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Capital IconMinnesota Legislature

SF 4699

Conference Committee Report - 93rd Legislature (2023 - 2024) Posted on 05/19/2024 07:44pm

KEY: stricken = removed, old language.
underscored = added, new language.
Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 1.39 1.40 1.41 1.42 1.43 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 2.37 2.38 2.39 2.40 2.41 2.42 2.43 2.44 2.45 2.46 2.47 2.48 2.49 2.50 2.51 2.52 2.53 2.54 2.55 2.56 2.57 2.58 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 3.36 3.37 3.38 3.39 3.40 3.41 3.42 3.43 3.44 3.45 3.46
4.1 4.2
4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 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 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 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 8.1 8.2 8.3 8.4 8.5 8.6
8.7
8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31
10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 12.33 12.34 12.35 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31
14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11
14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9
16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21
16.22
16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 17.34 17.35 17.36 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33 18.34 18.35 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33
19.34
20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27
20.28 20.29
20.30 20.31 20.32 20.33 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 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8
22.9
22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10
23.11 23.12
23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24
23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32 24.1 24.2 24.3
24.4
24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20
24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 25.1 25.2
25.3 25.4
25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8
26.9
26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 26.33 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 28.31 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24
29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14
30.15
30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34 31.35 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 32.35 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29
33.30 33.31 33.32 33.33 33.34 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 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11
35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29
36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13
36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 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 38.34 38.35 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 39.34 39.35 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30
41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13
41.14 41.15
41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31
41.32
42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16
42.17 42.18 42.19
42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 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 43.32 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 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 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15
47.16
47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 48.1 48.2 48.3 48.4 48.5 48.6
48.7 48.8 48.9
48.10
48.11 48.12
48.13 48.14 48.15 48.16 48.17 48.18
48.19
48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22
49.23 49.24
49.25 49.26 49.27 49.28 49.29 49.30 49.31
49.32 49.33
50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15
50.16 50.17
50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32
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 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 53.32
54.1 54.2 54.3
54.4
54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13
54.14 54.15
54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28
54.29
55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15
55.16 55.17
55.18 55.19 55.20 55.21 55.22 55.23 55.24
55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 56.1 56.2 56.3 56.4
56.5 56.6
56.7 56.8 56.9 56.10 56.11 56.12
56.13 56.14
56.15 56.16 56.17 56.18
56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 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 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 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
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 60.33 60.34 60.35 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11
61.12
61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 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
63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10
63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32
64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24
64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 64.33 64.34 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22
65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 65.32 65.33 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
67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9
67.10 67.11
67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22
67.23 67.24
67.25 67.26 67.27 67.28 67.29 67.30 67.31 68.1 68.2 68.3 68.4 68.5 68.6
68.7 68.8 68.9 68.10 68.11 68.12 68.13
68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27
68.28 68.29
69.1 69.2 69.3 69.4 69.5
69.6 69.7
69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 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
71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 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 73.34 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10
74.11 74.12
74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 74.33 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15
75.16 75.17
75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28
75.29 75.30
76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 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
79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 81.32 82.1 82.2 82.3 82.4
82.5
82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28
83.29
83.30 83.31 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18
84.19
84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 86.1 86.2
86.3
86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17
87.18
87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30
87.31
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 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 90.1 90.2 90.3
90.4 90.5 90.6
90.7 90.8 90.9 90.10 90.11 90.12
90.13 90.14 90.15
90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27
90.28
90.29 90.30 90.31 90.32
91.1 91.2 91.3
91.4 91.5 91.6 91.7 91.8 91.9
91.10
91.11 91.12 91.13 91.14 91.15 91.16
91.17 91.18 91.19 91.20 91.21 91.22 91.23
91.24
91.25 91.26 91.27 91.28 91.29
91.30
92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 92.32 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 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
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 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
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
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
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
104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8
104.9 104.10 104.11
104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20
104.21 104.22 104.23 104.24 104.25
104.26 104.27 104.28 104.29 104.30 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 106.1 106.2
106.3 106.4 106.5 106.6 106.7
106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18
106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32
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
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
109.26 109.27 109.28 109.29 110.1 110.2
110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10
110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13
111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 112.33 112.34 113.1 113.2 113.3 113.4 113.5 113.6
113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23
114.24 114.25 114.26 114.27 114.28
114.29 114.30 114.31 114.32 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14
115.15 115.16 115.17 115.18 115.19 115.20
115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 115.33 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10
116.11 116.12 116.13 116.14 116.15 116.16 116.17
116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 120.34 120.35 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15
121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30
121.31 121.32 121.33 122.1 122.2 122.3
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
123.1 123.2 123.3 123.4 123.5
123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19
123.20 123.21 123.22 123.23 123.24 123.25
123.26 123.27 123.28 123.29 123.30 123.31
124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 127.33 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 128.34 128.35 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.34 129.33 130.2 130.1 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 130.34 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 131.33 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10
133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29
135.1 135.2
135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15
135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24
137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 138.1 138.2 138.3 138.4
138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27
138.28
138.29 138.30 138.31 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12
139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31
139.32
140.1 140.2 140.3 140.4 140.5
140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 141.1 141.2 141.3
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
142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 142.33 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12
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
145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17
145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27
147.28 147.29 147.30 147.31 147.32 147.33 147.34 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14
149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21
150.22 150.23 150.24 150.25 150.26 150.27 150.28
150.29 150.30 150.31 150.32 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28
151.29 151.30 151.31 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8
152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 153.1 153.2 153.3 153.4 153.5
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
153.27 153.28 153.29 153.30 154.1 154.2
154.3 154.4 154.5 154.6 154.7 154.8 154.9
154.10 154.11 154.12 154.13 154.14 154.15
154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27
154.28 154.29 154.30 154.31 155.1 155.2 155.3
155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12
155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24
155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 157.33 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 159.32 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 160.34 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 161.33 161.34 161.35 162.1 162.2
162.3 162.4 162.5 162.6 162.7
162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26
162.27 162.28 162.29 162.30 162.31 162.32 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 163.33 163.34 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23
164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 165.1 165.2 165.3 165.4 165.5 165.6 165.7
165.8
165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26
165.27
165.28 165.29 165.30 166.1 166.2 166.3 166.4 166.5 166.6
166.7
166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11
168.12 168.13 168.14 168.15 168.16
168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24
168.25 168.26 168.27 168.28 168.29 168.30 168.31 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9
169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 170.1 170.2 170.3
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
171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9
171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 172.1 172.2 172.3 172.4 172.5
172.6
172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31
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
174.1 174.2 174.3 174.4 174.5 174.6
174.7 174.8 174.9 174.10 174.11
174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 175.1 175.2 175.3 175.4 175.5
175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19
175.20 175.21 175.22 175.23 175.24 175.25 175.26
175.27 175.28 175.29 175.30 175.31 175.32 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18
176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 177.1 177.2
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
177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16
179.17 179.18
179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31
179.32
180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 180.33 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21
183.22 183.23
183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 184.1 184.2 184.3 184.4
184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17
184.18 184.19 184.20 184.21
184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 185.1 185.2 185.3
185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29
185.30 185.31 185.32 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30
186.31 186.32 186.33 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 187.33 188.1 188.2 188.3 188.4
188.5
188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 188.32 188.33 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8
189.9 189.10
189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29
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
191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16
192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19
194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26
195.27 195.28 195.29 195.30 195.31 195.32 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26
196.27 196.28 196.29 196.30 196.31 196.32 197.1 197.2 197.3 197.4 197.5
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
197.26 197.27 197.28 197.29 197.30 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15
198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24
198.25 198.26 198.27
198.28 198.29 198.30 198.31 198.32 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32
200.33
201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14
201.15 201.16 201.17 201.18
201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30
201.31
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
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
203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9
205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 205.33 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 206.33 206.34 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24
207.25 207.26
207.27 207.28 207.29 207.30 207.31 208.1 208.2 208.3
208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11
208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28
208.29 208.30 208.31 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30
210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13
210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30
211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24
211.25 211.26 211.27 211.28 211.29 211.30 211.31 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25
212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 212.34 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11
214.12
214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 215.1 215.2 215.3 215.4 215.5 215.6
215.7 215.8
215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 217.1 217.2 217.3
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
218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 219.32 219.33 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22
221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14
224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 224.33 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33 225.34 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9
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
226.27 226.28 226.29 226.30 226.31 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 227.33 227.34 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 228.32 228.33 228.34 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32
230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10
232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 232.32 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12
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
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
234.27 234.28 234.29 234.30 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9
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
238.1 238.2 238.3
238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 239.33 239.34
240.1 240.2 240.3
240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10
241.11
241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23
242.24
242.25 242.26 242.27 242.28 242.29 242.30 243.1 243.2
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
244.1 244.2
244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25
246.26
246.27 246.28 246.29 246.30 246.31 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13
247.14
247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 248.32 248.33 249.1 249.2
249.3
249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 250.1 250.2 250.3
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
251.1 251.2 251.3 251.4 251.5
251.6
251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 251.33 252.1 252.2 252.3 252.4
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
252.26 252.27 252.28 252.29 252.30 252.31 252.32 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24
253.25
253.26 253.27 253.28 253.29 253.30 253.31 253.32 253.33 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30
255.1
255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10
255.11
255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 256.1 256.2 256.3 256.4
256.5
256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29
257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20
257.21
257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24
258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 260.33 261.1 261.2
261.3 261.4 261.5 261.6 261.7 261.8
261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10
262.11 262.12 262.13 262.14 262.15 262.16
262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 262.33 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 263.33 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8
264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 264.33 264.34 264.35 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21
265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 265.33 265.34 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 266.33 266.34 267.1 267.2 267.3 267.4 267.5
267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 267.33 267.34 267.35 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 268.32 268.33 268.34 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 269.33 269.34 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27
270.28 270.29 270.30 270.31 270.32 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8
272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 272.33 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19
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
276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 277.32 277.33 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23
278.24
278.25 278.26 278.27 278.28 278.29 278.30 278.31 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9
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
281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 281.32 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10
282.11
282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 282.32 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8
283.9
283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 284.1 284.2
284.3
284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11
285.12
285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23
285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21
286.22
286.23 286.24 286.25 286.26 286.27 286.28 286.29 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30
288.31
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
289.30 289.31 289.32 289.33 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8
290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 290.33 290.34 291.1 291.2 291.3 291.4 291.5 291.6 291.7
291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 292.1 292.2 292.3
292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 292.33 292.34 292.35
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
293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 294.32 294.33 295.1 295.2
295.3
295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 296.1
296.2
296.3 296.4 296.5 296.6 296.7
296.8
296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15
297.16
297.17 297.18 297.19
297.20 297.21 297.22 297.23 297.24 297.25
297.26
298.1 298.2
298.3 298.4 298.5 298.6
298.7
298.8 298.9 298.10
298.11
298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22
299.23
299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31
299.32
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
300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11
302.12
302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10
303.11
303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13
304.14
304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 305.1 305.2
305.3
305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 305.33
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
307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 309.1 309.2 309.3 309.4 309.5 309.6
309.7
309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 310.1 310.2 310.3 310.4 310.5
310.6
310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 310.33 311.1 311.2 311.3 311.4 311.5
311.6
311.7 311.8 311.9 311.10 311.11 311.12 311.13
311.14
311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 312.1 312.2
312.3
312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12
312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24
312.25 312.26 312.27 312.28 312.29 312.30 313.1 313.2 313.3 313.4
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
314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 316.1 316.2 316.3
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
317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 318.33 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29
322.30
323.1 323.2 323.3 323.4 323.5 323.6 323.7
323.8
323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17
323.18
323.19 323.20 323.21 323.22 323.23 323.24
323.25
323.26 323.27 323.28 323.29 323.30 324.1 324.2 324.3 324.4 324.5
324.6
324.7 324.8 324.9 324.10 324.11 324.12 324.13
324.14
324.15 324.16 324.17
324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 325.1 325.2 325.3
325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12
326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 326.32 327.1 327.2 327.3 327.4 327.5
327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28
328.29 328.30 328.31 328.32 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13
329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28
330.29 330.30 330.31 330.32 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29
331.30 331.31 331.32 331.33 332.1 332.2 332.3
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
332.24 332.25 332.26 332.27 332.28 332.29 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30
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
334.28 334.29 334.30 334.31 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27
335.28 335.29 335.30 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12
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
337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16
337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23
338.24 338.25 338.26 338.27 338.28 338.29
339.1 339.2 339.3 339.4 339.5 339.6
339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26
340.27
340.28 340.29 340.30 340.31 340.32 341.1 341.2
341.3
341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11
341.12 341.13
341.14 341.15 341.16 341.17
341.18 341.19
341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 342.1 342.2
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
342.25 342.26 342.27 342.28 342.29 343.1 343.2
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
343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8
344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 345.1 345.2 345.3 345.4 345.5
345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18
345.19 345.20 345.21 345.22 345.23 345.24
345.25 345.26 345.27 345.28 345.29
346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9
346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21
346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22
348.23 348.24 348.25 348.26 348.27 348.28 348.29 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14
349.15 349.16
349.17 349.18
349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 349.33 350.1 350.2
350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 350.34 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 351.33 351.34 351.35 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32 352.33 352.34 352.35 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 353.33 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28
354.29
354.30 354.31 354.32 354.33 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 355.32 355.33 355.34 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 356.33 356.34 356.35 356.36 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 357.33 357.34 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21
358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 358.33
359.1 359.2 359.3 359.4
359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32
359.33 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15
360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 360.33 360.34 360.35 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31
361.32 361.33 361.34 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8
362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29 362.30 362.31 362.32 362.33 362.34
363.1
363.2 363.3 363.4 363.5 363.6
363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28
364.29
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
365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 365.33 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 366.33 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 367.31 367.32 367.33 367.34 367.35 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 368.32 368.33 368.34 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 369.32 369.33 369.34 370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 370.32 370.33 370.34 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 371.33 371.34 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30 372.31 372.32 372.33 372.34 372.35 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 373.32 373.33 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 374.34 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 375.32 375.33 375.34 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32 376.33 376.34 376.35 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 377.31 377.32 377.33 377.34 377.35 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26
378.27 378.28
378.29 378.30 378.31 378.32 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30
379.31 379.32 379.33
380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30 380.31 380.32 380.33 380.34 380.35 380.36 380.37 380.38 380.39 380.40 380.41 380.42 380.43 380.44 380.45 380.46 380.47 380.48 380.49 380.50 380.51 380.52 380.53 380.54 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 381.33 381.34 381.35 381.36 381.37 381.38 381.39 381.40 381.41 381.42 381.43 381.44 381.45 381.46 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11

CONFERENCE COMMITTEE REPORT ON S.F. No. 4699

A bill for an act
relating to state government; modifying provisions governing health care, health
insurance, health policy, emergency medical services, the Department of Health,
the Department of Human Services, MNsure, health care workforce, health-related
licensing boards, health care affordability and delivery, background studies, child
protection and welfare, child care licensing, behavioral health, economic assistance,
housing and homelessness, human services policy, the Minnesota Indian Family
Preservation Act, and the Department of Children, Youth, and Families; establishing
the Office of Emergency Medical Services; establishing the Minnesota African
American Family Preservation and Child Welfare Disproportionality Act; making
technical and conforming changes; requiring reports; imposing penalties; providing
appointments; making forecast adjustments; appropriating money; amending
Minnesota Statutes 2022, sections 16A.055, subdivision 1a, by adding a subdivision;
16A.103, by adding a subdivision; 62A.0411; 62A.15, subdivision 4, by adding a
subdivision; 62A.28, subdivision 2; 62D.02, subdivisions 4, 7; 62D.03, subdivision
1; 62D.05, subdivision 1; 62D.06, subdivision 1; 62D.14, subdivision 1; 62D.19;
62D.20, subdivision 1; 62D.22, subdivision 5; 62E.02, subdivision 3; 62J.49,
subdivision 1; 62J.61, subdivision 5; 62M.01, subdivision 3; 62Q.097, by adding
a subdivision; 62Q.14; 62V.05, subdivision 12; 62V.08; 62V.11, subdivision 4;
103I.621, subdivisions 1, 2; 121A.15, subdivision 3, by adding a subdivision;
144.05, subdivision 6, by adding a subdivision; 144.058; 144.0724, subdivisions
2, 3a, 4, 6, 7, 8, 9, 11; 144.1464, subdivisions 1, 2, 3; 144.1501, subdivision 5;
144.1911, subdivision 2; 144.212, by adding a subdivision; 144.216, subdivision
2, by adding subdivisions; 144.218, by adding a subdivision; 144.292, subdivision
6; 144.293, subdivisions 2, 4, 9, 10; 144.493, by adding a subdivision; 144.494,
subdivision 2; 144.551, subdivision 1; 144.555, subdivisions 1a, 1b, 2, by adding
subdivisions; 144.605, by adding a subdivision; 144.99, subdivision 3; 144A.10,
subdivisions 15, 16; 144A.471, by adding a subdivision; 144A.474, subdivision
13; 144A.61, subdivision 3a; 144A.70, subdivisions 3, 5, 6, 7; 144A.71, subdivision
2, by adding a subdivision; 144A.72, subdivision 1; 144A.73; 144E.001, subdivision
3a, by adding subdivisions; 144E.101, by adding a subdivision; 144E.16,
subdivisions 5, 7; 144E.19, subdivision 3; 144E.27, subdivisions 3, 5, 6; 144E.28,
subdivisions 3, 5, 6, 8; 144E.285, subdivisions 1, 2, 4, 6, by adding subdivisions;
144E.287; 144E.305, subdivision 3; 144G.08, subdivision 29; 144G.10, by adding
a subdivision; 144G.16, subdivision 6; 146B.03, subdivision 7a; 146B.10,
subdivisions 1, 3; 148.235, subdivision 10; 149A.02, subdivisions 3, 3b, 16, 23,
26a, 27, 35, 37c, by adding subdivisions; 149A.03; 149A.65; 149A.70, subdivisions
1, 2, 3, 5; 149A.71, subdivisions 2, 4; 149A.72, subdivisions 3, 9; 149A.73,
subdivision 1; 149A.74, subdivision 1; 149A.93, subdivision 3; 149A.94,
subdivisions 1, 3, 4; 149A.97, subdivision 2; 151.01, subdivisions 23, 27; 151.065,
by adding subdivisions; 151.066, subdivisions 1, 2, 3; 151.212, by adding a
subdivision; 151.37, by adding a subdivision; 151.74, subdivision 6; 152.22,
subdivision 14, by adding a subdivision; 152.25, subdivision 2; 152.27, subdivisions
2, 6, by adding a subdivision; 176.175, subdivision 2; 214.025; 214.04, subdivision
2a; 214.29; 214.31; 214.355; 243.166, subdivision 7, as amended; 245.096; 245.462,
subdivision 6; 245.4663, subdivision 2; 245A.04, subdivision 10, by adding a
subdivision; 245A.043, subdivisions 2, 4, by adding subdivisions; 245A.07,
subdivision 6; 245A.10, subdivisions 1, as amended, 2, as amended; 245A.14,
subdivision 17; 245A.144; 245A.175; 245A.52, subdivision 2, by adding a
subdivision; 245A.66, subdivision 2; 245C.05, subdivision 5; 245C.08, subdivision
4; 245C.10, subdivision 18; 245C.14, subdivision 1, by adding a subdivision;
245C.15, subdivisions 3, 4; 245C.22, subdivision 4; 245C.24, subdivisions 2, 5;
245C.30, by adding a subdivision; 245E.08; 245F.09, subdivision 2; 245F.14, by
adding a subdivision; 245F.17; 245G.07, subdivision 4; 245G.08, subdivisions 5,
6; 245G.10, by adding a subdivision; 245G.22, subdivisions 6, 7; 245H.01, by
adding subdivisions; 245H.08, subdivision 1; 245H.14, subdivisions 1, 4; 245I.02,
subdivisions 17, 19; 245I.10, subdivision 9; 245I.11, subdivision 1, by adding a
subdivision; 245I.20, subdivision 4; 245I.23, subdivision 14; 256.01, subdivision
41, by adding a subdivision; 256.029, as amended; 256.045, subdivisions 3b, as
amended, 5, as amended, 7, as amended; 256.0451, subdivisions 1, as amended,
22, 24; 256.046, subdivision 2, as amended; 256.9657, subdivision 8, by adding
a subdivision; 256.969, by adding subdivisions; 256B.056, subdivisions 1a, 10;
256B.0622, subdivisions 2a, 3a, 7a, 7d; 256B.0623, subdivision 5; 256B.0625,
subdivisions 12, 20, 39, by adding subdivisions; 256B.0757, subdivisions 4a, 4d,
by adding a subdivision; 256B.0943, subdivision 12; 256B.0947, subdivision 5;
256B.76, subdivision 6; 256B.795; 256I.04, subdivision 2f; 256J.08, subdivision
34a; 256J.28, subdivision 1; 256K.45, subdivision 2; 256N.22, subdivision 10;
256N.24, subdivision 10; 256N.26, subdivisions 12, 13, 15, 16, 18, 21, 22; 256P.05,
by adding a subdivision; 256R.02, subdivision 20; 259.20, subdivision 2; 259.37,
subdivision 2; 259.52, subdivisions 2, 4; 259.53, by adding a subdivision; 259.79,
subdivision 1; 259.83, subdivision 4; 260.755, subdivisions 2a, 5, 14, 17a, by
adding subdivisions; 260.775; 260.785, subdivisions 1, 3; 260.810, subdivision 3;
260C.007, subdivisions 6, 26b; 260C.141, by adding a subdivision; 260C.178,
subdivisions 1, as amended, 7; 260C.202; 260C.209, subdivision 1; 260C.212,
subdivisions 1, 2; 260C.301, subdivision 1, as amended; 260C.329, subdivisions
3, 8; 260C.4411, by adding a subdivision; 260C.515, subdivision 4; 260C.607,
subdivisions 1, 6; 260C.611; 260C.613, subdivision 1; 260C.615, subdivision 1;
260D.01; 260E.03, subdivision 23, as amended; 260E.30, subdivision 3, as
amended; 260E.33, subdivision 2, as amended; 317A.811, subdivisions 1, 2, 4;
393.07, subdivision 10a; 518.17, by adding a subdivision; 519.05; 524.3-801, as
amended; Minnesota Statutes 2023 Supplement, sections 13.46, subdivision 4, as
amended; 15A.0815, subdivision 2; 43A.08, subdivision 1a; 62J.84, subdivision
10; 62Q.46, subdivision 1; 62Q.473, by adding subdivisions; 62Q.522, subdivision
1; 119B.011, subdivision 15; 119B.16, subdivisions 1a, 1c; 119B.161, subdivision
2; 124D.142, subdivision 2, as amended; 142A.03, by adding a subdivision;
144.0526, subdivision 1; 144.1501, subdivisions 1, 2, 3, 4; 144.1505, subdivision
2; 144.2252, subdivision 2; 144.2253; 144.587, subdivision 4; 144A.4791,
subdivision 10; 144E.101, subdivisions 6, 7, as amended; 145.561, subdivision 4;
151.555, subdivisions 1, 4, 5, 6, 7, 8, 9, 11, 12; 151.74, subdivision 3; 152.126,
subdivision 6; 152.28, subdivision 1; 245.4889, subdivision 1; 245A.02, subdivision
2c; 245A.03, subdivisions 2, as amended, 7, as amended; 245A.043, subdivision
3; 245A.07, subdivision 1, as amended; 245A.11, subdivision 7; 245A.16,
subdivisions 1, as amended, 11; 245A.211, subdivision 4; 245A.242, subdivision
2; 245A.50, subdivisions 3, 4; 245A.66, subdivision 4, as amended; 245C.02,
subdivisions 6a, 13e; 245C.033, subdivision 3; 245C.08, subdivision 1; 245C.10,
subdivision 15; 245C.15, subdivisions 2, 4a; 245C.31, subdivision 1; 245G.22,
subdivisions 2, 17; 245H.06, subdivisions 1, 2; 245H.08, subdivisions 4, 5;
254B.04, subdivision 1a; 256.01, subdivision 12b; 256.043, subdivisions 3, 3a;
256.045, subdivision 3, as amended; 256.046, subdivision 3; 256.0471, subdivision
1, as amended; 256.969, subdivision 2b; 256B.0622, subdivisions 7b, 8; 256B.0625,
subdivisions 3a, 5m, 9, 13e, as amended, 13f, 13k, 16; 256B.064, subdivision 4;
256B.0671, subdivision 5; 256B.0701, subdivision 6; 256B.0947, subdivision 7;
256B.764; 256D.01, subdivision 1a; 256E.38, subdivision 4; 256I.05, subdivisions
1a, 11; 256L.03, subdivision 1; 256M.42, by adding a subdivision; 256P.06,
subdivision 3; 259.83, subdivisions 1, 1b, 3a; 260.014, by adding a subdivision;
260.755, subdivisions 1a, 3, 3a, 5b, 20, 22; 260.758, subdivisions 2, 4, 5; 260.761;
260.762; 260.763, subdivisions 1, 4, 5; 260.765, subdivisions 2, 3a, 4b; 260.771,
subdivisions 1a, 1b, 1c, 2b, 2d, 6, by adding a subdivision; 260.773, subdivisions
1, 2, 3, 4, 5, 10, 11; 260.774, subdivisions 1, 2, 3; 260.781, subdivision 1; 260.786,
subdivision 2; 260.795, subdivision 1; 342.01, subdivision 63; 342.52, subdivision
3; 342.53; 342.54, subdivision 2; 342.55, subdivision 2; 518A.42, subdivision 3;
Laws 1987, chapter 404, section 18, subdivision 1; Laws 2023, chapter 22, section
4, subdivision 2; Laws 2023, chapter 57, article 1, section 6; Laws 2023, chapter
70, article 1, section 35; article 11, section 13, subdivision 8; article 12, section
30, subdivisions 2, 3; article 14, section 42, subdivision 6; article 20, sections 2,
subdivisions 5, 22, 24, 29, 31; 3, subdivision 2; 12, as amended; 23; Laws 2024,
chapter 80, article 1, sections 38, subdivisions 1, 2, 5, 6, 7, 9; 96; article 2, sections
5, subdivision 21, by adding a subdivision; 6, subdivisions 2, 3, 3a, by adding a
subdivision; 7, subdivision 2; 10, subdivisions 1, 6; 16, subdivision 1, by adding
a subdivision; 30, subdivision 2; 31; 74; article 4, section 26; article 6, section 4;
article 7, section 4; proposing coding for new law in Minnesota Statutes, chapters
62D; 62J; 62Q; 137; 142A; 144; 144A; 144E; 145; 149A; 151; 214; 245C; 245H;
256B; 259; 260; 260D; 260E; 524; proposing coding for new law as Minnesota
Statutes, chapters 142B; 142F; 332C; repealing Minnesota Statutes 2022, sections
62A.041, subdivision 3; 144.218, subdivision 3; 144.497; 144E.001, subdivision
5; 144E.01; 144E.123, subdivision 5; 144E.27, subdivisions 1, 1a; 144E.50,
subdivision 3; 245A.065; 245C.125; 256.01, subdivisions 12, 12a; 256B.79,
subdivision 6; 256D.19, subdivisions 1, 2; 256D.20, subdivisions 1, 2, 3, 4;
256D.23, subdivisions 1, 2, 3; 256R.02, subdivision 46; 260.755, subdivision 13;
Minnesota Statutes 2023 Supplement, sections 62J.312, subdivision 6; 62Q.522,
subdivisions 3, 4; 144.0528, subdivision 5; 245C.08, subdivision 2; Laws 2023,
chapter 25, section 190, subdivision 10; Laws 2024, chapter 80, article 1, sections
38, subdivisions 3, 4, 11; 39; 43, subdivision 2; article 2, sections 1, subdivision
11; 3, subdivision 3; 4, subdivision 4; 6, subdivision 4; 10, subdivision 4; 33; 69;
article 7, sections 3; 9; Minnesota Rules, parts 9502.0425, subparts 5, 10;
9545.0805, subpart 1; 9545.0845; 9560.0232, subpart 5.

