult:
new text end
new text begin
(1) examining the environment surrounding the alleged incident;
new text end
new text begin
(2) consulting with professionals; and
new text end
new text begin
(3) communicating with state, federal, tribal, and other agencies including:
new text end
new text begin
(i) service providers;
new text end
new text begin
(ii) case managers;
new text end
new text begin
(iii) ombudsmen; and
new text end
new text begin
(iv) support persons for the vulnerable adult.
new text end
new text begin
(d) The lead investigative agency may decide not to conduct an interview of a vulnerable
adult, reporter, or witness under paragraph (b) if:
new text end
new text begin
(1) the vulnerable adult, reporter, or witness declines to have an interview with the
agency or is unable to be contacted despite the agency's diligent attempts;
new text end
new text begin
(2) an interview of the vulnerable adult or reporter was conducted by law enforcement
or a professional trained in forensic interview and an additional interview will not further
the investigation;
new text end
new text begin
(3) an interview of the witness will not further the investigation; or
new text end
new text begin
(4) the agency has a reason to believe that the interview will endanger the vulnerable
adult.
new text end
Sec. 37.
Minnesota Statutes 2020, section 626.557, subdivision 12b, is amended to read:
Subd. 12b.
Data management.
(a) In performing any of the duties of this section as a
lead investigative agency, the county social service agency shall maintain appropriate
records. Data collected by the county social service agency under this sectionnew text begin while providing
adult protective servicesnew text end are welfare data under section 13.46. new text begin Investigative data collected
under this section are confidential data on individuals or protected nonpublic data as defined
under section 13.02. new text end Notwithstanding section 13.46, subdivision 1, paragraph (a), data under
this paragraph that are inactive investigative data on an individual who is a vendor of services
are private data on individuals, as defined in section 13.02. The identity of the reporter may
only be disclosed as provided in paragraph (c).
Data maintained by the common entry point are confidential data on individuals or
protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163, the
common entry point shall maintain data for three calendar years after date of receipt and
then destroy the data unless otherwise directed by federal requirements.
(b) The commissioners of health and human services shall prepare an investigation
memorandum for each report alleging maltreatment investigated under this section. County
social service agencies must maintain private data on individuals but are not required to
prepare an investigation memorandum. During an investigation by the commissioner of
health or the commissioner of human services, data collected under this section are
confidential data on individuals or protected nonpublic data as defined in section 13.02.
Upon completion of the investigation, the data are classified as provided in clauses (1) to
(3) and paragraph (c).
(1) The investigation memorandum must contain the following data, which are public:
(i) the name of the facility investigated;
(ii) a statement of the nature of the alleged maltreatment;
(iii) pertinent information obtained from medical or other records reviewed;
(iv) the identity of the investigator;
(v) a summary of the investigation's findings;
(vi) statement of whether the report was found to be substantiated, inconclusive, false,
or that no determination will be made;
(vii) a statement of any action taken by the facility;
(viii) a statement of any action taken by the lead investigative agency; and
(ix) when a lead investigative agency's determination has substantiated maltreatment, a
statement of whether an individual, individuals, or a facility were responsible for the
substantiated maltreatment, if known.
The investigation memorandum must be written in a manner which protects the identity
of the reporter and of the vulnerable adult and may not contain the names or, to the extent
possible, data on individuals or private data listed in clause (2).
(2) Data on individuals collected and maintained in the investigation memorandum are
private data, including:
(i) the name of the vulnerable adult;
(ii) the identity of the individual alleged to be the perpetrator;
(iii) the identity of the individual substantiated as the perpetrator; and
(iv) the identity of all individuals interviewed as part of the investigation.
(3) Other data on individuals maintained as part of an investigation under this section
are private data on individuals upon completion of the investigation.
(c) deleted text begin After the assessment or investigation is completed,deleted text end The name of the reporter must
be confidential. The subject of the report may compel disclosure of the name of the reporter
only with the consent of the reporter or upon a written finding by a court that the report was
false and there is evidence that the report was made in bad faith. This subdivision does not
alter disclosure responsibilities or obligations under the Rules of Criminal Procedure, except
that where the identity of the reporter is relevant to a criminal prosecution, the district court
shall do an in-camera review prior to determining whether to order disclosure of the identity
of the reporter.
(d) Notwithstanding section 138.163, data maintained under this section by the
commissioners of health and human services must be maintained under the following
schedule and then destroyed unless otherwise directed by federal requirements:
(1) data from reports determined to be false, maintained for three years after the finding
was made;
(2) data from reports determined to be inconclusive, maintained for four years after the
finding was made;
(3) data from reports determined to be substantiated, maintained for seven years after
the finding was made; and
(4) data from reports which were not investigated by a lead investigative agency and for
which there is no final disposition, maintained for three years from the date of the report.
(e) The commissioners of health and human services shall annually publish on their
websites the number and type of reports of alleged maltreatment involving licensed facilities
reported under this section, the number of those requiring investigation under this section,
and the resolution of those investigations. On a biennial basis, the commissioners of health
and human services shall jointly report the following information to the legislature and the
governor:
(1) the number and type of reports of alleged maltreatment involving licensed facilities
reported under this section, the number of those requiring investigations under this section,
the resolution of those investigations, and which of the two lead agencies was responsible;
(2) trends about types of substantiated maltreatment found in the reporting period;
(3) if there are upward trends for types of maltreatment substantiated, recommendations
for addressing and responding to them;
(4) efforts undertaken or recommended to improve the protection of vulnerable adults;
(5) whether and where backlogs of cases result in a failure to conform with statutory
time frames and recommendations for reducing backlogs if applicable;
(6) recommended changes to statutes affecting the protection of vulnerable adults; and
(7) any other information that is relevant to the report trends and findings.
(f) Each lead investigative agency must have a record retention policy.
(g) Lead investigative agencies,new text begin county agencies responsible for adult protective services,new text end
prosecuting authorities, and law enforcement agencies may exchange not public data, as
defined in section 13.02,new text begin with a tribal agency, facility, service provider, vulnerable adult,
primary support person for a vulnerable adult, state licensing board, federal or state agency,
the ombudsman for long-term care, or the ombudsman for mental health and developmental
disabilities,new text end if the agency or authority deleted text begin requestingdeleted text end new text begin providingnew text end the data determines that the data
are pertinent and necessary deleted text begin to the requesting agency in initiating, furthering, or completingdeleted text end new text begin
to prevent further maltreatment of a vulnerable adult, to safeguard a vulnerable adult, or fornew text end
an investigation under this section. Data collected under this section must be made available
to prosecuting authorities and law enforcement officials, local county agencies, and licensing
agencies investigating the alleged maltreatment under this section. The lead investigative
agency shall exchange not public data with the vulnerable adult maltreatment review panel
established in section 256.021 if the data are pertinent and necessary for a review requested
under that section. Notwithstanding section 138.17, upon completion of the review, not
public data received by the review panel must be destroyed.
(h) Each lead investigative agency shall keep records of the length of time it takes to
complete its investigations.
(i) A lead investigative agency may notify other affected parties and their authorized
representative if the lead investigative agency has reason to believe maltreatment has occurred
and determines the information will safeguard the well-being of the affected parties or dispel
widespread rumor or unrest in the affected facility.
(j) Under any notification provision of this section, where federal law specifically
prohibits the disclosure of patient identifying information, a lead investigative agency may
not provide any notice unless the vulnerable adult has consented to disclosure in a manner
which conforms to federal requirements.
Sec. 38.
Minnesota Statutes 2020, section 626.5571, subdivision 1, is amended to read:
Subdivision 1.
Establishment of team.
A county may establish a multidisciplinary adult
protection team comprised of the director of the local welfare agency or designees, the
county attorney or designees, the county sheriff or designees, and representatives of health
care. In addition, representatives of mental health or other appropriate human service
agencies, representatives from local tribal governments, deleted text begin anddeleted text end adult advocate groupsnew text begin , and any
other organization with relevant expertisenew text end may be added to the adult protection team.
Sec. 39.
Minnesota Statutes 2020, section 626.5571, subdivision 2, is amended to read:
Subd. 2.
Duties of team.
A multidisciplinary adult protection team may provide public
and professional education, develop resources for prevention, intervention, and treatment,
and provide case consultation to the local welfare agency to better enable the agency to
carry out its deleted text begin adult protectiondeleted text end functions under section 626.557 and to meet the community's
needs deleted text begin for adult protection servicesdeleted text end . Case consultation may be performed by a committee of
the team composed of the team members representing social services, law enforcement, the
county attorney, health care, and persons directly involved in an individual case as determined
by the case consultation committee. Case consultation deleted text begin isdeleted text end new text begin includesnew text end a case review process that
results in recommendations about services to be provided to the identified adult and family.
Sec. 40.
Minnesota Statutes 2020, section 626.5572, subdivision 2, is amended to read:
Subd. 2.
Abuse.
"Abuse" means:
(a) An act against a vulnerable adult that constitutes a violation of, an attempt to violate,
or aiding and abetting a violation of:
(1) assault in the first through fifth degrees as defined in sections 609.221 to 609.224;
(2) the use of drugs to injure or facilitate crime as defined in section 609.235;
(3) the solicitation, inducement, and promotion of prostitution as defined in section
609.322; and
(4) criminal sexual conduct in the first through fifth degrees as defined in sections
609.342 to 609.3451.
A violation includes any action that meets the elements of the crime, regardless of
whether there is a criminal proceeding or conviction.
(b) Conduct which is not an accident or therapeutic conduct as defined in this section,
which produces or could reasonably be expected to produce physical pain or injury or
emotional distress including, but not limited to, the following:
(1) hitting, slapping, kicking, pinching, biting, or corporal punishment of a vulnerable
adult;
(2) use of repeated or malicious oral, written, or gestured language toward a vulnerable
adult or the treatment of a vulnerable adult which would be considered by a reasonable
person to be disparaging, derogatory, humiliating, harassing, or threatening;new text begin or
new text end
(3) use of any aversive or deprivation procedure, unreasonable confinement, or
involuntary seclusion, including the forced separation of the vulnerable adult from other
persons against the will of the vulnerable adult or the legal representative of the vulnerable
adultdeleted text begin ; anddeleted text end new text begin unless authorized under applicable licensing requirements or Minnesota Rules,
chapter 9544.
new text end
deleted text begin
(4) use of any aversive or deprivation procedures for persons with developmental
disabilities or related conditions not authorized under section 245.825.
deleted text end
(c) Any sexual contact or penetration as defined in section 609.341, between a facility
staff person or a person providing services in the facility and a resident, patient, or client
of that facility.
(d) The act of forcing, compelling, coercing, or enticing a vulnerable adult against the
vulnerable adult's will to perform services for the advantage of another.
(e) For purposes of this section, a vulnerable adult is not abused for the sole reason that
the vulnerable adult or a person with authority to make health care decisions for the
vulnerable adult under sections 144.651, 144A.44, chapter 145B, 145C or 252A, or section
253B.03 or 524.5-313, refuses consent or withdraws consent, consistent with that authority
and within the boundary of reasonable medical practice, to any therapeutic conduct, including
any care, service, or procedure to diagnose, maintain, or treat the physical or mental condition
of the vulnerable adult or, where permitted under law, to provide nutrition and hydration
parenterally or through intubation. This paragraph does not enlarge or diminish rights
otherwise held under law by:
(1) a vulnerable adult or a person acting on behalf of a vulnerable adult, including an
involved family member, to consent to or refuse consent for therapeutic conduct; or
(2) a caregiver to offer or provide or refuse to offer or provide therapeutic conduct.
(f) For purposes of this section, a vulnerable adult is not abused for the sole reason that
the vulnerable adult, a person with authority to make health care decisions for the vulnerable
adult, or a caregiver in good faith selects and depends upon spiritual means or prayer for
treatment or care of disease or remedial care of the vulnerable adult in lieu of medical care,
provided that this is consistent with the prior practice or belief of the vulnerable adult or
with the expressed intentions of the vulnerable adult.
(g) For purposes of this section, a vulnerable adult is not abused for the sole reason that
the vulnerable adult, who is not impaired in judgment or capacity by mental or emotional
dysfunction or undue influence, engages in consensual sexual contact with:
(1) a person, including a facility staff person, when a consensual sexual personal
relationship existed prior to the caregiving relationship; or
(2) a personal care attendant, regardless of whether the consensual sexual personal
relationship existed prior to the caregiving relationship.
Sec. 41.
Minnesota Statutes 2020, section 626.5572, subdivision 4, is amended to read:
Subd. 4.
Caregiver.
"Caregiver" means an individual or facility who has responsibility
for new text begin all or a portion ofnew text end the care of a vulnerable adult deleted text begin as a result of a family relationship, or
who has assumed responsibility for all or a portion of the care of a vulnerable adultdeleted text end
voluntarily, by contract, or by agreement.
Sec. 42.
Minnesota Statutes 2020, section 626.5572, subdivision 17, is amended to read:
Subd. 17.
Neglect.
deleted text begin
"Neglect" means:
deleted text end
new text begin
Neglect means neglect by a caregiver or self-neglect.
new text end
(a)new text begin "Caregiver neglect" meansnew text end the failure or omission by a caregiver to supply a vulnerable
adult with care or services, including but not limited to, food, clothing, shelter, health care,
or supervision which is:
(1) reasonable and necessary to obtain or maintain the vulnerable adult's physical or
mental health or safety, considering the physical and mental capacity or dysfunction of the
vulnerable adult; and
(2) which is not the result of an accident or therapeutic conduct.
(b) deleted text begin The absence or likelihood of absence of care or services, including but not limited
to, food, clothing, shelter, health care, or supervision necessary to maintain the physical
and mental health of the vulnerable adultdeleted text end new text begin "Self-neglect" means neglect by a vulnerable adult
of the vulnerable adult's own food, clothing, shelter, health care, or other services that are
not the responsibility of a caregivernew text end which a reasonable person would deem essential to
obtain or maintain the vulnerable adult's health, safety, or comfort deleted text begin considering the physical
or mental capacity or dysfunction of the vulnerable adultdeleted text end .
(c) For purposes of this section, a vulnerable adult is not neglected for the sole reason
that:
(1) the vulnerable adult or a person with authority to make health care decisions for the
vulnerable adult under sections 144.651, 144A.44, chapter 145B, 145C, or 252A, or sections
253B.03 or 524.5-101 to 524.5-502, refuses consent or withdraws consent, consistent with
that authority and within the boundary of reasonable medical practice, to any therapeutic
conduct, including any care, service, or procedure to diagnose, maintain, or treat the physical
or mental condition of the vulnerable adult, or, where permitted under law, to provide
nutrition and hydration parenterally or through intubation; this paragraph does not enlarge
or diminish rights otherwise held under law by:
(i) a vulnerable adult or a person acting on behalf of a vulnerable adult, including an
involved family member, to consent to or refuse consent for therapeutic conduct; or
(ii) a caregiver to offer or provide or refuse to offer or provide therapeutic conduct; or
(2) the vulnerable adult, a person with authority to make health care decisions for the
vulnerable adult, or a caregiver in good faith selects and depends upon spiritual means or
prayer for treatment or care of disease or remedial care of the vulnerable adult in lieu of
medical care, provided that this is consistent with the prior practice or belief of the vulnerable
adult or with the expressed intentions of the vulnerable adult;
(3) the vulnerable adult, who is not impaired in judgment or capacity by mental or
emotional dysfunction or undue influence, engages in consensual sexual contact with:
(i) a person including a facility staff person when a consensual sexual personal
relationship existed prior to the caregiving relationship; or
(ii) a personal care attendant, regardless of whether the consensual sexual personal
relationship existed prior to the caregiving relationship; or
(4) an individual makes an error in the provision of therapeutic conduct to a vulnerable
adult which does not result in injury or harm which reasonably requires medical or mental
health care; or
(5) an individual makes an error in the provision of therapeutic conduct to a vulnerable
adult that results in injury or harm, which reasonably requires the care of a physician, and:
(i) the necessary care is provided in a timely fashion as dictated by the condition of the
vulnerable adult;
(ii) if after receiving care, the health status of the vulnerable adult can be reasonably
expected, as determined by the attending physician, to be restored to the vulnerable adult's
preexisting condition;
(iii) the error is not part of a pattern of errors by the individual;
(iv) if in a facility, the error is immediately reported as required under section 626.557,
and recorded internally in the facility;
(v) if in a facility, the facility identifies and takes corrective action and implements
measures designed to reduce the risk of further occurrence of this error and similar errors;
and
(vi) if in a facility, the actions required under items (iv) and (v) are sufficiently
documented for review and evaluation by the facility and any applicable licensing,
certification, and ombudsman agency.
(d) Nothing in this definition requires a caregiver, if regulated, to provide services in
excess of those required by the caregiver's license, certification, registration, or other
regulation.
(e) If the findings of an investigation by a lead investigative agency result in a
determination of substantiated maltreatment for the sole reason that the actions required of
a facility under paragraph (c), clause (5), item (iv), (v), or (vi), were not taken, then the
facility is subject to a correction order. An individual will not be found to have neglected
or maltreated the vulnerable adult based solely on the facility's not having taken the actions
required under paragraph (c), clause (5), item (iv), (v), or (vi). This must not alter the lead
investigative agency's determination of mitigating factors under section 626.557, subdivision
9c, paragraph deleted text begin (c)deleted text end new text begin (f)new text end .
ARTICLE 14
CHILD PROTECTION
Section 1.
Minnesota Statutes 2020, section 242.19, subdivision 2, is amended to read:
Subd. 2.
Dispositions.
When a child has been committed to the commissioner of
corrections by a juvenile court, upon a finding of delinquency, the commissioner may for
the purposes of treatment and rehabilitation:
(1) order the child's confinement to the Minnesota Correctional Facility-Red Wing,
which shall accept the child, or to a group foster home under the control of the commissioner
of corrections, or to private facilities or facilities established by law or incorporated under
the laws of this state that may care for delinquent children;
(2) order the child's release on parole under such supervisions and conditions as the
commissioner believes conducive to law-abiding conduct, treatment and rehabilitation;
(3) order reconfinement or renewed parole as often as the commissioner believes to be
desirable;
(4) revoke or modify any order, except an order of discharge, as often as the commissioner
believes to be desirable;
(5) discharge the child when the commissioner is satisfied that the child has been
rehabilitated and that such discharge is consistent with the protection of the public;
(6) if the commissioner finds that the child is eligible for probation or parole and it
appears from the commissioner's investigation that conditions in the child's or the guardian's
home are not conducive to the child's treatment, rehabilitation, or law-abiding conduct, refer
the child, together with the commissioner's findings, to a local social services agency or a
licensed child-placing agency for placement in a foster care or, when appropriate, for
initiation of child in need of protection or services proceedings as provided in sections
260C.001 to 260C.421. The commissioner of corrections shall reimburse local social services
agencies for foster care costs they incur for the child while on probation or parole to the
extent that funds for this purpose are made available to the commissioner by the legislature.
The juvenile court deleted text begin shalldeleted text end new text begin may new text end order the parents of a child on probation or parole to pay the
costs of foster care under section 260B.331, subdivision 1, new text begin if the local social services agency
has determined that requiring reimbursement is in the child's best interests,new text end according to
their ability to pay, and to the extent that the commissioner of corrections has not reimbursed
the local social services agency.
Sec. 2.
Minnesota Statutes 2020, section 260.761, subdivision 2, is amended to read:
Subd. 2.
Agency and court notice to tribes.
(a) When a local social services agency
has information that a family assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver sex trafficking
assessmentnew text end being conducted may involve an Indian child, the local social services agency
shall notify the Indian child's tribe of the family assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver
sex trafficking assessmentnew text end according to section 260E.18.new text begin The local social services agency
shall providenew text end initial notice deleted text begin shall be provideddeleted text end by telephone and by e-mail or facsimile. The
local social services agency shall request that the tribe or a designated tribal representative
participate in evaluating the family circumstances, identifying family and tribal community
resources, and developing case plans.
(b) When a local social services agency has information that a child receiving services
may be an Indian child, the local social services agency shall notify the tribe by telephone
and by e-mail or facsimile of the child's full name and date of birth, the full names and dates
of birth of the child's biological parents, and, if known, the full names and dates of birth of
the child's grandparents and of the child's Indian custodian. This notification must be provided
deleted text begin sodeleted text end new text begin fornew text end the tribe deleted text begin candeleted text end new text begin tonew text end determine if the child is enrolled in the tribe or eligible for new text begin tribal
new text end membership, and deleted text begin must be provideddeleted text end new text begin the agency must provide this notification to the tribenew text end
within seven daysnew text begin of receiving information that the child may be an Indian childnew text end . If
information regarding the child's grandparents or Indian custodian is not available within
the seven-day period, the local social services agency shall continue to request this
information and shall notify the tribe when it is received. Notice shall be provided to all
tribes to which the child may have any tribal lineage. If the identity or location of the child's
parent or Indian custodian and tribe cannot be determined, the local social services agency
shall provide the notice required in this paragraph to the United States secretary of the
interior.
(c) In accordance with sections 260C.151 and 260C.152, when a court has reason to
believe that a child placed in emergency protective care is an Indian child, the court
administrator or a designee shall, as soon as possible and before a hearing takes place, notify
the tribal social services agency by telephone and by e-mail or facsimile of the date, time,
and location of the emergency protective case hearing. The court shall make efforts to allow
appearances by telephone for tribal representatives, parents, and Indian custodians.
(d) A local social services agency must provide the notices required under this subdivision
at the earliest possible time to facilitate involvement of the Indian child's tribe. Nothing in
this subdivision is intended to hinder the ability of the local social services agency and the
court to respond to an emergency situation. Lack of participation by a tribe shall not prevent
the tribe from intervening in services and proceedings at a later date. A tribe may participate
new text begin in a case new text end at any time. At any stage of the local social services agency's involvement with
an Indian child, the agency shall provide full cooperation to the tribal social services agency,
including disclosure of all data concerning the Indian child. Nothing in this subdivision
relieves the local social services agency of satisfying the notice requirements in the Indian
Child Welfare Act.
Sec. 3.
Minnesota Statutes 2020, section 260B.331, subdivision 1, is amended to read:
Subdivision 1.
Care, examination, or treatment.
(a)(1) Whenever legal custody of a
child is transferred by the court to a local social services agency, or
(2) whenever legal custody is transferred to a person other than the local social services
agency, but under the supervision of the local social services agency, and
(3) whenever a child is given physical or mental examinations or treatment under order
of the court, and no provision is otherwise made by law for payment for the care,
examination, or treatment of the child, these costs are a charge upon the welfare funds of
the county in which proceedings are held upon certification of the judge of juvenile court.
(b) The court deleted text begin shalldeleted text end new text begin maynew text end order, and the local social services agency deleted text begin shalldeleted text end new text begin maynew text end require,
the parents or custodian of a child, while the child is under the age of 18, to use deleted text begin the totaldeleted text end
income and resources attributable to the child for the period of care, examination, or
treatment, except for clothing and personal needs allowance as provided in section 256B.35,
to reimburse the county for the cost of care, examination, or treatment. Income and resources
attributable to the child include, but are not limited to, Social Security benefits, Supplemental
Security Income (SSI), veterans benefits, railroad retirement benefits and child support.
When the child is over the age of 18, and continues to receive care, examination, or treatment,
the court deleted text begin shalldeleted text end new text begin maynew text end order, and the local social services agency deleted text begin shalldeleted text end new text begin maynew text end require,
reimbursement from the child for the cost of care, examination, or treatment from the income
and resources attributable to the child less the clothing and personal needs allowance.new text begin The
local social services agency shall determine whether requiring reimbursement, either through
child support or parental fees, for the cost of care, examination, or treatment from income
and resources attributable to the child is in the child's best interests. In determining whether
to require reimbursement, the local social services agency shall consider:
new text end
new text begin
(1) whether requiring reimbursement would compromise a parent's ability to meet the
child's treatment and rehabilitation needs before the child returns to the parent's home;
new text end
new text begin
(2) whether requiring reimbursement would compromise the parent's ability to meet the
child's needs after the child returns home; and
new text end
new text begin
(3) whether redirecting existing child support payments or changing the representative
payee of social security benefits to the local social services agency would limit the parent's
ability to maintain financial stability for the child upon the child's return home.
new text end
(c) If the income and resources attributable to the child are not enough to reimburse the
county for the full cost of the care, examination, or treatment, the court deleted text begin shalldeleted text end new text begin maynew text end inquire
into the ability of the parents to deleted text begin support the childdeleted text end new text begin reimburse the county for the cost of care,
examination, or treatmentnew text end and, after giving the parents a reasonable opportunity to be heard,
the court deleted text begin shalldeleted text end new text begin maynew text end order, and the local social services agency deleted text begin shalldeleted text end new text begin maynew text end require, the parents
to contribute to the cost of care, examination, or treatment of the child. deleted text begin Except in delinquency
cases where the victim is a member of the child's immediate family,deleted text end When determining the
amount to be contributed by the parents, the court shall use a fee schedule based upon ability
to pay that is established by the local social services agency and approved by the
commissioner of human services. deleted text begin In delinquency cases where the victim is a member of the
child's immediate family,deleted text end The court shall deleted text begin use the fee schedule but may alsodeleted text end take into account
deleted text begin the seriousness of the offense and any expenses which the parents have incurred as a result
of the offensedeleted text end new text begin any expenses that the parents may have incurred as a result of the offense,
including but not limited to co-payments for mental health treatment and attorney feesnew text end . The
income of a stepparent who has not adopted a child shall be excluded in calculating the
parental contribution under this section.new text begin The local social services agency shall determine
whether requiring reimbursement from the parents, either through child support or parental
fees, for the cost of care, examination, or treatment from income and resources attributable
to the child is in the child's best interests. In determining whether to require reimbursement,
the local social services agency shall consider:
new text end
new text begin
(1) whether requiring reimbursement would compromise a parent's ability to meet the
child's treatment and rehabilitation needs before the child returns to the parent's home;
new text end
new text begin
(2) whether requiring reimbursement would compromise the parent's ability to meet the
child's needs after the child returns home; and
new text end
new text begin
(3) whether requiring reimbursement would compromise the parent's ability to meet the
needs of the family.
new text end
(d)new text begin If the local social services agency determines that requiring reimbursement is in the
child's best interests,new text end the court shall order the amount of reimbursement attributable to the
parents or custodian, or attributable to the child, or attributable to both sources, withheld
under chapter 518A from the income of the parents or the custodian of the child. A parent
or custodian who fails to pay without good reason may be proceeded against for contempt,
or the court may inform the county attorney, who shall proceed to collect the unpaid sums,
or both procedures may be used.
(e) If the court orders a physical or mental examination for a child, the examination is
a medically necessary service for purposes of determining whether the service is covered
by a health insurance policy, health maintenance contract, or other health coverage plan.
Court-ordered treatment shall be subject to policy, contract, or plan requirements for medical
necessity. Nothing in this paragraph changes or eliminates benefit limits, conditions of
coverage, co-payments or deductibles, provider restrictions, or other requirements in the
policy, contract, or plan that relate to coverage of other medically necessary services.
Sec. 4.
Minnesota Statutes 2021 Supplement, section 260C.007, subdivision 14, is amended
to read:
Subd. 14.
Egregious harm.
"Egregious harm" means the infliction of bodily harm to a
child or neglect of a child which demonstrates a grossly inadequate ability to provide
minimally adequate parental care. deleted text begin The egregious harm need not have occurred in the state
or in the county where a termination of parental rights action is otherwise properly venued.deleted text end new text begin
A district court may still have proper venue over an action to terminate parental rights when
the egregious harm did not occur in the state or county where the district court is located.new text end
Egregious harm includes, but is not limited to:
(1) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes a violation of sections 609.185 to
609.2114, 609.222, subdivision 2, 609.223, or any other similar law of any other state;
(2) the infliction of "substantial bodily harm" to a child, as defined in section 609.02,
subdivision 7a;
(3) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony malicious punishment of a
child under section 609.377;
(4) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony unreasonable restraint of a
child under section 609.255, subdivision 3;
(5) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes felony neglect or endangerment of
a child under section 609.378;
(6) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes assault under section 609.221, 609.222,
or 609.223;
(7) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutesnew text begin sex trafficking,new text end solicitation,
inducement, deleted text begin ordeleted text end promotion of, or receiving profit derived from prostitution under section
609.322;
(8) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes murder or voluntary manslaughter
as defined by United States Code, title 18, section 1111(a) or 1112(a);
(9) conduct deleted text begin towardsdeleted text end new text begin towardnew text end a child that constitutes aiding or abetting, attempting,
conspiring, or soliciting to commit a murder or voluntary manslaughter that constitutes a
violation of United States Code, title 18, section 1111(a) or 1112(a); or
(10) conduct toward a child that constitutes criminal sexual conduct under sections
609.342 to 609.345 or sexual extortion under section 609.3458.
Sec. 5.
Minnesota Statutes 2020, section 260C.331, subdivision 1, is amended to read:
Subdivision 1.
Care, examination, or treatment.
(a) Except where parental rights are
terminated,
(1) whenever legal custody of a child is transferred by the court to a responsible social
services agency,
(2) whenever legal custody is transferred to a person other than the responsible social
services agency, but under the supervision of the responsible social services agency, or
(3) whenever a child is given physical or mental examinations or treatment under order
of the court, and no provision is otherwise made by law for payment for the care,
examination, or treatment of the child, these costs are a charge upon the welfare funds of
the county in which proceedings are held upon certification of the judge of juvenile court.
(b) The court deleted text begin shalldeleted text end new text begin maynew text end order, and the responsible social services agency deleted text begin shalldeleted text end new text begin maynew text end
require, the parents or custodian of a child, while the child is under the age of 18, to use deleted text begin the
totaldeleted text end income and resources attributable to the child for the period of care, examination, or
treatment, except for clothing and personal needs allowance as provided in section 256B.35,
to reimburse the county for the cost of care, examination, or treatment. Income and resources
attributable to the child include, but are not limited to, Social Security benefits, Supplemental
Security Income (SSI), veterans benefits, railroad retirement benefits and child support.
When the child is over the age of 18, and continues to receive care, examination, or treatment,
the court deleted text begin shalldeleted text end new text begin maynew text end order, and the responsible social services agency deleted text begin shalldeleted text end new text begin maynew text end require,
reimbursement from the child for the cost of care, examination, or treatment from the income
and resources attributable to the child less the clothing and personal needs allowance. Income
does not include earnings from a child over the age of 18 who is working as part of a plan
under section 260C.212, subdivision 1, paragraph (c), clause (12), to transition from foster
care, or the income and resources deleted text begin from sources other than Supplemental Security Income
and child supportdeleted text end that are needed to complete the requirements listed in section 260C.203.new text begin
The responsible social services agency shall determine whether requiring reimbursement,
either through child support or parental fees, for the cost of care, examination, or treatment
from the parents or custodian of a child is in the child's best interests. In determining whether
to require reimbursement, the responsible social services agency shall consider:
new text end
new text begin
(1) whether requiring reimbursement would compromise the parent's ability to meet the
requirements of the reunification plan;
new text end
new text begin
(2) whether requiring reimbursement would compromise the parent's ability to meet the
child's needs after reunification; and
new text end
new text begin
(3) whether redirecting existing child support payments or changing the representative
payee of social security benefits to the responsible social services agency would limit the
parent's ability to maintain financial stability for the child.
new text end
(c) If the income and resources attributable to the child are not enough to reimburse the
county for the full cost of the care, examination, or treatment, the court deleted text begin shalldeleted text end new text begin maynew text end inquire
into the ability of the parents to deleted text begin support the childdeleted text end new text begin reimburse the county for the cost of care,
examination, or treatmentnew text end and, after giving the parents a reasonable opportunity to be heard,
the court deleted text begin shalldeleted text end new text begin maynew text end order, and the responsible social services agency deleted text begin shalldeleted text end new text begin maynew text end require, the
parents to contribute to the cost of care, examination, or treatment of the child. When
determining the amount to be contributed by the parents, the court shall use a fee schedule
based upon ability to pay that is established by the responsible social services agency and
approved by the commissioner of human services. The income of a stepparent who has not
adopted a child shall be excluded in calculating the parental contribution under this section.new text begin
In determining whether to require reimbursement, the responsible social services agency
shall consider:
new text end
new text begin
(1) whether requiring reimbursement would compromise the parent's ability to meet the
requirements of the reunification plan;
new text end
new text begin
(2) whether requiring reimbursement would compromise the parent's ability to meet the
child's needs after reunification; and
new text end
new text begin
(3) whether requiring reimbursement would compromise the parent's ability to meet the
needs of the family.
new text end
(d)new text begin If the responsible social services agency determines that reimbursement is in the
child's best interest,new text end the court shall order the amount of reimbursement attributable to the
parents or custodian, or attributable to the child, or attributable to both sources, withheld
under chapter 518A from the income of the parents or the custodian of the child. A parent
or custodian who fails to pay without good reason may be proceeded against for contempt,
or the court may inform the county attorney, who shall proceed to collect the unpaid sums,
or both procedures may be used.
(e) If the court orders a physical or mental examination for a child, the examination is
a medically necessary service for purposes of determining whether the service is covered
by a health insurance policy, health maintenance contract, or other health coverage plan.
Court-ordered treatment shall be subject to policy, contract, or plan requirements for medical
necessity. Nothing in this paragraph changes or eliminates benefit limits, conditions of
coverage, co-payments or deductibles, provider restrictions, or other requirements in the
policy, contract, or plan that relate to coverage of other medically necessary services.
(f) Notwithstanding paragraph (b), (c), or (d), a parent, custodian, or guardian of the
child is not required to use income and resources attributable to the child to reimburse the
county for costs of care and is not required to contribute to the cost of care of the child
during any period of time when the child is returned to the home of that parent, custodian,
or guardian pursuant to a trial home visit under section 260C.201, subdivision 1, paragraph
(a).
Sec. 6.
Minnesota Statutes 2020, section 260C.451, subdivision 8, is amended to read:
Subd. 8.
Notice of termination of foster care.
When a child in foster care between the
ages of 18 and 21 ceases to meet one of the eligibility criteria of subdivision 3a, the
responsible social services agency shall give the child written notice that foster care will
terminate 30 days from the date the notice is sent. The child or the child's guardian ad litem
may file a motion asking the court to review the agency's determination within 15 days of
receiving the notice. The child deleted text begin shalldeleted text end new text begin mustnew text end not be discharged from foster care until the motion
is heard. The agency shall work with the child to new text begin prepare for the child's new text end transition out of
foster care deleted text begin asdeleted text end new text begin . The agency must provide the court with the child's personalized transition
plan new text end required new text begin to be developed new text end under section deleted text begin 260C.203, paragraph (d), clause (2)deleted text end new text begin 260C.452,
subdivision 4, if the motion is filednew text end . The written notice of termination of benefits shall be
on a form prescribed by the commissioner and shall also give notice of the right to have the
agency's determination reviewed by the court in the proceeding where the court conducts
the reviews required under section 260C.203, 260C.317, or 260C.515, subdivision 5 or 6.
A copy of the termination notice shall be sent to the child and the child's attorney, if any,
the foster care provider, the child's guardian ad litem, and the court. The agency is not
responsible for paying foster care benefits for any period of time after the child actually
leaves foster care.
Sec. 7.
Minnesota Statutes 2020, section 260C.451, is amended by adding a subdivision
to read:
new text begin Subd. 8a. new text end
new text begin Transition planning. new text end
new text begin
For a youth who will be discharged from foster care at
18 years of age or older, the responsible social services agency must develop a personalized
transition plan as directed by the youth during the 180-day period immediately prior to the
expected date of discharge according to section 260C.452, subdivision 4. A youth's
personalized transition plan must include the support beyond 21 program under subdivision
8b for eligible youth. With a youth's consent, the responsible social services agency may
share the youth's personalized transition plan with a contracted agency providing case
management services under section 260C.452.
new text end
Sec. 8.
Minnesota Statutes 2020, section 260C.451, is amended by adding a subdivision
to read:
new text begin Subd. 8b. new text end
new text begin Support beyond 21 program. new text end
new text begin
For a youth who was eligible for extended
foster care under subdivision 3 and is discharged at age 21, the responsible social services
agency must ensure that the youth is referred to the support beyond 21 program. The support
beyond 21 program must provide a youth with one additional year of financial support for
housing and basic needs to assist the youth aging out of extended foster care at age 21. A
youth receiving benefits under the support beyond 21 program is also eligible for the
successful transition to adulthood program for additional support under section 260C.452.
A youth who transitions to residential services under sections 256B.092 and 256B.49 is not
eligible for the support beyond 21 program.
new text end
Sec. 9.
Minnesota Statutes 2020, section 260E.01, is amended to read:
260E.01 POLICY.
(a) The legislature hereby declares that the public policy of this state is to protect children
whose health or welfare may be jeopardized through maltreatment. While it is recognized
that most parents want to keep their children safe, sometimes circumstances or conditions
interfere with their ability to do so. When this occurs, the health and safety of the children
must be of paramount concern. Intervention and prevention efforts must address immediate
concerns for child safety and the ongoing risk of maltreatment and should engage the
protective capacities of families. In furtherance of this public policy, it is the intent of the
legislature under this chapter to:
(1) protect children and promote child safety;
(2) strengthen the family;
(3) make the home, school, and community safe for children by promoting responsible
child care in all settings; and
(4) provide, when necessary, a safe temporary or permanent home environment for
maltreated children.
(b) In addition, it is the policy of this state to:
(1) require the reporting of maltreatment of children in the home, school, and community
settings;
(2) provide for deleted text begin thedeleted text end voluntary reporting of maltreatment of children;
(3) require an investigation when the report alleges sexual abuse or substantial child
endangermentnew text begin , except when the report alleges sex trafficking by a noncaregiver sex traffickernew text end ;
(4) provide a family assessment, if appropriate, when the report does not allege sexual
abuse or substantial child endangerment; deleted text begin and
deleted text end
(5) new text begin provide a noncaregiver sex trafficking assessment when the report alleges sex
trafficking by a noncaregiver sex trafficker; and
new text end
new text begin (6) new text end provide protective, family support, and family preservation services when needed
in appropriate cases.
Sec. 10.
Minnesota Statutes 2020, section 260E.02, subdivision 1, is amended to read:
Subdivision 1.
Establishment of team.
A county shall establish a multidisciplinary
child protection team that may include, but new text begin is new text end not deleted text begin bedeleted text end limited to, the director of the local
welfare agency or designees, the county attorney or designees, the county sheriff or designees,
representatives of health and education, representatives of mental healthnew text begin , representatives of
agencies providing specialized services or responding to youth who experience or are at
risk of experiencing sex trafficking or sexual exploitation,new text end or other appropriate human
services or community-based agencies, and parent groups. As used in this section, a
"community-based agency" may include, but is not limited to, schools, social services
agencies, family service and mental health collaboratives, children's advocacy centers, early
childhood and family education programs, Head Start, or other agencies serving children
and families. A member of the team must be designated as the lead person of the team
responsible for the planning process to develop standards for the team's activities with
battered women's and domestic abuse programs and services.
Sec. 11.
Minnesota Statutes 2020, section 260E.03, is amended by adding a subdivision
to read:
new text begin Subd. 15a. new text end
new text begin Noncaregiver sex trafficker. new text end
new text begin
"Noncaregiver sex trafficker" means an
individual who is alleged to have engaged in the act of sex trafficking a child and who is
not a person responsible for the child's care, who does not have a significant relationship
with the child as defined in section 609.341, and who is not a person in a current or recent
position of authority as defined in section 609.341, subdivision 10.
new text end
Sec. 12.
Minnesota Statutes 2020, section 260E.03, is amended by adding a subdivision
to read:
new text begin Subd. 15b. new text end
new text begin Noncaregiver sex trafficking assessment. new text end
new text begin
"Noncaregiver sex trafficking
assessment" is a comprehensive assessment of child safety, the risk of subsequent child
maltreatment, and strengths and needs of the child and family. The local welfare agency
shall only perform a noncaregiver sex trafficking assessment when a maltreatment report
alleges sex trafficking of a child by someone other than the child's caregiver. A noncaregiver
sex trafficking assessment does not include a determination of whether child maltreatment
occurred. A noncaregiver sex trafficking assessment includes a determination of a family's
need for services to address the safety of a child or children, the safety of family members,
and the risk of subsequent child maltreatment.
new text end
Sec. 13.
Minnesota Statutes 2021 Supplement, section 260E.03, subdivision 22, is amended
to read:
Subd. 22.
Substantial child endangerment.
"Substantial child endangerment" means
that a person responsible for a child's care, by act or omission, commits or attempts to
commit an act against a child deleted text begin under theirdeleted text end new text begin in the person'snew text end care that constitutes any of the
following:
(1) egregious harm under subdivision 5;
(2) abandonment under section 260C.301, subdivision 2;
(3) neglect under subdivision 15, paragraph (a), clause (2), that substantially endangers
the child's physical or mental health, including a growth delay, which may be referred to
as failure to thrive, that has been diagnosed by a physician and is due to parental neglect;
(4) murder in the first, second, or third degree under section 609.185, 609.19, or 609.195;
(5) manslaughter in the first or second degree under section 609.20 or 609.205;
(6) assault in the first, second, or third degree under section 609.221, 609.222, or 609.223;
(7) new text begin sex trafficking, new text end solicitation, inducement, deleted text begin anddeleted text end new text begin ornew text end promotion of prostitution under
section 609.322;
(8) criminal sexual conduct under sections 609.342 to 609.3451;
(9) sexual extortion under section 609.3458;
(10) solicitation of children to engage in sexual conduct under section 609.352;
(11) malicious punishment or neglect or endangerment of a child under section 609.377
or 609.378;
(12) use of a minor in sexual performance under section 617.246; or
(13) parental behavior, status, or condition deleted text begin that mandates thatdeleted text end new text begin requiringnew text end the county
attorneynew text begin tonew text end file a termination of parental rights petition under section 260C.503, subdivision
2.
Sec. 14.
Minnesota Statutes 2020, section 260E.14, subdivision 2, is amended to read:
Subd. 2.
Sexual abuse.
(a) The local welfare agency is the agency responsible for
investigating an allegation of sexual abuse if the alleged offender is the parent, guardian,
sibling, or an individual functioning within the family unit as a person responsible for the
child's care, or a person with a significant relationship to the child if that person resides in
the child's household.
(b) The local welfare agency is also responsible for new text begin assessing or new text end investigating when a
child is identified as a victim of sex trafficking.
Sec. 15.
Minnesota Statutes 2020, section 260E.14, subdivision 5, is amended to read:
Subd. 5.
Law enforcement.
(a) The local law enforcement agency is the agency
responsible for investigating a report of maltreatment if a violation of a criminal statute is
alleged.
(b) Law enforcement and the responsible agency must coordinate their investigations
or assessments as required under this chapter when deleted text begin thedeleted text end new text begin : (1) anew text end report alleges maltreatment
that is a violation of a criminal statute by a person who is a parent, guardian, sibling, person
responsible for the child's care deleted text begin functioningdeleted text end within the family unit, ornew text begin by anew text end person who lives
in the child's household and who has a significant relationship to the childdeleted text begin ,deleted text end in a setting other
than a facility as defined in section 260E.03new text begin ; or (2) a report alleges sex trafficking of a childnew text end .
Sec. 16.
Minnesota Statutes 2020, section 260E.17, subdivision 1, is amended to read:
Subdivision 1.
Local welfare agency.
(a) Upon receipt of a report, the local welfare
agency shall determine whether to conduct a family assessment deleted text begin ordeleted text end new text begin ,new text end an investigationnew text begin , or a
noncaregiver sex trafficking assessmentnew text end as appropriate to prevent or provide a remedy for
maltreatment.
(b) The local welfare agency shall conduct an investigation when the report involves
sexual abusenew text begin , except as indicated in paragraph (f),new text end or substantial child endangerment.
(c) The local welfare agency shall begin an immediate investigation deleted text begin if,deleted text end at any time when
the local welfare agency is deleted text begin usingdeleted text end new text begin responding withnew text end a family assessment deleted text begin response,deleted text end new text begin andnew text end the
local welfare agency determines that there is reason to believe that sexual abuse deleted text begin ordeleted text end new text begin ,new text end substantial
child endangermentnew text begin ,new text end or a serious threat to the child's safety exists.
(d) The local welfare agency may conduct a family assessment for reports that do not
allege sexual abusenew text begin , except as indicated in paragraph (f),new text end or substantial child endangerment.
In determining that a family assessment is appropriate, the local welfare agency may consider
issues of child safety, parental cooperation, and the need for an immediate response.
(e) The local welfare agency may conduct a family assessment deleted text begin ondeleted text end new text begin fornew text end a report that was
initially screened and assigned for an investigation. In determining that a complete
investigation is not required, the local welfare agency must document the reason for
terminating the investigation and notify the local law enforcement agency if the local law
enforcement agency is conducting a joint investigation.
new text begin
(f) The local welfare agency shall conduct a noncaregiver sex trafficking assessment
when a maltreatment report alleges sex trafficking of a child and the alleged offender is a
noncaregiver sex trafficker as defined by section 260E.03, subdivision 15a.
new text end
new text begin
(g) During a noncaregiver sex trafficking assessment, the local welfare agency shall
initiate an immediate investigation if there is reason to believe that a child's parent, caregiver,
or household member allegedly engaged in the act of sex trafficking a child or is alleged to
have engaged in any conduct requiring the agency to conduct an investigation.
new text end
Sec. 17.
Minnesota Statutes 2020, section 260E.18, is amended to read:
260E.18 NOTICE TO CHILD'S TRIBE.
The local welfare agency shall provide immediate notice, according to section 260.761,
subdivision 2, to an Indian child's tribe when the agency has reason to believe new text begin that new text end the family
assessment deleted text begin ordeleted text end new text begin ,new text end investigationnew text begin , or noncaregiver sex trafficking assessmentnew text end may involve an
Indian child. For purposes of this section, "immediate notice" means notice provided within
24 hours.
Sec. 18.
Minnesota Statutes 2021 Supplement, section 260E.20, subdivision 2, is amended
to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall deleted text begin conduct adeleted text end new text begin havenew text end face-to-face contact with the child reported to be maltreated
and with the child's primary caregiver sufficient to complete a safety assessment and ensure
the immediate safety of the child.
(b) new text begin Except in a noncaregiver sex trafficking assessment, new text end thenew text begin local welfare agency shall
havenew text end face-to-face contact with the child and primary caregiver deleted text begin shall occurdeleted text end immediatelynew text begin after
the agency screens in a reportnew text end if sexual abuse or substantial child endangerment is alleged
and within five calendar daysnew text begin of a screened in reportnew text end for all other reports. If the alleged
offender was not already interviewed as the primary caregiver, the local welfare agency
shall also conduct a face-to-face interview with the alleged offender in the early stages of
the assessment or investigationnew text begin , except in a noncaregiver sex trafficking assessmentnew text end .
Face-to-face contact with the child and primary caregiver in response to a report alleging
sexual abuse or substantial child endangerment may be postponed for no more than five
calendar days if the child is residing in a location that is confirmed to restrict contact with
the alleged offender as established in guidelines issued by the commissioner, or if the local
welfare agency is pursuing a court order for the child's caregiver to produce the child for
questioning under section 260E.22, subdivision 5.
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.new text begin
When conducting a noncaregiver sex trafficking assessment, the local child welfare agency
is not required to inform or interview the alleged offender.
new text end
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statementnew text begin , except
when conducting a noncaregiver sex trafficking assessmentnew text end . The alleged offender may
submit supporting documentation relevant to the assessment or investigation.
Sec. 19.
Minnesota Statutes 2020, section 260E.24, subdivision 2, is amended to read:
Subd. 2.
Determination after family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end .
After conducting a family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end , the local welfare agency shall determine whether child protective services are
needed to address the safety of the child and other family members and the risk of subsequent
maltreatment.
Sec. 20.
Minnesota Statutes 2020, section 260E.24, subdivision 7, is amended to read:
Subd. 7.
Notification at conclusion of family assessmentnew text begin or a noncaregiver sex
trafficking assessmentnew text end .
Within ten working days of the conclusion of a family assessmentnew text begin
or a noncaregiver sex trafficking assessmentnew text end , the local welfare agency shall notify the parent
or guardian of the child of the need for services to address child safety concerns or significant
risk of subsequent maltreatment. The local welfare agency and the family may also jointly
agree that family support and family preservation services are needed.
Sec. 21.
Minnesota Statutes 2020, section 260E.33, subdivision 1, is amended to read:
Subdivision 1.
Followingnew text begin anew text end family assessmentnew text begin or a noncaregiver sex trafficking
assessmentnew text end .
Administrative reconsideration is not applicable to a family assessment new text begin or a
noncaregiver sex trafficking assessment new text end since no determination concerning maltreatment
is made.
Sec. 22.
Minnesota Statutes 2020, section 260E.35, subdivision 6, is amended to read:
Subd. 6.
Data retention.
(a) Notwithstanding sections 138.163 and 138.17, a record
maintained or a record derived from a report of maltreatment by a local welfare agency,
agency responsible for assessing or investigating the report, court services agency, or school
under this chapter shall be destroyed as provided in paragraphs (b) to (e) by the responsible
authority.
(b) For a report alleging maltreatment that was not accepted for new text begin an new text end assessment or new text begin an
new text end investigation, a family assessment case, new text begin a noncaregiver sex trafficking assessment case, new text end and
a case where an investigation results in no determination of maltreatment or the need for
child protective services, the record must be maintained for a period of five years after the
datenew text begin thatnew text end the report was not accepted for assessment or investigation or the date of the final
entry in the case record. A record of a report that was not accepted must contain sufficient
information to identify the subjects of the report, the nature of the alleged maltreatment,
and the reasons deleted text begin as todeleted text end why the report was not accepted. Records under this paragraph may
not be used for employment, background checks, or purposes other than to assist in future
screening decisions and risk and safety assessments.
(c) All records relating to reports that, upon investigation, indicate deleted text begin eitherdeleted text end maltreatment
or a need for child protective services shall be maintained for ten years after the date of the
final entry in the case record.
(d) All records regarding a report of maltreatment, including a notification of intent to
interview that was received by a school under section 260E.22, subdivision 7, shall be
destroyed by the school when ordered to do so by the agency conducting the assessment or
investigation. The agency shall order the destruction of the notification when other records
relating to the report under investigation or assessment are destroyed under this subdivision.
(e) Private or confidential data released to a court services agency under subdivision 3,
paragraph (d), must be destroyed by the court services agency when ordered to do so by the
local welfare agency that released the data. The local welfare agency or agency responsible
for assessing or investigating the report shall order destruction of the data when other records
relating to the assessment or investigation are destroyed under this subdivision.
Sec. 23.
Minnesota Statutes 2020, section 518A.43, subdivision 1, is amended to read:
Subdivision 1.
General factors.
