SF 695

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:14am

A bill for an act
relating to state government; making changes to health and human services;
amending provisions related to continuing care, child care, Minnesota family
investment program, adult supports, program integrity, health care programs
including MinnesotaCare, medical assistance, and general assistance medical
care, state-operated services, the sex offender program, the Department of
Health, chemical and mental health, health-related fees; establishing licensing
for body art technicians and establishments; establishing and increasing fees;
requiring reports; appropriating money; amending Minnesota Statutes 2008,
sections 60A.092, subdivision 2; 62D.03, subdivision 4; 62D.05, subdivision
3; 62J.692, subdivision 7; 62Q.19, subdivision 1; 103I.208, subdivision 2;
119B.09, subdivision 7; 119B.13, subdivision 6; 125A.744, subdivision 3;
144.0724, subdivisions 2, 4, 8, by adding subdivisions; 144.121, subdivisions
1a, 1b; 144.122; 144.1222, subdivision 1a; 144.1501, subdivision 2; 144.226,
subdivision 4; 144.72, subdivisions 1, 3; 144.9501, subdivisions 22b, 26a, by
adding subdivisions; 144.9505, subdivisions 1g, 4; 144.9508, subdivisions 2, 3,
4; 144.97, subdivisions 2, 4, 6, by adding subdivisions; 144.98, subdivisions
1, 2, 3, by adding subdivisions; 144.99, subdivision 1; 144A.073, by adding
a subdivision; 144A.44, subdivision 2; 144A.46, subdivision 1; 144D.03, by
adding a subdivision; 148.108; 148.6445, by adding a subdivision; 148D.180,
subdivisions 1, 2, 3, 5; 148E.180, subdivisions 1, 2, 3, 5; 152.126, subdivisions
1, 2; 153A.17; 156.015; 157.15, by adding a subdivision; 157.16; 157.22;
176.011, subdivision 9; 198.003, by adding subdivisions; 245A.03, by adding a
subdivision; 245A.10, subdivision 3; 245A.11, by adding subdivisions; 245A.16,
subdivision 3; 245C.03, subdivision 2; 245C.04, subdivisions 1, 3; 245C.05,
subdivision 4; 245C.08, subdivision 2; 245C.10, subdivision 3, by adding a
subdivision; 245C.17, by adding a subdivision; 245C.20; 245C.21, subdivision
1a; 245C.23, subdivision 2; 246.50, subdivision 5, by adding subdivisions;
246.51, by adding subdivisions; 246.511; 246.52; 246.54, subdivision 2;
246B.01, by adding subdivisions; 252.025, subdivision 7; 252.46, by adding
a subdivision; 256.01, subdivision 2b, by adding subdivisions; 256.476,
subdivisions 5, 11; 256.9657, subdivision 1; 256.969, subdivisions 2b, 3a, by
adding subdivisions; 256.975, subdivision 7; 256.983, subdivision 1; 256B.04,
subdivision 16; 256B.055, subdivisions 7, 12; 256B.056, subdivisions 3, 3b, 3c,
3d; 256B.057, subdivision 9, by adding a subdivision; 256B.0575; 256B.0595,
subdivisions 1, 2; 256B.06, subdivisions 4, 5; 256B.0621, subdivision 2;
256B.0625, subdivisions 3, 6a, 7, 8, 8a, 11, 13, 13e, 13h, 17, 17a, 19a, 19c, 26,
47, by adding subdivisions; 256B.0651; 256B.0652; 256B.0653; 256B.0654;
256B.0655, subdivisions 1b, 4; 256B.0657, subdivisions 2, 6, 8; 256B.0751,
subdivision 7; 256B.08, by adding a subdivision; 256B.0911, subdivisions 1, 1a,
3, 3a, 3b, 3c, 4a, 5, 6, 7, by adding subdivisions; 256B.0913, subdivision 4;
256B.0915, subdivisions 3a, 3e, 3h, 5, by adding a subdivision; 256B.0917,
by adding a subdivision; 256B.092, subdivision 8a, by adding a subdivision;
256B.0943, subdivision 12; 256B.15, subdivisions 1, 1a, 1h, 2, by adding
subdivisions; 256B.199; 256B.37, subdivisions 1, 5; 256B.434, subdivision
4; 256B.437, subdivision 6; 256B.441, subdivisions 51a, 53, by adding
subdivisions; 256B.49, subdivisions 12, 13, 14, 17, by adding a subdivision;
256B.501, subdivision 4a; 256B.5011, subdivision 2; 256B.5012, by adding a
subdivision; 256B.69, subdivisions 5a, 5c, 5f, 6, 23, by adding a subdivision;
256B.76, subdivision 1; 256D.03, subdivision 4; 256G.02, subdivision 6;
256I.03, subdivision 7; 256I.05, subdivision 1a; 256J.24, subdivision 5; 256J.42,
by adding a subdivision; 256J.425, subdivisions 2, 3, 4, by adding a subdivision;
256J.45, subdivision 3; 256J.46, subdivision 1; 256J.49, subdivision 1; 256J.521,
subdivision 2; 256J.53, subdivision 1; 256J.545; 256J.561, subdivisions 2, 3;
256J.57, subdivision 1; 256J.575, subdivisions 3, 4, 6, 7; 256J.621; 256J.626,
subdivision 7; 256J.95, subdivisions 3, 11, 13; 256L.03, subdivision 1; 256L.04,
subdivisions 1, 7a, 10a, by adding a subdivision; 256L.05, subdivisions 3, 3a,
by adding a subdivision; 256L.07, subdivisions 1, 2, 3, by adding a subdivision;
256L.11, subdivision 1; 256L.12, subdivisions 7, 9; 256L.15, subdivisions 2, 3;
256L.17, subdivision 5; 327.14, by adding a subdivision; 327.15; 327.16; 327.20,
subdivision 1, by adding a subdivision; 501B.89, by adding a subdivision;
519.05; 604A.33, subdivision 1; 609.232, subdivision 11; 626.556, subdivision
3c; 626.5572, subdivisions 6, 13, 21; Laws 2003, First Special Session chapter
14, article 13C, section 2, subdivision 1, as amended; Laws 2008, chapter
358, article 3, section 8; proposing coding for new law in Minnesota Statutes,
chapters 144; 156; 246B; 256; 256B; proposing coding for new law as Minnesota
Statutes, chapter 146B; repealing Minnesota Statutes 2008, sections 62Q.80,
subdivision 1a; 103I.112; 144.9501, subdivision 17b; 148D.180, subdivision
8; 246.51, subdivision 1; 246.53, subdivision 3; 256.962, subdivision 7;
256B.037; 256B.0625, subdivision 9; 256B.0655, subdivisions 1, 1a, 1b, 1c,
1d, 1e, 1f, 1g, 1h, 1i, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13; 256B.071, subdivisions
1, 2, 3, 4; 256B.0951; 256B.19, subdivision 1d; 256B.431, subdivision 23;
256B.69, subdivision 6c; 256I.06, subdivision 9; 256L.17, subdivision 6; 327.14,
subdivisions 5, 6; Minnesota Rules, parts 4626.2015, subpart 9; 9100.0400,
subparts 1, 3; 9100.0500; 9100.0600.

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

ARTICLE 1

CONTINUING CARE

Section 1.

Minnesota Statutes 2008, section 144.0724, subdivision 2, is amended to
read:

Subd. 2.

Definitions.

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

(a) "Assessment reference date" means the last day of the minimum data set
observation period. The date sets the designated endpoint of the common observation
period, and all minimum data set items refer back in time from that point.

(b) "Case mix index" means the weighting factors assigned to the RUG-III
classifications.

(c) "Index maximization" means classifying a resident who could be assigned to
more than one category, to the category with the highest case mix index.

(d) "Minimum data set" means the assessment instrument specified by the Centers for
Medicare and Medicaid Services and designated by the Minnesota Department of Health.

(e) "Representative" means a person who is the resident's guardian or conservator,
the person authorized to pay the nursing home expenses of the resident, a representative
of the nursing home ombudsman's office whose assistance has been requested, or any
other individual designated by the resident.

(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing
facility's residents according to their clinical and functional status identified in data
supplied by the facility's minimum data set.

new text begin (g) "Activities of daily living" means grooming, dressing, bathing, transferring,
mobility, positioning, eating, and toileting.
new text end

new text begin (h) "Nursing facility level of care determination" means the assessment process
that results in a determination of a resident's or prospective resident's need for nursing
facility level of care as established in subdivision 11 for purposes of medical assistance
payment of long-term care services for:
new text end

new text begin (1) nursing facility services under section 256B.434 or 256B.441;
new text end

new text begin (2) elderly waiver services under section 256B.0915;
new text end

new text begin (3) CADI and TBI waiver services under section 256B.49; and
new text end

new text begin (4) state payment of alternative care services under section 256B.0913.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 2.

Minnesota Statutes 2008, section 144.0724, subdivision 4, is amended to read:

Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and
electronically submit to the commissioner of health case mix assessments that conform
with the assessment schedule defined by Code of Federal Regulations, title 42, section
483.20, and published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
Instrument User's Manual, version 2.0, October 1995, and subsequent clarifications made
in the Long-Term Care Assessment Instrument Questions and Answers, version 2.0,
August 1996. The commissioner of health may substitute successor manuals or question
and answer documents published by the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services, to replace or supplement the
current version of the manual or document.

(b) The assessments used to determine a case mix classification for reimbursement
include the following:

(1) a new admission assessment must be completed by day 14 following admission;

(2) an annual assessment must be completed within 366 days of the last
comprehensive assessment;

(3) a significant change assessment must be completed within 14 days of the
identification of a significant change; and

(4) the second quarterly assessment following either a new admission assessment,
an annual assessment, or a significant change assessment, and all quarterly assessments
beginning October 1, 2006. Each quarterly assessment must be completed within 92
days of the previous assessment.

new text begin (c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:
new text end

new text begin (1) preadmission screening completed under section 256B.0911, subdivision 4a,
by a county, tribe, or managed care organization under contract with the Department
of Human Services; and
new text end

new text begin (2) a face-to-face long-term care consultation assessment completed under section
256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care organization
under contract with the Department of Human Services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 3.

Minnesota Statutes 2008, section 144.0724, subdivision 8, is amended to read:

Subd. 8.

Request for reconsideration of resident classifications.

(a) The resident,
or resident's representative, or the nursing facility or boarding care home may request that
the commissioner of health reconsider the assigned reimbursement classification. The
request for reconsideration must be submitted in writing to the commissioner within
30 days of the day the resident or the resident's representative receives the resident
classification notice. The request for reconsideration must include the name of the
resident, the name and address of the facility in which the resident resides, the reasons for
the reconsideration, the requested classification changes, and documentation supporting
the requested classification. The documentation accompanying the reconsideration request
is limited to documentation which establishes that the needs of the resident at the time of
the assessment justify a classification which is different than the classification established
by the commissioner of health.

(b) Upon request, the nursing facility must give the resident or the resident's
representative a copy of the assessment form and the other documentation that was given
to the commissioner of health to support the assessment findings. The nursing facility
shall also provide access to and a copy of other information from the resident's record that
has been requested by or on behalf of the resident to support a resident's reconsideration
request. A copy of any requested material must be provided within three working days of
receipt of a written request for the information. If a facility fails to provide the material
within this time, it is subject to the issuance of a correction order and penalty assessment
under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order
issued under this subdivision must require that the nursing facility immediately comply
with the request for information and that as of the date of the issuance of the correction
order, the facility shall forfeit to the state a $100 fine for the first day of noncompliance, and
an increase in the $100 fine by $50 increments for each day the noncompliance continues.

(c) In addition to the information required under paragraphs (a) and (b), a
reconsideration request from a nursing facility must contain the following information: (i)
the date the reimbursement classification notices were received by the facility; (ii) the date
the classification notices were distributed to the resident or the resident's representative;
and (iii) a copy of a notice sent to the resident or to the resident's representative. This
notice must inform the resident or the resident's representative that a reconsideration of the
resident's classification is being requested, the reason for the request, that the resident's
rate will change if the request is approved by the commissioner, the extent of the change,
that copies of the facility's request and supporting documentation are available for review,
and that the resident also has the right to request a reconsideration. If the facility fails to
provide the required information with the reconsideration request, the request must be
denied, and the facility may not make further reconsideration requests on that specific
reimbursement classification.

(d) Reconsideration by the commissioner must be made by individuals not involved
in reviewing the assessment, audit, or reconsideration that established the disputed
classification. The reconsideration must be based upon the initial assessment and upon the
information provided to the commissioner under paragraphs (a) and (b). If necessary for
evaluating the reconsideration request, the commissioner may conduct on-site reviews.
Within 15 working days of receiving the request for reconsideration, the commissioner
shall affirm or modify the original resident classification. The original classification
must be modified if the commissioner determines that the assessment resulting in the
classification did not accurately reflect the needs or assessment characteristics of the
resident at the time of the assessment. The resident and the nursing facility or boarding
care home shall be notified within five working days after the decision is made. A decision
by the commissioner under this subdivision is the final administrative decision of the
agency for the party requesting reconsideration.

(e) The resident classification established by the commissioner shall be the
classification that applies to the resident while the request for reconsideration is pending. new text begin
If a request for reconsideration applies to an assessment used to determine nursing facility
level of care under subdivision 4, paragraph (c), the resident shall continue to be eligible
for nursing facility level of care while the request for reconsideration is pending.
new text end

(f) The commissioner may request additional documentation regarding a
reconsideration necessary to make an accurate reconsideration determination.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 4.

Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision
to read:

new text begin Subd. 11. new text end

new text begin Nursing facility level of care. new text end

new text begin (a) For purposes of medical assistance
payment of long-term care services, a recipient must be determined, using assessments
defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
new text end

new text begin (1) the person needs the assistance of another person or constant supervision to begin
and complete at least four of the following activities of daily living:
new text end

new text begin (i) bathing;
new text end

new text begin (ii) bed mobility;
new text end

new text begin (iii) dressing;
new text end

new text begin (iv) eating:
new text end

new text begin (v) grooming:
new text end

new text begin (vi) toileting;
new text end

new text begin (vii) transferring; and
new text end

new text begin (viii) walking;
new text end

new text begin (2) the person needs the assistance of another person or constant supervision to begin
and complete toileting, transferring, or positioning and the assistance cannot be scheduled;
new text end

new text begin (3) the person has significant difficulty with memory, using information, daily
decision making, or behavioral needs that require intervention;
new text end

new text begin (4) the person has had a qualifying nursing facility stay of at least 90 days; or
new text end

new text begin (5) the person is determined to be at risk for nursing facility admission or
readmission through a face-to-face long-term care consultation assessment as specified
in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
organization under contract with the Department of Human Services. The person is
considered at risk under this clause if the person currently lives alone or will live alone
upon discharge and also meets one of the following criteria:
new text end

new text begin new text end

new text begin (i) the person has experienced a fall resulting in a fracture;
new text end

new text begin (ii) the person has been determined to be at risk of maltreatment or neglect,
including self-neglect; or
new text end

new text begin (iii) the person has a sensory impairment that substantially impacts functional ability
and maintenance of a community residence.
new text end

new text begin (b) The assessment used to establish medical assistance payment for nursing facility
services must be the most recent assessment performed under subdivision 4, paragraph
(b), that occurred no more than 90 calendar days before the effective date of medical
assistance eligibility for payment of long-term care services. In no case shall medical
assistance payment for long-term care services occur prior to the date of the determination
of nursing facility level of care.
new text end

new text begin (c) The assessment used to establish medical assistance payment for long-term care
services provided under sections 256B.0915 and 256B.49 and alternative care payment
for services provided under section 256B.0913 must be the most recent face-to-face
assessment performed under subdivision 4, paragraph (c), clause (2), that occurred no
more than 60 calendar days before the effective date of medical assistance eligibility
for payment of long-term care services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 5.

Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision
to read:

new text begin Subd. 12. new text end

new text begin Appeal of nursing facility level of care determination. new text end

new text begin A resident or
prospective resident whose level of care determination results in a denial of long-term care
services can appeal the determination as outlined in section 256B.0911, subdivision 3a,
paragraph (h), clause (7).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 6.

Minnesota Statutes 2008, section 144A.073, is amended by adding a
subdivision to read:

new text begin Subd. 12. new text end

new text begin Extension of approval of moratorium exception projects.
new text end

new text begin Notwithstanding subdivision 3, the commissioner of health shall extend project approval
by an additional 18 months for an approved proposal for an exception to the nursing home
licensure and certification moratorium if the proposal was approved under this section
between July 1, 2007, and June 30, 2009.
new text end

Sec. 7.

Minnesota Statutes 2008, section 144A.44, subdivision 2, is amended to read:

Subd. 2.

Interpretation and enforcement of rights.

These rights are established
for the benefit of persons who receive home care services. "Home care services" means
home care services as defined in section 144A.43, subdivision 3 new text begin , and unlicensed personal
care assistance services, including services covered by medical assistance under section
256B.0625, subdivision 19a new text end . A home care provider may not require a person to surrender
these rights as a condition of receiving services. A guardian or conservator or, when there
is no guardian or conservator, a designated person, may seek to enforce these rights. This
statement of rights does not replace or diminish other rights and liberties that may exist
relative to persons receiving home care services, persons providing home care services, or
providers licensed under Laws 1987, chapter 378. A copy of these rights must be provided
to an individual at the time home care services new text begin , including personal care assistance
services, new text end are initiated. The copy shall also contain the address and phone number of the
Office of Health Facility Complaints and the Office of Ombudsman for Long-Term Care
and a brief statement describing how to file a complaint with these offices. Information
about how to contact the Office of Ombudsman for Long-Term Care shall be included in
notices of change in client fees and in notices where home care providers initiate transfer
or discontinuation of services.

Sec. 8.

Minnesota Statutes 2008, section 144D.03, is amended by adding a subdivision
to read:

new text begin Subd. 3. new text end

new text begin Certificate of transitional consultation. new text end

new text begin A housing with services
establishment shall not execute a contract or allow a prospective resident to move in until
the establishment has received certification from the Senior LinkAge Line that transition
to housing with services consultation under section 256B.0911, subdivision 3c, has been
completed. The housing with services establishment shall maintain copies of contracts
and certificates for audit for a period of three years.
new text end

Sec. 9.

Minnesota Statutes 2008, section 198.003, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Medicare certification. new text end

new text begin (a) The commissioner shall apply to the federal
government under the following schedule for certification of the veterans homes for
participation as providers in the Medicare program under title XVIII of the Social Security
Act:
new text end

new text begin (1) the veterans homes in Fergus Falls, Luverne, and Silver Bay by the end of fiscal
year 2010; and
new text end

new text begin (2) the veterans home in Minneapolis by the end of fiscal year 2011.
new text end

new text begin (b) Upon certification of a facility, the commissioner shall seek to maximize
Medicare reimbursements under Medicare part A and part B for services to eligible
residents.
new text end

Sec. 10.

Minnesota Statutes 2008, section 198.003, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Use of Medicare Part D for pharmacy costs. new text end

new text begin (a) The commissioner
shall maximize the use of Medicare Part D to pay pharmacy costs for eligible veterans
residing at the veterans homes.
new text end

new text begin (b) The commissioner shall encourage eligible veterans to participate in the
Medicare Part D program and assist veterans in obtaining Part D coverage.
new text end

Sec. 11.