May 19, 2024
The Honorable Bobby Joe Champion
President of the Senate

The Honorable Melissa Hortman
Speaker of the House of Representatives

We, the undersigned conferees for S.F. No. 4699 report that we have agreed upon the
items in dispute and recommend as follows:

That the House recede from its amendments and that S.F. No. 4699 be further amended
as follows:

Delete everything after the enacting clause and insert:

"ARTICLE 1

DEPARTMENT OF HUMAN SERVICES HEALTH CARE FINANCE

Section 1.

Minnesota Statutes 2023 Supplement, section 256.9631, is amended to read:


256.9631 deleted text begin DIRECT PAYMENT SYSTEMdeleted text end new text begin ALTERNATIVE CARE DELIVERY
MODELS
new text end FOR MEDICAL ASSISTANCE AND MINNESOTACARE.

Subdivision 1.

Direction to the commissioner.

(a) The commissionernew text begin , in order to deliver
services to eligible individuals, achieve better health outcomes, and reduce the cost of health
care for the state,
new text end shall develop deleted text begin andeleted text end implementation deleted text begin plandeleted text end new text begin plansnew text end for deleted text begin a direct payment system
to deliver services to eligible individuals in order to achieve better health outcomes and
reduce the cost of health care for the state. Under this system,
deleted text end new text begin at least three care delivery
models that:
new text end

new text begin (1) are alternatives to the use of commercial managed care plans to deliver health care
to Minnesota health care program enrollees; and
new text end

new text begin (2) do not shift financial risk to nongovernmental entities.
new text end

new text begin (b) One of the alternative models must be a direct payment system under whichnew text end eligible
individuals deleted text begin mustdeleted text end receive services through the deleted text begin medical assistancedeleted text end fee-for-service system,
county-based purchasing plans, deleted text begin ordeleted text end new text begin andnew text end county-owned health maintenance organizations. new text begin At
least one additional model must include county-based purchasing plans and county-owned
health maintenance organizations in their design, and must allow these entities to deliver
care in geographic areas on a single plan basis, if:
new text end

new text begin (1) these entities contract with all providers that agree to contract terms for network
participation; and
new text end

new text begin (2) the commissioner of human services determines that an entity's provider network is
adequate to ensure enrollee access and choice.
new text end

new text begin (c) Before determining the alternative models for which implementation plans will be
developed, the commissioner shall consult with the chairs and ranking minority members
of the legislative committees with jurisdiction over health care finance and policy.
new text end

new text begin (d) new text end The commissioner shall present deleted text begin andeleted text end implementation deleted text begin plandeleted text end new text begin plansnew text end for the deleted text begin direct payment
system
deleted text end new text begin selected modelsnew text end to the chairs and ranking minority members of the legislative
committees with jurisdiction over health care finance and policy by January 15, 2026. The
commissioner may contract for technical assistance in developing the implementation deleted text begin plandeleted text end new text begin
plans
new text end and conducting related studies and analyses.

deleted text begin (b) For the purposes of the direct payment system, the commissioner shall make the
following assumptions:
deleted text end

deleted text begin (1) health care providers are reimbursed directly for all medical assistance covered
services provided to eligible individuals, using the fee-for-service payment methods specified
in chapters
deleted text end deleted text begin 256deleted text end deleted text begin , deleted text end deleted text begin 256Bdeleted text end deleted text begin , deleted text end deleted text begin 256Rdeleted text end deleted text begin , and deleted text end deleted text begin 256Sdeleted text end deleted text begin ;
deleted text end

deleted text begin (2) payments to a qualified hospital provider are equivalent to the payments that would
have been received based on managed care direct payment arrangements. If necessary, a
qualified hospital provider may use a county-owned health maintenance organization to
receive direct payments as described in section 256B.1973; and
deleted text end

deleted text begin (3) county-based purchasing plans and county-owned health maintenance organizations
must be reimbursed at the capitation rate determined under sections 256B.69 and 256B.692.
deleted text end

Subd. 2.

Definitions.

(a) For purposes of this section, the following terms have the
meanings given.

(b) "Eligible individuals" means deleted text begin qualifieddeleted text end new text begin allnew text end medical assistance deleted text begin enrollees, defined as
persons eligible for medical assistance as families and children and adults without children
deleted text end new text begin
and MinnesotaCare enrollees
new text end .

new text begin (c) "Minnesota health care programs" means the medical assistance and MinnesotaCare
programs.
new text end

deleted text begin (c)deleted text end new text begin (d)new text end "Qualified hospital provider" means a nonstate government teaching hospital
with high medical assistance utilization and a level 1 trauma center, and all of the hospital's
owned or affiliated health care professionals, ambulance services, sites, and clinics.

Subd. 3.

Implementation deleted text begin plandeleted text end new text begin plansnew text end .

(a) deleted text begin Thedeleted text end new text begin Eachnew text end implementation plan must include:

(1) a timeline for the development and recommended implementation date of the deleted text begin direct
payment system
deleted text end new text begin alternative modelnew text end . In recommending a timeline, the commissioner must
consider:

(i) timelines required by the existing contracts with managed care plans and county-based
purchasing plans to sunset existing delivery models;

(ii) in counties that choose to operate a county-based purchasing plan under section
256B.692, timelines for any new procurements required for those counties to establish a
new county-based purchasing plan or participate in an existing county-based purchasing
plan;

(iii) in counties that choose to operate a county-owned health maintenance organization
under section 256B.69, timelines for any new procurements required for those counties to
establish a new county-owned health maintenance organization or to continue serving
enrollees through an existing county-owned health maintenance organization; and

(iv) a recommendation on whether the commissioner should contract with a third-party
administrator to administer the deleted text begin direct payment systemdeleted text end new text begin alternative model,new text end and the timeline
needed for procuring an administrator;

(2) the procedures to be used to ensure continuity of care for enrollees who transition
from managed care to fee-for-service and any administrative resources needed to carry out
these procedures;

(3) recommended quality measures for health care service delivery;

(4) any changes to fee-for-service payment rates that the commissioner determines are
necessary to ensure provider access and high-quality care and to reduce health disparities;

(5) recommendations on ensuring effective care coordination under the deleted text begin direct payment
system
deleted text end new text begin alternative modelnew text end , especially for enrollees whonew text begin :
new text end

new text begin (i) are age 65 or older, blind, or have disabilities;
new text end

new text begin (ii)new text end have complex medical conditionsdeleted text begin , whodeleted text end new text begin ;
new text end

new text begin (iii)new text end face socioeconomic barriers to receiving caredeleted text begin , or whodeleted text end new text begin ; or
new text end

new text begin (iv)new text end are from underserved populations that experience health disparities;

(6) recommendations on deleted text begin whether the direct payment system should provide supplemental
payments
deleted text end new text begin payment arrangementsnew text end for care coordination, including:

(i) the provider types eligible for deleted text begin supplementaldeleted text end new text begin care coordinationnew text end payments;

(ii) procedures to coordinate deleted text begin supplementaldeleted text end new text begin care coordinationnew text end payments with existing
supplemental or cost-based payment methods or to replace these existing methods; and

(iii) procedures to align care coordination initiatives funded deleted text begin through supplemental
payments
deleted text end under deleted text begin this sectiondeleted text end new text begin the alternative modelnew text end with existing care coordination initiatives;

(7) recommendations on whether the deleted text begin direct payment systemdeleted text end new text begin alternative modelnew text end should
include funding to providers for outreach initiatives to patients who, because of mental
illness, homelessness, or other circumstances, are unlikely to obtain needed care and
treatment;

(8) recommendations for a supplemental payment to qualified hospital providers to offset
any potential revenue losses resulting from the shift from managed care payments;new text begin and
new text end

deleted text begin (9) recommendations on whether and how the direct payment system should be expanded
to deliver services and care coordination to medical assistance enrollees who are age 65 or
older, are blind, or have a disability and to persons enrolled in MinnesotaCare; and
deleted text end

deleted text begin (10)deleted text end new text begin (9)new text end recommendations for statutory changes necessary to implement the deleted text begin direct
payment system
deleted text end new text begin alternative modelnew text end .

(b) In developing deleted text begin thedeleted text end new text begin eachnew text end implementation plan, the commissioner shall:

(1) calculate the projected cost of deleted text begin a direct payment systemdeleted text end new text begin the alternative modelnew text end relative
to the cost of the current system;

(2) assess gaps in care coordination under the current medical assistance and
MinnesotaCare programs;

(3) evaluate the effectiveness of approaches other states have taken to coordinate care
under a fee-for-service system, including the coordination of care provided to persons who
new text begin are age 65 or older, new text end are blindnew text begin ,new text end or have disabilities;

(4) estimate the loss of revenue and cost savings from other payment enhancements
based on managed care plan directed payments and pass-throughs;

(5) estimate cost trends under deleted text begin a direct payment systemdeleted text end new text begin the alternative modelnew text end for managed
care payments to county-based purchasing plans and county-owned health maintenance
organizations;

(6) estimate the impact of deleted text begin a direct payment systemdeleted text end new text begin the alternative modelnew text end on other revenue,
including taxes, surcharges, or other federally approved in lieu of services and on other
arrangements allowed under managed care;

(7) consider allowing eligible individuals to opt out of managed care as an alternative
approach;

deleted text begin (8) assess the feasibility of a medical assistance outpatient prescription drug benefit
carve-out under section 256B.69, subdivision 6d, and in consultation with the commissioners
of commerce and health, assess the feasibility of including MinnesotaCare enrollees and
private sector enrollees of health plan companies in the drug benefit carve-out. The
assessment of feasibility must address and include recommendations related to the process
and terms by which the commissioner would contract with health plan companies to
administer prescription drug benefits and develop and manage a drug formulary, and the
impact of the drug-benefit carve-out on health care providers, including small pharmacies;
deleted text end

deleted text begin (9)deleted text end new text begin (8)new text end consult with the commissioners of health and commerce and the contractor or
contractors analyzing the Minnesota Health Plan deleted text begin under section 19deleted text end and other health reform
models on plan design and assumptions; and

deleted text begin (10)deleted text end new text begin (9)new text end conduct other analyses necessary to develop the implementation plan.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256.9657, is amended by adding a subdivision
to read:


new text begin Subd. 2a.new text end

new text begin Teaching hospital surcharge.new text end

new text begin (a) Each teaching hospital shall pay to the
medical assistance account a surcharge equal to 1.41 percent of its fiscal year 2021 net
patient revenue for inpatient services. The initial surcharge must not be collected more than
30 days before the commissioner makes the first of the payments required under section
256.969, subdivision 2g. Subsequent surcharge payments must be paid annually in the form
and manner specified by the commissioner. The surcharge must comply with all applicable
federal requirements and federal laws, including but not limited to Code of Federal
Regulations, title 42, section 433.68.
new text end

new text begin (b) Revenue from the surcharge must be used by the commissioner only to pay the
nonfederal share of the medical assistance supplemental payments described in section
256.969, subdivision 2g, and must be used to supplement, and not supplant, medical
assistance reimbursement to teaching hospitals.
new text end

new text begin (c) For purposes of this subdivision, "teaching hospital" means any Minnesota hospital
with a Centers for Medicare and Medicaid Services designation of "teaching hospital" as
reported on form CMS-2552-10, worksheet S-2, line 56, that is eligible for reimbursement
under section 256.969, subdivision 2g.
new text end

new text begin (d) Notwithstanding paragraph (c), the following hospitals are exempt from paying the
surcharge under this section:
new text end

new text begin (1) all hospitals in Minnesota designated as a children's hospital under Medicare, including
Children's Health Care, doing business as Children's Minnesota, and Gillette Children's
Specialty Healthcare, doing business as Gillette Children's;
new text end

new text begin (2) teaching hospitals with three or fewer full-time equivalent trainees, based on a
Medicare cost report filed for the fiscal year ending in 2022;
new text end

new text begin (3) federal Indian Health Service facilities; and
new text end

new text begin (4) regional treatment centers.
new text end

new text begin (e) The teaching hospital surcharge established under this subdivision must only be
assessed if the annual inpatient supplemental payments under section 256.969, subdivision
2g, are approved by the Centers for Medicare and Medicaid Services.
new text end

new text begin (f) The commissioner must reduce the surcharge percentage in paragraph (a) such that
the aggregate amount collected from hospitals under this subdivision does not exceed the
total amount needed for the nonfederal share of the annual inpatient supplemental payments
authorized by section 256.969, subdivision 2g.
new text end

new text begin (g) For purposes of this subdivision, net patient revenue for inpatient services must be
calculated by:
new text end

new text begin (1) determining gross inpatient hospital facility charges from the hospital's audited
statements or, if not contained or segregated within the hospital's audited financial statements,
using detailed internal financial income statements or schedules; and
new text end

new text begin (2) subtracting from gross inpatient hospital facility charges:
new text end

new text begin (i) all professional fee charges, home health charges, skilled nursing facility charges,
hospice charges, end-stage renal disease charges, and other nonhospital charges; and
new text end

new text begin (ii) applicable contractual allowances.
new text end

new text begin (h) Teaching hospitals subject to the surcharge under this subdivision shall submit to
the commissioner, in the form and manner specified by the commissioner, all documentation
necessary to provide reconciliation of the net patient revenue calculation under paragraph
(b).
new text end

new text begin (i) This subdivision is effective on the later of July 1, 2025, or 60 days after the end of
the first legislative regular session that begins following federal approval for all of the
following: (1) the amendment in this act adding section 256.9657, subdivision 2a; (2) the
amendment in this act to section 256.969, subdivision 2b; and (3) the amendment in this
act adding section 256.969, subdivision 2g. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
new text end

new text begin (j) This subdivision is subject to the implementation requirements in section 9.
new text end

new text begin (k) This subdivision expires June 30, 2030, or five years after federal approval is obtained,
whichever is later.
new text end

Sec. 3.

Minnesota Statutes 2023 Supplement, section 256.969, subdivision 2b, is amended
to read:


Subd. 2b.

Hospital payment rates.

(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:

(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;

(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;

(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and

(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.

(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.

(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year or years for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.

(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).

(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:

(1) pediatric services;

(2) behavioral health services;

(3) trauma services as defined by the National Uniform Billing Committee;

(4) transplant services;

(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;

(6) outlier admissions;

(7) low-volume providers; and

(8) services provided by small rural hospitals that are not critical access hospitals.

(f) Hospital payment rates established under paragraph (c) must incorporate the following:

(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;

(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;

(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and

(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.

(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.

(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year or years and the next base year or years. In
any year that inpatient claims volume falls below the threshold required to ensure a
statistically valid sample of claims, the commissioner may combine claims data from two
consecutive years to serve as the base year. Years in which inpatient claims volume is
reduced or altered due to a pandemic or other public health emergency shall not be used as
a base year or part of a base year if the base year includes more than one year. Changes in
costs between base years shall be measured using the lower of the hospital cost index defined
in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year or years for which filed Medicare cost reports are available, except
that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019.
The estimated change in the average payment per hospital discharge resulting from a
scheduled rebasing must be calculated and made available to the legislature by January 15
of each year in which rebasing is scheduled to occur, and must include by hospital the
differential in payment rates compared to the individual hospital's costs.

(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:

(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;

(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and

(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.

(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:

(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;

(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;

(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);

(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and

(6) geographic location.

(k) new text begin Subject to subdivision 2g, new text end effective for discharges occurring on or after January 1,
2024, the rates paid to hospitals described in paragraph (a), clauses (2) to (4), must include
a rate factor specific to each hospital that qualifies for a medical education and research
cost distribution under section 62J.692, subdivision 4, paragraph (a).

new text begin EFFECTIVE DATE.new text end

new text begin (a) This section is effective the later of July 1, 2025, or 60 days
after the end of the first legislative session that begins following federal approval of all of
the following:
new text end

new text begin (1) the amendment in this act to add Minnesota Statutes, section 256.9657, subdivision
2a;
new text end

new text begin (2) the amendments in this act to Minnesota Statutes, section 256.969, subdivision 2b;
and
new text end

new text begin (3) the amendment in this act to add Minnesota Statutes, section 256.969, subdivision
2g.
new text end

new text begin (b) The commissioner of human services shall notify the revisor of statutes when federal
approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to
read:


new text begin Subd. 2g.new text end

new text begin Annual supplemental payment for graduate medical education.new text end

new text begin (a) The
commissioner and contracted managed care organizations shall annually pay an inpatient
supplemental payment to all eligible hospitals for graduate medical education. A hospital
must be an eligible hospital to receive an annual supplemental payment under this
subdivision. Payments under this subdivision must comply with all applicable federal
requirements and federal laws and meet the requirements of Code of Federal Regulations,
title 42, section 438.60.
new text end

new text begin (b) For purposes of this subdivision, "eligible hospital" means a hospital that:
new text end

new text begin (1) is located in Minnesota;
new text end

new text begin (2) participates in Minnesota's medical assistance program;
new text end

new text begin (3) has received fee-for-service medical assistance payments in the payment year; and
new text end

new text begin (4) is either:
new text end

new text begin (i) eligible to receive graduate medical education payments from the Medicare program
under Code of Federal Regulations, title 42, section 413.75; or
new text end

new text begin (ii) a hospital in Minnesota designated as a children's hospital under Medicare, including
Children's Health Care, doing business as Children's Minnesota, and Gillette Children's
Specialty Healthcare, doing business as Gillette Children's.
new text end

new text begin (c) The annual inpatient supplemental payment must be calculated as follows:
new text end

new text begin (1) $425,000 per full-time equivalent trained for each of the first ten full-time equivalents
at a hospital;
new text end

new text begin (2) $350,000 per full-time equivalent trained for each full-time equivalent between 11
and 20 full-time equivalents at a hospital;
new text end

new text begin (3) $95,000 per full-time equivalent trained for each full-time equivalent between 21
and 30 full-time equivalents at a hospital;
new text end

new text begin (4) $70,000 per full-time equivalent trained for each full-time equivalent between 31
and 400 full-time equivalents at a hospital; and
new text end

new text begin (5) $50,000 per full-time equivalent trained for each full-time equivalent above 401
full-time equivalents at a hospital.
new text end

new text begin (d) The data source for the full-time equivalent trained under paragraph (c) must be the
Medicare cost report for the fiscal year ending in calendar year 2022. The full-time equivalent
is calculated by adding the two values populated on lines 10 and 11 on worksheet E, part
A, of the Medicare cost report for that year, except that for eligible hospitals that are children's
hospitals, the full-time equivalent is calculated based on interns and residents, as determined
by adding form CMS-2552-10, worksheet E-4, lines 6, 10.01, and 15.01, or its equivalent,
for that year.
new text end

new text begin (e) An eligible hospital must not accept any reimbursement under section 62J.692 if it
would result in payments in excess of eligible expenditures. The surcharge paid under section
256.9657, subdivision 2a, and the payment received under this section must be reported in
the application under section 62J.692.
new text end

new text begin (f) The supplemental payments under this subdivision:
new text end

new text begin (1) must not be included as public program revenue under section 62J.692; and
new text end

new text begin (2) must be deemed permissible pass-through payments for graduate medical education
under Code of Federal Regulations, title 42, section 438.6(d), or when the state makes
payments directly to teaching hospitals for graduate medical education costs approved under
the state plan under Code of Federal Regulations, title 42, section 438.60.
new text end

new text begin (g) The total aggregate state and federal supplemental payments for hospitals under this
subdivision must not exceed $203,000,000 per year. The commissioner may reduce the
amount paid for each full-time equivalent, as described in paragraph (c), on an equal basis
to limit the total cost of all supplemental payments to the total dollar amounts available.
new text end

new text begin (h) This subdivision is effective the later of July 1, 2025, or 60 days after the end of the
first legislative regular session that begins following federal approval for all of the following:
(1) the amendment in this act adding section 256.9657, subdivision 2a; (2) the amendment
in this act to section 256.969, subdivision 2b; and (3) the amendment in this act to add
section 256.969, subdivision 2g. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

new text begin (i) This subdivision is subject to the implementation requirements in section 9.
new text end

new text begin (j) This subdivision expires June 30, 2030, or five years after federal approval is obtained,
whichever is later.
new text end

Sec. 5.

Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to
read:


new text begin Subd. 32.new text end

new text begin Biological products for cell and gene therapy.new text end

new text begin (a) Effective July 1, 2025,
and upon necessary federal approval of documentation required to enter into a value-based
arrangement under section 256B.0625, subdivision 13k, the commissioner may provide
separate reimbursement to hospitals for biological products provided in the inpatient hospital
setting as part of cell or gene therapy to treat rare diseases, as defined in United States Code,
title 21, section 360bb, if the drug manufacturer enters into a value-based arrangement with
the commissioner.
new text end

new text begin (b) The commissioner shall establish the separate reimbursement rate for biological
products provided under paragraph (a) based on the methodology used for drugs administered
in an outpatient setting under section 256B.0625, subdivision 13e, paragraph (e).
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 6.

Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 13e, as
amended by Laws 2024, chapter 85, section 66, is amended to read:


Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The professional dispensing fee shall be
deleted text begin $10.77deleted text end new text begin $11.55new text end for prescriptions filled with legend drugs meeting the definition of "covered
outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The
dispensing fee for intravenous solutions that must be compounded by the pharmacist shall
be deleted text begin $10.77deleted text end new text begin $11.55new text end per claim. The professional dispensing fee for prescriptions filled with
over-the-counter drugs meeting the definition of covered outpatient drugs shall be deleted text begin $10.77deleted text end new text begin
$11.55
new text end for dispensed quantities equal to or greater than the number of units contained in
the manufacturer's original package. The professional dispensing fee shall be prorated based
on the percentage of the package dispensed when the pharmacy dispenses a quantity less
than the number of units contained in the manufacturer's original package. The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units
contained in the manufacturer's original package and shall be prorated based on the
percentage of the package dispensed when the pharmacy dispenses a quantity less than the
number of units contained in the manufacturer's original package. The National Average
Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug.
For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient
cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for
a provider participating in the federal 340B Drug Pricing Program shall be either the 340B
Drug Pricing Program ceiling price established by the Health Resources and Services
Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as
the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in
the United States, not including prompt pay or other discounts, rebates, or reductions in
price, for the most recent month for which information is available, as reported in wholesale
price guides or other publications of drug or biological pricing data. The maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to
the actual acquisition cost of the drug product and no higher than the NADAC of the generic
product. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.

(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.

(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.

(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.

(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.

(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.

(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.

(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for specialty prescription drugs and a single
statewide cost of dispensing for nonspecialty prescription drugs for all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted by
medical assistance prescription volume, median, median weighted by total prescription
volume, and median weighted by total medical assistance prescription volume. The
commissioner shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey must be completed no later than January 1, 2021,
and repeated every three years. The commissioner shall provide a summary of the results
of each cost of dispensing survey and provide recommendations for any changes to the
dispensing fee to the chairs and ranking minority members of the legislative committees
with jurisdiction over medical assistance pharmacy reimbursement. Notwithstanding section
256.01, subdivision 42, this paragraph does not expire.

(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective October 1, 2024.
new text end

Sec. 7.

Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 13k, is
amended to read:


Subd. 13k.

Value-based purchasing arrangements.

(a) The commissioner may enter
into a value-based purchasing arrangement under medical assistance or MinnesotaCare, by
written arrangement with a drug manufacturer based on agreed-upon metrics. The
commissioner may contract with a vendor to implement and administer the value-based
purchasing arrangement. A value-based purchasing arrangement may include but is not
limited to rebates, discounts, price reductions, risk sharing, reimbursements, guarantees,
shared savings payments, withholds, or bonuses. A value-based purchasing arrangement
must provide at least the same value or discount in the aggregate as would claiming the
mandatory federal drug rebate under the Federal Social Security Act, section 1927.

(b) Nothing in this section shall be interpreted as requiring a drug manufacturer or the
commissioner to enter into an arrangement as described in paragraph (a).

(c) Nothing in this section shall be interpreted as altering or modifying medical assistance
coverage requirements under the federal Social Security Act, section 1927.

(d) If the commissioner determines that a state plan amendment is necessary before
implementing a value-based purchasing arrangement, the commissioner shall request the
amendment and may delay implementing this provision until the amendment is approved.

new text begin (e) The commissioner may provide separate reimbursement to hospitals for drugs provided
in the inpatient hospital setting as part of a value-based purchasing arrangement. This
payment must be separate from the diagnostic related group reimbursement for the inpatient
admission or discharge associated with a stay during which the patient received a drug under
this section. For payments made under this section, the hospital must not be reimbursed for
the drug under the payment methodology in section 256.969. The commissioner shall
establish the separate reimbursement rate for drugs provided under this section based on
the methodology used for drugs administered in an outpatient setting under section
256B.0625, subdivision 13e, paragraph (e).
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 8.