Among other reasons, deviation from the presumptive
child support obligation computed under section 518A.34 is intended to encourage prompt
and regular payments of child support and to prevent either parent or the joint children from
living in poverty. In addition to the child support guidelines and other factors used to calculate
the child support obligation under section 518A.34, the court must take into consideration
the following factors in setting or modifying child support or in determining whether to
deviate upward or downward from the presumptive child support obligation:
(1) all earnings, income, circumstances, and resources of each parent, including real and
personal property, but excluding income from excess employment of the obligor or obligee
that meets the criteria of section 518A.29, paragraph (b);
(2) the extraordinary financial needs and resources, physical and emotional condition,
and educational needs of the child to be supported;
(3) the standard of living the child would enjoy if the parents were currently living
together, but recognizing that the parents now have separate households;
(4) whether the child resides in a foreign country for more than one year that has a
substantially higher or lower cost of living than this country;
(5) which parent receives the income taxation dependency exemption and the financial
benefit the parent receives from it;
(6) the parents' debts as provided in subdivision 2; deleted text begin and
deleted text end
(7) the obligor's total payments for court-ordered child support exceed the limitations
set forth in section 571.922deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) in cases involving court-ordered out-of-home placement, whether ordering and
redirecting a child support obligation to reimburse the county for the cost of care,
examination, or treatment would compromise the parent's ability to meet the requirements
of a reunification plan or the parent's ability to meet the child's needs after reunification.
new text end
Sec. 24. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FOSTER
CARE FEDERAL CASH ASSISTANCE BENEFITS PRESERVATION.
new text end
new text begin
(a) The commissioner of human services shall develop a plan to implement procedures
and policies necessary to cease allowing a financially responsible agency to use the federal
cash assistance benefits of a child in foster care to pay for out-of-home placement costs for
the child. The plan must ensure that federal cash assistance benefits are preserved and made
available to meet the best interests of the child and must include recommendations on the
following, in compliance with all applicable federal laws and Minnesota Statutes, chapters
260C and 256N:
new text end
new text begin
(1) policies for youth and caregiver access to preserved federal cash assistance benefit
payments;
new text end
new text begin
(2) representative payees for children in voluntary foster care for treatment pursuant to
Minnesota Statutes, chapter 260D; and
new text end
new text begin
(3) family preservation and reunification.
new text end
new text begin
(b) For purposes of this section, "federal cash assistance benefits" means all benefits
from programs administered by the Social Security Administration, including from the
Supplemental Security Income and the Retirement, Survivors, Disability Insurance programs.
new text end
new text begin
(c) When developing the plan under this section, the commissioner shall consult or
engage with:
new text end
new text begin
(1) individuals or entities with experience managing trusts and investment;
new text end
new text begin
(2) individuals or entities with expertise in providing tax advice;
new text end
new text begin
(3) individuals or entities with expertise in preserving assets to avoid negative impacts
on public assistance eligibility;
new text end
new text begin
(4) other relevant state agencies;
new text end
new text begin
(5) Tribal nations that have joined or are in the formal planning process to join the
American Indian Child Welfare Initiative;
new text end
new text begin
(6) counties;
new text end
new text begin
(7) the Children's Justice Initiative;
new text end
new text begin
(8) organizations that serve and advocate for children and families in the child protection
system;
new text end
new text begin
(9) parents, legal custodians, foster families, and kinship caregivers, to the extent possible;
new text end
new text begin
(10) youth who have been or are currently in out-of-home placement; and
new text end
new text begin
(11) other relevant stakeholders.
new text end
new text begin
(d) By December 15, 2022, each county shall provide the following data for fiscal years
2019 and 2020 to the commissioner in a form prescribed by the commissioner:
new text end
new text begin
(1) the nonduplicated number of children in foster care in the county who received
federal cash assistance benefits;
new text end
new text begin
(2) the number of children for whom the county was the representative payee for federal
cash assistance benefits; and
new text end
new text begin
(3) the amount of money that the county collected in federal cash assistance benefits as
the representative payee for children in the county.
new text end
new text begin
(e) By January 15, 2024, the commissioner shall submit a report to the chairs and ranking
minority members of the legislative committees with jurisdiction over human services and
child welfare outlining the plan developed under this section. The report must include a
projected timeline for implementation of the plan, estimated implementation costs, and any
legislative recommendations that may be required to implement the plan.
new text end
ARTICLE 15
ECONOMIC ASSISTANCE POLICY
Section 1.
Minnesota Statutes 2020, section 256P.04, subdivision 11, is amended to read:
Subd. 11.
Participant's completion of household report form.
(a) When a participant
is required to complete a household report form, the following paragraphs apply.
(b) If the agency receives an incomplete household report form, the agency must
immediately deleted text begin return the incomplete form and clearly state what the participant must do for
the form to be completedeleted text end new text begin contact the participant by phone or in writing to acquire the necessary
information to complete the formnew text end .
(c) The automated eligibility system must send a notice of proposed termination of
assistance to the participant if a complete household report form is not received by the
agency. The automated notice must be mailed to the participant by approximately the 16th
of the month. When a participant submits an incomplete form on or after the date a notice
of proposed termination has been sent, the termination is valid unless the participant submits
a complete form before the end of the month.
(d) The submission of a household report form is considered to have continued the
participant's application for assistance if a complete household report form is received within
a calendar month after the month in which the form was due. Assistance shall be paid for
the period beginning with the first day of that calendar month.
(e) An agency must allow good cause exemptions for a participant required to complete
a household report form when any of the following factors cause a participant to fail to
submit a completed household report form before the end of the month in which the form
is due:
(1) an employer delays completion of employment verification;
(2) the agency does not help a participant complete the household report form when the
participant asks for help;
(3) a participant does not receive a household report form due to a mistake on the part
of the department or the agency or a reported change in address;
(4) a participant is ill or physically or mentally incapacitated; or
(5) some other circumstance occurs that a participant could not avoid with reasonable
care which prevents the participant from providing a completed household report form
before the end of the month in which the form is due.
Sec. 2.
Minnesota Statutes 2021 Supplement, section 256P.06, subdivision 3, is amended
to read:
Subd. 3.
Income inclusions.
The following must be included in determining the income
of an assistance unit:
(1) earned income; and
(2) unearned income, which includes:
(i) interest and dividends from investments and savings;
(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;
(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;
(iv) income from trusts, excluding special needs and supplemental needs trusts;
(v) interest income from loans made by the participant or household;
(vi) cash prizes and winnings;
(vii) unemployment insurance income that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
(A) 18 years of age and enrolled in a secondary school; or
(B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-time;
(viii) retirement, survivors, and disability insurance payments;
(ix) nonrecurring income over $60 per quarter unless the nonrecurring income is: (A)
from tax refunds, tax rebates, or tax credits; (B) a reimbursement, rebate, award, grant, or
refund of personal or real property or costs or losses incurred when these payments are
made by: a public agency; a court; solicitations through public appeal; a federal, state, or
local unit of government; or a disaster assistance organization; (C) provided as an in-kind
benefit; or (D) earmarked and used for the purpose for which it was intended, subject to
verification requirements under section 256P.04;
(x) retirement benefits;
(xi) cash assistance benefits, as defined by each program in chapters 119B, 256D, 256I,
and 256J;
(xii) Tribal per capita payments unless excluded by federal and state law;
deleted text begin
(xiii) income and payments from service and rehabilitation programs that meet or exceed
the state's minimum wage rate;
deleted text end
deleted text begin (xiv)deleted text end new text begin (xiii)new text end income from members of the United States armed forces unless excluded
from income taxes according to federal or state law;
deleted text begin (xv)deleted text end new text begin (xiv)new text end all child support payments for programs under chapters 119B, 256D, and 256I;
deleted text begin (xvi)deleted text end new text begin (xv)new text end the amount of child support received that exceeds $100 for assistance units
with one child and $200 for assistance units with two or more children for programs under
chapter 256J;
deleted text begin (xvii)deleted text end new text begin (xvi)new text end spousal support; and
deleted text begin (xviii)deleted text end new text begin (xvii)new text end workers' compensation.
Sec. 3.
Minnesota Statutes 2020, section 268.19, subdivision 1, is amended to read:
Subdivision 1.
Use of data.
(a) Except as provided by this section, data gathered from
any person under the administration of the Minnesota Unemployment Insurance Law are
private data on individuals or nonpublic data not on individuals as defined in section 13.02,
subdivisions 9 and 12, and may not be disclosed except according to a district court order
or section 13.05. A subpoena is not considered a district court order. These data may be
disseminated to and used by the following agencies without the consent of the subject of
the data:
(1) state and federal agencies specifically authorized access to the data by state or federal
law;
(2) any agency of any other state or any federal agency charged with the administration
of an unemployment insurance program;
(3) any agency responsible for the maintenance of a system of public employment offices
for the purpose of assisting individuals in obtaining employment;
(4) the public authority responsible for child support in Minnesota or any other state in
accordance with section 256.978;
(5) human rights agencies within Minnesota that have enforcement powers;
(6) the Department of Revenue to the extent necessary for its duties under Minnesota
laws;
(7) public and private agencies responsible for administering publicly financed assistance
programs for the purpose of monitoring the eligibility of the program's recipients;
(8) the Department of Labor and Industry and the Commerce Fraud Bureau in the
Department of Commerce for uses consistent with the administration of their duties under
Minnesota law;
(9) the Department of Human Services and the Office of Inspector General and its agents
within the Department of Human Services, including county fraud investigators, for
investigations related to recipient or provider fraud and employees of providers when the
provider is suspected of committing public assistance fraud;
(10) local and state welfare agencies for monitoring the eligibility of the data subject
for assistance programs, or for any employment or training program administered by those
agencies, whether alone, in combination with another welfare agency, or in conjunction
with the department or to monitor and evaluate the statewide Minnesota family investment
program new text begin and other cash assistance programs, the Supplemental Nutrition Assistance Program,
and the Supplemental Nutrition Assistance Program Employment and Training program new text end by
providing data on recipients and former recipients of Supplemental Nutrition Assistance
Program (SNAP) benefits, cash assistance under chapter 256, 256D, 256J, or 256K, child
care assistance under chapter 119B, or medical programs under chapter 256B or 256L or
formerly codified under chapter 256D;
(11) local and state welfare agencies for the purpose of identifying employment, wages,
and other information to assist in the collection of an overpayment debt in an assistance
program;
(12) local, state, and federal law enforcement agencies for the purpose of ascertaining
the last known address and employment location of an individual who is the subject of a
criminal investigation;
(13) the United States Immigration and Customs Enforcement has access to data on
specific individuals and specific employers provided the specific individual or specific
employer is the subject of an investigation by that agency;
(14) the Department of Health for the purposes of epidemiologic investigations;
(15) the Department of Corrections for the purposes of case planning and internal research
for preprobation, probation, and postprobation employment tracking of offenders sentenced
to probation and preconfinement and postconfinement employment tracking of committed
offenders;
(16) the state auditor to the extent necessary to conduct audits of job opportunity building
zones as required under section 469.3201; and
(17) the Office of Higher Education for purposes of supporting program improvement,
system evaluation, and research initiatives including the Statewide Longitudinal Education
Data System.
(b) Data on individuals and employers that are collected, maintained, or used by the
department in an investigation under section 268.182 are confidential as to data on individuals
and protected nonpublic data not on individuals as defined in section 13.02, subdivisions 3
and 13, and must not be disclosed except under statute or district court order or to a party
named in a criminal proceeding, administrative or judicial, for preparation of a defense.
(c) Data gathered by the department in the administration of the Minnesota unemployment
insurance program must not be made the subject or the basis for any suit in any civil
proceedings, administrative or judicial, unless the action is initiated by the department.
Sec. 4. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber each section of Minnesota Statutes listed in column
A with the number listed in column B. The revisor shall also make necessary grammatical
and cross-reference changes consistent with the renumbering.
new text end
|
new text begin
Column A new text end |
new text begin
Column B new text end |
|
new text begin
256D.051, subdivision 20 new text end |
new text begin
256D.60, subdivision 1 new text end |
|
new text begin
256D.051, subdivision 21 new text end |
new text begin
256D.60, subdivision 2 new text end |
|
new text begin
256D.051, subdivision 22 new text end |
new text begin
256D.60, subdivision 3 new text end |
|
new text begin
256D.051, subdivision 23 new text end |
new text begin
256D.60, subdivision 4 new text end |
|
new text begin
256D.051, subdivision 24 new text end |
new text begin
256D.60, subdivision 5 new text end |
|
new text begin
256D.0512 new text end |
new text begin
256D.61 new text end |
|
new text begin
256D.0515 new text end |
new text begin
256D.62 new text end |
|
new text begin
256D.0516 new text end |
new text begin
256D.63 new text end |
|
new text begin
256D.053 new text end |
new text begin
256D.64 new text end |
Sec. 5. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 256D.055,
new text end
new text begin
is repealed.
new text end
ARTICLE 16
ECONOMIC ASSISTANCE
Section 1.
Minnesota Statutes 2020, section 119B.011, subdivision 15, is amended to read:
Subd. 15.
Income.
new text begin (a) new text end "Income" means earned income as defined under section 256P.01,
subdivision 3, unearned income as defined under section 256P.01, subdivision 8, and public
assistance cash benefits, including the Minnesota family investment program, diversionary
work program, work benefit, Minnesota supplemental aid, general assistance, refugee cash
assistance, at-home infant child care subsidy payments, deleted text begin anddeleted text end child support and maintenance
distributed to deleted text begin thedeleted text end new text begin anew text end family under section 256.741, subdivision 2adeleted text begin .deleted text end new text begin , and nonrecurring income
over $60 per quarter unless the nonrecurring income is:
new text end
new text begin
(1) from tax refunds, tax rebates, or tax credits;
new text end
new text begin
(2) from a reimbursement, rebate, award, grant, or refund of personal or real property
or costs or losses incurred when these payments are made by a public agency, a court, a
solicitation through public appeal, the federal government, a state or local unit of government,
or a disaster assistance organization;
new text end
new text begin
(3) provided as an in-kind benefit; or
new text end
new text begin
(4) earmarked and used for the purpose for which it was intended.
new text end
new text begin (b)new text end The following are deducted from income: funds used to pay for health insurance
premiums for family members, and child or spousal support paid to or on behalf of a person
or persons who live outside of the household. Income sources not included in this subdivision
and section 256P.06, subdivision 3, are not countednew text begin as incomenew text end .
Sec. 2.
Minnesota Statutes 2020, section 119B.025, subdivision 4, is amended to read:
Subd. 4.
Changes in eligibility.
(a) The county shall process a change in eligibility
factors according to paragraphs (b) to (g).
(b) A family is subject to the reporting requirements in section 256P.07new text begin , subdivision 6new text end .
(c) If a family reports a change or a change is known to the agency before the family's
regularly scheduled redetermination, the county must act on the change. The commissioner
shall establish standards for verifying a change.
(d) A change in income occurs on the day the participant received the first payment
reflecting the change in income.
(e) During a family's 12-month eligibility period, if the family's income increases and
remains at or below 85 percent of the state median income, adjusted for family size, there
is no change to the family's eligibility. The county shall not request verification of the
change. The co-payment fee shall not increase during the remaining portion of the family's
12-month eligibility period.
(f) During a family's 12-month eligibility period, if the family's income increases and
exceeds 85 percent of the state median income, adjusted for family size, the family is not
eligible for child care assistance. The family must be given 15 calendar days to provide
verification of the change. If the required verification is not returned or confirms ineligibility,
the family's eligibility ends following a subsequent 15-day adverse action notice.
(g) Notwithstanding Minnesota Rules, parts 3400.0040, subpart 3, and 3400.0170,
subpart 1, if an applicant or participant reports that employment ended, the agency may
accept a signed statement from the applicant or participant as verification that employment
ended.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256D.03, is amended by adding a subdivision to
read:
new text begin Subd. 2b. new text end
new text begin Budgeting and reporting. new text end
new text begin
Every county agency shall determine eligibility
and calculate benefit amounts for general assistance according to chapter 256P.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 4.
Minnesota Statutes 2020, section 256D.0515, is amended to read:
256D.0515 ASSET LIMITATIONS FOR SUPPLEMENTAL NUTRITION
ASSISTANCE PROGRAM HOUSEHOLDS.
All Supplemental Nutrition Assistance Program (SNAP) households must be determined
eligible for the benefit discussed under section 256.029. SNAP households must demonstrate
that their gross income is equal to or less than deleted text begin 165deleted text end new text begin 200new text end percent of the federal poverty
guidelines for the same family size.
Sec. 5.
Minnesota Statutes 2020, section 256D.0516, subdivision 2, is amended to read:
Subd. 2.
SNAP reporting requirements.
The commissioner of human services shall
implement simplified reporting as permitted under the Food and Nutrition Act of 2008, as
amended, and the SNAP regulations in Code of Federal Regulations, title 7, part 273. SNAP
benefit recipient households required to report periodically shall not be required to report
more often than one time every six months. deleted text begin This provision shall not apply to households
receiving food benefits under the Minnesota family investment program waiver.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 6.
Minnesota Statutes 2020, section 256D.06, subdivision 1, is amended to read:
Subdivision 1.
Eligibility; amount of assistance.
General assistance shall be granted
new text begin to an individual or married couple new text end in an amount deleted text begin that when added to the countable income
as determined to be actuallydeleted text end new text begin equal to the difference between the countable incomenew text end available
deleted text begin to the assistance unitdeleted text end under section 256P.06deleted text begin , the total amount equals the applicable standard
of assistance for general assistancedeleted text end new text begin and the standard for the individual or married couple
using the MFIP transitional standard cash portion described in section 256J.24, subdivision
5, paragraph (a)new text end . In determining eligibility for and the amount of assistance for an individual
or married couple, the agency shall apply the earned income disregard as determined in
section 256P.03.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2023.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256D.06, subdivision 2, is amended to read:
Subd. 2.
Emergency need.
(a) Notwithstanding the provisions of subdivision 1, a grant
of emergency general assistance shall, to the extent funds are available, be made to an
eligible single adult, married couple, or family for an emergency need where the recipient
requests temporary assistance not exceeding 30 days if an emergency situation appears to
exist under written criteria adopted by the county agency. If an applicant or recipient relates
facts to the county agency which may be sufficient to constitute an emergency situation,
the county agency shall, to the extent funds are available, advise the person of the procedure
for applying for assistance according to this subdivision.
(b) The applicant must be ineligible for assistance under chapter 256J, must have annual
net income no greater than 200 percent of the federal poverty guidelines for the previous
calendar year, and may new text begin only new text end receive an emergency assistance grant deleted text begin not more thandeleted text end once in
any 12-month period.
(c) Funding for an emergency general assistance program is limited to the appropriation.
Each fiscal year, the commissioner shall allocate to counties the money appropriated for
emergency general assistance grants based on each county agency's average share of state's
emergency general expenditures for the immediate past three fiscal years as determined by
the commissioner, and may reallocate any unspent amounts to other counties. new text begin The
commissioner may disregard periods of pandemic or other disaster, including fiscal years
2021 and 2022, when determining the amount allocated to counties. new text end No county shall be
allocated less than $1,000 for a fiscal year.
(d) Any emergency general assistance expenditures by a county above the amount of
the commissioner's allocation to the county must be made from county funds.
Sec. 8.
Minnesota Statutes 2020, section 256D.06, subdivision 5, is amended to read:
Subd. 5.
Eligibility; requirements.
(a) Any applicant, otherwise eligible for general
assistance and possibly eligible for maintenance benefits from any other source shall (1)
make application for those benefits within deleted text begin 30deleted text end new text begin 90new text end days of the general assistance applicationnew text begin ,
unless an applicant had good cause to not apply within that periodnew text end ; and (2) execute an interim
assistance agreement on a form as directed by the commissioner.
(b) The commissioner shall review a denial of an application for other maintenance
benefits and may require a recipient of general assistance to file an appeal of the denial if
appropriate. If found eligible for benefits from other sources, and a payment received from
another source relates to the period during which general assistance was also being received,
the recipient shall be required to reimburse the county agency for the interim assistance
paid. Reimbursement shall not exceed the amount of general assistance paid during the time
period to which the other maintenance benefits apply and shall not exceed the state standard
applicable to that time period.
(c) The commissioner may contract with the county agencies, qualified agencies,
organizations, or persons to provide advocacy and support services to process claims for
federal disability benefits for applicants or recipients of services or benefits supervised by
the commissioner using money retained under this section.
(d) The commissioner may provide methods by which county agencies shall identify,
refer, and assist recipients who may be eligible for benefits under federal programs for
people with a disability.
(e) The total amount of interim assistance recoveries retained under this section for
advocacy, support, and claim processing services shall not exceed 35 percent of the interim
assistance recoveries in the prior fiscal year.
Sec. 9.
Minnesota Statutes 2020, section 256E.36, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) The definitions in this subdivision apply to this section.
(b) "Commissioner" means the commissioner of human services.
(c) "Eligible organization" means a local governmental unitnew text begin , federally recognized Tribal
Nation,new text end or nonprofit organization providing or seeking to provide emergency services for
homeless persons.
(d) "Emergency services" means:
(1) providing emergency shelter for homeless persons; and
(2) assisting homeless persons in obtaining essential services, including:
(i) access to permanent housing;
(ii) medical and psychological help;
(iii) employment counseling and job placement;
(iv) substance abuse treatment;
(v) financial assistance available from other programs;
(vi) emergency child care;
(vii) transportation; and
(viii) other services needed to stabilize housing.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 10.
new text begin
[256E.361] EMERGENCY SHELTER FACILITIES GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services.
new text end
new text begin
(c) "Eligible organization" means a local governmental unit, federally recognized Tribal
Nation, or nonprofit organization seeking to acquire, construct, renovate, furnish, or equip
facilities for emergency homeless shelters for individuals and families experiencing
homelessness.
new text end
new text begin
(d) "Emergency services" has the meaning given in section 256E.36, subdivision 1,
paragraph (d).
new text end
new text begin
(e) "Emergency shelter facility" or "facility" means a facility that provides a safe, sanitary,
accessible, and suitable emergency shelter for individuals and families experiencing
homelessness, regardless of whether the facility provides emergency shelter for emergency
services during the day, overnight, or both.
new text end
new text begin Subd. 2. new text end
new text begin Program established; purpose. new text end
new text begin
An emergency shelter facilities grant program
is established to help eligible organizations acquire, construct, renovate, furnish, or equip
emergency shelter facilities for individuals and families experiencing homelessness. The
program shall be administered by the commissioner.
new text end
new text begin Subd. 3. new text end
new text begin Distribution of grants. new text end
new text begin
The commissioner must make grants with the purpose
of ensuring that emergency shelter facilities are available to meet the needs of individuals
and families experiencing homelessness statewide.
new text end
new text begin Subd. 4. new text end
new text begin Applications. new text end
new text begin
An eligible organization may apply to the commissioner for a
grant to acquire, construct, renovate, furnish, or equip an emergency shelter facility providing
or seeking to provide emergency services for individuals and families experiencing
homelessness. The commissioner shall use a competitive request for proposal process to
identify potential projects and eligible organizations on a statewide basis.
new text end
new text begin Subd. 5. new text end
new text begin Criteria for grant awards. new text end
new text begin
The commissioner shall award grants based on the
following criteria:
new text end
new text begin
(1) whether the application is for a grant to acquire, construct, renovate, furnish, or equip
an emergency shelter facility for individuals and families experiencing homelessness;
new text end
new text begin
(2) evidence of the applicant's need for state assistance and the need for the particular
facility to be funded; and
new text end
new text begin
(3) the applicant's long-range plans for future funding if the need continues to exist for
the emergency services provided at the facility.
new text end
new text begin Subd. 6. new text end
new text begin Availability of appropriations. new text end
new text begin
Appropriations under this section are available
for a four-year period that begins on July 1 of the fiscal year in which the appropriation
occurs. Unspent funds at the end of the four-year period shall be returned back to the general
fund.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256I.03, subdivision 13, is amended to read:
Subd. 13.
Prospective budgeting.
"Prospective budgeting" deleted text begin means estimating the amount
of monthly income a person will have in the payment monthdeleted text end new text begin has the meaning given in
section 256P.01, subdivision 9new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256I.06, subdivision 6, is amended to read:
Subd. 6.
Reports.
Recipients must report changes in circumstances according to section
256P.07 deleted text begin that affect eligibility or housing support payment amounts, other than changes in
earned income, within ten days of the changedeleted text end . Recipients with countable earned income
must complete a household report form deleted text begin at leastdeleted text end once every six monthsnew text begin according to section
256P.10new text end . deleted text begin If the report form is not received before the end of the month in which it is due,
the county agency must terminate eligibility for housing support payments. The termination
shall be effective on the first day of the month following the month in which the report was
due. If a complete report is received within the month eligibility was terminated, the
individual is considered to have continued an application for housing support payment
effective the first day of the month the eligibility was terminated.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 13.
Minnesota Statutes 2021 Supplement, section 256I.06, subdivision 8, is amended
to read:
Subd. 8.
Amount of housing support payment.
(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision 2a.
(b) For an individual with earned income under paragraph (a), prospective budgeting
new text begin under section 256P.09 new text end must be used deleted text begin to determine the amount of the individual's payment
for the following six-month period. An increase in income shall not affect an individual's
eligibility or payment amount until the month following the reporting month. A decrease
in income shall be effective the first day of the month after the month in which the decrease
is reporteddeleted text end .
(c) For an individual who receives housing support payments under section 256I.04,
subdivision 1, paragraph (c), the amount of the housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256I.09, is amended to read:
256I.09 COMMUNITY LIVING INFRASTRUCTURE.
The commissioner shall award grants to agencies through an annual competitive process.
Grants awarded under this section may be used for: (1) outreach to locate and engage people
who are homeless or residing in segregated settings to screen for basic needs and assist with
referral to community living resources; (2) building capacity to provide technical assistance
and consultation on housing and related support service resources for persons with both
disabilities and low income; deleted text begin ordeleted text end (3) streamlining the administration and monitoring activities
related to housing support fundsnew text begin ; or (4) direct assistance to individuals to access or maintain
housing in community settingsnew text end . Agencies may collaborate and submit a joint application
for funding under this section.
Sec. 15.
Minnesota Statutes 2020, section 256J.08, subdivision 71, is amended to read:
Subd. 71.
Prospective budgeting.
"Prospective budgeting" deleted text begin means a method of
determining the amount of the assistance payment in which the budget month and payment
month are the samedeleted text end new text begin has the meaning given in section 256P.01, subdivision 9new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256J.08, subdivision 79, is amended to read:
Subd. 79.
Recurring income.
"Recurring income" means a form of income which is:
(1) received periodically, and may be received irregularly when receipt can be anticipated
even though the date of receipt cannot be predicted; and
(2) from the same source or of the same type that is received and budgeted in a
prospective month deleted text begin and is received in one or both of the first two retrospective monthsdeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 17.
Minnesota Statutes 2021 Supplement, section 256J.21, subdivision 3, is amended
to read:
Subd. 3.
Initial income test.
new text begin (a) new text end The agency shall determine initial eligibility by
considering all earned and unearned income as defined in section 256P.06. To be eligible
for MFIP, the assistance unit's countable income minus the earned income disregards in
paragraph (a) and section 256P.03 must be below the family wage level according to section
256J.24, subdivision 7, for that size assistance unit.
deleted text begin (a)deleted text end new text begin (b)new text end The initial eligibility determination must disregard the following items:
(1) the earned income disregard as determined in section 256P.03;
(2) dependent care costs must be deducted from gross earned income for the actual
amount paid for dependent care up to a maximum of $200 per month for each child less
than two years of age, and $175 per month for each child two years of age and older;
(3) all payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household shall be disregarded from the income
of the person with the legal obligation to pay support; and
(4) an allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver according to section 256J.36.
deleted text begin (b) After initial eligibility is established,deleted text end new text begin (c) The income test is for a six-month period.new text end
The assistance payment calculation is based on deleted text begin the monthly income testdeleted text end new text begin prospective budgeting
according to section 256P.09new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256J.21, subdivision 4, is amended to read:
Subd. 4.
deleted text begin Monthlydeleted text end Income test and determination of assistance payment.
deleted text begin The county
agency shall determine ongoing eligibility and the assistance payment amount according
to the monthly income test.deleted text end To be eligible for MFIP, the result of the computations in
paragraphs (a) to (e) new text begin applied to prospective budgeting new text end must be at least $1.
(a) Apply an income disregard as defined in section 256P.03, to gross earnings and
subtract this amount from the family wage level. If the difference is equal to or greater than
the MFIP transitional standard, the assistance payment is equal to the MFIP transitional
standard. If the difference is less than the MFIP transitional standard, the assistance payment
is equal to the difference. The earned income disregard in this paragraph must be deducted
every month there is earned income.
(b) All payments made according to a court order for spousal support or the support of
children not living in the assistance unit's household must be disregarded from the income
of the person with the legal obligation to pay support.
(c) An allocation for the unmet need of an ineligible spouse or an ineligible child under
the age of 21 for whom the caregiver is financially responsible and who lives with the
caregiver must be made according to section 256J.36.
(d) Subtract unearned income dollar for dollar from the MFIP transitional standard to
determine the assistance payment amount.
(e) When income is both earned and unearned, the amount of the assistance payment
must be determined by first treating gross earned income as specified in paragraph (a). After
determining the amount of the assistance payment under paragraph (a), unearned income
must be subtracted from that amount dollar for dollar to determine the assistance payment
amount.
deleted text begin
(f) When the monthly income is greater than the MFIP transitional standard after
deductions and the income will only exceed the standard for one month, the county agency
must suspend the assistance payment for the payment month.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 19.
Minnesota Statutes 2021 Supplement, section 256J.33, subdivision 1, is amended
to read:
Subdivision 1.
Determination of eligibility.
(a) A county agency must determine MFIP
eligibility prospectively deleted text begin for a payment monthdeleted text end based on deleted text begin retrospectivelydeleted text end assessing income
and the county agency's best estimate of the circumstances that will exist in the payment
month.
(b) deleted text begin Except as described in section 256J.34, subdivision 1, when prospective eligibility
exists,deleted text end A county agency must calculate the amount of the assistance payment using
deleted text begin retrospectivedeleted text end new text begin prospectivenew text end budgeting. To determine MFIP eligibility and the assistance
payment amount, a county agency must apply countable income, described in sections
256P.06 and 256J.37, subdivisions 3 to deleted text begin 10deleted text end new text begin 9new text end , received by members of an assistance unit or
by other persons whose income is counted for the assistance unit, described under sections
256J.37, subdivisions 1 to 2, and 256P.06, subdivision 1.
(c) This income must be applied to the MFIP standard of need or family wage level
subject to this section and sections 256J.34 to 256J.36. Countable income as described in
section 256P.06, subdivision 3, received deleted text begin in a calendar monthdeleted text end must be applied to the needs
of an assistance unit.
new text begin
(d) An assistance unit is not eligible when the countable income equals or exceeds the
MFIP standard of need or the family wage level for the assistance unit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024, except that the amendment
to paragraph (b) striking "10" and inserting "9" is effective July 1, 2023.
new text end
Sec. 20.
Minnesota Statutes 2020, section 256J.33, subdivision 2, is amended to read:
Subd. 2.
Prospective eligibility.
An agency must determine whether the eligibility
requirements that pertain to an assistance unit, including those in sections 256J.11 to 256J.15
and 256P.02, will be met prospectively for the payment deleted text begin monthdeleted text end new text begin periodnew text end . deleted text begin Except for the
provisions in section 256J.34, subdivision 1,deleted text end The income test will be applied deleted text begin retrospectivelydeleted text end new text begin
prospectivelynew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256J.37, subdivision 3, is amended to read:
Subd. 3.
Earned income of wage, salary, and contractual employees.
The agency
must include gross earned income less any disregards in the initial deleted text begin and monthlydeleted text end income
test. Gross earned income received by persons employed on a contractual basis must be
prorated over the period covered by the contract even when payments are received over a
lesser period of time.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256J.37, subdivision 3a, is amended to read:
Subd. 3a.
Rental subsidies; unearned income.
(a) Effective July 1, 2003, the agency
shall count $50 of the value of public and assisted rental subsidies provided through the
Department of Housing and Urban Development (HUD) as unearned income to the cash
portion of the MFIP grant. The full amount of the subsidy must be counted as unearned
income when the subsidy is less than $50. The income from this subsidy shall be budgeted
according to section deleted text begin 256J.34deleted text end new text begin 256P.09new text end .
(b) The provisions of this subdivision shall not apply to an MFIP assistance unit which
includes a participant who is:
(1) age 60 or older;
(2) a caregiver who is suffering from an illness, injury, or incapacity that has been
certified by a qualified professional when the illness, injury, or incapacity is expected to
continue for more than 30 days and severely limits the person's ability to obtain or maintain
suitable employment; or
(3) a caregiver whose presence in the home is required due to the illness or incapacity
of another member in the assistance unit, a relative in the household, or a foster child in the
household when the illness or incapacity and the need for the participant's presence in the
home has been certified by a qualified professional and is expected to continue for more
than 30 days.
(c) The provisions of this subdivision shall not apply to an MFIP assistance unit where
the parental caregiver is an SSI participant.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256J.95, subdivision 19, is amended to read:
Subd. 19.
DWP overpayments and underpayments.
DWP benefits are subject to
overpayments and underpayments. Anytime an overpayment or an underpayment is
determined for DWP, the correction shall be calculated using prospective budgeting.
Corrections shall be determined based on the policy in section deleted text begin 256J.34, subdivision 1,
paragraphs (a), (b), and (c)deleted text end new text begin 256P.09, subdivisions 1 to 4new text end . ATM errors must be recovered as
specified in section 256P.08, subdivision 7. Cross program recoupment of overpayments
cannot be assigned to or from DWP.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256K.45, subdivision 3, is amended to read:
Subd. 3.
Street and community outreach and drop-in program.
Youth drop-in centers
must provide walk-in access to crisis intervention and ongoing supportive services including
one-to-one case management services on a self-referral basis. Street and community outreach
programs must locate, contact, and provide information, referrals, and services to homeless
youth, youth at risk of homelessness, and runaways. Information, referrals, and services
provided may include, but are not limited to:
(1) family reunification services;
(2) conflict resolution or mediation counseling;
(3) assistance in obtaining temporary emergency shelter;
(4) assistance in obtaining food, clothing, medical care, or mental health counseling;
(5) counseling regarding violence, sexual exploitation, substance abuse, sexually
transmitted diseases, and pregnancy;
(6) referrals to other agencies that provide support services to homeless youth, youth at
risk of homelessness, and runaways;
(7) assistance with education, employment, and independent living skills;
(8) aftercare services;
(9) specialized services for highly vulnerable runaways and homeless youth, including
deleted text begin teendeleted text end new text begin but not limited to youth at risk of discrimination based on sexual orientation or gender
identity, young new text end parents, emotionally disturbed and mentally ill youth, and sexually exploited
youth; and
(10) homelessness prevention.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256P.01, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Prospective budgeting. new text end
new text begin
"Prospective budgeting" means estimating the amount
of monthly income that an assistance unit will have in the payment month.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 26.
Minnesota Statutes 2021 Supplement, section 256P.04, subdivision 4, is amended
to read:
Subd. 4.
Factors to be verified.
(a) The agency shall verify the following at application:
(1) identity of adults;
(2) age, if necessary to determine eligibility;
(3) immigration status;
(4) income;
(5) spousal support and child support payments made to persons outside the household;
(6) vehicles;
(7) checking and savings accounts, including but not limited to any business accounts
used to pay expenses not related to the business;
(8) inconsistent information, if related to eligibility;
(9) residence;new text begin and
new text end
(10) Social Security numberdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(11) use of nonrecurring income under section 256P.06, subdivision 3, clause (2), item
(ix), for the intended purpose for which it was given and received.
deleted text end
(b) Applicants who are qualified noncitizens and victims of domestic violence as defined
under section 256J.08, subdivision 73, clauses (8) and (9), are not required to verify the
information in paragraph (a), clause (10). When a Social Security number is not provided
to the agency for verification, this requirement is satisfied when each member of the
assistance unit cooperates with the procedures for verification of Social Security numbers,
issuance of duplicate cards, and issuance of new numbers which have been established
jointly between the Social Security Administration and the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 27.
Minnesota Statutes 2021 Supplement, section 256P.04, subdivision 8, is amended
to read:
Subd. 8.
Recertification.
The agency shall recertify eligibility annually. During
recertificationnew text begin and reporting under section 256P.10new text end , the agency shall verify the following:
(1) income, unless excluded, including self-employment earnings;
(2) assets when the value is within $200 of the asset limit; and
(3) inconsistent information, if related to eligibility.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 28.
Minnesota Statutes 2021 Supplement, section 256P.06, subdivision 3, is amended
to read:
Subd. 3.
Income inclusions.
The following must be included in determining the income
of an assistance unit:
(1) earned income; and
(2) unearned income, which includes:
(i) interest and dividends from investments and savings;
(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;
(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;
(iv) income from trusts, excluding special needs and supplemental needs trusts;
(v) interest income from loans made by the participant or household;
(vi) cash prizes and winnings;
(vii) unemployment insurance income that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
(A) 18 years of age and enrolled in a secondary school; or
(B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-time;
(viii) new text begin for the purposes of programs under chapters 256D and 256I, new text end retirement, survivors,
and disability insurance payments;
deleted text begin
(ix) nonrecurring income over $60 per quarter unless the nonrecurring income is: (A)
from tax refunds, tax rebates, or tax credits; (B) a reimbursement, rebate, award, grant, or
refund of personal or real property or costs or losses incurred when these payments are
made by: a public agency; a court; solicitations through public appeal; a federal, state, or
local unit of government; or a disaster assistance organization; (C) provided as an in-kind
benefit; or (D) earmarked and used for the purpose for which it was intended, subject to
verification requirements under section 256P.04;
deleted text end
deleted text begin (x)deleted text end new text begin (ix)new text end retirement benefits;
deleted text begin (xi)deleted text end new text begin (x)new text end cash assistance benefits, as defined by each program in chapters 119B, 256D,
256I, and 256J;
deleted text begin (xii)deleted text end new text begin (xi)new text end Tribal per capita payments unless excluded by federal and state law;
deleted text begin (xiii)deleted text end new text begin (xii)new text end income and payments from service and rehabilitation programs that meet or
exceed the state's minimum wage rate;
deleted text begin (xiv)deleted text end new text begin (xiii)new text end income from members of the United States armed forces unless excluded
from income taxes according to federal or state law;
deleted text begin (xv)deleted text end new text begin (xiv) for the purposes of programs under chapters 119B, 256D, and 256I,new text end all child
support payments deleted text begin for programs under chapters 119B, 256D, and 256Ideleted text end ;
deleted text begin (xvi)deleted text end new text begin (xv) for the purposes of programs under chapter 256J,new text end the amount of child support
received that exceeds $100 for assistance units with one child and $200 for assistance units
with two or more children deleted text begin for programs under chapter 256Jdeleted text end ;
deleted text begin (xvii)deleted text end new text begin (xvi)new text end spousal support; deleted text begin and
deleted text end
deleted text begin (xviii)deleted text end new text begin (xvii)new text end workers' compensationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(xviii) for the purposes of programs under chapters 119B and 256J, the amount of
retirement, survivors, and disability insurance payments that exceeds the applicable monthly
federal maximum Supplemental Security Income payments.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, except the amendment
removing nonrecurring income over $60 per quarter is effective July 1, 2023.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256P.07, subdivision 1, is amended to read:
Subdivision 1.
Exempted programs.
Participants who new text begin receive Supplemental Security
Income and new text end qualify for Minnesota supplemental aid under chapter 256D deleted text begin anddeleted text end new text begin ornew text end for housing
support under chapter 256I deleted text begin on the basis of eligibility for Supplemental Security Incomedeleted text end are
exempt from deleted text begin this sectiondeleted text end new text begin reporting income under this chapternew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256P.07, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Child care assistance programs. new text end
new text begin
Participants who qualify for child care
assistance programs under chapter 119B are exempt from this section except the reporting
requirements in subdivision 6.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256P.07, subdivision 2, is amended to read:
Subd. 2.
Reporting requirements.
An applicant or participant must provide information
on an application and any subsequent reporting forms about the assistance unit's
circumstances that affect eligibility or benefits. An applicant or assistance unit must report
changes new text begin that affect eligibility or benefits as new text end identified in deleted text begin subdivisiondeleted text end new text begin subdivisionsnew text end 3new text begin , 4, 5,
7, 8, and 9, during the application period or by the tenth of the month following the month
the assistance unit's circumstances changednew text end . When information is not accurately reported,
both an overpayment and a referral for a fraud investigation may result. When information
or documentation is not provided, the receipt of any benefit may be delayed or denied,
depending on the type of information required and its effect on eligibility.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256P.07, subdivision 3, is amended to read:
Subd. 3.
Changes that must be reported.
deleted text begin
An assistance unit must report the changes
or anticipated changes specified in clauses (1) to (12) within ten days of the date they occur,
at the time of recertification of eligibility under section 256P.04, subdivisions 8 and 9, or
within eight calendar days of a reporting period, whichever occurs first. An assistance unit
must report other changes at the time of recertification of eligibility under section 256P.04,
subdivisions 8 and 9, or at the end of a reporting period, as applicable. When an agency
could have reduced or terminated assistance for one or more payment months if a delay in
reporting a change specified under clauses (1) to (12) had not occurred, the agency must
determine whether a timely notice could have been issued on the day that the change
occurred. When a timely notice could have been issued, each month's overpayment
subsequent to that notice must be considered a client error overpayment under section
119B.11, subdivision 2a, or 256P.08. Changes in circumstances that must be reported within
ten days must also be reported for the reporting period in which those changes occurred.
Within ten days, an assistance unit must report:
deleted text end
deleted text begin
(1) a change in earned income of $100 per month or greater with the exception of a
program under chapter 119B;
deleted text end
deleted text begin
(2) a change in unearned income of $50 per month or greater with the exception of a
program under chapter 119B;
deleted text end
deleted text begin
(3) a change in employment status and hours with the exception of a program under
chapter 119B;
deleted text end
deleted text begin
(4) a change in address or residence;
deleted text end
deleted text begin
(5) a change in household composition with the exception of programs under chapter
256I;
deleted text end
deleted text begin
(6) a receipt of a lump-sum payment with the exception of a program under chapter
119B;
deleted text end
deleted text begin
(7) an increase in assets if over $9,000 with the exception of programs under chapter
119B;
deleted text end
deleted text begin
(8) a change in citizenship or immigration status;
deleted text end
deleted text begin
(9) a change in family status with the exception of programs under chapter 256I;
deleted text end
deleted text begin
(10) a change in disability status of a unit member, with the exception of programs under
chapter 119B;
deleted text end
deleted text begin
(11) a new rent subsidy or a change in rent subsidy with the exception of a program
under chapter 119B; and
deleted text end
deleted text begin
(12) a sale, purchase, or transfer of real property with the exception of a program under
chapter 119B.
deleted text end
new text begin
(a) An assistance unit must report changes or anticipated changes as described in this
subdivision.
new text end
new text begin
(b) An assistance unit must report:
new text end
new text begin
(1) a change in eligibility for Supplemental Security Income, Retirement Survivors
Disability Insurance, or another federal income support;
new text end
new text begin
(2) a change in address or residence;
new text end
new text begin
(3) a change in household composition with the exception of programs under chapter
256I;
new text end
new text begin
(4) cash prizes and winnings according to guidance provided for the Supplemental
Nutrition Assistance Program;
new text end
new text begin
(5) a change in citizenship or immigration status;
new text end
new text begin
(6) a change in family status with the exception of programs under chapter 256I; and
new text end
new text begin
(7) a change that makes the value of the unit's assets at or above the asset limit.
new text end
new text begin
(c) When an agency could have reduced or terminated assistance for one or more payment
months if a delay in reporting a change specified under paragraph (b) had not occurred, the
agency must determine the first month that the agency could have reduced or terminated
assistance following a timely notice given on the date of the change in income. Each month's
overpayment starting with that month must be considered a client error overpayment under
section 256P.08.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024, except that the amendment
striking clause (6) is effective July 1, 2023.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256P.07, subdivision 4, is amended to read:
Subd. 4.
MFIP-specific reporting.
In addition to subdivision 3, an assistance unit under
chapter 256Jdeleted text begin , within ten days of the change,deleted text end must report:
(1) a pregnancy not resulting in birth when there are no other minor children; deleted text begin and
deleted text end
(2) a change in school attendance of a parent under 20 years of age deleted text begin or of an employed
child.deleted text end new text begin ; and
new text end
new text begin
(3) an individual in the household who is 18 or 19 years of age attending high school
who graduates or drops out of school.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256P.07, subdivision 6, is amended to read:
Subd. 6.
Child care assistance programs-specific reporting.
(a) deleted text begin In addition to
subdivision 3,deleted text end An assistance unit under chapter 119B, within ten days of the change, must
report:
(1) a change in a parentally responsible individual's custody schedule for any child
receiving child care assistance program benefits;
(2) a permanent end in a parentally responsible individual's authorized activity; deleted text begin and
deleted text end
(3) if the unit's family's annual included income exceeds 85 percent of the state median
income, adjusted for family sizedeleted text begin .deleted text end new text begin ;
new text end
new text begin
(4) a change in address or residence;
new text end
new text begin
(5) a change in household composition;
new text end
new text begin
(6) a change in citizenship or immigration status; and
new text end
new text begin
(7) a change in family status.
new text end
(b) An assistance unit subject to section 119B.095, subdivision 1, paragraph (b), must
report a change in the unit's authorized activity status.
(c) An assistance unit must notify the county when the unit wants to reduce the number
of authorized hours for children in the unit.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256P.07, subdivision 7, is amended to read:
Subd. 7.
Minnesota supplemental aid-specific reporting.
new text begin (a) new text end In addition to subdivision
3, an assistance unit participating in the Minnesota supplemental aid program under deleted text begin section
256D.44, subdivision 5, paragraph (g), within ten days of the change,deleted text end new text begin chapter 256D and not
receiving Supplemental Security Incomenew text end must report deleted text begin shelter expenses.deleted text end new text begin :
new text end
new text begin
(1) a change in unearned income of $50 per month or greater; and
new text end
new text begin
(2) a change in earned income of $100 per month or greater.
new text end
new text begin
(b) An assistance unit receiving housing assistance under section 256D.44, subdivision
5, paragraph (g), including assistance units that also receive Supplemental Security Income,
must report:
new text end
new text begin
(1) a change in shelter expenses; and
new text end
new text begin
(2) a new rent subsidy or a change in rent subsidy.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256P.07, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Housing support-specific reporting. new text end
new text begin
(a) In addition to subdivision 3, an
assistance unit participating in the housing support program under chapter 256I and not
receiving Supplemental Security Income must report:
new text end
new text begin
(1) a change in unearned income of $50 per month or greater; and
new text end
new text begin
(2) a change in earned income of $100 per month or greater, unless the assistance unit
is already subject to six-month reporting requirements in section 256P.10.
new text end
new text begin
(b) Notwithstanding the exemptions in subdivisions 1 and 3, an assistance unit receiving
housing support under chapter 256I, including an assistance unit that receives Supplemental
Security Income, must report:
new text end
new text begin
(1) a new rent subsidy or a change in rent subsidy;
new text end
new text begin
(2) a change in the disability status of a unit member; and
new text end
new text begin
(3) a change in household composition if the assistance unit is a participant in housing
support under section 256I.04, subdivision 3, paragraph (a), clause (3).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256P.07, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin General assistance-specific reporting. new text end
new text begin
In addition to subdivision 3, an
assistance unit participating in the general assistance program under chapter 256D must
report:
new text end
new text begin
(1) a change in unearned income of $50 per month or greater;
new text end
new text begin
(2) a change in earned income of $100 per month or greater, unless the assistance unit
is already subject to six-month reporting requirements in section 256P.10; and
new text end
new text begin
(3) changes in any condition that would result in the loss of basis for eligibility in section
256D.05, subdivision 1, paragraph (a).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 38.
new text begin
[256P.09] PROSPECTIVE BUDGETING OF BENEFITS.
new text end
new text begin Subdivision 1. new text end
new text begin Exempted programs. new text end
new text begin
Assistance units that qualify for child care
assistance programs under chapter 119B, assistance units that receive housing support under
chapter 256I and are not subject to reporting under section 256P.10, and assistance units
that qualify for Minnesota supplemental aid under chapter 256D are exempt from this
section.
new text end
new text begin Subd. 2. new text end
new text begin Prospective budgeting of benefits. new text end
new text begin
An agency subject to this chapter must use
prospective budgeting to calculate the assistance payment amount.
new text end
new text begin Subd. 3. new text end
new text begin Initial income. new text end
new text begin
For the purpose of determining an assistance unit's level of
benefits, an agency must take into account the income already received by the assistance
unit during or anticipated to be received during the application period. Income anticipated
to be received only in the initial month of eligibility should only be counted in the initial
month.
new text end
new text begin Subd. 4. new text end
new text begin Income determination. new text end
new text begin
An agency must use prospective budgeting to determine
the amount of the assistance unit's benefit for the eligibility period based on the best
information available at the time of approval. An agency shall only count anticipated income
when the participant and the agency are reasonably certain of the amount of the payment
and the month in which the payment will be received. If the exact amount of the income is
not known, the agency shall consider only the amounts that can be anticipated as income.
new text end
new text begin Subd. 5. new text end
new text begin Income changes. new text end
new text begin
An increase in income shall not affect an assistance unit's
eligibility or benefit amount until the next review unless otherwise required to be reported
in section 256P.07. A decrease in income shall be effective on the date that the change
occurs if the change is reported by the tenth of the month following the month when the
change occurred. If the assistant unit does not report the change in income by the tenth of
the month following the month when the change occurred, the change in income shall be
effective on the date the change was reported.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024.
new text end
Sec. 39.
new text begin
[256P.10] SIX-MONTH REPORTING.
new text end
new text begin Subdivision 1. new text end
new text begin Exempted programs. new text end
new text begin
Assistance units that qualify for child care
assistance programs under chapter 119B, assistance units that qualify for Minnesota
supplemental aid under chapter 256D, and assistance units that qualify for housing support
under chapter 256I and also receive Supplemental Security Income are exempt from this
section.
new text end
new text begin Subd. 2. new text end
new text begin Reporting. new text end
new text begin
(a) An assistance unit that qualifies for the Minnesota family
investment program under chapter 256J, an assistance unit that qualifies for general assistance
under chapter 256D with an earned income of $100 per month or greater, or an assistance
unit that qualifies for housing support under chapter 256I with an earned income of $100
per month or greater is subject to six-month reviews. The initial reporting period may be
shorter than six months in order to align with other programs' reporting periods.
new text end
new text begin
(b) An assistance unit that qualifies for the Minnesota family investment program or an
assistance unit that qualifies for general assistance with an earned income of $100 per month
or greater must complete household report forms as required by the commissioner for
redetermination of benefits.
new text end
new text begin
(c) An assistance unit that qualifies for housing support with an earned income of $100
per month or greater must complete household report forms as prescribed by the
commissioner to provide information about earned income.
new text end
new text begin
(d) An assistance unit that qualifies for housing support and also receives assistance
through the Minnesota family investment program shall be subject to requirements of this
section for purposes of the Minnesota family investment program but not for housing support.
new text end
new text begin
(e) An assistance unit covered by this section must submit a household report form in
compliance with the provisions in section 256P.04, subdivision 11.
new text end
new text begin
(f) An assistance unit covered by this section may choose to report changes under this
section at any time.
new text end
new text begin Subd. 3. new text end
new text begin When to terminate assistance. new text end
new text begin
(a) An agency must terminate benefits when
the assistance unit fails to submit the household report form before the end of the six-month
review period as described in subdivision 2, paragraph (a). If the assistance unit submits
the household report form within 30 days of the termination of benefits and remains eligible,
benefits must be reinstated and made available retroactively for the full benefit month.
new text end
new text begin
(b) When an assistance unit is determined to be ineligible for assistance according to
this section and chapter 256D, 256I, or 256J, the commissioner must terminate assistance.
new text end
Sec. 40. new text begin PILOT PROGRAM FOR CHOSEN FAMILY HOSTING TO PREVENT
YOUTH HOMELESSNESS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of human services must establish a
pilot program for providers seeking to establish or expand services for homeless youth that
formalize situations where a caring adult who a youth considers chosen family allows a
youth to stay at the adult's residence to avoid being homeless.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given them.
new text end
new text begin
(b) "Chosen family" means any individual, related by blood or affinity, whose close
association fulfills the need of a familial relationship.
new text end
new text begin
(c) "Set of participants" means a youth aged 18 to 24 and (1) an adult host who is the
youth's chosen family and with whom the youth is living in an intergenerational hosting
arrangement to avoid being homeless, or (2) a relative with whom the youth is living to
avoid being homeless.
new text end
new text begin Subd. 3. new text end
new text begin Administration. new text end
new text begin
(a) The commissioner of human services, as authorized by
Minnesota Statutes, section 256.01, subdivision 2, paragraph (a), clause (6), shall contract
with a technical assistance provider to:
new text end
new text begin
(1) provide technical assistance to funding recipients;
new text end
new text begin
(2) facilitate a monthly learning cohort for funding recipients;
new text end
new text begin
(3) evaluate the efficacy and cost-effectiveness of the pilot program; and
new text end
new text begin
(4) submit annual updates and a final report to the commissioner.
new text end
new text begin
(b) When developing the criteria for awarding funds, the commissioner must include a
requirement that all funding recipients:
new text end
new text begin
(1) partner with sets of participants, with a case manager caseload consistent with existing
norms for homeless youth;
new text end
new text begin
(2) mediate agreements within each set of participants about shared expectations regarding
the living arrangement;
new text end
new text begin
(3) provide monthly stipends to sets of participants to offset the costs created by the
living arrangement;
new text end
new text begin
(4) connect sets of participants to community resources;
new text end
new text begin
(5) if the adult host is a renter, help facilitate ongoing communication between the
property owner and adult host;
new text end
new text begin
(6) offer strategies to address barriers faced by adult hosts who are renters;
new text end
new text begin
(7) assist the youth in identifying and strengthening their circle of support, giving focused
attention to adults who can serve as permanent connections and provide ongoing support
throughout the youth's life; and
new text end
new text begin
(8) actively participate in monthly cohort meetings.
new text end
new text begin Subd. 4. new text end
new text begin Technical assistance provider. new text end
new text begin
The commissioner must select a technical
assistance provider to provide assistance to funding recipients. In order to be selected, the
technical assistance provider must:
new text end
new text begin
(1) have in-depth experience with research on and evaluation of youth homelessness
from a holistic perspective that addresses the four core outcomes developed by the United
States Interagency Council on Homelessness to prevent and end youth homelessness;
new text end
new text begin
(2) offer education and have previous experience providing technical assistance on
supporting chosen family hosting arrangements to organizations that serve homeless youth;
new text end
new text begin
(3) have expertise on how to address barriers faced by chosen family hosts who are
renters; and
new text end
new text begin
(4) be located in Minnesota.
new text end
new text begin Subd. 5. new text end
new text begin Eligible applicants. new text end
new text begin
To be eligible for funding under this section, an applicant
must be a provider serving homeless youth in Minnesota. The money must be awarded to
funding recipients beginning no later than March 31, 2023.
new text end
new text begin Subd. 6. new text end
new text begin Applications. new text end
new text begin
Providers seeking funding under this section shall apply to the
commissioner. The applicant must include a description of the project that the applicant is
proposing, the amount of money that the applicant is seeking, and a proposed budget
describing how the applicant will spend the money.
new text end
new text begin Subd. 7. new text end
new text begin Reporting. new text end
new text begin
The technical assistance provider must submit annual updates and
a final report to the commissioner in a manner specified by the commissioner on the technical
assistance provider's findings regarding the efficacy and cost-effectiveness of the pilot
program.
new text end
Sec. 41. new text begin DIRECTION TO COMMISSIONER; INCOME AND ASSET EXCLUSION
FOR LOCAL GUARANTEED INCOME DEMONSTRATION PROJECTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services unless specified
otherwise.
new text end
new text begin
(c) "Guaranteed income demonstration project" means a local demonstration project to
evaluate how unconditional cash payments have a causal effect on income volatility, financial
well-being, and early childhood development in infants and toddlers.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner; income and asset exclusion. new text end
new text begin
(a) During the duration of the
guaranteed income demonstration project, the commissioner shall not count payments made
to families by the guaranteed income demonstration project as income or assets for purposes
of determining or redetermining eligibility for the following programs:
new text end
new text begin
(1) child care assistance programs under Minnesota Statutes, chapter 119B; and
new text end
new text begin
(2) the Minnesota family investment program, work benefit program, or diversionary
work program under Minnesota Statutes, chapter 256J.
new text end
new text begin
(b) During the duration of the guaranteed income demonstration project, the commissioner
shall not count payments made to families by the guaranteed income demonstration project
as income or assets for purposes of determining or redetermining eligibility for the following
programs:
new text end
new text begin
(1) medical assistance under Minnesota Statutes, chapter 256B; and
new text end
new text begin
(2) MinnesotaCare under Minnesota Statutes, chapter 256L.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, except for subdivision 2,
paragraph (b), which is effective July 1, 2022, or upon federal approval, whichever is later.
new text end
Sec. 42. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 256J.08, subdivisions 10, 61, 62, 81, and 83;
256J.30, subdivisions 5 and 7; 256J.33, subdivisions 3 and 5; 256J.34, subdivisions 1, 2, 3,
and 4; and 256J.37, subdivision 10,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2021 Supplement, sections 256J.08, subdivision 53; 256J.30,
subdivision 8; and 256J.33, subdivision 4,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective March 1, 2024, except the repeal of
Minnesota Statutes 2020, sections 256J.08, subdivision 62, and 256J.37, subdivision 10,
and Minnesota Statutes 2021 Supplement, section 256J.08, subdivision 53, is effective July
1, 2023.
new text end
ARTICLE 17
DIRECT CARE AND TREATMENT POLICY
Section 1.