Minnesota Statutes 2008, section 245A.03, is amended by adding a
subdivision to read:

new text begin Subd. 7. new text end

new text begin Licensing moratorium. new text end

new text begin (a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
9555.6265, under this chapter for a physical location that will not be the primary residence
of the license holder for the entire period of licensure. If a license is issued during this
moratorium, and the license holder changes the license holder's primary residence away
from the physical location of the foster care license, the commissioner shall revoke the
license according to section 245A.07. Exceptions to the moratorium include:
new text end

new text begin (1) foster care settings that are required to be registered under chapter 144D;
new text end

new text begin (2) foster care licenses replacing foster care licenses in existence on the effective
date of this section and determined to be needed by the commissioner under paragraph (b);
new text end

new text begin (3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center;
new text end

new text begin (4) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for persons requiring hospital level care; or
new text end

new text begin (5) new foster care licenses determined to be needed by the commissioner for the
transition of people from personal care assistance to the home and community-based
services.
new text end

new text begin (b) The commissioner shall determine the need for newly licensed foster care homes
as defined under this subdivision. As part of the determination, the commissioner shall
consider the availability of foster care capacity in the area which the licensee seeks to
operate, and the recommendation of the local county board. The determination by the
commissioner must be final. A determination of need is not required for a change in
ownership at the same address.
new text end

new text begin (c) Residential settings that would otherwise be subject to the moratorium established
in paragraph (a), that are in the process of receiving an adult or child foster care license as
of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
or child foster care license. For this paragraph, all of the following conditions must be met
to be considered in process of receiving an adult or child foster care license:
new text end

new text begin (1) participants have made decisions to move into the residential setting, including
documentation in each participant's care plan;
new text end

new text begin (2) the provider has purchased housing or has made a financial investment in the
property;
new text end

new text begin (3) the lead agency has approved the plans, including costs for the residential setting
for each individual;
new text end

new text begin (4) the completion of the licensing process, including all necessary inspections, is
the only remaining component prior to being able to provide services; and
new text end

new text begin (5) the needs of the individuals cannot be met within the existing capacity in that
county.
new text end

new text begin To qualify for the process under this paragraph, the lead agency must submit
documentation to the commissioner by August 1, 2009, that all of the above criteria are
met.
new text end

new text begin (d) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011.
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. 12.

Minnesota Statutes 2008, section 245A.11, is amended by adding a
subdivision to read:

new text begin Subd. 8. new text end

new text begin Community residential setting license. new text end

new text begin (a) The commissioner shall
establish provider standards for residential support services that integrate service standards
and the residential setting under one license. The commissioner shall propose statutory
language and an implementation plan for licensing requirements for residential support
services to the legislature by January 15, 2011.
new text end

new text begin (b) Providers licensed under chapter 245B, and providing, contracting, or arranging
for services in settings licensed as adult foster care under Minnesota Rules, parts
9555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to
2960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph
(b), must be required to obtain a community residential setting license.
new text end

Sec. 13.

Minnesota Statutes 2008, section 252.46, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Day training and habilitation rates. new text end

new text begin The commissioner shall establish
a statewide rate-setting methodology for all day training and habilitation services. The
rate-setting methodology must abide by the principles of transparency and equitability
across the state. The methodology must involve a uniform process of structuring rates for
each service and must promote quality and participant choice.
new text end

Sec. 14.

new text begin [256.0281] INTERAGENCY DATA EXCHANGE.
new text end

new text begin The Department of Human Services, the Department of Health, and the Office of the
Ombudsman for Mental Health and Developmental Disabilities may establish interagency
agreements governing the electronic exchange of data on providers and individuals
collected, maintained, or used by each agency when such exchange is outlined by each
agency in an interagency agreement to accomplish the purposes in clauses (1) to (4):
new text end

new text begin (1) to improve provider enrollment processes for home and community-based
services and state plan home care services;
new text end

new text begin (2) to improve quality management of providers between state agencies;
new text end

new text begin (3) to establish and maintain provider eligibility to participate as providers under
Minnesota health care programs; and
new text end

new text begin (4) to meet the quality assurance reporting requirements under federal law under
section 1915(c) of the Social Security Act related to home and community-based waiver
programs.
new text end

new text begin Each interagency agreement must include provisions to ensure anonymity of individuals,
including mandated reporters, and must outline the specific uses of and access to shared
data within each agency. Electronic interfaces between source data systems developed
under these interagency agreements must incorporate these provisions as well as other
HIPPA provisions related to individual data.
new text end

Sec. 15.

Minnesota Statutes 2008, section 256.476, subdivision 5, is amended to read:

Subd. 5.

Reimbursement, allocations, and reporting.

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

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

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

(2) their eligibility for current program and services;

(3) the deleted text begin amount of nonfederal dollars deleted text end new text begin monthly grant levels new text end allowed under subdivision
11; and

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

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

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

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

(f) The county allocation for each person or the person's legal representative or other
authorized representative cannot exceed the amount allowed under subdivision 11.

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

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

Sec. 16.

Minnesota Statutes 2008, section 256.476, subdivision 11, is amended to read:

Subd. 11.

Consumer support grant program after July 1, 2001.

(a) Effective
July 1, 2001, the commissioner shall allocate consumer support grant resources to
serve additional individuals based on a review of Medicaid authorization and payment
information of persons eligible for a consumer support grant from the most recent fiscal
year. The commissioner shall use the following methodology to calculate maximum
allowable monthly consumer support grant levels:

(1) For individuals whose program of origination is medical assistance home care
under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly
grant levels are calculated by:

(i) determining deleted text begin the nonfederal share deleted text end new text begin 50 percent new text end of the average service authorization
for each home care rating;

(ii) calculating the overall ratio of actual payments to service authorizations by
program;

(iii) applying the overall ratio to the average service authorization level of each
home care rating;

(iv) adjusting the result for any authorized rate increases provided by the legislature;
and

(v) adjusting the result for the average monthly utilization per recipient.

(2) The commissioner may review and evaluate the methodology to reflect changes
in the home care program's overall ratio of actual payments to service authorizations.

(b) Effective January 1, 2004, persons previously receiving exception grants will
have their grants calculated using the methodology in paragraph (a), clause (1). If a person
currently receiving an exception grant wishes to have their home care rating reevaluated,
they may request an assessment as defined in section 256B.0651, subdivision 1, paragraph
(b).

Sec. 17.

Minnesota Statutes 2008, section 256.9657, subdivision 1, is amended to read:

Subdivision 1.

Nursing home license surcharge.

(a) Effective July 1, 1993,
each non-state-operated nursing home licensed under chapter 144A shall pay to the
commissioner an annual surcharge according to the schedule in subdivision 4. The
surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds
is reduced, the surcharge shall be based on the number of remaining licensed beds the
second month following the receipt of timely notice by the commissioner of human
services that beds have been delicensed. The nursing home must notify the commissioner
of health in writing when beds are delicensed. The commissioner of health must notify
the commissioner of human services within ten working days after receiving written
notification. If the notification is received by the commissioner of human services by
the 15th of the month, the invoice for the second following month must be reduced
to recognize the delicensing of beds. Beds on layaway status continue to be subject to
the surcharge. The commissioner of human services must acknowledge a medical care
surcharge appeal within 30 days of receipt of the written appeal from the provider.

(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.

(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased
to $990.

(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased
to $2,815.

(e) The commissioner may reduce, and may subsequently restore, the surcharge
under paragraph (d) based on the commissioner's determination of a permissible surcharge.

(f) Between April 1, 2002, and August 15, 2004, a facility governed by this
subdivision may elect to assume full participation in the medical assistance program
by agreeing to comply with all of the requirements of the medical assistance program,
including the rate equalization law in section 256B.48, subdivision 1, paragraph (a), and
all other requirements established in law or rule, and to begin intake of new medical
assistance recipients. Rates will be determined under Minnesota Rules, parts 9549.0010
to 9549.0080. Notwithstanding section 256B.431, subdivision 27, paragraph (i), rate
calculations will be subject to limits as prescribed in rule and law. Other than the
adjustments in sections 256B.431, subdivisions 30 and 32; 256B.437, subdivision 3,
paragraph (b), Minnesota Rules, part 9549.0057, and any other applicable legislation
enacted prior to the finalization of rates, facilities assuming full participation in medical
assistance under this paragraph are not eligible for any rate adjustments until the July 1
following their settle-up period.

new text begin (g) Effective July 1, 2009, the surcharge in paragraph (d) shall be increased to $3,165.
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 2008, section 256.975, subdivision 7, is amended to read:

Subd. 7.

Consumer information and assistance new text begin and long-term care options
counseling new text end ; deleted text begin senior linkage deleted text end new text begin Senior LinkAge Line new text end .

(a) The Minnesota Board on Aging
shall operate a statewide deleted text begin information and assistance deleted text end service to aid older Minnesotans and
their families in making informed choices about long-term care options and health care
benefits. Language services to persons with limited English language skills may be made
available. The service, known as Senior LinkAge Line, must be available during business
hours through a statewide toll-free number and must also be available through the Internet.

(b) The service must deleted text begin assist deleted text end new text begin provide long-term care options counseling by assisting new text end
older adults, caregivers, and providers in accessing information new text begin and options counseling
new text end about choices in long-term care services that are purchased through private providers or
available through public options. The service must:

(1) develop a comprehensive database that includes detailed listings in both
consumer- and provider-oriented formats;

(2) make the database accessible on the Internet and through other telecommunication
and media-related tools;

(3) link callers to interactive long-term care screening tools and make these tools
available through the Internet by integrating the tools with the database;

(4) develop community education materials with a focus on planning for long-term
care and evaluating independent living, housing, and service options;

(5) conduct an outreach campaign to assist older adults and their caregivers in
finding information on the Internet and through other means of communication;

(6) implement a messaging system for overflow callers and respond to these callers
by the next business day;

(7) link callers with county human services and other providers to receive more
in-depth assistance and consultation related to long-term care options;

(8) link callers with quality profiles for nursing facilities and other providers
developed by the commissioner of health; deleted text begin and
deleted text end

(9) incorporate information deleted text begin about deleted text end new text begin and availability of new text end housing new text begin options, as well as
registered housing new text end with services and consumer rights within the MinnesotaHelp.info
network long-term care database to facilitate consumer comparison of services and costs
among housing with services establishments and with other in-home services and to
support financial self-sufficiency as long as possible. Housing with services establishments
and their arranged home care providers shall provide deleted text begin information to the commissioner
of human services that is consistent with information required by the commissioner of
health under section 144G.06, the Uniform Consumer Information Guide deleted text end new text begin price and
other information requested by the commissioner of human services regarding rents and
services. The commissioners of human services and health shall align the data elements
required by this section, and section 144G.06, the Uniform Consumer Information Guide,
to provide consumers standardized information and ease of comparison of long-term care
options new text end . The commissioner of human services shall provide the data to the Minnesota
Board on Aging for inclusion in the MinnesotaHelp.info network long-term care database new text begin ;
new text end

new text begin (10) provide long-term care options counseling. Long-term care options counselors
shall:
new text end

new text begin (i) for individuals not eligible for case management under a public program or public
funding source, provide interactive decision support under which consumers, family
members, or other helpers are supported in their deliberations to determine appropriate
long-term care choices in the context of the consumer's needs, preferences, values, and
individual circumstances, including implementing a community support plan;
new text end

new text begin (ii) provide Web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care basics,
issues to be considered, and the range of options available in the community;
new text end

new text begin (iii) provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for the more
distant future; and
new text end

new text begin (iv) provide expertise in benefits and financing options for long-term care, including
Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
private pay options, and ways to access low or no-cost services or benefits through
volunteer-based or charitable programs; and
new text end

new text begin (11) using risk management and support planning protocols, provide long-term
care options counseling to prospective residents of housing with services establishments
registered under chapter 144D and current residents of nursing homes deemed appropriate
for discharge by the commissioner.
new text end

new text begin In order to meet this requirement, the commissioner shall provide designated Senior
LinkAge Line contact centers with a list of nursing home residents appropriate for
discharge planning via a secure Web portal. Senior LinkAge Line shall provide these
residents, if they indicate a preference to receive long-term care options counseling,
with initial assessment, review of risk factors, independent living support consultation,
or referral to:
new text end

new text begin (i) services under section 256B.0911, subdivision 3;
new text end

new text begin (ii) designated care coordinators of contracted entities under section 256B.035 for
persons who are enrolled in a managed care plan; or
new text end

new text begin (iii) the long-term care consultation team for those who are appropriate for relocation
service coordination due to high-risk factors or psychological or physical disability new text end .

deleted text begin (c) The Minnesota Board on Aging shall conduct an evaluation of the effectiveness
of the statewide information and assistance, and submit this evaluation to the legislature
by December 1, 2002. The evaluation must include an analysis of funding adequacy, gaps
in service delivery, continuity in information between the service and identified linkages,
and potential use of private funding to enhance the service.
deleted text end

Sec. 19.

Minnesota Statutes 2008, section 256B.0625, subdivision 6a, is amended to
read:

Subd. 6a.

Home health services.

Home health services are those services specified
in deleted text begin Minnesota Rules, part 9505.0295 deleted text end new text begin sections 256B.0651 and 256B.0653 new text end . Medical
assistance covers home health services at a recipient's home residence. Medical assistance
does not cover home health services for residents of a hospital, nursing facility, or
intermediate care facility, unless the commissioner of human services has deleted text begin prior deleted text end authorized
skilled nurse visits for less than 90 days for a resident at an intermediate care facility for
persons with developmental disabilities, to prevent an admission to a hospital or nursing
facility or unless a resident who is otherwise eligible is on leave from the facility and the
facility either pays for the home health services or forgoes the facility per diem for the
leave days that home health services are used. Home health services must be provided by
a Medicare certified home health agency. All nursing and home health aide services must
be provided according to sections 256B.0651 to deleted text begin 256B.0656 deleted text end new text begin 256B.0653 new text end .

Sec. 20.

Minnesota Statutes 2008, section 256B.0625, subdivision 7, is amended to
read:

Subd. 7.

Private duty nursing.

Medical assistance covers private duty nursing
services in a recipient's home. Recipients who are authorized to receive private duty
nursing services in their home may use approved hours outside of the home during hours
when normal life activities take them outside of their home. To use private duty nursing
services at school, the recipient or responsible party must provide written authorization in
the care plan identifying the chosen provider and the daily amount of services to be used at
school. Medical assistance does not cover private duty nursing services for residents of a
hospital, nursing facility, intermediate care facility, or a health care facility licensed by the
commissioner of health, except as authorized in section 256B.64 for ventilator-dependent
recipients in hospitals or unless a resident who is otherwise eligible is on leave from the
facility and the facility either pays for the private duty nursing services or forgoes the
facility per diem for the leave days that private duty nursing services are used. Total hours
of service and payment allowed for services outside the home cannot exceed that which is
otherwise allowed in an in-home setting according to sections 256B.0651 and deleted text begin 256B.0653 deleted text end
to 256B.0656. All private duty nursing services must be provided according to
the limits established under sections 256B.0651 and 256B.0653 to 256B.0656. Private
duty nursing services may not be reimbursed if the nurse is the new text begin family new text end foster care provider
of a recipient who is under age 18 new text begin , unless allowed under section 256B.0654, subdivision 4 new text end .

Sec. 21.

Minnesota Statutes 2008, section 256B.0625, subdivision 8, is amended to
read:

Subd. 8.

Physical therapy.

Medical assistance covers physical therapy new text begin , as
described in section 148.65, new text end and related services, including specialized maintenance
therapy. Services provided by a physical therapy assistant shall be reimbursed at the
same rate as services performed by a physical therapist when the services of the physical
therapy assistant are provided under the direction of a physical therapist who is on the
premises. Services provided by a physical therapy assistant that are provided under the
direction of a physical therapist who is not on the premises shall be reimbursed at 65
percent of the physical therapist rate.

Sec. 22.

Minnesota Statutes 2008, section 256B.0625, subdivision 8a, is amended to
read:

Subd. 8a.

Occupational therapy.

Medical assistance covers occupational therapy new text begin ,
as described in section 148.6404, new text end and related services, including specialized maintenance
therapy. Services provided by an occupational therapy assistant shall be reimbursed at
the same rate as services performed by an occupational therapist when the services of
the occupational therapy assistant are provided under the direction of the occupational
therapist who is on the premises. Services provided by an occupational therapy assistant
that are provided under the direction of an occupational therapist who is not on the
premises shall be reimbursed at 65 percent of the occupational therapist rate.

Sec. 23.

Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to
read:

Subd. 19a.

Personal care deleted text begin assistant deleted text end new text begin assistance new text end services.

Medical assistance covers
personal care deleted text begin assistant deleted text end new text begin assistance new text end services in a recipient's home. To qualify for personal
care deleted text begin assistant deleted text end new text begin assistance new text end services, new text begin a recipient must require assistance and be determined
dependent in one activity of daily living as defined in section 256B.0659, subdivision 1,
paragraph (b), or in a Level I behavior as defined in section 256B.0659, subdivision 1,
paragraph (c). Beginning July 1, 2011, to qualify for personal care assistance services, a
recipient must require assistance and be determined dependent in at least two activities
of daily living as defined in section 256B.0659. new text end Recipients or responsible parties must
be able to identify the recipient's needs, direct and evaluate task accomplishment, and
provide for health and safety. Approved hours may be used outside the home when normal
life activities take them outside the home. To use personal care deleted text begin assistant deleted text end new text begin assistance
new text end services at school, the recipient or responsible party must provide written authorization
in the care plan identifying the chosen provider and the daily amount of services to be
used at school. Total hours for services, whether actually performed inside or outside
the recipient's home, cannot exceed that which is otherwise allowed for personal care
deleted text begin assistant deleted text end new text begin assistance new text end services in an in-home setting according to sections 256B.0651
deleted text begin and 256B.0653 deleted text end to 256B.0656. Medical assistance does not cover personal care deleted text begin assistant deleted text end new text begin
assistance new text end services for residents of a hospital, nursing facility, intermediate care facility,
health care facility licensed by the commissioner of health, or unless a resident who is
otherwise eligible is on leave from the facility and the facility either pays for the personal
care deleted text begin assistant deleted text end new text begin assistance new text end services or forgoes the facility per diem for the leave days that
personal care deleted text begin assistant deleted text end new text begin assistance new text end services are used. All personal care deleted text begin assistant deleted text end new text begin assistance
new text end services must be provided according to sections 256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656.
Personal care deleted text begin assistant deleted text end new text begin assistance new text end services may not be reimbursed if the personal care
assistant is the spouse or deleted text begin legal deleted text end new text begin paid new text end guardian of the recipient or the parent of a recipient
under age 18, or the responsible party or the new text begin family new text end foster care provider of a recipient who
cannot direct the recipient's own care unless, in the case of a foster care provider, a county
or state case manager visits the recipient as needed, but not less than every six months,
to monitor the health and safety of the recipient and to ensure the goals of the care plan
are met. deleted text begin Parents of adult recipients, adult children of the recipient or adult siblings of
the recipient may be reimbursed for personal care assistant services, if they are granted
a waiver under sections 256B.0651 and 256B.0653 to 256B.0656 deleted text end . Notwithstanding the
provisions of section deleted text begin 256B.0655, subdivision 2, paragraph (b), clause (4) deleted text end new text begin 256B.0659 new text end , the
deleted text begin noncorporate legal deleted text end new text begin unpaid new text end guardian or conservator of an adult, who is not the responsible
party and not the personal care provider organization, may be deleted text begin granted a hardship waiver
under sections 256B.0651 and 256B.0653 to 256B.0656, to be deleted text end reimbursed to provide
personal care deleted text begin assistant deleted text end new text begin assistance new text end services to the recipient new text begin if the guardian or conservator
meets all criteria for a personal care assistant according to section 256B.0659 new text end , and shall
not be considered to have a service provider interest for purposes of participation on the
screening team under section 256B.092, subdivision 7.

Sec. 24.

Minnesota Statutes 2008, section 256B.0625, subdivision 19c, is amended to
read:

Subd. 19c.

Personal care.