Minnesota Statutes 2023 Supplement, section 256L.04, subdivision 10, is amended
to read:


Subd. 10.

Citizenship requirements.

(a) Eligibility for MinnesotaCare is available to
citizens or nationals of the United States; lawfully present noncitizens as defined in Code
of Federal Regulations, deleted text begin title 8, section 103.12deleted text end new text begin title 45, section 155.20new text end ; and undocumented
noncitizens. For purposes of this subdivision, an undocumented noncitizen is an individual
who resides in the United States without the approval or acquiescence of the United States
Citizenship and Immigration Services. Families with children who are citizens or nationals
of the United States must cooperate in obtaining satisfactory documentary evidence of
citizenship or nationality according to the requirements of the federal Deficit Reduction
Act of 2005, Public Law 109-171.

(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are ineligible for medical assistance by reason of immigration status and
who have incomes equal to or less than 200 percent of federal poverty guidelines, except
that these persons may be eligible for emergency medical assistance under section 256B.06,
subdivision 4
.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective November 1, 2024.
new text end

Sec. 9. new text begin IMPLEMENTATION OF TEACHING HOSPITAL SURCHARGE AND
GRADUATE MEDICAL EDUCATION SUPPLEMENTAL PAYMENT.
new text end

new text begin (a) The commissioner of human services shall submit to the Centers for Medicare and
Medicaid Services a request for federal approval to implement the teaching hospital surcharge
under Minnesota Statutes, section 256.9657, subdivision 2a, and the graduate medical
education supplemental payments under Minnesota Statutes, section 256.969, subdivisions
2b and 2g. At least 60 days before submitting the request for approval, the commissioner
of human services shall make available to the public the draft surcharge requirements, draft
supplemental payment rates, and an estimate of each nonexempt hospital's surcharge amount.
The commissioner shall provide at least 60 days for public comment.
new text end

new text begin (b) During the design, and prior to submission, of the request for approval described in
paragraph (a), the commissioner must consult with representatives of eligible hospitals, as
defined in Minnesota Statutes, section 256.969, subdivision 2g.
new text end

new text begin (c) If federal approval is received under paragraph (a), the commissioner shall provide
a 30-day public comment period on the federally approved terms and conditions for the
surcharge and supplemental payments. If, during the 30-day comment period, the
commissioner receives a documented, written statement of opposition from representatives
of one or more eligible hospitals, as defined in Minnesota Statutes, section 256.9657,
subdivision 2a, the commissioner shall publish the written statement and indefinitely suspend
implementation of both the teaching hospital surcharge under Minnesota Statutes, section
256.9657, subdivision 2a, and the supplemental payments under Minnesota Statutes, section
256.969, subdivisions 2b and 2g.
new text end

new text begin (d) By December 15, 2024, the commissioner of health may make recommendations to
the legislature for program modifications and conforming amendments to Minnesota Statutes,
section 62J.692, that are necessary as a result of the amendments to Minnesota Statutes,
section 256.969, subdivisions 2b and 2g. In developing the recommendations under this
paragraph, the commissioner of health must consult with eligible hospitals, as defined in
Minnesota Statutes, section 256.969, subdivision 2g.
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. new text begin COUNTY-ADMINISTERED RURAL MEDICAL ASSISTANCE MODEL.
new text end

new text begin Subdivision 1.new text end

new text begin Model development.new text end

new text begin (a) The commissioner of human services, in
collaboration with the Association of Minnesota Counties and county-based purchasing
plans, shall develop a county-administered rural medical assistance (CARMA) model and
a detailed plan for implementing the CARMA model.
new text end

new text begin (b) The CARMA model must be designed to achieve the following objectives:
new text end

new text begin (1) provide a distinct county owned and administered alternative to the prepaid medical
assistance program;
new text end

new text begin (2) facilitate greater integration of health care and social services to address social
determinants of health in rural communities, with the degree of integration of social services
varying with each county's needs and resources;
new text end

new text begin (3) account for the smaller number of medical assistance enrollees and locally available
providers of behavioral health, oral health, specialty and tertiary care, nonemergency medical
transportation, and other health care services in rural communities; and
new text end

new text begin (4) promote greater accountability for health outcomes, health equity, customer service,
community outreach, and cost of care.
new text end

new text begin Subd. 2.new text end

new text begin County participation.new text end

new text begin The CARMA model must give each rural county the
option of applying to participate in the CARMA model as an alternative to participation in
the prepaid medical assistance program. The CARMA model must include a process for
the commissioner to determine whether and how a rural county can participate.
new text end

new text begin Subd. 3.new text end

new text begin Report to the legislature.new text end

new text begin (a) The commissioner shall report recommendations
and an implementation plan for the CARMA model to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance
by January 15, 2025. The CARMA model and implementation plan must address the issues
and consider the recommendations identified in the document titled "Recommendations
Not Contingent on Outcome(s) of Current Litigation," attached to the September 13, 2022,
e-filing to the Second Judicial District Court (Correspondence for Judicial Approval Index
#102), that relates to the final contract decisions of the commissioner of human services
regarding South Country Health Alliance v. Minnesota Department of Human Services, No.
62-CV-22-907 (Ramsey Cnty. Dist. Ct. 2022).
new text end

new text begin (b) The report must also identify the clarifications, approvals, and waivers that are needed
from the Centers for Medicare and Medicaid Services and include any draft legislation
necessary to implement the CARMA model.
new text end

ARTICLE 2

DEPARTMENT OF HUMAN SERVICES HEALTH CARE POLICY

Section 1.

Minnesota Statutes 2022, section 62M.01, subdivision 3, is amended to read:


Subd. 3.

Scope.

(a) Nothing in this chapter applies to review of claims after submission
to determine eligibility for benefits under a health benefit plan. The appeal procedure
described in section 62M.06 applies to any complaint as defined under section 62Q.68,
subdivision 2
, that requires a medical determination in its resolution.

(b) new text begin Effective January 1, 2026, new text end this chapter deleted text begin does not applydeleted text end new text begin appliesnew text end to managed care plans
or county-based purchasing plans when the plan is providing coverage to state public health
care program enrollees under chapter 256B or 256L.

new text begin (c) Effective January 1, 2026, the following sections of this chapter apply to services
delivered under chapters 256B and 256L: 62M.02, subdivisions 1 to 5, 7 to 12, 13, 14 to
18, and 21; 62M.04; 62M.05, subdivisions 1 to 4; 62M.06, subdivisions 1 to 3; 62M.07;
62M.072; 62M.09; 62M.10; 62M.12; 62M.17, subdivision 2; and 62M.18.
new text end

Sec. 2.

Minnesota Statutes 2023 Supplement, section 256.0471, subdivision 1, as amended
by Laws 2024, chapter 80, article 1, section 76, is amended to read:


Subdivision 1.

Qualifying overpayment.

Any overpayment fornew text begin state-funded medicalnew text end
assistancenew text begin under chapter 256B and state-funded MinnesotaCare under chapter 256Lnew text end granted
pursuant to section 256.045, subdivision 10; deleted text begin chapter 256B for state-funded medical
assistance;
deleted text end and new text begin for assistance granted undernew text end chapters 256D, 256I, new text begin andnew text end 256K, deleted text begin and 256L for
state-funded MinnesotaCare
deleted text end except agency error claims, become a judgment by operation
of law 90 days after the notice of overpayment is personally served upon the recipient in a
manner that is sufficient under rule 4.03(a) of the Rules of Civil Procedure for district courts,
or by certified mail, return receipt requested. This judgment shall be entitled to full faith
and credit in this and any other state.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2024.
new text end

Sec. 3.

Minnesota Statutes 2022, section 256.9657, subdivision 8, is amended to read:


Subd. 8.

Commissioner's duties.

deleted text begin (a) Beginning October 1, 2023, the commissioner of
human services shall annually report to the chairs and ranking minority members of the
legislative committees with jurisdiction over health care policy and finance regarding the
provider surcharge program. The report shall include information on total billings, total
collections, and administrative expenditures for the previous fiscal year. This paragraph
expires January 1, 2032.
deleted text end

deleted text begin (b)deleted text end new text begin (a)new text end The surcharge shall be adjusted by inflationary and caseload changes in future
bienniums to maintain reimbursement of health care providers in accordance with the
requirements of the state and federal laws governing the medical assistance program,
including the requirements of the Medicaid moratorium amendments of 1991 found in
Public Law No. 102-234.

deleted text begin (c)deleted text end new text begin (b)new text end The commissioner shall request the Minnesota congressional delegation to support
a change in federal law that would prohibit federal disallowances for any state that makes
a good faith effort to comply with Public Law 102-234 by enacting conforming legislation
prior to the issuance of federal implementing regulations.

Sec. 4.

Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to
read:


new text begin Subd. 2h.new text end

new text begin Alternate inpatient payment rate for a discharge.new text end

new text begin (a) Effective retroactively
from January 1, 2024, in any rate year in which a children's hospital discharge is included
in the federally required disproportionate share hospital payment audit, where the patient
discharged had resided in a children's hospital for over 20 years, the commissioner shall
compute an alternate inpatient rate for the children's hospital. The alternate payment rate
must be the rate computed under this section excluding the disproportionate share hospital
payment under subdivision 9, paragraph (d), clause (1), increased by an amount equal to
99 percent of what the disproportionate share hospital payment would have been under
subdivision 9, paragraph (d), clause (1), had the discharge been excluded.
new text end

new text begin (b) In any rate year in which payment to a children's hospital is made using this alternate
payment rate, payments must not be made to the hospital under subdivisions 2e, 2f, and 9.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 5.

Minnesota Statutes 2022, section 256B.056, subdivision 1a, is amended to read:


Subd. 1a.

Income and assets generally.

(a)(1) Unless specifically required by state law
or rule or federal law or regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons whose eligibility category is based
on blindness, disability, or age of 65 or more years, the methodologies for the Supplemental
Security Income program shall be used, except as provided deleted text begin underdeleted text end new text begin in clause (2) andnew text end
subdivision 3, paragraph (a), clause (6).

new text begin (2) State tax credits, rebates, and refunds must not be counted as income. State tax credits,
rebates, and refunds must not be counted as assets for a period of 12 months after the month
of receipt.
new text end

deleted text begin (2)deleted text end new text begin (3)new text end Increases in benefits under title II of the Social Security Act shall not be counted
as income for purposes of this subdivision until July 1 of each year. Effective upon federal
approval, for children eligible under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical assistance is determined
without regard to parental income, child support payments, including any payments made
by an obligor in satisfaction of or in addition to a temporary or permanent order for child
support, and Social Security payments are not counted as income.

(b)(1) The modified adjusted gross income methodology as defined in United States
Code, title 42, section 1396a(e)(14), shall be used for eligibility categories based on:

(i) children under age 19 and their parents and relative caretakers as defined in section
256B.055, subdivision 3a;

(ii) children ages 19 to 20 as defined in section 256B.055, subdivision 16;

(iii) pregnant women as defined in section 256B.055, subdivision 6;

(iv) infants as defined in sections 256B.055, subdivision 10, and 256B.057, subdivision
1; and

(v) adults without children as defined in section 256B.055, subdivision 15.

For these purposes, a "methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.

(2) For individuals whose income eligibility is determined using the modified adjusted
gross income methodology in clause (1):

(i) the commissioner shall subtract from the individual's modified adjusted gross income
an amount equivalent to five percent of the federal poverty guidelines; and

(ii) the individual's current monthly income and household size is used to determine
eligibility for the 12-month eligibility period. If an individual's income is expected to vary
month to month, eligibility is determined based on the income predicted for the 12-month
eligibility period.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6.

Minnesota Statutes 2022, section 256B.056, subdivision 10, is amended to read:


Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the
12-month postpartum period to update their income and asset information and to submit
any required income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph (c), and shall pay for private-sector coverage if this is
determined to be cost-effective.

(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.

(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.

(e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to deleted text begin identify unreported accountsdeleted text end new text begin verify assetsnew text end as
required in section 256.01, subdivision 18f. If a person refuses or revokes the authorization,
the commissioner may determine that the applicant or recipient is ineligible for medical
assistance. For purposes of this paragraph, an authorization to deleted text begin identify unreported accountsdeleted text end new text begin
verify assets
new text end meets the requirements of the Right to Financial Privacy Act, United States
Code, title 12, chapter 35, and need not be furnished to the financial institution.

(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.

Sec. 7.

Minnesota Statutes 2023 Supplement, section 256B.0622, subdivision 8, is amended
to read:


Subd. 8.

Medical assistance payment for assertive community treatment and
intensive residential treatment services.

(a) Payment for intensive residential treatment
services and assertive community treatment in this section shall be based on one daily rate
per provider inclusive of the following services received by an eligible client in a given
calendar day: all rehabilitative services under this section, staff travel time to provide
rehabilitative services under this section, and nonresidential crisis stabilization services
under section 256B.0624.

(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each client for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.

(c) The commissioner shall determine one rate for each provider that will bill medical
assistance for residential services under this section and one rate for each assertive community
treatment provider. If a single entity provides both services, one rate is established for the
entity's residential services and another rate for the entity's nonresidential services under
this section. A provider is not eligible for payment under this section without authorization
from the commissioner. The commissioner shall develop rates using the following criteria:

(1) the provider's cost for services shall include direct services costs, other program
costs, and other costs determined as follows:

(i) the direct services costs must be determined using actual costs of salaries, benefits,
payroll taxes, and training of direct service staff and service-related transportation;

(ii) other program costs not included in item (i) must be determined as a specified
percentage of the direct services costs as determined by item (i). The percentage used shall
be determined by the commissioner based upon the average of percentages that represent
the relationship of other program costs to direct services costs among the entities that provide
similar services;

(iii) physical plant costs calculated based on the percentage of space within the program
that is entirely devoted to treatment and programming. This does not include administrative
or residential space;

(iv) assertive community treatment physical plant costs must be reimbursed as part of
the costs described in item (ii); and

(v) subject to federal approval, up to an additional five percent of the total rate may be
added to the program rate as a quality incentive based upon the entity meeting performance
criteria specified by the commissioner;

(2) actual cost is defined as costs which are allowable, allocable, and reasonable, and
consistent with federal reimbursement requirements under Code of Federal Regulations,
title 48, chapter 1, part 31, relating to for-profit entities, and Office of Management and
Budget Circular Number A-122, relating to nonprofit entities;

(3) the number of service units;

(4) the degree to which clients will receive services other than services under this section;
and

(5) the costs of other services that will be separately reimbursed.

(d) The rate for intensive residential treatment services and assertive community treatment
must exclude the medical assistance room and board rate, as defined in section 256B.056,
subdivision 5d, and services not covered under this section, such as partial hospitalization,
home care, and inpatient services.

(e) Physician services that are not separately billed may be included in the rate to the
extent that a psychiatrist, or other health care professional providing physician services
within their scope of practice, is a member of the intensive residential treatment services
treatment team. Physician services, whether billed separately or included in the rate, may
be delivered by telehealth. For purposes of this paragraph, "telehealth" has the meaning
given to "mental health telehealth" in section 256B.0625, subdivision 46, when telehealth
is used to provide intensive residential treatment services.

(f) When services under this section are provided by an assertive community treatment
provider, case management functions must be an integral part of the team.

(g) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payors.

(h) The rates for existing programs must be established prospectively based upon the
expenditures and utilization over a prior 12-month period using the criteria established in
paragraph (c). The rates for new programs must be established based upon estimated
expenditures and estimated utilization using the criteria established in paragraph (c).

(i) Effective for the rate years beginning on and after January 1, 2024, rates for assertive
community treatment, adult residential crisis stabilization services, and intensive residential
treatment services must be annually adjusted for inflation using the Centers for Medicare
and Medicaid Services Medicare Economic Index, as forecasted in the deleted text begin fourthdeleted text end new text begin thirdnew text end quarter
of the calendar year before the rate year. The inflation adjustment must be based on the
12-month period from the midpoint of the previous rate year to the midpoint of the rate year
for which the rate is being determined.

(j) Entities who discontinue providing services must be subject to a settle-up process
whereby actual costs and reimbursement for the previous 12 months are compared. In the
event that the entity was paid more than the entity's actual costs plus any applicable
performance-related funding due the provider, the excess payment must be reimbursed to
the department. If a provider's revenue is less than actual allowed costs due to lower
utilization than projected, the commissioner may reimburse the provider to recover its actual
allowable costs. The resulting adjustments by the commissioner must be proportional to the
percent of total units of service reimbursed by the commissioner and must reflect a difference
of greater than five percent.

(k) A provider may request of the commissioner a review of any rate-setting decision
made under this subdivision.

Sec. 8.

Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 9, is amended
to read:


Subd. 9.

Dental services.

(a) Medical assistance covers medically necessary dental
services.

(b) The following guidelines apply to dental services:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants are covered once every five years per permanent molar; and

(3) application of fluoride varnish is covered once every six months.

(c) In addition to the services specified in paragraph deleted text begin (b)deleted text end new text begin (a)new text end , medical assistance covers
the following services:

(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.

(d) The commissioner shall not require prior authorization for the services included in
paragraph (c), clauses (1) to (3), and shall prohibit managed care and county-based purchasing
plans from requiring prior authorization for the services included in paragraph (c), 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 the day following final enactment.
new text end

Sec. 9.

Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 13e, as
amended by Laws 2024, chapter 85, section 66, is amended to read:


Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chainnew text begin , unless the prescription savings club or prescription discount club is one
in which an individual pays a recurring monthly access fee for unlimited access to a defined
list of drugs for which the pharmacy does not bill the member or a payer on a
per-standard-transaction basis
new text end . The amount of payment basis must be reduced to reflect all
discount amounts applied to the charge by any third-party provider/insurer agreement or
contract for submitted charges to medical assistance programs. The net submitted charge
may not be greater than the patient liability for the service. The professional dispensing fee
shall be $10.77 for prescriptions filled with legend drugs meeting the definition of "covered
outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The
dispensing fee for intravenous solutions that must be compounded by the pharmacist shall
be $10.77 per claim. The professional dispensing fee for prescriptions filled with
over-the-counter drugs meeting the definition of covered outpatient drugs shall be $10.77
for dispensed quantities equal to or greater than the number of units contained in the
manufacturer's original package. The professional dispensing fee shall be prorated based
on the percentage of the package dispensed when the pharmacy dispenses a quantity less
than the number of units contained in the manufacturer's original package. The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units
contained in the manufacturer's original package and shall be prorated based on the
percentage of the package dispensed when the pharmacy dispenses a quantity less than the
number of units contained in the manufacturer's original package. The National Average
Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug.
For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient
cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for
a provider participating in the federal 340B Drug Pricing Program shall be either the 340B
Drug Pricing Program ceiling price established by the Health Resources and Services
Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as
the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in
the United States, not including prompt pay or other discounts, rebates, or reductions in
price, for the most recent month for which information is available, as reported in wholesale
price guides or other publications of drug or biological pricing data. The maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to
the actual acquisition cost of the drug product and no higher than the NADAC of the generic
product. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.

(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.

(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.

(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.

(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.

(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.

(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.

(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for specialty prescription drugs and a single
statewide cost of dispensing for nonspecialty prescription drugs for all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted by
medical assistance prescription volume, median, median weighted by total prescription
volume, and median weighted by total medical assistance prescription volume. The
commissioner shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey must be completed no later than January 1, 2021,
and repeated every three years. The commissioner shall provide a summary of the results
of each cost of dispensing survey and provide recommendations for any changes to the
dispensing fee to the chairs and ranking minority members of the legislative committees
with jurisdiction over medical assistance pharmacy reimbursement. Notwithstanding section
256.01, subdivision 42, this paragraph does not expire.

(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.

Sec. 10.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 25c.new text end

new text begin Applicability of utilization review provisions.new text end

new text begin Effective January 1, 2026,
the following provisions of chapter 62M apply to the commissioner when delivering services
under chapters 256B and 256L: 62M.02, subdivisions 1 to 5, 7 to 12, 13, 14 to 18, and 21;
62M.04; 62M.05, subdivisions 1 to 4; 62M.06, subdivisions 1 to 3; 62M.07; 62M.072;
62M.09; 62M.10; 62M.12; 62M.17, subdivision 2; and 62M.18.
new text end

Sec. 11.

Minnesota Statutes 2023 Supplement, section 256B.0701, subdivision 6, is
amended to read:


Subd. 6.

Recuperative care facility rate.

(a) The recuperative care facility rate is for
facility costs and must be paid from state money in an amount equal to the deleted text begin medical assistance
room and board
deleted text end new text begin MSA equivalentnew text end rate new text begin as defined in section 256I.03, subdivision 11a, new text end at the
time the recuperative care services were provided. The eligibility standards in chapter 256I
do not apply to the recuperative care facility rate. The recuperative care facility rate is only
paid when the recuperative care services rate is paid to a provider. Providers may opt to
only receive the recuperative care services rate.

(b) Before a recipient is discharged from a recuperative care setting, the provider must
ensure that the recipient's medical condition is stabilized or that the recipient is being
discharged to a setting that is able to meet that recipient's needs.

Sec. 12.

Minnesota Statutes 2023 Supplement, section 256B.0947, subdivision 7, is
amended to read:


Subd. 7.

Medical assistance payment and rate setting.

(a) Payment for services in this
section must be based on one daily encounter rate per provider inclusive of the following
services received by an eligible client in a given calendar day: all rehabilitative services,
supports, and ancillary activities under this section, staff travel time to provide rehabilitative
services under this section, and crisis response services under section 256B.0624.

(b) Payment must not be made to more than one entity for each client for services
provided under this section on a given day. If services under this section are provided by a
team that includes staff from more than one entity, the team shall determine how to distribute
the payment among the members.

(c) The commissioner shall establish regional cost-based rates for entities that will bill
medical assistance for nonresidential intensive rehabilitative mental health services. In
developing these rates, the commissioner shall consider:

(1) the cost for similar services in the health care trade area;

(2) actual costs incurred by entities providing the services;

(3) the intensity and frequency of services to be provided to each client;

(4) the degree to which clients will receive services other than services under this section;
and

(5) the costs of other services that will be separately reimbursed.

(d) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers.

(e) Effective for the rate years beginning on and after January 1, 2024, rates must be
annually adjusted for inflation using the Centers for Medicare and Medicaid Services
Medicare Economic Index, as forecasted in the deleted text begin fourthdeleted text end new text begin thirdnew text end quarter of the calendar year
before the rate year. The inflation adjustment must be based on the 12-month period from
the midpoint of the previous rate year to the midpoint of the rate year for which the rate is
being determined.

Sec. 13.

Minnesota Statutes 2023 Supplement, section 256B.764, is amended to read:


256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.

(a) Effective for services rendered on or after July 1, 2007, payment rates for family
planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
when these services are provided by a community clinic as defined in section 145.9268,
subdivision 1.

(b) Effective for services rendered on or after July 1, 2013, payment rates for family
planning services shall be increased by 20 percent over the rates in effect June 30, 2013,
when these services are provided by a community clinic as defined in section 145.9268,
subdivision 1
. The commissioner shall adjust capitation rates to managed care and
county-based purchasing plans to reflect this increase, and shall require plans to pass on the
full amount of the rate increase to eligible community clinics, in the form of higher payment
rates for family planning services.

(c) Effective for services provided on or after January 1, 2024, payment rates for family
planningnew text begin , when such services are provided by an eligible community clinic as defined in
section 145.9268, subdivision 1,
new text end and abortion services shall be increased by 20 percent.
This increase does not apply to federally qualified health centers, rural health centers, or
Indian health services.

Sec. 14.

Minnesota Statutes 2023 Supplement, section 256L.03, subdivision 1, is amended
to read:


Subdivision 1.

Covered health services.

(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, deleted text begin adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services,
deleted text end nonemergency medical transportation
services, personal care assistance and case management services, community first services
and supports under section 256B.85, behavioral health home services under section
256B.0757, housing stabilization services under section 256B.051, and nursing home or
intermediate care facilities services.

(b) Covered health services shall be expanded as provided in this section.

(c) For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.

Sec. 15.

Minnesota Statutes 2022, section 524.3-801, as amended by Laws 2024, chapter
79, article 9, section 20, is amended to read:


524.3-801 NOTICE TO CREDITORS.

(a) Unless notice has already been given under this section, upon appointment of a
general personal representative in informal proceedings or upon the filing of a petition for
formal appointment of a general personal representative, notice thereof, in the form prescribed
by court rule, shall be given under the direction of the court administrator by publication
once a week for two successive weeks in a legal newspaper in the county wherein the
proceedings are pending giving the name and address of the general personal representative
and notifying creditors of the estate to present their claims within four months after the date
of the court administrator's notice which is subsequently published or be forever barred,
unless they are entitled to further service of notice under paragraph (b) or (c).

(b) The personal representative shall, within three months after the date of the first
publication of the notice, serve a copy of the notice upon each then known and identified
creditor in the manner provided in paragraph (c). If the decedent or a predeceased spouse
of the decedent received assistance for which a claim could be filed under section 246.53,
256B.15, 256D.16, or 261.04, notice to the commissioner of human services or direct care
and treatment executive board, as applicable, must be given under paragraph (d) instead of
under this paragraph or paragraph (c). A creditor is "known" if: (i) the personal representative
knows that the creditor has asserted a claim that arose during the decedent's life against
either the decedent or the decedent's estate; (ii) the creditor has asserted a claim that arose
during the decedent's life and the fact is clearly disclosed in accessible financial records
known and available to the personal representative; or (iii) the claim of the creditor would
be revealed by a reasonably diligent search for creditors of the decedent in accessible
financial records known and available to the personal representative. Under this section, a
creditor is "identified" if the personal representative's knowledge of the name and address
of the creditor will permit service of notice to be made under paragraph (c).

(c) Unless the claim has already been presented to the personal representative or paid,
the personal representative shall serve a copy of the notice required by paragraph (b) upon
each creditor of the decedent who is then known to the personal representative and identified
either by delivery of a copy of the required notice to the creditor, or by mailing a copy of
the notice to the creditor by certified, registered, or ordinary first class mail addressed to
the creditor at the creditor's office or place of residence.