Minnesota Statutes 2020, section 253B.18, subdivision 6, is amended to read:
Subd. 6.
Transfer.
(a) A patient who is a person who has a mental illness and is
dangerous to the public shall not be transferred out of a secure treatment facility unless it
appears to the satisfaction of the commissioner, after a hearing and favorable recommendation
by a majority of the special review board, that the transfer is appropriate. Transfer may be
to another state-operated treatment program. In those instances where a commitment also
exists to the Department of Corrections, transfer may be to a facility designated by the
commissioner of corrections.
(b) The following factors must be considered in determining whether a transfer is
appropriate:
(1) the person's clinical progress and present treatment needs;
(2) the need for security to accomplish continuing treatment;
(3) the need for continued institutionalization;
(4) which facility can best meet the person's needs; and
(5) whether transfer can be accomplished with a reasonable degree of safety for the
public.
new text begin
(c) If a committed person has been transferred out of a secure treatment facility pursuant
to this subdivision, that committed person may voluntarily return to a secure treatment
facility for a period of up to 60 days with the consent of the head of the treatment facility.
new text end
new text begin
(d) If the committed person is not returned to the original, nonsecure transfer facility
within 60 days of being readmitted to a secure treatment facility, the transfer is revoked and
the committed person shall remain in a secure treatment facility. The committed person
shall immediately be notified in writing of the revocation.
new text end
new text begin
(e) Within 15 days of receiving notice of the revocation, the committed person may
petition the special review board for a review of the revocation. The special review board
shall review the circumstances of the revocation and shall recommend to the commissioner
whether or not the revocation shall be upheld. The special review board may also recommend
a new transfer at the time of the revocation hearing.
new text end
new text begin
(f) No action by the special review board is required if the transfer has not been revoked
and the committed person is returned to the original, nonsecure transfer facility with no
substantive change to the conditions of the transfer ordered under this subdivision.
new text end
new text begin
(g) The head of the treatment facility may revoke a transfer made under this subdivision
and require a committed person to return to a secure treatment facility if:
new text end
new text begin
(1) remaining in a nonsecure setting does not provide a reasonable degree of safety to
the committed person or others; or
new text end
new text begin
(2) the committed person has regressed clinically and the facility to which the committed
person was transferred does not meet the committed person's needs.
new text end
new text begin
(h) Upon the revocation of the transfer, the committed person shall be immediately
returned to a secure treatment facility. A report documenting the reasons for revocation
shall be issued by the head of the treatment facility within seven days after the committed
person is returned to the secure treatment facility. Advance notice to the committed person
of the revocation is not required.
new text end
new text begin
(i) The committed person must be provided a copy of the revocation report and informed,
orally and in writing, of the rights of a committed person under this section. The revocation
report shall be served upon the committed person, the committed person's counsel, and the
designated agency. The report shall outline the specific reasons for the revocation, including
but not limited to the specific facts upon which the revocation is based.
new text end
new text begin
(j) If a committed person's transfer is revoked, the committed person may re-petition for
transfer according to subdivision 5.
new text end
new text begin
(k) A committed person aggrieved by a transfer revocation decision may petition the
special review board within seven business days after receipt of the revocation report for a
review of the revocation. The matter shall be scheduled within 30 days. The special review
board shall review the circumstances leading to the revocation and, after considering the
factors in paragraph (b), shall recommend to the commissioner whether or not the revocation
shall be upheld. The special review board may also recommend a new transfer out of a
secure facility at the time of the revocation hearing.
new text end
Sec. 2.
Minnesota Statutes 2021 Supplement, section 256.01, subdivision 42, is amended
to read:
Subd. 42.
Expiration of report mandates.
(a) If the submission of a report by the
commissioner of human services to the legislature is mandated by statute and the enabling
legislation does not include a date for the submission of a final reportnew text begin or an expiration datenew text end ,
the mandate to submit the report shall expire in accordance with this section.
(b) If the mandate requires the submission of an annual new text begin or more frequent new text end report and the
mandate was enacted before January 1, 2021, the mandate shall expire on January 1, 2023.
If the mandate requires the submission of a biennial or less frequent report and the mandate
was enacted before January 1, 2021, the mandate shall expire on January 1, 2024.
(c) Any reporting mandate enacted on or after January 1, 2021, shall expire three years
after the date of enactment if the mandate requires the submission of an annualnew text begin or more
frequentnew text end report and shall expire five years after the date of enactment if the mandate requires
the submission of a biennial or less frequent report unless the enacting legislation provides
for a different expiration date.
(d)new text begin By January 15 of each year,new text end the commissioner shall submit a list deleted text begin to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services by February 15 of each year, beginning February 15, 2022,deleted text end of all reports set to
expire during the following calendar year deleted text begin in accordance with this sectiondeleted text end new text begin to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services. Notwithstanding paragraph (c), this paragraph does not expirenew text end .
Sec. 3.
Laws 2009, chapter 79, article 13, section 3, subdivision 10, as amended by Laws
2009, chapter 173, article 2, section 1, is amended to read:
Subd. 10.State-Operated Services
|
||||||
The amounts that may be spent from the
appropriation for each purpose are as follows:
Transfer Authority Related to
State-Operated Services. Money
appropriated to finance state-operated services
may be transferred between the fiscal years of
the biennium with the approval of the
commissioner of finance.
County Past Due Receivables. The
commissioner is authorized to withhold county
federal administrative reimbursement when
the county of financial responsibility for
cost-of-care payments due the state under
Minnesota Statutes, section 246.54 or
253B.045, is 90 days past due. The
commissioner shall deposit the withheld
federal administrative earnings for the county
into the general fund to settle the claims with
the county of financial responsibility. The
process for withholding funds is governed by
Minnesota Statutes, section 256.017.
Forecast and Census Data. The
commissioner shall include census data and
fiscal projections for state-operated services
and Minnesota sex offender services with the
deleted text begin November anddeleted text end February budget deleted text begin forecasts.
Notwithstanding any contrary provision in this
article, this paragraph shall not expiredeleted text end new text begin forecastnew text end .
|
(a) Adult Mental Health Services |
106,702,000 |
107,201,000 |
||||
Appropriation Limitation. No part of the
appropriation in this article to the
commissioner for mental health treatment
services provided by state-operated services
shall be used for the Minnesota sex offender
program.
Community Behavioral Health Hospitals.
Under Minnesota Statutes, section 246.51,
subdivision 1, a determination order for the
clients served in a community behavioral
health hospital operated by the commissioner
of human services is only required when a
client's third-party coverage has been
exhausted.
Base Adjustment. The general fund base is
decreased by $500,000 for fiscal year 2012
and by $500,000 for fiscal year 2013.
|
(b) Minnesota Sex Offender Services |
||||||
| Appropriations by Fund |
||
| General |
38,348,000 |
67,503,000 |
| Federal Fund |
26,495,000 |
0 |
Use of Federal Stabilization Funds. Of this
appropriation, $26,495,000 in fiscal year 2010
is from the fiscal stabilization account in the
federal fund to the commissioner. This
appropriation must not be used for any activity
or service for which federal reimbursement is
claimed. This is a onetime appropriation.
|
(c) Minnesota Security Hospital and METO Services |
||||||
| Appropriations by Fund |
||
| General |
230,000 |
83,735,000 |
| Federal Fund |
83,505,000 |
0 |
Minnesota Security Hospital. For the
purposes of enhancing the safety of the public,
improving supervision, and enhancing
community-based mental health treatment,
state-operated services may establish
additional community capacity for providing
treatment and supervision of clients who have
been ordered into a less restrictive alternative
of care from the state-operated services
transitional services program consistent with
Minnesota Statutes, section 246.014.
Use of Federal Stabilization Funds.
$83,505,000 in fiscal year 2010 is appropriated
from the fiscal stabilization account in the
federal fund to the commissioner. This
appropriation must not be used for any activity
or service for which federal reimbursement is
claimed. This is a onetime appropriation.
Sec. 4. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, sections 246.0136; 252.025, subdivision 7; and 252.035,
new text end
new text begin
are
repealed.
new text end
ARTICLE 18
PREVENTING HOMELESSNESS
Section 1.
Minnesota Statutes 2020, section 145.4716, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Funding. new text end
new text begin
The commissioner must prioritize providing trauma-informed,
culturally inclusive services for sexually exploited youth or youth at risk of sexual
exploitation under this section.
new text end
Sec. 2.
Minnesota Statutes 2020, section 256E.33, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) The definitions in this subdivision apply to this section.
(b) "Transitional housing" means housing designed for independent living and provided
to a homeless person or family at a rental rate of at least 25 percent of the family income
for a period of up to deleted text begin 24deleted text end new text begin 36new text end months. If a transitional housing program is associated with a
licensed facility or shelter, it must be located in a separate facility or a specified section of
the main facility where residents can be responsible for their own meals and other daily
needs.
(c) "Support services" means an assessment service that identifies the needs of individuals
for independent living and arranges or provides for the appropriate educational, social, legal,
advocacy, child care, employment, financial, health care, or information and referral services
to meet these needs.
Sec. 3.
Minnesota Statutes 2020, section 256E.33, subdivision 2, is amended to read:
Subd. 2.
Establishment and administration.
A transitional housing program is
established to be administered by the commissioner. The commissioner may make grants
to eligible recipients or enter into agreements with community action agencies or other
public or private nonprofit agencies to make grants to eligible recipients to initiate, maintain,
or expand programs to provide transitional housing and support services for persons in need
of transitional housing, which may include up to six months of follow-up support services
for persons who complete transitional housing as they stabilize in permanent housing. The
commissioner must ensure that money appropriated to implement this section is distributed
as soon as practicable. The commissioner may make grants directly to eligible recipients.
The commissioner may new text begin extend new text end use deleted text begin up to ten percent of the appropriation available fordeleted text end new text begin ofnew text end
this program for persons needing assistance longer than deleted text begin 24deleted text end new text begin 36new text end months.
Sec. 4.
Minnesota Statutes 2020, section 256I.03, subdivision 7, is amended to read:
Subd. 7.
Countable income.
"Countable income" means all income received by an
applicant or recipient as described under section 256P.06, less any applicable exclusions or
disregards. For a recipient of any cash benefit from the SSI programnew text begin who does not live in
a setting as described in section 256I.04, subdivision 2a, paragraph (b), clause (2)new text end , countable
income means the SSI benefit limit in effect at the time the person is a recipient of housing
support, less the medical assistance personal needs allowance under section 256B.35. deleted text begin If the
SSI limit or benefit is reduced for a person due to events other than receipt of additional
income, countable income means actual income less any applicable exclusions and disregards.deleted text end new text begin
If there is a reduction in a housing support recipient's benefit due to circumstances other
than receipt of additional income, applicable exclusions and disregards apply when
determining countable income. For a recipient of any cash benefit from the RSDI program,
SSI program, or veterans' programs who lives in a setting as described in section 256I.04,
subdivision 2a, paragraph (b), clause (2), countable income means 30 percent of the
recipient's total benefit amount from these programs, after applicable exclusions or disregards,
at the time the person is a recipient of housing support. For these recipients, the medical
assistance personal needs allowance, as described in section 256I.04, subdivision 1, paragraph
(a), clause (2), does not apply.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256K.45, is amended by adding a subdivision to
read:
new text begin Subd. 7. new text end
new text begin Awarding of grants. new text end
new text begin
(a) Grants shall be awarded under this section only after
a review of the grant recipient's application materials, including past performance and
utilization of grant money. The commissioner shall not reduce an existing grant award
amount unless the commissioner first determines that the grant recipient has failed to meet
performance measures or has used grant money improperly.
new text end
new text begin
(b) For grants awarded pursuant to a two-year grant contract, the commissioner shall
permit grant recipients to carry over any unexpended amount from the first contract year
to the second contract year.
new text end
Sec. 6.
Laws 2021, First Special Session chapter 8, article 6, section 1, subdivision 7, is
amended to read:
Subd. 7.
Report.
(a) No later than February 1, 2022, the task force shall submit an initial
report to the chairs and ranking minority members of the house of representatives and senate
committees and divisions with jurisdiction over housing and preventing homelessness on
its findings and recommendations.
(b) No later than deleted text begin August 31, 2022deleted text end new text begin December 15, 2022new text end , the task force shall submit a final
report to the chairs and ranking minority members of the house of representatives and senate
committees and divisions with jurisdiction over housing and preventing homelessness on
its findings and recommendations.
Sec. 7. new text begin PREGNANT AND PARENTING HOMELESS YOUTH STUDY.
new text end
new text begin
(a) The commissioner of human services must conduct a study of the prevalence of
pregnancy and parenting among homeless youth and youth who are at risk of homelessness.
new text end
new text begin
(b) The commissioner shall submit a final report by December 31, 2023, to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services finance and policy.
new text end
Sec. 8. new text begin SEXUAL EXPLOITATION AND TRAFFICKING STUDY.
new text end
new text begin
(a) The commissioner of health must conduct a prevalence study on youth and adult
victim survivors of sexual exploitation and trafficking.
new text end
new text begin
(b) The commissioner shall submit a final report by June 30, 2024, to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services finance and policy.
new text end
Sec. 9. new text begin EMERGENCY SHELTER FACILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services.
new text end
new text begin
(c) "Eligible applicant" means a statutory or home rule charter city, county, Tribal
government, not-for-profit corporation under section 501(c)(3) of the Internal Revenue
Code, or housing and redevelopment authority established under Minnesota Statutes, section
469.003.
new text end
new text begin
(d) "Emergency shelter facility" or "facility" means a facility that provides a safe, sanitary,
accessible, and suitable emergency shelter for individuals and families experiencing
homelessness, regardless of whether the facility provides emergency shelter during the day,
overnight, or both.
new text end
new text begin Subd. 2. new text end
new text begin Project criteria. new text end
new text begin
(a) The commissioner shall prioritize grants under this section
for projects that improve or expand emergency shelter facility options by:
new text end
new text begin
(1) adding additional emergency shelter facilities by renovating existing facilities not
currently operating as emergency shelter facilities;
new text end
new text begin
(2) adding additional emergency shelter facility beds by renovating existing emergency
shelter facilities, including major projects that address an accumulation of deferred
maintenance or repair or replacement of mechanical, electrical, and safety systems and
components in danger of failure;
new text end
new text begin
(3) adding additional emergency shelter facility beds through acquisition and construction
of new emergency shelter facilities; and
new text end
new text begin
(4) improving the safety, sanitation, accessibility, and habitability of existing emergency
shelter facilities, including major projects that address an accumulation of deferred
maintenance or repair or replacement of mechanical, electrical, and safety systems and
components in danger of failure.
new text end
new text begin
(b) A grant under this section may be used to pay for 100 percent of total project capital
expenditures, or a specified project phase, up to $10,000,000 per project.
new text end
new text begin
(c) All projects funded with a grant under this section must meet all applicable state and
local building codes at the time of project completion.
new text end
new text begin
(d) The commissioner must use a competitive request for proposal process to identify
potential projects and eligible applicants on a statewide basis.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
ARTICLE 19
DHS LICENSING AND OPERATIONS POLICY
Section 1.
Minnesota Statutes 2020, section 245A.02, subdivision 5a, is amended to read:
Subd. 5a.
Controlling individual.
(a) "Controlling individual" means an owner of a
program or service provider licensed under this chapter and the following individuals, if
applicable:
(1) each officer of the organization, including the chief executive officer and chief
financial officer;
(2) the individual designated as the authorized agent under section 245A.04, subdivision
1, paragraph (b);
(3) the individual designated as the compliance officer under section 256B.04, subdivision
21, paragraph (g); deleted text begin and
deleted text end
(4) each managerial official whose responsibilities include the direction of the
management or policies of a programdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) the individual designated as the primary provider of care for a special family child
care program under section 245A.14, subdivision 4, paragraph (i).
new text end
(b) Controlling individual does not include:
(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;
(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program, receives remuneration from the program, or
owns any of the beneficial interests not excluded in this subdivision;
(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:
(i) whose securities are exempt under section 80A.45, clause (6); or
(ii) whose transactions are exempt under section 80A.46, clause (2);
(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation; or
(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).
(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245A.04, subdivision 4, is amended to read:
Subd. 4.
Inspections; waiver.
(a) Before issuing a license under this chapter, the
commissioner shall conduct an inspection of the program. The inspection must include but
is not limited to:
(1) an inspection of the physical plant;
(2) an inspection of records and documents;
(3) observation of the program in operation; and
(4) an inspection for the health, safety, and fire standards in licensing requirements for
a child care license holder.
(b) The observation in paragraph (a), clause (3), is not required prior to issuing a license
under subdivision 7. If the commissioner issues a license under this chapter, these
requirements must be completed within one year after the issuance of the license.
(c) Before completing a licensing inspection in a family child care program or child care
center, the licensing agency must offer the license holder an exit interview to discuss
violations or potential violations of law or rule observed during the inspection and offer
technical assistance on how to comply with applicable laws and rules. The commissioner
shall not issue a correction order or negative licensing action for violations of law or rule
not discussed in an exit interview, unless a license holder chooses not to participate in an
exit interview or not to complete the exit interview. If the license holder is unable to complete
the exit interview, the licensing agency must offer an alternate time for the license holder
to complete the exit interview.
(d) If a family child care license holder disputes a county licensor's interpretation of a
licensing requirement during a licensing inspection or exit interview, the license holder
may, within five business days after the exit interview or licensing inspection, request
clarification from the commissioner, in writing, in a manner prescribed by the commissioner.
The license holder's request must describe the county licensor's interpretation of the licensing
requirement at issue, and explain why the license holder believes the county licensor's
interpretation is inaccurate. The commissioner and the county must include the license
holder in all correspondence regarding the disputed interpretation, and must provide an
opportunity for the license holder to contribute relevant information that may impact the
commissioner's decision. The county licensor must not issue a correction order related to
the disputed licensing requirement until the commissioner has provided clarification to the
license holder about the licensing requirement.
(e) The commissioner or the county shall inspect at least deleted text begin annuallydeleted text end new text begin once each calendar
yearnew text end a child care provider licensed under this chapter and Minnesota Rules, chapter 9502
or 9503, for compliance with applicable licensing standards.
(f) No later than November 19, 2017, the commissioner shall make publicly available
on the department's website the results of inspection reports of all child care providers
licensed under this chapter and under Minnesota Rules, chapter 9502 or 9503, and the
number of deaths, serious injuries, and instances of substantiated child maltreatment that
occurred in licensed child care settings each year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2020, section 245A.07, subdivision 2a, is amended to read:
Subd. 2a.
Immediate suspension expedited hearing.
(a) Within five working days of
receipt of the license holder's timely appeal, the commissioner shall request assignment of
an administrative law judge. The request must include a proposed date, time, and place of
a hearing. A hearing must be conducted by an administrative law judge within 30 calendar
days of the request for assignment, unless an extension is requested by either party and
granted by the administrative law judge for good cause. The commissioner shall issue a
notice of hearing by certified mail or personal service at least ten working days before the
hearing. The scope of the hearing shall be limited solely to the issue of whether the temporary
immediate suspension should remain in effect pending the commissioner's final order under
section 245A.08, regarding a licensing sanction issued under subdivision 3 following the
immediate suspension. For suspensions under subdivision 2, paragraph (a), clause (1), the
burden of proof in expedited hearings under this subdivision shall be limited to the
commissioner's demonstration that reasonable cause exists to believe that the license holder's
actions or failure to comply with applicable law or rule poses, or the actions of other
individuals or conditions in the program poses an imminent risk of harm to the health, safety,
or rights of persons served by the program. "Reasonable cause" means there exist specific
articulable facts or circumstances which provide the commissioner with a reasonable
suspicion that there is an imminent risk of harm to the health, safety, or rights of persons
served by the program. When the commissioner has determined there is reasonable cause
to order the temporary immediate suspension of a license based on a violation of safe sleep
requirements, as defined in section 245A.1435, the commissioner is not required to
demonstrate that an infant died or was injured as a result of the safe sleep violations. For
suspensions under subdivision 2, paragraph (a), clause (2), the burden of proof in expedited
hearings under this subdivision shall be limited to the commissioner's demonstration by a
preponderance of the evidence that, since the license was revoked, the license holder
committed additional violations of law or rule which may adversely affect the health or
safety of persons served by the program.
(b) The administrative law judge shall issue findings of fact, conclusions, and a
recommendation within ten working days from the date of hearing. The parties shall have
ten calendar days to submit exceptions to the administrative law judge's report. The record
shall close at the end of the ten-day period for submission of exceptions. The commissioner's
final order shall be issued within ten working days from the close of the record. When an
appeal of a temporary immediate suspension is withdrawn or dismissed, the commissioner
shall issue a final order affirming the temporary immediate suspension within ten calendar
days of the commissioner's receipt of the withdrawal or dismissal. Within 90 calendar days
after new text begin an immediate suspension has been issued and the license holder has not submitted a
timely appeal under subdivision 2, paragraph (b), or within 90 calendar days after new text end a final
order affirming an immediate suspension, the commissioner shall deleted text begin make a determination
regardingdeleted text end new text begin determine:
new text end
new text begin (1)new text end whether a final licensing sanction shall be issued under subdivision 3new text begin , paragraph (a),
clauses (1) to (5)new text end . The license holder shall continue to be prohibited from operation of the
program during this 90-day perioddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(2) whether the outcome of related, ongoing investigations or judicial proceedings are
necessary to determine if a final licensing sanction under subdivision 3, paragraph (a),
clauses (1) to (5), will be issued, and persons served by the program remain at an imminent
risk of harm during the investigation period or proceedings. If so, the commissioner shall
issue a suspension in accordance with subdivision 3.
new text end
(c) When the final order under paragraph (b) affirms an immediate suspensionnew text begin or the
license holder does not submit a timely appeal of the immediate suspensionnew text end , and a final
licensing sanction is issued under subdivision 3 and the license holder appeals that sanction,
the license holder continues to be prohibited from operation of the program pending a final
commissioner's order under section 245A.08, subdivision 5, regarding the final licensing
sanction.
new text begin
(d) The license holder shall continue to be prohibited from operation of the program
while a suspension order issued under paragraph (b), clause (2), remains in effect.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end For suspensions under subdivision 2, paragraph (a), clause (3), the burden of
proof in expedited hearings under this subdivision shall be limited to the commissioner's
demonstration by a preponderance of the evidence that a criminal complaint and warrant
or summons was issued for the license holder that was not dismissed, and that the criminal
charge is an offense that involves fraud or theft against a program administered by the
commissioner.
Sec. 4.
Minnesota Statutes 2020, section 245A.07, subdivision 3, is amended to read:
Subd. 3.
License suspension, revocation, or fine.
(a) The commissioner may suspend
or revoke a license, or impose a fine if:
(1) a license holder fails to comply fully with applicable laws or rules including but not
limited to the requirements of this chapter and chapter 245C;
(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
been disqualified and the disqualification was not set aside and no variance has been granted;
(3) a license holder knowingly withholds relevant information from or gives false or
misleading information to the commissioner in connection with an application for a license,
in connection with the background study status of an individual, during an investigation,
or regarding compliance with applicable laws or rules;
(4) a license holder is excluded from any program administered by the commissioner
under section 245.095; deleted text begin or
deleted text end
(5) revocation is required under section 245A.04, subdivision 7, paragraph (d)deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(6) suspension is necessary under subdivision 2a, paragraph (b), clause (2).
new text end
A license holder who has had a license issued under this chapter suspended, revoked,
or has been ordered to pay a fine must be given notice of the action by certified mail or
personal service. If mailed, the notice must be mailed to the address shown on the application
or the last known address of the license holder. The notice must state in plain language the
reasons the license was suspended or revoked, or a fine was ordered.
(b) If the license was suspended or revoked, the notice must inform the license holder
of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
the commissioner within ten calendar days after the license holder receives notice that the
license has been suspended or revoked. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received the
order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits a
timely appeal of an order suspending or revoking a license, the license holder may continue
to operate the program as provided in section 245A.04, subdivision 7, paragraphs (f) and
(g), until the commissioner issues a final order on the suspension or revocation.
(c)(1) If the license holder was ordered to pay a fine, the notice must inform the license
holder of the responsibility for payment of fines and the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal of an
order to pay a fine must be made in writing by certified mail or personal service. If mailed,
the appeal must be postmarked and sent to the commissioner within ten calendar days after
the license holder receives notice that the fine has been ordered. If a request is made by
personal service, it must be received by the commissioner within ten calendar days after
the license holder received the order.
(2) The license holder shall pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies. If the license holder
receives state funds, the state, county, or municipal agencies or departments responsible for
administering the funds shall withhold payments and recover any payments made while the
license is suspended for failure to pay a fine. A timely appeal shall stay payment of the fine
until the commissioner issues a final order.
(3) A license holder shall promptly notify the commissioner of human services, in writing,
when a violation specified in the order to forfeit a fine is corrected. If upon reinspection the
commissioner determines that a violation has not been corrected as indicated by the order
to forfeit a fine, the commissioner may issue a second fine. The commissioner shall notify
the license holder by certified mail or personal service that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.
(4) Fines shall be assessed as follows:
(i) the license holder shall forfeit $1,000 for each determination of maltreatment of a
child under chapter 260E or the maltreatment of a vulnerable adult under section 626.557
for which the license holder is determined responsible for the maltreatment under section
260E.30, subdivision 4, paragraphs (a) and (b), or 626.557, subdivision 9c, paragraph (c);
(ii) if the commissioner determines that a determination of maltreatment for which the
license holder is responsible is the result of maltreatment that meets the definition of serious
maltreatment as defined in section 245C.02, subdivision 18, the license holder shall forfeit
$5,000;
(iii) for a program that operates out of the license holder's home and a program licensed
under Minnesota Rules, parts 9502.0300 to 9502.0445, the fine assessed against the license
holder shall not exceed $1,000 for each determination of maltreatment;
(iv) the license holder shall forfeit $200 for each occurrence of a violation of law or rule
governing matters of health, safety, or supervision, including but not limited to the provision
of adequate staff-to-child or adult ratios, and failure to comply with background study
requirements under chapter 245C; and
(v) the license holder shall forfeit $100 for each occurrence of a violation of law or rule
other than those subject to a $5,000, $1,000, or $200 fine in items (i) to (iv).
For purposes of this section, "occurrence" means each violation identified in the
commissioner's fine order. Fines assessed against a license holder that holds a license to
provide home and community-based services, as identified in section 245D.03, subdivision
1, and a community residential setting or day services facility license under chapter 245D
where the services are provided, may be assessed against both licenses for the same
occurrence, but the combined amount of the fines shall not exceed the amount specified in
this clause for that occurrence.
(5) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder will be personally liable for payment. In the case of a corporation, each
controlling individual is personally and jointly liable for payment.
(d) Except for background study violations involving the failure to comply with an order
to immediately remove an individual or an order to provide continuous, direct supervision,
the commissioner shall not issue a fine under paragraph (c) relating to a background study
violation to a license holder who self-corrects a background study violation before the
commissioner discovers the violation. A license holder who has previously exercised the
provisions of this paragraph to avoid a fine for a background study violation may not avoid
a fine for a subsequent background study violation unless at least 365 days have passed
since the license holder self-corrected the earlier background study violation.
Sec. 5.
Minnesota Statutes 2021 Supplement, section 245A.14, subdivision 4, is amended
to read:
Subd. 4.
Special family child care homes.
Nonresidential child care programs serving
14 or fewer children that are conducted at a location other than the license holder's own
residence shall be licensed under this section and the rules governing family child care or
group family child care if:
(a) the license holder is the primary provider of care and the nonresidential child care
program is conducted in a dwelling that is located on a residential lot;
(b) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;
(c) the license holder is a church or religious organization;
(d) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;
(e) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 14 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:
(1) the program does not exceed a capacity of 14 children more than a cumulative total
of four hours per day;
(2) the program meets a one to seven staff-to-child ratio during the variance period;
(3) all employees receive at least an extra four hours of training per year than required
in the rules governing family child care each year;
(4) the facility has square footage required per child under Minnesota Rules, part
9502.0425;
(5) the program is in compliance with local zoning regulations;
(6) the program is in compliance with the applicable fire code as follows:
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code 2015,
Section 202, unless the rooms in which the children are cared for are located on a level of
exit discharge and each of these child care rooms has an exit door directly to the exterior,
then the applicable fire code is Group E occupancies, as provided in the Minnesota State
Fire Code 2015, Section 202; and
(7) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or
(f) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:
(1) the program is in compliance with local zoning regulations;
(2) the program is in compliance with the applicable fire code as follows:
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire Code 2015,
Section 202;
(3) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and
(4) the license holder prominently displays the license issued by the commissioner which
contains the statement "This special family child care provider is not licensed as a child
care center."
(g) Notwithstanding Minnesota Rules, part 9502.0335, subpart 12, the commissioner
may issue up to four licenses to an organization licensed under paragraph (b), (c), or (e).
Each license must have its own primary provider of care as required under paragraph (i).
Each license must operate as a distinct and separate program in compliance with all applicable
laws and regulations.
(h) For licenses issued under paragraph (b), (c), (d), (e), or (f), the commissioner may
approve up to four licenses at the same location or under one contiguous roof if each license
holder is able to demonstrate compliance with all applicable rules and laws. Each licensed
program must operate as a distinct program and within the capacity, age, and ratio
distributions of each license.
(i) For a license issued under paragraph (b), (c), or (e), the license holder must designate
a person to be the primary provider of care at the licensed location on a form and in a manner
prescribed by the commissioner. The license holder shall notify the commissioner in writing
before there is a change of the person designated to be the primary provider of care. The
primary provider of care:
(1) must be the person who will be the provider of care at the program and present during
the hours of operation;
(2) must operate the program in compliance with applicable laws and regulations under
chapter 245A and Minnesota Rules, chapter 9502;
(3) is considered a child care background study subject as defined in section 245C.02,
subdivision 6a, and must comply with background study requirements in chapter 245C; deleted text begin and
deleted text end
(4) must complete the training that is required of license holders in section 245A.50deleted text begin .deleted text end new text begin ;
new text end
new text begin
(5) is authorized to communicate with the county licensing agency and the department
on matters related to licensing; and
new text end
new text begin
(6) must meet the requirements of Minnesota Rules, part 9502.0355, subpart 3, before
providing group family child care.
new text end
(j) For any license issued under this subdivision, the license holder must ensure that any
other caregiver, substitute, or helper who assists in the care of children meets the training
requirements in section 245A.50 and background study requirements under chapter 245C.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245A.1435, is amended to read:
245A.1435 REDUCTION OF RISK OF SUDDEN UNEXPECTED INFANT DEATH
IN LICENSED PROGRAMS.
(a) When a license holder is placing an infant to sleep, the license holder must place the
infant on the infant's back, unless the license holder has documentation from the infant's
physician or advanced practice registered nurse directing an alternative sleeping position
for the infant. The physician or advanced practice registered nurse directive must be on a
form deleted text begin approveddeleted text end new text begin developednew text end by the commissioner and must remain on file at the licensed
location.
An infant who independently rolls onto its stomach after being placed to sleep on its
back may be allowed to remain sleeping on its stomach if the infant is at least six months
of age or the license holder has a signed statement from the parent indicating that the infant
regularly rolls over at home.
(b) The license holder must place the infant in a crib directly on a firm mattress with a
fitted sheet that is appropriate to the mattress size, that fits tightly on the mattress, and
overlaps the underside of the mattress so it cannot be dislodged by pulling on the corner of
the sheet with reasonable effort. The license holder must not place anything in the crib with
the infant except for the infant's pacifier, as defined in Code of Federal Regulations, title
16, part 1511. new text begin The pacifier must be free from any sort of attachment. new text end The requirements of
this section apply to license holders serving infants younger than one year of age. Licensed
child care providers must meet the crib requirements under section 245A.146. A correction
order shall not be issued under this paragraph unless there is evidence that a violation
occurred when an infant was present in the license holder's care.
(c) If an infant falls asleep before being placed in a crib, the license holder must move
the infant to a crib as soon as practicable, and must keep the infant within sight of the license
holder until the infant is placed in a crib. When an infant falls asleep while being held, the
license holder must consider the supervision needs of other children in care when determining
how long to hold the infant before placing the infant in a crib to sleep. The sleeping infant
must not be in a position where the airway may be blocked or with anything covering the
infant's face.
new text begin
(d) When a license holder places an infant under one year of age down to sleep, the
infant's clothing or sleepwear must not have weighted materials, a hood, or a bib.
new text end
new text begin
(e) A license holder may place an infant under one year of age down to sleep wearing
a helmet if the license holder has signed documentation by a physician, advanced practice
registered nurse, licensed occupational therapist, or a licensed physical therapist on a form
developed by the commissioner.
new text end
deleted text begin (d)deleted text end new text begin (f)new text end Placing a swaddled infant down to sleep in a licensed setting is not recommended
for an infant of any age and is prohibited for any infant who has begun to roll over
independently. However, with the written consent of a parent or guardian according to this
paragraph, a license holder may place the infant who has not yet begun to roll over on its
own down to sleep in a deleted text begin one-piece sleeper equipped with an attached system that fastens
securely only across the upper torso, with no constriction of the hips or legs, to create adeleted text end
swaddlenew text begin . A swaddle is defined as one-piece sleepwear that wraps over the infant's arms,
fastens securely only across the infant's upper torso, and does not constrict the infant's hips
or legs. If a swaddle is used by a license holder, the license holder must ensure that it meets
the requirements of paragraph (d) and is not so tight that it restricts the infant's ability to
breathe or so loose that the fabric could cover the infant's nose and mouthnew text end . Prior to any use
of swaddling for sleep by a provider licensed under this chapter, the license holder must
obtain informed written consent for the use of swaddling from the parent or guardian of the
infant on a form deleted text begin provideddeleted text end new text begin developednew text end by the commissioner deleted text begin and prepared in partnership with
the Minnesota Sudden Infant Death Centerdeleted text end .
new text begin
(g) A license holder may request a variance to this section to permit the use of a
cradleboard when requested by a parent or guardian for a cultural accommodation. Only
the commissioner may issue a variance for the use of a cradleboard. The variance request
must be submitted on a form developed by the commissioner in partnership with Tribal
welfare agencies and the Department of Health.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245A.1443, is amended to read:
245A.1443 deleted text begin CHEMICAL DEPENDENCYdeleted text end new text begin SUBSTANCE USE DISORDER
TREATMENT LICENSEDnew text end PROGRAMS THAT SERVE PARENTS WITH THEIR
CHILDREN.
Subdivision 1.
Application.
This section applies to deleted text begin chemical dependencydeleted text end new text begin residential
substance use disordernew text end treatment facilities that are licensed under this chapter and deleted text begin Minnesota
Rules,deleted text end chapter deleted text begin 9530,deleted text end new text begin 245Gnew text end and that provide services in accordance with section 245G.19.
Subd. 2.
Requirements for providing education.
(a) On or before the date of a child's
initial physical presence at the facility, the license holder must provide education to the
child's parent related to safe bathing and reducing the risk of sudden unexpected infant death
and abusive head trauma from shaking infants and young children. new text begin The license holder must
use the educational material developed by the commissioner to comply with this requirement.
new text end At a minimum, the education must address:
(1) instruction that a child or infant should never be left unattended around water, a tub
should be filled with only two to four inches of water for infants, and an infant should never
be put into a tub when the water is running; and
(2) the risk factors related to sudden unexpected infant death and abusive head trauma
from shaking infants and young children, and means of reducing the risks, including the
safety precautions identified in section 245A.1435 and the deleted text begin dangersdeleted text end new text begin risksnew text end of co-sleeping.
(b) The license holder must document the parent's receipt of the education and keep the
documentation in the parent's file. The documentation must indicate whether the parent
agrees to comply with the safeguards. If the parent refuses to comply, program staff must
provide additional education to the parent deleted text begin at appropriate intervals, at least weeklydeleted text end new text begin as described
in the parental supervision plan. The parental supervision plan must include the intervention,
frequency, and staff responsiblenew text end for the duration of the parent's participation in the program
or until the parent agrees to comply with the safeguards.
Subd. 3.
Parental supervision of children.
(a) On or before the date of a child's initial
physical presence at the facility, the license holder must deleted text begin complete anddeleted text end document deleted text begin an
assessment ofdeleted text end the parent's capacity to meet the health and safety needs of the child while
on the facility premisesdeleted text begin , including identifying circumstances when the parent may be unable
to adequately care for their child due todeleted text end new text begin considering the following factorsnew text end :
(1) the parent's physical deleted text begin ordeleted text end new text begin andnew text end mental health;
(2) the parent being under the influence of drugs, alcohol, medications, or other chemicals;
deleted text begin
(3) the parent being unable to provide appropriate supervision for the child; or
deleted text end
new text begin
(3) the child's physical and mental health; and
new text end
(4) any other information available to the license holder that indicates the parent may
not be able to adequately care for the child.
(b) The license holder must have written procedures specifying the actions to be taken
by staff if a parent is or becomes unable to adequately care for the parent's child.
new text begin
(c) If the parent refuses to comply with the safeguards described in subdivision 2 or is
unable to adequately care for the child, the license holder must develop a parental supervision
plan in conjunction with the client. The plan must account for any factors in paragraph (a)
that contribute to the parent's inability to adequately care for the child. The plan must be
dated and signed by the staff person who completed the plan.
new text end
Subd. 4.
Alternative supervision arrangements.
The license holder must have written
procedures addressing whether the program permits a parent to arrange for supervision of
the parent's child by another client in the program. If permitted, the facility must have a
procedure that requires staff approval of the supervision arrangement before the supervision
by the nonparental client occurs. The procedure for approval must include an assessment
of the nonparental client's capacity to assume the supervisory responsibilities using the
criteria in subdivision 3. The license holder must document the license holder's approval of
the supervisory arrangement and the assessment of the nonparental client's capacity to
supervise the child, and must keep this documentation in the file of the parent of the child
being supervised.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 8.
Minnesota Statutes 2020, section 245A.146, subdivision 3, is amended to read:
Subd. 3.
License holder documentation of cribs.
(a) Annually, from the date printed
on the license, all license holders shall check all their cribs' brand names and model numbers
against the United States Consumer Product Safety Commission website listing of unsafe
cribs.
(b) The license holder shall maintain written documentation to be reviewed on site for
each crib showing that the review required in paragraph (a) has been completed, and which
of the following conditions applies:
(1) the crib was not identified as unsafe on the United States Consumer Product Safety
Commission website;
(2) the crib was identified as unsafe on the United States Consumer Product Safety
Commission website, but the license holder has taken the action directed by the United
States Consumer Product Safety Commission to make the crib safe; or
(3) the crib was identified as unsafe on the United States Consumer Product Safety
Commission website, and the license holder has removed the crib so that it is no longer
used by or accessible to children in care.
(c) Documentation of the review completed under this subdivision shall be maintained
by the license holder on site and made available to parents or guardians of children in care
and the commissioner.
(d) Notwithstanding Minnesota Rules, part 9502.0425, a family child care provider that
complies with this section may use a mesh-sided or fabric-sided play yard, pack and play,
or playpen or crib that has not been identified as unsafe on the United States Consumer
Product Safety Commission website for the care or sleeping of infants.
(e) On at least a monthly basis, the family child care license holder shall perform safety
inspections of every mesh-sided or fabric-sided play yard, pack and play, or playpen used
by or that is accessible to any child in care, and must document the following:
(1) there are no tears, holes, or loose or unraveling threads in mesh or fabric sides of
crib;
(2) the weave of the mesh on the crib is no larger than one-fourth of an inch;
(3) no mesh fabric is unsecure or unattached to top rail and floor plate of crib;
(4) no tears or holes to top rail of crib;
(5) the mattress floor board is not soft and does not exceed one inch thick;
(6) the mattress floor board has no rips or tears in covering;
(7) the mattress floor board in use is deleted text begin a waterproofdeleted text end new text begin annew text end original mattress or replacement
mattress provided by the manufacturer of the crib;
(8) there are no protruding or loose rivets, metal nuts, or bolts on the crib;
(9) there are no knobs or wing nuts on outside crib legs;
(10) there are no missing, loose, or exposed staples; and
(11) the latches on top and side rails used to collapse crib are secure, they lock properly,
and are not loose.
new text begin
(f) If a cradleboard is used in a licensed setting, the license holder must check the
cradleboard not less than monthly to ensure the cradleboard is structurally sound and does
not have loose or protruding parts. The license holder shall maintain written documentation
of the review.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 9.
Minnesota Statutes 2020, section 245A.16, subdivision 1, is amended to read:
Subdivision 1.
Delegation of authority to agencies.
(a) County agencies and private
agencies that have been designated or licensed by the commissioner to perform licensing
functions and activities under section 245A.04 and background studies for family child care
under chapter 245C; to recommend denial of applicants under section 245A.05; to issue
correction orders, to issue variances, and recommend a conditional license under section
245A.06; or to recommend suspending or revoking a license or issuing a fine under section
245A.07, shall comply with rules and directives of the commissioner governing those
functions and with this section. The following variances are excluded from the delegation
of variance authority and may be issued only by the commissioner:
(1) dual licensure of family child care and child foster care, dual licensure of child and
adult foster care, and adult foster care and family child care;
(2) adult foster care maximum capacity;
(3) adult foster care minimum age requirement;
(4) child foster care maximum age requirement;
(5) variances regarding disqualified individuals except that, before the implementation
of NETStudy 2.0, county agencies may issue variances under section 245C.30 regarding
disqualified individuals when the county is responsible for conducting a consolidated
reconsideration according to sections 245C.25 and 245C.27, subdivision 2, clauses (a) and
(b), of a county maltreatment determination and a disqualification based on serious or
recurring maltreatment;
(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours;
(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holder; deleted text begin and
deleted text end
(8) variances to section 245A.53 for a time-limited period. If the commissioner grants
a variance under this clause, the license holder must provide notice of the variance to all
parents and guardians of the children in caredeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(9) variances to section 245A.1435 for the use of a cradleboard for a cultural
accommodation.
new text end
Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency must
not grant a license holder a variance to exceed the maximum allowable family child care
license capacity of 14 children.
(b) A county agency that has been designated by the commissioner to issue family child
care variances must:
(1) publish the county agency's policies and criteria for issuing variances on the county's
public website and update the policies as necessary; and
(2) annually distribute the county agency's policies and criteria for issuing variances to
all family child care license holders in the county.
(c) Before the implementation of NETStudy 2.0, county agencies must report information
about disqualification reconsiderations under sections 245C.25 and 245C.27, subdivision
2, paragraphs (a) and (b), and variances granted under paragraph (a), clause (5), to the
commissioner at least monthly in a format prescribed by the commissioner.
(d) For family child care programs, the commissioner shall require a county agency to
conduct one unannounced licensing review at least annually.
(e) For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.
(f) A license issued under this section may be issued for up to two years.
(g) During implementation of chapter 245D, the commissioner shall consider:
(1) the role of counties in quality assurance;
(2) the duties of county licensing staff; and
(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.
Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.
(h) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county and
private agencies.
(i) A county agency shall report to the commissioner, in a manner prescribed by the
commissioner, the following information for a licensed family child care program:
(1) the results of each licensing review completed, including the date of the review, and
any licensing correction order issued;
(2) any death, serious injury, or determination of substantiated maltreatment; and
(3) any fires that require the service of a fire department within 48 hours of the fire. The
information under this clause must also be reported to the state fire marshal within two
business days of receiving notice from a licensed family child care provider.
Sec. 10.
Minnesota Statutes 2020, section 245F.15, subdivision 1, is amended to read:
Subdivision 1.
Qualifications for all staff who have direct patient contact.
deleted text begin (a)deleted text end All
staff who have direct patient contact must be at least 18 years of age deleted text begin and must, at the time
of hiring, document that they meet the requirements in paragraph (b), (c), or (d)deleted text end .
deleted text begin
(b) Program directors, supervisors, nurses, and alcohol and drug counselors must be free
of substance use problems for at least two years immediately preceding their hiring and
must sign a statement attesting to that fact.
deleted text end
deleted text begin
(c) Recovery peers must be free of substance use problems for at least one year
immediately preceding their hiring and must sign a statement attesting to that fact.
deleted text end
deleted text begin
(d) Technicians and other support staff must be free of substance use problems for at
least six months immediately preceding their hiring and must sign a statement attesting to
that fact.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 245F.16, subdivision 1, is amended to read:
Subdivision 1.
Policy requirements.
A license holder must have written personnel
policies and must make them available to staff members at all times. The personnel policies
must:
(1) ensure that a staff member's retention, promotion, job assignment, or pay are not
affected by a good-faith communication between the staff member and the Department of
Human Services, Department of Health, Ombudsman for Mental Health and Developmental
Disabilities, law enforcement, or local agencies that investigate complaints regarding patient
rights, health, or safety;
(2) include a job description for each position that specifies job responsibilities, degree
of authority to execute job responsibilities, standards of job performance related to specified
job responsibilities, and qualifications;
(3) provide for written job performance evaluations for staff members of the license
holder at least annually;
(4) describe deleted text begin behavior that constitutes groundsdeleted text end new text begin the processnew text end for disciplinary action,
suspension, or dismissaldeleted text begin , including policies that address substance use problems and meet
the requirements of section 245F.15, subdivisions 1 and 2. The policies and procedures
must list behaviors or incidents that are considered substance use problems. The list must
include:deleted text end new text begin of a staff person for violating the drug and alcohol policy described in section
245A.04, subdivision 1, paragraph (c);
new text end
deleted text begin
(i) receiving treatment for substance use disorder within the period specified for the
position in the staff qualification requirements;
deleted text end
deleted text begin
(ii) substance use that has a negative impact on the staff member's job performance;
deleted text end
deleted text begin
(iii) substance use that affects the credibility of treatment services with patients, referral
sources, or other members of the community; and
deleted text end
deleted text begin
(iv) symptoms of intoxication or withdrawal on the job;
deleted text end
(5) include policies prohibiting personal involvement with patients and policies
prohibiting patient maltreatment as specified under sections 245A.65, 626.557, and 626.5572
and chapters 260E and 604;
(6) include a chart or description of organizational structure indicating the lines of
authority and responsibilities;
(7) include a written plan for new staff member orientation that, at a minimum, includes
training related to the specific job functions for which the staff member was hired, program
policies and procedures, patient needs, and the areas identified in subdivision 2, paragraphs
(b) to (e); and
(8) include a policy on the confidentiality of patient information.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 12.
Minnesota Statutes 2020, section 245G.01, subdivision 4, is amended to read:
Subd. 4.
Alcohol and drug counselor.
"Alcohol and drug counselor" deleted text begin has the meaning
given in section 148F.01, subdivision 5deleted text end new text begin means a person who is qualified according to section
245G.11, subdivision 5new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2020, section 245G.01, subdivision 17, is amended to read:
Subd. 17.