Medical assistance covers personal care deleted text begin assistant deleted text end new text begin
assistance new text end services provided by an individual who is qualified to provide the services
according to subdivision 19a and sections 256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656,
deleted text begin where the services have a statement of need by a physician, deleted text end provided in accordance with
a plan, and deleted text begin are deleted text end supervised by deleted text begin the recipient or deleted text end a qualified professional. deleted text begin The physician's
statement of need for personal care assistant services shall be documented on a form
approved by the commissioner and include the diagnosis or condition of the person that
results in a need for personal care assistant services and be updated when the person's
medical condition requires a change, but at least annually if the need for personal care
assistant services is ongoing.
deleted text end

"Qualified professional" means a mental health professional as defined in section 245.462,
subdivision 18, or 245.4871, subdivision 27; or a registered nurse as defined in sections
148.171 to 148.285, deleted text begin or deleted text end a licensed social worker as defined in section 148B.21 new text begin , or a
qualified developmental disabilities specialist under Code of Federal Regulations, title 42,
section 483.430 new text end . deleted text begin As part of the assessment, the county public health nurse will assist the
recipient or responsible party to identify the most appropriate person to provide supervision
of the personal care assistant. deleted text end The qualified professional shall perform the duties deleted text begin described deleted text end
new text begin required new text end in deleted text begin Minnesota Rules, part 9505.0335, subpart 4 deleted text end new text begin section 256B.0659 new text end .

Sec. 25.

Minnesota Statutes 2008, section 256B.0651, is amended to read:

256B.0651 HOME CARE SERVICES.

Subdivision 1.

Definitions.

(a) deleted text begin "Activities of daily living" includes eating, toileting,
grooming, dressing, bathing, transferring, mobility, and positioning deleted text end new text begin For the purposes of
sections 256B.0651 to 256B.0656 and 256B.0659, the terms in paragraphs (b) to (g)
have the meanings given new text end .

(b) new text begin "Activities of daily living" has the meaning given in section 256B.0659,
subdivision 1, paragraph (b).
new text end

new text begin (c) new text end "Assessment" means a review and evaluation of a recipient's need for home care
services conducted in person. deleted text begin Assessments for home health agency services shall be
conducted by a home health agency nurse. Assessments for medical assistance home care
services for developmental disability and alternative care services for developmentally
disabled home and community-based waivered recipients may be conducted by the county
public health nurse to ensure coordination and avoid duplication. Assessments must be
completed on forms provided by the commissioner within 30 days of a request for home
care services by a recipient or responsible party.
deleted text end

deleted text begin (c) deleted text end new text begin (d) new text end "Home care services" deleted text begin means a health service, determined by the commissioner
as medically necessary, that is ordered by a physician and documented in a service plan
that is reviewed by the physician at least once every 60 days for the provision of home
health services, or private duty nursing, or at least once every 365 days for personal care.
Home care services are provided to the recipient at the recipient's residence that is a
place other than a hospital or long-term care facility or as specified in section 256B.0625 deleted text end new text begin
means medical assistance covered services that are home health agency services, including
skilled nurse visits; home health aide visits; physical therapy, occupational therapy,
respiratory therapy, and language-speech pathology therapy; private duty nursing; and
personal care assistance new text end .

new text begin (e) "Home residence" means a residence owned or rented by the recipient either
alone, with roommates of the recipient's choosing, or with an unpaid responsible party
or legal representative; or a family foster home where the license holder lives with the
recipient and is not paid to provide home care services for the recipient except as allowed
under sections 256B.0651, subdivision 9, and 256B.0654, subdivision 4.
new text end

deleted text begin (d) deleted text end new text begin (f) new text end "Medically necessary" has the meaning given in Minnesota Rules, parts
9505.0170 to 9505.0475.

deleted text begin (e) "Telehomecare" means the use of telecommunications technology by a home
health care professional to deliver home health care services, within the professional's
scope of practice, to a patient located at a site other than the site where the practitioner
is located.
deleted text end

new text begin (g) "Ventilator-dependent" means an individual who receives mechanical ventilation
for life support at least six hours per day and is expected to be or has been dependent on a
ventilator for at least 30 consecutive days.
new text end

Subd. 2.

Services covered.

Home care services covered under this section and
sections deleted text begin 256B.0653 deleted text end new text begin 256B.0652 new text end to 256B.0656 new text begin and 256B.0659 new text end include:

(1) nursing services under deleted text begin section deleted text end new text begin sections new text end 256B.0625, subdivision 6a new text begin , and
256B.0653 new text end ;

(2) private duty nursing services under deleted text begin section deleted text end new text begin sections new text end 256B.0625, subdivision
7 new text begin , and 256B.0654 new text end ;

(3) home health services under deleted text begin section deleted text end new text begin sections new text end 256B.0625, subdivision 6a new text begin , and
256B.0653 new text end ;

(4) personal care deleted text begin assistant deleted text end new text begin assistance new text end services under deleted text begin section deleted text end new text begin sections new text end 256B.0625,
subdivision 19a new text begin , and 256B.0659 new text end ;

(5) supervision of personal care deleted text begin assistant deleted text end new text begin assistance new text end services provided by a qualified
professional under deleted text begin section deleted text end new text begin sections new text end 256B.0625, subdivision 19a new text begin , and 256B.0659 new text end ;

(6) deleted text begin qualified professional of personal care assistant services under the fiscal
intermediary option as specified in section 256B.0655, subdivision 7;
deleted text end

deleted text begin (7) deleted text end face-to-face assessments by county public health nurses for services under
deleted text begin section deleted text end new text begin sections new text end 256B.0625, subdivision 19a new text begin , and 256B.0659 new text end ; and

deleted text begin (8) deleted text end new text begin (7) new text end service updates and review of temporary increases for personal care deleted text begin assistant deleted text end new text begin
assistance new text end services by the county public health nurse for services under deleted text begin section deleted text end new text begin sections new text end
256B.0625, subdivision 19a new text begin , and 256B.0659 new text end .

Subd. 3.

Noncovered home care services.

The following home care services are
not eligible for payment under medical assistance:

deleted text begin (1) skilled nurse visits for the sole purpose of supervision of the home health aide;
deleted text end

deleted text begin (2) a skilled nursing visit:
deleted text end

deleted text begin (i) only for the purpose of monitoring medication compliance with an established
medication program for a recipient; or
deleted text end

deleted text begin (ii) to administer or assist with medication administration, including injections,
prefilling syringes for injections, or oral medication set-up of an adult recipient, when as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient is physically and mentally able to self-administer or prefill
a medication;
deleted text end

deleted text begin (3) home care services to a recipient who is eligible for covered services under the
Medicare program or any other insurance held by the recipient;
deleted text end

deleted text begin (4) services to other members of the recipient's household;
deleted text end

deleted text begin (5) a visit made by a skilled nurse solely to train other home health agency workers;
deleted text end

deleted text begin (6) any home care service included in the daily rate of the community-based
residential facility where the recipient is residing;
deleted text end

deleted text begin (7) nursing and rehabilitation therapy services that are reasonably accessible to a
recipient outside the recipient's place of residence, excluding the assessment, counseling
and education, and personal assistant care;
deleted text end

deleted text begin (8) any home health agency service, excluding personal care assistant services and
private duty nursing services, which are performed in a place other than the recipient's
residence; and
deleted text end

deleted text begin (9) Medicare evaluation or administrative nursing visits on dual-eligible recipients
that do not qualify for Medicare visit billing.
deleted text end

new text begin (1) services provided in a nursing facility, hospital, or intermediate care facility with
exceptions in section 256B.0653;
new text end

new text begin (2) services for the sole purpose of monitoring medication compliance with an
established medication program for a recipient;
new text end

new text begin (3) home care services for covered services under the Medicare program or any other
insurance held by the recipient;
new text end

new text begin (4) services to other members of the recipient's household;
new text end

new text begin (5) any home care service included in the daily rate of the community-based
residential facility where the recipient is residing;
new text end

new text begin (6) nursing and rehabilitation therapy services that are reasonably accessible to a
recipient outside the recipient's place of residence, excluding the assessment, counseling
and education, and personal assistance care; or
new text end

new text begin (7) Medicare evaluation or administrative nursing visits on dual-eligible recipients
that do not qualify for Medicare visit billing.
new text end

Subd. 4.

deleted text begin Prior deleted text end Authorization; exceptions.

All home care services above the limits
in subdivision 11 must receive the commissioner's deleted text begin prior deleted text end authorization new text begin before services
begin new text end , except when:

(1) the home care services were required to treat an emergency medical condition
that if not immediately treated could cause a recipient serious physical or mental disability,
continuation of severe pain, or death. The provider must request retroactive authorization
no later than five working days after giving the initial service. The provider must be able
to substantiate the emergency by documentation such as reports, notes, and admission or
discharge histories;

(2) deleted text begin the home care services were provided on or after the date on which the recipient's
eligibility began, but before the date on which the recipient was notified that the case was
opened. Authorization will be considered if the request is submitted by the provider
within 20 working days of the date the recipient was notified that the case was opened deleted text end new text begin
a recipient's eligibility lapse from medical assistance has been retroactively reinstated
and an authorization for home care services is completed based on the date of a current
assessment, eligibility, and request for authorization new text end ;

(3) a third-party payor for home care services has denied or adjusted a payment.
Authorization requests must be submitted by the provider within 20 working days of the
notice of denial or adjustment. A copy of the notice must be included with the request;

(4) the commissioner has determined that a county or state human services agency
has made an error; or

(5) deleted text begin the professional nurse determines an immediate need for up to 40 skilled nursing
or home health aide visits per calendar year and submits a request for authorization within
20 working days of the initial service date, and medical assistance is determined to be
the appropriate payer deleted text end new text begin if a recipient enrolled in managed care experiences a temporary
disenrollment from a health plan, the commissioner shall accept the current health plan
authorization for personal care assistance services for up to 60 days. The request must
be received within the first 30 days of the disenrollment. If the recipient's reenrollment
in managed care is after the 60 days and before 90 days, the provider shall request an
additional 30-day extension of the current health plan authorization, for a total limit of
90 days from the time of disenrollment new text end .

deleted text begin Subd. 5. deleted text end

deleted text begin Retroactive authorization. deleted text end

deleted text begin A request for retroactive authorization will be
evaluated according to the same criteria applied to prior authorization requests.
deleted text end

Subd. 6.

deleted text begin Prior deleted text end Authorization.

new text begin (a) new text end The commissioner, or the commissioner's
designee, shall review the assessment, deleted text begin service update, deleted text end request for temporary services,
deleted text begin request for flexible use option, deleted text end service plan, and any additional information that is
submitted. The commissioner shall, within 30 days after receiving a complete request,
assessment, and service plan, authorize home care services as deleted text begin follows: deleted text end new text begin provided in this
section.
new text end

deleted text begin (a) Home health services. deleted text end new text begin (b) new text end deleted text begin All deleted text end Home health services deleted text begin provided by a home health
aide deleted text end new text begin including skilled nurse visits and home health aide visits new text end must be deleted text begin prior deleted text end authorized
by the commissioner or the commissioner's designee. deleted text begin Prior deleted text end Authorization must be based
on medical necessity and cost-effectiveness when compared with other care options.
new text begin The commissioner must receive the request for authorization of skilled nurse visits and
home health aide visits within 20 working days of the start of service. new text end When home health
services are used in combination with personal care and private duty nursing, the cost of
all home care services shall be considered for cost-effectiveness. deleted text begin The commissioner shall
limit home health aide visits to no more than one visit each per day. The commissioner, or
the commissioner's designee, may authorize up to two skilled nurse visits per day.
deleted text end

deleted text begin (b) Ventilator-dependent recipients. deleted text end new text begin (c) new text end If the recipient is ventilator-dependent, the
monthly medical assistance authorization for home care services shall not exceed what the
commissioner would pay for care at the highest cost hospital designated as a long-term
hospital under the Medicare program. For purposes of this paragraph, home care services
means all new text begin direct care new text end services provided in the home that would be included in the payment
for care at the long-term hospital. deleted text begin "Ventilator-dependent" means an individual who
receives mechanical ventilation for life support at least six hours per day and is expected
to be or has been dependent for at least 30 consecutive days. deleted text end new text begin Recipients who meet the
definition of ventilator dependent and the EN home care rating and utilize a combination
of home care services are limited up to a total of 24 hours of home care services per day.
Additional hours may be authorized when a recipient's assessment indicates a need for two
staff to perform activities. Additional time is limited to four hours per day.
new text end

Subd. 7.

deleted text begin Prior deleted text end Authorization; time limits.

new text begin (a) new text end The commissioner or the
commissioner's designee shall determine the time period for which deleted text begin a prior deleted text end new text begin an new text end authorization
shall be effective deleted text begin and, if flexible use has been requested, whether to allow the flexible use
option deleted text end . If the recipient continues to require home care services beyond the duration of
the deleted text begin prior deleted text end authorization, the home care provider must request a new deleted text begin prior deleted text end authorization.
A personal care provider agency must request a new personal care deleted text begin assistant deleted text end new text begin assistance
new text end services assessment, or service update if allowed, at least 60 days prior to the end of
the current deleted text begin prior deleted text end authorization time period. The request for the assessment must be
made on a form approved by the commissioner. deleted text begin Under no circumstances, other than the
exceptions in subdivision 4, shall a prior deleted text end new text begin An new text end authorization new text begin must new text end be valid deleted text begin prior to the date
the commissioner receives the request or deleted text end for new text begin no new text end more than 12 months.

new text begin (b) The amount and type of personal care assistance services authorized based
upon the assessment and service plan must remain in effect for the recipient whether
the recipient chooses a different provider or enrolls or disenrolls from a managed care
plan under section 256B.0659, unless the service needs of the recipient change and new
assessment is warranted under section 256B.0655, subdivision 1b. new text end

new text begin (c) new text end A recipient who appeals a reduction in previously authorized home care
services may continue previously authorized services, other than temporary services
under subdivision 8, pending an appeal under section 256.045. The commissioner must
deleted text begin provide deleted text end new text begin ensure that the recipient has a copy of the most recent service plan that contains
new text end a detailed explanation of deleted text begin why the authorized services deleted text end new text begin which areas of covered personal
care assistance tasks new text end are reduced deleted text begin in amount from those requested by the home care
provider deleted text end new text begin , and provide notice of the amount of time per day reduced, and the reasons for
the reduction in the recipient's notice of denial, termination, or reduction new text end .

Subd. 8.

deleted text begin Prior deleted text end Authorization requests; temporary services.

The agency nurse,
deleted text begin the deleted text end independently enrolled private duty nurse, or county public health nurse may request
a temporary authorization for home care services deleted text begin by telephone deleted text end . The commissioner may
approve a temporary level of home care services based on the assessment, and service
or care plan information, and primary payer coverage determination information as
required. Authorization for a temporary level of home care services including nurse
supervision is limited to the time specified by the commissioner, but shall not exceed
45 days deleted text begin , unless extended because the county public health nurse has not completed the
required assessment and service plan, or the commissioner's determination has not been
made deleted text end . The level of services authorized under this provision shall have no bearing on a
future deleted text begin prior deleted text end authorization.

Subd. 9.

deleted text begin Prior deleted text end Authorization for foster care setting.

new text begin (a) new text end Home care services
provided in an adult or child foster care setting must receive deleted text begin prior deleted text end authorization by the
deleted text begin department deleted text end new text begin commissioner new text end according to the limits established in subdivision 11.

new text begin (b) new text end The commissioner may not authorize:

(1) home care services that are the responsibility of the foster care provider under
the terms of the foster care placement agreement new text begin , difficulty of care rate, new text end and administrative
rules;

(2) personal care deleted text begin assistant deleted text end new text begin assistance new text end services when the foster care license holder is
also the personal care provider or personal care assistant deleted text begin unless the recipient can direct the
recipient's own care, or case management is provided as required in section 256B.0625,
subdivision 19a deleted text end new text begin , unless the foster home is the licensed provider's primary residence new text end ; new text begin or
new text end

deleted text begin (3) personal care assistant services when the responsible party is an employee of, or
under contract with, or has any direct or indirect financial relationship with the personal
care provider or personal care assistant, unless case management is provided as required
in section 256B.0625, subdivision 19a; or
deleted text end

deleted text begin (4) deleted text end new text begin (3) new text end personal care assistant and private duty nursing services when the deleted text begin number deleted text end
deleted text begin of foster care residents deleted text end new text begin licensed capacity new text end is greater than four deleted text begin unless the county responsible
for the recipient's foster placement made the placement prior to April 1, 1992, requests
that personal care assistant and private duty nursing services be provided, and case
management is provided as required in section 256B.0625, subdivision 19a deleted text end .

deleted text begin Subd. 10. deleted text end

deleted text begin Limitation on payments. deleted text end

deleted text begin Medical assistance payments for home care
services shall be limited according to subdivisions 4 to 12 and sections 256B.0654,
subdivision 2, and 256B.0655, subdivisions 3 and 4.
deleted text end

Subd. 11.

Limits on services without deleted text begin prior deleted text end authorization.

A recipient may receive
the following home care services during a calendar year:

(1) up to two face-to-face assessments to determine a recipient's need for personal
care deleted text begin assistant deleted text end new text begin assistance new text end services;

(2) one service update done to determine a recipient's need for personal care deleted text begin assistant deleted text end new text begin
assistance new text end services; and

(3) up to nine new text begin face-to-face new text end skilled nurse visits.

Subd. 12.

Approval of home care services.

The commissioner or the
commissioner's designee shall determine the medical necessity of home care services, the
level of caregiver according to subdivision 2, and the institutional comparison according to
subdivisions 4 to 12 and sections 256B.0654, subdivision 2, and deleted text begin 256B.0655, subdivisions
3 and 4 deleted text end new text begin 256B.0659 new text end , the cost-effectiveness of services, and the amount, scope, and duration
of home care services reimbursable by medical assistance, based on the assessment,
primary payer coverage determination information as required, the service plan, the
recipient's age, the cost of services, the recipient's medical condition, and diagnosis or
disability. The commissioner may publish additional criteria for determining medical
necessity according to section 256B.04.

Subd. 13.

Recovery of excessive payments.

The commissioner shall seek
monetary recovery from providers of payments made for services which exceed the limits
established in this section and sections 256B.0653 to 256B.0656. This subdivision does
not apply to services provided to a recipient at the previously authorized level pending an
appeal under section 256.045, subdivision 10.

new text begin Subd. 14. new text end

new text begin Referrals to Medicare providers required. new text end

new text begin Home care providers that
do not participate in or accept Medicare assignment must refer and document the referral
of dual-eligible recipients to Medicare providers when Medicare is determined to be the
appropriate payer for services and supplies and equipment. Providers must be terminated
from participation in the medical assistance program for failure to make these referrals.
new text end

new text begin Subd. 15. new text end

new text begin Quality assurance for program integrity. new text end

new text begin The commissioner shall
establish an ongoing quality assurance process for home care services to monitor program
integrity, including provider standards and training, consumer surveys, and random
reviews of documentation.
new text end

new text begin Subd. 16. new text end

new text begin Oversight of enrolled providers. new text end

new text begin The commissioner has the authority to
request proof of documentation of meeting provider standards, quality standards of care,
correct billing practices, and other information. Failure to provide access and information
to demonstrate compliance with laws, rules, or policies must result in suspension, denial,
or termination of the provider agency's enrollment with the department.
new text end

Sec. 26.

Minnesota Statutes 2008, section 256B.0652, is amended to read:

256B.0652 deleted text begin PRIOR deleted text end AUTHORIZATION AND REVIEW OF HOME CARE
SERVICES.

Subdivision 1.

State coordination.

The commissioner shall supervise the
coordination of the deleted text begin prior deleted text end authorization and review of home care services that are
reimbursed by medical assistance.

Subd. 2.

Duties.

(a) The commissioner may contract with or employ deleted text begin qualified
registered nurses and deleted text end necessary deleted text begin support deleted text end staff, or contract with qualified agencies, to
provide home care deleted text begin prior deleted text end authorization and review services for medical assistance
recipients who are receiving home care services.