(d)(1) Effective for decedents dying on or after July 1, 1997, if the decedent or a
predeceased spouse of the decedent received assistance for which a claim could be filed
under section 246.53, 256B.15, 256D.16, or 261.04, the personal representative or the
attorney for the personal representative shall serve the commissioner or executive board,
as applicable, with notice in the manner prescribed in paragraph (c)new text begin , or electronically in a
manner prescribed by the commissioner or executive board,
new text end as soon as practicable after the
appointment of the personal representative. The notice must state the decedent's full name,
date of birth, and Social Security number and, to the extent then known after making a
reasonably diligent inquiry, the full name, date of birth, and Social Security number for
each of the decedent's predeceased spouses. The notice may also contain a statement that,
after making a reasonably diligent inquiry, the personal representative has determined that
the decedent did not have any predeceased spouses or that the personal representative has
been unable to determine one or more of the previous items of information for a predeceased
spouse of the decedent. A copy of the notice to creditors must be attached to and be a part
of the notice to the commissioner or executive board.

(2) Notwithstanding a will or other instrument or law to the contrary, except as allowed
in this paragraph, no property subject to administration by the estate may be distributed by
the estate or the personal representative until 70 days after the date the notice is served on
the commissioner or executive board as provided in paragraph (c), unless the local agency
consents as provided for in clause (6). This restriction on distribution does not apply to the
personal representative's sale of real or personal property, but does apply to the net proceeds
the estate receives from these sales. The personal representative, or any person with personal
knowledge of the facts, may provide an affidavit containing the description of any real or
personal property affected by this paragraph and stating facts showing compliance with this
paragraph. If the affidavit describes real property, it may be filed or recorded in the office
of the county recorder or registrar of titles for the county where the real property is located.
This paragraph does not apply to proceedings under sections 524.3-1203 and 525.31, or
when a duly authorized agent of a county is acting as the personal representative of the
estate.

(3) At any time before an order or decree is entered under section 524.3-1001 or
524.3-1002, or a closing statement is filed under section 524.3-1003, the personal
representative or the attorney for the personal representative may serve an amended notice
on the commissioner or executive board to add variations or other names of the decedent
or a predeceased spouse named in the notice, the name of a predeceased spouse omitted
from the notice, to add or correct the date of birth or Social Security number of a decedent
or predeceased spouse named in the notice, or to correct any other deficiency in a prior
notice. The amended notice must state the decedent's name, date of birth, and Social Security
number, the case name, case number, and district court in which the estate is pending, and
the date the notice being amended was served on the commissioner or executive board. If
the amendment adds the name of a predeceased spouse omitted from the notice, it must also
state that spouse's full name, date of birth, and Social Security number. The amended notice
must be served on the commissioner or executive board in the same manner as the original
notice. Upon service, the amended notice relates back to and is effective from the date the
notice it amends was served, and the time for filing claims arising under section 246.53,
256B.15, 256D.16 or 261.04 is extended by 60 days from the date of service of the amended
notice. Claims filed during the 60-day period are undischarged and unbarred claims, may
be prosecuted by the entities entitled to file those claims in accordance with section
524.3-1004, and the limitations in section 524.3-1006 do not apply. The personal
representative or any person with personal knowledge of the facts may provide and file or
record an affidavit in the same manner as provided for in clause (1).

(4) Within one year after the date an order or decree is entered under section 524.3-1001
or 524.3-1002 or a closing statement is filed under section 524.3-1003, any person who has
an interest in property that was subject to administration by the estate may serve an amended
notice on the commissioner or executive board to add variations or other names of the
decedent or a predeceased spouse named in the notice, the name of a predeceased spouse
omitted from the notice, to add or correct the date of birth or Social Security number of a
decedent or predeceased spouse named in the notice, or to correct any other deficiency in
a prior notice. The amended notice must be served on the commissioner or executive board
in the same manner as the original notice and must contain the information required for
amendments under clause (3). If the amendment adds the name of a predeceased spouse
omitted from the notice, it must also state that spouse's full name, date of birth, and Social
Security number. Upon service, the amended notice relates back to and is effective from
the date the notice it amends was served. If the amended notice adds the name of an omitted
predeceased spouse or adds or corrects the Social Security number or date of birth of the
decedent or a predeceased spouse already named in the notice, then, notwithstanding any
other laws to the contrary, claims against the decedent's estate on account of those persons
resulting from the amendment and arising under section 246.53, 256B.15, 256D.16, or
261.04 are undischarged and unbarred claims, may be prosecuted by the entities entitled to
file those claims in accordance with section 524.3-1004, and the limitations in section
524.3-1006 do not apply. The person filing the amendment or any other person with personal
knowledge of the facts may provide and file or record an affidavit describing affected real
or personal property in the same manner as clause (1).

(5) After one year from the date an order or decree is entered under section 524.3-1001
or 524.3-1002, or a closing statement is filed under section 524.3-1003, no error, omission,
or defect of any kind in the notice to the commissioner or executive board required under
this paragraph or in the process of service of the notice on the commissioner or executive
board, or the failure to serve the commissioner or executive board with notice as required
by this paragraph, makes any distribution of property by a personal representative void or
voidable. The distributee's title to the distributed property shall be free of any claims based
upon a failure to comply with this paragraph.

(6) The local agency may consent to a personal representative's request to distribute
property subject to administration by the estate to distributees during the 70-day period after
service of notice on the commissioner or executive board. The local agency may grant or
deny the request in whole or in part and may attach conditions to its consent as it deems
appropriate. When the local agency consents to a distribution, it shall give the estate a written
certificate evidencing its consent to the early distribution of assets at no cost. The certificate
must include the name, case number, and district court in which the estate is pending, the
name of the local agency, describe the specific real or personal property to which the consent
applies, state that the local agency consents to the distribution of the specific property
described in the consent during the 70-day period following service of the notice on the
commissioner or executive board, state that the consent is unconditional or list all of the
terms and conditions of the consent, be dated, and may include other contents as may be
appropriate. The certificate must be signed by the director of the local agency or the director's
designees and is effective as of the date it is dated unless it provides otherwise. The signature
of the director or the director's designee does not require any acknowledgment. The certificate
shall be prima facie evidence of the facts it states, may be attached to or combined with a
deed or any other instrument of conveyance and, when so attached or combined, shall
constitute a single instrument. If the certificate describes real property, it shall be accepted
for recording or filing by the county recorder or registrar of titles in the county in which the
property is located. If the certificate describes real property and is not attached to or combined
with a deed or other instrument of conveyance, it shall be accepted for recording or filing
by the county recorder or registrar of titles in the county in which the property is located.
The certificate constitutes a waiver of the 70-day period provided for in clause (2) with
respect to the property it describes and is prima facie evidence of service of notice on the
commissioner or executive board. The certificate is not a waiver or relinquishment of any
claims arising under section 246.53, 256B.15, 256D.16, or 261.04, and does not otherwise
constitute a waiver of any of the personal representative's duties under this paragraph.
Distributees who receive property pursuant to a consent to an early distribution shall remain
liable to creditors of the estate as provided for by law.

(7) All affidavits provided for under this paragraph:

(i) shall be provided by persons who have personal knowledge of the facts stated in the
affidavit;

(ii) may be filed or recorded in the office of the county recorder or registrar of titles in
the county in which the real property they describe is located for the purpose of establishing
compliance with the requirements of this paragraph; and

(iii) are prima facie evidence of the facts stated in the affidavit.

(8) This paragraph applies to the estates of decedents dying on or after July 1, 1997.
Clause (5) also applies with respect to all notices served on the commissioner of human
services before July 1, 1997, under Laws 1996, chapter 451, article 2, section 55. All notices
served on the commissioner before July 1, 1997, pursuant to Laws 1996, chapter 451, article
2, section 55, shall be deemed to be legally sufficient for the purposes for which they were
intended, notwithstanding any errors, omissions or other defects.

Sec. 16. new text begin DIRECTION TO COMMISSIONER; REIMBURSEMENT FOR
EXTRACORPOREAL MEMBRANE OXYGENATION CANNULATION AS AN
OUTPATIENT SERVICE.
new text end

new text begin The commissioner of human services, in consultation with providers and hospitals, shall
determine the feasibility of an outpatient reimbursement mechanism for medical assistance
coverage of extracorporeal membrane oxygenation (ECMO) cannulation performed outside
an inpatient hospital setting or in a self-contained mobile ECMO unit. If an outpatient
reimbursement mechanism is feasible, then the commissioner of human services shall
develop a recommended payment mechanism. By January 15, 2025, the commissioner of
human services shall submit a recommendation and the required legislative language to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health care finance. If such a payment mechanism is infeasible, the commissioner of human
services shall submit an explanation as to why it is infeasible.
new text end

ARTICLE 3

HEALTH CARE

Section 1.

Minnesota Statutes 2022, section 62V.05, subdivision 12, is amended to read:


Subd. 12.

Reports on interagency agreements and intra-agency transfers.

The
MNsure Board shall provide deleted text begin quarterly reports to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance on:
deleted text end new text begin legislative reports on interagency agreements and intra-agency transfers according
to section 15.0395.
new text end

deleted text begin (1) interagency agreements or service-level agreements and any renewals or extensions
of existing interagency or service-level agreements with a state department under section
15.01, state agency under section 15.012, or the Department of Information Technology
Services, with a value of more than $100,000, or related agreements with the same department
or agency with a cumulative value of more than $100,000; and
deleted text end

deleted text begin (2) transfers of appropriations of more than $100,000 between accounts within or between
agencies.
deleted text end

deleted text begin The report must include the statutory citation authorizing the agreement, transfer or dollar
amount, purpose, and effective date of the agreement, the duration of the agreement, and a
copy of the agreement.
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. 2.

Minnesota Statutes 2022, section 62V.08, is amended to read:


62V.08 REPORTS.

(a) MNsure shall submit a report to the legislature by deleted text begin January 15, 2015deleted text end new text begin March 31, 2025new text end ,
and each deleted text begin January 15deleted text end new text begin March 31new text end thereafter, on: (1) the performance of MNsure operations;
(2) meeting MNsure responsibilities; (3) an accounting of MNsure budget activities; (4)
practices and procedures that have been implemented to ensure compliance with data
practices laws, and a description of any violations of data practices laws or procedures; and
(5) the effectiveness of the outreach and implementation activities of MNsure in reducing
the rate of uninsurance.

(b) MNsure must publish its administrative and operational costs on a website to educate
consumers on those costs. The information published must include: (1) the amount of
premiums and federal premium subsidies collected; (2) the amount and source of revenue
received under section 62V.05, subdivision 1, paragraph (b), clause (3); (3) the amount and
source of any other fees collected for purposes of supporting operations; and (4) any misuse
of funds as identified in accordance with section 3.975. The website must be updated at
least annually.

Sec. 3.

Minnesota Statutes 2022, section 62V.11, subdivision 4, is amended to read:


Subd. 4.

Review of costs.

The board shall submit for review the annual budget of MNsure
for the next fiscal year by March deleted text begin 15deleted text end new text begin 31new text end of each year, beginning March deleted text begin 15, 2014deleted text end new text begin 31, 2025new text end .

Sec. 4.

Minnesota Statutes 2023 Supplement, section 151.74, subdivision 3, is amended
to read:


Subd. 3.

Access to urgent-need insulin.

(a) MNsure shall develop an application form
to be used by an individual who is in urgent need of insulin. The application must ask the
individual to attest to the eligibility requirements described in subdivision 2. The form shall
be accessible through MNsure's website. MNsure shall also make the form available to
pharmacies and health care providers who prescribe or dispense insulin, hospital emergency
departments, urgent care clinics, and community health clinics. By submitting a completed,
signed, and dated application to a pharmacy, the individual attests that the information
contained in the application is correct.

(b) If the individual is in urgent need of insulin, the individual may present a completed,
signed, and dated application form to a pharmacy. The individual must also:

(1) have a valid insulin prescription; and

(2) present the pharmacist with identification indicating Minnesota residency in the form
of a valid Minnesota identification card, driver's license or permit, individual taxpayer
identification number, or Tribal identification card as defined in section 171.072, paragraph
(b). If the individual in urgent need of insulin is under the age of 18, the individual's parent
or legal guardian must provide the pharmacist with proof of residency.

(c) Upon receipt of a completed and signed application, the pharmacist shall dispense
the prescribed insulin in an amount that will provide the individual with a 30-day supply.
The pharmacy must notify the health care practitioner who issued the prescription order no
later than 72 hours after the insulin is dispensed.

(d) The pharmacy may submit to the manufacturer of the dispensed insulin product or
to the manufacturer's vendor a claim for payment that is in accordance with the National
Council for Prescription Drug Program standards for electronic claims processing, unless
the manufacturer agrees to send to the pharmacy a replacement supply of the same insulin
as dispensed in the amount dispensed. If the pharmacy submits an electronic claim to the
manufacturer or the manufacturer's vendor, the manufacturer or vendor shall reimburse the
pharmacy in an amount that covers the pharmacy's acquisition cost.

(e) The pharmacy may collect an insulin co-payment from the individual to cover the
pharmacy's costs of processing and dispensing in an amount not to exceed $35 for the 30-day
supply of insulin dispensed.

(f) The pharmacy shall also provide each eligible individual with the information sheet
described in subdivision 7 and a list of trained navigators provided by the Board of Pharmacy
for the individual to contact if the individual deleted text begin is in need of accessingdeleted text end new text begin needs to accessnew text end ongoing
insulin coverage options, including assistance in:

(1) applying for medical assistance or MinnesotaCare;

(2) applying for a qualified health plan offered through MNsure, subject to open and
special enrollment periods;

(3) accessing information on providers who participate in prescription drug discount
programs, including providers who are authorized to participate in the 340B program under
section 340b of the federal Public Health Services Act, United States Code, title 42, section
256b; and

(4) accessing insulin manufacturers' patient assistance programs, co-payment assistance
programs, and other foundation-based programs.

(g) The pharmacist shall retain a copy of the application form submitted by the individual
to the pharmacy for reporting and auditing purposes.

new text begin (h) A manufacturer may submit to the commissioner of administration a request for
reimbursement in an amount not to exceed $35 for each 30-day supply of insulin the
manufacturer provides under paragraph (d). The commissioner of administration shall
determine the manner and format for submitting and processing requests for reimbursement.
After receiving a reimbursement request, the commissioner of administration shall reimburse
the manufacturer in an amount not to exceed $35 for each 30-day supply of insulin the
manufacturer provided under paragraph (d).
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective December 1, 2024.
new text end

Sec. 5.

Minnesota Statutes 2022, section 151.74, subdivision 6, is amended to read:


Subd. 6.

Continuing safety net program; process.

(a) The individual shall submit to
a pharmacy the statement of eligibility provided by the manufacturer under subdivision 5,
paragraph (b). Upon receipt of an individual's eligibility status, the pharmacy shall submit
an order containing the name of the insulin product and the daily dosage amount as contained
in a valid prescription to the product's manufacturer.

(b) The pharmacy must include with the order to the manufacturer the following
information:

(1) the pharmacy's name and shipping address;

(2) the pharmacy's office telephone number, fax number, email address, and contact
name; and

(3) any specific days or times when deliveries are not accepted by the pharmacy.

(c) Upon receipt of an order from a pharmacy and the information described in paragraph
(b), the manufacturer shall send to the pharmacy a 90-day supply of insulin as ordered,
unless a lesser amount is requested in the order, at no charge to the individual or pharmacy.

(d) Except as authorized under paragraph (e), the pharmacy shall provide the insulin to
the individual at no charge to the individual. The pharmacy shall not provide insulin received
from the manufacturer to any individual other than the individual associated with the specific
order. The pharmacy shall not seek reimbursement for the insulin received from the
manufacturer or from any third-party payer.

(e) The pharmacy may collect a co-payment from the individual to cover the pharmacy's
costs for processing and dispensing in an amount not to exceed $50 for each 90-day supply
if the insulin is sent to the pharmacy.

(f) The pharmacy may submit to a manufacturer a reorder for an individual if the
individual's eligibility statement has not expired. Upon receipt of a reorder from a pharmacy,
the manufacturer must send to the pharmacy an additional 90-day supply of the product,
unless a lesser amount is requested, at no charge to the individual or pharmacy if the
individual's eligibility statement has not expired.

(g) Notwithstanding paragraph (c), a manufacturer may send the insulin as ordered
directly to the individual if the manufacturer provides a mail order service option.

new text begin (h) A manufacturer may submit to the commissioner of administration a request for
reimbursement in an amount not to exceed $105 for each 90-day supply of insulin the
manufacturer provides under paragraphs (c) and (f). The commissioner of administration
shall determine the manner and format for submitting and processing requests for
reimbursement. After receiving a reimbursement request, the commissioner of administration
shall reimburse the manufacturer in an amount not to exceed $105 for each 90-day supply
of insulin the manufacturer provided under paragraphs (c) and (f). If the manufacturer
provides less than a 90-day supply of insulin under paragraphs (c) and (f), the manufacturer
may submit a request for reimbursement not to exceed $35 for each 30-day supply of insulin
provided.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective December 1, 2024.
new text end

Sec. 6.

new text begin [151.741] INSULIN MANUFACTURER REGISTRATION FEE.
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) "Board" means the Minnesota Board of Pharmacy under section 151.02.
new text end

new text begin (c) "Manufacturer" means a manufacturer licensed under section 151.252 and engaged
in the manufacturing of prescription insulin.
new text end

new text begin Subd. 2.new text end

new text begin Assessment of registration fee.new text end

new text begin (a) The board shall assess each manufacturer
an annual registration fee of $100,000, except as provided in paragraph (b). The board shall
notify each manufacturer of this requirement beginning November 1, 2024, and each
November 1 thereafter.
new text end

new text begin (b) A manufacturer may request an exemption from the annual registration fee. The
board shall exempt a manufacturer from the annual registration fee if the manufacturer can
demonstrate to the board, in the form and manner specified by the board, that gross revenue
from sales of prescription insulin produced by that manufacturer and sold or delivered within
or into Minnesota was less than five percent of the total gross revenue from sales of
prescription insulin produced by all manufacturers and sold or delivered within or into
Minnesota in the previous calendar year.
new text end

new text begin Subd. 3.new text end

new text begin Payment of the registration fee; deposit of fee.new text end

new text begin (a) Each manufacturer must
pay the registration fee by March 1, 2025, and by each March 1 thereafter. In the event of
a change in ownership of the manufacturer, the new owner must pay the registration fee
that the original owner would have been assessed had the original owner retained ownership.
The board may assess a late fee of ten percent per month or any portion of a month that the
registration fee is paid after the due date.
new text end

new text begin (b) The registration fee, including any late fees, must be deposited in the insulin safety
net program account.
new text end

new text begin Subd. 4.new text end

new text begin Insulin safety net program account.new text end

new text begin The insulin safety net program account
is established in the special revenue fund in the state treasury. Money in the account is
appropriated each fiscal year to:
new text end

new text begin (1) the MNsure board in an amount sufficient to carry out assigned duties under section
151.74, subdivision 7; and
new text end

new text begin (2) the Board of Pharmacy in an amount sufficient to cover costs incurred by the board
in assessing and collecting the registration fee under this section and in administering the
insulin safety net program under section 151.74.
new text end

new text begin Subd. 5.new text end

new text begin Insulin repayment account; annual transfer from health care access fund.new text end

new text begin (a)
The insulin repayment account is established in the special revenue fund in the state treasury.
Money in the account is appropriated each fiscal year to the commissioner of administration
to reimburse manufacturers for insulin dispensed under the insulin safety net program in
section 151.74, in accordance with section 151.74, subdivisions 3, paragraph (h), and 6,
paragraph (h), and to cover costs incurred by the commissioner in providing these
reimbursement payments.
new text end

new text begin (b) By June 30, 2025, and each June 30 thereafter, the commissioner of administration
shall certify to the commissioner of management and budget the total amount expended in
the prior fiscal year for:
new text end

new text begin (1) reimbursement to manufacturers for insulin dispensed under the insulin safety net
program in section 151.74, in accordance with section 151.74, subdivisions 3, paragraph
(h), and 6, paragraph (h); and
new text end

new text begin (2) costs incurred by the commissioner of administration in providing the reimbursement
payments described in clause (1).
new text end

new text begin (c) The commissioner of management and budget shall transfer from the health care
access fund to the special revenue fund, beginning July 1, 2025, and each July 1 thereafter,
an amount equal to the amount to which the commissioner of administration certified
pursuant to paragraph (b).
new text end

new text begin Subd. 6.new text end

new text begin Contingent transfer by commissioner.new text end

new text begin If subdivisions 2 and 3, or the
application of subdivisions 2 and 3 to any person or circumstance, are held invalid for any
reason in a court of competent jurisdiction, the invalidity of subdivisions 2 and 3 does not
affect other provisions of this act, and the commissioner of management and budget shall
annually transfer from the health care access fund to the insulin safety net program account
an amount sufficient to implement subdivision 4.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2024.
new text end

Sec. 7.

Laws 2020, chapter 73, section 8, is amended to read:


Sec. 8. APPROPRIATIONS.

(a) $297,000 is appropriated in fiscal year 2020 from the health care access fund to the
Board of Directors of MNsure deleted text begin to train navigators to assist individuals and provide
compensation as required
deleted text end new text begin for the insulin safety net programnew text end under Minnesota Statutes,
section 151.74deleted text begin , subdivision 7deleted text end . deleted text begin Of this appropriation, $108,000 is for implementing the
training requirements for navigators and $189,000 is for application assistance bonus
payments.
deleted text end This is a onetime appropriation and is available until deleted text begin December 31, 2024deleted text end new text begin June
30, 2027
new text end .

(b) $250,000 is appropriated in fiscal year 2020 from the health care access fund to the
Board of Directors of MNsure for a public awareness campaign for the insulin safety net
program established under Minnesota Statutes, section 151.74. This is a onetime appropriation
and is available until December 31, 2024.

(c) $76,000 is appropriated in fiscal year 2021 from the health care access fund to the
Board of Pharmacy to implement Minnesota Statutes, section 151.74. The base for this
appropriation is $76,000 in fiscal year 2022; $76,000 in fiscal year 2023; $76,000 in fiscal
year 2024; $38,000 in fiscal year 2025; and $0 in fiscal year 2026.

(d) $136,000 in fiscal year 2021 is appropriated from the health care access fund to the
commissioner of health to implement the survey to assess program satisfaction in Minnesota
Statutes, section 151.74, subdivision 12. The base for this appropriation is $80,000 in fiscal
year 2022 and $0 in fiscal year 2023. This is a onetime appropriation.

Sec. 8. new text begin REPEALER; SUNSET FOR THE LONG-TERM SAFETY NET INSULIN
PROGRAM.
new text end

new text begin Minnesota Statutes 2022, section 151.74, subdivision 16,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 the day following final enactment.
new text end

ARTICLE 4

HEALTH INSURANCE

Section 1.

Minnesota Statutes 2022, section 43A.24, is amended by adding a subdivision
to read:


new text begin Subd. 4.new text end

new text begin For-profit health maintenance organizations prohibited. new text end

new text begin The commissioner
must ensure that state paid hospital, medical, and dental benefits are not provided to eligible
employees by a health maintenance organization which is not a nonprofit corporation
organized under chapter 317A or a local governmental unit, as defined in section 62D.02.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 2.

Minnesota Statutes 2022, section 62A.0411, is amended to read:


62A.0411 MATERNITY CARE.

new text begin Subdivision 1.new text end

new text begin Minimum inpatient care.new text end

Every health plan deleted text begin as defined in section 62Q.01,
subdivision 3
, that provides maternity benefits
deleted text end mustdeleted text begin , consistent with other coinsurance,
co-payment, deductible, and related contract terms,
deleted text end provide coverage of a minimum of 48
hours of inpatient care following a vaginal delivery and a minimum of 96 hours of inpatient
care following a caesarean section for a mother and her newborn. The health plan shall not
provide any compensation or other nonmedical remuneration to encourage a mother and
newborn to leave inpatient care before the duration minimums specified in this section.

new text begin Subd. 1a.new text end

new text begin Medical facility transfer.new text end

new text begin (a) If a health care provider acting within the
provider's scope of practice recommends that either the mother or newborn be transferred
to a different medical facility, every health plan must provide the coverage required under
subdivision 1 for the mother, newborn, and newborn siblings at both medical facilities. The
coverage required under this subdivision includes but is not limited to expenses related to
transferring all individuals from one medical facility to a different medical facility.
new text end

new text begin (b) The coverage required under this subdivision must be provided without cost sharing,
including but not limited to deductible, co-pay, or coinsurance. The coverage required under
this paragraph must be provided without any limitation that is not generally applicable to
other coverages under the plan.
new text end

new text begin (c) Notwithstanding paragraph (b), a health plan that is a high-deductible health plan in
conjunction with a health savings account must include cost-sharing for the coverage required
under this subdivision at the minimum level necessary to preserve the enrollee's ability to
make tax-exempt contributions and withdrawals from the health savings account as provided
in section 223 of the Internal Revenue Code of 1986.
new text end

new text begin Subd. 2.new text end

new text begin Minimum postdelivery outpatient care.new text end

new text begin (a) new text end The health plan must also provide
coverage for postdelivery new text begin outpatient new text end care to a mother and her newborn if the duration of
inpatient care is less than the minimums provided in this section.

new text begin (b) new text end Postdelivery care consists of a minimum of one home visit by a registered nurse.
Services provided by the registered nurse include, but are not limited to, parent education,
assistance and training in breast and bottle feeding, and conducting any necessary and
appropriate clinical tests. The home visit must be conducted within four days following the
discharge of the mother and her child.

new text begin Subd. 3.new text end

new text begin Health plan defined.new text end

new text begin For purposes of this section, "health plan" has the meaning
given in section 62Q.01, subdivision 3, and county-based purchasing plans.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to all policies,
plans, certificates, and contracts offered, issued, or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2022, section 62A.15, is amended by adding a subdivision to
read:


new text begin Subd. 3d.new text end

new text begin Pharmacist.new text end

new text begin All benefits provided by a policy or contract referred to in
subdivision 1 relating to expenses incurred for medical treatment or services provided by
a licensed physician must include services provided by a licensed pharmacist, according to
the requirements of section 151.01, to the extent a licensed pharmacist's services are within
the pharmacist's scope of practice.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to policies
or contracts offered, issued, or renewed on or after that date.
new text end

Sec. 4.

Minnesota Statutes 2022, section 62A.15, subdivision 4, is amended to read:


Subd. 4.

Denial of benefits.