Licensed professional in private practice.
new text begin (a) new text end "Licensed professional in
private practice" means an individual who:
(1) is licensed under chapter 148F, or is exempt from licensure under that chapter but
is otherwise licensed to provide alcohol and drug counseling services;
(2) practices solely within the permissible scope of the individual's license as defined
in the law authorizing licensure; and
(3) does not affiliate with other licensed or unlicensed professionals to provide alcohol
and drug counseling services. deleted text begin Affiliation does not include conferring with another
professional or making a client referral.
deleted text end
new text begin
(b) For purposes of this subdivision, affiliate includes but is not limited to:
new text end
new text begin
(1) using the same electronic record system as another professional, except when the
system prohibits each professional from accessing the records of another professional;
new text end
new text begin
(2) advertising the services of more than one professional together;
new text end
new text begin
(3) accepting client referrals made to a group of professionals;
new text end
new text begin
(4) providing services to another professional's clients when that professional is absent;
or
new text end
new text begin
(5) appearing in any way to be a group practice or program.
new text end
new text begin
(c) For purposes of this subdivision, affiliate does not include:
new text end
new text begin
(1) conferring with another professional;
new text end
new text begin
(2) making a client referral to another professional;
new text end
new text begin
(3) contracting with the same agency as another professional for billing services;
new text end
new text begin
(4) using the same waiting area for clients in an office as another professional; or
new text end
new text begin
(5) using the same receptionist as another professional if the receptionist supports each
professional independently.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2020, section 245G.06, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Documentation of treatment services. new text end
new text begin
The license holder must ensure that
the staff member who provides the treatment service documents in the client record the
date, type, and amount of each treatment service provided to a client and the client's response
to each treatment service within seven days of providing the treatment service.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 15.
Minnesota Statutes 2020, section 245G.06, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Client record documentation requirements. new text end
new text begin
(a) The license holder must
document in the client record any significant event that occurs at the program on the day
the event occurs. A significant event is an event that impacts the client's relationship with
other clients, staff, or the client's family, or the client's treatment plan.
new text end
new text begin
(b) A residential treatment program must document in the client record the following
items on the day that each occurs:
new text end
new text begin
(1) medical and other appointments the client attended;
new text end
new text begin
(2) concerns related to medications that are not documented in the medication
administration record; and
new text end
new text begin
(3) concerns related to attendance for treatment services, including the reason for any
client absence from a treatment service.
new text end
new text begin
(c) Each entry in a client's record must be accurate, legible, signed, dated, and include
the job title or position of the staff person that made the entry. A late entry must be clearly
labeled "late entry." A correction to an entry must be made in a way in which the original
entry can still be read.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 16.
Minnesota Statutes 2020, section 245G.06, subdivision 3, is amended to read:
Subd. 3.
deleted text begin Documentation of treatment services;deleted text end Treatment plan review.
deleted text begin
(a) A review
of all treatment services must be documented weekly and include a review of:
deleted text end
deleted text begin
(1) care coordination activities;
deleted text end
deleted text begin
(2) medical and other appointments the client attended;
deleted text end
deleted text begin
(3) issues related to medications that are not documented in the medication administration
record; and
deleted text end
deleted text begin
(4) issues related to attendance for treatment services, including the reason for any client
absence from a treatment service.
deleted text end
deleted text begin
(b) A note must be entered immediately following any significant event. A significant
event is an event that impacts the client's relationship with other clients, staff, the client's
family, or the client's treatment plan.
deleted text end
deleted text begin (c)deleted text end A treatment plan review must be entered in a client's file weekly or after each treatment
service, whichever is less frequent, by the deleted text begin staff member providing the servicedeleted text end new text begin alcohol and
drug counselor responsible for the client's treatment plannew text end . The review must indicate the span
of time covered by the review and each of the six dimensions listed in section 245G.05,
subdivision 2, paragraph (c). The review must:
deleted text begin
(1) indicate the date, type, and amount of each treatment service provided and the client's
response to each service;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end address each goal in the treatment plan and whether the methods to address the
goals are effective;
deleted text begin (3)deleted text end new text begin (2)new text end include monitoring of any physical and mental health problems;
deleted text begin (4)deleted text end new text begin (3)new text end document the participation of others;
deleted text begin (5)deleted text end new text begin (4)new text end document staff recommendations for changes in the methods identified in the
treatment plan and whether the client agrees with the change; and
deleted text begin (6)deleted text end new text begin (5)new text end include a review and evaluation of the individual abuse prevention plan according
to section 245A.65.
deleted text begin
(d) Each entry in a client's record must be accurate, legible, signed, and dated. A late
entry must be clearly labeled "late entry." A correction to an entry must be made in a way
in which the original entry can still be read.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 17.
Minnesota Statutes 2020, section 245G.08, subdivision 5, is amended to read:
Subd. 5.
Administration of medication and assistance with self-medication.
(a) A
license holder must meet the requirements in this subdivision if a service provided includes
the administration of medication.
(b) A staff member, other than a licensed practitioner or nurse, who is delegated by a
licensed practitioner or a registered nurse the task of administration of medication or assisting
with self-medication, must:
(1) successfully complete a medication administration training program for unlicensed
personnel through an accredited Minnesota postsecondary educational institution. A staff
member's completion of the course must be documented in writing and placed in the staff
member's personnel file;
(2) be trained according to a formalized training program that is taught by a registered
nurse and offered by the license holder. The training must include the process for
administration of naloxone, if naloxone is kept on site. A staff member's completion of the
training must be documented in writing and placed in the staff member's personnel records;
or
(3) demonstrate to a registered nurse competency to perform the delegated activity. A
registered nurse must be employed or contracted to develop the policies and procedures for
administration of medication or assisting with self-administration of medication, or both.
(c) A registered nurse must provide supervision as defined in section 148.171, subdivision
23. The registered nurse's supervision must include, at a minimum, monthly on-site
supervision or more often if warranted by a client's health needs. The policies and procedures
must include:
(1) a provision that a delegation of administration of medication is new text begin limited to a method
a staff member has been trained to administer and new text end limited to deleted text begin the administration ofdeleted text end new text begin :
new text end
new text begin (i)new text end a medication that is administered orally, topically, or as a suppository, an eye drop,
an ear drop, deleted text begin ordeleted text end an inhalantnew text begin , or an intranasalnew text end ;new text begin and
new text end
new text begin
(ii) an intramuscular injection of naloxone or epinephrine;
new text end
(2) a provision that each client's file must include documentation indicating whether
staff must conduct the administration of medication or the client must self-administer
medication, or both;
(3) a provision that a client may carry emergency medication such as nitroglycerin as
instructed by the client's physician or advanced practice registered nurse;
(4) a provision for the client to self-administer medication when a client is scheduled to
be away from the facility;
(5) a provision that if a client self-administers medication when the client is present in
the facility, the client must self-administer medication under the observation of a trained
staff member;
(6) a provision that when a license holder serves a client who is a parent with a child,
the parent may only administer medication to the child under a staff member's supervision;
(7) requirements for recording the client's use of medication, including staff signatures
with date and time;
(8) guidelines for when to inform a nurse of problems with self-administration of
medication, including a client's failure to administer, refusal of a medication, adverse
reaction, or error; and
(9) procedures for acceptance, documentation, and implementation of a prescription,
whether written, verbal, telephonic, or electronic.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2020, section 245G.09, subdivision 3, is amended to read:
Subd. 3.
Contents.
Client records must contain the following:
(1) documentation that the client was given information on client rights and
responsibilities, grievance procedures, tuberculosis, and HIV, and that the client was provided
an orientation to the program abuse prevention plan required under section 245A.65,
subdivision 2, paragraph (a), clause (4). If the client has an opioid use disorder, the record
must contain documentation that the client was provided educational information according
to section 245G.05, subdivision 1, paragraph (b);
(2) an initial services plan completed according to section 245G.04;
(3) a comprehensive assessment completed according to section 245G.05;
(4) an assessment summary completed according to section 245G.05, subdivision 2;
(5) an individual abuse prevention plan according to sections 245A.65, subdivision 2,
and 626.557, subdivision 14, when applicable;
(6) an individual treatment plan according to section 245G.06, subdivisions 1 and 2;
(7) documentation of treatment servicesnew text begin , significant events, appointments, concerns,new text end and
treatment plan deleted text begin reviewdeleted text end new text begin reviewsnew text end according to section 245G.06, deleted text begin subdivisiondeleted text end new text begin subdivisions 2a,
2b, andnew text end 3; and
(8) a summary at the time of service termination according to section 245G.06,
subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 19.
Minnesota Statutes 2020, section 245G.11, subdivision 1, is amended to read:
Subdivision 1.
General qualifications.
(a) All staff members who have direct contact
must be 18 years of age or older. deleted text begin At the time of employment, each staff member must meet
the qualifications in this subdivision. For purposes of this subdivision, "problematic substance
use" means a behavior or incident listed by the license holder in the personnel policies and
procedures according to section 245G.13, subdivision 1, clause (5).
deleted text end
deleted text begin
(b) A treatment director, supervisor, nurse, counselor, student intern, or other professional
must be free of problematic substance use for at least the two years immediately preceding
employment and must sign a statement attesting to that fact.
deleted text end
deleted text begin
(c) A paraprofessional, recovery peer, or any other staff member with direct contact
must be free of problematic substance use for at least one year immediately preceding
employment and must sign a statement attesting to that fact.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 20.
Minnesota Statutes 2020, section 245G.11, subdivision 10, is amended to read:
Subd. 10.
Student interns.
A qualified staff member must supervise and be responsible
for a treatment service performed by a student intern and must review and sign each
assessment, deleted text begin progress note, anddeleted text end individual treatment plannew text begin , and treatment plan reviewnew text end prepared
by a student intern. A student intern must receive the orientation and training required in
section 245G.13, subdivisions 1, clause (7), and 2. No more than 50 percent of the treatment
staff may be students or licensing candidates with time documented to be directly related
to the provision of treatment services for which the staff are authorized.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 21.
Minnesota Statutes 2020, section 245G.13, subdivision 1, is amended to read:
Subdivision 1.
Personnel policy requirements.
A license holder must have written
personnel policies that are available to each staff member. The personnel policies must:
(1) ensure that staff member retention, promotion, job assignment, or pay are not affected
by a good faith communication between a staff member and the department, the Department
of Health, the ombudsman for mental health and developmental disabilities, law enforcement,
or a local agency for the investigation of a complaint regarding a client's rights, health, or
safety;
(2) contain a job description for each staff member position specifying responsibilities,
degree of authority to execute job responsibilities, and qualification requirements;
(3) provide for a job performance evaluation based on standards of job performance
conducted on a regular and continuing basis, including a written annual review;
(4) describe behavior that constitutes grounds for disciplinary action, suspension, or
dismissal, including deleted text begin policies that address staff member problematic substance use and the
requirements of section 245G.11, subdivision 1,deleted text end policies prohibiting personal involvement
with a client in violation of chapter 604, and policies prohibiting client abuse described in
sections 245A.65, 626.557, and 626.5572, and chapter 260E;
deleted text begin
(5) identify how the program will identify whether behaviors or incidents are problematic
substance use, including a description of how the facility must address:
deleted text end
deleted text begin
(i) receiving treatment for substance use within the period specified for the position in
the staff qualification requirements, including medication-assisted treatment;
deleted text end
deleted text begin
(ii) substance use that negatively impacts the staff member's job performance;
deleted text end
deleted text begin
(iii) substance use that affects the credibility of treatment services with a client, referral
source, or other member of the community;
deleted text end
deleted text begin
(iv) symptoms of intoxication or withdrawal on the job; and
deleted text end
deleted text begin
(v) the circumstances under which an individual who participates in monitoring by the
health professional services program for a substance use or mental health disorder is able
to provide services to the program's clients;
deleted text end
new text begin
(5) describe the process for disciplinary action, suspension, or dismissal of a staff person
for violating the drug and alcohol policy described in section 245A.04, subdivision 1,
paragraph (c);
new text end
(6) include a chart or description of the organizational structure indicating lines of
authority and responsibilities;
(7) include orientation within 24 working hours of starting for each new staff member
based on a written plan that, at a minimum, must provide training related to the staff member's
specific job responsibilities, policies and procedures, client confidentiality, HIV minimum
standards, and client needs; and
(8) include policies outlining the license holder's response to a staff member with a
behavior problem that interferes with the provision of treatment service.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 22.
Minnesota Statutes 2020, section 245G.20, is amended to read:
245G.20 LICENSE HOLDERS SERVING PERSONS WITH CO-OCCURRING
DISORDERS.
A license holder specializing in the treatment of a person with co-occurring disorders
must:
(1) demonstrate that staff levels are appropriate for treating a client with a co-occurring
disorder, and that there are adequate staff members with mental health training;
(2) have continuing access to a medical provider with appropriate expertise in prescribing
psychotropic medication;
(3) have a mental health professional available for staff member supervision and
consultation;
(4) determine group size, structure, and content considering the special needs of a client
with a co-occurring disorder;
(5) have documentation of active interventions to stabilize mental health symptoms
present in the individual treatment plans and deleted text begin progress notesdeleted text end new text begin treatment plan reviewsnew text end ;
(6) have continuing documentation of collaboration with continuing care mental health
providers, and involvement of the providers in treatment planning meetings;
(7) have available program materials adapted to a client with a mental health problem;
(8) have policies that provide flexibility for a client who may lapse in treatment or may
have difficulty adhering to established treatment rules as a result of a mental illness, with
the goal of helping a client successfully complete treatment; and
(9) have individual psychotherapy and case management available during treatment
service.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 23.
Minnesota Statutes 2020, section 245G.22, subdivision 7, is amended to read:
Subd. 7.
Restrictions for unsupervised use of methadone hydrochloride.
(a) If a
medical director or prescribing practitioner assesses and determines that a client meets the
criteria in subdivision 6 and may be dispensed a medication used for the treatment of opioid
addiction, the restrictions in this subdivision must be followed when the medication to be
dispensed is methadone hydrochloride. The results of the assessment must be contained in
the client file.new text begin The number of unsupervised use medication doses per week in paragraphs
(b) to (d) is in addition to the number of unsupervised use medication doses a client may
receive for days the clinic is closed for business as allowed by subdivision 6, paragraph (a).
new text end
(b) During the first 90 days of treatment, the unsupervised use medication supply must
be limited to a maximum of a single dose each week and the client shall ingest all other
doses under direct supervision.
(c) In the second 90 days of treatment, the unsupervised use medication supply must be
limited to two doses per week.
(d) In the third 90 days of treatment, the unsupervised use medication supply must not
exceed three doses per week.
(e) In the remaining months of the first year, a client may be given a maximum six-day
unsupervised use medication supply.
(f) After one year of continuous treatment, a client may be given a maximum two-week
unsupervised use medication supply.
(g) After two years of continuous treatment, a client may be given a maximum one-month
unsupervised use medication supply, but must make monthly visits to the program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24.
Minnesota Statutes 2020, section 245H.05, is amended to read:
245H.05 MONITORING AND INSPECTIONS.
(a) The commissioner must conduct an on-site inspection of a certified license-exempt
child care center at least deleted text begin annuallydeleted text end new text begin once each calendar yearnew text end to determine compliance with
the health, safety, and fire standards specific to a certified license-exempt child care center.
(b) No later than November 19, 2017, the commissioner shall make publicly available
on the department's website the results of inspection reports for all certified centers including
the number of deaths, serious injuries, and instances of substantiated child maltreatment
that occurred in certified centers each year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 25.
Minnesota Statutes 2020, section 245H.08, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Authority to modify requirements. new text end
new text begin
(a) Notwithstanding subdivisions 4 and
5, for children in kindergarten through 13 years old, the commissioner may increase the
maximum group size to no more than 40 children and may increase the minimally acceptable
staff-to-child ratio to one to 20 during a national security or peacetime emergency declared
under section 12.31, or during a public health emergency declared due to a pandemic by
the United States Secretary of Health and Human Services under section 319 of the Public
Health Service Act, United States Code, title 42, section 247d.
new text end
new text begin
(b) If the commissioner modifies requirements under this subdivision, a certified center
operating under the modified requirements must have at least one staff person who is at
least 18 years old with each group of 40 children.
new text end
Sec. 26.
Laws 2020, First Special Session chapter 7, section 1, subdivision 5, as amended
by Laws 2021, First Special Session chapter 7, article 2, section 73, is amended to read:
Subd. 5.
Waivers and modifications; extension deleted text begin for 365 daysdeleted text end .
When the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, waiver CV23: modifying background
study requirements, issued by the commissioner of human services pursuant to Executive
Orders 20-11 and 20-12, including any amendments to the modification issued before the
peacetime emergency expires, shall remain in effect deleted text begin for 365 days after the peacetime
emergency endsdeleted text end new text begin until January 1, 2023new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27. new text begin CHILD CARE REGULATION MODERNIZATION; PILOT PROJECTS.
new text end
new text begin
The commissioner of human services may conduct and administer pilot projects to test
methods and procedures for the projects to modernize regulation of child care centers and
family child care allowed under Laws 2021, First Special Session chapter 7, article 2, sections
75 and 81. To carry out the pilot projects, the commissioner of human services may, by
issuing a commissioner's order, waive enforcement of existing specific statutory program
requirements, rules, and standards in one or more counties. The commissioner's order
establishing the waiver must provide alternative methods and procedures of administration
and must not be in conflict with the basic purposes, coverage, or benefits provided by law.
In no event may a pilot project under this section extend beyond February 1, 2024. Pilot
projects must comply with the requirements of the child care and development fund plan.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; AMENDING
CHILDREN'S RESIDENTIAL FACILITY AND DETOXIFICATION PROGRAM
RULES.
new text end
new text begin
(a) The commissioner of human services must amend Minnesota Rules, part 2960.0460,
to remove all references to repealed Minnesota Rules, part 2960.0460, subpart 2.
new text end
new text begin
(b) The commissioner must amend Minnesota Rules, part 2960.0470, to require license
holders to have written personnel policies that describe the process for disciplinary action,
suspension, or dismissal of a staff person for violating the drug and alcohol policy described
in Minnesota Statutes, section 245A.04, subdivision 1, paragraph (c), and Minnesota Rules,
part 2960.0030, subpart 9.
new text end
new text begin
(c) The commissioner must amend Minnesota Rules, part 9530.6565, subpart 1, to
remove items A and B and the documentation requirement that references these items.
new text end
new text begin
(d) The commissioner must amend Minnesota Rules, part 9530.6570, subpart 1, item
D, to remove the existing language and insert language to require license holders to have
written personnel policies that describe the process for disciplinary action, suspension, or
dismissal of a staff person for violating the drug and alcohol policy described in Minnesota
Statutes, section 245A.04, subdivision 1, paragraph (c).
new text end
new text begin
(e) For purposes of this section, the commissioner may use the good cause exempt
process under Minnesota Statutes, section 14.388, subdivision 1, clause (3), and Minnesota
Statutes, section 14.386, does not apply.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 29. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 245F.15, subdivision 2; and 245G.11, subdivision
2,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 2960.0460, subpart 2; and 9530.6565, subpart 2,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
ARTICLE 20
OPIOID SETTLEMENT
Section 1.
new text begin
[3.757] RELEASE OF OPIOID-RELATED CLAIMS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Municipality" has the meaning provided in section 466.01, subdivision 1.
new text end
new text begin
(c) "Opioid litigation" means any civil litigation, demand, or settlement in lieu of litigation
alleging unlawful conduct related to the marketing, sale, or distribution of opioids in this
state or other alleged illegal actions that contributed to the excessive use of opioids.
new text end
new text begin
(d) "Released claim" means any cause of action or other claim that has been released in
a statewide opioid settlement agreement, including matters identified as a released claim as
that term or a comparable term is defined in a statewide opioid settlement agreement.
new text end
new text begin
(e) "Settling defendant" means Johnson & Johnson, AmerisourceBergen Corporation,
Cardinal Health, Inc., and McKesson Corporation, as well as related subsidiaries, affiliates,
officers, directors, and other related entities specifically named as a released entity in a
statewide opioid settlement agreement.
new text end
new text begin
(f) "Statewide opioid settlement agreement" means an agreement, including consent
judgments, assurances of discontinuance, and related agreements or documents, between
the attorney general, on behalf of the state, and a settling defendant, to provide or allocate
remuneration for conduct related to the marketing, sale, or distribution of opioids in this
state or other alleged illegal actions that contributed to the excessive use of opioids.
new text end
new text begin Subd. 2. new text end
new text begin Release of claims. new text end
new text begin
(a) No municipality shall have the authority to assert, file,
or enforce a released claim against a settling defendant.
new text end
new text begin
(b) Any claim in pending opioid litigation filed by a municipality against a settling
defendant that is within the scope of a released claim is extinguished by operation of law.
new text end
new text begin
(c) The attorney general shall have authority to appear or intervene in opioid litigation
where a municipality has asserted, filed, or enforced a released claim against a settling
defendant and release with prejudice any released claims.
new text end
new text begin
(d) This section does not limit any causes of action, claims, or remedies, nor the authority
to assert, file, or enforce such causes of action, claims, or remedies, by a party other than a
municipality.
new text end
new text begin
(e) This section does not limit any causes of action, claims, or remedies, nor the authority
to assert, file, or enforce such causes of action, claims, or remedies by a municipality against
entities and individuals other than a released claim against a settling defendant.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2021 Supplement, section 16A.151, subdivision 2, is amended
to read:
Subd. 2.
Exceptions.
(a) If a state official litigates or settles a matter on behalf of specific
injured persons or entities, this section does not prohibit distribution of money to the specific
injured persons or entities on whose behalf the litigation or settlement efforts were initiated.
If money recovered on behalf of injured persons or entities cannot reasonably be distributed
to those persons or entities because they cannot readily be located or identified or because
the cost of distributing the money would outweigh the benefit to the persons or entities, the
money must be paid into the general fund.
(b) Money recovered on behalf of a fund in the state treasury other than the general fund
may be deposited in that fund.
(c) This section does not prohibit a state official from distributing money to a person or
entity other than the state in litigation or potential litigation in which the state is a defendant
or potential defendant.
(d) State agencies may accept funds as directed by a federal court for any restitution or
monetary penalty under United States Code, title 18, section 3663(a)(3), or United States
Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue
account and are appropriated to the commissioner of the agency for the purpose as directed
by the federal court.
(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph
(t), may be deposited as provided in section 16A.98, subdivision 12.
(f) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, related
to alleged violations of consumer fraud laws in the marketing, sale, or distribution of opioids
in this state or other alleged illegal actions that contributed to the excessive use of opioids,
must be deposited in deleted text begin a separate account in the state treasury and the commissioner shall
notify the chairs and ranking minority members of the Finance Committee in the senate and
the Ways and Means Committee in the house of representatives that an account has been
created. Notwithstanding section 11A.20, all investment income and all investment losses
attributable to the investment of this account shall be credited to the accountdeleted text end new text begin the settlement
account established in the opiate epidemic response fund under section 256.043, subdivision
1new text end . This paragraph does not apply to attorney fees and costs awarded to the state or the
Attorney General's Office, to contract attorneys hired by the state or Attorney General's
Office, or to other state agency attorneys. deleted text begin If the licensing fees under section 151.065,
subdivision 1, clause (16), and subdivision 3, clause (14), are reduced and the registration
fee under section 151.066, subdivision 3, is repealed in accordance with section 256.043,
subdivision 4, then the commissioner shall transfer from the separate account created in
this paragraph to the opiate epidemic response fund under section 256.043 an amount that
ensures that $20,940,000 each fiscal year is available for distribution in accordance with
section 256.043, subdivision 3.
deleted text end
(g) Notwithstanding paragraph (f), if money is received from a settlement agreement or
an assurance of discontinuance entered into by the attorney general of the state or a court
order in litigation brought by the attorney general of the state on behalf of the state or a state
agency against a consulting firm working for an opioid manufacturer or opioid wholesale
drug distributor deleted text begin and deposited into the separate account created under paragraph (f)deleted text end , the
commissioner shall deleted text begin annually transfer from the separate account to the opiate epidemic
response fund under section 256.043 an amount equal to the estimated amount submitted
to the commissioner by the Board of Pharmacy in accordance with section 151.066,
subdivision 3, paragraph (b). The amount transferred shall be included in the amount available
for distribution in accordance with section 256.043, deleted text begin subdivision 3deleted text end . This transfer shall occur
each year until the registration fee under section 151.066, subdivision 3, is repealed in
accordance with section 256.043, subdivision 4, or the money deposited in the account in
accordance with this paragraph has been transferred, whichever occurs firstdeleted text end new text begin deposit any
money received into the settlement account established within the opiate epidemic response
fund under section 256.042, subdivision 1. Notwithstanding section 256.043, subdivision
3a, paragraph (a), any amount deposited into the settlement account in accordance with this
paragraph shall be appropriated to the commissioner of human services to award as grants
as specified by the opiate epidemic response advisory council in accordance with section
256.043, subdivision 3a, paragraph (d)new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2021 Supplement, section 151.066, subdivision 3, is amended
to read:
Subd. 3.
Determination of an opiate product registration fee.
(a) The board shall
annually assess an opiate product registration fee on any manufacturer of an opiate that
annually sells, delivers, or distributes an opiate within or into the state 2,000,000 or more
units as reported to the board under subdivision 2.
(b) For purposes of assessing the annual registration fee under this section and
determining the number of opiate units a manufacturer sold, delivered, or distributed within
or into the state, the board shall not consider any opiate that is used for medication-assisted
therapy for substance use disorders. deleted text begin If there is money deposited into the separate account
as described in section 16A.151, subdivision 2, paragraph (g), The board shall submit to
the commissioner of management and budget an estimate of the difference in the annual
fee revenue collected under this section due to this exception.
deleted text end
(c) The annual registration fee for each manufacturer meeting the requirement under
paragraph (a) is $250,000.
(d) In conjunction with the data reported under this section, and notwithstanding section
152.126, subdivision 6, the board may use the data reported under section 152.126,
subdivision 4, to determine which manufacturers meet the requirement under paragraph (a)
and are required to pay the registration fees under this subdivision.
(e) By April 1 of each year, beginning April 1, 2020, the board shall notify a manufacturer
that the manufacturer meets the requirement in paragraph (a) and is required to pay the
annual registration fee in accordance with section 151.252, subdivision 1, paragraph (b).
(f) A manufacturer may dispute the board's determination that the manufacturer must
pay the registration fee no later than 30 days after the date of notification. However, the
manufacturer must still remit the fee as required by section 151.252, subdivision 1, paragraph
(b). The dispute must be filed with the board in the manner and using the forms specified
by the board. A manufacturer must submit, with the required forms, data satisfactory to the
board that demonstrates that the assessment of the registration fee was incorrect. The board
must make a decision concerning a dispute no later than 60 days after receiving the required
dispute forms. If the board determines that the manufacturer has satisfactorily demonstrated
that the fee was incorrectly assessed, the board must refund the amount paid in error.
(g) For purposes of this subdivision, a unit means the individual dosage form of the
particular drug product that is prescribed to the patient. One unit equals one tablet, capsule,
patch, syringe, milliliter, or gram.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2021 Supplement, section 256.042, subdivision 4, is amended
to read:
Subd. 4.
Grants.
(a) The commissioner of human services shall submit a report of the
grants proposed by the advisory council to be awarded for the upcoming calendar year to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services policy and finance, by December 1 of each year, beginning
March 1, 2020.
(b) The grants shall be awarded to proposals selected by the advisory council that address
the priorities in subdivision 1, paragraph (a), clauses (1) to (4), unless otherwise appropriated
by the legislature. The advisory council shall determine grant awards and funding amounts
based on the funds appropriated to the commissioner under section 256.043, subdivision 3,
paragraph deleted text begin (e)deleted text end new text begin (h), and subdivision 3a, paragraph (d)new text end . The commissioner shall award the
grants from the opiate epidemic response fund and administer the grants in compliance with
section 16B.97. No more than ten percent of the grant amount may be used by a grantee for
administration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256.043, subdivision 1, is amended to read:
Subdivision 1.
Establishment.
new text begin (a) new text end The opiate epidemic response fund is established in
the state treasury. deleted text begin The registration fees assessed by the Board of Pharmacy under section
151.066 and the license fees identified in section 151.065, subdivision 7, paragraphs (b)
and (c), shall be deposited into the fund.deleted text end new text begin The commissioner of management and budget
shall establish within the opiate epidemic response fund two accounts: (1) a registration and
license fee account; and (2) a settlement account.new text end Beginning in fiscal year 2021, for each
fiscal year, the fund shall be administered according to this section.
new text begin
(b) The commissioner of management and budget shall deposit into the registration and
license fee account the registration fee assessed by the Board of Pharmacy under section
151.066 and the license fees identified in section 151.065, subdivision 7, paragraphs (b)
and (c).
new text end
new text begin
(c) The commissioner of management and budget shall deposit into the settlement account
any money received by the state resulting from a settlement agreement or an assurance of
discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, related
to alleged violations of consumer fraud laws in the marketing, sale, or distribution of opioids
in this state or other alleged illegal actions that contributed to the excessive use of opioids,
pursuant to section 16A.151, subdivision 2, paragraph (f).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2021 Supplement, section 256.043, subdivision 3, is amended
to read:
Subd. 3.
Appropriations from deleted text begin funddeleted text end new text begin registration and license fee accountnew text end .
(a)new text begin The
appropriations in paragraphs (b) to (h) shall be made from the registration and license fee
account on a fiscal year basis in the order specified.
new text end
deleted text begin Afterdeleted text end new text begin (b) new text end The appropriations new text begin specified new text end in Laws 2019, chapter 63, article 3, section 1,
deleted text begin paragraph (e), are made, $249,000 is appropriated to the commissioner of human services
for the provision of administrative services to the Opiate Epidemic Response Advisory
Council and for the administration of the grants awarded under paragraph (e).deleted text end new text begin paragraphs
(b), (f), (g), and (h), as amended by Laws 2020, chapter 115, article 3, section 35, shall be
made accordingly.
new text end
new text begin
(c) $300,000 is appropriated to the commissioner of management and budget for
evaluation activities under section 256.042, subdivision 1, paragraph (c).
new text end
new text begin
(d) $249,000 is appropriated to the commissioner of human services for the provision
of administrative services to the Opiate Epidemic Response Advisory Council and for the
administration of the grants awarded under paragraph (h).
new text end
deleted text begin (b)deleted text end new text begin (e)new text end $126,000 is appropriated to the Board of Pharmacy for the collection of the
registration fees under section 151.066.
deleted text begin (c)deleted text end new text begin (f)new text end $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.
deleted text begin (d)deleted text end new text begin (g)new text end After the appropriations in paragraphs deleted text begin (a)deleted text end new text begin (b)new text end to deleted text begin (c)deleted text end new text begin (f)new text end are made, 50 percent of
the remaining amount is appropriated to the commissioner of human services for distribution
to county social service deleted text begin and tribal social servicedeleted text end agencies new text begin and Tribal social service agency
initiative projects authorized under section 256.01, subdivision 14b, new text end to provide child
protection services to children and families who are affected by addiction. The commissioner
shall distribute this money proportionally to deleted text begin counties and tribaldeleted text end new text begin countynew text end social service agencies
new text begin and Tribal social service agency initiative projects new text end based on out-of-home placement episodes
where parental drug abuse is the primary reason for the out-of-home placement using data
from the previous calendar year. County deleted text begin and tribaldeleted text end social service agencies new text begin and Tribal social
service agency initiative projects new text end receiving funds from the opiate epidemic response fund
must annually report to the commissioner on how the funds were used to provide child
protection services, including measurable outcomes, as determined by the commissioner.
County social service agencies and Tribal social service deleted text begin agenciesdeleted text end new text begin agency initiative projectsnew text end
must not use funds received under this paragraph to supplant current state or local funding
received for child protection services for children and families who are affected by addiction.
deleted text begin (e)deleted text end new text begin (h)new text end After deleted text begin makingdeleted text end the appropriations in paragraphs deleted text begin (a)deleted text end new text begin (b)new text end to deleted text begin (d)deleted text end new text begin (g) are madenew text end , the
remaining amount in the deleted text begin funddeleted text end new text begin accountnew text end is appropriated to the commissioner new text begin of human services
new text end to award grants as specified by the Opiate Epidemic Response Advisory Council in
accordance with section 256.042, unless otherwise appropriated by the legislature.
deleted text begin (f)deleted text end new text begin (i)new text end Beginning in fiscal year 2022 and each year thereafter, funds for county social
service deleted text begin and tribal social servicedeleted text end agencies new text begin and Tribal social service agency initiative projects
new text end under paragraph deleted text begin (d)deleted text end new text begin (g)new text end and grant funds specified by the Opiate Epidemic Response Advisory
Council under paragraph deleted text begin (e) shalldeleted text end new text begin (h) maynew text end be distributed on a calendar year basis.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256.043, is amended by adding a subdivision to
read:
new text begin Subd. 3a. new text end
new text begin Appropriations from settlement account. new text end
new text begin
(a) The appropriations in paragraphs
(b) to (e) shall be made from the settlement account on a fiscal year basis in the order
specified.
new text end
new text begin
(b) If the balance in the registration and license fee account is not sufficient to fully fund
the appropriations specified in subdivision 3, paragraphs (b) to (f), an amount necessary to
meet any insufficiency shall be transferred from the settlement account to the registration
and license fee account to fully fund the required appropriations.
new text end
new text begin
(c) $209,000 in fiscal year 2023 and $239,000 in fiscal year 2024 and subsequent fiscal
years are appropriated to the commissioner of human services for the administration of
grants awarded under paragraph (e). $276,000 in fiscal year 2023 and $246,000 in fiscal
year 2024 and subsequent fiscal years are appropriated to the commissioner of human
services for data collection and analysis of settlement funds as required under section
256.042, subdivision 5, paragraph (d).
new text end
new text begin
(d) After any appropriations necessary under paragraphs (b) and (c) are made, an amount
equal to the calendar year allocation to Tribal social service agency initiative projects under
subdivision 3, paragraph (g), is appropriated from the settlement account to the commissioner
of human services for distribution to Tribal social service agency initiative projects to
provide child protection services to children and families who are affected by addiction.
The requirements related to proportional distribution, annual reporting, and maintenance
of effort specified in subdivision 3, paragraph (g), also apply to the appropriations made
under this paragraph.
new text end
new text begin
(e) After making the appropriations in paragraphs (b) to (d), the remaining amount in
the account is appropriated to the commissioner of human services to award grants as
specified by the Opiate Epidemic Response Advisory Council in accordance with section
256.042.
new text end
new text begin
(f) Funds for Tribal social service agency initiative projects under paragraph (d) and
grant funds specified by the Opiate Epidemic Response Advisory Council under paragraph
(e) may be distributed on a calendar year basis.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2021 Supplement, section 256.043, subdivision 4, is amended
to read:
Subd. 4.
Settlement; sunset.
(a) If the state receives a total sum of $250,000,000 either
as a result of a settlement agreement or an assurance of discontinuance entered into by the
attorney general of the state, or resulting from a court order in litigation brought by the
attorney general of the state on behalf of the state or a state agency related to alleged
violations of consumer fraud laws in the marketing, sale, or distribution of opioids in this
state, or other alleged illegal actions that contributed to the excessive use of opioids, or from
the fees collected under sections 151.065, subdivisions 1 and 3, and 151.066, that are
deposited into the opiate epidemic response fund established in this section, or from a
combination of both, the fees specified in section 151.065, subdivisions 1, clause (16), and
3, clause (14), shall be reduced to $5,260, and the opiate registration fee in section 151.066,
subdivision 3, shall be repealed.new text begin For purposes of this paragraph, any money received as a
result of a settlement agreement specified in this paragraph and directly allocated or
distributed and received by either the state or a municipality as defined in section 466.01,
subdivision 1, shall be counted toward determining when the $250,000,000 is reached.
new text end
(b) The commissioner of management and budget shall inform the Board of Pharmacy,
the governor, and the legislature when the amount specified in paragraph (a) has been
reached. The board shall apply the reduced license fee for the next licensure period.
(c) Notwithstanding paragraph (a), the reduction of the license fee in section 151.065,
subdivisions 1 and 3, and the repeal of the registration fee in section 151.066 shall not occur
before July 1, deleted text begin 2024deleted text end new text begin 2031new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Laws 2019, chapter 63, article 3, section 1, as amended by Laws 2020, chapter
115, article 3, section 35, is amended to read:
Section 1. APPROPRIATIONS.
(a) Board of Pharmacy; administration. $244,000 in fiscal year 2020 is appropriated
from the general fund to the Board of Pharmacy for onetime information technology and
operating costs for administration of licensing activities under Minnesota Statutes, section
151.066. This is a onetime appropriation.
(b) Commissioner of human services; administration. $309,000 in fiscal year 2020
is appropriated from the general fund and $60,000 in fiscal year 2021 is appropriated from
the opiate epidemic response fund to the commissioner of human services for the provision
of administrative services to the Opiate Epidemic Response Advisory Council and for the
administration of the grants awarded under paragraphs (f), (g), and (h). The opiate epidemic
response fund base for this appropriation is $60,000 in fiscal year 2022, $60,000 in fiscal
year 2023, $60,000 in fiscal year 2024, and deleted text begin $0deleted text end new text begin $60,000new text end in fiscal year 2025.
(c) Board of Pharmacy; administration. $126,000 in fiscal year 2020 is appropriated
from the general fund to the Board of Pharmacy for the collection of the registration fees
under section 151.066.
(d) Commissioner of public safety; enforcement activities. $672,000 in fiscal year
2020 is appropriated from the general fund to the commissioner of public safety for the
Bureau of Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab
supplies and $288,000 is for special agent positions focused on drug interdiction and drug
trafficking.
(e) Commissioner of management and budget; evaluation activities. $300,000 in
fiscal year 2020 is appropriated from the general fund and $300,000 in fiscal year 2021 is
appropriated from the opiate epidemic response fund to the commissioner of management
and budget for evaluation activities under Minnesota Statutes, section 256.042, subdivision
1, paragraph (c). deleted text begin The opiate epidemic response fund base for this appropriation is $300,000
in fiscal year 2022, $300,000 in fiscal year 2023, $300,000 in fiscal year 2024, and $0 in
fiscal year 2025.
deleted text end
(f) Commissioner of human services; grants for Project ECHO. $400,000 in fiscal
year 2020 is appropriated from the general fund and $400,000 in fiscal year 2021 is
appropriated from the opiate epidemic response fund to the commissioner of human services
for grants of $200,000 to CHI St. Gabriel's Health Family Medical Center for the
opioid-focused Project ECHO program and $200,000 to Hennepin Health Care for the
opioid-focused Project ECHO program. The opiate epidemic response fund base for this
appropriation is $400,000 in fiscal year 2022, $400,000 in fiscal year 2023, $400,000 in
fiscal year 2024, and $0 in fiscal year 2025.
(g) Commissioner of human services; opioid overdose prevention grant. $100,000
in fiscal year 2020 is appropriated from the general fund and $100,000 in fiscal year 2021
is appropriated from the opiate epidemic response fund to the commissioner of human
services for a grant to a nonprofit organization that has provided overdose prevention
programs to the public in at least 60 counties within the state, for at least three years, has
received federal funding before January 1, 2019, and is dedicated to addressing the opioid
epidemic. The grant must be used for opioid overdose prevention, community asset mapping,
education, and overdose antagonist distribution. The opiate epidemic response fund base
for this appropriation is $100,000 in fiscal year 2022, $100,000 in fiscal year 2023, $100,000
in fiscal year 2024, and deleted text begin $0deleted text end new text begin $100,000new text end in fiscal year 2025.
(h) Commissioner of human services; traditional healing. $2,000,000 in fiscal year
2020 is appropriated from the general fund and $2,000,000 in fiscal year 2021 is appropriated
from the opiate epidemic response fund to the commissioner of human services to award
grants to Tribal nations and five urban Indian communities for traditional healing practices
to American Indians and to increase the capacity of culturally specific providers in the
behavioral health workforce. The opiate epidemic response fund base for this appropriation
is $2,000,000 in fiscal year 2022, $2,000,000 in fiscal year 2023, $2,000,000 in fiscal year
2024, and deleted text begin $0deleted text end new text begin $2,000,000new text end in fiscal year 2025.
(i) Board of Dentistry; continuing education. $11,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Dentistry to
implement the continuing education requirements under Minnesota Statutes, section 214.12,
subdivision 6.
(j) Board of Medical Practice; continuing education. $17,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Medical Practice
to implement the continuing education requirements under Minnesota Statutes, section
214.12, subdivision 6.
(k) Board of Nursing; continuing education. $17,000 in fiscal year 2020 is appropriated
from the state government special revenue fund to the Board of Nursing to implement the
continuing education requirements under Minnesota Statutes, section 214.12, subdivision
6.
(l) Board of Optometry; continuing education. $5,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Optometry to
implement the continuing education requirements under Minnesota Statutes, section 214.12,
subdivision 6.
(m) Board of Podiatric Medicine; continuing education. $5,000 in fiscal year 2020
is appropriated from the state government special revenue fund to the Board of Podiatric
Medicine to implement the continuing education requirements under Minnesota Statutes,
section 214.12, subdivision 6.
(n) Commissioner of health; nonnarcotic pain management and wellness. $1,250,000
is appropriated in fiscal year 2020 from the general fund to the commissioner of health, to
provide funding for:
(1) statewide mapping and assessment of community-based nonnarcotic pain management
and wellness resources; and
(2) up to five demonstration projects in different geographic areas of the state to provide
community-based nonnarcotic pain management and wellness resources to patients and
consumers.
The demonstration projects must include an evaluation component and scalability analysis.
The commissioner shall award the grant for the statewide mapping and assessment, and the
demonstration project grants, through a competitive request for proposal process. Grants
for statewide mapping and assessment and demonstration projects may be awarded
simultaneously. In awarding demonstration project grants, the commissioner shall give
preference to proposals that incorporate innovative community partnerships, are informed
and led by people in the community where the project is taking place, and are culturally
relevant and delivered by culturally competent providers. This is a onetime appropriation.
(o) Commissioner of health; administration. $38,000 in fiscal year 2020 is appropriated
from the general fund to the commissioner of health for the administration of the grants
awarded in paragraph (n).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Laws 2021, First Special Session chapter 7, article 16, section 12, is amended to
read:
Sec. 12. COMMISSIONER OF
|
$ |
300,000 |
$ |
deleted text begin
300,000
deleted text end
new text begin
0 new text end |
||
(a) This appropriation is from the opiate
epidemic response fund.
(b) Evaluation. $300,000 in fiscal year 2022
deleted text begin and $300,000 in fiscal year 2023deleted text end is for
evaluation activities under Minnesota Statutes,
section 256.042, subdivision 1, paragraph (c).
deleted text begin
(c) Base Level Adjustment. The opiate
epidemic response fund base is $300,000 in
fiscal year 2024 and $300,000 in fiscal year
2025.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11. new text begin TRANSFER; ELIMINATION OF ACCOUNT.
new text end
new text begin
(a) The commissioner of management and budget shall transfer any money in the separate
account established in the state treasury under Minnesota Statutes, section 16A.151,
subdivision 2, paragraph (f), to the settlement account in the opiate epidemic response fund
established under Minnesota Statutes, section 256.043, subdivision 1. Notwithstanding
section 256.043, subdivision 3a, paragraph (a), money transferred into the account under
this paragraph shall be appropriated to the commissioner of human services to award as
grants as specified by the Opiate Epidemic Response Advisory Council in accordance with
Minnesota Statutes, section 256.043, subdivision 3a, paragraph (d).
new text end
new text begin
(b) Once the money is transferred as required in paragraph (a), the commissioner of
management and budget shall eliminate the separate account established under Minnesota
Statutes, section 16A.151, subdivision 2, paragraph (f).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 21
CHILD CARE POLICY
Section 1.
Minnesota Statutes 2020, section 119B.011, subdivision 2, is amended to read:
Subd. 2.
Applicant.
"Child care fund applicants" means all parentsdeleted text begin ,deleted text end new text begin ;new text end stepparentsdeleted text begin ,deleted text end new text begin ;new text end legal
guardiansdeleted text begin , ordeleted text end new text begin ;new text end eligible relative caregivers deleted text begin who aredeleted text end new text begin ; relative custodians who accepted a transfer
of permanent legal and physical custody of a child under section 260C.515, subdivision 4,
or similar permanency disposition in Tribal code; successor custodians or guardians as
established by section 256N.22, subdivision 10; or foster parents providing care to a child
placed in a family foster home under section 260C.007, subdivision 16b. Applicants must
benew text end members of the family and reside in the household that applies for child care assistance
under the child care fund.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 7, 2023.
new text end
Sec. 2.
Minnesota Statutes 2020, section 119B.011, subdivision 5, is amended to read:
Subd. 5.
Child care.
"Child care" means the care of a child by someone other than a
parentdeleted text begin ,deleted text end new text begin ;new text end stepparentdeleted text begin ,deleted text end new text begin ;new text end legal guardiandeleted text begin ,deleted text end new text begin ;new text end eligible relative caregiverdeleted text begin ,deleted text end new text begin ; relative custodian who
accepted a transfer of permanent legal and physical custody of a child under section
260C.515, subdivision 4, or similar permanency disposition in Tribal code; successor
custodian or guardian as established according to section 256N.22, subdivision 10; foster
parent providing care to a child placed in a family foster home under section 260C.007,
subdivision 16b;new text end or deleted text begin the spousesdeleted text end new text begin spousenew text end of any of the foregoing in or outside the child's own
home for gain or otherwise, on a regular basis, for any part of a 24-hour day.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 7, 2023.
new text end
Sec. 3.
Minnesota Statutes 2020, section 119B.011, subdivision 13, is amended to read:
Subd. 13.
Family.
"Family" means parentsdeleted text begin ,deleted text end new text begin ;new text end stepparentsdeleted text begin ,deleted text end new text begin ;new text end guardians and their spousesdeleted text begin ,
ordeleted text end new text begin ;new text end other eligible relative caregivers and their spousesdeleted text begin ,deleted text end new text begin ; relative custodians who accepted a
transfer of permanent legal and physical custody of a child under section 260C.515,
subdivision 4, or similar permanency disposition in Tribal code, and their spouses; successor
custodians or guardians as established according to section 256N.22, subdivision 10, and
their spouses; or foster parents providing care to a child placed in a family foster home
under section 260C.007, subdivision 16b, and their spouses;new text end and deleted text begin their blood relateddeleted text end new text begin the
blood-relatednew text end dependent children and adoptive siblings under the age of 18 years living in
the same home deleted text begin includingdeleted text end new text begin of the above. This definition includesnew text end children temporarily absent
from the household in settings such as schools, foster care, and residential treatment facilities
deleted text begin or parents, stepparents, guardians and their spouses, or other relative caregivers and their
spousesdeleted text end new text begin and adultsnew text end temporarily absent from the household in settings such as schools, military
service, or rehabilitation programs. An adult family member who is not in an authorized
activity under this chapter may be temporarily absent for up to 60 days. When a minor
parent or parents and his, her, or their child or children are living with other relatives, and
the minor parent or parents apply for a child care subsidy, "family" means only the minor
parent or parents and their child or children. An adult age 18 or older who meets this
definition of family and is a full-time high school or postsecondary student may be considered
a dependent member of the family unit if 50 percent or more of the adult's support is provided
by the parentsdeleted text begin ,deleted text end new text begin ;new text end stepparentsdeleted text begin ,deleted text end new text begin ;new text end guardiansdeleted text begin ,deleted text end new text begin and their spouses; relative custodians who accepted
a transfer of permanent legal and physical custody of a child under section 260C.515,
subdivision 4, or similar permanency disposition in Tribal code, and their spouses; successor
custodians or guardians as established according to section 256N.22, subdivision 10, and
their spouses; foster parents providing care to a child placed in a family foster home under
section 260C.007, subdivision 16b,new text end and their spousesnew text begin ;new text end or eligible relative caregivers and
their spouses residing in the same household.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 7, 2023.
new text end
Sec. 4.
Minnesota Statutes 2021 Supplement, section 119B.03, subdivision 4a, is amended
to read:
Subd. 4a.
deleted text begin Temporary reprioritizationdeleted text end new text begin Funding prioritiesnew text end .
(a) deleted text begin Notwithstanding
subdivision 4deleted text end new text begin In the event that inadequate funding necessitates the use of waiting listsnew text end ,
priority for child care assistance under the basic sliding fee assistance program shall be
determined according to this subdivision deleted text begin beginning July 1, 2021, through May 31, 2024deleted text end .
(b) First priority must be given to eligible non-MFIP families who do not have a high
school diploma or commissioner of education-selected high school equivalency certification
or who need remedial and basic skill courses in order to pursue employment or to pursue
education leading to employment and who need child care assistance to participate in the
education program. This includes student parents as defined under section 119B.011,
subdivision 19b. Within this priority, the following subpriorities must be used:
(1) child care needs of minor parents;
(2) child care needs of parents under 21 years of age; and
(3) child care needs of other parents within the priority group described in this paragraph.
(c) Second priority must be given to families in which at least one parent is a veteran,
as defined under section 197.447.
(d) Third priority must be given to eligible families who do not meet the specifications
of paragraph (b), (c), (e), or (f).
(e) Fourth priority must be given to families who are eligible for portable basic sliding
fee assistance through the portability pool under subdivision 9.
(f) Fifth priority must be given to eligible families receiving services under section
119B.011, subdivision 20a, if the parents have completed their MFIP or DWP transition
year, or if the parents are no longer receiving or eligible for DWP supports.
(g) Families under paragraph (f) must be added to the basic sliding fee waiting list on
the date they complete their transition year under section 119B.011, subdivision 20.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 5.
Minnesota Statutes 2021 Supplement, section 119B.13, subdivision 1, is amended
to read:
Subdivision 1.
Subsidy restrictions.
(a) Beginning deleted text begin November 15, 2021deleted text end new text begin October 3, 2022new text end ,
the maximum rate paid for child care assistance in any county or county price cluster under
the child care fund shall bedeleted text begin :
deleted text end
deleted text begin (1) for all infants and toddlers,deleted text end the greater of the deleted text begin 40thdeleted text end new text begin 75thnew text end percentile of the 2021 child
care provider rate survey or the rates in effect at the time of the updatedeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(2) for all preschool and school-age children, the greater of the 30th percentile of the
2021 child care provider rate survey or the rates in effect at the time of the update.
deleted text end
(b) Beginning the first full service period on or after January 1, 2025, new text begin and every three
years thereafter, new text end the maximum rate paid for child care assistance in a county or county price
cluster under the child care fund shall bedeleted text begin :
deleted text end
deleted text begin (1) for all infants and toddlers,deleted text end the greater of the deleted text begin 40thdeleted text end new text begin 75thnew text end percentile of the deleted text begin 2024deleted text end new text begin most
recentnew text end child care provider rate survey or the rates in effect at the time of the updatedeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(2) for all preschool and school-age children, the greater of the 30th percentile of the
2024 child care provider rate survey or the rates in effect at the time of the update.
deleted text end
The rates under paragraph (a) continue until the rates under this paragraph go into effect.
(c) For a child care provider located within the boundaries of a city located in two or
more of the counties of Benton, Sherburne, and Stearns, the maximum rate paid for child
care assistance shall be equal to the maximum rate paid in the county with the highest
maximum reimbursement rates or the provider's charge, whichever is less. The commissioner
may: (1) assign a county with no reported provider prices to a similar price cluster; and (2)
consider county level access when determining final price clusters.
(d) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.
(e) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.
(f) If a child uses one provider, the maximum payment for one day of care must not
exceed the daily rate. The maximum payment for one week of care must not exceed the
weekly rate.