(b) Reimbursement for the deleted text begin prior deleted text end authorization function shall be made through the
medical assistance administrative authority. The state shall pay deleted text begin the nonfederal share deleted text end new text begin 50
percent of the administrative functions new text end . The functions will be to:

(1) assess the recipient's individual need for services required to be cared for safely
in the community;

(2) ensure that a deleted text begin service deleted text end new text begin care new text end plan that meets the recipient's needs is developed
by the appropriate agency or individual;

(3) ensure cost-effectiveness new text begin and nonduplication new text end of medical assistance home care
services;

(4) recommend the approval or denial of the use of medical assistance funds to pay
for home care services;

(5) reassess the recipient's need for and level of home care services at a frequency
determined by the commissioner; deleted text begin and
deleted text end

(6) conduct on-site assessments when determined necessary by the commissioner
and recommend changes to care plans that will provide more efficient and appropriate
home care new text begin ; and
new text end

new text begin (7) on the department's Web site:
new text end

new text begin (i) provide a link to MinnesotaHelp.info for a list of enrolled home care agencies
with the following information: main office address, contact information for the agency,
counties in which services are provided, type of home care services provided, whether
the personal care assistance choice option is offered, types of qualified professionals
employed, number of personal care assistants employed, and data on staff turnover; and
new text end

new text begin (ii) post data on home care services including information from both fee-for-service
and managed care plans on recipients as available new text end .

(c) In addition, the commissioner or the commissioner's designee may:

(1) review new text begin care plans, new text end service plans new text begin , new text end and reimbursement data for utilization of
services that exceed community-based standards for home care, inappropriate home care
services, medical necessity, home care services that do not meet quality of care standards,
or unauthorized services and make appropriate referrals within the department or to other
appropriate entities based on the findings;

(2) assist the recipient in obtaining services necessary to allow the recipient to
remain safely in or return to the community;

(3) coordinate home care services with other medical assistance services under
section 256B.0625;

(4) assist the recipient with problems related to the provision of home care services;

(5) assure the quality of home care services; and

(6) assure that all liable third-party payers including new text begin , but not limited to, new text end Medicare
have been used prior to medical assistance for home care services deleted text begin , including but not
limited to, home health agency, elected hospice benefit, waivered services, alternative care
program services, and personal care services deleted text end .

(d) For the purposes of this section, "home care services" means medical assistance
services defined under section 256B.0625, subdivisions 6a, 7, and 19a.

Subd. 3.

Assessment and deleted text begin prior deleted text end authorization process new text begin for persons receiving
personal care assistance and developmental disabilities services new text end .

deleted text begin Effective January 1,
1996, deleted text end For purposes of providing informed choice, coordinating of local planning decisions,
and streamlining administrative requirements, the assessment and deleted text begin prior deleted text end authorization
process for persons receiving both home care and home and community-based waivered
services for persons with developmental disabilities shall meet the requirements of
sections 256B.0651 and 256B.0653 to 256B.0656 with the following exceptions:

(a) Upon request for home care services and subsequent assessment by the public
health nurse under sections 256B.0651 and 256B.0653 to 256B.0656, the public health
nurse shall participate in the screening process, as appropriate, and, if home care
services are determined to be necessary, participate in the development of a service plan
coordinating the need for home care and home and community-based waivered services
with the assigned county case manager, the recipient of services, and the recipient's legal
representative, if any.

(b) The public health nurse shall give deleted text begin prior deleted text end authorization for home care services
to the extent that home care services are:

(1) medically necessary;

(2) chosen by the recipient and their legal representative, if any, from the array of
home care and home and community-based waivered services available;

(3) coordinated with other services to be received by the recipient as described
in the service plan; and

(4) provided within the county's reimbursement limits for home care and home and
community-based waivered services for persons with developmental disabilities.

(c) If the public health agency is or may be the provider of home care services to the
recipient, the public health agency shall provide the commissioner of human services with
a written plan that specifies how the assessment and deleted text begin prior deleted text end authorization process will be
held separate and distinct from the provision of services.

Sec. 27.

Minnesota Statutes 2008, section 256B.0653, is amended to read:

256B.0653 HOME HEALTH AGENCY deleted text begin COVERED deleted text end SERVICES.

Subdivision 1.

deleted text begin Homecare; skilled nurse visits deleted text end new text begin Scope new text end .

deleted text begin "Skilled nurse visits" are
provided in a recipient's residence under a plan of care or service plan that specifies a level
of care which the nurse is qualified to provide. These services are:
deleted text end

deleted text begin (1) nursing services according to the written plan of care or service plan and accepted
standards of medical and nursing practice in accordance with chapter 148;
deleted text end

deleted text begin (2) services which due to the recipient's medical condition may only be safely and
effectively provided by a registered nurse or a licensed practical nurse;
deleted text end

deleted text begin (3) assessments performed only by a registered nurse; and
deleted text end

deleted text begin (4) teaching and training the recipient, the recipient's family, or other caregivers
requiring the skills of a registered nurse or licensed practical nurse. deleted text end new text begin This section applies to
home health agency services including, home health aide, skilled nursing visits, physical
therapy, occupational therapy, respiratory therapy, and speech language pathology therapy.
new text end

Subd. 2.

deleted text begin Telehomecare; skilled nurse visits deleted text end new text begin Definitions new text end .

deleted text begin Medical assistance
covers skilled nurse visits according to section 256B.0625, subdivision 6a, provided via
telehomecare, for services which do not require hands-on care between the home care
nurse and recipient. The provision of telehomecare must be made via live, two-way
interactive audiovisual technology and may be augmented by utilizing store-and-forward
technologies. Store-and-forward technology includes telehomecare services that do not
occur in real time via synchronous transmissions, and that do not require a face-to-face
encounter with the recipient for all or any part of any such telehomecare visit. Individually
identifiable patient data obtained through real-time or store-and-forward technology must
be maintained as health records according to sections 144.291 to 144.298. If the video
is used for research, training, or other purposes unrelated to the care of the patient, the
identity of the patient must be concealed. A communication between the home care nurse
and recipient that consists solely of a telephone conversation, facsimile, electronic mail, or
a consultation between two health care practitioners, is not to be considered a telehomecare
visit. Multiple daily skilled nurse visits provided via telehomecare are allowed. Coverage
of telehomecare is limited to two visits per day. All skilled nurse visits provided via
telehomecare must be prior authorized by the commissioner or the commissioner's
designee and will be covered at the same allowable rate as skilled nurse visits provided
in-person. deleted text end new text begin For the purposes of this section, the following terms have the meanings given.
new text end

new text begin (a) "Assessment" means an evaluation of the recipient's medical need for home
health agency services by a registered nurse or appropriate therapist that is conducted
within 30 days of a request.
new text end

new text begin (b) "Home care therapies" means occupational, physical, and respiratory therapy
and speech-language pathology services provided in the home by a Medicare certified
home health agency.
new text end

new text begin (c) "Home health agency services" means services delivered in the recipient's home
residence, except as specified in section 256B.0625, by a home health agency to a recipient
with medical needs due to illness, disability, or physical conditions.
new text end

new text begin (d) "Home health aide" means an employee of a home health agency who completes
medically oriented tasks written in the plan of care for a recipient.
new text end

new text begin (e) "Home health agency" means a home care provider agency that is
Medicare-certified.
new text end

new text begin (f) "Occupational therapy services" mean the services defined in section 148.6402.
new text end

new text begin (g) "Physical therapy services" mean the services defined in section 148.65.
new text end

new text begin (h) "Respiratory therapy services" mean the services defined in chapter 147C and
Minnesota Rules, part 4668.0003, subpart 37.
new text end

new text begin (i) "Speech-language pathology services" mean the services defined in section
148.512.
new text end

new text begin (j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
required due to a recipient's medical condition that can only be safely provided by a
professional nurse to restore and maintain optimal health.
new text end

new text begin (k) "Store-and-forward technology" means telehomecare services that do not occur
in real time via synchronous transmissions such as diabetic and vital sign monitoring.
new text end

new text begin (l) "Telehomecare" means the use of telecommunications technology via
live, two-way interactive audiovisual technology which may be augmented by
store-and-forward technology.
new text end

new text begin (m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to
deliver a skilled nurse visit to a recipient located at a site other than the site where the
nurse is located and is used in combination with face-to-face skilled nurse visits to
adequately meet the recipient's needs.
new text end

Subd. 3.

deleted text begin Therapies through home health agencies deleted text end new text begin Home health aide visits new text end .

deleted text begin (a) Medical assistance covers physical therapy and related services, including specialized
maintenance therapy. Services provided by a physical therapy assistant shall be
reimbursed at the same rate as services performed by a physical therapist when the
services of the physical therapy assistant are provided under the direction of a physical
therapist who is on the premises. Services provided by a physical therapy assistant that are
provided under the direction of a physical therapist who is not on the premises shall be
reimbursed at 65 percent of the physical therapist rate. Direction of the physical therapy
assistant must be provided by the physical therapist as described in Minnesota Rules, part
9505.0390, subpart 1, item B. The physical therapist and physical therapist assistant may
not both bill for services provided to a recipient on the same day.
deleted text end

deleted text begin (b) Medical assistance covers occupational therapy and related services, including
specialized maintenance therapy. Services provided by an occupational therapy assistant
shall be reimbursed at the same rate as services performed by an occupational therapist
when the services of the occupational therapy assistant are provided under the direction of
the occupational therapist who is on the premises. Services provided by an occupational
therapy assistant under the direction of an occupational therapist who is not on the
premises shall be reimbursed at 65 percent of the occupational therapist rate. Direction
of the occupational therapy assistant must be provided by the occupational therapist as
described in Minnesota Rules, part 9505.0390, subpart 1, item B. The occupational
therapist and occupational therapist assistant may not both bill for services provided
to a recipient on the same day.
deleted text end

new text begin (a) Home health aide visits must be provided by a certified home health aide
using a written plan of care that is updated in compliance with Medicare regulations.
A home health aide shall provide hands-on personal care, perform simple procedures
as an extension of therapy or nursing services, and assist in instrumental activities of
daily living as defined in section 256B.0659. Home health aide visits must be provided
in the recipient's home.
new text end

new text begin (b) All home health aide visits must have authorization under section 256B.0652.
The commissioner shall limit home health aide visits to no more than one visit per day
per recipient.
new text end

new text begin (c) Home health aides must be supervised by a registered nurse or an appropriate
therapist when providing services that are an extension of therapy.
new text end

new text begin Subd. 4. new text end

new text begin Skilled nurse visit services. new text end

new text begin (a) Skilled nurse visit services must be
provided by a registered nurse or a licensed practical nurse under the supervision of a
registered nurse, according to the written plan of care and accepted standards of medical
and nursing practice according to chapter 148. Skilled nurse visit services must be ordered
by a physician and documented in a plan of care that is reviewed and approved by the
ordering physician at least once every 60 days. All skilled nurse visits must be medically
necessary and provided in the recipient's home residence except as allowed under section
256B.0625, subdivision 6a.
new text end

new text begin (b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of
up to two visits per day per recipient. All visits must be based on assessed needs.
new text end

new text begin (c) Telehomecare skilled nurse visits are allowed when the recipient's health status
can be accurately measured and assessed without a need for a face-to-face, hands-on
encounter. All telehomecare skilled nurse visits must have authorization and are paid at
the same allowable rates as face-to-face skilled nurse visits.
new text end

new text begin (d) The provision of telehomecare must be made via live, two-way interactive
audiovisual technology and may be augmented by utilizing store-and-forward
technologies. Individually identifiable patient data obtained through real-time or
store-and-forward technology must be maintained as health records according to sections
144.291 to 144.298. If the video is used for research, training, or other purposes unrelated
to the care of the patient, the identity of the patient must be concealed.
new text end

new text begin (e) Authorization for skilled nurse visits must be completed under section
256B.0652. A total of nine face-to-face skilled nurses visits per calendar year do not
require authorization. All telehomecare skilled nurse visits require authorization.
new text end

new text begin Subd. 5. new text end

new text begin Home care therapies. new text end

new text begin (a) Home care therapies include the following:
physical therapy, occupational therapy, respiratory therapy, and speech and language
pathology therapy services.
new text end

new text begin (b) Home care therapies must be:
new text end

new text begin (1) provided in the recipient's residence after it has been determined the recipient is
unable to access outpatient therapy;
new text end

new text begin (2) prescribed, ordered, or referred by a physician and documented in a plan of care
and reviewed, according to Minnesota Rules, part 9505.0390;
new text end

new text begin (3) assessed by an appropriate therapist; and
new text end

new text begin (4) provided by a Medicare-certified home health agency enrolled as a Medicaid
provider agency.
new text end

new text begin (c) Restorative and specialized maintenance therapies must be provided according to
Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be
used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
new text end

new text begin (d) For both physical and occupational therapies, the therapist and the therapist's
assistant may not both bill for services provided to a recipient on the same day.
new text end

new text begin Subd. 6. new text end

new text begin Noncovered home health agency services. new text end

new text begin The following are not eligible
for payment under medical assistance as a home health agency service:
new text end

new text begin (1) telehomecare skilled nurses services that is communication between the home
care nurse and recipient that consists solely of a telephone conversation, facsimile,
electronic mail, or a consultation between two health care practitioners;
new text end

new text begin (2) the following skilled nurse visits:
new text end

new text begin (i) for the purpose of monitoring medication compliance with an established
medication program for a recipient;
new text end

new text begin (ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when,
as determined and documented by the registered nurse, the need can be met by an
available pharmacy or the recipient or a family member is physically and mentally able
to self-administer or prefill a medication;
new text end

new text begin (iii) services done for the sole purpose of supervision of the home health aide or
personal care assistant;
new text end

new text begin (iv) services done for the sole purpose to train other home health agency workers;
new text end

new text begin (v) services done for the sole purpose of blood samples or lab draw or Synagis
injections when the recipient is able to access these services outside the home; and
new text end

new text begin (vi) Medicare evaluation or administrative nursing visits required by Medicare;
new text end

new text begin (3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education; and
new text end

new text begin (4) home care therapies provided in other settings such as a clinic, day program, or as
an inpatient or when the recipient can access therapy outside of the recipient's residence.
new text end

Sec. 28.

Minnesota Statutes 2008, section 256B.0654, is amended to read:

256B.0654 PRIVATE DUTY NURSING.

Subdivision 1.

Definitions.

deleted text begin (a) "Assessment" means a review and evaluation of a
recipient's need for home care services conducted in person. Assessments for private duty
nursing shall be conducted by a registered private duty nurse. Assessments for medical
assistance home care services for developmental disabilities and alternative care services
for developmentally disabled home and community-based waivered recipients may be
conducted by the county public health nurse to ensure coordination and avoid duplication.
deleted text end

deleted text begin (b) deleted text end new text begin (a) new text end "Complex deleted text begin and regular deleted text end private duty nursing care" means deleted text begin :
deleted text end

deleted text begin (1) complex care is private duty deleted text end nursing new text begin services new text end provided to recipients who are
ventilator dependent or for whom a physician has certified that deleted text begin were it not for private duty
nursing deleted text end the recipient would meet the criteria for inpatient hospital intensive care unit
(ICU) level of care deleted text begin ; and
deleted text end

deleted text begin (2) regular care is private duty nursing provided to all other recipients deleted text end .

new text begin (b) "Private duty nursing" means ongoing professional nursing services by a
registered or licensed practical nurse including assessment, professional nursing tasks, and
education, based on an assessment and physician orders to maintain or restore optimal
health of the recipient.
new text end

new text begin (c) "Private duty nursing agency" means a medical assistance enrolled provider
licensed under chapter 144A to provide private duty nursing services.
new text end

new text begin (d) "Regular private duty nursing" means nursing services provided to a recipient
who is considered stable and not at an inpatient hospital intensive care unit level of care,
but may have episodes of instability that are not life threatening.
new text end

new text begin (e) "Shared private duty nursing" means the provision of nursing services by a
private duty nurse to two recipients at the same time and in the same setting.
new text end

Subd. 2.

new text begin Authorization; new text end private duty nursing services.

(a) All private duty
nursing services shall be deleted text begin prior deleted text end authorized by the commissioner or the commissioner's
designee. deleted text begin Prior deleted text end Authorization for private duty nursing services shall be based on
medical necessity and cost-effectiveness when compared with alternative care options.
The commissioner may authorize medically necessary private duty nursing services in
quarter-hour units when:

(1) the recipient requires more individual and continuous care than can be provided
during a new text begin skilled new text end nurse visit; or

(2) the cares are outside of the scope of services that can be provided by a home
health aide or personal care assistant.

(b) The commissioner may authorize:

(1) up to two times the average amount of direct care hours provided in nursing
facilities statewide for case mix classification "K" as established by the annual cost report
submitted to the department by nursing facilities in May 1992;

(2) private duty nursing in combination with other home care services up to the total
cost allowed under section 256B.0655, subdivision 4;

(3) up to 16 hours per day if the recipient requires more nursing than the maximum
number of direct care hours as established in clause (1) and the recipient meets the hospital
admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540.

(c) The commissioner may authorize up to 16 hours per day of medically necessary
private duty nursing services or up to 24 hours per day of medically necessary private duty
nursing services until such time as the commissioner is able to make a determination of
eligibility for recipients who are cooperatively applying for home care services under
the community alternative care program developed under section 256B.49, or until it is
determined by the appropriate regulatory agency that a health benefit plan is or is not
required to pay for appropriate medically necessary health care services. Recipients
or their representatives must cooperatively assist the commissioner in obtaining this
determination. Recipients who are eligible for the community alternative care program
may not receive more hours of nursing under this section and sections 256B.0651,
256B.0653, deleted text begin 256B.0655, and deleted text end 256B.0656 new text begin , and 256B.0659 new text end than would otherwise be
authorized under section 256B.49.

new text begin Subd. 2a. new text end

new text begin Private duty nursing services. new text end

new text begin (a) Private duty nursing services must
be used:
new text end

new text begin (1) in the recipient's home or outside the home when normal life activities require;
new text end

new text begin (2) when the recipient requires more individual and continuous care than can be
provided during a skilled nurse visit; and
new text end

new text begin (3) when the care required is outside of the scope of services that can be provided by
a home health aide or personal care assistant.
new text end

new text begin (b) Private duty nursing services must be:
new text end

new text begin (1) assessed by a registered nurse on a form approved by the commissioner;
new text end

new text begin (2) ordered by a physician and documented in a plan of care that is reviewed by the
physician at least once every 60 days; and
new text end

new text begin (3) authorized by the commissioner under section 256B.0652.
new text end

new text begin Subd. 2b. new text end

new text begin Noncovered private duty nursing services. new text end

new text begin Private duty nursing
services do not cover the following:
new text end

new text begin (1) nursing services by a nurse who is the foster care provider of a person who has
not reached 18 years of age unless allowed under subdivision 4;
new text end

new text begin (2) nursing services to more than two persons receiving shared private duty nursing
services from a private duty nurse in a single setting; and
new text end

new text begin (3) nursing services provided by a registered nurse or licensed practical nurse who is
the recipient's legal guardian or related to the recipient as spouse, parent, or family foster
parent whether by blood, marriage, or adoption except as specified in section 256B.0652,
subdivision 4.
new text end

Subd. 3.

Shared private duty nursing deleted text begin care deleted text end option.