(a) No carrier referred to in subdivision 1 may, in the
payment of claims to employees in this state, deny benefits payable for services covered by
the policy or contract if the services are lawfully performed by a licensed chiropractor, a
licensed optometrist, a registered nurse meeting the requirements of subdivision 3a, a licensed
physician assistant, deleted text begin ordeleted text end a licensed acupuncture practitionernew text begin , or a licensed pharmacistnew text end .

(b) When carriers referred to in subdivision 1 make claim determinations concerning
the appropriateness, quality, or utilization of chiropractic health care for Minnesotans, any
of these determinations that are made by health care professionals must be made by, or
under the direction of, or subject to the review of licensed doctors of chiropractic.

(c) When a carrier referred to in subdivision 1 makes a denial of payment claim
determination concerning the appropriateness, quality, or utilization of acupuncture services
for individuals in this state performed by a licensed acupuncture practitioner, a denial of
payment claim determination that is made by a health professional must be made by, under
the direction of, or subject to the review of a licensed acupuncture practitioner.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to policies
or contracts offered, issued, or renewed on or after that date.
new text end

Sec. 5.

Minnesota Statutes 2022, section 62A.28, subdivision 2, is amended to read:


Subd. 2.

Required coverage.

new text begin (a) new text end 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 prosthesesnew text begin , including all equipment and accessories necessary for regular use of scalp
hair prostheses,
new text end worn for hair loss suffered as a result of new text begin a health condition, including but
not limited to
new text end alopecia areatanew text begin or the treatment for cancer, unless there is a clinical basis for
limitation
new text end .

new text begin (b) new 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 (c) The coverage required by this section for scalp hair prostheses is limited to $1,000
per benefit year.
new text end

new text begin (d) A scalp hair prosthesis must be prescribed by a doctor to be covered under this
section.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to all policies,
plans, certificates, and contracts offered, issued, or renewed on or after that date.
new text end

Sec. 6.

new text begin [62A.3098] RAPID WHOLE GENOME SEQUENCING; COVERAGE.
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 section, "rapid whole genome sequencing"
or "rWGS" means an investigation of the entire human genome, including coding and
noncoding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing
genetic changes that returns the final results in 14 days. Rapid whole genome sequencing
includes patient-only whole genome sequencing and duo and trio whole genome sequencing
of the patient and the patient's biological parent or parents.
new text end

new text begin Subd. 2.new text end

new text begin Required coverage.new text end

new text begin A health plan that provides coverage to Minnesota residents
must cover rWGS testing if the enrollee:
new text end

new text begin (1) is 21 years of age or younger;
new text end

new text begin (2) has a complex or acute illness of unknown etiology that is not confirmed to have
been caused by an environmental exposure, toxic ingestion, an infection with a normal
response to therapy, or trauma; and
new text end

new text begin (3) is receiving inpatient hospital services in an intensive care unit or a neonatal or high
acuity pediatric care unit.
new text end

new text begin Subd. 3.new text end

new text begin Coverage criteria.new text end

new text begin Coverage may be based on the following medical necessity
criteria:
new text end

new text begin (1) the enrollee has symptoms that suggest a broad differential diagnosis that would
require an evaluation by multiple genetic tests if rWGS testing is not performed;
new text end

new text begin (2) timely identification of a molecular diagnosis is necessary in order to guide clinical
decision making, and the rWGS testing may aid in guiding the treatment or management
of the enrollee's condition; and
new text end

new text begin (3) the enrollee's complex or acute illness of unknown etiology includes at least one of
the following conditions:
new text end

new text begin (i) congenital anomalies involving at least two organ systems, or complex or multiple
congenital anomalies in one organ system;
new text end

new text begin (ii) specific organ malformations that are highly suggestive of a genetic etiology;
new text end

new text begin (iii) abnormal laboratory tests or abnormal chemistry profiles suggesting the presence
of a genetic disease, complex metabolic disorder, or inborn error of metabolism;
new text end

new text begin (iv) refractory or severe hypoglycemia or hyperglycemia;
new text end

new text begin (v) abnormal response to therapy related to an underlying medical condition affecting
vital organs or bodily systems;
new text end

new text begin (vi) severe muscle weakness, rigidity, or spasticity;
new text end

new text begin (vii) refractory seizures;
new text end

new text begin (viii) a high-risk stratification on evaluation for a brief resolved unexplained event with
any of the following features:
new text end

new text begin (A) a recurrent event without respiratory infection;
new text end

new text begin (B) a recurrent seizure-like event; or
new text end

new text begin (C) a recurrent cardiopulmonary resuscitation;
new text end

new text begin (ix) abnormal cardiac diagnostic testing results that are suggestive of possible
channelopathies, arrhythmias, cardiomyopathies, myocarditis, or structural heart disease;
new text end

new text begin (x) abnormal diagnostic imaging studies that are suggestive of underlying genetic
condition;
new text end

new text begin (xi) abnormal physiologic function studies that are suggestive of an underlying genetic
etiology; or
new text end

new text begin (xii) family genetic history related to the patient's condition.
new text end

new text begin Subd. 4.new text end

new text begin Cost sharing.new text end

new text begin Coverage provided in this section is subject to the enrollee's
health plan cost-sharing requirements, including any deductibles, co-payments, or coinsurance
requirements that apply to diagnostic testing services.
new text end

new text begin Subd. 5.new text end

new text begin Payment for services provided.new text end

new text begin If the enrollee's health plan uses a capitated
or bundled payment arrangement to reimburse a provider for services provided in an inpatient
setting, reimbursement for services covered under this section must be paid separately and
in addition to any reimbursement otherwise payable to the provider under the capitated or
bundled payment arrangement, unless the health carrier and the provider have negotiated
an increased capitated or bundled payment rate that includes the services covered under this
section.
new text end

new text begin Subd. 6.new text end

new text begin Genetic data.new text end

new text begin Genetic data generated as a result of performing rWGS and
covered under this section: (1) must be used for the primary purpose of assisting the ordering
provider and treating care team to diagnose and treat the patient; (2) is protected health
information as set forth under the Health Insurance Portability and Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical Health Act, and
any promulgated regulations, including but not limited to Code of Federal Regulations, title
45, parts 160 and 164, subparts A and E; and (3) is a protected health record under sections
144.291 to 144.298.
new text end

new text begin Subd. 7.new text end

new text begin Reimbursement.new text end

new text begin (a) The commissioner of commerce must reimburse health
carriers for coverage under this section. Reimbursement is available only for coverage that
would not have been provided by the health plan without the requirements of this section.
Treatments and services covered by the health plan as of January 1, 2024, are ineligible for
payments under this subdivision by the commissioner of commerce.
new text end

new text begin (b) Health carriers must report to the commissioner of commerce quantified costs
attributable to the additional benefit under this section in a format developed by the
commissioner. A health plan's coverage as of January 1, 2024, must be used by the health
carrier as the basis for determining whether coverage would not have been provided by the
health plan for purposes of this subdivision.
new text end

new text begin (c) The commissioner of commerce must evaluate submissions and make payments to
health carriers as provided in Code of Federal Regulations, title 45, section 155.170.
new text end

new text begin Subd. 8.new text end

new text begin Appropriation.new text end

new text begin Each fiscal year, an amount necessary to make payments to
health carriers to defray the cost of providing coverage under this section is appropriated
to the commissioner of commerce.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to a health
plan offered, issued, or sold on or after that date.
new text end

Sec. 7.

new text begin [62A.59] COVERAGE OF SERVICE; PRIOR AUTHORIZATION.
new text end

new text begin Subdivision 1.new text end

new text begin Service for which prior authorization not required.new text end

new text begin A health carrier
must not retrospectively deny or limit coverage of a health care service for which prior
authorization was not required by the health carrier, unless there is evidence that the health
care service was provided based on fraud or misinformation.
new text end

new text begin Subd. 2.new text end

new text begin Service for which prior authorization required but not obtained.new text end

new text begin A health
carrier must not deny or limit coverage of a health care service which the enrollee has already
received solely on the basis of lack of prior authorization if the service would otherwise
have been covered had the prior authorization been obtained.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2026, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 8.

new text begin [62C.045] APPLICATION OF OTHER LAW.
new text end

new text begin Sections 145D.30 to 145D.37 apply to service plan corporations operating under this
chapter.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 9.

Minnesota Statutes 2022, section 62D.02, subdivision 7, is amended to read:


Subd. 7.

Comprehensive health maintenance services.

"Comprehensive health
maintenance services" means a set of comprehensive health services which the enrollees
might reasonably require to be maintained in good health including as a minimum, but not
limited to, emergency care, emergency ground ambulance transportation services, inpatient
hospital and physician care, outpatient health services and preventive health services.
deleted text begin Elective, induced abortion, except as medically necessary to prevent the death of the mother,
whether performed in a hospital, other abortion facility or the office of a physician, shall
not be mandatory for any health maintenance organization.
deleted text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 10.

Minnesota Statutes 2022, section 62D.04, subdivision 5, is amended to read:


Subd. 5.

Participation; government programs.

Health maintenance organizations new text begin that
are a nonprofit corporation organized under chapter 317A or a local governmental unit
new text end shall,
as a condition of receiving and retaining a certificate of authority, participate in the medical
assistance and MinnesotaCare programs. A health maintenance organization new text begin governed by
this subdivision
new text end is required to submit proposals in good faith that meet the requirements of
the request for proposal provided that the requirements can be reasonably met by a health
maintenance organization to serve individuals eligible for the above programs in a geographic
region of the state if, at the time of publication of a request for proposal, the percentage of
recipients in the public programs in the region who are enrolled in the health maintenance
organization is less than the health maintenance organization's percentage of the total number
of individuals enrolled in health maintenance organizations in the same region. Geographic
regions shall be defined by the commissioner of human services in the request for proposals.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 11.

new text begin [62D.1071] COVERAGE OF LICENSED PHARMACIST SERVICES.
new text end

new text begin Subdivision 1.new text end

new text begin Pharmacist.new text end

new text begin All benefits provided by a health maintenance contract
relating to expenses incurred for medical treatment or services provided by a licensed
physician must include services provided by a licensed pharmacist to the extent a licensed
pharmacist's services are within the pharmacist's scope of practice.
new text end

new text begin Subd. 2.new text end

new text begin Denial of benefits.new text end

new text begin When paying claims for enrollees in Minnesota, a health
maintenance organization must not deny payment for medical services covered by an
enrollee's health maintenance contract if the services are lawfully performed by a licensed
pharmacist.
new text end

new text begin Subd. 3.new text end

new text begin Exemptions.new text end

new text begin (a) This section does not apply to or affect the coverage or
reimbursement for medication therapy management services under section 62Q.676 or
256B.0625, subdivisions 5, 13h, and 28a.
new text end

new text begin (b) This section does not apply to managed care organizations or county-based purchasing
plans when the plan provides coverage to public health care program enrollees under chapter
256B or 256L.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 12.

Minnesota Statutes 2022, section 62D.12, subdivision 19, is amended to read:


Subd. 19.

Coverage of service.

A health maintenance organization may not deny or
limit coverage of a service which the enrollee has already received solely on the basis of
lack of prior authorization or second opinion, to the extent that the service would otherwise
have been covered under the member's contract by the health maintenance organization had
prior authorization or second opinion been obtained.new text begin This subdivision expires December
31, 2025, for health plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 13.

Minnesota Statutes 2022, section 62D.20, subdivision 1, is amended to read:


Subdivision 1.

Rulemaking.

The commissioner of health may, pursuant to chapter 14,
promulgate such reasonable rules as are necessary or proper to carry out the provisions of
sections 62D.01 to 62D.30. Included among such rules shall be those which provide minimum
requirements for the provision of comprehensive health maintenance services, as defined
in section 62D.02, subdivision 7, and reasonable exclusions therefrom. deleted text begin Nothing in such
rules shall force or require a health maintenance organization to provide elective, induced
abortions, except as medically necessary to prevent the death of the mother, whether
performed in a hospital, other abortion facility, or the office of a physician; the rules shall
provide every health maintenance organization the option of excluding or including elective,
induced abortions, except as medically necessary to prevent the death of the mother, as part
of its comprehensive health maintenance services.
deleted text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 14.

Minnesota Statutes 2022, section 62D.22, subdivision 5, is amended to read:


Subd. 5.

Other state law.

Except as otherwise provided in sections 62A.01 to 62A.42
and 62D.01 to 62D.30, deleted text begin and except as they eliminate elective, induced abortions, wherever
performed, from health or maternity benefits,
deleted text end provisions of the insurance laws and provisions
of nonprofit health service plan corporation laws shall not be applicable to any health
maintenance organization granted a certificate of authority under sections 62D.01 to 62D.30.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 15.

Minnesota Statutes 2022, section 62D.22, is amended by adding a subdivision to
read:


new text begin Subd. 5a.new text end

new text begin Application of other law.new text end

new text begin Effective July 1, 2025, sections 145D.30 to 145D.37
apply to nonprofit health maintenance organizations operating under this chapter.
new text end

Sec. 16.

new text begin [62D.221] OVERSIGHT OF TRANSACTIONS.
new text end

new text begin Subdivision 1.new text end

new text begin Insurance provisions applicable to health maintenance
organizations.
new text end

new text begin Health maintenance organizations are subject to sections 60A.135, 60A.136,
60A.137, 60A.16, 60A.161, 60D.17, 60D.18, and 60D.20 and must comply with the
provisions of these sections applicable to insurers. In applying these sections to health
maintenance organizations, "commissioner" means the commissioner of health. Health
maintenance organizations are subject to Minnesota Rules, chapter 2720, as applicable to
sections 60D.17, 60D.18, and 60D.20, and must comply with the provisions of chapter 2720
applicable to insurers, unless the commissioner of health adopts rules to implement this
subdivision.
new text end

new text begin Subd. 2.new text end

new text begin Statement.new text end

new text begin In addition to the conditions in section 60D.17, subdivision 1,
subjecting a health maintenance organization to filing requirements, no person other than
the issuer shall acquire all or substantially all of the assets of a domestic nonprofit health
maintenance organization through any means unless at the time the offer, request, or
invitation is made or the agreement is entered into the person has filed with the commissioner
and has sent to the health maintenance organization a statement containing the information
required in section 60D.17 and the offer, request, invitation, agreement, or acquisition has
been approved by the commissioner of health in the manner prescribed in section 60D.17.
new text end

Sec. 17.

Minnesota Statutes 2022, section 62M.02, subdivision 1a, is amended to read:


Subd. 1a.

Adverse determination.

"Adverse determination" means a decision by a
utilization review organization relating to an admission, extension of stay, or health care
service that is partially or wholly adverse to the enrollee, includingnew text begin :
new text end

new text begin (1)new text end a decision to deny an admission, extension of stay, or health care service on the basis
that it is not medically necessarynew text begin ; or
new text end

new text begin (2) an authorization for a health care service that is less intensive than the health care
service specified in the original request for authorization
new text end .

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 18.

Minnesota Statutes 2022, section 62M.02, subdivision 5, is amended to read:


Subd. 5.

Authorization.

"Authorization" means a determination by a utilization review
organization that an admission, extension of stay, or other health care service has been
reviewed and that, based on the information provided, it satisfies the utilization review
requirements of the applicable health new text begin benefit new text end plan and the health plan company new text begin or
commissioner
new text end will then pay for the covered benefit, provided the preexisting limitation
provisions, the general exclusion provisions, and any deductible, co-payment, coinsurance,
or other policy requirements have been met.

Sec. 19.

Minnesota Statutes 2022, section 62M.02, is amended by adding a subdivision
to read:


new text begin Subd. 8a.new text end

new text begin Commissioner.new text end

new text begin "Commissioner" means, effective January 1, 2026, for the
sections specified in section 62M.01, subdivision 3, paragraph (c), the commissioner of
human services, unless otherwise specified.
new text end

Sec. 20.

Minnesota Statutes 2022, section 62M.02, subdivision 11, is amended to read:


Subd. 11.

Enrollee.

"Enrollee" meansnew text begin :
new text end

new text begin (1)new text end an individual covered by a health benefit plan and includes an insured policyholder,
subscriber, contract holder, member, covered person, or certificate holdernew text begin ; or
new text end

new text begin (2) effective January 1, 2026, for the sections specified in section 62M.01, subdivision
3, paragraph (c), a recipient receiving coverage through fee-for-service under chapters 256B
and 256L
new text end .

Sec. 21.

Minnesota Statutes 2022, section 62M.02, subdivision 12, is amended to read:


Subd. 12.

Health benefit plan.

new text begin (a) new text end "Health benefit plan" meansnew text begin :
new text end

new text begin (1)new text end a policy, contract, or certificate issued by a health plan company for the coverage of
medical, dental, or hospital benefitsnew text begin ; or
new text end

new text begin (2) effective January 1, 2026, for the sections specified in section 62M.01, subdivision
3, paragraph (c), coverage of medical, dental, or hospital benefits through fee-for-service
under chapters 256B and 256L, as specified by the commissioner on the agency's public
website or through other forms of recipient and provider guidance
new text end .

new text begin (b)new text end A health benefit plan does not include coverage that is:

(1) limited to disability or income protection coverage;

(2) automobile medical payment coverage;

(3) supplemental to liability insurance;

(4) designed solely to provide payments on a per diem, fixed indemnity, or nonexpense
incurred basis;

(5) credit accident and health insurance issued under chapter 62B;

(6) blanket accident and sickness insurance as defined in section 62A.11;

(7) accident only coverage issued by a licensed and tested insurance agent; or

(8) workers' compensation.

Sec. 22.

Minnesota Statutes 2022, section 62M.02, subdivision 21, is amended to read:


Subd. 21.

Utilization review organization.

"Utilization review organization" means an
entity including but not limited to an insurance company licensed under chapter 60A to
offer, sell, or issue a policy of accident and sickness insurance as defined in section 62A.01;
a prepaid limited health service organization issued a certificate of authority and operating
under sections 62A.451 to 62A.4528; a health service plan licensed under chapter 62C; a
health maintenance organization licensed under chapter 62D; a community integrated service
network licensed under chapter 62N; an accountable provider network operating under
chapter 62T; a fraternal benefit society operating under chapter 64B; a joint self-insurance
employee health plan operating under chapter 62H; a multiple employer welfare arrangement,
as defined in section 3 of the Employee Retirement Income Security Act of 1974 (ERISA),
United States Code, title 29, section 1103, as amended; a third-party administrator licensed
under section 60A.23, subdivision 8, which conducts utilization review and authorizes or
makes adverse determinations regarding an admission, extension of stay, or other health
care services for a Minnesota resident; new text begin effective January 1, 2026, for the sections specified
in section 62M.01, subdivision 3, paragraph (c), the commissioner of human services for
purposes of delivering services through fee-for-service under chapters 256B and 256L;
new text end any
other entity that provides, offers, or administers hospital, outpatient, medical, prescription
drug, or other health benefits to individuals treated by a health professional under a policy,
plan, or contract; or any entity performing utilization review that is affiliated with, under
contract with, or conducting utilization review on behalf of, a business entity in this state.
Utilization review organization does not include a clinic or health care system acting pursuant
to a written delegation agreement with an otherwise regulated utilization review organization
that contracts with the clinic or health care system. The regulated utilization review
organization is accountable for the delegated utilization review activities of the clinic or
health care system.

Sec. 23.

Minnesota Statutes 2022, section 62M.04, subdivision 1, is amended to read:


Subdivision 1.

Responsibility for obtaining authorization.

A health benefit plan that
includes utilization review requirements must specify the process for notifying the utilization
review organization in a timely manner and obtaining authorization for health care services.
Each health plan company must provide a clear and concise description of this process to
an enrollee as part of the policy, subscriber contract, or certificate of coverage. new text begin Effective
January 1, 2026, the commissioner must provide a clear and concise description of this
process to fee-for-service recipients receiving services under chapters 256B and 256L,
through the agency's public website or through other forms of recipient guidance.
new text end In addition
to the enrollee, the utilization review organization must allow any provider or provider's
designee, or responsible patient representative, including a family member, to fulfill the
obligations under the health new text begin benefit new text end plan.

A claims administrator that contracts directly with providers for the provision of health
care services to enrollees may, through contract, require the provider to notify the review
organization in a timely manner and obtain authorization for health care services.

Sec. 24.

Minnesota Statutes 2022, section 62M.05, subdivision 3a, is amended to read:


Subd. 3a.

Standard review determination.

(a) deleted text begin Notwithstanding subdivision 3b, a
standard review determination on all requests for utilization review must be communicated
to the provider and enrollee in accordance with this subdivision within five business days
after receiving the request if the request is received electronically, or within six business
days if received through nonelectronic means, provided that all information reasonably
necessary to make a determination on the request has been made available to the utilization
review organization. Effective January 1, 2022,
deleted text end A standard review determination on all
requests for utilization review must be communicated to the provider and enrollee in
accordance with this subdivision within five business days after receiving the request,
regardless of how the request was received, provided that all information reasonably
necessary to make a determination on the request has been made available to the utilization
review organization.

(b) When a determination is made to authorize, notification must be provided promptly
by telephone to the provider. The utilization review organization shall send written
notification to the provider or shall maintain an audit trail of the determination and telephone
notification. For purposes of this subdivision, "audit trail" includes documentation of the
telephone notification, including the date; the name of the person spoken to; the enrollee;
the service, procedure, or admission authorized; and the date of the service, procedure, or
admission. If the utilization review organization indicates authorization by use of a number,
the number must be called the "authorization number." For purposes of this subdivision,
notification may also be made by facsimile to a verified number or by electronic mail to a
secure electronic mailbox. These electronic forms of notification satisfy the "audit trail"
requirement of this paragraph.

(c) When an adverse determination is made, notification must be provided within the
time periods specified in paragraph (a) by telephone, by facsimile to a verified number, or
by electronic mail to a secure electronic mailbox to the attending health care professional
and hospital or physician office as applicable. Written notification must also be sent to the
hospital or physician office as applicable and attending health care professional if notification
occurred by telephone. For purposes of this subdivision, notification may be made by
facsimile to a verified number or by electronic mail to a secure electronic mailbox. Written
notification must be sent to the enrollee and may be sent by United States mail, facsimile
to a verified number, or by electronic mail to a secure mailbox. The written notification
must include all reasons relied on by the utilization review organization for the determination
and the process for initiating an appeal of the determination. Upon request, the utilization
review organization shall provide the provider or enrollee with the criteria used to determine
the necessity, appropriateness, and efficacy of the health care service and identify the
database, professional treatment parameter, or other basis for the criteria. Reasons for an
adverse determination may include, among other things, the lack of adequate information
to authorize after a reasonable attempt has been made to contact the provider or enrollee.

(d) When an adverse determination is made, the written notification must inform the
enrollee and the attending health care professional of the right to submit an appeal to the
internal appeal process described in section 62M.06 and the procedure for initiating the
internal appeal. The written notice shall be provided in a culturally and linguistically
appropriate manner consistent with the provisions of the Affordable Care Act as defined
under section 62A.011, subdivision 1a.

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 2022, section 62M.07, subdivision 2, is amended to read:


Subd. 2.

Prior authorization of deleted text begin emergencydeleted text end new text begin certainnew text end services prohibited.

No utilization
review organization, health plan company, or claims administrator may conduct or require
prior authorization ofnew text begin :
new text end

new text begin (1)new text end emergency confinement or an emergency service. The enrollee or the enrollee's
authorized representative may be required to notify the health plan company, claims
administrator, or utilization review organization as soon as reasonably possible after the
beginning of the emergency confinement or emergency servicedeleted text begin .deleted text end new text begin ;
new text end

new text begin (2) outpatient mental health treatment or outpatient substance use disorder treatment,
except for treatment which is a medication. Prior authorizations required for medications
used for outpatient mental health treatment or outpatient substance use disorder treatment
must be processed according to section 62M.05, subdivision 3b, for initial determinations,
and according to section 62M.06, subdivision 2, for appeals;
new text end

new text begin (3) antineoplastic cancer treatment that is consistent with guidelines of the National
Comprehensive Cancer Network, except for treatment which is a medication. Prior
authorizations required for medications used for antineoplastic cancer treatment must be
processed according to section 62M.05, subdivision 3b, for initial determinations, and
according to section 62M.06, subdivision 2, for appeals;
new text end

new text begin (4) services that currently have a rating of A or B from the United States Preventive
Services Task Force, immunizations recommended by the Advisory Committee on
Immunization Practices of the Centers for Disease Control and Prevention, or preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130;
new text end

new text begin (5) pediatric hospice services provided by a hospice provider licensed under sections
144A.75 to 144A.755; and
new text end

new text begin (6) treatment delivered through a neonatal abstinence program operated by pediatric
pain or palliative care subspecialists.
new text end

new text begin Clauses (2) to (6) are effective January 1, 2026, and apply to health benefit plans offered,
sold, issued, or renewed on or after that date.
new text end

Sec. 26.

Minnesota Statutes 2022, section 62M.07, subdivision 4, is amended to read:


Subd. 4.

Submission of prior authorization requests.

new text begin (a) new text end If prior authorization for a
health care service is required, the utilization review organization, health plan company, or
claim administrator must allow providers to submit requests for prior authorization of the
health care services without unreasonable delay by telephone, facsimile, or voice mail or
through an electronic mechanism 24 hours a day, seven days a week. This subdivision does
not apply to dental service covered under MinnesotaCare or medical assistance.

new text begin (b) Effective January 1, 2027, for health benefit plans offered, sold, issued, or renewed
on or after that date, utilization review organizations, health plan companies, and claims
administrators must have and maintain a prior authorization application programming
interface (API) that automates the prior authorization process for health care services,
excluding prescription drugs and medications. The API must allow providers to determine
whether a prior authorization is required for health care services, identify prior authorization
information and documentation requirements, and facilitate the exchange of prior
authorization requests and determinations from provider electronic health records or practice
management systems. The API must use the Health Level Seven (HL7) Fast Healthcare
Interoperability Resources (FHIR) standard in accordance with Code of Federal Regulations,
title 45, section 170.215(a)(1), and the most recent standards and guidance adopted by the
United States Department of Health and Human Services to implement that section. Prior
authorization submission requests for prescription drugs and medications must comply with
the requirements of section 62J.497.
new text end

Sec. 27.