(g) If a child uses two providers under section 119B.097, the maximum payment must
not exceed:
(1) the daily rate for one day of care;
(2) the weekly rate for one week of care by the child's primary provider; and
(3) two daily rates during two weeks of care by a child's secondary provider.
(h) Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.
(i) If the provider charge is greater than the maximum provider rate allowed, the parent
is responsible for payment of the difference in the rates in addition to any family co-payment
fee.
(j) new text begin Beginning October 3, 2022, new text end the maximum registration fee paid for child care assistance
in any county or county price cluster under the child care fund shall be deleted text begin set as follows: (1)
beginning November 15, 2021,deleted text end the greater of the deleted text begin 40thdeleted text end new text begin 75thnew text end percentile of the deleted text begin 2021deleted text end new text begin most
recentnew text end child care provider rate survey or the registration fee in effect at the time of the
updatedeleted text begin ; and (2) beginning the first full service period on or after January 1, 2025, the
maximum registration fee shall be the greater of the 40th percentile of the 2024 child care
provider rate survey or the registration fee in effect at the time of the update. The registration
fees under clause (1) continue until the registration fees under clause (2) go into effectdeleted text end .
(k) Maximum registration fees must be set for licensed family child care and for child
care centers. For a child care provider located in the boundaries of a city located in two or
more of the counties of Benton, Sherburne, and Stearns, the maximum registration fee paid
for child care assistance shall be equal to the maximum registration fee paid in the county
with the highest maximum registration fee or the provider's charge, whichever is less.
Sec. 6.
Minnesota Statutes 2020, section 119B.19, subdivision 7, is amended to read:
Subd. 7.
Child care resource and referral programs.
Within each region, a child care
resource and referral program must:
(1) maintain one database of all existing child care resources and services and one
database of family referrals;
(2) provide a child care referral service for families;
(3) develop resources to meet the child care service needs of families;
(4) increase the capacity to provide culturally responsive child care services;
(5) coordinate professional development opportunities for child care and school-age
care providers;
(6) administer and award child care services grants;
(7) cooperate with the Minnesota Child Care Resource and Referral Network and its
member programs to develop effective child care services and child care resources; deleted text begin and
deleted text end
(8) assist in fostering coordination, collaboration, and planning among child care programs
and community programs such as school readiness, Head Start, early childhood family
education, local interagency early intervention committees, early childhood screening,
special education services, and other early childhood care and education services and
programs that provide flexible, family-focused services to families with young children to
the extent possibledeleted text begin .deleted text end new text begin ;
new text end
new text begin
(9) administer the child care one-stop regional assistance network to assist child care
providers and individuals interested in becoming child care providers with establishing and
sustaining a licensed family child care or group family child care program or a child care
center; and
new text end
new text begin
(10) provide supports that enable economically challenged individuals to obtain the job
skills training, career counseling, and job placement assistance necessary to begin a career
path in child care.
new text end
Sec. 7.
new text begin
[119B.27] SHARED SERVICES GRANTS.
new text end
new text begin
The commissioner of human services shall establish a grant program to enable family
child care providers to implement shared services alliances.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 8.
new text begin
[119B.28] CHILD CARE PROVIDER ACCESS TO TECHNOLOGY
GRANTS.
new text end
new text begin
The commissioner of human services shall distribute money through grants to one or
more organizations to offer grants or other supports to child care providers to improve their
access to computers, the Internet, subscriptions to online child care management applications,
and other technologies intended to improve business practices. Up to ten percent of the
grant funds may be used to administer the program.
new text end
Sec. 9.
Laws 2021, First Special Session chapter 7, article 14, section 21, subdivision 4,
is amended to read:
Subd. 4.
Grant awards.
(a) The commissioner shall award transition grants to all eligible
programs on a noncompetitive basis through August 31, 2021.
(b) The commissioner shall award base grant amounts to all eligible programs on a
noncompetitive basis beginning September 1, 2021deleted text begin , through June 30, 2023deleted text end . The base grant
amounts shall be:
(1) based on the full-time equivalent number of staff who regularly care for children in
the program, including any employees, sole proprietors, or independent contractors;new text begin and
new text end
deleted text begin
(2) reduced between July 1, 2022, and June 30, 2023, with amounts for the final month
being no more than 50 percent of the amounts awarded in September 2021; and
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end enhanced in amounts determined by the commissioner for any providers receiving
payments through the child care assistance program under sections 119B.03 and 119B.05
or early learning scholarships under section 124D.165.
(c) The commissioner may provide grant amounts in addition to any base grants received
to eligible programs in extreme financial hardship until all money set aside for that purpose
is awarded.
(d) The commissioner may pay any grants awarded to eligible programs under this
section in the form and manner established by the commissioner, except that such payments
must occur on a monthly basis.
Sec. 10. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
ALLOCATING BASIC SLIDING FEE FUNDS.
new text end
new text begin
Notwithstanding Minnesota Statutes, section 119B.03, subdivisions 6, 6a, and 6b, the
commissioner of human services must allocate additional basic sliding fee child care money
for calendar year 2024 to counties and Tribes to account for the change in the definition of
family. In allocating the additional money, the commissioner shall consider:
new text end
new text begin
(1) the number of children in the county or Tribe who receive care from a relative
custodian who accepted a transfer of permanent legal and physical custody of a child under
section 260C.515, subdivision 4, or similar permanency disposition in Tribal code; successor
custodian or guardian as established according to section 256N.22, subdivision 10; or foster
parents in a family foster home under section 260C.007, subdivision 16b; and
new text end
new text begin
(2) the average basic sliding fee cost of care in the county or Tribe.
new text end
Sec. 11. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; INCREASE
FOR MAXIMUM RATES.
new text end
new text begin
Notwithstanding Minnesota Statutes, section 119B.03, subdivisions 6, 6a, and 6b, the
commissioner of human services shall allocate additional basic sliding fee child care funds
for calendar year 2023 to counties and Tribes for updated maximum rates based on relative
need to cover maximum rate increases. In distributing the additional funds, the commissioner
shall consider the following factors by county and Tribe:
new text end
new text begin
(1) number of children covered by the county or Tribe;
new text end
new text begin
(2) provider types that care for covered children;
new text end
new text begin
(3) age of covered children; and
new text end
new text begin
(4) amount of the increase in maximum rates.
new text end
Sec. 12. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; CHILD
CARE AND DEVELOPMENT FUND ALLOCATION.
new text end
new text begin
The commissioner of human services shall allocate $75,364,000 in fiscal year 2023 from
the child care and development fund for rate and registration fee increases under Minnesota
Statutes, section 119B.13, subdivision 1, paragraphs (a) and (j). This is a onetime allocation.
new text end
Sec. 13. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; COST
ESTIMATION MODEL FOR EARLY CARE AND LEARNING PROGRAMS.
new text end
new text begin
(a) The commissioner of human services shall develop a cost estimation model for
providing early care and learning in the state. In developing the model, the commissioner
shall consult with relevant entities and stakeholders, including but not limited to the State
Advisory Council on Early Childhood Education and Care under Minnesota Statutes, section
124D.141; county administrators; child care resource and referral organizations under
Minnesota Statutes, section 119B.19, subdivision 1; and organizations representing
caregivers, teachers, and directors.
new text end
new text begin
(b) The commissioner shall contract with an organization with experience and expertise
in early care and learning cost estimation modeling to conduct the work outlined in this
section. If practicable, the commissioner shall contract with First Children's Finance.
new text end
new text begin
(c) The commissioner shall ensure that the model can estimate variation in the cost of
early care and learning by:
new text end
new text begin
(1) quality of care;
new text end
new text begin
(2) geographic area;
new text end
new text begin
(3) type of child care provider and associated licensing standards;
new text end
new text begin
(4) age of child;
new text end
new text begin
(5) whether the early care and learning is inclusive, caring for children with disabilities
alongside children without disabilities;
new text end
new text begin
(6) provider and staff compensation, including benefits such as professional development
stipends, health benefits, and retirement benefits;
new text end
new text begin
(7) a provider's fixed costs, including rent and mortgage payments, property taxes, and
business-related insurance payments;
new text end
new text begin
(8) a provider's operating expenses, including expenses for training and substitutes; and
new text end
new text begin
(9) a provider's hours of operation.
new text end
new text begin
(d) By January 30, 2024, the commissioner shall report to the legislative committees
with jurisdiction over early childhood programs on the development of the cost estimation
model. The report shall include:
new text end
new text begin
(1) recommendations for how the model could be used in conjunction with a child care
provider wage scale to set provider payment rates for child care assistance under Minnesota
Statutes, chapter 119B; and
new text end
new text begin
(2) the department's plan to seek federal approval to use the model for provider payment
rates for child care assistance.
new text end
Sec. 14. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; CHILD
CARE PROVIDER WAGE SCALE.
new text end
new text begin
(a) The commissioner of human services shall develop, in consultation with the
commissioner of employment and economic development, the commissioner of education,
and relevant stakeholders, a child care provider wage scale that:
new text end
new text begin
(1) provides for wages that are equivalent to elementary school educators with similar
credentials and experience;
new text end
new text begin
(2) incentivizes child care providers and staff to increase child care-related qualifications;
new text end
new text begin
(3) incorporates payments toward compensation benefits, including professional
development stipends, health benefits, and retirement benefits; and
new text end
new text begin
(4) accounts for the business structures of different types of child care providers, including
licensed family child care providers and legal, nonlicensed child care providers.
new text end
new text begin
(b) By January 30, 2024, the commissioner shall report to the legislative committees
with jurisdiction over early childhood programs on the development of the wage scale and
make recommendations for how the wage scale could be used to inform payment rates for
child care assistance under Minnesota Statutes, chapter 119B.
new text end
Sec. 15. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; BRAIN
BUILDERS BONUS PILOT PROGRAM.
new text end
new text begin
(a) The commissioner of human services shall develop and implement a brain builders
bonus pilot program to provide incentives or other supports to eligible child care providers
that provide consistent care for infants and toddlers, as defined in Minnesota Statutes, section
245A.02, subdivision 19, who receive child care assistance under Minnesota Statutes, chapter
119B, or an early learning scholarship under Minnesota Statutes, section 124D.165.
new text end
new text begin
(b) "Eligible child care providers" for purposes of the pilot program are family child
care providers and group family child care providers licensed under Minnesota Statutes,
chapter 245A, and legal nonlicensed child care providers, as defined in Minnesota Statutes,
section 119B.011, subdivision 16.
new text end
new text begin
(c) The commissioner may administer the pilot program and measure the program's
outcomes through a grant to a public or private nonprofit organization with the demonstrated
ability to manage benefit programs for child care professionals.
new text end
new text begin
(d) By January 31, 2024, the commissioner shall report to the legislative committees
with jurisdiction over early childhood on implementation of the pilot program, including:
a description of the incentives and supports provided; the number of the providers that
received the incentives and supports, disaggregated by provider type; the average length of
time a provider who received incentives or supports cared for an infant or toddler; and other
outcomes of the program. The report shall also include the commissioner's recommendations
on the utility and feasibility of making the pilot program permanent.
new text end
Sec. 16. new text begin DIRECTION TO COMMISSIONER OF INFORMATION TECHNOLOGY
SERVICES; INFORMATION TECHNOLOGY SYSTEMS FOR EARLY
CHILDHOOD PROGRAMS.
new text end
new text begin
(a) The commissioner of information technology services shall develop and implement,
to the extent practicable with the available appropriation, a plan to modernize the information
technology systems that support the programs impacting early childhood, including child
care and early learning programs and those serving young children administered by the
Departments of Education and Human Services and other departments with programs
impacting early childhood as identified by the Children's Cabinet. The commissioner may
contract for the services contained in this section.
new text end
new text begin
(b) The plan must support the goal of creating information technology systems for early
childhood programs that collect, analyze, share, and report data on program participation,
school readiness, early screening, and other childhood indicators. The plan must include
strategies to:
new text end
new text begin
(1) increase the efficiency and effectiveness with which early childhood programs serve
children and families;
new text end
new text begin
(2) improve coordination among early childhood programs for families; and
new text end
new text begin
(3) assess the impact of early childhood programs on children's outcomes, including
school readiness.
new text end
new text begin
(c) In developing and implementing the plan required under this section, the commissioner
or the contractor must consult with the commissioners of education and human services,
and other departments with programs impacting early childhood as identified by the
Children's Cabinet; the Children's Cabinet; and other stakeholders.
new text end
new text begin
(d) By February 1, 2023, the commissioner must provide a preliminary report on the
status of the plan's development and implementation to the chairs and ranking minority
members of the committees of the legislature with jurisdiction over early childhood programs.
new text end
Sec. 17. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 119B.03, subdivision 4,
new text end
new text begin
is repealed effective July 1,
2022.
new text end
ARTICLE 22
MISCELLANEOUS
Section 1.
Minnesota Statutes 2020, section 34A.01, subdivision 4, is amended to read:
Subd. 4.
Food.
"Food" means every ingredient used for, entering into the consumption
of, or used or intended for use in the preparation of food, drink, confectionery, or condiment
for humans or other animals, whether simple, mixed, or compound; and articles used as
components of these ingredientsnew text begin , except that edible cannabinoid products, as defined in
section 151.72, subdivision 1, paragraph (c), are not foodnew text end .
Sec. 2.
Minnesota Statutes 2020, section 137.68, is amended to read:
137.68 new text begin MINNESOTA RARE DISEASE new text end ADVISORY COUNCIL deleted text begin ON RARE
DISEASESdeleted text end .
Subdivision 1.
Establishment.
deleted text begin The University of Minnesota is requested to establishdeleted text end new text begin
There is establishednew text end an advisory council on rare diseases to provide advice onnew text begin policies,
access, equity,new text end research, diagnosis, treatment, and education related to rare diseases.new text begin The
advisory council is established in honor of Chloe Barnes and her experiences in the health
care system.new text end For purposes of this section, "rare disease" has the meaning given in United
States Code, title 21, section 360bb. The council shall be called the deleted text begin Chloe Barnes Advisory
Council on Rare Diseasesdeleted text end new text begin Minnesota Rare Disease Advisory Councilnew text end .new text begin The Council on
Disability shall house the advisory council.
new text end
Subd. 2.
Membership.
(a) The advisory council deleted text begin maydeleted text end new text begin shallnew text end consist of new text begin at least 17 new text end public
members new text begin who reflect statewide representation and are new text end appointed by deleted text begin the Board of Regents
or a designeedeleted text end new text begin the governornew text end according to paragraph (b) and four members of the legislature
appointed according to paragraph (c).
(b) deleted text begin The Board of Regents or a designee is requested todeleted text end new text begin The governor shallnew text end appoint new text begin at
least new text end the following public membersnew text begin according to section 15.059new text end :
(1) three physicians licensed and practicing in the state with experience researching,
diagnosing, or treating rare diseases, including one specializing in pediatrics;
(2) one registered nurse or advanced practice registered nurse licensed and practicing
in the state with experience treating rare diseases;
(3) at least two hospital administrators, or their designees, from hospitals in the state
that provide care to persons diagnosed with a rare disease. One administrator or designee
appointed under this clause must represent a hospital in which the scope of service focuses
on rare diseases of pediatric patients;
(4) three persons age 18 or older who either have a rare disease or are a caregiver of a
person with a rare diseasenew text begin . One person appointed under this clause must reside in rural
Minnesotanew text end ;
(5) a representative of a rare disease patient organization that operates in the state;
(6) a social worker with experience providing services to persons diagnosed with a rare
disease;
(7) a pharmacist with experience with drugs used to treat rare diseases;
(8) a dentist licensed and practicing in the state with experience treating rare diseases;
(9) a representative of the biotechnology industry;
(10) a representative of health plan companies;
(11) a medical researcher with experience conducting research on rare diseases; deleted text begin and
deleted text end
(12) a genetic counselor with experience providing services to persons diagnosed with
a rare disease or caregivers of those personsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(13) representatives with other areas of expertise as identified by the advisory council.
new text end
(c) The advisory council shall include two members of the senate, one appointed by the
majority leader and one appointed by the minority leader; and two members of the house
of representatives, one appointed by the speaker of the house and one appointed by the
minority leader.
(d) The commissioner of health or a designee, a representative of Mayo Medical School,
and a representative of the University of Minnesota Medical School shall serve as ex officio,
nonvoting members of the advisory council.
(e) deleted text begin Initial appointments to the advisory council shall be made no later than September
1, 2019.deleted text end new text begin Notwithstanding section 15.059,new text end members appointed according to paragraph (b)
shall serve for a term of three years, except that the initial members appointed according to
paragraph (b) shall have an initial term of two, three, or four years determined by lot by the
chairperson. Members appointed according to paragraph (b) shall serve until their successors
have been appointed.
new text begin
(f) Members may be reappointed for additional terms according to the advisory council's
operating procedures.
new text end
Subd. 3.
Meetings.
deleted text begin The Board of Regents or a designee is requested to convene the first
meeting of the advisory council no later than October 1, 2019.deleted text end The advisory council shall
meet at the call of the chairperson or at the request of a majority of advisory council members.new text begin
Meetings of the advisory council are subject to section 13D.01, and notice of its meetings
is governed by section 13D.04.
new text end
new text begin Subd. 3a. new text end
new text begin Chairperson; executive director; staff; executive committee. new text end
new text begin
(a) The
advisory council shall elect a chairperson and other officers as it deems necessary and in
accordance with the advisory council's operating procedures.
new text end
new text begin
(b) The advisory council shall be governed by an executive committee elected by the
members of the advisory council. One member of the executive committee must be the
advisory council chairperson.
new text end
new text begin
(c) The advisory council shall appoint an executive director. The executive director
serves as an ex officio nonvoting member of the executive committee. The advisory council
may delegate to the executive director any powers and duties under this section that do not
require advisory council approval. The executive director serves in the unclassified service
and may be removed at any time by a majority vote of the advisory council. The executive
director may employ and direct staff necessary to carry out advisory council mandates,
policies, activities, and objectives.
new text end
new text begin
(d) The executive committee may appoint additional subcommittees and work groups
as necessary to fulfill the duties of the advisory council.
new text end
Subd. 4.
Duties.
(a) The advisory council's duties may include, but are not limited to:
(1) in conjunction with the state's medical schools, the state's schools of public health,
and hospitals in the state that provide care to persons diagnosed with a rare disease,
developing resources or recommendations relating to quality of and access to treatment and
services in the state for persons with a rare disease, including but not limited to:
(i) a list of existing, publicly accessible resources on research, diagnosis, treatment, and
education relating to rare diseases;
(ii) identifying best practices for rare disease care implemented in other states, at the
national level, and at the international level that will improve rare disease care in the state
and seeking opportunities to partner with similar organizations in other states and countries;
(iii) identifyingnew text begin and addressingnew text end problems faced by patients with a rare disease when
changing health plans, including recommendations on how to remove obstacles faced by
these patients to finding a new health plan and how to improve the ease and speed of finding
a new health plan that meets the needs of patients with a rare disease; deleted text begin and
deleted text end
new text begin
(iv) identifying and addressing barriers faced by patients with a rare disease to obtaining
care, caused by prior authorization requirements in private and public health plans; and
new text end
deleted text begin (iv)deleted text end new text begin (v)new text end identifyingnew text begin , recommending, and implementingnew text end best practices to ensure health
care providers are adequately informed of the most effective strategies for recognizing and
treating rare diseases; deleted text begin and
deleted text end
(2) advising, consulting, and cooperating with the Department of Health,new text begin includingnew text end the
Advisory Committee on Heritable and Congenital Disordersdeleted text begin ,deleted text end new text begin ; the Department of Human
Services, including the Drug Utilization Review Board and the Drug Formulary Committee;new text end
and other agencies of state government in developing new text begin recommendations, new text end informationnew text begin ,new text end and
programs for the public and the health care community relating to diagnosis, treatment, and
awareness of rare diseasesdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(3) advising on policy issues and advancing policy initiatives at the state and federal
levels; and
new text end
new text begin
(4) receiving funds and issuing grants.
new text end
(b) The advisory council shall collect additional topic areas for study and evaluation
from the general public. In order for the advisory council to study and evaluate a topic, the
topic must be approved for study and evaluation by the advisory council.
Subd. 5.
Conflict of interest.
Advisory council members are subject to the deleted text begin Board of
Regents policy on conflictsdeleted text end new text begin advisory council's conflictnew text end of interestnew text begin policy as outlined in the
advisory council's operating proceduresnew text end .
Subd. 6.
Annual report.
By January 1 of each year, beginning January 1, 2020, the
advisory council shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over higher education and health care policy on the advisory
council's activities under subdivision 4 and other issues on which the advisory council may
choose to report.
Sec. 3.
Minnesota Statutes 2020, section 151.72, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given.
new text begin
(b) "Certified hemp" means hemp plants that have been tested and found to meet the
requirements of chapter 18K and the rules adopted thereunder.
new text end
new text begin
(c) "Edible cannabinoid product" means any product that is intended to be eaten or
consumed as a beverage by humans, contains a cannabinoid in combination with food
ingredients, and is not a drug.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end "Hemp" has the meaning given to "industrial hemp" in section 18K.02, subdivision
3.
new text begin
(e) "Label" has the meaning given in section 151.01, subdivision 18.
new text end
deleted text begin (c)deleted text end new text begin (f)new text end "Labeling" means all labels and other written, printed, or graphic matter that are:
(1) affixed to the immediate container in which a product regulated under this section
is sold; deleted text begin or
deleted text end
(2) provided, in any manner, with the immediate container, including but not limited to
outer containers, wrappers, package inserts, brochures, or pamphletsdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) provided on that portion of a manufacturer's website that is linked by a scannable
barcode or matrix barcode.
new text end
new text begin
(g) "Matrix barcode" means a code that stores data in a two-dimensional array of
geometrically shaped dark and light cells capable of being read by the camera on a
smartphone or other mobile device.
new text end
new text begin
(h) "Nonintoxicating cannabinoid" means substances extracted from certified hemp
plants that do not produce intoxicating effects when consumed by any route of administration.
new text end
Sec. 4.
Minnesota Statutes 2020, section 151.72, subdivision 2, is amended to read:
Subd. 2.
Scope.
(a) This section applies to the sale of any product that contains
deleted text begin nonintoxicatingdeleted text end cannabinoids extracted from hemp deleted text begin other than fooddeleted text end new text begin andnew text end that isnew text begin an edible
cannabinoid product or isnew text end intended for human or animal consumption by any route of
administration.
(b) This section does not apply to any product dispensed by a registered medical cannabis
manufacturer pursuant to sections 152.22 to 152.37.
new text begin
(c) The board must have no authority over food products, as defined in section 34A.01,
subdivision 4, that do not contain cannabinoids extracted or derived from hemp.
new text end
Sec. 5.
Minnesota Statutes 2020, section 151.72, subdivision 3, is amended to read:
Subd. 3.
Sale of cannabinoids derived from hemp.
new text begin (a) new text end Notwithstanding any other
section of this chapter, a product containing nonintoxicating cannabinoidsnew text begin , including an
edible cannabinoid product,new text end may be sold for human or animal consumption new text begin only new text end if all of
the requirements of this section are metnew text begin , provided that a product sold for human or animal
consumption does not contain more than 0.3 percent of any tetrahydrocannabinol and an
edible cannabinoid product does not contain an amount of any tetrahydrocannabinol that
exceeds the limits established in subdivision 5a, paragraph (f)new text end .
new text begin
(b) No other substance extracted or otherwise derived from hemp may be sold for human
consumption if the substance is intended:
new text end
new text begin
(1) for external or internal use in the diagnosis, cure, mitigation, treatment, or prevention
of disease in humans or other animals; or
new text end
new text begin
(2) to affect the structure or any function of the bodies of humans or other animals.
new text end
new text begin
(c) No product containing any cannabinoid or tetrahydrocannabinol extracted or otherwise
derived from hemp may be sold to any individual who is under the age of 21.
new text end
new text begin
(d) Products that meet the requirements of this section are not controlled substances
under section 152.02.
new text end
Sec. 6.
Minnesota Statutes 2020, section 151.72, subdivision 4, is amended to read:
Subd. 4.
Testing requirements.
(a) A manufacturer of a product regulated under this
section must submit representative samples of the product to an independent, accredited
laboratory in order to certify that the product complies with the standards adopted by the
board. Testing must be consistent with generally accepted industry standards for herbal and
botanical substances, and, at a minimum, the testing must confirm that the product:
(1) contains the amount or percentage of cannabinoids that is stated on the label of the
product;
(2) does not contain more than trace amounts of any new text begin mold, residual solvents, new text end pesticides,
fertilizers, or heavy metals; and
(3) does not contain deleted text begin a delta-9 tetrahydrocannabinol concentration that exceeds the
concentration permitted for industrial hemp as defined in section 18K.02, subdivision 3deleted text end new text begin
more than 0.3 percent of any tetrahydrocannabinolnew text end .
(b) Upon the request of the board, the manufacturer of the product must provide the
board with the results of the testing required in this section.
new text begin
(c) Testing of the hemp from which the nonintoxicating cannabinoid was derived, or
possession of a certificate of analysis for such hemp, does not meet the testing requirements
of this section.
new text end
Sec. 7.
Minnesota Statutes 2021 Supplement, section 151.72, subdivision 5, is amended
to read:
Subd. 5.
Labeling requirements.
(a) A product regulated under this section must bear
a label that contains, at a minimum:
(1) the name, location, contact phone number, and website of the manufacturer of the
product;
(2) the name and address of the independent, accredited laboratory used by the
manufacturer to test the product; and
(3) an accurate statement of the amount or percentage of cannabinoids found in each
unit of the product meant to be consumeddeleted text begin ; ordeleted text end new text begin .
new text end
deleted text begin
(4) instead of the information required in clauses (1) to (3), a scannable bar code or QR
code that links to the manufacturer's website.
deleted text end
new text begin
(b) The information in paragraph (a) may be provided on an outer package if the
immediate container that holds the product is too small to contain all of the information.
new text end
new text begin
(c) The information required in paragraph (a) may be provided through the use of a
scannable barcode or matrix barcode that links to a page on the manufacturer's website if
that page contains all of the information required by this subdivision.
new text end
new text begin (d) new text end The label must also include a statement stating that deleted text begin thisdeleted text end new text begin thenew text end product does not claim
to diagnose, treat, cure, or prevent any disease and has not been evaluated or approved by
the United States Food and Drug Administration (FDA) unless the product has been so
approved.
deleted text begin (b)deleted text end new text begin (e)new text end The information required deleted text begin to be on the labeldeleted text end new text begin by this subdivisionnew text end must be prominently
and conspicuously placed deleted text begin anddeleted text end new text begin on the label or displayed on the websitenew text end in terms that can be
easily read and understood by the consumer.
deleted text begin (c)deleted text end new text begin (f)new text end The deleted text begin labeldeleted text end new text begin labelingnew text end must not contain any claim that the product may be used or is
effective for the prevention, treatment, or cure of a disease or that it may be used to alter
the structure or function of human or animal bodies, unless the claim has been approved by
the FDA.
Sec. 8.
Minnesota Statutes 2020, section 151.72, is amended by adding a subdivision to
read:
new text begin Subd. 5a. new text end
new text begin Additional requirements for edible cannabinoid products. new text end
new text begin
(a) In addition
to the testing and labeling requirements under subdivisions 4 and 5, an edible cannabinoid
must meet the requirements of this subdivision.
new text end
new text begin
(b) An edible cannabinoid product must not:
new text end
new text begin
(1) bear the likeness or contain cartoon-like characteristics of a real or fictional person,
animal, or fruit that appeals to children;
new text end
new text begin
(2) be modeled after a brand of products primarily consumed by or marketed to children;
new text end
new text begin
(3) be made by applying an extracted or concentrated hemp-derived cannabinoid to a
commercially available candy or snack food item;
new text end
new text begin
(4) contain an ingredient, other than a hemp-derived cannabinoid, that is not approved
by the United States Food and Drug Administration for use in food;
new text end
new text begin
(5) be packaged in a way that resembles the trademarked, characteristic, or
product-specialized packaging of any commercially available food product; or
new text end
new text begin
(6) be packaged in a container that includes a statement, artwork, or design that could
reasonably mislead any person to believe that the package contains anything other than an
edible cannabinoid product.
new text end
new text begin
(c) An edible cannabinoid product must be prepackaged in packaging or a container that
is child-resistant, tamper-evident, and opaque or placed in packaging or a container that is
child-resistant, tamper-evident, and opaque at the final point of sale to a customer. The
requirement that packaging be child-resistant does not apply to an edible cannabinoid product
that is intended to be consumed as a beverage and which contains no more than a trace
amount of any tetrahydrocannabinol.
new text end
new text begin
(d) If an edible cannabinoid product is intended for more than a single use or contains
multiple servings, each serving must be indicated by scoring, wrapping, or other indicators
designating the individual serving size.
new text end
new text begin
(e) A label containing at least the following information must be affixed to the packaging
or container of all edible cannabinoid products sold to consumers:
new text end
new text begin
(1) the serving size;
new text end
new text begin
(2) the cannabinoid profile per serving and in total;
new text end
new text begin
(3) a list of ingredients, including identification of any major food allergens declared
by name; and
new text end
new text begin
(4) the following statement: "Keep this product out of reach of children."
new text end
new text begin
(f) An edible cannabinoid product must not contain more than five milligrams of any
tetrahydrocannabinol in a single serving, or more than a total of 50 milligrams of any
tetrahydrocannabinol per package.
new text end
Sec. 9.
Minnesota Statutes 2020, section 151.72, subdivision 6, is amended to read:
Subd. 6.
Enforcement.
(a) A product deleted text begin solddeleted text end new text begin regulatednew text end under this sectionnew text begin , including an
edible cannabinoid product,new text end shall be considered an adulterated drug if:
(1) it consists, in whole or in part, of any filthy, putrid, or decomposed substance;
(2) it has been produced, prepared, packed, or held under unsanitary conditions where
it may have been rendered injurious to health, or where it may have been contaminated with
filth;
(3) its container is composed, in whole or in part, of any poisonous or deleterious
substance that may render the contents injurious to health;
(4) it contains any new text begin food additives, new text end color additivesnew text begin ,new text end or excipients that have been found by
the FDA to be unsafe for human or animal consumption; deleted text begin or
deleted text end
(5) it contains an amount or percentage of new text begin nonintoxicating new text end cannabinoids that is different
than the amount or percentage stated on the labeldeleted text begin .deleted text end new text begin ;
new text end
new text begin
(6) it contains more than 0.3 percent of any tetrahydrocannabinol or, if the product is
an edible cannabinoid product, an amount of tetrahydrocannabinol that exceeds the limits
established in subdivision 5a, paragraph (f); or
new text end
new text begin
(7) it contains more than trace amounts of mold, residual solvents, pesticides, fertilizers,
or heavy metals.
new text end
(b) A product deleted text begin solddeleted text end new text begin regulatednew text end under this section shall be considered a misbranded drug
if the product's labeling is false or misleading in any manner or in violation of the
requirements of this section.
(c) The board's authority to issue cease and desist orders under section 151.06; to embargo
adulterated and misbranded drugs under section 151.38; and to seek injunctive relief under
section 214.11, extends to any violation of this section.
Sec. 10.
Minnesota Statutes 2020, section 152.01, subdivision 23, is amended to read:
Subd. 23.
Analog.
(a) Except as provided in paragraph (b), "analog" means a substance,
the chemical structure of which is substantially similar to the chemical structure of a
controlled substance in Schedule I or II:
(1) that has a stimulant, depressant, or hallucinogenic effect on the central nervous system
that is substantially similar to or greater than the stimulant, depressant, or hallucinogenic
effect on the central nervous system of a controlled substance in Schedule I or II; or
(2) with respect to a particular person, if the person represents or intends that the substance
have a stimulant, depressant, or hallucinogenic effect on the central nervous system that is
substantially similar to or greater than the stimulant, depressant, or hallucinogenic effect
on the central nervous system of a controlled substance in Schedule I or II.
(b) "Analog" does not include:
(1) a controlled substance;
(2) any substance for which there is an approved new drug application under the Federal
Food, Drug, and Cosmetic Act; deleted text begin or
deleted text end
(3) with respect to a particular person, any substance, if an exemption is in effect for
investigational use, for that person, as provided by United States Code, title 21, section 355,
and the person is registered as a controlled substance researcher as required under section
152.12, subdivision 3, to the extent conduct with respect to the substance is pursuant to the
exemption and registrationnew text begin ; or
new text end
new text begin (4) marijuana or tetrahydrocannabinols naturally contained in a plant of the genus
cannabis or in the resinous extractives of the plantnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022, and applies to crimes
committed on or after that date.
new text end
Sec. 11.
Minnesota Statutes 2020, section 152.02, subdivision 2, is amended to read:
Subd. 2.
Schedule I.
(a) Schedule I consists of the substances listed in this subdivision.
(b) Opiates. Unless specifically excepted or unless listed in another schedule, any of the
following substances, including their analogs, isomers, esters, ethers, salts, and salts of
isomers, esters, and ethers, whenever the existence of the analogs, isomers, esters, ethers,
and salts is possible:
(1) acetylmethadol;
(2) allylprodine;
(3) alphacetylmethadol (except levo-alphacetylmethadol, also known as levomethadyl
acetate);
(4) alphameprodine;
(5) alphamethadol;
(6) alpha-methylfentanyl benzethidine;
(7) betacetylmethadol;
(8) betameprodine;
(9) betamethadol;
(10) betaprodine;
(11) clonitazene;
(12) dextromoramide;
(13) diampromide;
(14) diethyliambutene;
(15) difenoxin;
(16) dimenoxadol;
(17) dimepheptanol;
(18) dimethyliambutene;
(19) dioxaphetyl butyrate;
(20) dipipanone;
(21) ethylmethylthiambutene;
(22) etonitazene;
(23) etoxeridine;
(24) furethidine;
(25) hydroxypethidine;
(26) ketobemidone;
(27) levomoramide;
(28) levophenacylmorphan;
(29) 3-methylfentanyl;
(30) acetyl-alpha-methylfentanyl;
(31) alpha-methylthiofentanyl;
(32) benzylfentanyl beta-hydroxyfentanyl;
(33) beta-hydroxy-3-methylfentanyl;
(34) 3-methylthiofentanyl;
(35) thenylfentanyl;
(36) thiofentanyl;
(37) para-fluorofentanyl;
(38) morpheridine;
(39) 1-methyl-4-phenyl-4-propionoxypiperidine;
(40) noracymethadol;
(41) norlevorphanol;
(42) normethadone;
(43) norpipanone;
(44) 1-(2-phenylethyl)-4-phenyl-4-acetoxypiperidine (PEPAP);
(45) phenadoxone;
(46) phenampromide;
(47) phenomorphan;
(48) phenoperidine;
(49) piritramide;
(50) proheptazine;
(51) properidine;
(52) propiram;
(53) racemoramide;
(54) tilidine;
(55) trimeperidine;
(56) N-(1-Phenethylpiperidin-4-yl)-N-phenylacetamide (acetyl fentanyl);
(57) 3,4-dichloro-N-[(1R,2R)-2-(dimethylamino)cyclohexyl]-N-
methylbenzamide(U47700);
(58) N-phenyl-N-[1-(2-phenylethyl)piperidin-4-yl]furan-2-carboxamide(furanylfentanyl);
(59) 4-(4-bromophenyl)-4-dimethylamino-1-phenethylcyclohexanol (bromadol);
(60) N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopropanecarboxamide (Cyclopropryl
fentanyl);
(61) N-(1-phenethylpiperidin-4-yl)-N-phenylbutanamide) (butyryl fentanyl);
(62) 1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) (MT-45);
(63) N-(1-phenethylpiperidin-4-yl)-N-phenylcyclopentanecarboxamide (cyclopentyl
fentanyl);
(64) N-(1-phenethylpiperidin-4-yl)-N-phenylisobutyramide (isobutyryl fentanyl);
(65) N-(1-phenethylpiperidin-4-yl)-N-phenylpentanamide (valeryl fentanyl);
(66) N-(4-chlorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide
(para-chloroisobutyryl fentanyl);
(67) N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)butyramide (para-fluorobutyryl
fentanyl);
(68) N-(4-methoxyphenyl)-N-(1-phenethylpiperidin-4-yl)butyramide
(para-methoxybutyryl fentanyl);
(69) N-(2-fluorophenyl)-2-methoxy-N-(1-phenethylpiperidin-4-yl)acetamide (ocfentanil);
(70) N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide (4-fluoroisobutyryl
fentanyl or para-fluoroisobutyryl fentanyl);
(71) N-(1-phenethylpiperidin-4-yl)-N-phenylacrylamide (acryl fentanyl or
acryloylfentanyl);
(72) 2-methoxy-N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide (methoxyacetyl
fentanyl);
(73) N-(2-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)propionamide (ortho-fluorofentanyl
or 2-fluorofentanyl);
(74) N-(1-phenethylpiperidin-4-yl)-N-phenyltetrahydrofuran-2-carboxamide
(tetrahydrofuranyl fentanyl); and
(75) Fentanyl-related substances, their isomers, esters, ethers, salts and salts of isomers,
esters and ethers, meaning any substance not otherwise listed under another federal
Administration Controlled Substance Code Number or not otherwise listed in this section,
and for which no exemption or approval is in effect under section 505 of the Federal Food,
Drug, and Cosmetic Act, United States Code , title 21, section 355, that is structurally related
to fentanyl by one or more of the following modifications:
(i) replacement of the phenyl portion of the phenethyl group by any monocycle, whether
or not further substituted in or on the monocycle;
(ii) substitution in or on the phenethyl group with alkyl, alkenyl, alkoxyl, hydroxyl, halo,
haloalkyl, amino, or nitro groups;
(iii) substitution in or on the piperidine ring with alkyl, alkenyl, alkoxyl, ester, ether,
hydroxyl, halo, haloalkyl, amino, or nitro groups;
(iv) replacement of the aniline ring with any aromatic monocycle whether or not further
substituted in or on the aromatic monocycle; or
(v) replacement of the N-propionyl group by another acyl group.
(c) Opium derivatives. Any of the following substances, their analogs, salts, isomers,
and salts of isomers, unless specifically excepted or unless listed in another schedule,
whenever the existence of the analogs, salts, isomers, and salts of isomers is possible:
(1) acetorphine;
(2) acetyldihydrocodeine;
(3) benzylmorphine;
(4) codeine methylbromide;
(5) codeine-n-oxide;
(6) cyprenorphine;
(7) desomorphine;
(8) dihydromorphine;
(9) drotebanol;
(10) etorphine;
(11) heroin;
(12) hydromorphinol;
(13) methyldesorphine;
(14) methyldihydromorphine;
(15) morphine methylbromide;
(16) morphine methylsulfonate;
(17) morphine-n-oxide;
(18) myrophine;
(19) nicocodeine;
(20) nicomorphine;
(21) normorphine;
(22) pholcodine; and
(23) thebacon.
(d) Hallucinogens. Any material, compound, mixture or preparation which contains any
quantity of the following substances, their analogs, salts, isomers (whether optical, positional,
or geometric), and salts of isomers, unless specifically excepted or unless listed in another
schedule, whenever the existence of the analogs, salts, isomers, and salts of isomers is
possible:
(1) methylenedioxy amphetamine;
(2) methylenedioxymethamphetamine;
(3) methylenedioxy-N-ethylamphetamine (MDEA);
(4) n-hydroxy-methylenedioxyamphetamine;
(5) 4-bromo-2,5-dimethoxyamphetamine (DOB);
(6) 2,5-dimethoxyamphetamine (2,5-DMA);
(7) 4-methoxyamphetamine;
(8) 5-methoxy-3, 4-methylenedioxyamphetamine;
(9) alpha-ethyltryptamine;
(10) bufotenine;
(11) diethyltryptamine;
(12) dimethyltryptamine;
(13) 3,4,5-trimethoxyamphetamine;
(14) 4-methyl-2, 5-dimethoxyamphetamine (DOM);
(15) ibogaine;
(16) lysergic acid diethylamide (LSD);
(17) mescaline;
(18) parahexyl;
(19) N-ethyl-3-piperidyl benzilate;
(20) N-methyl-3-piperidyl benzilate;
(21) psilocybin;
(22) psilocyn;
(23) tenocyclidine (TPCP or TCP);
(24) N-ethyl-1-phenyl-cyclohexylamine (PCE);
(25) 1-(1-phenylcyclohexyl) pyrrolidine (PCPy);
(26) 1-[1-(2-thienyl)cyclohexyl]-pyrrolidine (TCPy);
(27) 4-chloro-2,5-dimethoxyamphetamine (DOC);
(28) 4-ethyl-2,5-dimethoxyamphetamine (DOET);
(29) 4-iodo-2,5-dimethoxyamphetamine (DOI);
(30) 4-bromo-2,5-dimethoxyphenethylamine (2C-B);
(31) 4-chloro-2,5-dimethoxyphenethylamine (2C-C);
(32) 4-methyl-2,5-dimethoxyphenethylamine (2C-D);
(33) 4-ethyl-2,5-dimethoxyphenethylamine (2C-E);
(34) 4-iodo-2,5-dimethoxyphenethylamine (2C-I);
(35) 4-propyl-2,5-dimethoxyphenethylamine (2C-P);
(36) 4-isopropylthio-2,5-dimethoxyphenethylamine (2C-T-4);
(37) 4-propylthio-2,5-dimethoxyphenethylamine (2C-T-7);
(38) 2-(8-bromo-2,3,6,7-tetrahydrofuro [2,3-f][1]benzofuran-4-yl)ethanamine
(2-CB-FLY);
(39) bromo-benzodifuranyl-isopropylamine (Bromo-DragonFLY);
(40) alpha-methyltryptamine (AMT);
(41) N,N-diisopropyltryptamine (DiPT);
(42) 4-acetoxy-N,N-dimethyltryptamine (4-AcO-DMT);
(43) 4-acetoxy-N,N-diethyltryptamine (4-AcO-DET);
(44) 4-hydroxy-N-methyl-N-propyltryptamine (4-HO-MPT);
(45) 4-hydroxy-N,N-dipropyltryptamine (4-HO-DPT);
(46) 4-hydroxy-N,N-diallyltryptamine (4-HO-DALT);
(47) 4-hydroxy-N,N-diisopropyltryptamine (4-HO-DiPT);
(48) 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DiPT);
(49) 5-methoxy-α-methyltryptamine (5-MeO-AMT);
(50) 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT);
(51) 5-methylthio-N,N-dimethyltryptamine (5-MeS-DMT);
(52) 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT);
(53) 5-methoxy-α-ethyltryptamine (5-MeO-AET);
(54) 5-methoxy-N,N-dipropyltryptamine (5-MeO-DPT);
(55) 5-methoxy-N,N-diethyltryptamine (5-MeO-DET);
(56) 5-methoxy-N,N-diallyltryptamine (5-MeO-DALT);
(57) methoxetamine (MXE);
(58) 5-iodo-2-aminoindane (5-IAI);
(59) 5,6-methylenedioxy-2-aminoindane (MDAI);
(60) 2-(4-bromo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25B-NBOMe);
(61) 2-(4-chloro-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25C-NBOMe);
(62) 2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25I-NBOMe);
(63) 2-(2,5-Dimethoxyphenyl)ethanamine (2C-H);
(64) 2-(4-Ethylthio-2,5-dimethoxyphenyl)ethanamine (2C-T-2);
(65) N,N-Dipropyltryptamine (DPT);
(66) 3-[1-(Piperidin-1-yl)cyclohexyl]phenol (3-HO-PCP);
(67) N-ethyl-1-(3-methoxyphenyl)cyclohexanamine (3-MeO-PCE);
(68) 4-[1-(3-methoxyphenyl)cyclohexyl]morpholine (3-MeO-PCMo);
(69) 1-[1-(4-methoxyphenyl)cyclohexyl]-piperidine (methoxydine, 4-MeO-PCP);
(70) 2-(2-Chlorophenyl)-2-(ethylamino)cyclohexan-1-one (N-Ethylnorketamine,
ethketamine, NENK);
(71) methylenedioxy-N,N-dimethylamphetamine (MDDMA);
(72) 3-(2-Ethyl(methyl)aminoethyl)-1H-indol-4-yl (4-AcO-MET); and
(73) 2-Phenyl-2-(methylamino)cyclohexanone (deschloroketamine).
(e) Peyote. All parts of the plant presently classified botanically as Lophophora williamsii
Lemaire, whether growing or not, the seeds thereof, any extract from any part of the plant,
and every compound, manufacture, salts, derivative, mixture, or preparation of the plant,
its seeds or extracts. The listing of peyote as a controlled substance in Schedule I does not
apply to the nondrug use of peyote in bona fide religious ceremonies of the American Indian
Church, and members of the American Indian Church are exempt from registration. Any
person who manufactures peyote for or distributes peyote to the American Indian Church,
however, is required to obtain federal registration annually and to comply with all other
requirements of law.
(f) Central nervous system depressants. Unless specifically excepted or unless listed in
another schedule, any material compound, mixture, or preparation which contains any
quantity of the following substances, their analogs, salts, isomers, and salts of isomers
whenever the existence of the analogs, salts, isomers, and salts of isomers is possible:
(1) mecloqualone;
(2) methaqualone;
(3) gamma-hydroxybutyric acid (GHB), including its esters and ethers;
(4) flunitrazepam;
(5) 2-(2-Methoxyphenyl)-2-(methylamino)cyclohexanone (2-MeO-2-deschloroketamine,
methoxyketamine);
(6) tianeptine;
(7) clonazolam;
(8) etizolam;
(9) flubromazolam; and
(10) flubromazepam.
(g) Stimulants. Unless specifically excepted or unless listed in another schedule, any
material compound, mixture, or preparation which contains any quantity of the following
substances, their analogs, salts, isomers, and salts of isomers whenever the existence of the
analogs, salts, isomers, and salts of isomers is possible:
(1) aminorex;
(2) cathinone;
(3) fenethylline;
(4) methcathinone;
(5) methylaminorex;
(6) N,N-dimethylamphetamine;
(7) N-benzylpiperazine (BZP);
(8) methylmethcathinone (mephedrone);
(9) 3,4-methylenedioxy-N-methylcathinone (methylone);
(10) methoxymethcathinone (methedrone);
(11) methylenedioxypyrovalerone (MDPV);
(12) 3-fluoro-N-methylcathinone (3-FMC);
(13) methylethcathinone (MEC);
(14) 1-benzofuran-6-ylpropan-2-amine (6-APB);
(15) dimethylmethcathinone (DMMC);
(16) fluoroamphetamine;
(17) fluoromethamphetamine;
(18) α-methylaminobutyrophenone (MABP or buphedrone);
(19) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)butan-1-one (butylone);
(20) 2-(methylamino)-1-(4-methylphenyl)butan-1-one (4-MEMABP or BZ-6378);
(21) 1-(naphthalen-2-yl)-2-(pyrrolidin-1-yl) pentan-1-one (naphthylpyrovalerone or
naphyrone);
(22) (alpha-pyrrolidinopentiophenone (alpha-PVP);
(23) (RS)-1-(4-methylphenyl)-2-(1-pyrrolidinyl)-1-hexanone (4-Me-PHP or MPHP);
(24) 2-(1-pyrrolidinyl)-hexanophenone (Alpha-PHP);
(25) 4-methyl-N-ethylcathinone (4-MEC);
(26) 4-methyl-alpha-pyrrolidinopropiophenone (4-MePPP);
(27) 2-(methylamino)-1-phenylpentan-1-one (pentedrone);
(28) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)pentan-1-one (pentylone);
(29) 4-fluoro-N-methylcathinone (4-FMC);
(30) 3,4-methylenedioxy-N-ethylcathinone (ethylone);
(31) alpha-pyrrolidinobutiophenone (α-PBP);
(32) 5-(2-Aminopropyl)-2,3-dihydrobenzofuran (5-APDB);
(33) 1-phenyl-2-(1-pyrrolidinyl)-1-heptanone (PV8);
(34) 6-(2-Aminopropyl)-2,3-dihydrobenzofuran (6-APDB);
(35) 4-methyl-alpha-ethylaminopentiophenone (4-MEAPP);
(36) 4'-chloro-alpha-pyrrolidinopropiophenone (4'-chloro-PPP);
(37) 1-(1,3-Benzodioxol-5-yl)-2-(dimethylamino)butan-1-one (dibutylone, bk-DMBDB);
(38) 1-(3-chlorophenyl) piperazine (meta-chlorophenylpiperazine or mCPP);
(39) 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)-pentan-1-one (N-ethylpentylone, ephylone);
and
(40) any other substance, except bupropion or compounds listed under a different
schedule, that is structurally derived from 2-aminopropan-1-one by substitution at the
1-position with either phenyl, naphthyl, or thiophene ring systems, whether or not the
compound is further modified in any of the following ways:
(i) by substitution in the ring system to any extent with alkyl, alkylenedioxy, alkoxy,
haloalkyl, hydroxyl, or halide substituents, whether or not further substituted in the ring
system by one or more other univalent substituents;
(ii) by substitution at the 3-position with an acyclic alkyl substituent;
(iii) by substitution at the 2-amino nitrogen atom with alkyl, dialkyl, benzyl, or
methoxybenzyl groups; or
(iv) by inclusion of the 2-amino nitrogen atom in a cyclic structure.
(h) deleted text begin Marijuana,deleted text end new text begin Syntheticnew text end tetrahydrocannabinolsdeleted text begin ,deleted text end and synthetic cannabinoids. Unless
specifically excepted or unless listed in another schedule, any deleted text begin natural ordeleted text end synthetic material,
compound, mixture, or preparation that contains any quantity of the following substances,
their analogs, isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever
the existence of the isomers, esters, ethers, or salts is possible:
deleted text begin
(1) marijuana;
deleted text end
deleted text begin (2)deleted text end new text begin (1) syntheticnew text end tetrahydrocannabinols deleted text begin naturally contained in a plant of the genus
Cannabis,deleted text end new text begin that are thenew text end synthetic equivalents of the substances contained in the cannabis
plant or in the resinous extractives of the plant, or synthetic substances with similar chemical
structure and pharmacological activity to those substances contained in the plant or resinous
extract, including, but not limited to, 1 cis or trans tetrahydrocannabinol, 6 cis or trans
tetrahydrocannabinol, and 3,4 cis or trans tetrahydrocannabinol;new text begin and
new text end
deleted text begin (3)deleted text end new text begin (2)new text end synthetic cannabinoids, including the following substances:
(i) Naphthoylindoles, which are any compounds containing a 3-(1-napthoyl)indole
structure with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group, whether or not further substituted in the indole ring to any
extent and whether or not substituted in the naphthyl ring to any extent. Examples of
naphthoylindoles include, but are not limited to:
(A) 1-Pentyl-3-(1-naphthoyl)indole (JWH-018 and AM-678);
(B) 1-Butyl-3-(1-naphthoyl)indole (JWH-073);
(C) 1-Pentyl-3-(4-methoxy-1-naphthoyl)indole (JWH-081);
(D) 1-[2-(4-morpholinyl)ethyl]-3-(1-naphthoyl)indole (JWH-200);
(E) 1-Propyl-2-methyl-3-(1-naphthoyl)indole (JWH-015);
(F) 1-Hexyl-3-(1-naphthoyl)indole (JWH-019);
(G) 1-Pentyl-3-(4-methyl-1-naphthoyl)indole (JWH-122);
(H) 1-Pentyl-3-(4-ethyl-1-naphthoyl)indole (JWH-210);
(I) 1-Pentyl-3-(4-chloro-1-naphthoyl)indole (JWH-398);
(J) 1-(5-fluoropentyl)-3-(1-naphthoyl)indole (AM-2201).