(a) Medical assistance
payments for shared private duty nursing services by a private duty nurse shall be limited
according to this subdivision. deleted text begin For the purposes of this section and sections 256B.0651,
256B.0653, 256B.0655, and 256B.0656, "private duty nursing agency" means an agency
licensed under chapter 144A to provide private duty nursing services. deleted text end new text begin Unless otherwise
provided in this subdivision, all other statutory and regulatory provisions relating to
private duty nursing services apply to shared private duty nursing services. Nothing in
this subdivision shall be construed to reduce the total number of private duty nursing
hours authorized for an individual recipient.
new text end

deleted text begin (b) Recipients of private duty nursing services may share nursing staff and the
commissioner shall provide a rate methodology for shared private duty nursing. For two
persons sharing nursing care, the rate paid to a provider shall not exceed 1.5 times the
regular private duty nursing rates paid for serving a single individual by a registered nurse
or licensed practical nurse. These rates apply only to situations in which both recipients
are present and receive shared private duty nursing care on the date for which the service
is billed. No more than two persons may receive shared private duty nursing services
from a private duty nurse in a single setting.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Shared private duty nursing deleted text begin care deleted text end is the provision of nursing services by a
private duty nurse to two new text begin medical assistance eligible new text end recipients at the same time and in
the same setting. new text begin This subdivision does not apply when a private duty nurse is caring for
multiple recipients in more than one setting.
new text end

new text begin (c) new text end For the purposes of this subdivision, "setting" means:

(1) the home new text begin residence new text end or foster care home of one of the individual recipients new text begin as
defined in section 256B.0651 new text end ; deleted text begin or
deleted text end

(2) a child care program licensed under chapter 245A or operated by a local school
district or private school; deleted text begin or
deleted text end

(3) an adult day care service licensed under chapter 245A; or

(4) outside the home new text begin residence new text end or foster care home of one of the recipients when
normal life activities take the recipients outside the home.

deleted text begin This subdivision does not apply when a private duty nurse is caring for multiple
recipients in more than one setting.
deleted text end

new text begin (d) The private duty nursing agency must offer the recipient the option of shared or
one-on-one private duty nursing services. The recipient may withdraw from participating
in a shared service arrangement at any time.
new text end

deleted text begin (d) deleted text end new text begin (e) new text end The recipient or the recipient's legal representative, and the recipient's
physician, in conjunction with the deleted text begin home health care deleted text end new text begin private duty nursing new text end agency, shall
determine:

(1) whether shared private duty nursing care is an appropriate option based on the
individual needs and preferences of the recipient; and

(2) the amount of shared private duty nursing services authorized as part of the
overall authorization of nursing services.

deleted text begin (e) deleted text end new text begin (f) new text end The recipient or the recipient's legal representative, in conjunction with the
private duty nursing agency, shall approve the setting, grouping, and arrangement of
shared private duty nursing care based on the individual needs and preferences of the
recipients. Decisions on the selection of recipients to share services must be based on the
ages of the recipients, compatibility, and coordination of their care needs.

deleted text begin (f) deleted text end new text begin (g) new text end The following items must be considered by the recipient or the recipient's
legal representative and the private duty nursing agency, and documented in the recipient's
health service record:

(1) the additional training needed by the private duty nurse to provide care to
two recipients in the same setting and to ensure that the needs of the recipients are met
appropriately and safely;

(2) the setting in which the shared private duty nursing care will be provided;

(3) the ongoing monitoring and evaluation of the effectiveness and appropriateness
of the service and process used to make changes in service or setting;

(4) a contingency plan which accounts for absence of the recipient in a shared private
duty nursing setting due to illness or other circumstances;

(5) staffing backup contingencies in the event of employee illness or absence; and

(6) arrangements for additional assistance to respond to urgent or emergency care
needs of the recipients.

deleted text begin (g) The provider must offer the recipient or responsible party the option of shared or
one-on-one private duty nursing services. The recipient or responsible party can withdraw
from participating in a shared service arrangement at any time.
deleted text end

(h) deleted text begin The private duty nursing agency must document the following in the
health service record for each individual recipient sharing private duty nursing care deleted text end new text begin
The documentation for shared private duty nursing must be on a form approved by
the commissioner for each individual recipient sharing private duty nursing. The
documentation must be part of the recipient's health service record and include new text end :

(1) permission by the recipient or the recipient's legal representative for the
maximum number of shared nursing deleted text begin care deleted text end hours per week chosen by the recipient new text begin and
permission for shared private duty nursing services provided in and outside the recipient's
home residence new text end ;

(2) deleted text begin permission by the recipient or the recipient's legal representative for shared
private duty nursing services provided outside the recipient's residence;
deleted text end

deleted text begin (3) permission by the recipient or the recipient's legal representative for others to
receive shared private duty nursing services in the recipient's residence;
deleted text end

deleted text begin (4) deleted text end revocation by the recipient or the recipient's legal representative deleted text begin of deleted text end new text begin for new text end the shared
private duty nursing deleted text begin care authorization, or the shared care to be provided to others in the
recipient's residence, or the shared private duty nursing services to be provided outside deleted text end new text begin
permission, or services provided to others in and outside new text end the recipient's residence; and

deleted text begin (5) deleted text end new text begin (3) new text end daily documentation of the shared private duty nursing services provided by
each identified private duty nurse, including:

(i) the names of each recipient receiving shared private duty nursing services
deleted text begin together deleted text end ;

(ii) the setting for the shared services, including the starting and ending times that
the recipient received shared private duty nursing care; and

(iii) notes by the private duty nurse regarding changes in the recipient's condition,
problems that may arise from the sharing of private duty nursing services, and scheduling
and care issues.

deleted text begin (i) Unless otherwise provided in this subdivision, all other statutory and regulatory
provisions relating to private duty nursing services apply to shared private duty nursing
services.
deleted text end

deleted text begin Nothing in this subdivision shall be construed to reduce the total number of private
duty nursing hours authorized for an individual recipient under subdivision 2.
deleted text end

new text begin (i) The commissioner shall provide a rate methodology for shared private duty
nursing. For two persons sharing nursing care, the rate paid to a provider must not exceed
1.5 times the regular private duty nursing rates paid for serving a single individual by a
registered nurse or licensed practical nurse. These rates apply only to situations in which
both recipients are present and receive shared private duty nursing care on the date for
which the service is billed.
new text end

Subd. 4.

Hardship criteria; private duty nursing.

(a) Payment is allowed for
extraordinary services that require specialized nursing skills and are provided by parents
of minor children, spouses, and legal guardians who are providing private duty nursing
care under the following conditions:

(1) the provision of these services is not legally required of the parents, spouses,
or legal guardians;

(2) the services are necessary to prevent hospitalization of the recipient; and

(3) the recipient is eligible for state plan home care or a home and community-based
waiver and one of the following hardship criteria are met:

(i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to
provide nursing care for the recipient; deleted text begin or
deleted text end

(ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with
less compensation to provide nursing care for the recipient; deleted text begin or
deleted text end

(iii) the parent, spouse, or legal guardian takes a leave of absence without pay to
provide nursing care for the recipient; or

(iv) because of labor conditions, special language needs, or intermittent hours of
care needed, the parent, spouse, or legal guardian is needed in order to provide adequate
private duty nursing services to meet the medical needs of the recipient.

(b) Private duty nursing may be provided by a parent, spouse, new text begin family foster parent,
new text end or legal guardian who is a nurse licensed in Minnesota. Private duty nursing services
provided by a parent, spouse, new text begin family foster parent, new text end or legal guardian cannot be used in
lieu of nursing services covered and available under liable third-party payors, including
Medicare. The private duty nursing provided by a parent, spouse, new text begin family foster parent, new text end or
legal guardian must be included in the service deleted text begin plan deleted text end new text begin agreement new text end . Authorized deleted text begin skilled deleted text end nursing
services new text begin for a single recipient or recipients with the same residence and new text end provided by the
parent, spouse, new text begin family foster parent, new text end or legal guardian may not exceed 50 percent of the
total approved nursing hours, or eight hours per day, whichever is less, up to a maximum
of 40 hours per week. new text begin A parent or parents, spouse, family foster parent, or legal guardian
shall not provide more than 40 hours of services in a seven-day period. For parents, family
foster parents, and legal guardians, 40 hours is the total amount allowed regardless of the
number of children or adults who receive services. new text end Nothing in this subdivision precludes
the parent's, spouse's, or legal guardian's obligation of assuming the nonreimbursed family
responsibilities of emergency backup caregiver and primary caregiver.

(c) A parent new text begin , family foster parent, new text end or a spouse may not be paid to provide private
duty nursing care if new text begin :
new text end

new text begin (1) new text end the parent or spouse fails to pass a criminal background check according to
chapter 245C deleted text begin , or if deleted text end new text begin ;
new text end

new text begin (2) new text end it has been determined by the deleted text begin home health deleted text end new text begin private duty nursing new text end agency, the
case manager, or the physician that the private duty nursing deleted text begin care deleted text end provided by the parent,
new text begin family foster parent, new text end spouse, or legal guardian is unsafe new text begin ; or
new text end

new text begin (3) the parent, family foster parent, spouse, or legal guardian do not follow physician
orders new text end .

new text begin (d) For purposes of this section, "assessment" means a review and evaluation of a
recipient's need for home care services conducted in person. Assessments for private duty
nursing must be conducted by a registered nurse.
new text end

Sec. 29.

Minnesota Statutes 2008, section 256B.0655, subdivision 1b, is amended to
read:

Subd. 1b.

Assessment.

"Assessment" means a review and evaluation of a recipient's
need for home care services conducted in person. Assessments for personal care assistant
services shall be conducted by the county public health nurse or a certified public
health nurse under contract with the county. deleted text begin A face-to-face deleted text end new text begin An in-person new text end assessment
must include: documentation of health status, determination of need, evaluation of
service effectiveness, identification of appropriate services, service plan development
or modification, coordination of services, referrals and follow-up to appropriate payers
and community resources, completion of required reports, recommendation of service
authorization, and consumer education. Once the need for personal care assistant
services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654,
and 256B.0656, the county public health nurse or certified public health nurse under
contract with the county is responsible for communicating this recommendation to the
commissioner and the recipient. deleted text begin A face-to-face assessment for personal care assistant
services is conducted on those recipients who have never had a county public health
nurse assessment. A face-to-face deleted text end new text begin An in-person new text end assessment must occur at least annually or
when there is a significant change in the recipient's condition or when there is a change
in the need for personal care assistant services. A service update may substitute for
the annual face-to-face assessment when there is not a significant change in recipient
condition or a change in the need for personal care assistant service. A service update
may be completed by telephone, used when there is no need for an increase in personal
care assistant services, and used for two consecutive assessments if followed by a
face-to-face assessment. A service update must be completed on a form approved by the
commissioner. A service update or review for temporary increase includes a review of
initial baseline data, evaluation of service effectiveness, redetermination of service need,
modification of service plan and appropriate referrals, update of initial forms, obtaining
service authorization, and on going consumer education. Assessments must be completed
on forms provided by the commissioner within 30 days of a request for home care services
by a recipient or responsible party or personal care provider agency.

Sec. 30.

Minnesota Statutes 2008, section 256B.0655, subdivision 4, is amended to
read:

Subd. 4.

deleted text begin Prior deleted text end Authorization new text begin ; personal care assistance and qualified
professional new text end .

deleted text begin The commissioner, or the commissioner's designee, shall review the
assessment, service update, request for temporary services, request for flexible use option,
service plan, and any additional information that is submitted. The commissioner shall,
within 30 days after receiving a complete request, assessment, and service plan, authorize
home care services as follows:
deleted text end

deleted text begin (1) deleted text end new text begin (a) new text end All personal care deleted text begin assistant deleted text end new text begin assistance new text end services deleted text begin and deleted text end new text begin , new text end supervision by a
qualified professional, deleted text begin if requested by the recipient, deleted text end new text begin and additional services beyond the
limits established in section 256B.0652, subdivision 11, new text end must be deleted text begin prior deleted text end authorized by
the commissioner or the commissioner's designee new text begin before services begin new text end except for the
assessments established in deleted text begin section deleted text end new text begin sections new text end 256B.0651, subdivision 11 new text begin , and 256B.0911 new text end . new text begin
The authorization for personal care assistance and qualified professional services under
section 256B.0659 must be completed within 30 days after receiving a complete request.
new text end

new text begin (b) new text end The amount of personal care deleted text begin assistant deleted text end new text begin assistance new text end services authorized must be
based on the recipient's home care rating. new text begin The home care rating shall be determined by
the commissioner or the commissioner's designee based on information submitted to the
commissioner identifying the following:
new text end

new text begin (1) total number of dependencies of activities of daily living as defined in section
256B.0659;
new text end

new text begin (2) number of complex health-related functions as defined in section 256B.0659; and
new text end

new text begin (3) number of behavior descriptions as defined in section 256B.0659.
new text end

new text begin (c) The methodology to determine total time for personal care assistance services for
each home care rating is based on the median paid units per day for each home care rating
from fiscal year 2007 data for the personal care assistance program. Each home care rating
has a base level of hours assigned. Additional time is added through the assessment and
identification of the following:
new text end

new text begin (1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in section 256B.0659;
new text end

new text begin (2) 30 additional minutes per day for each complex health-related function as
defined in section 256B.0659; and
new text end

new text begin (3) 30 additional minutes per day for each behavior issue as defined in section
256B.0659.
new text end

new text begin (d) A limit of 96 units of qualified professional supervision may be authorized for
each recipient receiving personal care assistance services. A request to the commissioner
to exceed this total in a calendar year must be requested by the personal care provider
agency on a form approved by the commissioner.
new text end

deleted text begin A child may not be found to be dependent in an activity of daily living if because
of the child's age an adult would either perform the activity for the child or assist the
child with the activity and the amount of assistance needed is similar to the assistance
appropriate for a typical child of the same age. Based on medical necessity, the
commissioner may authorize:
deleted text end

deleted text begin (A) up to two times the average number of direct care hours provided in nursing
facilities for the recipient's comparable case mix level; or
deleted text end

deleted text begin (B) up to three times the average number of direct care hours provided in nursing
facilities for recipients who have complex medical needs or are dependent in at least seven
activities of daily living and need physical assistance with eating or have a neurological
diagnosis; or
deleted text end

deleted text begin (C) up to 60 percent of the average reimbursement rate, as of July 1, 1991, for care
provided in a regional treatment center for recipients who have Level I behavior, plus any
inflation adjustment as provided by the legislature for personal care service; or
deleted text end

deleted text begin (D) up to the amount the commissioner would pay, as of July 1, 1991, plus any
inflation adjustment provided for home care services, for care provided in a regional
treatment center for recipients referred to the commissioner by a regional treatment center
preadmission evaluation team. For purposes of this clause, home care services means
all services provided in the home or community that would be included in the payment
to a regional treatment center; or
deleted text end

deleted text begin (E) up to the amount medical assistance would reimburse for facility care for
recipients referred to the commissioner by a preadmission screening team established
under section 256B.0911 or 256B.092; and
deleted text end

deleted text begin (F) a reasonable amount of time for the provision of supervision by a qualified
professional of personal care assistant services, if a qualified professional is requested by
the recipient or responsible party.
deleted text end

deleted text begin (2) The number of direct care hours shall be determined according to the annual cost
report submitted to the department by nursing facilities. The average number of direct care
hours, as established by May 1, 1992, shall be calculated and incorporated into the home
care limits on July 1, 1992. These limits shall be calculated to the nearest quarter hour.
deleted text end

deleted text begin (3) The home care rating shall be determined by the commissioner or the
commissioner's designee based on information submitted to the commissioner by the
county public health nurse on forms specified by the commissioner. The home care rating
shall be a combination of current assessment tools developed under sections 256B.0911
and 256B.501 with an addition for seizure activity that will assess the frequency and
severity of seizure activity and with adjustments, additions, and clarifications that are
necessary to reflect the needs and conditions of recipients who need home care including
children and adults under 65 years of age. The commissioner shall establish these forms
and protocols under this section and sections 256B.0651, 256B.0653, 256B.0654, and
256B.0656 and shall use an advisory group, including representatives of recipients,
providers, and counties, for consultation in establishing and revising the forms and
protocols.
deleted text end

deleted text begin (4) A recipient shall qualify as having complex medical needs if the care required is
difficult to perform and because of recipient's medical condition requires more time than
community-based standards allow or requires more skill than would ordinarily be required
and the recipient needs or has one or more of the following:
deleted text end

deleted text begin (A) daily tube feedings;
deleted text end

deleted text begin (B) daily parenteral therapy;
deleted text end

deleted text begin (C) wound or decubiti care;
deleted text end

deleted text begin (D) postural drainage, percussion, nebulizer treatments, suctioning, tracheotomy
care, oxygen, mechanical ventilation;
deleted text end

deleted text begin (E) catheterization;
deleted text end

deleted text begin (F) ostomy care;
deleted text end

deleted text begin (G) quadriplegia; or
deleted text end

deleted text begin (H) other comparable medical conditions or treatments the commissioner determines
would otherwise require institutional care.
deleted text end

deleted text begin (5) A recipient shall qualify as having Level I behavior if there is reasonable
supporting evidence that the recipient exhibits, or that without supervision, observation, or
redirection would exhibit, one or more of the following behaviors that cause, or have the
potential to cause:
deleted text end

deleted text begin (A) injury to the recipient's own body;
deleted text end

deleted text begin (B) physical injury to other people; or
deleted text end

deleted text begin (C) destruction of property.
deleted text end

deleted text begin (6) Time authorized for personal care relating to Level I behavior in paragraph
(5), clauses (A) to (C), shall be based on the predictability, frequency, and amount of
intervention required.
deleted text end

deleted text begin (7) A recipient shall qualify as having Level II behavior if the recipient exhibits on a
daily basis one or more of the following behaviors that interfere with the completion of
personal care assistant services under subdivision 2, paragraph (a):
deleted text end

deleted text begin (A) unusual or repetitive habits;
deleted text end

deleted text begin (B) withdrawn behavior; or
deleted text end

deleted text begin (C) offensive behavior.
deleted text end

deleted text begin (8) A recipient with a home care rating of Level II behavior in paragraph (7), clauses
(A) to (C), shall be rated as comparable to a recipient with complex medical needs under
paragraph (4). If a recipient has both complex medical needs and Level II behavior, the
home care rating shall be the next complex category up to the maximum rating under
paragraph (1), clause (B).
deleted text end

Sec. 31.