Minnesota Statutes 2022, section 62M.07, is amended by adding a subdivision
to read:


new text begin Subd. 5.new text end

new text begin Treatment of a chronic condition.new text end

new text begin This subdivision is effective January 1,
2026, and applies to health benefit plans offered, sold, issued, or renewed on or after that
date. An authorization for treatment of a chronic health condition does not expire unless
the standard of treatment for that health condition changes. A chronic health condition is a
condition that is expected to last one year or more and:
new text end

new text begin (1) requires ongoing medical attention to effectively manage the condition or prevent
an adverse health event; or
new text end

new text begin (2) limits one or more activities of daily living.
new text end

Sec. 28.

Minnesota Statutes 2022, section 62M.10, subdivision 7, is amended to read:


Subd. 7.

Availability of criteria.

(a) For utilization review determinations other than
prior authorization, a utilization review organization shall, upon request, provide to an
enrollee, a provider, and the commissioner of commerce the criteria used to determine the
medical necessity, appropriateness, and efficacy of a procedure or service and identify the
database, professional treatment guideline, or other basis for the criteria.

(b) For prior authorization determinations, a utilization review organization must submit
the organization's current prior authorization requirements and restrictions, including written,
evidence-based, clinical criteria used to make an authorization or adverse determination, to
all health plan companies for which the organization performs utilization review. A health
plan company must post on its public website the prior authorization requirements and
restrictions of any utilization review organization that performs utilization review for the
health plan company. These prior authorization requirements and restrictions must be detailed
and written in language that is easily understandable to providers.new text begin This paragraph does not
apply to the commissioner of human services when delivering services through fee-for-service
under chapters 256B and 256L.
new text end

new text begin (c) Effective January 1, 2026, the commissioner of human services must post on the
department's public website the prior authorization requirements and restrictions, including
written, evidence-based, clinical criteria used to make an authorization or adverse
determination, that apply to prior authorization determinations for fee-for-service under
chapters 256B and 256L. These prior authorization requirements and restrictions must be
detailed and written in language that is easily understandable to providers.
new text end

Sec. 29.

Minnesota Statutes 2022, section 62M.10, subdivision 8, is amended to read:


Subd. 8.

Notice; new prior authorization requirements or restrictions; change to
existing requirement or restriction.

(a) Before a utilization review organization may
implement a new prior authorization requirement or restriction or amend an existing prior
authorization requirement or restriction, the utilization review organization must submit the
new or amended requirement or restriction to all health plan companies for which the
organization performs utilization review. A health plan company must post on its website
the new or amended requirement or restriction.new text begin This paragraph does not apply to the
commissioner of human services when delivering services through fee-for-service under
chapters 256B and 256L.
new text end

(b) At least 45 days before a new prior authorization requirement or restriction or an
amended existing prior authorization requirement or restriction is implemented, the utilization
review organization, health plan company, or claims administrator must provide written or
electronic notice of the new or amended requirement or restriction to all Minnesota-based,
in-network attending health care professionals who are subject to the prior authorization
requirements and restrictions.new text begin This paragraph does not apply to the commissioner of human
services when delivering services through fee-for-service under chapters 256B and 256L.
new text end

new text begin (c) Effective January 1, 2026, before the commissioner of human services may implement
a new prior authorization requirement or restriction or amend an existing prior authorization
requirement or restriction, the commissioner, at least 45 days before the new or amended
requirement or restriction takes effect, must provide written or electronic notice of the new
or amended requirement or restriction, to all health care professionals participating as
fee-for-service providers under chapters 256B and 256L who are subject to the prior
authorization requirements and restrictions.
new text end

Sec. 30.

Minnesota Statutes 2022, section 62M.17, subdivision 2, is amended to read:


Subd. 2.

Effect of change in prior authorization clinical criteria.

(a) If, during a plan
year, a utilization review organization changes coverage terms for a health care service or
the clinical criteria used to conduct prior authorizations for a health care service, the change
in coverage terms or change in clinical criteria shall not apply until the next plan year for
any enrollee who received prior authorization for a health care service using the coverage
terms or clinical criteria in effect before the effective date of the change.

(b) Paragraph (a) does not apply if a utilization review organization changes coverage
terms for a drug or device that has been deemed unsafe by the United States Food and Drug
Administration (FDA); that has been withdrawn by either the FDA or the product
manufacturer; or when an independent source of research, clinical guidelines, or
evidence-based standards has issued drug- or device-specific warnings or recommended
changes in drug or device usage.

(c) Paragraph (a) does not apply if a utilization review organization changes coverage
terms for a service or the clinical criteria used to conduct prior authorizations for a service
when an independent source of research, clinical guidelines, or evidence-based standards
has recommended changes in usage of the service for reasons related to patient harm.new text begin This
paragraph expires December 31, 2025, for health benefit plans offered, sold, issued, or
renewed on or after that date.
new text end

new text begin (d) Effective January 1, 2026, and applicable to health benefit plans offered, sold, issued,
or renewed on or after that date, paragraph (a) does not apply if a utilization review
organization changes coverage terms for a service or the clinical criteria used to conduct
prior authorizations for a service when an independent source of research, clinical guidelines,
or evidence-based standards has recommended changes in usage of the service for reasons
related to previously unknown and imminent patient harm.
new text end

deleted text begin (d)deleted text end new text begin (e)new text end Paragraph (a) does not apply if a utilization review organization removes a brand
name drug from its formulary or places a brand name drug in a benefit category that increases
the enrollee's cost, provided the utilization review organization (1) adds to its formulary 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 (2) provides at least a 60-day notice to
prescribers, pharmacists, and affected enrollees.

Sec. 31.

new text begin [62M.19] ANNUAL REPORT TO COMMISSIONER OF HEALTH; PRIOR
AUTHORIZATIONS.
new text end

new text begin On or before September 1 each year, each utilization review organization must report
to the commissioner of health, in a form and manner specified by the commissioner,
information on prior authorization requests for the previous calendar year. The report
submitted under this subdivision must include the following data:
new text end

new text begin (1) the total number of prior authorization requests received;
new text end

new text begin (2) the number of prior authorization requests for which an authorization was issued;
new text end

new text begin (3) the number of prior authorization requests for which an adverse determination was
issued;
new text end

new text begin (4) the number of adverse determinations reversed on appeal;
new text end

new text begin (5) the 25 codes with the highest number of prior authorization requests and the
percentage of authorizations for each of these codes;
new text end

new text begin (6) the 25 codes with the highest percentage of prior authorization requests for which
an authorization was issued and the total number of the requests;
new text end

new text begin (7) the 25 codes with the highest percentage of prior authorization requests for which
an adverse determination was issued but which was reversed on appeal and the total number
of the requests;
new text end

new text begin (8) the 25 codes with the highest percentage of prior authorization requests for which
an adverse determination was issued and the total number of the requests; and
new text end

new text begin (9) the reasons an adverse determination to a prior authorization request was issued,
expressed as a percentage of all adverse determinations. The reasons listed may include but
are not limited to:
new text end

new text begin (i) the patient did not meet prior authorization criteria;
new text end

new text begin (ii) incomplete information was submitted by the provider to the utilization review
organization;
new text end

new text begin (iii) the treatment program changed; and
new text end

new text begin (iv) the patient is no longer covered by the health benefit plan.
new text end

Sec. 32.

Minnesota Statutes 2022, section 62Q.097, is amended by adding a subdivision
to read:


new text begin Subd. 3.new text end

new text begin Prohibited application questions.new text end

new text begin An application for provider credentialing
must not:
new text end

new text begin (1) require the provider to disclose past health conditions;
new text end

new text begin (2) require the provider to disclose current health conditions, if the provider is being
treated so that the condition does not affect the provider's ability to practice medicine; or
new text end

new text begin (3) require the disclosure of any health conditions that would not affect the provider's
ability to practice medicine in a competent, safe, and ethical manner.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section applies to applications for provider credentialing
submitted to a health plan company on or after January 1, 2025.
new text end

Sec. 33.

Minnesota Statutes 2022, section 62Q.14, is amended to read:


62Q.14 RESTRICTIONS ON ENROLLEE SERVICES.

No health plan company may restrict the choice of an enrollee as to where the enrollee
receives services related to:

(1) the voluntary planning of the conception and bearing of childrendeleted text begin , provided that this
clause does not refer to abortion services
deleted text end ;

(2) the diagnosis of infertility;

(3) the testing and treatment of a sexually transmitted disease; and

(4) the testing for AIDS or other HIV-related conditions.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 34.

Minnesota Statutes 2022, section 62Q.19, subdivision 3, is amended to read:


Subd. 3.

Health plan company affiliation.

A health plan company must offer a provider
contract to deleted text begin anydeleted text end new text begin allnew text end designated essential community deleted text begin providerdeleted text end new text begin providersnew text end located within the
area served by the health plan company. new text begin A health plan company must include all essential
community providers that have accepted a contract in each of the company's provider
networks.
new text end A health plan company shall not restrict enrollee access to services designated
to be provided by the essential community provider for the population that the essential
community provider is certified to serve. A health plan company may also make other
providers available for these services. A health plan company may require an essential
community provider to meet all data requirements, utilization review, and quality assurance
requirements on the same basis as other health plan providers.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 35.

Minnesota Statutes 2022, section 62Q.19, is amended by adding a subdivision to
read:


new text begin Subd. 4a.new text end

new text begin Contract payment rates; private.new text end

new text begin An essential community provider and a
health plan company may negotiate the payment rate for covered services provided by the
essential community provider. This rate must be at least the same rate per unit of service
as is paid by the health plan company to the essential community provider under the provider
contract between the two with the highest number of enrollees receiving health care services
from the provider or, if there is no provider contract between the health plan company and
the essential community provider, the rate must be at least the same rate per unit of service
as is paid to other plan providers for the same or similar services. The provider contract
used to set the rate under this subdivision must be in relation to an individual, small group,
or large group health plan. This subdivision applies only to provider contracts in relation
to individual, small employer, and large group health plans.
new text end

Sec. 36.

Minnesota Statutes 2022, section 62Q.19, subdivision 5, is amended to read:


Subd. 5.

Contract payment ratesnew text begin ; publicnew text end .

An essential community provider and a
health plan company may negotiate the payment rate for covered services provided by the
essential community provider. This rate must be at least the same rate per unit of service
as is paid to other health plan providers for the same or similar services. new text begin This subdivision
applies only to provider contracts in relation to health plans offered through the State
Employee Group Insurance Program, medical assistance, and MinnesotaCare.
new text end

Sec. 37.

Minnesota Statutes 2023 Supplement, section 62Q.473, is amended by adding a
subdivision to read:


new text begin Subd. 3.new text end

new text begin Reimbursement.new text end

new text begin (a) The commissioner of commerce must reimburse health
plan companies for coverage under this section. Reimbursement is available only for coverage
that would not have been provided by the health plan without the requirements of this
section. Treatments and services covered by the health plan as of January 1, 2023, are
ineligible for payment under this subdivision by the commissioner of commerce.
new text end

new text begin (b) Health plan companies must report to the commissioner of commerce quantified
costs attributable to the additional benefit under this section in a format developed by the
commissioner. A health plan's coverage as of January 1, 2023, must be used by the health
plan company as the basis for determining whether coverage would not have been provided
by the health plan for purposes of this subdivision.
new text end

new text begin (c) The commissioner of commerce must evaluate submissions and make payments to
health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 38.

Minnesota Statutes 2023 Supplement, section 62Q.473, is amended by adding a
subdivision to read:


new text begin Subd. 4.new text end

new text begin Appropriation.new text end

new text begin Each fiscal year, an amount necessary to make payments to
health plan companies to defray the cost of providing coverage under this section is
appropriated to the commissioner of commerce.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 39.

new text begin [62Q.524] COVERAGE OF ABORTIONS AND ABORTION-RELATED
SERVICES.
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 section, "abortion" means any medical
treatment intended to induce the termination of a pregnancy with a purpose other than
producing a live birth.
new text end

new text begin Subd. 2.new text end

new text begin Required coverage.new text end

new text begin (a) A health plan must provide coverage for abortions and
abortion-related services, including preabortion services and follow-up services.
new text end

new text begin (b) A health plan must not impose on the coverage under this section any co-payment,
coinsurance, deductible, or other enrollee cost-sharing that is greater than the cost-sharing
that applies to similar services covered under the health plan.
new text end

new text begin (c) A health plan must not impose any limitation on the coverage under this section,
including but not limited to any utilization review, prior authorization, referral requirements,
restrictions, or delays, that is not generally applicable to other coverages under the plan.
new text end

new text begin Subd. 3.new text end

new text begin Exclusion.new text end

new text begin This section does not apply to managed care organizations or
county-based purchasing plans when the plan provides coverage to public health care
program enrollees under chapter 256B or 256L.
new text end

new text begin Subd. 4.new text end

new text begin Reimbursement.new text end

new text begin (a) The commissioner of commerce must reimburse health
plan companies for coverage under this section. Reimbursement is available only for coverage
that would not have been provided by the health plan without the requirements of this
section. Treatments and services covered by the health plan as of January 1, 2024, are
ineligible for payment under this subdivision by the commissioner of commerce.
new text end

new text begin (b) Health plan companies must report to the commissioner of commerce quantified
costs attributable to the additional benefit under this section in a format developed by the
commissioner. A health plan's coverage as of January 1, 2024, must be used by the health
plan company as the basis for determining whether coverage would not have been provided
by the health plan for purposes of this subdivision.
new text end

new text begin (c) The commissioner of commerce must evaluate submissions and make payments to
health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
new text end

new text begin Subd. 5.new text end

new text begin Appropriation.new text end

new text begin Each fiscal year, an amount necessary to make payments to
health plan companies to defray the cost of providing coverage under this section is
appropriated to the commissioner of commerce.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 40.

new text begin [62Q.531] AMINO ACID-BASED FORMULA COVERAGE.
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 term has the
meaning given.
new text end

new text begin (b) "Formula" means an amino acid-based elemental formula.
new text end

new text begin Subd. 2.new text end

new text begin Required coverage.new text end

new text begin A health plan company must provide coverage for formula
when formula is medically necessary.
new text end

new text begin Subd. 3.new text end

new text begin Covered conditions.new text end

new text begin Conditions for which formula is medically necessary
include but are not limited to:
new text end

new text begin (1) cystic fibrosis;
new text end

new text begin (2) amino acid, organic acid, and fatty acid metabolic and malabsorption disorders;
new text end

new text begin (3) IgE mediated allergies to food proteins;
new text end

new text begin (4) food protein-induced enterocolitis syndrome;
new text end

new text begin (5) eosinophilic esophagitis;
new text end

new text begin (6) eosinophilic gastroenteritis;
new text end

new text begin (7) eosinophilic colitis; and
new text end

new text begin (8) mast cell activation syndrome.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, issued, or sold on or after that date.
new text end

Sec. 41.

new text begin [62Q.665] COVERAGE FOR ORTHOTIC AND PROSTHETIC DEVICES.
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) "Accredited facility" means any entity that is accredited to provide comprehensive
orthotic or prosthetic devices or services by a Centers for Medicare and Medicaid Services
approved accrediting agency.
new text end

new text begin (c) "Orthosis" means:
new text end

new text begin (1) an external medical device that is:
new text end

new text begin (i) custom-fabricated or custom-fitted to a specific patient based on the patient's unique
physical condition;
new text end

new text begin (ii) applied to a part of the body to correct a deformity, provide support and protection,
restrict motion, improve function, or relieve symptoms of a disease, syndrome, injury, or
postoperative condition; and
new text end

new text begin (iii) deemed medically necessary by a prescribing physician or licensed health care
provider who has authority in Minnesota to prescribe orthotic and prosthetic devices, supplies,
and services; and
new text end

new text begin (2) any provision, repair, or replacement of a device that is furnished or performed by:
new text end

new text begin (i) an accredited facility in comprehensive orthotic services; or
new text end

new text begin (ii) a health care provider licensed in Minnesota and operating within the provider's
scope of practice which allows the provider to provide orthotic or prosthetic devices, supplies,
or services.
new text end

new text begin (d) "Orthotics" means:
new text end

new text begin (1) the science and practice of evaluating, measuring, designing, fabricating, assembling,
fitting, adjusting, or servicing and providing the initial training necessary to accomplish the
fitting of an orthotic device for the support, correction, or alleviation of a neuromuscular
or musculoskeletal dysfunction, disease, injury, or deformity;
new text end

new text begin (2) evaluation, treatment, and consultation related to an orthotic device;
new text end

new text begin (3) basic observation of gait and postural analysis;
new text end

new text begin (4) assessing and designing orthosis to maximize function and provide support and
alignment necessary to prevent or correct a deformity or to improve the safety and efficiency
of mobility and locomotion;
new text end

new text begin (5) continuing patient care to assess the effect of an orthotic device on the patient's
tissues; and
new text end

new text begin (6) proper fit and function of the orthotic device by periodic evaluation.
new text end

new text begin (e) "Prosthesis" means:
new text end

new text begin (1) an external medical device that is:
new text end

new text begin (i) used to replace or restore a missing limb, appendage, or other external human body
part; and
new text end

new text begin (ii) deemed medically necessary by a prescribing physician or licensed health care
provider who has authority in Minnesota to prescribe orthotic and prosthetic devices, supplies,
and services; and
new text end

new text begin (2) any provision, repair, or replacement of a device that is furnished or performed by:
new text end

new text begin (i) an accredited facility in comprehensive prosthetic services; or
new text end

new text begin (ii) a health care provider licensed in Minnesota and operating within the provider's
scope of practice which allows the provider to provide orthotic or prosthetic devices, supplies,
or services.
new text end

new text begin (f) "Prosthetics" means:
new text end

new text begin (1) the science and practice of evaluating, measuring, designing, fabricating, assembling,
fitting, aligning, adjusting, or servicing, as well as providing the initial training necessary
to accomplish the fitting of, a prosthesis through the replacement of external parts of a
human body lost due to amputation or congenital deformities or absences;
new text end

new text begin (2) the generation of an image, form, or mold that replicates the patient's body segment
and that requires rectification of dimensions, contours, and volumes for use in the design
and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial
appendage that is designed either to support body weight or to improve or restore function
or anatomical appearance, or both;
new text end

new text begin (3) observational gait analysis and clinical assessment of the requirements necessary to
refine and mechanically fix the relative position of various parts of the prosthesis to maximize
function, stability, and safety of the patient;
new text end

new text begin (4) providing and continuing patient care in order to assess the prosthetic device's effect
on the patient's tissues; and
new text end

new text begin (5) assuring proper fit and function of the prosthetic device by periodic evaluation.
new text end

new text begin Subd. 2.new text end

new text begin Coverage.new text end

new text begin (a) A health plan must provide coverage for orthotic and prosthetic
devices, supplies, and services, including repair and replacement, at least equal to the
coverage provided under federal law for health insurance for the aged and disabled under
sections 1832, 1833, and 1834 of the Social Security Act, United States Code, title 42,
sections 1395k, 1395l, and 1395m, but only to the extent consistent with this section.
new text end

new text begin (b) A health plan must not subject orthotic and prosthetic benefits to separate financial
requirements that apply only with respect to those benefits. A health plan may impose
co-payment and coinsurance amounts on those benefits, except that any financial
requirements that apply to such benefits must not be more restrictive than the financial
requirements that apply to the health plan's medical and surgical benefits, including those
for internal restorative devices.
new text end

new text begin (c) A health plan may limit the benefits for, or alter the financial requirements for,
out-of-network coverage of prosthetic and orthotic devices, except that the restrictions and
requirements that apply to those benefits must not be more restrictive than the financial
requirements that apply to the out-of-network coverage for the health plan's medical and
surgical benefits.
new text end

new text begin (d) A health plan must cover orthoses and prostheses when furnished under an order by
a prescribing physician or licensed health care prescriber who has authority in Minnesota
to prescribe orthoses and prostheses, and that coverage for orthotic and prosthetic devices,
supplies, accessories, and services must include those devices or device systems, supplies,
accessories, and services that are customized to the covered individual's needs.
new text end

new text begin (e) A health plan must cover orthoses and prostheses determined by the enrollee's provider
to be the most appropriate model that meets the medical needs of the enrollee for purposes
of performing physical activities, as applicable, including but not limited to running, biking,
and swimming, and maximizing the enrollee's limb function.
new text end

new text begin (f) A health plan must cover orthoses and prostheses for showering or bathing.
new text end

new text begin Subd. 3.new text end

new text begin Prior authorization.new text end

new text begin A health plan may require prior authorization for orthotic
and prosthetic devices, supplies, and services in the same manner and to the same extent as
prior authorization is required for any other covered benefit.
new text end

new text begin Subd. 4.new text end

new text begin Reimbursement.new text end

new text begin (a) The commissioner of commerce must reimburse health
plan companies for coverage under this section. Reimbursement is available only for coverage
that would not have been provided by the health plan without the requirements of this
section. Treatments and services covered by the health plan as of January 1, 2024, are
ineligible for payment under this subdivision by the commissioner of commerce.
new text end

new text begin (b) Health plan companies must report to the commissioner of commerce quantified
costs attributable to the additional benefit under this section in a format developed by the
commissioner. A health plan's coverage as of January 1, 2024, must be used by the health
plan company as the basis for determining whether coverage would not have been provided
by the health plan for purposes of this subdivision.
new text end

new text begin (c) The commissioner of commerce must evaluate submissions and make payments to
health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
new text end

new text begin Subd. 5.new text end

new text begin Appropriation.new text end

new text begin Each fiscal year, an amount necessary to make payments to
health plan companies to defray the cost of providing coverage under this section is
appropriated to the commissioner of commerce.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to all health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 42.

new text begin [62Q.6651] MEDICAL NECESSITY AND NONDISCRIMINATION
STANDARDS FOR COVERAGE OF PROSTHETICS OR ORTHOTICS.
new text end

new text begin (a) When performing a utilization review for a request for coverage of prosthetic or
orthotic benefits, a health plan company shall apply the most recent version of evidence-based
treatment and fit criteria as recognized by relevant clinical specialists.
new text end

new text begin (b) A health plan company shall render utilization review determinations in a
nondiscriminatory manner and shall not deny coverage for habilitative or rehabilitative
benefits, including prosthetics or orthotics, solely on the basis of an enrollee's actual or
perceived disability.
new text end

new text begin (c) A health plan company shall not deny a prosthetic or orthotic benefit for an individual
with limb loss or absence that would otherwise be covered for a nondisabled person seeking
medical or surgical intervention to restore or maintain the ability to perform the same
physical activity.
new text end

new text begin (d) A health plan offered, issued, or renewed in Minnesota that offers coverage for
prosthetics and custom orthotic devices shall include language describing an enrollee's rights
pursuant to paragraphs (b) and (c) in its evidence of coverage and any benefit denial letters.
new text end

new text begin (e) A health plan that provides coverage for prosthetic or orthotic services shall ensure
access to medically necessary clinical care and to prosthetic and custom orthotic devices
and technology from not less than two distinct prosthetic and custom orthotic providers in
the plan's provider network located in Minnesota. In the event that medically necessary
covered orthotics and prosthetics are not available from an in-network provider, the health
plan company shall provide processes to refer a member to an out-of-network provider and
shall fully reimburse the out-of-network provider at a mutually agreed upon rate less member
cost sharing determined on an in-network basis.
new text end

new text begin (f) If coverage for prosthetic or custom orthotic devices is provided, payment shall be
made for the replacement of a prosthetic or custom orthotic device or for the replacement
of any part of the devices, without regard to continuous use or useful lifetime restrictions,
if an ordering health care provider determines that the provision of a replacement device,
or a replacement part of a device, is necessary because:
new text end

new text begin (1) of a change in the physiological condition of the patient;
new text end

new text begin (2) of an irreparable change in the condition of the device or in a part of the device; or
new text end

new text begin (3) the condition of the device, or the part of the device, requires repairs and the cost of
the repairs would be more than 60 percent of the cost of a replacement device or of the part
being replaced.
new text end

new text begin (g) Confirmation from a prescribing health care provider may be required if the prosthetic
or custom orthotic device or part being replaced is less than three years old.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to all health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 43.

new text begin [62Q.666] INTERMITTENT CATHETERS.
new text end

new text begin Subdivision 1.new text end

new text begin Required coverage.new text end

new text begin A health plan must provide coverage for intermittent
urinary catheters and insertion supplies if intermittent catheterization is recommended by
the enrollee's health care provider. At least 180 intermittent catheters per month with insertion
supplies must be covered unless a lesser amount is prescribed by the enrollee's health care
provider. A health plan providing coverage under the medical assistance program may be
required to provide coverage for more than 180 intermittent catheters per month with
insertion supplies.
new text end

new text begin Subd. 2.new text end

new text begin Cost-sharing requirements.new text end

new text begin A health plan is prohibited from imposing a
deductible, co-payment, coinsurance, or other restriction on intermittent catheters and
insertion supplies that the health plan does not apply to durable medical equipment in general.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective for any health plan issued or renewed
on or after January 1, 2025.
new text end

Sec. 44.

new text begin [62Q.679] RELIGIOUS OBJECTIONS.
new text end

new text begin Subdivision 1.new text end

new text begin Definitions.new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Closely held for-profit entity" means an entity that is not a nonprofit entity, has
more than 50 percent of the value of its ownership interest owned directly or indirectly by
five or fewer owners, and has no publicly traded ownership interest. For purposes of this
paragraph:
new text end

new text begin (1) ownership interests owned by a corporation, partnership, limited liability company,
estate, trust, or similar entity are considered owned by that entity's shareholders, partners,
members, or beneficiaries in proportion to their interest held in the corporation, partnership,
limited liability company, estate, trust, or similar entity;
new text end

new text begin (2) ownership interests owned by a nonprofit entity are considered owned by a single
owner;
new text end

new text begin (3) ownership interests owned by all individuals in a family are considered held by a
single owner. For purposes of this clause, "family" means brothers and sisters, including
half-brothers and half-sisters, a spouse, ancestors, and lineal descendants; and
new text end

new text begin (4) if an individual or entity holds an option, warrant, or similar right to purchase an
ownership interest, the individual or entity is considered to be the owner of those ownership
interests.
new text end

new text begin (c) "Eligible organization" means an organization that opposes covering some or all
health benefits under section 62Q.522, 62Q.524, or 62Q.585 on account of religious
objections and that is:
new text end

new text begin (1) organized as a nonprofit entity and holds itself out to be religious; or
new text end

new text begin (2) organized and operates as a closely held for-profit entity, and the organization's
owners or highest governing body has adopted, under the organization's applicable rules of
governance and consistent with state law, a resolution or similar action establishing that the
organization objects to covering some or all health benefits under section 62Q.522, 62Q.524,
or 62Q.585 on account of the owners' sincerely held religious beliefs.
new text end

new text begin (d) "Exempt organization" means an organization that is organized and operates as a
nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal
Revenue Code of 1986, as amended.
new text end

new text begin Subd. 2.new text end

new text begin Exemption.new text end

new text begin (a) An exempt organization is not required to provide coverage
under section 62Q.522, 62Q.524, or 62Q.585 if the exempt organization has religious
objections to the coverage. An exempt organization that chooses to not provide coverage
pursuant to this paragraph must notify employees as part of the hiring process and must
notify all employees at least 30 days before:
new text end

new text begin (1) an employee enrolls in the health plan; or
new text end

new text begin (2) the effective date of the health plan, whichever occurs first.
new text end

new text begin (b) If the exempt organization provides partial coverage under section 62Q.522, 62Q.524,
or 62Q.585, the notice required under paragraph (a) must provide a list of the portions of
such coverage which the organization refuses to cover.
new text end

new text begin Subd. 3.new text end

new text begin Accommodation for eligible organizations.new text end

new text begin (a) A health plan established or
maintained by an eligible organization complies with the coverage requirements of section
62Q.522, 62Q.524, or 62Q.585, with respect to the health benefits identified in the notice
under this paragraph, if the eligible organization provides notice to any health plan company
with which the eligible organization contracts that it is an eligible organization and that the
eligible organization has a religious objection to coverage for all or a subset of the health
benefits under section 62Q.522, 62Q.524, or 62Q.585.
new text end

new text begin (b) The notice from an eligible organization to a health plan company under paragraph
(a) must include: (1) the name of the eligible organization; (2) a statement that it objects to
coverage for some or all of the health benefits under section 62Q.522, 62Q.524, or 62Q.585,
including a list of the health benefits to which the eligible organization objects, if applicable;
and (3) the health plan name. The notice must be executed by a person authorized to provide
notice on behalf of the eligible organization.
new text end

new text begin (c) An eligible organization must provide a copy of the notice under paragraph (a) to
prospective employees as part of the hiring process and to all employees at least 30 days
before:
new text end

new text begin (1) an employee enrolls in the health plan; or
new text end

new text begin (2) the effective date of the health plan, whichever occurs first.
new text end

new text begin (d) A health plan company that receives a copy of the notice under paragraph (a) with
respect to a health plan established or maintained by an eligible organization must, for all
future enrollments in the health plan:
new text end

new text begin (1) expressly exclude coverage for those health benefits identified in the notice under
paragraph (a) from the health plan; and
new text end

new text begin (2) provide separate payments for any health benefits required to be covered under
section 62Q.522, 62Q.524, or 62Q.585 for enrollees as long as the enrollee remains enrolled
in the health plan.
new text end

new text begin (e) The health plan company must not impose any cost-sharing requirements, including
co-pays, deductibles, or coinsurance, or directly or indirectly impose any premium, fee, or
other charge for the health benefits under section 62Q.522 on the enrollee. The health plan
company must not directly or indirectly impose any premium, fee, or other charge for the
health benefits under section 62Q.522, 62Q.524, or 62Q.585 on the eligible organization
or health plan.
new text end

new text begin (f) On January 1, 2025, and every year thereafter a health plan company must notify the
commissioner, in a manner determined by the commissioner, of the number of eligible
organizations granted an accommodation under this subdivision.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

Sec. 45.