(ii) Napthylmethylindoles, which are any compounds containing a
1H-indol-3-yl-(1-naphthyl)methane structure with substitution at the nitrogen atom of the
indole ring by an alkyl, haloalkyl, alkenyl, cycloalkylmethyl, cycloalkylethyl,
1-(N-methyl-2-piperidinyl)methyl or 2-(4-morpholinyl)ethyl group, whether or not further
substituted in the indole ring to any extent and whether or not substituted in the naphthyl
ring to any extent. Examples of naphthylmethylindoles include, but are not limited to:
(A) 1-Pentyl-1H-indol-3-yl-(1-naphthyl)methane (JWH-175);
(B) 1-Pentyl-1H-indol-3-yl-(4-methyl-1-naphthyl)methane (JWH-184).
(iii) Naphthoylpyrroles, which are any compounds containing a 3-(1-naphthoyl)pyrrole
structure with substitution at the nitrogen atom of the pyrrole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the pyrrole ring to any
extent, whether or not substituted in the naphthyl ring to any extent. Examples of
naphthoylpyrroles include, but are not limited to,
(5-(2-fluorophenyl)-1-pentylpyrrol-3-yl)-naphthalen-1-ylmethanone (JWH-307).
(iv) Naphthylmethylindenes, which are any compounds containing a naphthylideneindene
structure with substitution at the 3-position of the indene ring by an alkyl, haloalkyl, alkenyl,
cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indene ring to any
extent, whether or not substituted in the naphthyl ring to any extent. Examples of
naphthylemethylindenes include, but are not limited to,
E-1-[1-(1-naphthalenylmethylene)-1H-inden-3-yl]pentane (JWH-176).
(v) Phenylacetylindoles, which are any compounds containing a 3-phenylacetylindole
structure with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl,
alkenyl, cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indole ring to any
extent, whether or not substituted in the phenyl ring to any extent. Examples of
phenylacetylindoles include, but are not limited to:
(A) 1-(2-cyclohexylethyl)-3-(2-methoxyphenylacetyl)indole (RCS-8);
(B) 1-pentyl-3-(2-methoxyphenylacetyl)indole (JWH-250);
(C) 1-pentyl-3-(2-methylphenylacetyl)indole (JWH-251);
(D) 1-pentyl-3-(2-chlorophenylacetyl)indole (JWH-203).
(vi) Cyclohexylphenols, which are compounds containing a
2-(3-hydroxycyclohexyl)phenol structure with substitution at the 5-position of the phenolic
ring by an alkyl, haloalkyl, alkenyl, cycloalkylmethyl, cycloalkylethyl,
1-(N-methyl-2-piperidinyl)methyl or 2-(4-morpholinyl)ethyl group whether or not substituted
in the cyclohexyl ring to any extent. Examples of cyclohexylphenols include, but are not
limited to:
(A) 5-(1,1-dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (CP 47,497);
(B) 5-(1,1-dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol
(Cannabicyclohexanol or CP 47,497 C8 homologue);
(C) 5-(1,1-dimethylheptyl)-2-[(1R,2R)-5-hydroxy-2-(3-hydroxypropyl)cyclohexyl]
-phenol (CP 55,940).
(vii) Benzoylindoles, which are any compounds containing a 3-(benzoyl)indole structure
with substitution at the nitrogen atom of the indole ring by an alkyl, haloalkyl, alkenyl,
cycloalkylmethyl, cycloalkylethyl, 1-(N-methyl-2-piperidinyl)methyl or
2-(4-morpholinyl)ethyl group whether or not further substituted in the indole ring to any
extent and whether or not substituted in the phenyl ring to any extent. Examples of
benzoylindoles include, but are not limited to:
(A) 1-Pentyl-3-(4-methoxybenzoyl)indole (RCS-4);
(B) 1-(5-fluoropentyl)-3-(2-iodobenzoyl)indole (AM-694);
(C) (4-methoxyphenyl-[2-methyl-1-(2-(4-morpholinyl)ethyl)indol-3-yl]methanone (WIN
48,098 or Pravadoline).
(viii) Others specifically named:
(A) (6aR,10aR)-9-(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)
-6a,7,10,10a-tetrahydrobenzo[c]chromen-1-ol (HU-210);
(B) (6aS,10aS)-9-(hydroxymethyl)-6,6-dimethyl-3-(2-methyloctan-2-yl)
-6a,7,10,10a-tetrahydrobenzo[c]chromen-1-ol (Dexanabinol or HU-211);
(C) 2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]
-1,4-benzoxazin-6-yl-1-naphthalenylmethanone (WIN 55,212-2);
(D) (1-pentylindol-3-yl)-(2,2,3,3-tetramethylcyclopropyl)methanone (UR-144);
(E) (1-(5-fluoropentyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone
(XLR-11);
(F) 1-pentyl-N-tricyclo[3.3.1.13,7]dec-1-yl-1H-indazole-3-carboxamide
(AKB-48(APINACA));
(G) N-((3s,5s,7s)-adamantan-1-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide
(5-Fluoro-AKB-48);
(H) 1-pentyl-8-quinolinyl ester-1H-indole-3-carboxylic acid (PB-22);
(I) 8-quinolinyl ester-1-(5-fluoropentyl)-1H-indole-3-carboxylic acid (5-Fluoro PB-22);
(J) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-pentyl-1H-indazole- 3-carboxamide
(AB-PINACA);
(K) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-[(4-fluorophenyl)methyl]-
1H-indazole-3-carboxamide (AB-FUBINACA);
(L) N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-(cyclohexylmethyl)-1H-
indazole-3-carboxamide(AB-CHMINACA);
(M) (S)-methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3- methylbutanoate
(5-fluoro-AMB);
(N) [1-(5-fluoropentyl)-1H-indazol-3-yl](naphthalen-1-yl) methanone (THJ-2201);
(O) (1-(5-fluoropentyl)-1H-benzo[d]imidazol-2-yl)(naphthalen-1-yl)methanone)
(FUBIMINA);
(P) (7-methoxy-1-(2-morpholinoethyl)-N-((1S,2S,4R)-1,3,3-trimethylbicyclo
[2.2.1]heptan-2-yl)-1H-indole-3-carboxamide (MN-25 or UR-12);
(Q) (S)-N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)
-1H-indole-3-carboxamide (5-fluoro-ABICA);
(R) N-(1-amino-3-phenyl-1-oxopropan-2-yl)-1-(5-fluoropentyl)
-1H-indole-3-carboxamide;
(S) N-(1-amino-3-phenyl-1-oxopropan-2-yl)-1-(5-fluoropentyl)
-1H-indazole-3-carboxamide;
(T) methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido) -3,3-dimethylbutanoate;
(U) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1(cyclohexylmethyl)-1
H-indazole-3-carboxamide (MAB-CHMINACA);
(V) N-(1-Amino-3,3-dimethyl-1-oxo-2-butanyl)-1-pentyl-1H-indazole-3-carboxamide
(ADB-PINACA);
(W) methyl (1-(4-fluorobenzyl)-1H-indazole-3-carbonyl)-L-valinate (FUB-AMB);
(X) N-[(1S)-2-amino-2-oxo-1-(phenylmethyl)ethyl]-1-(cyclohexylmethyl)-1H-Indazole-
3-carboxamide. (APP-CHMINACA);
(Y) quinolin-8-yl 1-(4-fluorobenzyl)-1H-indole-3-carboxylate (FUB-PB-22); and
(Z) methyl N-[1-(cyclohexylmethyl)-1H-indole-3-carbonyl]valinate (MMB-CHMICA).
(ix) Additional substances specifically named:
(A) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1
H-pyrrolo[2,3-B]pyridine-3-carboxamide (5F-CUMYL-P7AICA);
(B) 1-(4-cyanobutyl)-N-(2- phenylpropan-2-yl)-1 H-indazole-3-carboxamide
(4-CN-Cumyl-Butinaca);
(C) naphthalen-1-yl-1-(5-fluoropentyl)-1-H-indole-3-carboxylate (NM2201; CBL2201);
(D) N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)-1
H-indazole-3-carboxamide (5F-ABPINACA);
(E) methyl-2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate
(MDMB CHMICA);
(F) methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate
(5F-ADB; 5F-MDMB-PINACA); and
(G) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)
1H-indazole-3-carboxamide (ADB-FUBINACA).
(i) A controlled substance analog, to the extent that it is implicitly or explicitly intended
for human consumption.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022, and applies to crimes
committed on or after that date.
new text end
Sec. 12.
Minnesota Statutes 2020, section 152.02, subdivision 3, is amended to read:
Subd. 3.
Schedule II.
(a) Schedule II consists of the substances listed in this subdivision.
(b) Unless specifically excepted or unless listed in another schedule, any of the following
substances whether produced directly or indirectly by extraction from substances of vegetable
origin or independently by means of chemical synthesis, or by a combination of extraction
and chemical synthesis:
(1) Opium and opiate, and any salt, compound, derivative, or preparation of opium or
opiate.
(i) Excluding:
(A) apomorphine;
(B) thebaine-derived butorphanol;
(C) dextrophan;
(D) nalbuphine;
(E) nalmefene;
(F) naloxegol;
(G) naloxone;
(H) naltrexone; and
(I) their respective salts;
(ii) but including the following:
(A) opium, in all forms and extracts;
(B) codeine;
(C) dihydroetorphine;
(D) ethylmorphine;
(E) etorphine hydrochloride;
(F) hydrocodone;
(G) hydromorphone;
(H) metopon;
(I) morphine;
(J) oxycodone;
(K) oxymorphone;
(L) thebaine;
(M) oripavine;
(2) any salt, compound, derivative, or preparation thereof which is chemically equivalent
or identical with any of the substances referred to in clause (1), except that these substances
shall not include the isoquinoline alkaloids of opium;
(3) opium poppy and poppy straw;
(4) coca leaves and any salt, cocaine compound, derivative, or preparation of coca leaves
(including cocaine and ecgonine and their salts, isomers, derivatives, and salts of isomers
and derivatives), and any salt, compound, derivative, or preparation thereof which is
chemically equivalent or identical with any of these substances, except that the substances
shall not include decocainized coca leaves or extraction of coca leaves, which extractions
do not contain cocaine or ecgonine;
(5) concentrate of poppy straw (the crude extract of poppy straw in either liquid, solid,
or powder form which contains the phenanthrene alkaloids of the opium poppy).
(c) Any of the following opiates, including their isomers, esters, ethers, salts, and salts
of isomers, esters and ethers, unless specifically excepted, or unless listed in another schedule,
whenever the existence of such isomers, esters, ethers and salts is possible within the specific
chemical designation:
(1) alfentanil;
(2) alphaprodine;
(3) anileridine;
(4) bezitramide;
(5) bulk dextropropoxyphene (nondosage forms);
(6) carfentanil;
(7) dihydrocodeine;
(8) dihydromorphinone;
(9) diphenoxylate;
(10) fentanyl;
(11) isomethadone;
(12) levo-alpha-acetylmethadol (LAAM);
(13) levomethorphan;
(14) levorphanol;
(15) metazocine;
(16) methadone;
(17) methadone - intermediate, 4-cyano-2-dimethylamino-4, 4-diphenylbutane;
(18) moramide - intermediate, 2-methyl-3-morpholino-1, 1-diphenyl-propane-carboxylic
acid;
(19) pethidine;
(20) pethidine - intermediate - a, 4-cyano-1-methyl-4-phenylpiperidine;
(21) pethidine - intermediate - b, ethyl-4-phenylpiperidine-4-carboxylate;
(22) pethidine - intermediate - c, 1-methyl-4-phenylpiperidine-4-carboxylic acid;
(23) phenazocine;
(24) piminodine;
(25) racemethorphan;
(26) racemorphan;
(27) remifentanil;
(28) sufentanil;
(29) tapentadol;
(30) 4-Anilino-N-phenethylpiperidine.
(d) Unless specifically excepted or unless listed in another schedule, any material,
compound, mixture, or preparation which contains any quantity of the following substances
having a stimulant effect on the central nervous system:
(1) amphetamine, its salts, optical isomers, and salts of its optical isomers;
(2) methamphetamine, its salts, isomers, and salts of its isomers;
(3) phenmetrazine and its salts;
(4) methylphenidate;
(5) lisdexamfetamine.
(e) Unless specifically excepted or unless listed in another schedule, any material,
compound, mixture, or preparation which contains any quantity of the following substances
having a depressant effect on the central nervous system, including its salts, isomers, and
salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible
within the specific chemical designation:
(1) amobarbital;
(2) glutethimide;
(3) secobarbital;
(4) pentobarbital;
(5) phencyclidine;
(6) phencyclidine immediate precursors:
(i) 1-phenylcyclohexylamine;
(ii) 1-piperidinocyclohexanecarbonitrile;
(7) phenylacetone.
(f) new text begin Cannabis and new text end cannabinoids:
(1) nabilone;
new text begin
(2) unless specifically excepted or unless listed in another schedule, any natural material,
compound, mixture, or preparation that contains any quantity of the following substances,
their analogs, isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever
the existence of the isomers, esters, ethers, or salts is possible:
new text end
new text begin
(i) marijuana; and
new text end
new text begin
(ii) tetrahydrocannabinols naturally contained in a plant of the genus cannabis or in the
resinous extractives of the plant, except that tetrahydrocannabinols does not include any
material, compound, mixture, or preparation that qualifies as industrial hemp as defined in
section 18K.02, subdivision 3; and
new text end
deleted text begin (2)deleted text end new text begin (3)new text end dronabinol [(-)-delta-9-trans-tetrahydrocannabinol (delta-9-THC)] in an oral
solution in a drug product approved for marketing by the United States Food and Drug
Administration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022, and applies to crimes
committed on or after that date.
new text end
Sec. 13.
Minnesota Statutes 2020, section 152.11, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Exception. new text end
new text begin
References in this section to Schedule II controlled substances do
not extend to marijuana or tetrahydrocannabinols.
new text end
Sec. 14.
Minnesota Statutes 2020, section 152.12, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Exception. new text end
new text begin
References in this section to Schedule II controlled substances do
not extend to marijuana or tetrahydrocannabinols.
new text end
Sec. 15.
Minnesota Statutes 2020, section 152.125, subdivision 3, is amended to read:
Subd. 3.
Limits on applicability.
This section does not apply to:
(1) a physician's treatment of an individual for chemical dependency resulting from the
use of controlled substances in Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to an individual whom the physician knows to be using the controlled
substances for nontherapeutic purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of an individual having intractable
pain; deleted text begin or
deleted text end
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain reliefnew text begin ; or
new text end
new text begin (5) the administration of medical cannabis under sections 152.22 to 152.37new text end .
Sec. 16.
Minnesota Statutes 2020, section 152.32, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Presumptiondeleted text end new text begin Presumptionsnew text end .
(a) There is a presumption that a patient
enrolled in the registry program under sections 152.22 to 152.37 is engaged in the authorized
use of medical cannabis.
(b) The presumption new text begin in paragraph (a) new text end may be rebutted by evidence that conduct related
to use of medical cannabis was not for the purpose of treating or alleviating the patient's
qualifying medical condition or symptoms associated with the patient's qualifying medical
condition.
new text begin
(c) Sections 152.22 to 152.37 do not create any positive conflict with federal drug laws
or regulations and are consistent with United States Code, title 21, section 903.
new text end
Sec. 17.
Minnesota Statutes 2020, section 152.32, subdivision 2, is amended to read:
Subd. 2.
Criminal and civil protections.
(a) Subject to section 152.23, the following
are not violations under this chapter:
(1) use or possession of medical cannabis or medical cannabis products by a patient
enrolled in the registry program, or possession by a registered designated caregiver or the
parent, legal guardian, or spouse of a patient if the parent, legal guardian, or spouse is listed
on the registry verification;
(2) possession, dosage determination, or sale of medical cannabis or medical cannabis
products by a medical cannabis manufacturer, employees of a manufacturer, a laboratory
conducting testing on medical cannabis, or employees of the laboratory; and
(3) possession of medical cannabis or medical cannabis products by any person while
carrying out the duties required under sections 152.22 to 152.37.
(b) Medical cannabis obtained and distributed pursuant to sections 152.22 to 152.37 and
associated property is not subject to forfeiture under sections 609.531 to 609.5316.
(c) The commissioner, the commissioner's staff, the commissioner's agents or contractors,
and any health care practitioner are not subject to any civil or disciplinary penalties by the
Board of Medical Practice, the Board of Nursing, or by any business, occupational, or
professional licensing board or entity, solely for the participation in the registry program
under sections 152.22 to 152.37. A pharmacist licensed under chapter 151 is not subject to
any civil or disciplinary penalties by the Board of Pharmacy when acting in accordance
with the provisions of sections 152.22 to 152.37. Nothing in this section affects a professional
licensing board from taking action in response to violations of any other section of law.
(d) Notwithstanding any law to the contrary, the commissioner, the governor of
Minnesota, or an employee of any state agency may not be held civilly or criminally liable
for any injury, loss of property, personal injury, or death caused by any act or omission
while acting within the scope of office or employment under sections 152.22 to 152.37.
(e) Federal, state, and local law enforcement authorities are prohibited from accessing
the patient registry under sections 152.22 to 152.37 except when acting pursuant to a valid
search warrant.
(f) Notwithstanding any law to the contrary, neither the commissioner nor a public
employee may release data or information about an individual contained in any report,
document, or registry created under sections 152.22 to 152.37 or any information obtained
about a patient participating in the program, except as provided in sections 152.22 to 152.37.
(g) No information contained in a report, document, or registry or obtained from a patient
under sections 152.22 to 152.37 may be admitted as evidence in a criminal proceeding
unless independently obtained or in connection with a proceeding involving a violation of
sections 152.22 to 152.37.
(h) Notwithstanding section 13.09, any person who violates paragraph (e) or (f) is guilty
of a gross misdemeanor.
(i) An attorney may not be subject to disciplinary action by the Minnesota Supreme
Court or professional responsibility board for providing legal assistance to prospective or
registered manufacturers or others related to activity that is no longer subject to criminal
penalties under state law pursuant to sections 152.22 to 152.37.
(j) Possession of a registry verification or application for enrollment in the program by
a person entitled to possess or apply for enrollment in the registry program does not constitute
probable cause or reasonable suspicion, nor shall it be used to support a search of the person
or property of the person possessing or applying for the registry verification, or otherwise
subject the person or property of the person to inspection by any governmental agency.
new text begin
(k) Subject to section 152.23, the listing of tetrahydrocannabinols as a Schedule I
controlled substance under this chapter does not apply to protected activities specified in
this subdivision.
new text end
Sec. 18.
Minnesota Statutes 2021 Supplement, section 363A.50, is amended to read:
363A.50 NONDISCRIMINATION IN ACCESS TO TRANSPLANTS.
Subdivision 1.
Definitions.
(a) For purposes of this section, the following terms have
the meanings given unless the context clearly requires otherwise.
(b) "Anatomical gift" has the meaning given in section 525A.02, subdivision 4.
(c) "Auxiliary aids and services" include, but are not limited to:
(1) qualified interpreters or other effective methods of making aurally delivered materials
available to individuals with hearing impairmentsnew text begin and to non-English-speaking individualsnew text end ;
(2) qualified readers, taped texts, texts in accessible electronic format, or other effective
methods of making visually delivered materials available to individuals with visual
impairments;
(3) the provision of information in a format that is accessible for individuals with
cognitive, neurological, developmental, intellectual, or physical disabilities;
(4) the provision of supported decision-making services; and
(5) the acquisition or modification of equipment or devices.
(d) "Covered entity" means:
(1) any licensed provider of health care services, including licensed health care
practitioners, hospitals, nursing facilities, laboratories, intermediate care facilities, psychiatric
residential treatment facilities, institutions for individuals with intellectual or developmental
disabilities, and prison health centers; or
(2) any entity responsible for matching anatomical gift donors to potential recipients.
(e) "Disability" has the meaning given in section 363A.03, subdivision 12.
(f) "Organ transplant" means the transplantation or infusion of a part of a human body
into the body of another for the purpose of treating or curing a medical condition.
(g) "Qualified individual" means an individual who, with or without available support
networks, the provision of auxiliary aids and services, or reasonable modifications to policies
or practices, meets the essential eligibility requirements for the receipt of an anatomical
gift.
(h) "Reasonable modifications" include, but are not limited to:
(1) communication with individuals responsible for supporting an individual with
postsurgical and post-transplantation care, including medication; and
(2) consideration of support networks available to the individual, including family,
friends, and home and community-based services, including home and community-based
services funded through Medicaid, Medicare, another health plan in which the individual
is enrolled, or any program or source of funding available to the individual, in determining
whether the individual is able to comply with post-transplant medical requirements.
(i) "Supported decision making" has the meaning given in section 524.5-102, subdivision
16a.
Subd. 2.
Prohibition of discrimination.
(a) A covered entity may not, on the basis of
a qualified individual'snew text begin race, ethnicity,new text end mental new text begin disability, new text end or physical disability:
(1) deem an individual ineligible to receive an anatomical gift or organ transplant;
(2) deny medical or related organ transplantation services, including evaluation, surgery,
counseling, and postoperative treatment and care;
(3) refuse to refer the individual to a transplant center or other related specialist for the
purpose of evaluation or receipt of an anatomical gift or organ transplant;
(4) refuse to place an individual on an organ transplant waiting list or place the individual
at a lower-priority position on the list than the position at which the individual would have
been placed if not for the individual's new text begin race, ethnicity, or new text end disability; or
(5) decline insurance coverage for any procedure associated with the receipt of the
anatomical gift or organ transplant, including post-transplantation and postinfusion care.
(b) Notwithstanding paragraph (a), a covered entity may take an individual's disability
into account when making treatment or coverage recommendations or decisions, solely to
the extent that the physical or mental disability has been found by a physician, following
an individualized evaluation of the potential recipient to be medically significant to the
provision of the anatomical gift or organ transplant. The provisions of this section may not
be deemed to require referrals or recommendations for, or the performance of, organ
transplants that are not medically appropriate given the individual's overall health condition.
(c) If an individual has the necessary support system to assist the individual in complying
with post-transplant medical requirements, an individual's inability to independently comply
with those requirements may not be deemed to be medically significant for the purposes of
paragraph (b).
(d) A covered entity must make reasonable modifications to policies, practices, or
procedures, when such modifications are necessary to make services such as
transplantation-related counseling, information, coverage, or treatment available to qualified
individuals with disabilities, unless the entity can demonstrate that making such modifications
would fundamentally alter the nature of such services.
(e) A covered entity must take such steps as may be necessary to ensure that no qualified
individual with a disability is denied services such as transplantation-related counseling,
information, coverage, or treatment because of the absence of auxiliary aids and services,
unless the entity can demonstrate that taking such steps would fundamentally alter the nature
of the services being offered or result in an undue burden. A covered entity is not required
to provide supported decision-making services.
(f) A covered entity must otherwise comply with the requirements of Titles II and III of
the Americans with Disabilities Act of 1990, the Americans with Disabilities Act
Amendments Act of 2008, and the Minnesota Human Rights Act.
(g) The provisions of this section apply to each part of the organ transplant process.
Subd. 3.
Remedies.
In addition to all other remedies available under this chapter, any
individual who has been subjected to discrimination in violation of this section may initiate
a civil action in a court of competent jurisdiction to enjoin violations of this section.
Sec. 19. new text begin FEDERAL SCHEDULE I EXEMPTION APPLICATION FOR MEDICAL
USE OF CANNABIS.
new text end
new text begin
By September 1, 2022, the commissioner of health shall apply to the Drug Enforcement
Administration's Office of Diversion Control for an exception under Code of Federal
Regulations, title 21, section 1307.03, and request formal written acknowledgment that the
listing of marijuana, marijuana extract, and tetrahydrocannabinols as controlled substances
in federal Schedule I does not apply to the protected activities in Minnesota Statutes, section
152.32, subdivision 2, pursuant to the medical cannabis program established under Minnesota
Statutes, sections 152.22 to 152.37. The application must include the list of presumptions
in Minnesota Statutes, section 152.32, subdivision 1.
new text end
Sec. 20. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber as Minnesota Statutes, section 256.4835, the
Minnesota Rare Disease Advisory Council that is currently coded as Minnesota Statutes,
section 137.68. The revisor shall also make necessary cross-reference changes consistent
with the renumbering.
new text end
ARTICLE 23
FORECAST ADJUSTMENTS AND CARRYFORWARD AUTHORITY
Section 1. new text begin HUMAN SERVICES APPROPRIATION.
|
new text begin
The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2021, First Special
Session chapter 7, article 16, from the general fund or any fund named to the Department
of Human Services for the purposes specified in this article, to be available for the fiscal
year indicated for each purpose. The figures "2022" and "2023" used in this article mean
that the appropriations listed under them are available for the fiscal years ending June 30,
2022, or June 30, 2023, respectively. "The first year" is fiscal year 2022. "The second year"
is fiscal year 2023. "The biennium" is fiscal years 2022 and 2023.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
(585,901,000) new text end |
new text begin
$ new text end |
new text begin
182,791,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
(406,629,000) new text end |
new text begin
185,395,000 new text end |
|
new text begin
Health Care Access Fund new text end |
new text begin
(86,146,000) new text end |
new text begin
(11,799,000) new text end |
|
new text begin
Federal TANF new text end |
new text begin
(93,126,000) new text end |
new text begin
9,195,000 new text end |
new text begin Subd. 2. new text end
new text begin
Forecasted Programs
|
||||||
|
new text begin
(a) MFIP/DWP new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
72,106,000 new text end |
new text begin
(14,397,000) new text end |
|
new text begin
Federal TANF new text end |
new text begin
(93,126,000) new text end |
new text begin
9,195,000 new text end |
|
new text begin
(b) MFIP Child Care Assistance new text end |
new text begin
(103,347,000) new text end |
new text begin
(73,738,000) new text end |
||||
|
new text begin
(c) General Assistance new text end |
new text begin
(4,175,000) new text end |
new text begin
(1,488,000) new text end |
||||
|
new text begin
(d) Minnesota Supplemental Aid new text end |
new text begin
318,000 new text end |
new text begin
1,613,000 new text end |
||||
|
new text begin
(e) Housing Support new text end |
new text begin
(1,994,000) new text end |
new text begin
9,257,000 new text end |
||||
|
new text begin
(f) Northstar Care for Children new text end |
new text begin
(9,613,000) new text end |
new text begin
(4,865,000) new text end |
||||
|
new text begin
(g) MinnesotaCare new text end |
new text begin
(86,146,000) new text end |
new text begin
(11,799,000) new text end |
||||
new text begin
These appropriations are from the health care
access fund.
new text end
|
new text begin
(h) Medical Assistance new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
(348,364,000) new text end |
new text begin
292,880,000 new text end |
|
new text begin
Health Care Access Fund new text end |
new text begin
-0- new text end |
new text begin
-0- new text end |
|
new text begin
(i) Alternative Care Program new text end |
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
|
new text begin
(j) Behavioral Health Fund new text end |
new text begin
(11,560,000) new text end |
new text begin
(23,867,000) new text end |
||||
new text begin Subd. 3. new text end
new text begin
Technical Activities
|
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
new text begin
These appropriations are from the federal
TANF fund.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Laws 2021, First Special Session chapter 7, article 16, section 2, subdivision 29,
is amended to read:
Subd. 29.Grant Programs; Disabilities Grants
|
31,398,000 |
31,010,000 |
||||
(a) Training Stipends for Direct Support
Services Providers. $1,000,000 in fiscal year
2022 is from the general fund for stipends for
individual providers of direct support services
as defined in Minnesota Statutes, section
256B.0711, subdivision 1. These stipends are
available to individual providers who have
completed designated voluntary trainings
made available through the State-Provider
Cooperation Committee formed by the State
of Minnesota and the Service Employees
International Union Healthcare Minnesota.
Any unspent appropriation in fiscal year 2022
is available in fiscal year 2023. This is a
onetime appropriation. This appropriation is
available only if the labor agreement between
the state of Minnesota and the Service
Employees International Union Healthcare
Minnesota under Minnesota Statutes, section
179A.54, is approved under Minnesota
Statutes, section 3.855.
(b) Parent-to-Parent Peer Support. $125,000
in fiscal year 2022 and $125,000 in fiscal year
2023 are from the general fund for a grant to
an alliance member of Parent to Parent USA
to support the alliance member's
parent-to-parent peer support program for
families of children with a disability or special
health care need.
(c) Self-Advocacy Grants. (1) $143,000 in
fiscal year 2022 and $143,000 in fiscal year
2023 are from the general fund for a grant
under Minnesota Statutes, section 256.477,
subdivision 1.
(2) $105,000 in fiscal year 2022 and $105,000
in fiscal year 2023 are from the general fund
for subgrants under Minnesota Statutes,
section 256.477, subdivision 2.
(d) Minnesota Inclusion Initiative Grants.
$150,000 in fiscal year 2022 and $150,000 in
fiscal year 2023 are from the general fund for
grants under Minnesota Statutes, section
256.4772.
(e) Grants to Expand Access to Child Care
for Children with Disabilities. $250,000 in
fiscal year 2022 and $250,000 in fiscal year
2023 are from the general fund for grants to
expand access to child care for children with
disabilities.new text begin Any unexpended amount in fiscal
year 2022 is available through June 30, 2023.new text end
This is a onetime appropriation.
(f) Parenting with a Disability Pilot Project.
The general fund base includes $1,000,000 in
fiscal year 2024 and $0 in fiscal year 2025 to
implement the parenting with a disability pilot
project.
(g) Base Level Adjustment. The general fund
base is $29,260,000 in fiscal year 2024 and
$22,260,000 in fiscal year 2025.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Laws 2021, First Special Session chapter 7, article 16, section 2, subdivision 31,
is amended to read:
Subd. 31.Grant Programs; Adult Mental Health
|
||||||
| Appropriations by Fund |
||
| General |
98,772,000 |
98,703,000 |
| Opiate Epidemic Response |
2,000,000 |
2,000,000 |
(a) Culturally and Linguistically
Appropriate Services Implementation
Grants. $2,275,000 in fiscal year 2022 and
$2,206,000 in fiscal year 2023 are from the
general fund for grants to disability services,
mental health, and substance use disorder
treatment providers to implement culturally
and linguistically appropriate services
standards, according to the implementation
and transition plan developed by the
commissioner.new text begin Any unexpended amount in
fiscal year 2022 is available through June 30,
2023.new text end The general fund base for this
appropriation is $1,655,000 in fiscal year 2024
and $0 in fiscal year 2025.
(b) Base Level Adjustment. The general fund
base is $93,295,000 in fiscal year 2024 and
$83,324,000 in fiscal year 2025. The opiate
epidemic response fund base is $2,000,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Laws 2021, First Special Session chapter 7, article 16, section 2, subdivision 33,
is amended to read:
Subd. 33.Grant Programs; Chemical
|
||||||
| Appropriations by Fund |
||
| General |
4,273,000 |
4,274,000 |
| Lottery Prize |
1,733,000 |
1,733,000 |
| Opiate Epidemic Response |
500,000 |
500,000 |
(a) Problem Gambling. $225,000 in fiscal
year 2022 and $225,000 in fiscal year 2023
are from the lottery prize fund for a grant to
the state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
(b) Recovery Community Organization
Grants. $2,000,000 in fiscal year 2022 and
$2,000,000 in fiscal year 2023 are from the
general fund for grants to recovery community
organizations, as defined in Minnesota
Statutes, section 254B.01, subdivision 8, to
provide for costs and community-based peer
recovery support services that are not
otherwise eligible for reimbursement under
Minnesota Statutes, section 254B.05, as part
of the continuum of care for substance use
disorders.new text begin Any unexpended amount in fiscal
year 2022 is available through June 30, 2023.new text end
The general fund base for this appropriation
is $2,000,000 in fiscal year 2024 and $0 in
fiscal year 2025
(c) Base Level Adjustment. The general fund
base is $4,636,000 in fiscal year 2024 and
$2,636,000 in fiscal year 2025. The opiate
epidemic response fund base is $500,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Laws 2021, First Special Session chapter 7, article 17, section 3, is amended to
read:
Sec. 3. GRANTS FOR TECHNOLOGY FOR HCBS RECIPIENTS.
(a) This act includes $500,000 in fiscal year 2022 and $2,000,000 in fiscal year 2023
for the commissioner of human services to issue competitive grants to home and
community-based service providers. Grants must be used to provide technology assistance,
including but not limited to Internet services, to older adults and people with disabilities
who do not have access to technology resources necessary to use remote service delivery
and telehealth.new text begin Any unexpended amount in fiscal year 2022 is available through June 30,
2023.new text end The general fund base included in this act for this purpose is $1,500,000 in fiscal year
2024 and $0 in fiscal year 2025.
(b) All grant activities must be completed by March 31, 2024.
(c) This section expires June 30, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Laws 2021, First Special Session chapter 7, article 17, section 6, is amended to
read:
Sec. 6. TRANSITION TO COMMUNITY INITIATIVE.
(a) This act includes $5,500,000 in fiscal year 2022 and $5,500,000 in fiscal year 2023
for additional funding for grants awarded under the transition to community initiative
described in Minnesota Statutes, section 256.478.new text begin Any unexpended amount in fiscal year
2022 is available through June 30, 2023.new text end The general fund base in this act for this purpose
is $4,125,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) All grant activities must be completed by March 31, 2024.
(c) This section expires June 30, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Laws 2021, First Special Session chapter 7, article 17, section 10, is amended to
read:
Sec. 10. PROVIDER CAPACITY GRANTS FOR RURAL AND UNDERSERVED
COMMUNITIES.
(a) This act includes $6,000,000 in fiscal year 2022 and $8,000,000 in fiscal year 2023
for the commissioner to establish a grant program for small provider organizations that
provide services to rural or underserved communities with limited home and
community-based services provider capacity. The grants are available to build organizational
capacity to provide home and community-based services in Minnesota and to build new or
expanded infrastructure to access medical assistance reimbursement.new text begin Any unexpended
amount in fiscal year 2022 is available through June 30, 2023.new text end The general fund base in this
act for this purpose is $8,000,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) The commissioner shall conduct community engagement, provide technical assistance,
and establish a collaborative learning community related to the grants available under this
section and work with the commissioner of management and budget and the commissioner
of the Department of Administration to mitigate barriers in accessing grant funds. Funding
awarded for the community engagement activities described in this paragraph is exempt
from state solicitation requirements under Minnesota Statutes, section 16B.97, for activities
that occur in fiscal year 2022.
(c) All grant activities must be completed by March 31, 2024.
(d) This section expires June 30, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Laws 2021, First Special Session chapter 7, article 17, section 11, is amended to
read:
Sec. 11. EXPAND MOBILE CRISIS.
(a) This act includes $8,000,000 in fiscal year 2022 and $8,000,000 in fiscal year 2023
for additional funding for grants for adult mobile crisis services under Minnesota Statutes,
section 245.4661, subdivision 9, paragraph (b), clause (15). new text begin Any unexpended amount in
fiscal year 2022 and fiscal year 2023 is available through June 30, 2024. new text end The general fund
base in this act for this purpose is $4,000,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) Beginning April 1, 2024, counties may fund and continue conducting activities
funded under this section.
(c) All grant activities must be completed by March 31, 2024.
(d) This section expires June 30, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Laws 2021, First Special Session chapter 7, article 17, section 12, is amended to
read:
Sec. 12. PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY AND CHILD
AND ADOLESCENT MOBILE TRANSITION UNIT.
(a) This act includes $2,500,000 in fiscal year 2022 and $2,500,000 in fiscal year 2023
for the commissioner of human services to create children's mental health transition and
support teams to facilitate transition back to the community of children from psychiatric
residential treatment facilities, and child and adolescent behavioral health hospitals.new text begin Any
unexpended amount in fiscal year 2022 is available through June 30, 2023.new text end The general
fund base included in this act for this purpose is $1,875,000 in fiscal year 2024 and $0 in
fiscal year 2025.
(b) Beginning April 1, 2024, counties may fund and continue conducting activities
funded under this section.
(c) This section expires March 31, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Laws 2021, First Special Session chapter 7, article 17, section 17, subdivision 3,
is amended to read:
Subd. 3.
Respite services for older adults grants.
(a) This act includes $2,000,000 in
fiscal year 2022 and $2,000,000 in fiscal year 2023 for the commissioner of human services
to establish a grant program for respite services for older adults. The commissioner must
award grants on a competitive basis to respite service providers.new text begin Any unexpended amount
in fiscal year 2022 is available through June 30, 2023.new text end The general fund base included in
this act for this purpose is $2,000,000 in fiscal year 2024 and $0 in fiscal year 2025.
(b) All grant activities must be completed by March 31, 2024.
(c) This subdivision expires June 30, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Laws 2021, First Special Session chapter 7, article 17, section 19, is amended to
read:
Sec. 19. CENTERS FOR INDEPENDENT LIVING HCBS ACCESS GRANT.
(a) This act includes $1,200,000 in fiscal year 2022 and $1,200,000 in fiscal year 2023
for grants to expand services to support people with disabilities from underserved
communities who are ineligible for medical assistance to live in their own homes and
communities by providing accessibility modifications, independent living services, and
public health program facilitation. The commissioner of human services must award the
grants in equal amounts to deleted text begin the eight organizationsdeleted text end new text begin grantees. To be eligible, a grantee must
be an organizationnew text end defined in Minnesota Statutes, section 268A.01, subdivision 8. new text begin Any
unexpended amount in fiscal year 2022 is available through June 30, 2023. new text end The general
fund base included in this act for this purpose is $0 in fiscal year 2024 and $0 in fiscal year
2025.
(b) All grant activities must be completed by March 31, 2024.
(c) This section expires June 30, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 24
APPROPRIATIONS
Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
|
new text begin
The sums shown in the columns marked "Appropriations" are added to or, if shown in
parentheses, subtracted from the appropriations in Laws 2021, First Special Session chapter
7, article 16, to the agencies and for the purposes specified in this article. The appropriations
are from the general fund or other named fund and are available for the fiscal years indicated
for each purpose. The figures "2022" and "2023" used in this article mean that the addition
to or subtraction from the appropriation listed under them is available for the fiscal year
ending June 30, 2022, or June 30, 2023, respectively. Base adjustments mean the addition
to or subtraction from the base level adjustment set in Laws 2021, First Special Session
chapter 7, article 16. Supplemental appropriations and reductions to appropriations for the
fiscal year ending June 30, 2022, are effective the day following final enactment unless a
different effective date is explicit.
new text end
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new text begin
APPROPRIATIONS new text end |
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new text begin
Available for the Year new text end |
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new text begin
Ending June 30 new text end |
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new text begin
2022 new text end |
new text begin
2023 new text end |
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Sec. 2. new text begin COMMISSIONER OF HUMAN
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||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
32,461,000 new text end |
new text begin
$ new text end |
new text begin
456,998,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
34,397,000 new text end |
new text begin
476,814,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
(1,936,000) new text end |
new text begin
(88,874,000) new text end |
|
new text begin
Federal TANF new text end |
new text begin
-0- new text end |
new text begin
7,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
-0- new text end |
new text begin
551,000 new text end |
new text begin Subd. 2. new text end
new text begin
Central Office; Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
397,000 new text end |
new text begin
96,704,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
10,592,000 new text end |
new text begin
(a) Background Studies. (1) $1,617,000 in
fiscal year 2023 is from the general fund to
provide a credit to providers who paid for
emergency background studies in NETStudy
2.0. This is a onetime appropriation.
new text end
new text begin
(2) $1,683,000 in fiscal year 2023 is from the
general fund to fund the costs of reprocessing
emergency studies conducted under
interagency agreements. This is a onetime
appropriation.
new text end
new text begin
(b) Supporting Drug Pricing Litigation
Costs. $397,000 in fiscal year 2022 is from
the general fund for costs to comply with
litigation requirements related to
pharmaceutical drug price litigation. This is a
onetime appropriation.
new text end
new text begin
(c) Information Technology and Data
Sharing Projects. $113,000 in fiscal year
2023 is from the general fund for staff and
costs related to the information technology
and data sharing projects for programs
impacting early childhood. The base for this
appropriation is $131,000 in fiscal year 2024
and $131,000 in fiscal year 2025.
new text end
new text begin
(d) Base Level Adjustment. The general fund
base is increased $12,787,000 in fiscal year
2024 and $9,679,000 in fiscal year 2025. The
health care access fund base is increased
$915,000 in fiscal year 2024 and $2,293,000
in fiscal year 2025.
new text end
new text begin Subd. 3. new text end
new text begin
Central Office; Children and Families
|
new text begin
-0- new text end |
new text begin
23,398,000 new text end |
||||
new text begin
(a) Foster Care Federal Cash Assistance
Benefits Plan. $373,000 in fiscal year 2023
is for the commissioner to develop the foster
care federal cash assistance benefits plan. The
base for this appropriation is $342,000 in fiscal
year 2024 and $127,000 in fiscal year 2025.
new text end
new text begin
(b) Pregnant and Parenting Homeless
Youth Study. $108,000 in fiscal year 2023 is
to fund a study of the prevalence of pregnancy
and parenting among homeless youths and
youths who are at risk of homelessness. This
is a onetime appropriation and is available
until June 30, 2024.
new text end
new text begin
(c) Chosen Family Hosting to Prevent
Youth Homelessness Pilot Program.
$218,000 in fiscal year 2023 is for the chosen
family hosting to prevent youth homelessness
pilot program for a contract with a technical
assistance provider to: (1) provide technical
assistance to funding recipients; (2) facilitate
a monthly learning cohort for funding
recipients; (3) evaluate the efficacy and
cost-effectiveness of the pilot program; and
(4) submit annual updates and a final report
to the commissioner. This is a onetime
appropriation and is available until June 30,
2027.
new text end
new text begin
(d) Ombudsperson for Family Child Care
Providers. The base shall include $125,000
in fiscal year 2025, $205,000 in fiscal year
2026, and $205,000 in fiscal year 2027 for the
ombudsperson for family child care providers
under Minnesota Statutes, section 245.975.
new text end
new text begin
(e) Information Technology and Data
Sharing Projects. $563,000 in fiscal year
2023 is for staff and costs related to the
information technology and data sharing
projects for programs impacting early
childhood. The base for this appropriation is
$646,000 in fiscal year 2024 and $646,000 in
fiscal year 2025.
new text end
new text begin
(f) Staff for Cost Estimation Model for
Early Care and Learning Programs.
$111,000 in fiscal year 2023 is for staff related
to developing a cost estimation model for early
care and learning programs. The base for this
appropriation is $127,000 in fiscal year 2024
and $0 in fiscal year 2025.
new text end
new text begin
(g) Base Level Adjustment. The general fund
base is increased $8,995,000 in fiscal year
2024 and $8,748,000 in fiscal year 2025.
new text end
new text begin Subd. 4. new text end
new text begin
Central Office; Health Care
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||||||
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new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
4,762,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
2,475,000 new text end |
new text begin
(a) Interactive Voice Response and
Improving Access for Applications and
Forms. $1,350,000 in fiscal year 2023 is from
the health care access fund for the
improvement of accessibility to Minnesota
health care programs applications, forms, and
other consumer support resources and services
to enrollees with limited English proficiency.
This is a onetime appropriation and is
available until June 30, 2025.
new text end
new text begin
(b) Community-Driven Improvements.
$680,000 in fiscal year 2023 is from the health
care access fund for Minnesota health care
program enrollee engagement activities.
new text end
new text begin
(c) Responding to COVID-19 in Minnesota
Health Care Programs. $1,000,000 in fiscal
year 2023 is from the general fund for contract
assistance relating to the resumption of
eligibility and redetermination processes in
Minnesota health care programs after the
expiration of the federal public health
emergency. Contracts entered into under this
section are for emergency acquisition and are
not subject to solicitation requirements under
Minnesota Statutes, section 16C.10,
subdivision 2. This is a onetime appropriation
and is available until June 30, 2025.
new text end
new text begin
(d) Initial PACE Implementation Funding.
$270,000 in fiscal year 2023 is from the
general fund to complete the initial actuarial
and administrative work necessary to
recommend a financing mechanism for the
operation of PACE under Minnesota Statutes,
section 256B.69, subdivision 23, paragraph
(e). This is a onetime appropriation.
new text end
new text begin
(e) Base Level Adjustment. The general fund
base is increased $3,698,000 in fiscal year
2024 and $5,214,000 in fiscal year 2025. The
health care access fund base is increased
$2,037,000 in fiscal year 2024 and $5,450,000
in fiscal year 2025.
new text end
new text begin Subd. 5. new text end
new text begin
Central Office; Continuing Care
|
new text begin
-0- new text end |
new text begin
3,478,000 new text end |
||||
new text begin
(a) Lifesharing Services. $57,000 in fiscal
year 2023 is for engaging stakeholders and
developing recommendations regarding
establishing a lifesharing service under the
state's medical assistance disability waivers
and elderly waiver. The base for this
appropriation is $43,000 in fiscal year 2024
and $0 in fiscal year 2025.
new text end
new text begin
(b) Initial PACE Implementation Funding.
$120,000 in fiscal year 2023 is to complete
the initial actuarial and administrative work
necessary to recommend a financing
mechanism for the operation of PACE under
Minnesota Statutes, section 256B.69,
subdivision 23, paragraph (e). This is a
onetime appropriation.
new text end
new text begin
(c) new text begin Base Level Adjustment.new text end The general fund
base is increased $168,000 in fiscal year 2024
and $125,000 in fiscal year 2025.
new text end
new text begin Subd. 6. new text end
new text begin
Central Office; Community Supports
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
7,059,000 new text end |
|
new text begin
Opioid Epidemic Response new text end |
new text begin
-0- new text end |
new text begin
551,000 new text end |
new text begin
(a) SEIU Health Care Arbitration Award.
$5,444 in fiscal year 2023 is from the general
fund for arbitration awards resulting from a
SEIU grievance. This is a onetime
appropriation.
new text end
new text begin
(b) Lifesharing Services. $57,000 in fiscal
year 2023 is from the general fund for
engaging stakeholders and developing
recommendations regarding establishing a
lifesharing service under the state's medical
assistance disability waivers and elderly
waiver. The general fund base for this
appropriation is $43,000 in fiscal year 2024
and $0 in fiscal year 2025.
new text end
new text begin
(c) Intermediate Care Facilities for Persons
with Developmental Disabilities; Rate
Study. $250,000 in fiscal year 2023 is from
the general fund for a study of medical
assistance rates for intermediate care facilities
for persons with developmental disabilities
under Minnesota Statutes, sections 256B.5011
to 256B.5015. This is a onetime appropriation.
new text end
new text begin
(d) Online tool accessibility and capacity
expansion. $150,000 in fiscal year 2023 is
from the general fund to expand the
accessibility and capacity of online tools for
people receiving services and direct support
workers. The general fund base for this
appropriation is $305,000 in fiscal year 2024
and $420,000 in fiscal year 2025.
new text end
new text begin
(e) Systemic critical incident review team.
$80,000 in fiscal year 2023 is from the general
fund to implement the systemic critical
incident review process in Minnesota Statutes,
section 256.01, subdivision 12b.
new text end
new text begin
(f) new text begin Base Level Adjustment.new text end The general fund
base is increased $8,450,000 in fiscal year
2024 and $8,722,000 in fiscal year 2025. The
opiate epidemic response base is increased
$511,000 in fiscal year 2024 and $611,000 in
fiscal year 2025.
new text end
new text begin Subd. 7. new text end
new text begin
Forecasted Programs; MFIP/DWP
|
||||||
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new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
5,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
-0- new text end |
new text begin
7,000 new text end |
new text begin Subd. 8. new text end
new text begin
Forecasted Programs; MFIP Child Care
|
new text begin
-0- new text end |
new text begin
(23,000) new text end |
||||
new text begin Subd. 9. new text end
new text begin
Forecasted Programs; Minnesota
|
new text begin
-0- new text end |
new text begin
1,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Forecasted Programs; Housing
|
new text begin
-0- new text end |
new text begin
4,304,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
new text begin
-0- new text end |
new text begin
28,724,000 new text end |
||||
new text begin
This appropriation is from the health care
access fund.
new text end
new text begin Subd. 12. new text end
new text begin
Forecasted Programs; Medical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
(75,208,000) new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
(134,601,000) new text end |
new text begin Subd. 13. new text end
new text begin
Forecasted Programs; Alternative
|
new text begin
-0- new text end |
new text begin
530,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
CD Treatment Fund
|
new text begin
-0- new text end |
new text begin
27,000 new text end |
||||
new text begin Subd. 15. new text end
new text begin
Grant Programs; BSF Child Care
|
new text begin
-0- new text end |
new text begin
6,000 new text end |
||||
new text begin
Base Level Adjustment. The general fund
base is increased $29,620,000 in fiscal year
2024 and $69,470,000 in fiscal year 2025. The
TANF base is increased $23,500,000 in fiscal
year 2024 and $23,500,000 in fiscal year 2025.
new text end
new text begin Subd. 16. new text end
new text begin
Grant Programs; Child Care
|
new text begin
-0- new text end |
new text begin
67,205,000 new text end |
||||
new text begin
(a) Child Care Provider Access to
Technology Grants. $300,000 in fiscal year
2023 is for child care provider access to
technology grants pursuant to Minnesota
Statutes, section 119B.28.
new text end
new text begin
(b) One-Stop Regional Assistance Network.
The base shall include $1,200,000 in fiscal
year 2025 for a grant to the statewide child
care resource and referral network to
administer the child care one-stop shop
regional assistance network in accordance with
Minnesota Statutes, section 119B.19,
subdivision 7, clause (9).
new text end
new text begin
(c) Child Care Workforce Development
Grants. The base shall include $1,300,000 in
fiscal year 2025 for a grant to the statewide
child care resource and referral network to
administer the child care workforce
development grants in accordance with
Minnesota Statutes, section 119B.19,
subdivision 7, clause (10).
new text end
new text begin
(d) Shared Services Innovation Grants. The
base shall include $500,000 in fiscal year 2024
and $500,000 in fiscal year 2025 for shared
services innovation grants pursuant to
Minnesota Statutes, section 119B.27.
new text end
new text begin
(e) Stabilization Grants for Child Care
Providers Experiencing Financial Hardship.
$31,476,000 in fiscal year 2023 is for child
care stabilization grants for child care
programs in extreme financial hardship. This
is a onetime appropriation and is available
until June 30, 2025. Use of grant money must
be made in accordance with eligibility and
compliance requirements established by the
commissioner.
new text end
new text begin
(f) Contract for Cost Estimation Model for
Early Care and Learning Programs.
$400,000 in fiscal year 2023 is for a
professional technical contract related to
developing a cost estimation model for early
care and learning programs.
new text end
new text begin
(g) Brain Builders Bonus Program.
$2,500,000 in fiscal year 2023 is for brain
builders bonus grants. The commissioner may
use up to ten percent of the appropriation for
administration. This is a onetime appropriation
and is available until June 30, 2025.
new text end
new text begin
(h) Child Care Stabilization Base Grants.
$29,929,000 in fiscal year 2023 is for child
care stabilization base grants under Laws
2021, First Special Session chapter 7, article
14, section 21, subdivision 4, paragraph (b).