new text begin [256B.0659] PERSONAL CARE ASSISTANCE PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms defined in
paragraphs (b) to (p) have the meanings given unless otherwise provided in text.
new text end

new text begin (b) "Activities of daily living" means grooming, dressing, bathing, transferring,
mobility, positioning, eating, and toileting.
new text end

new text begin (c) "Behavior" means a category to determine the home care rating and is based on
the criteria found in this section. "Level I behavior" means physical aggression towards
self, others, or property that requires the immediate response of another person.
new text end

new text begin (d) "Complex health-related needs" means a category to determine the home care
rating and is based on the criteria found in this section.
new text end

new text begin (e) "Critical activities of daily living" means transferring, mobility, eating, and
toileting.
new text end

new text begin (f) "Dependency in activities of daily living" means a person requires assistance to
begin and complete one or more of the activities of daily living.
new text end

new text begin (g) "Health-related procedures and tasks" means procedures and tasks that can
be delegated or assigned by a licensed health care professional under state law to be
performed by a personal care assistant.
new text end

new text begin (h) "Instrumental activities of daily living" means activities to include meal planning
and preparation; basic assistance with paying bills; shopping for food, clothing, and
other essential items; performing household tasks integral to the personal care assistance
services; communication by telephone and other media; and traveling, including to
medical appointments and to participate in the community.
new text end

new text begin (i) "Managing employee" has the same definition as Code of Federal Regulations,
title 42, section 455.
new text end

new text begin (j) "Qualified professional" means a professional providing supervision of personal
care assistance services and staff as defined in section 256B.0625, subdivision 19c.
new text end

new text begin (k) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and
includes personal care assistance provider organizations, personal care assistance choice
agency, class A licensed nursing agency, and Medicare-certified home health agency.
new text end

new text begin (l) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.
new text end

new text begin (m) "Personal care assistance care plan" means a written description of personal
care assistance services developed by the personal care assistance provider according
to the service plan.
new text end

new text begin (n) "Responsible party" means an individual who lives with and is capable of
providing the support necessary to assist the recipient to live in the community.
new text end

new text begin (o) "Self-administered medication" means medication taken orally, by injection or
insertion, or applied topically without the need for assistance.
new text end

new text begin (p) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.
new text end

new text begin Subd. 2. new text end

new text begin Personal care assistance services; covered services. new text end

new text begin (a) The personal
care assistance services eligible for payment include services and supports furnished
to an individual, as needed, to assist in:
new text end

new text begin (1) activities of daily living;
new text end

new text begin (2) health-related procedures and tasks;
new text end

new text begin (3) observation and redirection of behaviors; and
new text end

new text begin (4) instrumental activities of daily living.
new text end

new text begin (b) Activities of daily living include the following covered services:
new text end

new text begin (1) dressing, including assistance with choosing, application, and changing of
clothing and application of special appliances, wraps, or clothing;
new text end

new text begin (2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
except for recipients who are diabetic or have poor circulation;
new text end

new text begin (3) bathing, including assistance with basic personal hygiene and skin care;
new text end

new text begin (4) eating, including assistance with hand washing and application of orthotics
required for eating, transfers, and feeding;
new text end

new text begin (5) transfers, including assistance with transferring the recipient from one seating or
reclining area to another;
new text end

new text begin (6) mobility, including assistance with ambulation, including use of a wheelchair.
Mobility does not include providing transportation for a recipient;
new text end

new text begin (7) positioning, including assistance with positioning or turning a recipient for
necessary care and comfort; and
new text end

new text begin (8) toileting, including assistance with helping recipient with bowel or bladder
elimination and care including transfers, mobility, positioning, feminine hygiene, use of
toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and
adjusting clothing.
new text end

new text begin (c) Health-related procedures and tasks include the following covered services:
new text end

new text begin (1) range of motion and passive exercise to maintain a recipient's strength and
muscle functioning;
new text end

new text begin (2) assistance with self-administered medication as defined by this section, including
reminders to take medication, bringing medication to the recipient, and assistance with
opening medication under the direction of the recipient or responsible party;
new text end

new text begin (3) interventions for seizure disorders, including monitoring and observation; and
new text end

new text begin (4) other activities considered within the scope of the personal care service and
meeting the definition of health-related procedures and tasks under this section.
new text end

new text begin (d) A personal care assistant may provide health-related procedures and tasks
associated with the complex health-related needs of a recipient if the procedures and
tasks meet the definition of health-related procedures and tasks under this section and the
personal care assistant is trained by a qualified professional and demonstrates competency
to safely complete the procedures and tasks. Delegation of health-related procedures and
tasks and all training must be documented in the personal care assistance care plan and the
recipient's and personal care assistant's files.
new text end

new text begin (e) For a personal care assistant to provide the health-related procedures and tasks of
tracheostomy suctioning and services to recipients on ventilator support there must be:
new text end

new text begin (1) delegation and training by a registered nurse, certified or licensed respiratory
therapist, or a physician;
new text end

new text begin (2) utilization of clean rather than sterile procedure;
new text end

new text begin (3) specialized training about the health-related procedures and tasks and equipment,
including ventilator operation and maintenance;
new text end

new text begin (4) individualized training regarding the needs of the recipient; and
new text end

new text begin (5) supervision by a qualified professional who is a registered nurse.
new text end

new text begin (f) A personal care assistant may observe and redirect the recipient for episodes
where there is a need for redirection due to behaviors. Training of the personal care
assistant must occur based on the needs of the recipient, the personal care assistance care
plan, and any other support services provided.
new text end

new text begin (g) Instrumental activities of daily living under subdivision 1, paragraph (h).
new text end

new text begin Subd. 3. new text end

new text begin Noncovered personal care assistance services. new text end

new text begin (a) Personal care
assistance services are not eligible for medical assistance payment under this section
when provided:
new text end

new text begin (1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
guardian, licensed foster provider, or responsible party;
new text end

new text begin (2) in lieu of other staffing options in a residential or child care setting;
new text end

new text begin (3) solely as a child care or babysitting service; or
new text end

new text begin (4) without authorization by the commissioner or the commissioner's designee.
new text end

new text begin (b) The following personal care services are not eligible for medical assistance
payment under this section when provided in residential settings:
new text end

new text begin (1) when the provider of home care services who is not related by blood, marriage,
or adoption owns or otherwise controls the living arrangement, including licensed or
unlicensed services; or
new text end

new text begin (2) when personal care assistance services are the responsibility of a residential or
program license holder under the terms of a service agreement and administrative rules.
new text end

new text begin (c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
for medical assistance reimbursement for personal care assistance services under this
section include:
new text end

new text begin (1) sterile procedures;
new text end

new text begin (2) injections of fluids and medications into veins, muscles, or skin;
new text end

new text begin (3) home maintenance or chore services;
new text end

new text begin (4) homemaker services not an integral part of assessed personal care assistance
services needed by a recipient;
new text end

new text begin (5) application of restraints or implementation of procedures under section 245.825;
new text end

new text begin (6) instrumental activities of daily living for children under the age of 18; and
new text end

new text begin (7) assessments for personal care assistance services by personal care assistance
provider agencies or by independently enrolled registered nurses.
new text end

new text begin Subd. 4. new text end

new text begin Assessment for personal care assistance services. new text end

new text begin (a) An assessment
as defined in section 256B.0655, subdivision 1b, must be completed for personal care
assistance services.
new text end

new text begin (b) The following limitations apply to the assessment:
new text end

new text begin (1) a person must be assessed as dependent in an activity of daily living based
on the person's need, on a daily basis, for:
new text end

new text begin (i) cueing and constant supervision to complete the task; or
new text end

new text begin (ii) hands-on assistance to complete the task; and
new text end

new text begin (2) a child may not be found to be dependent in an activity of daily living if because
of the child's age an adult would either perform the activity for the child or assist the child
with the activity. Assistance needed is the assistance appropriate for a typical child of
the same age.
new text end

new text begin (c) Assessment for complex health-related needs must meet the criteria in this
paragraph. During the assessment process, a recipient qualifies as having complex
health-related needs if the recipient has one or more of the interventions that are ordered by
a physician, specified in a personal care assistance care plan, and found in the following:
new text end

new text begin (1) tube feedings requiring:
new text end

new text begin (i) a gastro/jejunostomy tube; or
new text end

new text begin (ii) continuous tube feeding lasting longer than 12 hours per day;
new text end

new text begin (2) wounds described as:
new text end

new text begin (i) stage III or stage IV;
new text end

new text begin (ii) multiple wounds;
new text end

new text begin (iii) requiring sterile or clean dressing changes or a wound vac; or
new text end

new text begin (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
specialized care;
new text end

new text begin (3) parenteral therapy described as:
new text end

new text begin (i) IV therapy more than two times per week lasting longer than four hours for
each treatment; or
new text end

new text begin (ii) total parenteral nutrition (TPN) daily;
new text end

new text begin (4) respiratory interventions including:
new text end

new text begin (i) oxygen required more than eight hours per day;
new text end

new text begin (ii) respiratory vest more than one time per day;
new text end

new text begin (iii) bronchial drainage treatments more than two times per day;
new text end

new text begin (iv) sterile or clean suctioning more than six times per day;
new text end

new text begin (v) dependence on another to apply respiratory ventilation augmentation devises
such as BiPAP and CPAP; and
new text end

new text begin (vi) ventilator dependence under section 256B.0652;
new text end

new text begin (5) insertion and maintenance of catheter including:
new text end

new text begin (i) sterile catheter changes more than one time per month;
new text end

new text begin (ii) clean self-catheterization more than six times per day; or
new text end

new text begin (iii) bladder irrigations;
new text end

new text begin (6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
new text end

new text begin (7) neurological intervention including:
new text end

new text begin (i) seizures more than two times per week and requiring significant physical
assistance to maintain safety; or
new text end

new text begin (ii) swallowing disorders diagnosed by a physician and requiring specialized
assistance from another on a daily basis; and
new text end

new text begin (8) other congenital or acquired diseases creating a need for significantly increased
direct hands-on assistance and interventions in six to eight activities of daily living.
new text end

new text begin (d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
assistance at least four times per week and shows one or more of the following behaviors:
new text end

new text begin (1) physical aggression towards self or others, or destruction of property that requires
the immediate response of another person;
new text end

new text begin (2) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
new text end

new text begin (3) verbally aggressive and resistive to care.
new text end

new text begin Subd. 5. new text end

new text begin Service, support planning, and referral. new text end

new text begin (a) The assessor, with the
recipient or responsible party, shall review the assessment information and determine
referrals for other payers, services, and community supports as appropriate.
new text end

new text begin (b) The recipient must be referred for evaluation, services, or supports that are
appropriate to help meet the recipient's needs including, but not limited to, the following
circumstances:
new text end

new text begin (1) when there is another payer who is responsible to provide the service to meet
the recipient's needs;
new text end

new text begin (2) when the recipient qualifies for assistance due to mental illness or behaviors
under this section, a referral for a mental health diagnostic and functional assessment
must be completed, or referral must be made for other specific mental health services or
other community services;
new text end

new text begin (3) when the recipient is eligible for medical assistance and meets medical assistance
eligibility for a home health aide or skilled nurse visit;
new text end

new text begin (4) when the recipient would benefit from an evaluation for another service; and
new text end

new text begin (5) when there is a more appropriate service to meet the assessed needs.
new text end

new text begin (c) The reimbursement rates for public health nurse visits that relate to the provision
of personal care assistance services under this section and section 256B.0625, subdivision
19a, are:
new text end

new text begin (1) $210.50 for a face-to-face assessment visit;
new text end

new text begin (2) $105.25 for each service update; and
new text end

new text begin (3) $105.25 for each request for a temporary service increase.
new text end

new text begin (d) The rates specified in paragraph (c) must be adjusted to reflect provider rate
increases for personal care assistance services that are approved by the legislature for the
fiscal year ending June 30, 2000, and subsequent fiscal years. Any requirements applied
by the legislature to provider rate increases for personal care assistance services also
apply to adjustments under this paragraph.
new text end

new text begin (e) Effective July 1, 2008, the payment rate for an assessment under this section and
section 256B.0651 shall be reduced by 25 percent when the assessment is not completed
on time and the service agreement documentation is not submitted in time to continue
services. The commissioner shall reduce the amount of the claim for those assessments
that are not submitted on time.
new text end

new text begin Subd. 6. new text end

new text begin Service plan. new text end

new text begin The service plan must be completed by the assessor with the
recipient and responsible party on a form determined by the commissioner and include
a summary of the assessment with a description of the need, authorized amount, and
expected outcomes and goals of personal care assistance services. The recipient and
the provider chosen by the recipient or responsible party must be given a copy of the
completed service plan within ten working days of the assessment. The recipient or
responsible party must be given information by the assessor about the options in the
personal care assistance program to allow for review and decision making.
new text end

new text begin Subd. 7. new text end

new text begin Personal care assistance care plan. new text end

new text begin (a) Each recipient must have a
current personal care assistance care plan based on the service plan in subdivision 6 that is
developed by the qualified professional with the recipient and responsible party. A copy of
the most current personal care assistance care plan is required to be in the recipient's home
and in the recipient's file at the provider agency.
new text end

new text begin (b) The personal care assistance care plan must have the following components:
new text end

new text begin (1) start and end date of the care plan;
new text end

new text begin (2) recipient demographic information, including name and telephone number;
new text end

new text begin (3) emergency numbers, procedures, and a description of measures to address
identified safety and vulnerability issues, including a backup staffing plan;
new text end

new text begin (4) name of responsible party and instructions for contact;
new text end

new text begin (5) description of the recipient's individualized needs for assistance with activities of
daily living, instrumental activities of daily living, health-related tasks, and behaviors; and
new text end

new text begin (6) dated signatures of recipient or responsible party and qualified professional.
new text end

new text begin (c) The personal care assistance care plan must have instructions and comments
about the recipient's needs for assistance and any special instructions or procedures
required. The month-to-month plan for the use of personal care assistance services is part
of the personal care assistance care plan. The personal care assistance care plan must
be completed within the first week after start of services with a personal care provider
agency and must be updated as needed when there is a change in need for personal care
assistance services. A new personal care assistance care plan is required annually at the
time of the reassessment.
new text end

new text begin Subd. 8. new text end

new text begin Communication with recipient's physician. new text end

new text begin The personal care assistance
program requires communication with the recipient's physician about a recipient's assessed
needs for personal care assistance services. The commissioner shall work with the state
medical director to develop options for communication with the recipient's physician.
new text end

new text begin Subd. 9. new text end

new text begin Responsible party; generally. new text end

new text begin (a) "Responsible party" means an
individual who lives with and is capable of providing the support necessary to assist the
recipient to live in the community.
new text end

new text begin (b) A responsible party must be 18 years of age, actively participate in planning and
directing of personal care assistance services, and attend all assessments for the recipient.
new text end

new text begin (c) A responsible party must not have a direct or indirect financial interest in care
provided to the recipient and must not be the:
new text end

new text begin (1) personal care assistant;
new text end

new text begin (2) home care provider agency owner or staff; or
new text end

new text begin (3) county staff acting as part of employment.
new text end

new text begin (d) A licensed family foster parent who lives with the recipient may be the
responsible party as long as the family foster parent meets the other responsible party
requirements.
new text end

new text begin (e) A responsible party is required when:
new text end

new text begin (1) the person is a minor according to section 524.5-102, subdivision 10;
new text end

new text begin (2) the person is an incapacitated adult according to section 524.5-102, subdivision
6, resulting in a court-appointed guardian; or
new text end

new text begin (3) the assessment according to section 256B.0655, subdivision 1b, determines that
the recipient is in need of a responsible party to direct the recipient's care.
new text end

new text begin (f) There may be two persons designated as the responsible party for reasons such as
divided households and court-ordered custodies. Each person named as responsible party
must meet the program criteria and responsibilities including living with the recipient at
the time they are serving as the responsible party.
new text end

new text begin (g) The recipient or the recipient's legal representative shall appoint a responsible
party if necessary to direct and supervise the care provided to the recipient. The
responsible party must be identified at the time of assessment and listed on the recipient's
service agreement and personal care assistance care plan.
new text end

new text begin Subd. 10. new text end

new text begin Responsible party; duties; delegation. new text end

new text begin (a) A responsible party shall
enter into a written agreement with a personal care assistance provider agency, on a form
determined by the commissioner, to perform the following duties:
new text end

new text begin (1) live with the individual who is receiving personal care assistance services;
new text end

new text begin (2) be available while care is provided in a method agreed upon by the individual
or the individual's legal representative and documented in the recipient's personal care
assistance care plan;
new text end

new text begin (3) monitor personal care assistance services to ensure the recipient's personal care
assistance care plan is being followed; and
new text end

new text begin (4) review and sign personal care assistance time sheets after services are provided
to provide verification of the personal care assistance services.
new text end

new text begin Failure to provide the support required by the recipient must result in a referral to the
county common entry point.
new text end

new text begin (b) Responsible parties who are parents of minors or guardians of minors or
incapacitated persons may delegate the responsibility to another adult who is not the
personal care assistant during a temporary absence of at least 24 hours but not more
than six months. The person delegated as a responsible party must be able to meet the
definition of the responsible party, except that the delegated responsible party is required
to reside with the recipient only while serving as the responsible party. The responsible
party must ensure that the delegate performs the functions of the responsible party, is
identified at the time of the assessment, and is listed on the personal care assistance
care plan. The responsible party must communicate to the personal care assistance
provider agency about the need for a delegate responsible party, including the name of the
delegated responsible party, dates the delegated responsible party will be living with the
recipient, and contact numbers.
new text end

new text begin Subd. 11. new text end

new text begin Personal care assistant; requirements. new text end

new text begin (a) A personal care assistant
must meet the following requirements:
new text end

new text begin (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
of age with these additional requirements:
new text end

new text begin (i) supervision by a qualified professional every 60 days; and
new text end

new text begin (ii) employment by only one personal care assistance provider agency responsible
for compliance with current labor laws;
new text end

new text begin (2) be employed by a personal care assistance provider agency;
new text end

new text begin (3) enroll with the department as a personal care assistant after clearing a background
study. Before a personal care assistant provides services, the personal care assistance
provider agency must initiate a background study on the personal care assistant under
chapter 245C, and the personal care assistance provider agency must have received a
notice from the commissioner that the personal care assistant is:
new text end

new text begin (i) not disqualified under section 245C.14; or
new text end

new text begin (ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
new text end

new text begin (4) be able to effectively communicate with the recipient and personal care
assistance provider agency;
new text end

new text begin (5) be able to provide covered personal care assistance services according to the
recipient's personal care assistance care plan, respond appropriately to recipient needs,
and report changes in the recipient's condition to the supervising qualified professional
or physician;
new text end

new text begin (6) not be a consumer of personal care assistance services;
new text end

new text begin (7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
new text end

new text begin (8) complete standardized training as determined by the commissioner before
completing enrollment. Personal care assistant training must include successful completion
of the following training components: basic first aid, vulnerable adult, child maltreatment,
OSHA universal precautions, basic roles and responsibilities of personal care assistants
including information about assistance with lifting and transfers for recipients, emergency
preparedness, orientation to positive behavioral practices, fraud issues, and completion of
time sheets. Upon completion of the training components, the personal care assistant must
demonstrate the competency to provide assistance to recipients;
new text end

new text begin (9) complete training and orientation on the needs of the recipient within the first
seven days after the services begin; and
new text end

new text begin (10) be limited to providing and being paid for up to 310 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with.
new text end

new text begin (b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
new text end

new text begin (c) Persons who do not qualify as a personal care assistant include parents and
stepparents of minors, spouses, paid legal guardians, foster care providers, except as
otherwise allowed in section 256B.0625, subdivision 19a, or staff of a residential setting.
new text end

new text begin Subd. 12. new text end

new text begin Documentation of personal care assistance services provided. new text end

new text begin (a)
Personal care assistance services for a recipient must be documented daily, on a time sheet
form approved by the commissioner by each personal care assistant. All documentation
may be Web-based or electronic or paper documents. The completed form must be
submitted on a monthly basis to the provider agency and kept in the recipient's health
record.
new text end

new text begin (b) The activity documentation must correspond to the personal care assistance care
plan and be reviewed by the qualified professional.
new text end

new text begin (c) The personal care assistant time sheet must be on a form approved by the
commissioner documenting time the personal care assistant provides services in the home.
The following criteria must be included in the time sheet:
new text end

new text begin (1) full name of personal care assistant and individual provider number;
new text end

new text begin (2) provider name and telephone numbers;
new text end

new text begin (3) full name of recipient;
new text end

new text begin (4) consecutive dates, including month, day, and year, and arrival and departure
time with a.m. or p.m. notations;
new text end

new text begin (5) signatures of recipient or the responsible party;
new text end

new text begin (6) personal signature of the personal care assistant;
new text end

new text begin (7) any shared care provided, if applicable;
new text end

new text begin (8) a statement that it is a federal crime to provide false information on personal
care service billings for medical assistance payments; and
new text end

new text begin (9) dates and location of recipient stays in a hospital, care facility, or incarceration.
new text end

new text begin Subd. 13. new text end

new text begin Qualified professional; qualifications. new text end

new text begin (a) The qualified professional
must be employed by a personal care assistance provider agency and meet the definition
under section 256B.0625, subdivision 19c. Before a qualified professional provides
services, the personal care assistance provider agency must initiate a background study on
the qualified professional under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the qualified professional:
new text end

new text begin (1) is not disqualified under section 245C.14; or
new text end

new text begin (2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.
new text end

new text begin (b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of
personal care assistance services. The qualified professional shall:
new text end

new text begin (1) develop and monitor with the recipient a personal care assistance care plan based
on the service plan and individualized needs of the recipient;
new text end

new text begin (2) develop and monitor with the recipient a monthly plan for the use of personal
care assistance services;
new text end

new text begin (3) review documentation of personal care assistance services provided;
new text end

new text begin (4) provide training and ensure competency for the personal care assistant in the
individual needs of the recipient; and
new text end

new text begin (5) document all training, communication, evaluations, and needed actions to
improve performance of the personal care assistants.
new text end

new text begin (c) The qualified professional shall complete the training approved by the
commissioner with basic information about the personal care assistance program within
six months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required trainings as an employee with a personal
care assistance provider agency do not need to repeat the required trainings if they are
hired by another agency, if they have completed the training within the last three years.
new text end

new text begin Subd. 14. new text end

new text begin Qualified professional; duties. new text end

new text begin (a) All personal care assistants must
be supervised by a qualified professional.
new text end

new text begin (b) Through direct training, observation, return demonstrations, and consultation
with the staff and the recipient, the qualified professional must ensure and document
that the personal care assistant is:
new text end

new text begin (1) capable of providing the required personal care assistance services;
new text end

new text begin (2) knowledgeable about the plan of personal care assistance services before services
are performed; and
new text end

new text begin (3) able to identify conditions that should be immediately brought to the attention of
the qualified professional.
new text end