Minnesota Statutes 2022, section 62Q.73, subdivision 2, is amended to read:


Subd. 2.

Exception.

(a) This section does not apply to governmental programs except
as permitted under paragraph (b). For purposes of this subdivision, "governmental programs"
means the prepaid medical assistance programdeleted text begin ,deleted text end new text begin ;new text end new text begin effective January 1, 2026, the medical
assistance fee-for-service program;
new text end the MinnesotaCare programdeleted text begin ,deleted text end new text begin ;new text end the demonstration project
for people with disabilitiesdeleted text begin ,deleted text end new text begin ;new text end and the federal Medicare program.

(b) In the course of a recipient's appeal of a medical determination to the commissioner
of human services under section 256.045, the recipient may request an expert medical
opinion be arranged by the external review entity under contract to provide independent
external reviews under this section. If such a request is made, the cost of the review shall
be paid by the commissioner of human services. Any medical opinion obtained under this
paragraph shall only be used by a state human services judge as evidence in the recipient's
appeal to the commissioner of human services under section 256.045.

(c) Nothing in this subdivision shall be construed to limit or restrict the appeal rights
provided in section 256.045 for governmental program recipients.

Sec. 46.

Minnesota Statutes 2023 Supplement, section 145D.01, subdivision 1, is amended
to read:


Subdivision 1.

Definitions.

(a) For purposes of this deleted text begin chapterdeleted text end new text begin section and section 145D.02new text end ,
the following terms have the meanings given.

(b) "Captive professional entity" means a professional corporation, limited liability
company, or other entity formed to render professional services in which a beneficial owner
is a health care provider employed by, controlled by, or subject to the direction of a hospital
or hospital system.

(c) "Commissioner" means the commissioner of health.

(d) "Control," including the terms "controlling," "controlled by," and "under common
control with," means the possession, direct or indirect, of the power to direct or cause the
direction of the management and policies of a health care entity, whether through the
ownership of voting securities, membership in an entity formed under chapter 317A, by
contract other than a commercial contract for goods or nonmanagement services, or otherwise,
unless the power is the result of an official position with, corporate office held by, or court
appointment of, the person. Control is presumed to exist if any person, directly or indirectly,
owns, controls, holds with the power to vote, or holds proxies representing 40 percent or
more of the voting securities of any other person, or if any person, directly or indirectly,
constitutes 40 percent or more of the membership of an entity formed under chapter 317A.
The attorney general may determine that control exists in fact, notwithstanding the absence
of a presumption to that effect.

(e) "Health care entity" means:

(1) a hospital;

(2) a hospital system;

(3) a captive professional entity;

(4) a medical foundation;

(5) a health care provider group practice;

(6) an entity organized or controlled by an entity listed in clauses (1) to (5); or

(7) an entity that owns or exercises control over an entity listed in clauses (1) to (5).

(f) "Health care provider" means a physician licensed under chapter 147, a physician
assistant licensed under chapter 147A, or an advanced practice registered nurse as defined
in section 148.171, subdivision 3, who provides health care services, including but not
limited to medical care, consultation, diagnosis, or treatment.

(g) "Health care provider group practice" means two or more health care providers legally
organized in a partnership, professional corporation, limited liability company, medical
foundation, nonprofit corporation, faculty practice plan, or other similar entity:

(1) in which each health care provider who is a member of the group provides services
that a health care provider routinely provides, including but not limited to medical care,
consultation, diagnosis, and treatment, through the joint use of shared office space, facilities,
equipment, or personnel;

(2) for which substantially all services of the health care providers who are group
members are provided through the group and are billed in the name of the group practice
and amounts so received are treated as receipts of the group; or

(3) in which the overhead expenses of, and the income from, the group are distributed
in accordance with methods previously determined by members of the group.

An entity that otherwise meets the definition of health care provider group practice in this
paragraph shall be considered a health care provider group practice even if its shareholders,
partners, members, or owners include a professional corporation, limited liability company,
or other entity in which any beneficial owner is a health care provider and that is formed to
render professional services.

(h) "Hospital" means a health care facility licensed as a hospital under sections 144.50
to 144.56.

(i) "Medical foundation" means a nonprofit legal entity through which health care
providers perform research or provide medical services.

(j) "Transaction" means a single action, or a series of actions within a five-year period,
which occurs in part within the state of Minnesota or involves a health care entity formed
or licensed in Minnesota, that constitutes:

(1) a merger or exchange of a health care entity with another entity;

(2) the sale, lease, or transfer of 40 percent or more of the assets of a health care entity
to another entity;

(3) the granting of a security interest of 40 percent or more of the property and assets
of a health care entity to another entity;

(4) the transfer of 40 percent or more of the shares or other ownership of a health care
entity to another entity;

(5) an addition, removal, withdrawal, substitution, or other modification of one or more
members of the health care entity's governing body that transfers control, responsibility for,
or governance of the health care entity to another entity;

(6) the creation of a new health care entity;

(7) an agreement or series of agreements that results in the sharing of 40 percent or more
of the health care entity's revenues with another entity, including affiliates of such other
entity;

(8) an addition, removal, withdrawal, substitution, or other modification of the members
of a health care entity formed under chapter 317A that results in a change of 40 percent or
more of the membership of the health care entity; or

(9) any other transfer of control of a health care entity to, or acquisition of control of a
health care entity by, another entity.

(k) A transaction as defined in paragraph (j) does not include:

(1) an action or series of actions that meets one or more of the criteria set forth in
paragraph (j), clauses (1) to (9), if, immediately prior to all such actions, the health care
entity directly, or indirectly through one or more intermediaries, controls, is controlled by,
or is under common control with, all other parties to the action or series of actions;

(2) a mortgage or other secured loan for business improvement purposes entered into
by a health care entity that does not directly affect delivery of health care or governance of
the health care entity;

(3) a clinical affiliation of health care entities formed solely for the purpose of
collaborating on clinical trials or providing graduate medical education;

(4) the mere offer of employment to, or hiring of, a health care provider by a health care
entity;

(5) contracts between a health care entity and a health care provider primarily for clinical
services; or

(6) a single action or series of actions within a five-year period involving only entities
that operate solely as a nursing home licensed under chapter 144A; a boarding care home
licensed under sections 144.50 to 144.56; a supervised living facility licensed under sections
144.50 to 144.56; an assisted living facility licensed under chapter 144G; a foster care setting
licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, for a physical location that
is not the primary residence of the license holder; a community residential setting as defined
in section 245D.02, subdivision 4a; or a home care provider licensed under sections 144A.471
to 144A.483.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 47.

new text begin [145D.30] DEFINITIONS.
new text end

new text begin Subdivision 1.new text end

new text begin Application.new text end

new text begin For purposes of sections 145D.30 to 145D.37, the following
terms have the meanings given unless the context clearly indicates otherwise.
new text end

new text begin Subd. 2.new text end

new text begin Commissionernew text end

new text begin "Commissioner" means the commissioner of commerce for a
nonprofit health coverage entity that is a nonprofit health service plan corporation operating
under chapter 62C or the commissioner of health for a nonprofit health coverage entity that
is a nonprofit health maintenance organization operating under chapter 62D.
new text end

new text begin Subd. 3.new text end

new text begin Control.new text end

new text begin "Control," including the terms "controlling," "controlled by," and
"under common control with," means the possession, direct or indirect, of the power to
direct or cause the direction of the management and policies of a nonprofit health coverage
entity, whether through the ownership of voting securities, through membership in an entity
formed under chapter 317A, by contract other than a commercial contract for goods or
nonmanagement services, or otherwise, unless the power is the result of an official position
with, corporate office held by, or court appointment of the person. Control is presumed to
exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or
holds proxies representing 40 percent or more of the voting securities of any other person
or if any person, directly or indirectly, constitutes 40 percent or more of the membership
of an entity formed under chapter 317A. The attorney general may determine that control
exists in fact, notwithstanding the absence of a presumption to that effect.
new text end

new text begin Subd. 4.new text end

new text begin Conversion transaction.new text end

new text begin "Conversion transaction" means a transaction otherwise
permitted under applicable law in which a nonprofit health coverage entity:
new text end

new text begin (1) merges, consolidates, converts, or transfers all or substantially all of its assets to any
entity except a corporation that is exempt under United States Code, title 26, section
501(c)(3);
new text end

new text begin (2) makes a series of separate transfers within a 60-month period that in the aggregate
constitute a transfer of all or substantially all of the nonprofit health coverage entity's assets
to any entity except a corporation that is exempt under United States Code, title 26, section
501(c)(3); or
new text end

new text begin (3) adds or substitutes one or more directors or officers that effectively transfer the
control of, responsibility for, or governance of the nonprofit health coverage entity to any
entity except a corporation that is exempt under United States Code, title 26, section
501(c)(3).
new text end

new text begin Subd. 5.new text end

new text begin Corporation.new text end

new text begin "Corporation" has the meaning given in section 317A.011,
subdivision 6, and also includes a nonprofit limited liability company organized under
section 322C.1101.
new text end

new text begin Subd. 6.new text end

new text begin Director.new text end

new text begin "Director" has the meaning given in section 317A.011, subdivision
7.
new text end

new text begin Subd. 7.new text end

new text begin Family member.new text end

new text begin "Family member" means a spouse, parent, child, spouse of
a child, brother, sister, or spouse of a brother or sister.
new text end

new text begin Subd. 8.new text end

new text begin Full and fair value.new text end

new text begin "Full and fair value" means at least the amount that the
public benefit assets of the nonprofit health coverage entity would be worth if the assets
were equal to stock in the nonprofit health coverage entity, if the nonprofit health coverage
entity was a for-profit corporation and if the nonprofit health coverage entity had 100 percent
of its stock authorized by the corporation and available for purchase without transfer
restrictions. The valuation shall consider market value, investment or earning value, net
asset value, goodwill, amount of donations received, and control premium, if any.
new text end

new text begin Subd. 9.new text end

new text begin Nonprofit health coverage entity.new text end

new text begin "Nonprofit health coverage entity" means
a domestic nonprofit health service plan corporation operating under chapter 62C or a
domestic nonprofit health maintenance organization operating under chapter 62D.
new text end

new text begin Subd. 10.new text end

new text begin Officer.new text end

new text begin "Officer" has the meaning given in section 317A.011, subdivision
15.
new text end

new text begin Subd. 11.new text end

new text begin Public benefit assets.new text end

new text begin "Public benefit assets" means the entirety of a nonprofit
health coverage entity's assets, whether tangible or intangible, including but not limited to
its goodwill and anticipated future revenue.
new text end

new text begin Subd. 12.new text end

new text begin Related organization.new text end

new text begin "Related organization" has the meaning given in section
317A.011, subdivision 18.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 48.

new text begin [145D.31] CERTAIN CONVERSION TRANSACTIONS PROHIBITED.
new text end

new text begin A nonprofit health coverage entity must not enter into a conversion transaction if:
new text end

new text begin (1) doing so would result in less than the full and fair value of all public benefit assets
remaining dedicated to the public benefit; or
new text end

new text begin (2) an individual who has been an officer, director, or other executive of the nonprofit
health coverage entity or of a related organization, or a family member of such an individual:
new text end

new text begin (i) has held or will hold, whether guaranteed or contingent, an ownership stake, stock,
securities, investment, or other financial interest in an entity to which the nonprofit health
coverage entity transfers public benefit assets in connection with the conversion transaction;
new text end

new text begin (ii) has received or will receive any type of compensation or other financial benefit,
except for salary or wages paid for employment, from an entity to which the nonprofit health
coverage entity transfers public benefit assets in connection with the conversion transaction;
new text end

new text begin (iii) has held or will hold, whether guaranteed or contingent, an ownership stake, stock,
securities, investment, or other financial interest in an entity that has or will have a business
relationship with an entity to which the nonprofit health coverage entity transfers public
benefit assets in connection with the conversion transaction; or
new text end

new text begin (iv) has received or will receive any type of compensation or other financial benefit,
except for salary or wages paid for employment, from an entity that has or will have a
business relationship with an entity to which the nonprofit health coverage entity transfers
public benefit assets in connection with the conversion transaction.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 49.

new text begin [145D.32] REQUIREMENTS FOR NONPROFIT HEALTH COVERAGE
ENTITY CONVERSION TRANSACTIONS.
new text end

new text begin Subdivision 1.new text end

new text begin Notice.new text end

new text begin (a) Before entering into a conversion transaction, a nonprofit
health coverage entity must notify the attorney general according to section 317A.811. In
addition to the elements listed in section 317A.811, subdivision 1, the notice required by
this subdivision must also include: (1) an itemization of the nonprofit health coverage entity's
public benefit assets and an independent third-party valuation of the nonprofit health coverage
entity's public benefit assets; and (2) other information contained in forms provided by the
attorney general.
new text end

new text begin (b) When the nonprofit health coverage entity provides the attorney general with the
notice and other information required under paragraph (a), the nonprofit health coverage
entity must also provide a copy of this notice and other information to the applicable
commissioner.
new text end

new text begin Subd. 2.new text end

new text begin Nonprofit health coverage entity requirements.new text end

new text begin Before entering into a
conversion transaction, a nonprofit health coverage entity must ensure that:
new text end

new text begin (1) the proposed conversion transaction complies with chapters 317A and 501B and
other applicable laws;
new text end

new text begin (2) the proposed conversion transaction does not involve or constitute a breach of
charitable trust;
new text end

new text begin (3) the nonprofit health coverage entity shall receive full and fair value for its public
benefit assets;
new text end

new text begin (4) the value of the public benefit assets to be transferred has not been manipulated in
a manner that causes or caused the value of the assets to decrease;
new text end

new text begin (5) the proceeds of the proposed conversion transaction shall be used in a manner
consistent with the public benefit for which the assets are held by the nonprofit health
coverage entity; and
new text end

new text begin (6) the proposed conversion transaction shall not result in a breach of fiduciary duty.
new text end

new text begin Subd. 3.new text end

new text begin Listening sessions and public comment.new text end

new text begin The attorney general or the
commissioner may hold public listening sessions or forums and may solicit public comments
regarding the proposed conversion transaction.
new text end

new text begin Subd. 4.new text end

new text begin Waiting period.new text end

new text begin (a) Subject to paragraphs (b) and (c), a nonprofit health
coverage entity must not enter into a conversion transaction until 60 days after the nonprofit
health coverage entity has given written notice as required in subdivision 1.
new text end

new text begin (b) The attorney general may waive all or part of the waiting period or may extend the
waiting period for an additional 60 days by notifying the nonprofit health coverage entity
of the extension in writing.
new text end

new text begin (c) The time periods specified in this subdivision shall be suspended while an
investigation into the conversion transaction is pending or while a request from the attorney
general for additional information is outstanding.
new text end

new text begin Subd. 5.new text end

new text begin Funds restricted for a particular purpose.new text end

new text begin Nothing in this section relieves a
nonprofit health coverage entity from complying with requirements for funds that are
restricted for a particular purpose. Funds restricted for a particular purpose must continue
to be used in accordance with the purpose for which they were restricted under sections
317A.671 and 501B.31. A nonprofit health coverage entity may not convert, transfer, or
sell assets if the transaction would result in the use of the assets conflicting with their
restricted purpose.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 50.

new text begin [145D.34] ENFORCEMENT AND REMEDIES.
new text end

new text begin Subdivision 1.new text end

new text begin Investigation.new text end

new text begin The attorney general has the powers in section 8.31.
Nothing in this subdivision limits the powers, remedies, or responsibilities of the attorney
general under this chapter; chapter 8, 309, 317A, or 501B; or any other chapter. For purposes
of this section, an approval by the commissioner for regulatory purposes does not impair
or inform the attorney general's authority.
new text end

new text begin Subd. 2.new text end

new text begin Enforcement and penalties.new text end

new text begin (a) The attorney general may bring an action in
district court to enjoin or unwind a conversion transaction or seek other equitable relief
necessary to protect the public interest if:
new text end

new text begin (1) a nonprofit health coverage entity or conversion transaction violates sections 145D.30
to 145D.32; or
new text end

new text begin (2) the conversion transaction is contrary to the public interest.
new text end

new text begin In seeking injunctive relief, the attorney general must not be required to establish irreparable
harm but must instead establish that a violation of sections 145D.30 to 145D.32 occurred
or that the requested order promotes the public interest.
new text end

new text begin (b) Factors informing whether a conversion transaction is contrary to the public interest
include but are not limited to whether:
new text end

new text begin (1) the conversion transaction shall result in increased health care costs for patients; and
new text end

new text begin (2) the conversion transaction shall adversely impact provider cost trends and containment
of total health care spending.
new text end

new text begin (c) The attorney general may enforce sections 145D.30 to 145D.32 under section 8.31.
new text end

new text begin (d) Failure of the entities involved in a conversion transaction to provide timely
information as required by the attorney general or the commissioner shall be an independent
and sufficient ground for a court to enjoin or unwind the transaction or provide other equitable
relief, provided the attorney general notifies the entities of the inadequacy of the information
provided and provides the entities with a reasonable opportunity to remedy the inadequacy.
new text end

new text begin (e) An officer, director, or other executive found to have violated sections 145D.30 to
145D.32 shall be subject to a civil penalty of up to $100,000 for each violation. A corporation
or other entity which is a party to or materially participated in a conversion transaction
found to have violated sections 145D.30 to 145D.32 shall be subject to a civil penalty of
up to $1,000,000. A court may also award reasonable attorney fees and costs of investigation
and litigation.
new text end

new text begin Subd. 3.new text end

new text begin Commissioner of health; data and research.new text end

new text begin The commissioner of health
must provide the attorney general, upon request, with data and research on broader market
trends, impacts on prices and outcomes, public health and population health considerations,
and health care access, for the attorney general to use when evaluating whether a conversion
transaction is contrary to public interest. The commissioner of health may share with the
attorney general, according to section 13.05, subdivision 9, any not public data, as defined
in section 13.02, subdivision 8a, held by the commissioner to aid in the investigation and
review of the conversion transaction, and the attorney general must maintain this data with
the same classification according to section 13.03, subdivision 4, paragraph (c).
new text end

new text begin Subd. 4.new text end

new text begin Failure to take action.new text end

new text begin Failure by the attorney general to take action with
respect to a conversion transaction under this section does not constitute approval of the
conversion transaction or waiver, nor shall failure prevent the attorney general from taking
action in the same, similar, or subsequent circumstances.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 51.

new text begin [145D.35] DATA PRACTICES.
new text end

new text begin Data provided by a nonprofit health coverage entity to the commissioner or the attorney
general under sections 145D.30 to 145D.32 are, for data on individuals, confidential data
on individuals as defined under section 13.02, subdivision 3, and, for data not on individuals,
protected nonpublic data as defined under section 13.02, subdivision 13. The provided data
are not subject to subpoena and shall not be subject to discovery or admissible in evidence
in any private civil action. The attorney general or the commissioner may provide access
to any data classified as confidential or protected nonpublic under this section to any law
enforcement agency if the attorney general or commissioner determines that the access aids
the law enforcement process. This section shall not be construed to limit the attorney general's
authority to use the data in furtherance of any legal action brought according to section
145D.34.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 52.

new text begin [145D.36] COMMISSIONER OF HEALTH; REPORTS AND ANALYSIS.
new text end

new text begin Notwithstanding any law to the contrary, the commissioner of health may use data or
information submitted under sections 60A.135 to 60A.137, 60A.17, 60D.18, 60D.20,
62D.221, and 145D.32 to conduct analyses of the aggregate impact of transactions within
nonprofit health coverage entities and organizations which include nonprofit health coverage
entities or their affiliates on access to or the cost of health care services, health care market
consolidation, and health care quality. The commissioner of health must issue periodic
public reports on the number and types of conversion transactions subject to sections 145D.30
to 145D.35 and on the aggregate impact of conversion transactions on health care costs,
quality, and competition in Minnesota.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 53.

new text begin [145D.37] RELATION TO OTHER LAW.
new text end

new text begin (a) Sections 145D.30 to 145D.36 are in addition to and do not affect or limit any power,
remedy, or responsibility of a health maintenance organization, a service plan corporation,
the attorney general, the commissioner of health, or the commissioner of commerce under
this chapter; chapter 8, 62C, 62D, 309, 317A, or 501B; or other law.
new text end

new text begin (b) Nothing in sections 145D.03 to 145D.36 authorizes a nonprofit health coverage entity
to enter into a conversion transaction not otherwise permitted under chapter 317A or 501B
or other law.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective July 1, 2025.
new text end

Sec. 54.

new text begin [214.41] PHYSICIAN WELLNESS PROGRAM.
new text end

new text begin Subdivision 1.new text end

new text begin Definition.new text end

new text begin For the purposes of this section, "physician wellness program"
means a program of evaluation, counseling, or other modality to address an issue related to
career fatigue or wellness related to work stress for physicians licensed under chapter 147
that is administered by a statewide association that is exempt from taxation under United
States Code, title 26, section 501(c)(6), and that primarily represents physicians and
osteopaths of multiple specialties. Physician wellness program does not include the provision
of services intended to monitor for impairment under the authority of section 214.31.
new text end

new text begin Subd. 2.new text end

new text begin Confidentiality.new text end

new text begin Any record of a person's participation in a physician wellness
program is confidential and not subject to discovery, subpoena, or a reporting requirement
to the applicable board, unless the person voluntarily provides for written release of the
information or the disclosure is required to meet the licensee's obligation to report according
to section 147.111.
new text end

new text begin Subd. 3.new text end

new text begin Civil liability.new text end

new text begin Any person, agency, institution, facility, or organization employed
by, contracting with, or operating a physician wellness program is immune from civil liability
for any action related to their duties in connection with a physician wellness program when
acting in good faith.
new text end

Sec. 55.

Minnesota Statutes 2022, section 256B.035, is amended to read:


256B.035 MANAGED CARE.

The commissioner of human services may contract with public or private entities or
operate a preferred provider program to deliver health care services to medical assistance
and MinnesotaCare program recipients. The commissioner may enter into risk-based and
non-risk-based contracts. new text begin The commissioner must not enter into a contract with a health
maintenance organization, as defined in section 62D.02, which is not a nonprofit corporation
organized under chapter 317A or a local governmental unit, as defined in section 62D.02.
new text end Contracts may be for the full range of health services, or a portion thereof, for medical
assistance populations to determine the effectiveness of various provider reimbursement
and care delivery mechanisms. The commissioner may seek necessary federal waivers and
implement projects when approval of the waivers is obtained from the Centers for Medicare
and Medicaid Services of the United States Department of Health and Human Services.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025, and applies to managed
care contracts under medical assistance and MinnesotaCare that take effect on or after that
date.
new text end

Sec. 56.

Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 3a, is
amended to read:


Subd. 3a.

Gender-affirming deleted text begin servicesdeleted text end new text begin carenew text end .

Medical assistance covers gender-affirming
deleted text begin servicesdeleted text end new text begin care, as defined in section 62Q.585new text end .

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 57.