The base for this appropriation is $78,183,000
in fiscal year 2024 and $80,350,000 in fiscal
year 2025.
new text end
new text begin
(i) Grants for Family, Friend, and Neighbor
Caregivers. $3,000,000 in fiscal year 2023 is
for grants to community-based organizations
working with family, friend, and neighbor
caregivers. In awarding the grants, the
commissioner shall prioritize
community-based organizations working with
family, friend, and neighbor caregivers who
serve children from low-income families,
families of color, Tribal communities, or
families with limited English language
proficiency. The commissioner may use up to
ten percent of the appropriation for statewide
outreach, training initiatives, research, and
data collection.
new text end
new text begin
(j) Base Level Adjustment. The general fund
base is increased $82,183,000 in fiscal year
2024 and $86,850,000 in fiscal year 2025.
new text end
new text begin Subd. 17. new text end
new text begin
Grant Programs; Children's Services
|
new text begin
-0- new text end |
new text begin
8,984,000 new text end |
||||
new text begin
(a) American Indian Child Welfare
Initiative; Mille Lacs Band of Ojibwe
Planning. $1,263,000 in fiscal year 2023 is
to support planning activities necessary for
the Mille Lacs Band of Ojibwe to join the
American Indian child welfare initiative. The
base for this appropriation is $2,671,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin
(b) Expand Parent Support Outreach
Program. The base shall include $7,000,000
in fiscal year 2024 and $7,000,000 in fiscal
year 2025 to expand the parent support
outreach program.
new text end
new text begin
(c) Thriving Families Safer Children. The
base shall include $30,000 in fiscal year 2024
to plan for an education attendance support
diversionary program to prevent entry into the
child welfare system. The commissioner shall
report back to the chairs and ranking minority
members of the legislative committees that
oversee child welfare by January 1, 2025, on
the plan for this program. This is a onetime
appropriation.
new text end
new text begin
(d) Family Group Decision Making. The
base shall include $5,000,000 in fiscal year
2024 and $5,000,000 in fiscal year 2025 to
expand the use of family group decision
making to provide opportunity for family
voices concerning critical decisions in child
safety and prevent entry into the child welfare
system.
new text end
new text begin
(e) Child Welfare Promising Practices. The
base shall include $5,000,000 in fiscal year
2024 and $5,000,000 in fiscal year 2025 to
develop promising practices for prevention of
out-of-home placement of children and youth.
new text end
new text begin
(f) Family Assessment Response. The base
shall include $23,550,000 in fiscal year 2024
and $23,550,000 in fiscal year 2025 to support
counties and Tribes that are members of the
American Indian child welfare initiative in
providing case management services and
support for families being served under family
assessment response and to prevent entry into
the child welfare system.
new text end
new text begin
(g) Extend Support for Youth Leaving
Foster Care. $600,000 in fiscal year 2023 is
to extend financial supports for young adults
aging out of foster care to age 22. The base
for this appropriation is $1,200,000 in fiscal
year 2024 and $1,200,000 in fiscal year 2025.
new text end
new text begin
(h) Grants to Counties for Child Protection
Staff. $1,000,000 in fiscal year 2023 is to
provide grants to counties and American
Indian child welfare initiative Tribes to be
used to reduce extended foster care caseload
sizes to ten cases per worker. The base for this
appropriation is $2,000,000 in fiscal year 2024
and $2,000,000 in fiscal year 2025.
new text end
new text begin
(i) Statewide Pool of Qualified Individuals.
$1,017,000 in fiscal year 2023 is for grants to
one or more grantees to establish and manage
a pool of state-funded qualified individuals to
assess potential out-of-home placement of a
child in a qualified residential treatment
program. Up to $200,000 of the grants each
fiscal year is available for grantee contracts to
manage the state-funded pool of qualified
individuals. This amount shall also pay for
qualified individual training, certification, and
background studies. Remaining grant money
shall be available until expended to provide
qualified individual services to counties and
Tribes that have joined the American Indian
child welfare initiative pursuant to Minnesota
Statutes, section 256.01, subdivision 14b, to
provide qualified residential treatment
program assessments at no cost to the county
or Tribal agency.
new text end
new text begin
(j) Quality Parenting Initiative Grant.
$100,000 in fiscal year 2023 is for a grant to
the Quality Parenting Initiative Minnesota, to
implement Quality Parenting Initiative
principles and practices and support children
and families experiencing foster care
placements. The grantee shall use grant funds
to provide training and technical assistance to
county and Tribal agencies, community-based
agencies, and other stakeholders on conducting
initial foster care phone calls under Minnesota
Statutes, section 260C.219, subdivision 6;
supporting practices that create partnerships
between birth and foster families; and
informing child welfare practices by
supporting youth leadership and the
participation of individuals with experience
in the foster care system. Upon request, the
commissioner shall make information
regarding the use of this grant funding
available to the chairs and ranking minority
members of the legislative committees with
jurisdiction over human services. This is a
onetime appropriation.
new text end
new text begin
(k) Costs of Foster Care or Care,
Examination, or Treatment. $5,000,000 in
fiscal year 2023 is for grants to counties and
Tribes, to reimburse counties and Tribes for
the costs of foster care or care, examination,
or treatment that would previously have been
paid by the parents or custodians of a child in
foster care using parental income and
resources, child support payments, or income
and resources attributable to a child under
Minnesota Statutes, sections 242.19, 256N.26,
260B.331, and 260C.331. Counties and Tribes
must apply for grant funds in a form
prescribed by the commissioner, and must
provide the information and data necessary to
calculate grant fund allocations accurately and
equitably, as determined by the commissioner.
This is a onetime appropriation and is
available until June 30, 2025.
new text end
new text begin
(l) Grants to Counties; Foster Care Federal
Cash Assistance Benefits Plan. $50,000 in
fiscal year 2023 is for the commissioner to
provide grants to counties to assist counties
with gathering and reporting the county data
required for the commissioner to develop the
foster care federal cash assistance benefits
plan. This is a onetime appropriation.
new text end
new text begin
(m) Base Level Adjustment. The general fund
base is increased $47,386,000 in fiscal year
2024 and $44,715,000 in fiscal year 2025.
new text end
new text begin Subd. 18. new text end
new text begin
Grant Programs; Children and
|
new text begin
14,000,000 new text end |
new text begin
147,160,000 new text end |
||||
new text begin
(a) Family and Community Resource Hubs.
$2,550,000 in fiscal year 2023 is to implement
a sustainable family and community resource
hub model through the community action
agencies under Minnesota Statutes, section
256E.31, and federally recognized Tribes. The
community resource hubs must offer
navigation to several supports and services,
including but not limited to basic needs and
economic assistance, disability services,
healthy development and screening,
developmental and behavioral concerns,
family well-being and mental health, early
learning and child care, dental care, legal
services, and culturally specific services for
American Indian families. The base for this
appropriation is $12,750,000 in fiscal year
2024 and $20,400,000 in fiscal year 2025.
new text end
new text begin
(b) Tribal Food Sovereignty Infrastructure
Grants. $4,000,000 in fiscal year 2023 is for
capital and infrastructure development to
support food system changes and provide
equitable access to existing and new methods
of food support for American Indian
communities, including federally recognized
Tribes and American Indian nonprofit
organizations. This is a onetime appropriation
and is available until June 30, 2025.
new text end
new text begin
(c) Tribal Food Security. $2,836,000 in fiscal
year 2023 is to promote food security for
American Indian communities, including
federally recognized Tribes and American
Indian nonprofit organizations. This includes
hiring staff, providing culturally relevant
training for building food access, purchasing
technical assistance materials and supplies,
and planning for sustainable food systems.
The base for this appropriation is $2,809,000
in fiscal year 2024 and $1,809,000 in fiscal
year 2025.
new text end
new text begin
(d) Capital for Emergency Food
Distribution Facilities. $14,931,000 in fiscal
year 2023 is for improving and expanding the
infrastructure of food shelf facilities across
the state, including adding freezer or cooler
space and dry storage space, improving the
safety and sanitation of existing food shelves,
and addressing deferred maintenance or other
facility needs of existing food shelves. Grant
money shall be made available to nonprofit
organizations, federally recognized Tribes,
and local units of government. This is a
onetime appropriation and is available until
June 30, 2025.
new text end
new text begin
(e) Food Support Grants. $5,000,000 in
fiscal year 2023 is to provide additional
resources to a diverse food support network
that includes food shelves, food banks, and
meal and food outreach programs. Grant
money shall be made available to nonprofit
organizations, federally recognized Tribes,
and local units of government. The base for
this appropriation is $3,000,000 in fiscal year
2024 and $0 in fiscal year 2025.
new text end
new text begin
(f) Transitional Housing. $2,500,000 in fiscal
year 2023 is for transitional housing programs
under Minnesota Statutes, section 256E.33.
new text end
new text begin
(g) Shelter-Linked Youth Mental Health
Grants. $1,650,000 in fiscal year 2023 is for
shelter-linked youth mental health grants under
Minnesota Statutes, section 256K.46.
new text end
new text begin
(h) Emergency Services Grants. $36,124,000
in fiscal year 2023 is for emergency services
under Minnesota Statutes, section 256E.36.
This appropriation is available until June 30,
2025. The base for this appropriation is
$19,283,000 in fiscal year 2024 and
$19,283,000 in fiscal year 2025.
new text end
new text begin
(i) Homeless Youth Act. $10,000,000 in fiscal
year 2023 is for homeless youth act grants
under Minnesota Statutes, section 256K.45,
subdivision 1. This appropriation is available
until June 30, 2025.
new text end
new text begin
(j) new text begin Safe Harbor Grants.new text end $5,500,000 in fiscal
year 2023 is for safe harbor grants to fund
street outreach, emergency shelter, and
transitional and long-term housing beds for
sexually exploited youth and youth at risk of
exploitation.
new text end
new text begin
(k) new text begin Emergency Shelter Facilities.new text end
$75,000,000 in fiscal year 2023 is for grants
to eligible applicants for the acquisition of
property; site preparation, including
demolition; predesign; design; construction;
renovation; furnishing; and equipping of
emergency shelter facilities in accordance with
emergency shelter facilities project criteria in
this act. This is a onetime appropriation and
is available until June 30, 2025.
new text end
new text begin
(l) new text begin Heading Home Ramsey Continuum of
Care.new text end (1) $8,000,000 in fiscal year 2022 is for
a grant to fund and support Heading Home
Ramsey Continuum of Care. This is a onetime
appropriation. The grant shall be used for:
new text end
new text begin
(i) maintaining funding for a 100-bed family
shelter that had been funded by CARES Act
money;
new text end
new text begin
(ii) maintaining funding for an existing
100-bed single room occupancy shelter and
developing a replacement single-room
occupancy shelter for housing up to 100 single
adults; and
new text end
new text begin
(iii) maintaining current day shelter
programming that had been funded with
CARES Act money and developing a
replacement for current day shelter facilities.
new text end
new text begin
(2) Ramsey County may use up to ten percent
of this appropriation for administrative
expenses. This appropriation is available until
June 30, 2025.
new text end
new text begin
(m)
new text end
new text begin
new text begin Hennepin County Funding for Serving
Homeless Persons.new text end (1) $6,000,000 in fiscal
year 2022 is for a grant to fund and support
Hennepin County shelters and services for
persons experiencing homelessness. This is a
onetime appropriation. Of this appropriation:
new text end
new text begin
(i) up to $4,000,000 in matching grant funding
is to design, construct, equip, and furnish the
Simpson Housing Services shelter facility in
the city of Minneapolis; and
new text end
new text begin
(ii) up to $2,000,000 is to maintain current
shelter and homeless response programming
that had been funded with federal funding
from the CARES Act of the American Rescue
Plan Act, including:
new text end
new text begin
(A) shelter operations and services to maintain
services at Avivo Village, including a shelter
comprised of 100 private dwellings and the
American Indian Community Development
Corporation Homeward Bound 50-bed shelter;
new text end
new text begin
(B) shelter operations and services to maintain
shelter services 24 hours per day, seven days
per week;
new text end
new text begin
(C) housing-focused case management; and
new text end
new text begin
(D) shelter diversion services.
new text end
new text begin
(2) Hennepin County may contract with
eligible nonprofit organizations and local and
Tribal governmental units to provide services
under the grant program. This appropriation
is available until June 30, 2025.
new text end
new text begin
(n) Chosen Family Hosting to Prevent
Youth Homelessness Pilot Program.
$1,000,000 in fiscal year 2023 is for the
chosen family hosting to prevent youth
homelessness pilot program to provide funds
to providers serving homeless youth. This is
a onetime appropriation and is available until
June 30, 2027.
new text end
new text begin
(o) Minnesota Association for Volunteer
Administration. $1,000,000 in fiscal year
2023 is for a grant to the Minnesota
Association for Volunteer Administration to
administer needs-based volunteerism subgrants
targeting underresourced nonprofit
organizations in greater Minnesota to support
selected organizations' ongoing efforts to
address and minimize disparities in access to
human services through increased
volunteerism. Successful subgrant applicants
must demonstrate that the populations to be
served by the subgrantee are considered
underserved or suffer from or are at risk of
homelessness, hunger, poverty, lack of access
to health care, or deficits in education. The
Minnesota Association for Volunteer
Administration must give priority to
organizations that are serving the needs of
vulnerable populations. By December 15,
2023, the Minnesota Association for Volunteer
Administration must report data on outcomes
from the subgrants and recommendations for
improving and sustaining volunteer efforts
statewide to the chairs and ranking minority
members of the legislative committees and
divisions with jurisdiction over human
services. This is a onetime appropriation and
is available until June 30, 2024.
new text end
new text begin
(p) Base Level Adjustment. The general fund
base is increased $57,492,000 in fiscal year
2024 and $61,142,000 in fiscal year 2025.
new text end
new text begin Subd. 19. new text end
new text begin
Grant Programs; Health Care Grants
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General Fund new text end |
new text begin
-0- new text end |
new text begin
3,500,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
(1,936,000) new text end |
new text begin
3,936,000 new text end |
new text begin
(a) Grant Funding to Support Urban
American Indians in Minnesota Health
Care Programs. $2,500,000 in fiscal year
2023 is from the general fund for funding to
the Indian Health Board of Minneapolis to
support continued access to health care
coverage through Minnesota health care
programs and improve access to quality care.
The general fund base for this appropriation
is $3,750,000 in fiscal year 2024 and
$1,260,000 in fiscal year 2025.
new text end
new text begin
(b) Grants for Navigator Organizations.
new text end
new text begin
(1) $1,936,000 in fiscal year 2023 is from the
health care access fund for grants to
organizations with a MNsure grant services
navigator assister contract in good standing
as of July 1, 2022. The grants to each
organization must be in proportion to the
number of medical assistance and
MinnesotaCare enrollees each organization
assisted that resulted in a successful
enrollment in the second quarter of fiscal year
2022, as determined by MNsure's navigator
payment process. This is a onetime
appropriation and is available until June 30,
2025.
new text end
new text begin
(2) $2,000,000 in fiscal year 2023 is from the
health care access fund for incentive payments
as defined in Minnesota Statutes, section
256.962, subdivision 5. This appropriation is
available until June 30, 2025. The health care
access fund base for this appropriation is
$1,000,000 in fiscal year 2024 and $0 in fiscal
year 2025.
new text end
new text begin
(c) Dental Home Pilot Project. $1,000,000
in fiscal year 2023 is from the general fund
for grants to individual providers and provider
networks participating in the dental home pilot
project. This is a onetime appropriation.
new text end
new text begin
(d) Base Level Adjustment. The general fund
base is increased $3,750,000 in fiscal year
2024 and $1,250,000 in fiscal year 2025. The
health care access fund base is increased
$1,000,000 in fiscal year 2024, and $0 in fiscal
year 2025.
new text end
new text begin Subd. 20. new text end
new text begin
Grant Programs; Other Long-Term
|
new text begin
-0- new text end |
new text begin
119,336,000 new text end |
||||
new text begin
(a)
new text end
new text begin
Workforce Incentive Fund Grant
Program. $118,000,000 in fiscal year 2023
is to assist disability, housing, substance use,
and older adult service providers of public
programs to pay for incentive benefits to
current and new workers. This is a onetime
appropriation and is available until June 30,
2025. Three percent of the total amount of the
appropriation may be used to administer the
program, which may include contracting with
a third-party administrator.
new text end
new text begin
(b) Supported Decision Making. $600,000
in fiscal year 2023 is for a grant to Volunteers
for America for the Centers for Excellence in
Supported Decision Making to assist older
adults and people with disabilities in avoiding
unnecessary guardianships through using less
restrictive alternatives, such as supported
decision making. The base for this
appropriation is $600,000 in fiscal year 2024,
$600,000 in fiscal year 2025, and $0 in fiscal
year 2026.
new text end
new text begin
(c) Support Coordination Training.
$736,000 in fiscal year 2023 is to develop and
implement a curriculum and training plan for
case managers to ensure all case managers
have the knowledge and skills necessary to
fulfill support planning and coordination
responsibilities for people who use home and
community-based disability services waivers
authorized under Minnesota Statutes, sections
256B.0913, 256B.092, and 256B.49, and
chapter 256S, and live in own-home settings.
Case manager support planning and
coordination responsibilities to be addressed
in the training include developing a plan with
the participant and their family to address
urgent staffing changes or unavailability and
other support coordination issues that may
arise for a participant. The commissioner shall
work with lead agencies, advocacy
organizations, and other stakeholders to
develop the training. An initial support
coordination training and competency
evaluation must be completed by all staff
responsible for case management, and the
support coordination training and competency
evaluation must be available to all staff
responsible for case management following
the initial training. The base for this
appropriation is $377,000 in fiscal year 2024,
$377,000 in fiscal year 2025, and $0 in fiscal
year 2026.
new text end
new text begin
(d) Base Level Adjustment. The general fund
base is increased $977,000 in fiscal year 2024
and $977,000 in fiscal year 2025.
new text end
new text begin Subd. 21. new text end
new text begin
Grant Programs; Disabilities Grants
|
new text begin
-0- new text end |
new text begin
8,950,000 new text end |
||||
new text begin
(a) Electronic Visit Verification (EVV)
Stipends. $6,440,000 in fiscal year 2023 is
for onetime stipends of $200 to bargaining
members to offset the potential costs related
to people using individual devices to access
EVV. $5,600,000 of the appropriation is for
stipends and the remaining 15 percent is for
administration of these stipends. This is a
onetime appropriation.
new text end
new text begin
(b) Self-Directed Collective Bargaining
Agreement; Temporary Rate Increase
Memorandum of Understanding. $1,610,000
in fiscal year 2023 is for onetime stipends for
individual providers covered by the SEIU
collective bargaining agreement based on the
memorandum of understanding related to the
temporary rate increase in effect between
December 1, 2020, and February 7, 2021.
$1,400,000 of the appropriation is for stipends
and the remaining 15 percent is for
administration of the stipends. This is a
onetime appropriation.
new text end
new text begin
(c) Service Employees International Union
Memorandums. The memorandums of
understanding submitted by the commissioner
of management and budget to the Legislative
Coordinating Commission Subcommittee on
Employee Relations on March 17, 2022, are
ratified.
new text end
new text begin
(d) Direct Care Service Corps Pilot Project.
$500,000 in fiscal year 2023 is for a grant to
HealthForce Minnesota at Winona State
University for purposes of the direct care
service corps pilot project in this act. Up to
$25,000 may be used by HealthForce
Minnesota for administrative costs. This is a
onetime appropriation.
new text end
new text begin
(e) Task Force on Disability Services
Accessibility. $300,000 in fiscal year 2023 is
for the Task Force on Disability Services
Accessibility. This is a onetime appropriation
and is available until March 31, 2026.
new text end
new text begin
(f) Base Level Adjustment. The general fund
base is increased $805,000 in fiscal year 2024
and $2,420,000 in fiscal year 2025.
new text end
new text begin Subd. 22. new text end
new text begin
Grant Programs; Adult Mental Health
|
new text begin
20,000,000 new text end |
new text begin
30,776,000 new text end |
||||
new text begin
(a) Expanding Support for Psychiatric
Residential Treatment Facilities. $800,000
in fiscal year 2023 is for start-up grants to
psychiatric residential treatment facilities as
described in Minnesota Statutes, section
256B.0941. Grantees may use grant money
for emergency workforce shortage uses.
Allowable grant uses related to emergency
workforce shortages may include but are not
limited to hiring and retention bonuses,
recruitment of a culturally responsive
workforce, and allowing providers to increase
the hourly rate in order to be competitive in
the market.
new text end
new text begin
(b) Workforce Incentive Fund Grant
Program. $20,000,000 in fiscal year 2022 is
to provide mental health public program
providers the ability to pay for incentive
benefits to current and new workers. This is
a onetime appropriation and is available until
June 30, 2025. Three percent of the total
amount of the appropriation may be used to
administer the program, which may include
contracting with a third-party administrator.
new text end
new text begin
(c) Cultural and Ethnic Minority
Infrastructure Grant Funding. $15,000,000
in fiscal year 2023 is for increasing cultural
and ethnic minority infrastructure grant
funding under Minnesota Statutes, section
245.4903. The base for this appropriation is
$10,000,000 in fiscal year 2024 and
$10,000,000 in fiscal year 2025.
new text end
new text begin
(d) Culturally Specific Grants. $2,000,000
in fiscal year 2023 is for grants for small to
midsize nonprofit organizations who represent
and support American Indian, Indigenous, and
other communities disproportionately affected
by the opiate crisis. These grants utilize
traditional healing practices and other
culturally congruent and relevant supports to
prevent and curb opiate use disorders through
housing, treatment, education, aftercare, and
other activities as determined by the
commissioner. The base for this appropriation
is $2,000,000 in fiscal year 2024 and $0 in
fiscal year 2025.
new text end
new text begin
(e) African American Community Mental
Health Center Grant. $1,000,000 in fiscal
year 2023 is for a grant to an African
American mental health service provider that
is a licensed community mental health center
specializing in services for African American
children and families. The center must offer
culturally specific, comprehensive,
trauma-informed, practice- and
evidence-based, person- and family-centered
mental health and substance use disorder
services; supervision and training; and care
coordination to all ages, regardless of ability
to pay or place of residence. Upon request, the
commissioner shall make information
regarding the use of this grant funding
available to the chairs and ranking minority
members of the legislative committees with
jurisdiction over human services. This is a
onetime appropriation and is available until
June 30, 2025.
new text end
new text begin
(f) Behavioral Health Peer Training.
$1,000,000 in fiscal year 2023 is for training
and development for mental health certified
peer specialists, mental health certified family
peer specialists, and recovery peer specialists.
Training and development may include but is
not limited to initial training and certification.
new text end
new text begin
(g) Intensive Residential Treatment Services
Locked Facilities. $2,796,000 in fiscal year
2023 is for start-up funds to intensive
residential treatment service providers to
provide treatment in locked facilities for
patients who have been transferred from a jail
or who have been deemed incompetent to
stand trial and a judge has determined that the
patient needs to be in a secure facility. This is
a onetime appropriation.
new text end
new text begin
(h) Base Level Adjustment. The general fund
base is increased $25,792,000 in fiscal year
2024 and $30,916,000 in fiscal year 2025. The
opiate epidemic response base is increased
$2,000,000 in fiscal year 2025.
new text end
new text begin Subd. 23. new text end
new text begin
Grant Programs; Child Mental Health
|
new text begin
-0- new text end |
new text begin
17,359,000 new text end |
||||
new text begin
(a) First Episode of Psychosis Grants.
$300,000 in fiscal year 2023 is for first
episode of psychosis grants under Minnesota
Statutes, section 245.4905.
new text end
new text begin
(b) Children's Residential Treatment
Services Emergency Funding. $2,500,000
in fiscal year 2023 is to provide licensed
children's residential treatment facilities with
emergency funding for staff overtime,
one-to-one staffing as needed, staff
recruitment and retention, and training and
related costs to maintain quality staff. Up to
$500,000 of this appropriation may be
allocated to support group home organizations
supporting children transitioning to lower
levels of care. This is a onetime appropriation.
new text end
new text begin
(c) Early Childhood Mental Health
Consultation. $3,759,000 in fiscal year 2023
is for grants to school districts and charter
schools for early childhood mental health
consultation under Minnesota Statutes, section
245.4889. The commissioner may use up to
$409,000 for administration.
new text end
new text begin
(d) Inpatient Psychiatric and Psychiatric
Residential Treatment Facilities.
$10,000,000 in fiscal year 2023 is for
competitive grants to hospitals or mental
health providers to retain, build, or expand
children's inpatient psychiatric beds for
children in need of acute high-level psychiatric
care or psychiatric residential treatment facility
beds as described in Minnesota Statutes,
section 256B.0941. In order to be eligible for
a grant, a hospital or mental health provider
must serve individuals covered by medical
assistance under Minnesota Statutes, section
256B.0625. The base for this appropriation is
$15,000,000 in fiscal year 2024 and $0 in
fiscal year 2025.
new text end
new text begin
(e) new text begin Base Level Adjustment.new text end The general fund
base is increased $19,859,000 in fiscal year
2024 and $4,859,000 in fiscal year 2025.
new text end
new text begin Subd. 24. new text end
new text begin
Grant Programs; Chemical
|
new text begin
-0- new text end |
new text begin
2,000,000 new text end |
||||
new text begin
(a) Emerging Mood Disorder Grant
Program. $1,000,000 in fiscal year 2023 is
for emerging mood disorder grants under
Minnesota Statutes, section 245.4904.
Grantees must use grant money as required in
Minnesota Statutes, section 245.4904,
subdivision 2.
new text end
new text begin
(b) Traditional Healing Grants. The base
shall include $2,000,000 in fiscal year 2025
to extend the traditional healing grant funding
appropriated in Laws 2019, chapter 63, article
3, section 1, paragraph (h), from the opiate
epidemic response account to the
commissioner of human services. This funding
is awarded to all Tribal nations and to five
urban Indian communities for traditional
healing practices to American Indians and to
increase the capacity of culturally specific
providers in the behavioral health workforce.
new text end
new text begin
(c) Base Level Adjustment. The opiate
epidemic response base is increased $100,000
in fiscal year 2025.
new text end
new text begin Subd. 25. new text end
new text begin
Direct Care and Treatment -
|
new text begin
-0- new text end |
new text begin
6,501,000 new text end |
||||
new text begin
Base Level Adjustment. The general fund
base is increased $5,267,000 in fiscal year
2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 26. new text end
new text begin
Technical Activities
|
new text begin
-0- new text end |
new text begin
-0- new text end |
||||
new text begin
(a) Transfers; Child Care and Development
Fund. For fiscal years 2024 and 2025, the base
shall include a transfer of $23,500,000 in fiscal
year 2024 and $23,500,000 in fiscal year 2025
from the TANF fund to the child care and
development fund. These are onetime
transfers.
new text end
new text begin
(b) Base Level Adjustment. The TANF base
is increased $23,500,000 in fiscal year 2024,
$23,500,000 in fiscal year 2025, and $0 in
fiscal year 2026.
new text end
Sec. 3. new text begin COMMISSIONER OF HEALTH
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
266,731,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
259,187,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
5,969,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
21,575,000 new text end |
new text begin Subd. 2. new text end
new text begin
Health Improvement
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
201,635,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
1,583,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
new text begin
21,575,000 new text end |
new text begin
(a) 988 National Suicide Prevention Lifeline.
$8,671,000 in fiscal year 2023 is from the
general fund for the 988 suicide prevention
lifeline in Minnesota Statutes, section 145.56.
Of this appropriation, $671,000 is for
administration and $8,000,000 is for grants.
new text end
new text begin
(b) Address Growing Health Care Costs.
new text end
new text begin
$2,476,000 in fiscal year 2023 is from the
general fund for initiatives aimed at addressing
growth in health care spending while ensuring
stability in rural health care programs. The
general fund base for this appropriation is
$3,057,000 in fiscal year 2024 and $3,057,000
in fiscal year 2025.
new text end
new text begin
(c)
new text end
new text begin
Community Health Workers.
new text end
new text begin
$1,462,000
in fiscal year 2023 is from the general fund
for a public health approach to developing
community health workers across Minnesota
under Minnesota Statutes, section 145.9282.
Of this appropriation, $462,000 is for
administration and $1,000,000 is for grants.
The general fund base for this appropriation
is $1,097,000 in fiscal year 2024, of which
$337,000 is for administration and $760,000
is for grants, and $1,098,000 in fiscal year
2025, of which $338,000 is for administration
and $760,000 is for grants.
new text end
new text begin
(d) Community Solutions for Healthy Child
Development. $10,000,000 in fiscal year 2023
is from the general fund for the community
solutions for the healthy child development
grant program under Minnesota Statutes,
section 145.9271. Of this appropriation,
$1,250,000 is for administration and
$8,750,000 is for grants. The general fund base
appropriation is $10,000,000 in fiscal year
2024 and $10,000,000 in fiscal year 2025, of
which $1,250,000 is for administration and
$8,750,000 is for grants in each fiscal year.
new text end
new text begin
(e) Disability as a Health Equity Issue.
$1,575,000 in fiscal year 2023 is from the
general fund to reduce disability-related health
disparities through collaboration and
coordination between state and community
partners under Minnesota Statutes, section
145.9283. Of this appropriation, $1,130,000
is for administration and $445,000 is for
grants. The general fund base for this
appropriation is $1,585,000 in fiscal year 2024
and $1,585,000 in fiscal year 2025, of which
$1,140,000 is for administration and $445,000
is for grants.
new text end
new text begin
(f) Drug Overdose and Substance Abuse
Prevention. $5,042,000 in fiscal year 2023 is
from the general fund for a public health
prevention approach to drug overdose and
substance use disorder in Minnesota Statutes,
section 144.8611. Of this appropriation,
$921,000 is for administration and $4,121,000
is for grants.
new text end
new text begin
(g) Healthy Beginnings, Healthy Families.
$11,700,000 in fiscal year 2023 is from the
general fund for Healthy Beginnings, Healthy
Families services under Minnesota Statutes,
section 145.987. The general fund base for
this appropriation is $11,818,000 in fiscal year
2024 and $11,763,000 in fiscal year 2025. Of
this appropriation:
new text end
new text begin
(1) $7,510,000 in fiscal year 2023 is for the
Minnesota Collaborative to Prevent Infant
Mortality under Minnesota Statutes, section
145.987, subdivisions 2, 3, and 4, of which
$1,535,000 is for administration and
$5,975,000 is for grants. The general fund base
for this appropriation is $7,501,000 in fiscal
year 2024, of which $1,526,000 is for
administration and $5,975,000 is for grants,
and $7,501,000 in fiscal year 2025, of which
$1,526,000 is for administration and
$5,975,000 is for grants.
new text end
new text begin
(2) $340,000 in fiscal year 2023 is for Help
Me Connect under Minnesota Statutes, section
145.987, subdivisions 5 and 6. The general
fund base for this appropriation is $663,000
in fiscal year 2024 and $663,000 in fiscal year
2025.
new text end
new text begin
(3) $1,940,000 in fiscal year 2023 is for
voluntary developmental and social-emotional
screening and follow-up under Minnesota
Statutes, section 145.987, subdivisions 7 and
8, of which $1,190,000 is for administration
and $750,000 is for grants. The general fund
base for this appropriation is $1,764,000 in
fiscal year 2024, of which $1,014,000 is for
administration and $750,000 is for grants, and
$1,764,000 in fiscal year 2025, of which
$1,014,000 is for administration and $750,000
is for grants.
new text end
new text begin
(4) $1,910,000 in fiscal year 2023 is for model
jail practices for incarcerated parents under
Minnesota Statutes, section 145.987,
subdivisions 9, 10, and 11, of which $485,000
is for administration and $1,425,000 is for
grants. The general fund base for this
appropriation is $1,890,000 in fiscal year
2024, of which $465,000 is for administration
and $1,425,000 is for grants, and $1,835,000
in fiscal year 2025, of which $410,000 is for
administration and $1,425,000 is for grants.
new text end
new text begin
(h) Home Visiting. $62,386,000 in fiscal year
2023 is from the general fund for universal,
voluntary home visiting services under
Minnesota Statutes, section 145.871. Of this
appropriation, up to seven percent is for
administration and at least 93 percent is for
implementation grants of home visiting
services to families. The general fund base for
this appropriation is $60,886,000 in fiscal year
2024 and $60,886,000 in fiscal year 2025.
new text end
new text begin
(i) Long COVID. $2,669,000 in fiscal year
2023 is from the general fund for a public
health approach to supporting long COVID
survivors under Minnesota Statutes, section
145.361. Of this appropriation, $2,119,000 is
for administration and $550,000 is for grants.
The base for this appropriation is $3,706,000
in fiscal year 2024 and $3,706,000 in fiscal
year 2025, of which $3,156,000 is for
administration and $550,000 is for grants in
each fiscal year.
new text end
new text begin
(j) Medical Education Research Cost
(MERC). Of the amount previously
appropriated in the general fund by Laws
2015, chapter 71, article 3, section 2, for the
MERC program, $150,000 in fiscal year 2023
and each year thereafter is for the
administration of grants under Minnesota
Statutes, section 62J.692.
new text end
new text begin
(k) No Surprises Act Enforcement. $964,000
in fiscal year 2023 is from the general fund
for implementation of the federal No Surprises
Act portion of the Consolidated
Appropriations Act, 2021, under Minnesota
Statutes, section 62Q.021, subdivision 3. The
general fund base for this appropriation is
$763,000 in fiscal year 2024 and $757,000 in
fiscal year 2025.
new text end
new text begin
(l) Public Health System Transformation.
$23,531,000 in fiscal year 2023 is from the
general fund for public health system
transformation. Of this appropriation:
new text end
new text begin
(1) $20,000,000 is for grants to community
health boards under Minnesota Statutes,
section 145A.131, subdivision 1, paragraph
(f).
new text end
new text begin
(2) $1,000,000 is for grants to Tribal
governments under Minnesota Statutes, section
145A.14, subdivision 2b.
new text end
new text begin
(3) $1,000,000 is for a public health
AmeriCorps program grant under Minnesota
Statutes, section 145.9292.
new text end
new text begin
(4) $1,531,000 is for the commissioner to
oversee and administer activities under this
paragraph.
new text end
new text begin
(m) Revitalize Health Care Workforce.
$21,575,000 in fiscal year 2023 is from the
health care access fund to address challenges
of Minnesota's health care workforce. Of this
appropriation:
new text end
new text begin
(1) $2,073,000 in fiscal year 2023 is for the
health professionals clinical training expansion
and rural and underserved clinical rotations
grant programs under Minnesota Statutes,
section 144.1505, of which $423,000 is for
administration and $1,650,000 is for grants.
Grant appropriations are available until
expended under Minnesota Statutes, section
144.1505, subdivision 2.
new text end
new text begin
(2) $4,507,000 in fiscal year 2023 is for the
primary care rural residency training grant
program under Minnesota Statutes, section
144.1507, of which $207,000 is for
administration and $4,300,000 is for grants.
Grant appropriations are available until
expended under Minnesota Statutes, section
144.1507, subdivision 2.
new text end
new text begin
(3) $430,000 in fiscal year 2023 is for the
international medical graduates assistance
program under Minnesota Statutes, section
144.1911, for international immigrant medical
graduates to fill a gap in their preparedness
for medical residencies or transition to a new
career making use of their medical degrees.
Of this appropriation, $55,000 is for
administration and $375,000 is for grants.
new text end
new text begin
(4) $12,565,000 in fiscal year 2023 is for a
grant program to health care systems,
hospitals, clinics, and other providers to ensure
the availability of clinical training for students,
residents, and graduate students to meet health
professions educational requirements under
Minnesota Statutes, section 144.1511, of
which $565,000 is for administration and
$12,000,000 is for grants.
new text end
new text begin
(5) $2,000,000 in fiscal year 2023 is for the
mental health cultural community continuing
education grant program, of which $460,000
is for administration and $1,540,000 is for
grants.
new text end
new text begin
(n) School Health. $837,000 in fiscal year
2023 is from the general fund for the School
Health Initiative under Minnesota Statutes,
section 145.988. The general fund base for
this appropriation is $3,462,000 in fiscal year
2024, of which $1,212,000 is for
administration and $2,250,000 is for grants
and $3,287,000 in fiscal year 2025, of which
$1,037,000 is for administration and
$2,250,000 is for grants.
new text end
new text begin
(o) Trauma System. $61,000 in fiscal year
2023 is from the general fund to administer
the trauma care system throughout the state
under Minnesota Statutes, sections 144.602,
144.603, 144.604, 144.606, and 144.608.
$430,000 in fiscal year 2023 is from the state
government special revenue fund for trauma
designations according to Minnesota Statutes,
sections 144.122, paragraph (g), 144.605, and
144.6071.
new text end
new text begin
(p) Mental Health Providers; Loan
Forgiveness, Grants, Information
Clearinghouse. $4,275,000 in fiscal year 2023
is from the general fund for activities to
increase the number of mental health
professionals in the state. Of this
appropriation:
new text end
new text begin
(1) $1,000,000 is for loan forgiveness under
the health professional education loan
forgiveness program under Minnesota Statutes,
section 144.1501, notwithstanding the
priorities and distribution requirements in that
section, for eligible mental health
professionals who provide clinical supervision
in their designated field;
new text end
new text begin
(2) $3,000,000 is for the mental health
provider supervision grant program under
Minnesota Statutes, section 144.1508;
new text end
new text begin
(3) $250,000 is for the mental health
professional scholarship grant program under
Minnesota Statutes, section 144.1509; and
new text end
new text begin
(4) $25,000 is for the commissioner to
establish and maintain a website to serve as
an information clearinghouse for mental health
professionals and individuals seeking to
qualify as a mental health professional. The
website must contain information on the
various master's level programs to become a
mental health professional, requirements for
supervision, where to find supervision, how
to access tools to study for the applicable
licensing examination, links to loan
forgiveness programs and tuition
reimbursement programs, and other topics of
use to individuals seeking to become a mental
health professional. This is a onetime
appropriation.
new text end
new text begin
(q) Palliative Care Advisory Council.
$44,000 in fiscal year 2023 is from the general
fund for the Palliative Care Advisory Council
under Minnesota Statutes, section 144.059.
new text end
new text begin
(r) Emmett Louis Till Victims Recovery
Program. $500,000 in fiscal year 2023 is from
the general fund for the Emmett Louis Till
Victims Recovery Program. This is a onetime
appropriation and is available until June 30,
2024.
new text end
new text begin
(s) Study; POLST Forms. $292,000 in fiscal
year 2023 is from the general fund for the
commissioner to study the creation of a
statewide registry of provider orders for
life-sustaining treatment and issue a report and
recommendations.
new text end
new text begin
(t) Benefit and Cost Analysis of Universal
Health Reform Proposal. $461,000 in fiscal
year 2023 is from the general fund for an
analysis of the benefits and costs of a universal
health care financing system and a similar
analysis of the current health care financing
system. Of this appropriation, $250,000 is for
a contract with the University of Minnesota
School of Public Health and the Carlson
School of Management. The general fund base
for this appropriation is $288,000 in fiscal year
2024, of which $250,000 is for a contract with
the University of Minnesota School of Public
Health and the Carlson School of
Management, and $0 in fiscal year 2025.
new text end
new text begin
(u) Technical Assistance; Health Care
Trends and Costs. $2,506,000 in fiscal year
2023 is from the general fund for technical
assistance to the Health Care Affordability
Board in analyzing health care trends and costs
and setting health care spending growth
targets. The general fund base for this
appropriation is $2,753,000 in fiscal year 2024
and $2,694,000 in fiscal year 2025.
new text end
new text begin
(v) Sexual Exploitation and Trafficking
Study. $300,000 in fiscal year 2023 is to fund
a prevalence study on youth and adult victim
survivors of sexual exploitation and
trafficking. This is a onetime appropriation
and is available until June 30, 2024.
new text end
new text begin
(w) Local and Tribal Public Health
Emergency Preparedness and Response.
$9,000,000 in fiscal year 2023 is from the
general fund for distribution to local and Tribal
public health organizations for emergency
preparedness and response capabilities. At
least 90 percent of this appropriation must be
distributed to local and Tribal public health
organizations, and up to ten percent of this
appropriation may be used by the
commissioner for administrative costs. Use of
this appropriation must align with the Centers
for Disease Control and Prevention's issued
report: Public Health Emergency Preparedness
and Response Capabilities: National Standards
for State, Local, Tribal, and Territorial Public
Health.
new text end
new text begin
(x) Loan Forgiveness for Nursing
Instructors. Notwithstanding the priorities
and distribution requirements in Minnesota
Statutes, section 144.1501, $50,000 in fiscal
year 2023 is from the general fund for loan
forgiveness under the health professional
education loan forgiveness program under
Minnesota Statutes, section 144.1501, for
eligible nurses who agree to teach.
new text end
new text begin
(y) Mental Health of Health Care Workers.
$1,000,000 in fiscal year 2023 is from the
general fund for competitive grants to
hospitals, community health centers, rural
health clinics, and medical professional
associations to establish or enhance
evidence-based or evidence-informed
programs dedicated to improving the mental
health of health care professionals.
new text end
new text begin
(z) Prevention of Violence in Health Care.
$50,000 in fiscal year 2023 is from the general
fund to continue the prevention of violence in
health care programs and to create violence
prevention resources for hospitals and other
health care providers to use to train their staff
on violence prevention.
new text end
new text begin
(aa) Hospital Nursing Loan Forgiveness.
$5,000,000 in fiscal year 2023 is from the
general fund for the hospital nursing loan
forgiveness program under Minnesota Statutes,
section 144.1504.
new text end
new text begin
(bb) Program to Distribute COVID-19
Tests, Masks, and Respirators. $15,000,000
in fiscal year 2023 is from the general fund
for a program to distribute COVID-19 tests,
masks, and respirators to individuals in the
state. This is a onetime appropriation.
new text end
new text begin
(cc) Safe Harbor Grants. $1,000,000 in fiscal
year 2023 is for grants to fund supportive
services, including but not limited to legal
services, mental health therapy, substance use
disorder counseling, and case management for
sexually exploited youth or youth at risk of
sexual exploitation under Minnesota Statutes,
section 145.4716.
new text end
new text begin
(dd) Dignity in Pregnancy and Childbirth
Act. $50,000 in fiscal year 2023 is from the
general fund for hosting and maintaining a
continuing education curriculum and course
under Minnesota Statutes, section 144.1461.
new text end
new text begin
(ee) Base Level Adjustments. The general
fund base is increased $186,852,000 in fiscal
year 2024 and $186,270,000 in fiscal year
2025. The state government special revenue
fund base is increased $1,373,000 in fiscal
year 2024 and $1,373,000 in fiscal year 2025.
new text end
new text begin Subd. 3. new text end
new text begin
Health Protection
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
-0- new text end |
new text begin
57,552,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
4,386,000 new text end |
new text begin
(a) Climate Resiliency. $1,977,000 in fiscal
year 2023 is from the general fund for climate
resiliency actions under Minnesota Statutes,
section 144.9981. Of this appropriation,
$977,000 is for administration and $1,000,000
is for grants. The general fund base for this
appropriation is $988,000 in fiscal year 2024,
of which $888,000 is for administration and
$100,000 is for grants, and $989,000 in fiscal
year 2025, of which $889,000 is for
administration and $100,000 is for grants.
new text end
new text begin
(b) Lead Testing and Remediation Grant
Program; Schools, Child Care Centers,
Family Child Care Providers. $3,054,000
in fiscal year 2023 is from the general fund
for a lead testing and remediation grant
program for schools, licensed child care
centers, and licensed family child care
providers under Minnesota Statutes, section
145.9272. Of this appropriation, $454,000 is
for administration and $2,600,000 is for
grants. The general fund base for this
appropriation is $2,540,000 in fiscal year
2024, of which $370,000 is for administration
and $2,170,000 is for grants, and $2,540,000
in fiscal year 2025, of which $371,000 is for
administration and $2,710,000 is for grants.
new text end
new text begin
(c) Lead Service Line Inventory. $4,029,000
in fiscal year 2023 is from the general fund
for grants to public water suppliers to complete
a lead service line inventory of their
distribution systems under Minnesota Statutes,
section 144.383, clause (6). Of this
appropriation, $279,000 is for administration
and $3,750,000 is for grants. The general fund
base for this appropriation is $4,029,000 in
fiscal year 2024, of which $279,000 is for
administration and $3,750,000 is for grants,
and $140,000 in fiscal year 2025, which is for
administration.
new text end
new text begin
(d) Lead Service Line Replacement.
$5,000,000 in fiscal year 2023 is from the
general fund for administrative costs related
to the replacement of lead service lines in the
state.
new text end
new text begin
(e) Reports and Posting; School Test Results
and Remediation for Lead in Drinking
Water. $249,000 in fiscal year 2023 is from
the general fund for the commissioner to
accept, post on the department website, and
annually update reports from schools of test
results for the presence of lead in drinking
water and remediation efforts according to
Minnesota Statutes, section 145.9274. The
general fund base for this appropriation is
$175,000 in fiscal year 2024 and $175,000 in
fiscal year 2025.
new text end
new text begin
(f) Grants to Local Public Health
Departments. $16,172,000 in fiscal year 2023
is from the general fund for grants to local
public health departments for public health
response related to defining elevated blood
lead level as 3.5 micrograms of lead or greater
per deciliter of whole blood. Of this amount,
$172,000 is available to the commissioner for
administrative costs. This appropriation is
available until June 30, 2025. The general fund
base for this appropriation is $5,000,000 in
fiscal year 2024 and $5,000,000 in fiscal year
2025.
new text end
new text begin
(g) Mercury in Skin-Lightening Products
Grants. $100,000 in fiscal year 2023 is from
the general fund for a skin-lightening products
public awareness and education grant program
under Minnesota Statutes, section 145.9275.
new text end
new text begin
(h) HIV Prevention for People Experiencing
Homelessness. $1,129,000 in fiscal year 2023
is from the general fund for expanding access
to harm reduction services and improving
linkages to care to prevent HIV/AIDS,
hepatitis, and other infectious diseases for
those experiencing homelessness or housing
instability under Minnesota Statutes, section
145.924, paragraph (d). Of this appropriation,
$169,000 is for administration and $960,000
is for grants.
new text end
new text begin
(i) Safety Improvements for State-Licensed
Long-Term Care Facilities. $5,500,000 in
fiscal year 2023 is from the general fund for
a temporary grant program for safety
improvements for state-licensed long-term
care facilities. Of this appropriation, $500,000
is for administration and $5,000,000 is for
grants. The general fund base for this
appropriation is $8,200,000 in fiscal year 2024
and $0 in fiscal year 2025. Of this
appropriation in fiscal year 2024, $700,000 is
for administration and $7,500,000 is for
grants. This appropriation is available until
June 30, 2025.
new text end
new text begin
(j) Mortuary Science. $219,000 in fiscal year
2023 is from the state government special
revenue fund for regulation of transfer care
specialists under Minnesota Statutes, chapter
149A, and for additional reporting
requirements under Minnesota Statutes,
section 149A.94. The state government special
revenue fund base for this appropriation is
$132,000 in fiscal year 2024 and $61,000 in
fiscal year 2025.
new text end
new text begin
(k) Public Health Response Contingency
Account. $20,000,000 in fiscal year 2023 is
from the general fund for transfer to the public
health response contingency account under
Minnesota Statutes, section 144.4199. This is
a onetime transfer.
new text end
new text begin
(l) Base Level Adjustments. The general fund
base is increased $22,444,000 in fiscal year
2024 and $10,239,000 in fiscal year 2025. The
state government special revenue fund base is
increased $4,299,000 in fiscal year 2024 and
$4,228,000 in fiscal year 2025.
new text end
Sec. 4. new text begin HEALTH-RELATED BOARDS
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
203,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
-0- new text end |
new text begin
175,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
-0- new text end |
new text begin
28,000 new text end |
new text begin
This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Board of Dentistry
|
new text begin
-0- new text end |
new text begin
3,000 new text end |
||||
new text begin Subd. 3. new text end
new text begin
Board of Dietetics and Nutrition
|
new text begin
-0- new text end |
new text begin
25,000 new text end |
||||
new text begin Subd. 4. new text end
new text begin
Board of Pharmacy
|
new text begin
-0- new text end |
new text begin
175,000 new text end |
||||
new text begin
This appropriation is from the general fund.
new text end
new text begin
Medication repository program.
new text end
new text begin
$175,000
in fiscal year 2023 is for transfer by the Board
of Pharmacy to the central repository to be
used to administer the medication repository
program according to the contract between the
central repository and the Board of Pharmacy.
new text end
Sec. 5. new text begin COUNCIL ON DISABILITY
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
375,000 new text end |
||
Sec. 6. new text begin OMBUDSMAN FOR MENTAL
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
189,000 new text end |
||
new text begin
Community Residential Setting Closures.
new text end
new text begin
$189,000 in fiscal year 2023 is for staffing
related to community residential setting
closures. The base for this appropriation is
$211,000 in fiscal year 2024 and $211,000 in
fiscal year 2025.
new text end
Sec. 7. new text begin EMERGENCY MEDICAL SERVICES
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
200,000 new text end |
||
new text begin
This is a onetime appropriation.
new text end
Sec. 8. new text begin BOARD OF DIRECTORS OF MNSURE
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
7,775,000 new text end |
||
new text begin
This appropriation may be transferred to the
MNsure account established in Minnesota
Statutes, section 62V.07.
new text end
new text begin
Base Adjustment. The general fund base for
this appropriation is $10,982,000 in fiscal year
2024, $6,450,000 in fiscal year 2025, and $0
in fiscal year 2026.
new text end
Sec. 9. new text begin HEALTH CARE AFFORDABILITY
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
1,070,000 new text end |
||
new text begin
(a) Health Care Affordability Board.
$1,070,000 in fiscal year 2023 is for the Health
Care Affordability Board to implement
Minnesota Statutes, sections 62J.86 to 62J.72.
new text end
new text begin
(b)
new text end
new text begin
Base Level Adjustment. The general fund
base is increased $1,417,000 in fiscal year
2024 and $1,485,000 in fiscal year 2025.
new text end
Sec. 10. new text begin COMMISSIONER OF COMMERCE
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
251,000 new text end |
||
new text begin
(a) Prescription Drug Affordability Board.
$197,000 in fiscal year 2023 is for the
commissioner of commerce to establish the
Prescription Drug Affordability Board under
Minnesota Statutes, section 62J.87, and for
the Prescription Drug Affordability Board to
implement the Prescription Drug Affordability
Act. Following the first meeting of the board
and prior to June 30, 2023, the commissioner
of commerce shall transfer any funds
remaining from this appropriation to the board.
The base for this appropriation is $357,000 in
fiscal year 2024 and $357,000 in fiscal year
2025.
new text end
new text begin
(b) Ectodermal Dysplasias. $54,000 in fiscal
year 2023 is for costs related to insurance
coverage of ectodermal dysplasias. The base
for this appropriation is $58,000 in fiscal year
2024 and $62,000 in fiscal year 2025.
new text end
Sec. 11. new text begin COMMISSIONER OF LABOR AND
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
641,000 new text end |
||
new text begin
Nursing Home Workforce Standards
Board. $641,000 in fiscal year 2023 is for
establishment and operation of the Nursing
Home Workforce Standards Board in
Minnesota Statutes, sections 181.211 to
181.217. The base for this appropriation is
$322,000 in fiscal year 2024 and $368,000 in
fiscal year 2025.
new text end
Sec. 12. new text begin ATTORNEY GENERAL
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
456,000 new text end |
||
new text begin
(a) Expert Witnesses. $200,000 in fiscal year
2023 is for expert witnesses and investigations
under Minnesota Statutes, section 62J.844.
This is a onetime appropriation.
new text end
new text begin
(b) Prescription Drug Enforcement.
$256,000 in fiscal year 2023 is for prescription
drug enforcement. This is a onetime
appropriation.
new text end
Sec. 13. new text begin COMMISSIONER OF EDUCATION
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
264,000 new text end |
||
new text begin
Information Technology and Data Sharing
Projects for Early Childhood Programs.
$264,000 in fiscal year 2023 is for staff and
costs related to the information technology
project and the data sharing project for
programs impacting early childhood. The base
for this appropriation is $503,000 in fiscal year
2024 and $493,000 in fiscal year 2025.
new text end
Sec. 14. new text begin COMMISSIONER OF INFORMATION
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
6,441,000 new text end |
||
new text begin
Information Technology Project for Early
Childhood Programs. $6,441,000 in fiscal
year 2023 is for staff and costs related to the
information technology project for programs
impacting early childhood. This is a onetime
appropriation and is available until June 30,
2027.
new text end
Sec. 15. new text begin COMMISSIONER OF
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
492,000 new text end |
||
new text begin
Information Technology and Data Sharing
Projects for Early Childhood Programs.