new text begin (c) The qualified professional shall evaluate the personal care assistant within
the first 14 days of starting to provide services for a recipient except for the personal
care assistance choice option under subdivision 19. The qualified professional shall
evaluate the personal care assistance services for a recipient through direct observation of
a personal care assistant's work:
new text end

new text begin (1) at least every 90 days thereafter for the first year of a recipient's services; and
new text end

new text begin (2) every 120 days after the first year of a recipient's service or whenever needed for
response to a recipient's request for increased supervision of the personal care assistance
staff.
new text end

new text begin (d) Communication with the recipient is a part of the evaluation process of the
personal care assistance staff.
new text end

new text begin (e) At each supervisory visit, the qualified professional shall evaluate personal care
assistance services including the following information:
new text end

new text begin (1) satisfaction level of the recipient with personal care assistance services;
new text end

new text begin (2) review of the month-to-month plan for use of personal care assistance services;
new text end

new text begin (3) review of documentation of personal care assistance services provided;
new text end

new text begin (4) whether the personal care assistance services are meeting the goals of the service
as stated in the personal care assistance care plan and service plan;
new text end

new text begin (5) a written record of the results of the evaluation and actions taken to correct any
deficiencies in the work of a personal care assistant; and
new text end

new text begin (6) revision of the personal care assistance care plan as necessary in consultation
with the recipient or responsible party, to meet the needs of the recipient.
new text end

new text begin (f) The qualified professional shall complete the required documentation in the
agency recipient and employee files and the recipient's home, including the following
documentation:
new text end

new text begin (1) the personal care assistance care plan based on the service plan and individualized
needs of the recipient;
new text end

new text begin (2) a month-to-month plan for use of personal care assistance services;
new text end

new text begin (3) changes in need of the recipient requiring a change to the level of service and the
personal care assistance care plan;
new text end

new text begin (4) evaluation results of supervision visits and identified issues with personal care
assistance staff with actions taken;
new text end

new text begin (5) all communication with the recipient and personal care assistance staff; and
new text end

new text begin (6) hands-on training or individualized training for the care of the recipient.
new text end

new text begin (g) The documentation in paragraph (f) must be done on agency forms.
new text end

new text begin (h) The services that are not eligible for payment as qualified professional services
include:
new text end

new text begin (1) direct professional nursing tasks that could be assessed and authorized as skilled
nursing tasks;
new text end

new text begin (2) supervision of personal care assistance completed by telephone;
new text end

new text begin (3) agency administrative activities;
new text end

new text begin (4) training other than the individualized training required to provide care for a
recipient; and
new text end

new text begin (5) any other activity that is not described in this section.
new text end

new text begin Subd. 15. new text end

new text begin Flexible use. new text end

new text begin (a) "Flexible use" means the scheduled use of authorized
hours of personal care assistance services, which vary within a service authorization
period covering no more than six months, in order to more effectively meet the needs and
schedule of the recipient. Each 12-month service agreement is divided into two six-month
authorization date spans. No more than 75 percent of the total authorized units for a
12-month service agreement may be used in a six-month date span.
new text end

new text begin (b) Authorization of flexible use occurs during the authorization process under
section 256B.0652. The flexible use of authorized hours does not increase the total
amount of authorized hours available to a recipient. The commissioner shall not authorize
additional personal care assistance services to supplement a service authorization that
is exhausted before the end date under a flexible service use plan, unless the assessor
determines a change in condition and a need for increased services is established.
Authorized hours not used within the six-month period must not be carried over to another
time period.
new text end

new text begin (c) A recipient who has terminated personal care assistance services before the end
of the 12-month authorization period must not receive additional hours upon reapplying
during the same 12-month authorization period, except if a change in condition is
documented. Services must be prorated for the remainder of the 12-month authorization
period based on the first six-month assessment.
new text end

new text begin (d) The recipient, responsible party, and qualified professional must develop a
written month-to-month plan of the projected use of personal care assistance services that
is part of the personal care assistance care plan and ensures:
new text end

new text begin (1) that the health and safety needs of the recipient are met throughout both date
spans of the authorization period; and
new text end

new text begin (2) that the total authorized amount of personal care assistance services for each date
span must not be used before the end of each date span in the authorization period.
new text end

new text begin (e) The personal care assistance provider agency shall monitor the use of personal
care assistance services to ensure health and safety needs of the recipient are met
throughout both date spans of the authorization period. The commissioner or the
commissioner's designee shall provide written notice to the provider and the recipient or
responsible party when a recipient is at risk of exceeding the personal care assistance
services prior to the end of the six-month period.
new text end

new text begin (f) Misuse and abuse of the flexible use of personal care assistance services resulting
in the overuse of units in a manner where the recipient will not have enough units to meet
their needs for assistance and ensure health and safety for the entire six-month date span
may lead to an action by the commissioner. The commissioner may take action including,
but not limited to: (1) restricting recipients to service authorizations of no more than one
month in duration; (2) requiring the recipient to have a responsible party; and (3) requiring
a qualified professional to monitor and report services on a monthly basis.
new text end

new text begin Subd. 16. new text end

new text begin Shared services. new text end

new text begin (a) Medical assistance payments for shared personal
care assistance services are limited according to this subdivision.
new text end

new text begin (b) Shared service is the provision of personal care assistance services by a personal
care assistant to two or three recipients, eligible for medical assistance, who voluntarily
enter into an agreement to receive services at the same time and in the same setting.
new text end

new text begin (c) For the purposes of this subdivision, "setting" means:
new text end

new text begin (1) the home residence or family foster care home of one or more of the individual
recipients; or
new text end

new text begin (2) a child care program licensed under chapter 245A or operated by a local school
district or private school.
new text end

new text begin (d) Shared personal care assistance services follow the same criteria for covered
services as subdivision 2.
new text end

new text begin (e) Noncovered shared personal care assistance services include the following:
new text end

new text begin (1) services for more than three recipients by one personal care assistant at one time;
new text end

new text begin (2) staff requirements for child care programs under chapter 245C;
new text end

new text begin (3) caring for multiple recipients in more than one setting;
new text end

new text begin (4) additional units of personal care assistance based on the selection of the option;
and
new text end

new text begin (5) use of more than one personal care assistance provider agency for the shared
care services.
new text end

new text begin (f) The option of shared personal care assistance is elected by the recipient or the
responsible party with the assistance of the assessor. The option must be determined
appropriate based on the ages of the recipients, compatibility, and coordination of their
assessed care needs. The recipient or the responsible party, in conjunction with the
qualified professional, shall arrange the setting and grouping of shared services based
on the individual needs and preferences of the recipients. The personal care assistance
provider agency shall offer the recipient or the responsible party the option of shared or
one-on-one personal care assistance services or a combination of both. The recipient or
the responsible party may withdraw from participating in a shared services arrangement at
any time.
new text end

new text begin (g) Authorization for the shared service option must be determined by the
commissioner based on the criteria that the shared service is appropriate to meet all of the
recipients' needs and their health and safety is maintained. The authorization of shared
services is part of the overall authorization of personal care assistance services. Nothing
in this subdivision must be construed to reduce the total number of hours authorized for
an individual recipient.
new text end

new text begin (h) A personal care assistant providing shared personal care assistance services must:
new text end

new text begin (1) receive training specific for each recipient served; and
new text end

new text begin (2) follow all required documentation requirements for time and services provided.
new text end

new text begin (i) A qualified professional shall:
new text end

new text begin (1) evaluate the ability of the personal care assistant to provide services for all of
the recipients in a shared setting;
new text end

new text begin (2) visit the shared setting as services are being provided at least once every six
months or whenever needed for response to a recipient's request for increased supervision
of the personal care assistance staff;
new text end

new text begin (3) provide ongoing monitoring and evaluation of the effectiveness and
appropriateness of the shared services;
new text end

new text begin (4) develop a contingency plan with each of the recipients which accounts for
absence of the recipient in a share services setting due to illness or other circumstances;
new text end

new text begin (5) obtain permission from each of the recipients who are sharing a personal care
assistant for number of shared hours for services provided inside and outside the home
residence; and
new text end

new text begin (6) document the training completed by the personal care assistants specific to the
shared setting and recipients sharing services.
new text end

new text begin Subd. 17. new text end

new text begin Shared services; rates. new text end

new text begin The commissioner shall provide a rate system for
shared personal care assistance services. For two persons sharing services, the rate paid
to a provider must not exceed one and one-half times the rate paid for serving a single
individual, and for three persons sharing services, the rate paid to a provider must not
exceed twice the rate paid for serving a single individual. These rates apply only when all
of the criteria for the shared care personal care assistance service have been met.
new text end

new text begin Subd. 18. new text end

new text begin Personal care assistance choice option; generally. new text end

new text begin (a) The
commissioner may allow a recipient of personal care assistance services to use a fiscal
intermediary to assist the recipient in paying and accounting for medically necessary
covered personal care assistance services. Unless otherwise provided in this section, all
other statutory and regulatory provisions relating to personal care assistance services apply
to a recipient using the personal care assistance choice option.
new text end

new text begin (b) Personal care assistance choice is an option of the personal care assistance
program that allows the recipient who receives personal care assistance services to be
responsible for the hiring, training, scheduling, and firing of personal care assistants. This
program offers greater control and choice for the recipient in who provides the personal
care assistance service and when the service is scheduled. The recipient or the recipient's
responsible party must choose a personal care assistance choice provider agency as
a fiscal intermediary. This personal care assistance choice provider agency manages
payroll, invoices the state, is responsible for all payroll related taxes and insurance, and is
responsible for providing the consumer training and support in managing the recipient's
personal care assistance services.
new text end

new text begin Subd. 19. new text end

new text begin Personal care assistance choice option; qualifications; duties. new text end

new text begin (a)
Under personal care assistance choice, the recipient or responsible party shall:
new text end

new text begin (1) recruit, hire, and terminate personal care assistants and a qualified professional;
new text end

new text begin (2) develop a personal care assistance care plan based on the assessed needs
and addressing the health and safety of the recipient with the assistance of a qualified
professional as needed;
new text end

new text begin (3) orient and train the personal care assistant with assistance as needed from the
qualified professional;
new text end

new text begin (4) supervise and evaluate the personal care assistant with the qualified professional,
who is required to visit the recipient at least every 180 days;
new text end

new text begin (5) monitor and verify in writing and report to the personal care assistance choice
agency the number of hours worked by the personal care assistant and the qualified
professional;
new text end

new text begin (6) engage in an annual face-to-face reassessment to determine continuing eligibility
and service authorization; and
new text end

new text begin (7) use the same personal care assistance choice provider agency if shared personal
assistance care is being used.
new text end

new text begin (b) The personal care assistance choice provider agency shall:
new text end

new text begin (1) meet all personal care assistance provider agency standards;
new text end

new text begin (2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;
new text end

new text begin (3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
professional, or the personal care assistant; and
new text end

new text begin (4) ensure arm's-length transactions without undue influence or coercion with the
recipient and personal care assistant.
new text end

new text begin (c) The duties of the personal care assistance choice provider agency are to:
new text end

new text begin (1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including, but not limited to, purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including, but not
limited to, workers' compensation and unemployment insurance;
new text end

new text begin (2) bill the medical assistance program for personal care assistance services and
qualified professional services;
new text end

new text begin (3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;
new text end

new text begin (4) pay the personal care assistant and qualified professional based on actual hours
of services provided;
new text end

new text begin (5) withhold and pay all applicable federal and state taxes;
new text end

new text begin (6) verify and keep records of hours worked by the personal care assistant and
qualified professional;
new text end

new text begin (7) make the arrangements and pay taxes and other benefits, if any; and comply with
any legal requirements for a Minnesota employer;
new text end

new text begin (8) enroll in the medical assistance program as a personal care assistance choice
agency; and
new text end

new text begin (9) enter into a written agreement as specified in subdivision 20 before services
are provided.
new text end

new text begin Subd. 20. new text end

new text begin Personal care assistance choice option; administration. new text end

new text begin (a) Before
services commence under the personal care assistance choice option, and annually
thereafter, the personal care assistance choice provider agency, recipient, or responsible
party, each personal care assistant, and the qualified professional shall enter into a written
agreement. The agreement must include at a minimum:
new text end

new text begin (1) duties of the recipient, qualified professional, personal care assistant, and
personal care assistance choice provider agency;
new text end

new text begin (2) salary and benefits for the personal care assistant and the qualified professional;
new text end

new text begin (3) administrative fee of the personal care assistance choice provider agency and
services paid for with that fee, including background study fees;
new text end

new text begin (4) grievance procedures to respond to complaints;
new text end

new text begin (5) procedures for hiring and terminating the personal care assistant; and
new text end

new text begin (6) documentation requirements including, but not limited to, time sheets, activity
records, and the personal care assistance care plan.
new text end

new text begin (b) Except for the administrative fee of the personal care assistance choice provider
agency as reported on the written agreement, the remainder of the rates paid to the personal
care assistance choice provider agency must be used to pay for the salary and benefits for
the personal care assistant or the qualified professional. The provider agency must use
a minimum of 70 percent of the revenue generated by the medical assistance rate for
personal care assistance services for employee personal care assistant wages and benefits.
new text end

new text begin (c) The commissioner shall deny, revoke, or suspend the authorization to use the
personal care assistance choice option if:
new text end

new text begin (1) it has been determined by the qualified professional or public health nurse that
the use of this option jeopardizes the recipient's health and safety;
new text end

new text begin (2) the parties have failed to comply with the written agreement specified in this
subdivision;
new text end

new text begin (3) the use of the option has led to abusive or fraudulent billing for personal care
assistance services; or
new text end

new text begin (4) the department terminates the personal care assistance choice option.
new text end

new text begin (d) The recipient or responsible party may appeal the commissioner's decision in
paragraph (c) according to section 256.045. The denial, revocation, or suspension to
use the personal care assistance choice option must not affect the recipient's authorized
level of personal care assistance services.
new text end

new text begin Subd. 21. new text end

new text begin Requirements for initial enrollment of personal care assistance
provider agencies. new text end

new text begin (a) All personal care assistance provider agencies must provide, at the
time of enrollment as a personal care assistance provider agency in a format determined
by the commissioner, information and documentation that includes, but is not limited to,
the following:
new text end

new text begin (1) the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;
new text end

new text begin (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;
new text end

new text begin (3) proof of fidelity bond coverage in the amount of $20,000;
new text end

new text begin (4) proof of workers' compensation insurance coverage;
new text end

new text begin (5) a description of the personal care assistance provider agency's organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directors, owners, or staff to other service providers;
new text end

new text begin (6) a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery;
and employee and consumer safety including process for notification and resolution
of consumer grievances, identification and prevention of communicable diseases, and
employee misconduct;
new text end

new text begin (7) copies of all other forms the personal care assistance provider agency uses in
the course of daily business including, but not limited to:
new text end

new text begin (i) a copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services approved
by the commissioner, and a letter requesting approval of the personal care assistance
provider agency's nonstandard time sheet;
new text end

new text begin (ii) the personal care assistance provider agency's template for the personal care
assistance care plan; and
new text end

new text begin (iii) the personal care assistance provider agency's template and the written
agreement in subdivision 20 for recipients using the personal care assistance choice
option, if applicable;
new text end

new text begin (8) a list of all trainings and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;
new text end

new text begin (9) documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;
new text end

new text begin (10) documentation of the agency's marketing practices;
new text end

new text begin (11) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services; and
new text end

new text begin (12) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services
for employee personal care assistant wages and benefits: 70 percent of revenue in the
personal care assistance choice option and 65 percent of revenue from other personal
care assistance services.
new text end

new text begin (b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider
agency enrolls as a vendor or upon request from the commissioner. The commissioner
shall collect the information specified in paragraph (a) from all personal care assistance
providers beginning upon enactment of this section.
new text end

new text begin (c) All personal care assistance provider agencies shall complete mandatory training
as determined by the commissioner before enrollment as a provider. Personal care
assistance provider agencies are required to send all owners, qualified professionals
employed by the agency, and all other managing employees to the initial and subsequent
trainings. Personal care assistance provider agency billing staff shall complete training
about personal care assistance program financial management. This training is effective
upon enactment of this section. Any personal care assistance provider agency enrolled
before that date shall, if it has not already, complete the provider training within 18 months
of the effective date of this section. Any new owners, new qualified professionals, and new
managing employees are required to complete mandatory training as a requisite of hiring.
new text end

new text begin Subd. 22. new text end

new text begin Annual review for personal care providers. new text end

new text begin (a) All personal care
assistance provider agencies shall resubmit, on an annual basis, the information specified
in subdivision 21, in a format determined by the commissioner, and provide a copy of the
personal care assistance provider agency's most current version of its grievance policies
and procedures along with a written record of grievances and resolutions of the grievances
that the personal care assistance provider agency has received in the previous year and any
other information requested by the commissioner.
new text end

new text begin (b) The commissioner shall send annual review notification to personal care
assistance provider agencies 30 days prior to renewal. The notification must:
new text end

new text begin (1) list the materials and information the personal care assistance provider agency is
required to submit;
new text end

new text begin (2) provide instructions on submitting information to the commissioner; and
new text end

new text begin (3) provide a due date by which the commissioner must receive the requested
information.
new text end

new text begin Personal care assistance provider agencies shall submit required documentation for
annual review within 30 days of notification from the commissioner. If no documentation
is submitted, the personal care assistance provider agency enrollment number must be
terminated or suspended.
new text end

new text begin (c) Personal care assistance provider agencies also currently licensed under
Minnesota Rules, part 4668.0012, as a class A provider or currently certified for
participation in Medicare as a home health agency are deemed in compliance with
the personal care assistance requirements for enrollment, annual review process, and
documentation.
new text end

new text begin Subd. 23. new text end

new text begin Enrollment requirements following termination. new text end

new text begin (a) A terminated
personal care assistance provider agency, including all named individuals on the current
enrollment disclosure form and known or discovered affiliates of the personal care
assistance provider agency, is not eligible to enroll as a personal care assistance provider
agency for two years following the termination.
new text end

new text begin (b) After the two-year period in paragraph (a), if the provider seeks to reenroll
as a personal care assistance provider agency, the personal care assistance provider
agency must be placed on a one-year probation period, beginning after completion of
the following:
new text end

new text begin (1) the department's provider trainings under this section; and
new text end

new text begin (2) initial enrollment requirements under subdivision 21.
new text end

new text begin (c) During the probationary period the commissioner shall complete site visits and
request submission of documentation to review compliance with program policy.
new text end

new text begin Subd. 24. new text end

new text begin Personal care assistance provider agency; general duties. new text end

new text begin A personal
care assistance provider agency shall:
new text end

new text begin (1) enroll as a Medicaid provider meeting all provider standards, including
completion of the required provider training;
new text end

new text begin (2) comply with general medical assistance coverage requirements;
new text end

new text begin (3) demonstrate compliance with law and policies of the personal care assistance
program to be determined by the commissioner;
new text end

new text begin (4) comply with background study requirements;
new text end

new text begin (5) verify and keep records of hours worked by the personal care assistant and
qualified professional;
new text end

new text begin (6) market agency services only through printed information in brochures and on
Web sites and not engage in any agency-initiated direct contact or marketing in person, by
phone, or other electronic means to potential recipients, guardians, or family members;
new text end

new text begin (7) pay the personal care assistant and qualified professional based on actual hours
of services provided;
new text end

new text begin (8) withhold and pay all applicable federal and state taxes;
new text end

new text begin (9) document that the agency uses a minimum of 65 percent of the revenue generated
by the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits;
new text end

new text begin (10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;
new text end

new text begin (11) enter into a written agreement under subdivision 20 before services are provided;
new text end

new text begin (12) report suspected neglect and abuse to the common entry point according to
section 256B.0651; and
new text end

new text begin (13) provide the recipient with a copy of the home care bill of rights at start of
service.
new text end

new text begin Subd. 25. new text end

new text begin Personal care assistance provider agency; background studies.
new text end

new text begin Personal care assistance provider agencies enrolled to provide personal care assistance
services under the medical assistance program shall comply with the following:
new text end