Minnesota Statutes 2022, section 256B.0625, subdivision 12, is amended to read:


Subd. 12.

Eyeglassesdeleted text begin , dentures, and prosthetic and orthotic devicesdeleted text end .

deleted text begin (a)deleted text end Medical
assistance covers eyeglassesdeleted text begin , dentures, and prosthetic and orthotic devicesdeleted text end if prescribed by
a licensed practitioner.

deleted text begin (b) For purposes of prescribing prosthetic and orthotic devices, "licensed practitioner"
includes a physician, an advanced practice registered nurse, a physician assistant, or a
podiatrist.
deleted 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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 58.

Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 16, is
amended to read:


Subd. 16.

Abortion services.

Medical assistance covers deleted text begin abortion services determined
to be medically necessary by the treating provider and delivered in accordance with all
applicable Minnesota laws
deleted text end new text begin abortions and abortion-related services, including preabortion
services and follow-up services
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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 59.

Minnesota Statutes 2022, section 256B.0625, subdivision 32, is amended to read:


Subd. 32.

Nutritional products.

Medical assistance covers nutritional products needed
for nutritional supplementation because solid food or nutrients thereof cannot be properly
absorbed by the body or needed for treatment of phenylketonuria, hyperlysinemia, maple
syrup urine disease, a combined allergy to human milk, cow's milk, and soy formula, or
any other childhood or adult diseases, conditions, or disorders identified by the commissioner
as requiring a similarly necessary nutritional product. new text begin Medical assistance covers amino
acid-based elemental formulas in the same manner as is required under section 62Q.531.
new text end Nutritional products needed for the treatment of a combined allergy to human milk, cow's
milk, and soy formula require prior authorization. Separate payment shall not be made for
nutritional products for residents of long-term care facilities. Payment for dietary
requirements is a component of the per diem rate paid to these facilities.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 60.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 72.new text end

new text begin Orthotic and prosthetic devices.new text end

new text begin Medical assistance covers orthotic and
prosthetic devices, supplies, and services according to section 256B.066.
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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 61.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 73.new text end

new text begin Rapid whole genome sequencing.new text end

new text begin Medical assistance covers rapid whole
genome sequencing (rWGS) testing. Coverage and eligibility for rWGS testing, and the use
of genetic data, must meet the requirements specified in section 62A.3098, subdivisions 1
to 3 and 6.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 62.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 74.new text end

new text begin Intermittent catheters.new text end

new text begin Medical assistance covers intermittent urinary catheters
and insertion supplies if intermittent catheterization is recommended by the enrollee's health
care provider. Medical assistance must meet the requirements that would otherwise apply
to a health plan under section 62Q.666.
new text end

Sec. 63.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 75.new text end

new text begin Scalp hair prostheses.new text end

new text begin Medical assistance covers scalp hair prostheses and
all equipment and accessories necessary for their regular use under the conditions and in
compliance with the requirements specified in section 62A.28, except that the limitation on
coverage required per benefit year set forth in section 62A.28, subdivision 2, paragraph (c),
does not apply.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 64.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:


new text begin Subd. 76.new text end

new text begin Transfer of mothers and newborns.new text end

new text begin Medical assistance covers the transfer
of mothers or newborns between medical facilities. Medical assistance must meet the same
requirements that would otherwise apply to a health plan under section 62A.0411.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 65.

new text begin [256B.066] ORTHOTIC AND PROSTHETIC DEVICES, SUPPLIES, AND
SERVICES.
new text end

new text begin Subdivision 1.new text end

new text begin Definitions.new text end

new text begin All terms used in this section have the meanings given them
in section 62Q.665, subdivision 1.
new text end

new text begin Subd. 2.new text end

new text begin Coverage requirements.new text end

new text begin (a) Medical assistance covers orthotic and prosthetic
devices, supplies, and services:
new text end

new text begin (1) furnished under an order by a prescribing physician or licensed health care prescriber
who has authority in Minnesota to prescribe orthoses and prostheses. Coverage for orthotic
and prosthetic devices, supplies, accessories, and services under this clause includes those
devices or device systems, supplies, accessories, and services that are customized to the
enrollee's needs;
new text end

new text begin (2) determined by the enrollee's provider to be the most appropriate model that meets
the medical needs of the enrollee for purposes of performing physical activities, as applicable,
including but not limited to running, biking, and swimming, and maximizing the enrollee's
limb function; or
new text end

new text begin (3) for showering or bathing.
new text end

new text begin (b) The coverage set forth in paragraph (a) includes the repair and replacement of those
orthotic and prosthetic devices, supplies, and services described therein.
new text end

new text begin (c) Coverage of a prosthetic or orthotic benefit must not be denied for an individual with
limb loss or absence that would otherwise be covered for a nondisabled person seeking
medical or surgical intervention to restore or maintain the ability to perform the same
physical activity.
new text end

new text begin (d) If coverage for prosthetic or custom orthotic devices is provided, payment must be
made for the replacement of a prosthetic or custom orthotic device or for the replacement
of any part of the devices, without regard to useful lifetime restrictions, if an ordering health
care provider determines that the provision of a replacement device, or a replacement part
of a device, is necessary because:
new text end

new text begin (1) of a change in the physiological condition of the enrollee;
new text end

new text begin (2) of an irreparable change in the condition of the device or in a part of the device; or
new text end

new text begin (3) the condition of the device, or the part of the device, requires repairs and the cost of
the repairs would be more than 60 percent of the cost of a replacement device or of the part
being replaced.
new text end

new text begin Subd. 3.new text end

new text begin Restrictions on coverage.new text end

new text begin (a) Prior authorization may be required for orthotic
and prosthetic devices, supplies, and services.
new text end

new text begin (b) A utilization review for a request for coverage of prosthetic or orthotic benefits must
apply the most recent version of evidence-based treatment and fit criteria as recognized by
relevant clinical specialists.
new text end

new text begin (c) Utilization review determinations must be rendered in a nondiscriminatory manner
and must not deny coverage for habilitative or rehabilitative benefits, including prosthetics
or orthotics, solely on the basis of an enrollee's actual or perceived disability.
new text end

new text begin (d) Evidence of coverage and any benefit denial letters must include language describing
an enrollee's rights pursuant to paragraphs (b) and (c).
new text end

new text begin (e) Confirmation from a prescribing health care provider may be required if the prosthetic
or custom orthotic device or part being replaced is less than three years old.
new text end

new text begin Subd. 4.new text end

new text begin Managed care plan access to care.new text end

new text begin (a) Managed care plans and county-based
purchasing plans subject to this section must ensure access to medically necessary clinical
care and to prosthetic and custom orthotic devices and technology from at least two distinct
prosthetic and custom orthotic providers in the plan's provider network located in Minnesota.
new text end

new text begin (b) In the event that medically necessary covered orthotics and prosthetics are not
available from an in-network provider, the plan must provide processes to refer an enrollee
to an out-of-network provider and must fully reimburse the out-of-network provider at a
mutually agreed upon rate less enrollee cost sharing determined on an in-network basis.
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. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 66.

Minnesota Statutes 2022, section 256B.69, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(a) "Commissioner" means the commissioner of human services. For the remainder of
this section, the commissioner's responsibilities for methods and policies for implementing
the project will be proposed by the project advisory committees and approved by the
commissioner.

(b) "Demonstration provider" means a new text begin nonprofit new text end health maintenance organization,
community integrated service network, or accountable provider network authorized and
operating under chapter 62D, 62N, or 62T that participates in the demonstration project
according to criteria, standards, methods, and other requirements established for the project
and approved by the commissioner. For purposes of this section, a county board, or group
of county boards operating under a joint powers agreement, is considered a demonstration
provider if the county or group of county boards meets the requirements of section 256B.692.

(c) "Eligible individuals" means those persons eligible for medical assistance benefits
as defined in sections 256B.055, 256B.056, and 256B.06.

(d) "Limitation of choice" means suspending freedom of choice while allowing eligible
individuals to choose among the demonstration providers.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 67.

Minnesota Statutes 2022, section 256L.12, subdivision 7, is amended to read:


Subd. 7.

Managed care plan vendor requirements.

new text begin (a) new text end The following requirements
apply to all counties or vendors who contract with the Department of Human Services to
serve MinnesotaCare recipients. Managed care plan contractors:

(1) shall authorize and arrange for the provision of the full range of services listed in
section 256L.03 in order to ensure appropriate health care is delivered to enrollees;

(2) shall accept the prospective, per capita payment or other contractually defined payment
from the commissioner in return for the provision and coordination of covered health care
services for eligible individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide services
to enrollees;

(4) shall provide for an enrollee grievance process as required by the commissioner and
set forth in the contract with the department;

(5) shall retain all revenue from enrollee co-payments;

(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status or
previous utilization of health services;

(7) shall demonstrate capacity to accept financial risk according to requirements specified
in the contract with the department. A health maintenance organization licensed under
chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required to
demonstrate financial risk capacity, beyond that which is required to comply with chapters
62C and 62D; and

(8) shall submit information as required by the commissioner, including data required
for assessing enrollee satisfaction, quality of care, cost, and utilization of services.

new text begin (b) A health maintenance organization must be a nonprofit corporation organized under
chapter 317A to serve as a managed care contractor under this section and section 256L.121.
new text end

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 68.

Minnesota Statutes 2022, section 317A.811, subdivision 1, is amended to read:


Subdivision 1.

When required.

(a) Except as provided in subdivision 6, the following
corporations shall notify the attorney general of their intent to dissolve, merge, consolidate,
or convert, or to transfer all or substantially all of their assets:

(1) a corporation that holds assets for a charitable purpose as defined in section 501B.35,
subdivision 2
; deleted text begin or
deleted text end

(2) a corporation that is exempt under section 501(c)(3) of the Internal Revenue Code
of 1986, or any successor sectiondeleted text begin .deleted text end new text begin ; or
new text end

new text begin (3) effective July 1, 2025, a nonprofit health coverage entity as defined in section
145D.30.
new text end

(b) The notice must include:

(1) the purpose of the corporation that is giving the notice;

(2) a list of assets owned or held by the corporation for charitable purposes;

(3) a description of restricted assets and purposes for which the assets were received;

(4) a description of debts, obligations, and liabilities of the corporation;

(5) a description of tangible assets being converted to cash and the manner in which
they will be sold;

(6) anticipated expenses of the transaction, including attorney fees;

(7) a list of persons to whom assets will be transferred, if known, or the name of the
converted organization;

(8) the purposes of persons receiving the assets or of the converted organization; and

(9) the terms, conditions, or restrictions, if any, to be imposed on the transferred or
converted assets.

The notice must be signed on behalf of the corporation by an authorized person.

Sec. 69. new text begin SUPERSEDING EFFECT.
new text end

new text begin Minnesota Statutes, section 62Q.679, in this article shall supersede Minnesota Statutes,
section 62Q.679, in 2024 S.F. No. 4097, article 1, section 8, if enacted.
new text end

Sec. 70. new text begin INITIAL REPORTS TO COMMISSIONER OF HEALTH; PRIOR
AUTHORIZATIONS.
new text end

new text begin Utilization review organizations must submit initial reports to the commissioner of health
under Minnesota Statutes, section 62M.19, by September 1, 2025.
new text end

Sec. 71. new text begin REPEALER.
new text end

new text begin (a)new text end new text begin Minnesota Statutes 2022, section 62A.041, subdivision 3,new text end new text begin is repealed.
new text end

new text begin (b)new text end new text begin Minnesota Statutes 2023 Supplement, section 62Q.522, subdivisions 3 and 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 January 1, 2025, and applies to health
plans offered, sold, issued, or renewed on or after that date.
new text end

ARTICLE 5

DEPARTMENT OF HEALTH FINANCE

Section 1.

Minnesota Statutes 2022, section 103I.621, subdivision 1, is amended to read:


Subdivision 1.

Permit.

(a) Notwithstanding any department or agency rule to the contrary,
the commissioner shall issue, on request by the owner of the property and payment of the
permit fee, permits for the reinjection of water by a properly constructed well into the same
aquifer from which the water was drawn for the operation of a groundwater thermal exchange
device.

(b) As a condition of the permit, an applicant must agree to allow inspection by the
commissioner during regular working hours for department inspectors.

(c) Not more than 200 permits may be issued for small systems having maximum
capacities of 20 gallons per minute or lessnew text begin and that are compliant with the natural resource
water-use requirements under subdivision 2
new text end . deleted text begin The small systems are subject to inspection
twice a year.
deleted text end

(d) Not more than deleted text begin tendeleted text end new text begin 100new text end permits may be issued for larger systems having maximum
capacities deleted text begin fromdeleted text end new text begin overnew text end 20 deleted text begin to 50deleted text end gallons per minutenew text begin and that are compliant with the natural
resource water-use requirements under subdivision 2
new text end . deleted text begin The larger systems are subject to
inspection four times a year.
deleted text end

(e) A person issued a permit must comply with this section new text begin and permit conditions deemed
necessary to protect public health and safety of the groundwater
new text end deleted text begin for the permit to be validdeleted text end .
new text begin The permit conditions may include but are not limited to requirements for:
new text end

new text begin (1) notification to the commissioner at intervals specified in the permit conditions;
new text end

new text begin (2) system operation and maintenance;
new text end

new text begin (3) system location and construction;
new text end

new text begin (4) well location and construction;
new text end

new text begin (5) signage;
new text end

new text begin (6) reports of system construction, performance, operation, and maintenance;
new text end

new text begin (7) removal of the system upon termination of its use or system failure;
new text end

new text begin (8) disclosure of the system at the time of property transfer;
new text end

new text begin (9) obtaining approval from the commissioner prior to deviation from the approval plan
and conditions;
new text end

new text begin (10) groundwater level monitoring; and
new text end

new text begin (11) groundwater quality monitoring.
new text end

new text begin (f) The property owner or the property owner's agent must submit to the commissioner
a permit application on a form provided by the commissioner, or in a format approved by
the commissioner, that provides any information necessary to protect public health and
safety of the groundwater.
new text end

new text begin (g) A permit granted under this section is not valid if a water-use permit is required for
the project and is not approved by the commissioner of natural resources.
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 2022, section 103I.621, subdivision 2, is amended to read:


Subd. 2.

Water-use requirements apply.

Water-use permit requirements and penalties
under chapter deleted text begin 103Fdeleted text end new text begin 103Gnew text end and related rules adopted and enforced by the commissioner of
natural resources apply to groundwater thermal exchange permit recipients. A person who
violates a provision of this section is subject to enforcement or penalties for the noncomplying
activity that are available to the commissioner and the Pollution Control Agency.

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 2023 Supplement, section 144.1501, subdivision 2, is amended
to read:


Subd. 2.

deleted text begin Creation of accountdeleted text end new text begin Availabilitynew text end .

(a) deleted text begin A health professional education loan
forgiveness program account is established.
deleted text end The commissioner of health shall use money
deleted text begin from the account to establish adeleted text end new text begin appropriated for health professional educationnew text end loan forgiveness
deleted text begin programdeleted text end new text begin in this sectionnew text end :

(1) for medical residents, new text begin physicians,new text end mental health professionals, and alcohol and drug
counselors agreeing to practice in designated rural areas or underserved urban communities
or specializing in the area of pediatric psychiatry;

(2) for midlevel practitioners agreeing to practice in designated rural areas or to teach
at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program
at the undergraduate level or the equivalent at the graduate level;

(3) for nurses who agree to practice in a Minnesota nursing home; in an intermediate
care facility for persons with developmental disability; in 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; in an assisted living facility as defined in section
144G.08, subdivision 7; or for a home care provider as defined in section 144A.43,
subdivision 4; or agree to teach at least 12 credit hours, or 720 hours per year in the nursing
field in a postsecondary program at the undergraduate level or the equivalent at the graduate
level;

(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;

(5) for pharmacists, advanced dental therapists, dental therapists, and public health nurses
who agree to practice in designated rural areas;

(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section deleted text begin 51, chapter 303deleted text end new text begin 51c.303new text end ; and

(7) for nurses employed as a hospital nurse by a nonprofit hospital and providing direct
care to patients at the nonprofit hospital.

(b) Appropriations made deleted text begin to the accountdeleted text end new text begin for health professional education loan forgiveness
in this section
new text end 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. 4.

Minnesota Statutes 2022, section 144.1501, subdivision 5, is amended to read:


Subd. 5.

Penalty for nonfulfillment.

If a participant does not fulfill the required
minimum commitment of service according to subdivision 3, 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
deleted text end new text begin a dedicated account in the special revenue fund. The balance of the account is appropriated
annually to the commissioner for
new text end the health professional education loan forgiveness program
deleted text begin accountdeleted text end established in subdivision 2. The commissioner shall allow waivers of all or part
of the money owed the commissioner as a result of a nonfulfillment penalty if emergency
circumstances prevented fulfillment of the minimum service commitment.

Sec. 5.

Minnesota Statutes 2022, section 144.555, subdivision 1a, is amended to read:


Subd. 1a.

Notice of closing, curtailing operations, relocating services, or ceasing to
offer certain services; hospitals.

(a) The controlling persons of a hospital licensed under
sections 144.50 to 144.56 or a hospital campus must notify the commissioner of health deleted text begin anddeleted text end new text begin ,new text end
the publicnew text begin , and othersnew text end at least deleted text begin 120deleted text end new text begin 182new text end days before the hospital or hospital campus voluntarily
plans to implement one of the deleted text begin followingdeleted text end scheduled actionsnew text begin listed in paragraph (b), unless
the controlling persons can demonstrate to the commissioner that meeting the advanced
notice requirement is not feasible and the commissioner approves a shorter advanced notice.
new text end

new text begin (b) The following scheduled actions require advanced notice under paragraph (a)new text end :

(1) deleted text begin ceasedeleted text end new text begin ceasingnew text end operations;

(2) deleted text begin curtaildeleted text end new text begin curtailingnew text end operations to the extent that patients must be relocated;

(3) deleted text begin relocatedeleted text end new text begin relocatingnew text end the provision of health services to another hospital or another
hospital campus; or

(4) deleted text begin cease offeringdeleted text end new text begin ceasing to offernew text end maternity care and newborn care services, intensive
care unit services, inpatient mental health services, or inpatient substance use disorder
treatment services.

new text begin (c) A notice required under this subdivision must comply with the requirements in
subdivision 1d.
new text end

deleted text begin (b)deleted text end new text begin (d)new text end The commissioner shall cooperate with the controlling persons and advise them
about relocating the patients.

Sec. 6.

Minnesota Statutes 2022, section 144.555, subdivision 1b, is amended to read:


Subd. 1b.

Public hearing.

Within deleted text begin 45deleted text end new text begin 30new text end days after receiving notice under subdivision
1a, the commissioner shall conduct a public hearing on the scheduled cessation of operations,
curtailment of operations, relocation of health services, or cessation in offering health
services. The commissioner must provide adequate public notice of the hearing in a time
and manner determined by the commissioner. The controlling persons of the hospital or
hospital campus must participate in the public hearing. The public hearing new text begin must be held at
a location that is within ten miles of the hospital or hospital campus or with the
commissioner's approval as close as is practicable, and that is provided or arranged by the
hospital or hospital campus. Video conferencing technology must be used to allow members
of the public to view and participate in the hearing. The public hearing
new text end must include:

(1) an explanation by the controlling persons of the reasons for ceasing or curtailing
operations, relocating health services, or ceasing to offer any of the listed health services;

(2) a description of the actions that controlling persons will take to ensure that residents
in the hospital's or campus's service area have continued access to the health services being
eliminated, curtailed, or relocated;

(3) an opportunity for public testimony on the scheduled cessation or curtailment of
operations, relocation of health services, or cessation in offering any of the listed health
services, and on the hospital's or campus's plan to ensure continued access to those health
services being eliminated, curtailed, or relocated; and

(4) an opportunity for the controlling persons to respond to questions from interested
persons.

Sec. 7.

Minnesota Statutes 2022, section 144.555, is amended by adding a subdivision to
read:


new text begin Subd. 1d.new text end

new text begin Methods of providing notice; content of notice.new text end

new text begin (a) A notice required under
subdivision 1a must be provided to patients, hospital personnel, the public, local units of
government, and the commissioner of health using at least the following methods:
new text end

new text begin (1) posting a notice of the proposed cessation of operations, curtailment, relocation of
health services, or cessation in offering health services at the main public entrance of the
hospital or hospital campus;
new text end

new text begin (2) providing written notice to the commissioner of health, to the city council in the city
where the hospital or hospital campus is located, and to the county board in the county
where the hospital or hospital campus is located;
new text end

new text begin (3) providing written notice to the local health department as defined in section 145A.02,
subdivision 8b, for the community where the hospital or hospital campus is located;
new text end

new text begin (4) providing notice to the public through a written public announcement which must
be distributed to local media outlets;
new text end

new text begin (5) providing written notice to existing patients of the hospital or hospital campus; and
new text end

new text begin (6) notifying all personnel currently employed in the unit, hospital, or hospital campus
impacted by the proposed cessation, curtailment, or relocation.
new text end

new text begin (b) A notice required under subdivision 1a must include:
new text end

new text begin (1) a description of the proposed cessation of operations, curtailment, relocation of health
services, or cessation in offering health services. The description must include:
new text end

new text begin (i) the number of beds, if any, that will be eliminated, repurposed, reassigned, or otherwise
reconfigured to serve populations or patients other than those currently served;
new text end

new text begin (ii) the current number of beds in the impacted unit, hospital, or hospital campus, and
the number of beds in the impacted unit, hospital, or hospital campus after the proposed
cessation, curtailment, or relocation takes place;
new text end

new text begin (iii) the number of existing patients who will be impacted by the proposed cessation,
curtailment, or relocation;
new text end

new text begin (iv) any decrease in personnel, or relocation of personnel to a different unit, hospital, or
hospital campus, caused by the proposed cessation, curtailment, or relocation;
new text end

new text begin (v) a description of the health services provided by the unit, hospital, or hospital campus
impacted by the proposed cessation, curtailment, or relocation; and
new text end

new text begin (vi) identification of the three nearest available health care facilities where patients may
obtain the health services provided by the unit, hospital, or hospital campus impacted by
the proposed cessation, curtailment, or relocation, and any potential barriers to seamlessly
transition patients to receive services at one of these facilities. If the unit, hospital, or hospital
campus impacted by the proposed cessation, curtailment, or relocation serves medical
assistance or Medicare enrollees, the information required under this item must specify
whether any of the three nearest available facilities serves medical assistance or Medicare
enrollees; and
new text end

new text begin (2) a telephone number, email address, and address for each of the following, to which
interested parties may offer comments on the proposed cessation, curtailment, or relocation:
new text end

new text begin (i) the hospital or hospital campus; and
new text end

new text begin (ii) the parent entity, if any, or the entity under contract, if any, that acts as the corporate
administrator of the hospital or hospital campus.
new text end

Sec. 8.

Minnesota Statutes 2022, section 144.555, subdivision 2, is amended to read:


Subd. 2.

Penaltynew text begin ; facilities other than hospitalsnew text end .

Failure to notify the commissioner
under subdivision 1deleted text begin , 1a, or 1c or failure to participate in a public hearing under subdivision
1b
deleted text end may result in issuance of a correction order under section 144.653, subdivision 5.

Sec. 9.

Minnesota Statutes 2022, section 144.555, is amended by adding a subdivision to
read:


new text begin Subd. 3.new text end

new text begin Penalties; hospitals.new text end

new text begin (a) Failure to participate in a public hearing under
subdivision 1b or failure to notify the commissioner under subdivision 1c may result in
issuance of a correction order under section 144.653, subdivision 5.
new text end

new text begin (b) Notwithstanding any law to the contrary, the commissioner must impose on the
controlling persons of a hospital or hospital campus a fine of $20,000 for each failure to
provide notice to an individual or entity or at a location required under subdivision 1d,
paragraph (a). The cumulative fines imposed under this paragraph must not exceed $60,000
for any scheduled action requiring notice under subdivision 1a. The commissioner is not
required to issue a correction order before imposing a fine under this paragraph. Section
144.653, subdivision 8, applies to fines imposed under this paragraph.
new text end

Sec. 10.

new text begin [144.556] RIGHT OF FIRST REFUSAL; SALE OF HOSPITAL OR
HOSPITAL CAMPUS.
new text end

new text begin (a) The controlling persons of a hospital licensed under sections 144.50 to 144.56 or a
hospital campus must not sell or convey the hospital or hospital campus, offer to sell or
convey the hospital or hospital campus to a person other than a local unit of government
listed in this paragraph, or voluntarily cease operations of the hospital or hospital campus
unless the controlling persons have first made a good faith offer to sell or convey the hospital
or hospital campus to the home rule charter or statutory city, county, town, or hospital
district in which the hospital or hospital campus is located.
new text end

new text begin (b) The offer to sell or convey the hospital or hospital campus to a local unit of
government under paragraph (a) must be at a price that does not exceed the current fair
market value of the hospital or hospital campus. A party to whom an offer is made under
paragraph (a) must accept or decline the offer within 60 days of receipt. If the party to whom
the offer is made fails to respond within 60 days of receipt, the offer is deemed declined.
new text end

Sec. 11.

Minnesota Statutes 2022, section 144A.61, subdivision 3a, is amended to read:


Subd. 3a.

Competency evaluation program.

new text begin (a) new text end The commissioner of health shall
approve the competency evaluation program.

new text begin (b) new text end A competency evaluation must be administered to persons who desire to be listed
in the nursing assistant registry. The tests may only be administered by technical colleges,
community colleges, or other organizations approved by the deleted text begin Department of Healthdeleted text end new text begin
commissioner of health
new text end .new text begin The commissioner must ensure any written portions of the
competency evaluation are available in languages other than English that are commonly
spoken by persons who desire to be listed in the nursing assistant registry. The commissioner
may consult with the state demographer or the commissioner of employment and economic
development when identifying languages that are commonly spoken by persons who desire
to be listed in the nursing assistant registry.
new text end

new text begin (c) new text end The commissioner of health shall approve a nursing assistant for the registry without
requiring a competency evaluation if the nursing assistant is in good standing on a nursing
assistant registry in another state.

new text begin EFFECTIVE DATE.new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 12.

Minnesota Statutes 2022, section 144A.70, subdivision 3, is amended to read:


Subd. 3.

Controlling person.

"Controlling person" means a business entitynew text begin or entitiesnew text end ,
officer, program administrator, or directornew text begin ,new text end whose responsibi