$492,000 in fiscal year 2023 is for the
commissioner of management and budget to:
(1) identify any state or federal statutes or
administrative rules and practices that prevent
or complicate data sharing among child care
and early learning programs administered by
the Departments of Education and Human
Services and other departments with programs
impacting early childhood as identified by the
Children's Cabinet; (2) support ongoing efforts
to address any barriers to data sharing; and (3)
support work related to the information
technology modernization project for
programs impacting early childhood. The
commissioner of management and budget must
consult with the commissioners of education,
human services, and information technology
services; the Children's Cabinet; and other
stakeholders. The commissioner of
management and budget must report
preliminary findings to the legislative
committees with jurisdiction over early
childhood programs by February 1, 2023, and
make a final report by February 1, 2024. The
base for this appropriation is $192,000 in fiscal
year 2024 and $97,000 in fiscal year 2025.
new text end
Sec. 16. new text begin COMMISSIONER OF EMPLOYMENT
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
255,000 new text end |
||
new text begin
Early Childhood Education Workforce
Study. $255,000 in fiscal year 2023 is for a
study on the early childhood education
workforce in Minnesota. The study must
provide a consolidated report of current data
on the makeup of the early childhood
education workforce, including those working
in certified and licensed child care centers and
family child care homes, Early Head Start and
Head Start programs, and school-based
programs, including early childhood special
education; wages, income, and benefits in the
industry; and barriers to entering these careers
or retaining workers in the field, along with
information on any other relevant issues
identified during the research process. At a
minimum, the study must replicate the data
points published in the study funded by the
Department of Human Services titled Child
Care Workforce in Minnesota: 2011 Statewide
Study of Demographics, Training and
Professional Development. The study must be
completed within 18 months, and the
commissioner may contract with another
organization to complete the study. This is a
onetime appropriation and is available until
December 30, 2023.
new text end
Sec. 17.
Laws 2021, First Special Session chapter 2, article 1, section 4, subdivision 2, is
amended to read:
Subd. 2.Operations and Maintenance
|
621,968,000 |
621,968,000 |
||||
(a) $15,000,000 in fiscal year 2022 and
$15,000,000 in fiscal year 2023 are to: (1)
increase the medical school's research
capacity; (2) improve the medical school's
ranking in National Institutes of Health
funding; (3) ensure the medical school's
national prominence by attracting and
retaining world-class faculty, staff, and
students; (4) invest in physician training
programs in rural and underserved
communities; and (5) translate the medical
school's research discoveries into new
treatments and cures to improve the health of
Minnesotans.
(b) $7,800,000 in fiscal year 2022 and
$7,800,000 in fiscal year 2023 are for health
training restoration. This appropriation must
be used to support all of the following: (1)
faculty physicians who teach at eight residency
program sites, including medical resident and
student training programs in the Department
of Family Medicine; (2) the Mobile Dental
Clinic; and (3) expansion of geriatric
education and family programs.
(c) $4,000,000 in fiscal year 2022 and
$4,000,000 in fiscal year 2023 are for the
Minnesota Discovery, Research, and
InnoVation Economy funding program for
cancer care research.
(d) $500,000 in fiscal year 2022 and $500,000
in fiscal year 2023 are for the University of
Minnesota, Morris branch, to cover the costs
of tuition waivers under Minnesota Statutes,
section 137.16.
(e) $150,000 in fiscal year 2022 and $150,000
in fiscal year 2023 are for the Chloe Barnes
Advisory Council on Rare Diseases under
Minnesota Statutes, section 137.68. new text begin The fiscal
year 2023 appropriation shall be transferred
to the Council on Disability. new text end The base for this
appropriation is $0 in fiscal year 2024 and
later.
(f) The total operations and maintenance base
for fiscal year 2024 and later is $620,818,000.
Sec. 18. new text begin APPROPRIATIONS FOR ADVISORY COUNCIL ON RARE DISEASES.
new text end
new text begin
In accordance with Minnesota Statutes, section 15.039, subdivision 6, the unexpended
balance of money appropriated from the general fund to the Board of Regents of the
University of Minnesota for purposes of the advisory council on rare diseases under
Minnesota Statutes, section 137.68, shall be under control of the Minnesota Rare Disease
Advisory Council and the Council on Disability.
new text end
Sec. 19. new text begin APPROPRIATION ENACTED MORE THAN ONCE.
new text end
new text begin
If an appropriation is enacted more than once in the 2022 legislative session, the
appropriation must be given effect only once.
new text end
Sec. 20. new text begin SUNSET OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2023, unless a
different effective date is explicit.
new text end
Sec. 21. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective the day following final enactment.
new text end
APPENDIX
Repealed Minnesota Statutes: UES4410-2
119B.03 BASIC SLIDING FEE PROGRAM.
Subd. 4.
Funding priority.
(a) First priority for child care assistance under the basic sliding fee program must be given to eligible non-MFIP families who do not have a high school diploma or commissioner of education-selected high school equivalency certification or who need remedial and basic skill courses in order to pursue employment or to pursue education leading to employment and who need child care assistance to participate in the education program. This includes student parents as defined under section 119B.011, subdivision 19b. Within this priority, the following subpriorities must be used:
(1) child care needs of minor parents;
(2) child care needs of parents under 21 years of age; and
(3) child care needs of other parents within the priority group described in this paragraph.
(b) Second priority must be given to parents who have completed their MFIP or DWP transition year, or parents who are no longer receiving or eligible for diversionary work program supports.
(c) Third priority must be given to families who are eligible for portable basic sliding fee assistance through the portability pool under subdivision 9.
(d) Fourth priority must be given to families in which at least one parent is a veteran as defined under section 197.447.
(e) Families under paragraph (b) must be added to the basic sliding fee waiting list on the date they begin the transition year under section 119B.011, subdivision 20, and must be moved into the basic sliding fee program as soon as possible after they complete their transition year.
144G.07 RETALIATION PROHIBITED.
Subd. 6.
Other laws.
Nothing in this section affects the rights and remedies available under section 626.557, subdivisions 10, 17, and 20.
150A.091 FEES.
Subd. 3.
Initial license or permit fees.
Along with the application fee, each of the following applicants shall submit a separate initial license or permit fee. The initial fee shall be established by the board not to exceed the following nonrefundable fee amounts:
(1) dentist or full faculty dentist, $168;
(2) dental therapist, $120;
(3) dental hygienist, $60;
(4) licensed dental assistant, $36; and
(5) dental assistant with a permit as described in Minnesota Rules, part 3100.8500, subpart 3, $12.
Subd. 15.
Verification of licensure.
Each institution or corporation shall submit with a request for verification of a license a fee in the amount of $5 for each license to be verified.
Subd. 17.
Advanced dental therapy examination fee.
Any dental therapist eligible to sit for the advanced dental therapy certification examination must submit with the application a fee as established by the board, not to exceed $250.
169A.70 ALCOHOL SAFETY PROGRAMS; CHEMICAL USE ASSESSMENTS.
Subd. 6.
Method of assessment.
(a) As used in this subdivision, "collateral contact" means an oral or written communication initiated by an assessor for the purpose of gathering information from an individual or agency, other than the offender, to verify or supplement information provided by the offender during an assessment under this section. The term includes contacts with family members and criminal justice agencies.
(b) An assessment conducted under this section must include at least one personal interview with the offender designed to make a determination about the extent of the offender's past and present chemical and alcohol use or abuse. It must also include collateral contacts and a review of relevant records or reports regarding the offender including, but not limited to, police reports, arrest reports, driving records, chemical testing records, and test refusal records. If the offender has a probation officer, the officer must be the subject of a collateral contact under this subdivision. If an assessor is unable to make collateral contacts, the assessor shall specify why collateral contacts were not made.
245A.03 WHO MUST BE LICENSED.
Subd. 5.
Excluded housing with services programs; right to seek licensure.
Nothing in this section shall prohibit a housing with services program that is excluded from licensure under subdivision 2, paragraph (a), clause (25), from seeking a license under this chapter. The commissioner shall ensure that any application received from such an excluded provider is processed in the same manner as all other applications for licensed adult foster care.
245F.15 STAFF QUALIFICATIONS.
Subd. 2.
Continuing employment; no substance use problems.
License holders must require staff to be free from substance use problems as a condition of continuing employment. Staff are not required to sign statements attesting to their freedom from substance use problems after the initial statement required by subdivision 1. Staff with substance use problems must be immediately removed from any responsibilities that include direct patient contact.
245G.11 STAFF QUALIFICATIONS.
Subd. 2.
Employment; prohibition on problematic substance use.
A staff member with direct contact must be free from problematic substance use as a condition of employment, but is not required to sign additional statements. A staff member with direct contact who is not free from problematic substance use must be removed from any responsibilities that include direct contact for the time period specified in subdivision 1. The time period begins to run on the date of the last incident of problematic substance use as described in the facility's policies and procedures according to section 245G.13, subdivision 1, clause (5).
245G.22 OPIOID TREATMENT PROGRAMS.
Subd. 19.
Placing authorities.
A program must provide certain notification and client-specific updates to placing authorities for a client who is enrolled in Minnesota health care programs. At the request of the placing authority, the program must provide client-specific updates, including but not limited to informing the placing authority of positive drug testings and changes in medications used for the treatment of opioid use disorder ordered for the client.
246.0136 ESTABLISHING ENTERPRISE ACTIVITIES IN STATE-OPERATED SERVICES.
Subdivision 1.
Planning for enterprise activities.
The commissioner of human services is directed to study and make recommendations to the legislature on establishing enterprise activities within state-operated services. Before implementing an enterprise activity, the commissioner must obtain statutory authorization for its implementation, except that the commissioner has authority to implement enterprise activities for adult mental health, adolescent services, and to establish a public group practice without statutory authorization. Enterprise activities are defined as the range of services, which are delivered by state employees, needed by people with disabilities and are fully funded by public or private third-party health insurance or other revenue sources available to clients that provide reimbursement for the services provided. Enterprise activities within state-operated services shall specialize in caring for vulnerable people for whom no other providers are available or for whom state-operated services may be the provider selected by the payer. In subsequent biennia after an enterprise activity is established within a state-operated service, the base state appropriation for that state-operated service shall be reduced proportionate to the size of the enterprise activity.
Subd. 2.
Required components of any proposal; considerations.
In any proposal for an enterprise activity brought to the legislature by the commissioner, the commissioner must demonstrate that there is public or private third-party health insurance or other revenue available to the people served, that the anticipated revenues to be collected will fully fund the services, that there will be sufficient funds for cash flow purposes, and that access to services by vulnerable populations served by state-operated services will not be limited by implementation of an enterprise activity. In studying the feasibility of establishing an enterprise activity, the commissioner must consider:
(1) creating public or private partnerships to facilitate client access to needed services;
(2) administrative simplification and efficiencies throughout the state-operated services system;
(3) converting or disposing of buildings not utilized and surplus lands; and
(4) exploring the efficiencies and benefits of establishing state-operated services as an independent state agency.
252.025 STATE HOSPITALS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES.
Subd. 7.
Minnesota extended treatment options.
The commissioner shall develop by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have developmental disabilities and exhibit severe behaviors which present a risk to public safety. This program is statewide and must provide specialized residential services in Cambridge and an array of community-based services with sufficient levels of care and a sufficient number of specialists to ensure that individuals referred to the program receive the appropriate care. The individuals working in the community-based services under this section are state employees supervised by the commissioner of human services. No layoffs shall occur as a result of restructuring under this section.
252.035 REGIONAL TREATMENT CENTER CATCHMENT AREAS.
The commissioner may administratively designate catchment areas for regional treatment centers and state nursing homes. Catchment areas may vary by client group served. Catchment areas in effect on January 1, 1989, may not be modified until the commissioner has consulted with the regional planning committees of the affected regional treatment centers.
254A.02 DEFINITIONS.
Subd. 8a.
Placing authority.
"Placing authority" means a county, prepaid health plan, or tribal governing board governed by Minnesota Rules, parts 9530.6600 to 9530.6655.
254A.04 CITIZENS ADVISORY COUNCIL.
There is hereby created an Alcohol and Other Drug Abuse Advisory Council to advise the Department of Human Services concerning the problems of substance misuse and substance use disorder, composed of ten members. Five members shall be individuals whose interests or training are in the field of alcohol-specific substance use disorder and alcohol misuse; and five members whose interests or training are in the field of substance use disorder and misuse of substances other than alcohol. The terms, compensation and removal of members shall be as provided in section 15.059. The council expires June 30, 2018. The commissioner of human services shall appoint members whose terms end in even-numbered years. The commissioner of health shall appoint members whose terms end in odd-numbered years.
254A.16 RESPONSIBILITIES OF THE COMMISSIONER.
Subd. 6.
Monitoring.
The commissioner shall gather and placing authorities shall provide information to measure compliance with Minnesota Rules, parts 9530.6600 to 9530.6655. The commissioner shall specify the format for data collection to facilitate tracking, aggregating, and using the information.
254A.19 CHEMICAL USE ASSESSMENTS.
Subd. 1a.
Emergency room patients.
A county may enter into a contract with a hospital to provide chemical use assessments under Minnesota Rules, parts 9530.6600 to 9530.6655, for patients admitted to an emergency room or inpatient hospital when:
(1) an assessor is not available; and
(2) detoxification services in the county are at full capacity.
Subd. 2.
Probation officer as contact.
When a chemical use assessment is required under Minnesota Rules, parts 9530.6600 to 9530.6655, for a person who is on probation or under other correctional supervision, the assessor, either orally or in writing, shall contact the person's probation officer to verify or supplement the information provided by the person.
Subd. 5.
Assessment via telehealth.
Notwithstanding Minnesota Rules, part 9530.6615, subpart 3, item A, a chemical use assessment may be conducted via telehealth as defined in section 256B.0625, subdivision 3b.
254B.04 ELIGIBILITY FOR BEHAVIORAL HEALTH FUND SERVICES.
Subd. 2b.
Eligibility for placement in opioid treatment programs.
Prior to placement of an individual who is determined by the assessor to require treatment for opioid addiction, the assessor must provide educational information concerning treatment options for opioid addiction, including the use of a medication for the use of opioid addiction. The commissioner shall develop educational materials supported by research and updated periodically that must be used by assessors to comply with this requirement.
Subd. 2c.
Eligibility to receive peer recovery support and treatment service coordination.
Notwithstanding Minnesota Rules, part 9530.6620, subpart 6, a placing authority may authorize peer recovery support and treatment service coordination for a person who scores a severity of one or more in dimension 4, 5, or 6, under Minnesota Rules, part 9530.6622. Authorization for peer recovery support and treatment service coordination under this subdivision does not need to be provided in conjunction with treatment services under Minnesota Rules, part 9530.6622, subpart 4, 5, or 6.
254B.041 CHEMICAL DEPENDENCY RULES.
Subd. 2.
Vendor collections; rule amendment.
The commissioner may amend Minnesota Rules, parts 9530.7000 to 9530.7025, to require a vendor of chemical dependency transitional and extended care rehabilitation services to collect the cost of care received under a program from an eligible person who has been determined to be partially responsible for treatment costs, and to remit the collections to the commissioner. The commissioner shall pay to a vendor, for the collections, an amount equal to five percent of the collections remitted to the commissioner by the vendor.
254B.14 CONTINUUM OF CARE PILOT PROJECTS; CHEMICAL HEALTH CARE.
Subdivision 1.
Authorization for continuum of care pilot projects.
The commissioner shall establish chemical dependency continuum of care pilot projects to begin implementing the measures developed with stakeholder input and identified in the report completed pursuant to Laws 2012, chapter 247, article 5, section 8. The pilot projects are intended to improve the effectiveness and efficiency of the service continuum for chemically dependent individuals in Minnesota while reducing duplication of efforts and promoting scientifically supported practices.
Subd. 2.
Program implementation.
(a) The commissioner, in coordination with representatives of the Minnesota Association of County Social Service Administrators and the Minnesota Inter-County Association, shall develop a process for identifying and selecting interested counties and providers for participation in the continuum of care pilot projects. There shall be three pilot projects: one representing the northern region, one for the metro region, and one for the southern region. The selection process of counties and providers must include consideration of population size, geographic distribution, cultural and racial demographics, and provider accessibility. The commissioner shall identify counties and providers that are selected for participation in the continuum of care pilot projects no later than September 30, 2013.
(b) The commissioner and entities participating in the continuum of care pilot projects shall enter into agreements governing the operation of the continuum of care pilot projects. The agreements shall identify pilot project outcomes and include timelines for implementation and beginning operation of the pilot projects.
(c) Entities that are currently participating in the navigator pilot project are eligible to participate in the continuum of care pilot project subsequent to or instead of participating in the navigator pilot project.
(d) The commissioner may waive administrative rule requirements that are incompatible with implementation of the continuum of care pilot projects.
(e) Notwithstanding section 254A.19, the commissioner may designate noncounty entities to complete chemical use assessments and placement authorizations required under section 254A.19 and Minnesota Rules, parts 9530.6600 to 9530.6655. Section 254A.19, subdivision 3, is applicable to the continuum of care pilot projects at the discretion of the commissioner.
Subd. 3.
Program design.
(a) The operation of the pilot projects shall include:
(1) new services that are responsive to the chronic nature of substance use disorder;
(2) telehealth services, when appropriate to address barriers to services;
(3) services that assure integration with the mental health delivery system when appropriate;
(4) services that address the needs of diverse populations; and
(5) an assessment and access process that permits clients to present directly to a service provider for a substance use disorder assessment and authorization of services.
(b) Prior to implementation of the continuum of care pilot projects, a utilization review process must be developed and agreed to by the commissioner, participating counties, and providers. The utilization review process shall be described in the agreements governing operation of the continuum of care pilot projects.
Subd. 4.
Notice of project discontinuation.
Each entity's participation in the continuum of care pilot project may be discontinued for any reason by the county or the commissioner after 30 days' written notice to the entity.
Subd. 5.
Duties of commissioner.
(a) Notwithstanding any other provisions in this chapter, the commissioner may authorize the behavioral health fund to pay for nontreatment services arranged by continuum of care pilot projects. Individuals who are currently accessing Rule 31 treatment services are eligible for concurrent participation in the continuum of care pilot projects.
(b) County expenditures for continuum of care pilot project services shall not be greater than their expected share of forecasted expenditures in the absence of the continuum of care pilot projects.
Subd. 6.
Managed care.
An individual who is eligible for the continuum of care pilot project is excluded from mandatory enrollment in managed care unless these services are included in the health plan's benefit set.
256B.057 ELIGIBILITY REQUIREMENTS FOR SPECIAL CATEGORIES.
Subd. 7.
Waiver of maintenance of effort requirement.
Unless a federal waiver of the maintenance of effort requirement of section 2105(d) of title XXI of the Balanced Budget Act of 1997, Public Law 105-33, Statutes at Large, volume 111, page 251, is granted by the federal Department of Health and Human Services by September 30, 1998, eligibility for children under age 21 must be determined without regard to asset standards established in section 256B.056, subdivision 3c. The commissioner of human services shall publish a notice in the State Register upon receipt of a federal waiver.
256B.063 COST SHARING.
Notwithstanding the provisions of section 256B.05, subdivision 2, the commissioner is authorized to promulgate rules pursuant to the Administrative Procedure Act, and to require a nominal enrollment fee, premium, or similar charge for recipients of medical assistance, if and to the extent required by applicable federal regulation.
256B.69 PREPAID HEALTH PLANS.
Subd. 20.
Ombudsperson.
The commissioner shall designate an ombudsperson to advocate for persons required to enroll in prepaid health plans under this section. The ombudsperson shall advocate for recipients enrolled in prepaid health plans through complaint and appeal procedures and ensure that necessary medical services are provided either by the prepaid health plan directly or by referral to appropriate social services. At the time of enrollment in a prepaid health plan, the local agency shall inform recipients about the ombudsperson program and their right to a resolution of a complaint by the prepaid health plan if they experience a problem with the plan or its providers.
256D.055 COUNTY DESIGN; WORK FOCUS PROGRAM.
The commissioner of human services shall issue a request for proposals from counties to submit a plan for developing and implementing a county-designed program. The plan shall be for first-time applicants for the Minnesota family investment program and must emphasize the importance of becoming employed and oriented into the work force in order to become self-sufficient. The plan must target public assistance applicants who are most likely to become self-sufficient quickly with short-term assistance or services such as child care, child support enforcement, or employment and training services.
The plan may include vendor payments, mandatory job search, refocusing existing county or provider efforts, or other program features. The commissioner may approve a county plan which allows a county to use other program funding for the county work focus program in a more flexible manner. Nothing in this section shall allow payments made to the public assistance applicant to be less than the amount the applicant would have received if the program had not been implemented, or reduce or eliminate a category of eligible participants from the program without legislative approval.
If the plan is approved by the commissioner, the county may implement the plan.
256J.08 DEFINITIONS.
Subd. 10.
Budget month.
"Budget month" means the calendar month which the county agency uses to determine the income or circumstances of an assistance unit to calculate the amount of the assistance payment in the payment month.
Subd. 53.
Lump sum.
"Lump sum" means nonrecurring income as described in section 256P.06, subdivision 3, clause (2), item (ix).
Subd. 61.
Monthly income test.
"Monthly income test" means the test used to determine ongoing eligibility and the assistance payment amount according to section 256J.21.
Subd. 62.
Nonrecurring income.
"Nonrecurring income" means a form of income which is received:
(1) only one time or is not of a continuous nature; or
(2) in a prospective payment month but is no longer received in the corresponding retrospective payment month.
Subd. 81.
Retrospective budgeting.
"Retrospective budgeting" means a method of determining the amount of the assistance payment in which the payment month is the second month after the budget month.
Subd. 83.
Significant change.
"Significant change" means a decline in gross income of the amount of the disregard as defined in section 256P.03 or more from the income used to determine the grant for the current month.
256J.30 APPLICANT AND PARTICIPANT REQUIREMENTS AND RESPONSIBILITIES.
Subd. 5.
Monthly MFIP household reports.
Each assistance unit with a member who has earned income or a recent work history, and each assistance unit that has income deemed to it from a financially responsible person must complete a monthly MFIP household report form. "Recent work history" means the individual received earned income in the report month or any of the previous three calendar months even if the earnings are excluded. To be complete, the MFIP household report form must be signed and dated by the caregivers no earlier than the last day of the reporting period. All questions required to determine assistance payment eligibility must be answered, and documentation of earned income must be included.
Subd. 7.
Due date of MFIP household report form.
An MFIP household report form must be received by the county agency by the eighth calendar day of the month following the reporting period covered by the form. When the eighth calendar day of the month falls on a weekend or holiday, the MFIP household report form must be received by the county agency the first working day that follows the eighth calendar day.
Subd. 8.
Late MFIP household report forms.
(a) Paragraphs (b) to (e) apply to the reporting requirements in subdivision 7.
(b) When the county agency receives an incomplete MFIP household report form, the county agency must immediately contact the caregiver by phone or in writing to acquire the necessary information to complete the form.
(c) The automated eligibility system must send a notice of proposed termination of assistance to the assistance unit if a complete MFIP household report form is not received by a county agency. The automated notice must be mailed to the caregiver by approximately the 16th of the month. When a caregiver submits an incomplete form on or after the date a notice of proposed termination has been sent, the termination is valid unless the caregiver submits a complete form before the end of the month.
(d) An assistance unit required to submit an MFIP household report form is considered to have continued its application for assistance if a complete MFIP household report form is received within a calendar month after the month in which the form was due and assistance shall be paid for the period beginning with the first day of that calendar month.
(e) A county agency must allow good cause exemptions from the reporting requirements under subdivision 5 when any of the following factors cause a caregiver to fail to provide the county agency with a completed MFIP household report form before the end of the month in which the form is due:
(1) an employer delays completion of employment verification;
(2) a county agency does not help a caregiver complete the MFIP household report form when the caregiver asks for help;
(3) a caregiver does not receive an MFIP household report form due to mistake on the part of the department or the county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally incapacitated; or
(5) some other circumstance occurs that a caregiver could not avoid with reasonable care which prevents the caregiver from providing a completed MFIP household report form before the end of the month in which the form is due.
256J.33 PROSPECTIVE AND RETROSPECTIVE MFIP ELIGIBILITY.
Subd. 3.
Retrospective eligibility.
After the first two months of MFIP eligibility, a county agency must continue to determine whether an assistance unit is prospectively eligible for the payment month by looking at all factors other than income and then determine whether the assistance unit is retrospectively income eligible by applying the monthly income test to the income from the budget month. When the monthly income test is not satisfied, the assistance payment must be suspended when ineligibility exists for one month or ended when ineligibility exists for more than one month.
Subd. 4.
Monthly income test.
A county agency must apply the monthly income test retrospectively for each month of MFIP eligibility. An assistance unit is not eligible when the countable income equals or exceeds the MFIP standard of need or the family wage level for the assistance unit. The income applied against the monthly income test must include:
(1) gross earned income from employment as described in chapter 256P, prior to mandatory payroll deductions, voluntary payroll deductions, wage authorizations, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36;
(2) gross earned income from self-employment less deductions for self-employment expenses in section 256J.37, subdivision 5, but prior to any reductions for personal or business state and federal income taxes, personal FICA, personal health and life insurance, and after the disregards in section 256J.21, subdivision 4, and the allocations in section 256J.36;
(3) unearned income as described in section 256P.06, subdivision 3, after deductions for allowable expenses in section 256J.37, subdivision 9, and allocations in section 256J.36;
(4) gross earned income from employment as determined under clause (1) which is received by a member of an assistance unit who is a minor child or minor caregiver and less than a half-time student;
(5) child support received by an assistance unit, excluded under section 256P.06, subdivision 3, clause (2), item (xvi);
(6) spousal support received by an assistance unit;
(7) the income of a parent when that parent is not included in the assistance unit;
(8) the income of an eligible relative and spouse who seek to be included in the assistance unit; and
(9) the unearned income of a minor child included in the assistance unit.
Subd. 5.
When to terminate assistance.
When an assistance unit is ineligible for MFIP assistance for two consecutive months, the county agency must terminate MFIP assistance.
256J.34 CALCULATING ASSISTANCE PAYMENTS.
Subdivision 1.
Prospective budgeting.
A county agency must use prospective budgeting to calculate the assistance payment amount for the first two months for an applicant who has not received assistance in this state for at least one payment month preceding the first month of payment under a current application. Notwithstanding subdivision 3, paragraph (a), clause (2), a county agency must use prospective budgeting for the first two months for a person who applies to be added to an assistance unit. Prospective budgeting is not subject to overpayments or underpayments unless fraud is determined under section 256.98.
(a) The county agency must apply the income received or anticipated in the first month of MFIP eligibility against the need of the first month. The county agency must apply the income received or anticipated in the second month against the need of the second month.
(b) When the assistance payment for any part of the first two months is based on anticipated income, the county agency must base the initial assistance payment amount on the information available at the time the initial assistance payment is made.
(c) The county agency must determine the assistance payment amount for the first two months of MFIP eligibility by budgeting both recurring and nonrecurring income for those two months.
Subd. 2.
Retrospective budgeting.
The county agency must use retrospective budgeting to calculate the monthly assistance payment amount after the payment for the first two months has been made under subdivision 1.
Subd. 3.
Additional uses of retrospective budgeting.
Notwithstanding subdivision 1, the county agency must use retrospective budgeting to calculate the monthly assistance payment amount for the first two months under paragraphs (a) and (b).
(a) The county agency must use retrospective budgeting to determine the amount of the assistance payment in the first two months of MFIP eligibility:
(1) when an assistance unit applies for assistance for the same month for which assistance has been interrupted, the interruption in eligibility is less than one payment month, the assistance payment for the preceding month was issued in this state, and the assistance payment for the immediately preceding month was determined retrospectively; or
(2) when a person applies in order to be added to an assistance unit, that assistance unit has received assistance in this state for at least the two preceding months, and that person has been living with and has been financially responsible for one or more members of that assistance unit for at least the two preceding months.
(b) Except as provided in clauses (1) to (4), the county agency must use retrospective budgeting and apply income received in the budget month by an assistance unit and by a financially responsible household member who is not included in the assistance unit against the MFIP standard of need or family wage level to determine the assistance payment to be issued for the payment month.
(1) When a source of income ends prior to the third payment month, that income is not considered in calculating the assistance payment for that month. When a source of income ends prior to the fourth payment month, that income is not considered when determining the assistance payment for that month.
(2) When a member of an assistance unit or a financially responsible household member leaves the household of the assistance unit, the income of that departed household member is not budgeted retrospectively for any full payment month in which that household member does not live with that household and is not included in the assistance unit.
(3) When an individual is removed from an assistance unit because the individual is no longer a minor child, the income of that individual is not budgeted retrospectively for payment months in which that individual is not a member of the assistance unit, except that income of an ineligible child in the household must continue to be budgeted retrospectively against the child's needs when the parent or parents of that child request allocation of their income against any unmet needs of that ineligible child.
(4) When a person ceases to have financial responsibility for one or more members of an assistance unit, the income of that person is not budgeted retrospectively for the payment months which follow the month in which financial responsibility ends.
Subd. 4.
Significant change in gross income.
The county agency must recalculate the assistance payment when an assistance unit experiences a significant change, as defined in section 256J.08, resulting in a reduction in the gross income received in the payment month from the gross income received in the budget month. The county agency must issue a supplemental assistance payment based on the county agency's best estimate of the assistance unit's income and circumstances for the payment month. Supplemental assistance payments that result from significant changes are limited to two in a 12-month period regardless of the reason for the change. Notwithstanding any other statute or rule of law, supplementary assistance payments shall not be made when the significant change in income is the result of receipt of a lump sum, receipt of an extra paycheck, business fluctuation in self-employment income, or an assistance unit member's participation in a strike or other labor action.
256J.37 TREATMENT OF INCOME AND LUMP SUMS.
Subd. 10.
Treatment of lump sums.
(a) The agency must treat lump-sum payments as earned or unearned income. If the lump-sum payment is included in the category of income identified in subdivision 9, it must be treated as unearned income. A lump sum is counted as income in the month received and budgeted either prospectively or retrospectively depending on the budget cycle at the time of receipt. When an individual receives a lump-sum payment, that lump sum must be combined with all other earned and unearned income received in the same budget month, and it must be applied according to paragraphs (a) to (c). A lump sum may not be carried over into subsequent months. Any funds that remain in the third month after the month of receipt are counted in the asset limit.
(b) For a lump sum received by an applicant during the first two months, prospective budgeting is used to determine the payment and the lump sum must be combined with other earned or unearned income received and budgeted in that prospective month.
(c) For a lump sum received by a participant after the first two months of MFIP eligibility, the lump sum must be combined with other income received in that budget month, and the combined amount must be applied retrospectively against the applicable payment month.
(d) When a lump sum, combined with other income under paragraphs (b) and (c), is less than the MFIP transitional standard for the appropriate payment month, the assistance payment must be reduced according to the amount of the countable income. When the countable income is greater than the MFIP standard or family wage level, the assistance payment must be suspended for the payment month.
256R.08 REPORTING OF FINANCIAL STATEMENTS.
Subd. 2.
Extensions.
The commissioner may grant up to a 15-day extension of the reporting deadline to a nursing facility for good cause. To receive such an extension, a nursing facility shall submit a written request by January 1. The commissioner shall notify the nursing facility of the decision by January 15. Between January 1 and February 1, the nursing facility may request a reporting extension for good cause by telephone and followed by a written request.
256R.49 RATE ADJUSTMENTS FOR COMPENSATION-RELATED COSTS FOR MINIMUM WAGE CHANGES.
Subdivision 1.
Rate adjustments for compensation-related costs.
(a) Rate increases provided under this section before October 1, 2016, expire effective January 1, 2018, and rate increases provided on or after October 1, 2016, expire effective January 1, 2019.
(b) Nursing facilities that receive approval of the applications in subdivision 2 must receive rate adjustments according to subdivision 4. The rate adjustments must be used to pay compensation costs for nursing facility employees paid less than $14 per hour.
Subd. 2.
Application process.
To receive a rate adjustment, nursing facilities must submit applications to the commissioner in a form and manner determined by the commissioner. The applications for the rate adjustments shall include specified data, and spending plans that describe how the funds from the rate adjustments will be allocated for compensation to employees paid less than $14 per hour. The applications must be submitted within three months of the effective date of any operating payment rate adjustment under this section. The commissioner may request any additional information needed to determine the rate adjustment within three weeks of receiving a complete application. The nursing facility must provide any additional information requested by the commissioner within six months of the effective date of any operating payment rate adjustment under this section. The commissioner may waive the deadlines in this section under extraordinary circumstances.
Subd. 3.
Additional application requirements for facilities with employees represented by an exclusive bargaining representative.
For nursing facilities in which employees are represented by an exclusive bargaining representative, the commissioner shall approve the applications submitted under subdivision 2 only upon receipt of a letter or letters of acceptance of the spending plans in regard to members of the bargaining unit, signed by the exclusive bargaining agent and dated after May 31, 2014. Upon receipt of the letter or letters of acceptance, the commissioner shall deem all requirements of this section as having been met in regard to the members of the bargaining unit.
Subd. 4.
Determination of the rate adjustments for compensation-related costs.
Based on the application in subdivision 2, the commissioner shall calculate the allowable annualized compensation costs by adding the totals of clauses (1), (2), and (3). The result must be divided by the standardized or resident days from the most recently available cost report to determine per day amounts, which must be included in the operating portion of the total payment rate and allocated to direct care or other operating as determined by the commissioner:
(1) the sum of the difference between $9.50 and any hourly wage rate less than $9.50 for October 1, 2016; and between the indexed value of the minimum wage, as defined in section 177.24, subdivision 1, paragraph (f), and any hourly wage less than that indexed value for rate years beginning on and after October 1, 2017; multiplied by the number of compensated hours at that wage rate;
(2) using wages and hours in effect during the first three months of calendar year 2014, beginning with the first pay period beginning on or after January 1, 2014; 22.2 percent of the sum of items (i) to (viii) for October 1, 2016;
(i) for all compensated hours from $8 to $8.49 per hour, the number of compensated hours is multiplied by $0.13;
(ii) for all compensated hours from $8.50 to $8.99 per hour, the number of compensated hours is multiplied by $0.25;
(iii) for all compensated hours from $9 to $9.49 per hour, the number of compensated hours is multiplied by $0.38;
(iv) for all compensated hours from $9.50 to $10.49 per hour, the number of compensated hours is multiplied by $0.50;
(v) for all compensated hours from $10.50 to $10.99 per hour, the number of compensated hours is multiplied by $0.40;
(vi) for all compensated hours from $11 to $11.49 per hour, the number of compensated hours is multiplied by $0.30;
(vii) for all compensated hours from $11.50 to $11.99 per hour, the number of compensated hours is multiplied by $0.20; and
(viii) for all compensated hours from $12 to $13 per hour, the number of compensated hours is multiplied by $0.10; and
(3) the sum of the employer's share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, pensions, and contributions to employee retirement accounts attributable to the amounts in clauses (1) and (2).
256S.19 MONTHLY CASE MIX BUDGET CAPS; NURSING FACILITY RESIDENTS.
Subd. 4.
Calculation of monthly conversion budget cap with consumer-directed community supports.
For the elderly waiver monthly conversion budget cap for the cost of elderly waiver services with consumer-directed community supports, the nursing facility case mix adjusted total payment rate used under subdivision 3 to calculate the monthly conversion budget cap for elderly waiver services without consumer-directed community supports must be reduced by a percentage equal to the percentage difference between the consumer-directed community supports budget limit that would be assigned according to the elderly waiver plan and the corresponding monthly case mix budget cap under this chapter, but not to exceed 50 percent.
501C.0408 TRUST FOR CARE OF ANIMAL.
Subd. 4.
Public health programs and trusts.
An irrevocable inter vivos trust created under this section is subject to section 501C.1206.
501C.1206 PUBLIC HEALTH CARE PROGRAMS AND CERTAIN TRUSTS.
(a) It is the public policy of this state that individuals use all available resources to pay for the cost of long-term care services, as defined in section 256B.0595, before turning to Minnesota health care program funds, and that trust instruments should not be permitted to shield available resources of an individual or an individual's spouse from such use.
(b) When a state or local agency makes a determination on an application by the individual or the individual's spouse for payment of long-term care services through a Minnesota public health care program pursuant to chapter 256B, any irrevocable inter vivos trust or any legal instrument, device, or arrangement similar to an irrevocable inter vivos trust created on or after July 1, 2005, containing assets or income of an individual or an individual's spouse, including those created by a person, court, or administrative body with legal authority to act in place of, at the direction of, upon the request of, or on behalf of the individual or individual's spouse, becomes revocable for the sole purpose of that determination. For purposes of this section, any inter vivos trust and any legal instrument, device, or arrangement similar to an inter vivos trust:
(1) shall be deemed to be located in and subject to the laws of this state; and
(2) is created as of the date it is fully executed by or on behalf of all of the settlors or others.
(c) For purposes of this section, a legal instrument, device, or arrangement similar to an irrevocable inter vivos trust means any instrument, device, or arrangement which involves a settlor who transfers or whose property is transferred by another including, but not limited to, any court, administrative body, or anyone else with authority to act on their behalf or at their direction, to an individual or entity with fiduciary, contractual, or legal obligations to the settlor or others to be held, managed, or administered by the individual or entity for the benefit of the settlor or others. These legal instruments, devices, or other arrangements are irrevocable inter vivos trusts for purposes of this section.
(d) In the event of a conflict between this section and the provisions of an irrevocable trust created on or after July 1, 2005, this section shall control.
(e) This section does not apply to trusts that qualify as supplemental needs trusts under section 501C.1205 or to trusts meeting the criteria of United States Code, title 42, section 1396p (d)(4)(a) and (c) for purposes of eligibility for medical assistance.
(f) This section applies to all trusts first created on or after July 1, 2005, as permitted under United States Code, title 42, section 1396p, and to all interests in real or personal property regardless of the date on which the interest was created, reserved, or acquired.
Repealed Minnesota Rule: UES4410-2
2960.0460 STAFF QUALIFICATIONS.
Subp. 2.
Qualifications applying to employees with direct resident contact.
An employee working directly with residents must be at least 21 years of age and must, at the time of hiring, document meeting the qualifications in item A or B.
A.
A program director, supervisor, counselor, or any other person who has direct resident contact must be free of chemical use problems for at least the two years immediately preceding hiring and freedom from chemical use problems must be maintained during employment.
B.
Overnight staff must be free of chemical use problems for at least one year preceding their hiring and maintain freedom from chemical use problems during their employment.
9530.6565 STAFF QUALIFICATIONS.
Subp. 2.
Continuing employment requirement.
License holders must require freedom from chemical use problems as a condition of continuing employment. Staff must remain free of chemical use problems although they are not required to sign statements after the initial statement required by subpart 1, item A. Staff with chemical use problems must be immediately removed from any responsibilities that include direct client contact.
9530.7000 DEFINITIONS.
Subpart 1.
Scope.
For the purposes of parts 9530.7000 to 9530.7030, the following terms have the meanings given them.
Subp. 2.
Chemical.
"Chemical" means alcohol, solvents, and other mood altering substances, including controlled substances as defined in Minnesota Statutes, chapter 152.
Subp. 5.
Chemical dependency treatment services.
"Chemical dependency treatment services" means services provided by chemical dependency treatment programs licensed according to Minnesota Statutes, chapter 245G, or certified according to parts 2960.0450 to 2960.0490.
Subp. 6.
Client.
"Client" means an individual who has requested chemical abuse or dependency services, or for whom chemical abuse or dependency services have been requested, from a local agency.
Subp. 7.
Commissioner.
"Commissioner" means the commissioner of the Minnesota Department of Human Services or the commissioner's designated representative.
Subp. 8.
Behavioral health fund.
"Behavioral health fund" means money appropriated for payment of chemical dependency treatment services under Minnesota Statutes, chapter 254B.
Subp. 9.
Copayment.
"Copayment" means the amount an insured person is obligated to pay before the person's third-party payment source is obligated to make a payment, or the amount an insured person is obligated to pay in addition to the amount the person's third-party payment source is obligated to pay.
Subp. 10.
Drug and Alcohol Abuse Normative Evaluation System or DAANES.
"Drug and Alcohol Abuse Normative Evaluation System" or "DAANES" means the client information system operated by the department's Chemical Dependency Program Division.
Subp. 13.
Income.
"Income" means the total amount of cash received by an individual from the following sources:
B.
cash receipts from nonfarm or farm self-employment, minus deductions allowed by the federal Internal Revenue Service for business or farm expenses;
C.
regular cash payments from social security, railroad retirement, unemployment compensation, workers' union funds, veterans' benefits, the Minnesota family investment program, Supplemental Security Income, General Assistance, training stipends, alimony, child support, and military family allotments;
D.
cash payments from private pensions, government employee pensions, and regular insurance or annuity payments;
F.
periodic cash receipts from estates or trusts.
Income does not include capital gains; any cash assets drawn down as withdrawals from a bank, the sale of property, a house, or a car; tax refunds, gifts, lump sum inheritances, one time insurance payments, or compensation for injury; court-ordered child support or health insurance premium payments made by the client or responsible relative; and noncash benefits such as health insurance, food or rent received in lieu of wages, and noncash benefits from programs such as Medicare, Medical Assistance, the Supplemental Nutrition Assistance Program, school lunches, and housing assistance. Annual income is the amount reported and verified by an individual as current income calculated prospectively to cover one year.
Subp. 14.
Local agency.
"Local agency" means the county or multicounty agency authorized under Minnesota Statutes, sections 254B.01, subdivision 5, and 254B.03, subdivision 1, to make placements under the behavioral health fund.
Subp. 17a.
Policyholder.
"Policyholder" means a person who has a third-party payment policy under which a third-party payment source has an obligation to pay all or part of a client's treatment costs.
Subp. 19.
Responsible relative.
"Responsible relative" means a person who is a member of the client's household and is a client's spouse or the parent of a minor child who is a client.
Subp. 20.
Third-party payment source.
"Third-party payment source" means a person, entity, or public or private agency other than medical assistance or general assistance medical care that has a probable obligation to pay all or part of the costs of a client's chemical dependency treatment.
9530.7005 SCOPE AND APPLICABILITY.
Parts 9530.7000 to 9530.7030 govern the administration of the behavioral health fund, establish the criteria to be applied by local agencies to determine a client's eligibility under the behavioral health fund, and establish a client's obligation to pay for chemical dependency treatment services.
These parts must be read in conjunction with Minnesota Statutes, chapter 254B, and parts 9530.6600 to 9530.6655.
9530.7010 COUNTY RESPONSIBILITY TO PROVIDE SERVICES.
The local agency shall provide chemical dependency treatment services to eligible clients who have been assessed and placed by the county according to parts 9530.6600 to 9530.6655 and Minnesota Statutes, chapter 256G.
9530.7012 VENDOR AGREEMENTS.
When a local agency enters into an agreement with a vendor of chemical dependency treatment services, the agreement must distinguish client per unit room and board costs from per unit chemical dependency treatment services costs.
For purposes of this part, "chemical dependency treatment services costs" are costs, including related administrative costs, of services that meet the criteria in items A to C:
A.
The services are provided within a program licensed according to Minnesota Statutes, chapter 245G, or certified according to parts 2960.0430 to 2960.0490.
B.
The services meet the definition of chemical dependency services in Minnesota Statutes, section 254B.01, subdivision 3.
C.
The services meet the applicable service standards for licensed chemical dependency treatment programs in item A, but are not under the jurisdiction of the commissioner.
This part also applies to vendors of room and board services that are provided concurrently with chemical dependency treatment services according to Minnesota Statutes, sections 254B.03, subdivision 2, and 254B.05, subdivision 1.
This part does not apply when a county contracts for chemical dependency services in an acute care inpatient hospital licensed by the Department of Health under chapter 4640.
9530.7015 CLIENT ELIGIBILITY; BEHAVIORAL HEALTH FUND.
Subpart 1.
Client eligibility to have treatment totally paid under the behavioral health fund.
A client who meets the criteria established in item A, B, C, or D shall be eligible to have chemical dependency treatment paid for totally with funds from the behavioral health fund.
B.
The client is eligible for medical assistance as determined under parts 9505.0010 to 9505.0140.
Subp. 2a.
Third-party payment source and client eligibility for the behavioral health fund.
Clients who meet the financial eligibility requirement in subpart 1 and who have a third-party payment source are eligible for the behavioral health fund if the third party payment source pays less than 100 percent of the treatment services determined according to parts 9530.6600 to 9530.6655.
Subp. 4.
Client ineligible to have treatment paid for from the behavioral health fund.
A client who meets the criteria in item A or B shall be ineligible to have chemical dependency treatment services paid for with behavioral health funds.
A.
The client has an income that exceeds current household size and income guidelines for entitled persons as defined in Minnesota Statutes, section 254B.04, subdivision 1, and as determined by the local agency under part 9530.7020, subpart 1.
B.
The client has an available third-party payment source that will pay the total cost of the client's treatment.
Subp. 5.
Eligibility of clients disenrolled from prepaid health plans.
A client who is disenrolled from a state prepaid health plan during a treatment episode is eligible for continued treatment service that is paid for by the behavioral health fund, until the treatment episode is completed or the client is re-enrolled in a state prepaid health plan if the client meets the criteria in item A or B. The client must:
A.
continue to be enrolled in MinnesotaCare, medical assistance, or general assistance medical care; or
Subp. 6.
County responsibility.
When a county commits a client under Minnesota Statutes, chapter 253B, to a regional treatment center for chemical dependency treatment services and the client is ineligible for the behavioral health fund, the county is responsible for the payment to the regional treatment center according to Minnesota Statutes, section 254B.05, subdivision 4.
9530.7020 LOCAL AGENCY TO DETERMINE CLIENT ELIGIBILITY.
Subpart 1.
Local agency duty to determine client eligibility.
The local agency shall determine a client's eligibility for the behavioral health fund at the time the client is assessed under parts 9530.6600 to 9530.6655. Client eligibility must be determined using forms prescribed by the department. To determine a client's eligibility, the local agency must determine the client's income, the size of the client's household, the availability of a third-party payment source, and a responsible relative's ability to pay for the client's chemical dependency treatment, as specified in items A to C.
A.
The local agency must determine the client's income. A client who is a minor child shall not be deemed to have income available to pay for chemical dependency treatment, unless the minor child is responsible for payment under Minnesota Statutes, section 144.347, for chemical dependency treatment services sought under Minnesota Statutes, section 144.343, subdivision 1.
B.
The local agency must determine the client's household size according to subitems (1), (2), and (3).
(1)
If the client is a minor child, the household size includes the following persons living in the same dwelling unit:
(2)
If the client is an adult, the household size includes the following persons living in the same dwelling unit:
(3)
For purposes of this item, household size includes a person listed in subitems (1) and (2) who is in out-of-home placement if a person listed in subitem (1) or (2) is contributing to the cost of care of the person in out-of-home placement.
C.
The local agency must determine the client's current prepaid health plan enrollment, the availability of a third-party payment source, including the availability of total payment, partial payment, and amount of copayment.
D.
The local agency must provide the required eligibility information to the department in the manner specified by the department.
E.
The local agency shall require the client and policyholder to conditionally assign to the department the client and policyholder's rights and the rights of minor children to benefits or services provided to the client if the department is required to collect from a third-party pay source.
Subp. 1a.
Redetermination of client eligibility.
The local agency shall redetermine a client's eligibility for CCDTF every six months after the initial eligibility determination, if the client has continued to receive uninterrupted chemical dependency treatment services for that six months. For purposes of this subpart, placement of a client into more than one chemical dependency treatment program in less than ten working days, or placement of a client into a residential chemical dependency treatment program followed by nonresidential chemical dependency treatment services shall be treated as a single placement.
Subp. 2.
Client, responsible relative, and policyholder obligation to cooperate.
A client, responsible relative, and policyholder shall provide income or wage verification, household size verification, and shall make an assignment of third-party payment rights under subpart 1, item C. If a client, responsible relative, or policyholder does not comply with the provisions of this subpart, the client shall be deemed to be ineligible to have the behavioral health fund pay for his or her chemical dependency treatment, and the client and responsible relative shall be obligated to pay for the full cost of chemical dependency treatment services provided to the client.
9530.7021 PAYMENT AGREEMENTS.
When the local agency, the client, and the vendor agree that the vendor will accept payment from a third-party payment source for an eligible client's treatment, the local agency, the client, and the vendor shall enter into a third-party payment agreement. The agreement must stipulate that the vendor will accept, as payment in full for services provided to the client, the amount the third-party payor is obligated to pay for services provided to the client. The agreement must be executed in a form prescribed by the commissioner and is not effective unless an authorized representative of each of the three parties has signed it. The local agency shall maintain a record of third-party payment agreements into which the local agency has entered.
The vendor shall notify the local agency as soon as possible and not less than one business day before discharging a client whose treatment is covered by a payment agreement under this part if the discharge is caused by disruption of the third-party payment.
9530.7022 CLIENT FEES.
9530.7025 DENIAL OF PAYMENT.
Subpart 1.
Denial of payment when required assessment not completed.
The department shall deny payments from the behavioral health fund to vendors for chemical dependency treatment services provided to clients who have not been assessed and placed by the county in accordance with parts 9530.6600 to 9530.6655.
Subp. 2.
Denial of state participation in behavioral health fund payments when client found not eligible.
The department shall pay vendors from the behavioral health fund for chemical dependency treatment services provided to clients and shall bill the county for 100 percent of the costs of chemical dependency treatment services as follows:
A.
The department shall bill the county for 100 percent of the costs of a client's chemical dependency treatment services when the department determines that the client was not placed in accordance with parts 9530.6600 to 9530.6655.
B.
When a county's allocation under Minnesota Statutes, section 254B.02, subdivisions 1 and 2, has been exhausted, and the county's maintenance of effort has been met as required under Minnesota Statutes, section 254B.02, subdivision 3, and the local agency has been notified by the department that the only clients who are eligible to have their treatment paid for from the behavioral health fund are clients who are eligible under part 9530.7015, subpart 1, the department shall bill the county for 100 percent of the costs of a client's chemical dependency treatment services when the department determines that the client was not eligible under part 9530.7015, subpart 1.
9530.7030 VENDOR MUST PARTICIPATE IN DAANES SYSTEM.
Subpart 1.
Participation a condition of eligibility.
To be eligible for payment under the behavioral health fund, a vendor must participate in the Drug and Alcohol Normative Evaluation System (DAANES) or submit to the commissioner the information required in DAANES in the format specified by the commissioner.
9555.6255 RESIDENT'S RIGHTS.
Subpart 1.
Information about rights.
The operator shall ensure that a resident and a resident's legal representative are given, at admission:
C.
the name, address, and telephone number of the local agency to which a resident or a resident's legal representative may submit an oral or written complaint.
Subp. 2.
Right to use telephone.
A resident has the right to daily, private access to and use of a non-coin operated telephone for local calls and long distance calls made collect or paid for by the resident.
Subp. 3.
Right to receive and send mail.
A resident has the right to receive and send uncensored, unopened mail.
Subp. 4.
Right to privacy.
A resident has the right to personal privacy and privacy for visits from others, and the respect of individuality and cultural identity. Privacy must be respected by operators, caregivers, household members, and volunteers by knocking on the door of a resident's bedroom and seeking consent before entering, except in an emergency, and during toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance as noted in the resident's individual record.
Subp. 5.
Right to use personal property.
A resident has the right to keep and use personal clothing and possessions as space permits, unless to do so would infringe on the health, safety, or rights of other residents or household members.
Subp. 6.
Right to associate.
A resident has the right to meet with or refuse to meet with visitors and participate in activities of commercial, religious, political, and community groups without interference if the activities do not infringe on the rights of other residents or household members.
Subp. 7.
Married residents.
Married residents have the right to privacy for visits by their spouses, and, if both spouses are residents of the adult foster home, they have the right to share a bedroom and bed.