new text begin (1) owners who have a five percent interest or more and all managerial officials are
subject to a background study as provided in chapter 245C. This applies to currently
enrolled personal care assistance provider agencies and those agencies seeking enrollment
as a personal care assistance provider agency. Managing employee has the same meaning
as Code of Federal Regulations, title 42, section 455. An organization is barred from
enrollment if:
new text end

new text begin (i) the organization has not initiated background studies on owners and managing
employees; or
new text end

new text begin (ii) the organization has initiated background studies on owners and managing
employees, but the commissioner has sent the organization a notice that an owner or
managing employee of the organization has been disqualified under section 245C.14,
and the owner or managing employee has not received a set aside of the disqualification
under section 245C.22;
new text end

new text begin (2) a background study must be initiated and completed for all qualified
professionals; and
new text end

new text begin (3) a background study must be initiated and completed for all personal care
assistants.
new text end

new text begin Subd. 26. new text end

new text begin Personal care assistance provider agency; communicable disease
prevention. new text end

new text begin A personal care assistance provider agency shall establish and implement
policies and procedures for prevention, control, and investigation of infections and
communicable diseases according to current nationally recognized infection control
practices or guidelines established by the United States Centers for Disease Control and
Prevention, as well as applicable regulations of other federal or state agencies.
new text end

new text begin Subd. 27. new text end

new text begin Personal care assistance provider agency; ventilator training. new text end

new text begin The
personal care assistance provider agency is required to provide training for the personal
care assistant responsible for working with a recipient who is ventilator dependent. All
training must be administered by a respiratory therapist, nurse, or physician. Qualified
professional supervision by a nurse must be completed and documented on file in the
personal care assistant's employment record and the recipient's health record. If offering
personal care services to a ventilator-dependent recipient, the personal care assistance
provider agency shall demonstrate the ability to:
new text end

new text begin (1) train the personal care assistant;
new text end

new text begin (2) supervise the personal care assistant in ventilator operation and maintenance; and
new text end

new text begin (3) supervise the recipient and responsible party in ventilator operation and
maintenance.
new text end

new text begin Subd. 28. new text end

new text begin Personal care assistance provider agency; required documentation.
new text end

new text begin Required documentation must be completed and kept in the personal care assistance
provider agency file or the recipient's home residence. The required documentation
consists of:
new text end

new text begin (1) employee files, including:
new text end

new text begin (i) applications for employment;
new text end

new text begin (ii) background study requests and results;
new text end

new text begin (iii) orientation records about the agency policies;
new text end

new text begin (iv) trainings completed with demonstration of competence;
new text end

new text begin (v) supervisory visits;
new text end

new text begin (vi) evaluations of employment; and
new text end

new text begin (vii) signature on fraud statement;
new text end

new text begin (2) recipient files, including:
new text end

new text begin (i) demographics;
new text end

new text begin (ii) emergency contact information and emergency backup plan;
new text end

new text begin (iii) medical assistance service plan;
new text end

new text begin (iv) personal care assistance care plan;
new text end

new text begin (v) month-to-month service use plan;
new text end

new text begin (vi) all communication records;
new text end

new text begin (vii) start of service information, including the written agreement with recipient; and
new text end

new text begin (viii) date the home care bill of rights was given to the recipient;
new text end

new text begin (3) agency policy manual, including:
new text end

new text begin (i) policies for employment and termination;
new text end

new text begin (ii) grievance policies with resolution of consumer grievances;
new text end

new text begin (iii) staff and consumer safety;
new text end

new text begin (iv) staff misconduct; and
new text end

new text begin (v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
resolution of consumer grievances;
new text end

new text begin (4) time sheets for each personal care assistant along with completed activity sheets
for each recipient served; and
new text end

new text begin (5) agency marketing and advertising materials and documentation of marketing
activities and costs.
new text end

new text begin Subd. 29. new text end

new text begin Transitional assistance. new text end

new text begin The commissioner, counties, and personal care
assistance providers shall work together to provide transitional assistance for recipients
and families to come into compliance with the new live-in responsible party requirements
of this section and ensure the personal care assistance services are not provided by the
housing provider. The commissioner and counties shall provide this assistance until July
1, 2010.
new text end

new text begin Subd. 30. new text end

new text begin Notice of service changes to recipients. new text end

new text begin All recipients who will be
affected by the changes in medical assistance home care services must be provided notice
of the changes at least 30 days before the effective date of the change. The notice shall
include how to get further information on the changes, how to get help to obtain other
services, if eligible, and appeal rights.
new text end

Sec. 32.

Minnesota Statutes 2008, section 256B.0911, subdivision 1, is amended to
read:

Subdivision 1.

Purpose and goal.

(a) The purpose of long-term care consultation
services is to assist persons with long-term or chronic care needs in making long-term
care decisions and selecting options that meet their needs and reflect their preferences.
The availability of, and access to, information and other types of assistance new text begin , including
assessment and support planning, new text end is also intended to prevent or delay certified nursing
facility placements and to provide transition assistance after admission. Further, the goal
of these services is to contain costs associated with unnecessary certified nursing facility
admissions. new text begin Long-term consultation services must be available to any person regardless
of public program eligibility. new text end The deleted text begin commissioners deleted text end new text begin commissioner new text end of human services deleted text begin and
health deleted text end shall seek to maximize use of available federal and state funds and establish the
broadest program possible within the funding available.

(b) These services must be coordinated with deleted text begin services deleted text end new text begin long-term care options
counseling new text end provided under section 256.975, subdivision 7, and deleted text begin with services provided by
other public and private agencies in the community deleted text end new text begin section 256.01, subdivision 24, for
telephone assistance and follow up and new text end to offer a variety of cost-effective alternatives
to persons with disabilities and elderly persons. The county new text begin or tribal new text end agency providing
long-term care consultation services shall encourage the use of volunteers from families,
religious organizations, social clubs, and similar civic and service organizations to provide
community-based services.

Sec. 33.

Minnesota Statutes 2008, section 256B.0911, subdivision 1a, is amended to
read:

Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) "Long-term care consultation services" means:

(1) deleted text begin providing information and education to the general public regarding availability
of the services authorized under this section;
deleted text end

deleted text begin (2) an intake process that provides access to the services described in this section;
deleted text end

deleted text begin (3) assessment of the health, psychological, and social needs of referred individuals;
deleted text end

deleted text begin (4) deleted text end assistance in identifying services needed to maintain an individual in the deleted text begin least
restrictive deleted text end new text begin most inclusive new text end environment;

deleted text begin (5) deleted text end new text begin (2) new text end providing recommendations on cost-effective community services that are
available to the individual;

deleted text begin (6) deleted text end new text begin (3) new text end development of an individual's new text begin person-centered new text end community support plan;

deleted text begin (7) deleted text end new text begin (4) new text end providing information regarding eligibility for Minnesota health care
programs;

new text begin (5) face-to-face long-term care consultation assessments, which may be completed
in a hospital, nursing facility, intermediate care facility for persons with developmental
disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
residence;
new text end

deleted text begin (8) preadmission deleted text end new text begin (6) federally mandated new text end screening to determine the need for
a deleted text begin nursing facility deleted text end new text begin institutional new text end level of care new text begin under section 256B.0911, subdivision 4,
paragraph (a) new text end ;

deleted text begin (9) preliminary deleted text end new text begin (7) new text end determination of deleted text begin Minnesota health care programs deleted text end new text begin home and
community-based waiver service new text end eligibility new text begin including level of care determination new text end for
individuals who need deleted text begin a nursing facility deleted text end new text begin an institutional new text end level of care new text begin as defined under
section 144.0724, subdivision 11, or 256B.092 new text end , new text begin service eligibility including state plan
home care services identified in section 256B.0625, subdivisions 6, 7, and 19, paragraphs
(a) and (c), based on assessment and support plan development new text end with appropriate referrals
deleted text begin for final determination deleted text end ;

deleted text begin (10) deleted text end new text begin (8) new text end providing recommendations for nursing facility placement when there are
no cost-effective community services available; and

deleted text begin (11) deleted text end new text begin (9) new text end assistance to transition people back to community settings after facility
admission.

new text begin (b) "Long-term options counseling" means the services provided by the linkage
lines as mandated by sections 256.01 and 256.975, subdivision 7, and also includes
telephone assistance and follow up once a long-term care consultation assessment has
been completed.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end "Minnesota health care programs" means the medical assistance program
under chapter 256B and the alternative care program under section 256B.0913.

new text begin (d) "Lead agencies" means counties or a collaboration of counties, tribes, and health
plans administering long-term care consultation assessment and support planning services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 34.

Minnesota Statutes 2008, section 256B.0911, is amended by adding a
subdivision to read:

new text begin Subd. 2b. new text end

new text begin Certified assessors. new text end

new text begin (a) Beginning January 1, 2011, each lead agency
shall use certified assessors who have completed training and certification process
determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
best practices in assessment and support planning including person-centered planning
principals and have a common set of skills that must ensure consistency and equitable
access to services statewide.
new text end

new text begin (b) Certified assessors are persons with a minimum of a bachelor's degree in social
work, nursing with a public health nursing certificate, or other closely related field with at
least one year of home and community-based experience or a two-year registered nursing
degree with at least three years of home and community-based experience that have
received training and certification specific to assessment and consultation for long-term
care services in the state.
new text end

Sec. 35.

Minnesota Statutes 2008, section 256B.0911, is amended by adding a
subdivision to read:

new text begin Subd. 2c. new text end

new text begin Assessor training and certification. new text end

new text begin The commissioner shall develop a
curriculum and an assessor certification process to begin no later than January 1, 2010.
All existing lead agency staff designated to provide the services defined in subdivision
1a must be certified by December 30, 2010. Each lead agency is required to ensure that
they have sufficient numbers of certified assessors to provide long-term consultation
assessment and support planning within the timelines and parameters of the service by
January 1, 2011. Certified assessors are required to be recertified every three years.
new text end

Sec. 36.

Minnesota Statutes 2008, section 256B.0911, subdivision 3, is amended to
read:

Subd. 3.

Long-term care consultation team.

(a) new text begin Until January 1, 2011, new text end a long-term
care consultation team shall be established by the county board of commissioners. Each
local consultation team shall consist of at least one social worker and at least one public
health nurse from their respective county agencies. The board may designate public
health or social services as the lead agency for long-term care consultation services. If a
county does not have a public health nurse available, it may request approval from the
commissioner to assign a county registered nurse with at least one year experience in
home care to participate on the team. Two or more counties may collaborate to establish
a joint local consultation team or teams.

(b) The team is responsible for providing long-term care consultation services to
all persons located in the county who request the services, regardless of eligibility for
Minnesota health care programs.

new text begin (c) The commissioner shall allow arrangements and make recommendations that
encourage counties to collaborate to establish joint local long-term care consultation teams
to ensure that long-term care consultations are done within the timelines and parameters
of the service. This includes integrated service models as required in subdivision 1,
paragraph (b).
new text end

Sec. 37.

Minnesota Statutes 2008, section 256B.0911, subdivision 3a, is amended to
read:

Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine new text begin personal care assistance
services, private duty nursing services, home health agency services, new text end waiver or alternative
care program eligibility, must be visited by a long-term care consultation team within
deleted text begin ten working deleted text end new text begin 15 calendar new text end days after the date on which an assessment was requested or
recommended. new text begin Face-to-face new text end assessments must be conducted according to paragraphs
(b) to (i).

(b) The county may utilize a team of either the social worker or public health nurse,
or both deleted text begin , deleted text end new text begin . After January 1, 2011, lead agencies shall use certified assessors new text end to conduct the
assessment in a face-to-face interview. The consultation team members must confer
regarding the most appropriate care for each individual screened or assessed.

(c) The deleted text begin long-term care consultation team must assess the health and social needs of
the person deleted text end new text begin assessment must be comprehensive and include a person-centered assessment
of the health, psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a support plan that meets the
consumers needs new text end , using an assessment form provided by the commissioner.

(d) The deleted text begin team must conduct the deleted text end assessment new text begin must be conducted new text end in a face-to-face
interview with the person being assessed and the person's legal representative, deleted text begin if applicable deleted text end new text begin
as required by legally executed documents, and other individuals as requested by the
person, who can provide information on the needs, strengths, and preferences of the
person necessary to develop a support plan that ensures the person's health and safety, but
who is not a provider of service or has any financial interest in the provision of services new text end .

(e) The deleted text begin team must provide the deleted text end person, or the person's legal representative, new text begin must
be provided new text end with written recommendations for deleted text begin facility- or deleted text end community-based services deleted text begin .
The team must document deleted text end new text begin or institutional care that include documentation new text end that the most
cost-effective alternatives available were offered to the individual. For purposes of
this requirement, "cost-effective alternatives" means community services and living
arrangements that cost the same as or less than deleted text begin nursing facility deleted text end new text begin institutional new text end care.

(f) If the person chooses to use community-based services, the deleted text begin team must provide
the deleted text end person or the person's legal representative new text begin must be provided new text end with a written community
support plan, regardless of whether the individual is eligible for Minnesota health care
programs. deleted text begin The deleted text end new text begin A new text end person may request assistance in deleted text begin developing a community support plan
deleted text end new text begin identifying community supports new text end without participating in a complete assessment. new text begin Upon
a request for assistance identifying community support, the person must be transferred
or referred to the services available under sections 256.975, subdivision 7, and 256.01,
subdivision 24, for telephone assistance and follow up.
new text end

(g) The person has the right to make the final decision between deleted text begin nursing
facility deleted text end new text begin institutional new text end placement and community placement after the deleted text begin screening team's
recommendation deleted text end new text begin recommendations have been provided new text end , except as provided in subdivision
4a, paragraph (c).

(h) The team must give the person receiving assessment or support planning, or
the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) the need for and purpose of preadmission screening if the person selects nursing
facility placement;

(2) the role of the long-term care consultation assessment and support planning in
waiver and alternative care program eligibility determination;

(3) information about Minnesota health care programs;

(4) the person's freedom to accept or reject the recommendations of the team;

(5) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;

(6) the long-term care consultant's decision regarding the person's need for deleted text begin nursing
facility deleted text end new text begin institutional new text end level of care new text begin as determined under criteria established in section
144.0724, subdivision 11, or 256B.092 new text end ; and

(7) the person's right to appeal the decision regarding the need for nursing facility
level of care or the county's final decisions regarding public programs eligibility according
to section 256.045, subdivision 3.

(i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and traumatic brain injury waiver programs under sections
256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility for no more
than 60 calendar days after the date of assessment. The effective eligibility start date
for these programs can never be prior to the date of assessment. If an assessment was
completed more than 60 days before the effective waiver or alternative care program
eligibility start date, assessment and support plan information must be updated in a
face-to-face visit and documented in the department's Medicaid Management Information
System (MMIS). The effective date of program eligibility in this case cannot be prior to
the date the updated assessment is completed.

Sec. 38.

Minnesota Statutes 2008, section 256B.0911, subdivision 3b, is amended to
read:

Subd. 3b.

Transition assistance.

(a) A long-term care consultation team shall
provide assistance to persons residing in a nursing facility, hospital, regional treatment
center, or intermediate care facility for persons with developmental disabilities who
request or are referred for assistance. Transition assistance must include assessment,
community support plan development, referrals new text begin to long-term care options counseling
under section 256B.975, subdivision 10, for community support plan implementation and
new text end to Minnesota health care programs, and referrals to programs that provide assistance
with housing. Transition assistance must also include information about the Centers for
Independent Living new text begin and the Senior LinkAge Line, new text end and about other organizations that
can provide assistance with relocation efforts, and information about contacting these
organizations to obtain their assistance and support.

(b) The county shall develop transition processes with institutional social workers
and discharge planners to ensure that:

(1) persons admitted to facilities receive information about transition assistance
that is available;

(2) the assessment is completed for persons within ten working days of the date of
request or recommendation for assessment; and

(3) there is a plan for transition and follow-up for the individual's return to the
community. The plan must require notification of other local agencies when a person
who may require assistance is screened by one county for admission to a facility located
in another county.

(c) If a person who is eligible for a Minnesota health care program is admitted to a
nursing facility, the nursing facility must include a consultation team member or the case
manager in the discharge planning process.

Sec. 39.

Minnesota Statutes 2008, section 256B.0911, subdivision 3c, is amended to
read:

Subd. 3c.

Transition to housing with services.

(a) Housing with services
establishments deleted text begin offering or providing assisted living under chapter 144G deleted text end shall inform
all prospective residents of the deleted text begin availability of and contact information for transitional
consultation services under this subdivision prior to executing a lease or contract with the
prospective resident deleted text end new text begin requirement to contact the Senior LinkAge Line for long-term care
options counseling and transitional consultation. The Senior LinkAge Line shall provide a
certificate to the prospective resident and also send a copy of the certificate to the housing
with services establishment, of the prospective resident's choice, that consultation has been
provided. The housing with services establishment shall not execute a contract or allow a
prospective resident to move in until the establishment has received certification from the
Senior LinkAge Line. The housing with services establishment shall maintain copies of
contracts and certificates for audit for a period of three years new text end . The purpose of transitional
long-term care consultation is to support persons with current or anticipated long-term
care needs in making informed choices among options that include the most cost-effective
and least restrictive settings, and to delay spenddown to eligibility for publicly funded
programs by connecting people to alternative services in their homes before transition to
housing with services. Regardless of the consultation, prospective residents maintain the
right to choose housing with services or assisted living if that option is their preference.

(b) Transitional consultation services are provided as determined by the
commissioner of human services in partnership with county long-term care consultation
units deleted text begin , and the Area Agencies on Aging deleted text end new text begin under section 144D.03, subdivision 3 new text end , and
are a combination of telephone-based and in-person assistance provided under models
developed by the commissioner. The consultation shall be performed in a manner that
provides objective and complete information. Transitional consultation must be provided
within five working days of the request of the prospective resident as follows:

(1) the consultation must be provided by a qualified professional as determined by
the commissioner;

(2) the consultation must include a review of the prospective resident's reasons for
considering assisted living, the prospective resident's personal goals, a discussion of the
prospective resident's immediate and projected long-term care needs, and alternative
community services or assisted living settings that may meet the prospective resident's
needs; deleted text begin and
deleted text end

(3) the prospective resident shall be informed of the availability of long-term care
consultation services described in subdivision 3a that are available at no charge to the
prospective resident to assist the prospective resident in assessment and planning to meet
the prospective resident's long-term care needs. new text begin The Senior LinkAge Line and long-term
care consultation team shall give the highest priority to referrals who are at highest risk of
nursing facility placement or as needed for determining eligibility; and
new text end

new text begin (4) a prospective resident does not include:
new text end

new text begin (i) a person moved from the community to housing with services during nonworking
hours when the move is based on a recent precipitating event that precludes the person
from living safely in the community, such as sustaining an injury or the caregiver's
inability to continue to provide needed care; and
new text end

new text begin (ii) the Senior LinkAge Line is contacted on the first working day following the
nonworking day move to the registered housing with services.
new text end

Sec. 40.

Minnesota Statutes 2008, section 256B.0911, subdivision 4a, is amended to
read:

Subd. 4a.

Preadmission screening activities related to nursing facility
admissions.

(a) All applicants to Medicaid certified nursing facilities, including certified
boarding care facilities, must be screened prior to admission regardless of income, assets,
or funding sources for nursing facility care, except as described in subdivision 4b. The
purpose of the screening is to determine the need for nursing facility level of care as
described in paragraph (d) and to complete activities required under federal law related to
mental illness and developmental disability as outlined in paragraph (b).

(b) A person who has a diagnosis or possible diagnosis of mental illness or
developmental disability must receive a preadmission screening before admission
regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need
for further evaluation and specialized services, unless the admission prior to screening is
authorized by the local mental health authority or the local developmental disabilities case
manager, or unless authorized by the county agency according to Public Law 101-508.

The following criteria apply to the preadmission screening:

(1) the county must use forms and criteria developed by the commissioner to identify
persons who require referral for further evaluation and determination of the need for
specialized services; and

(2) the evaluation and determination of the need for specialized services must be
done by:

(i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or

(ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a
qualified developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title 42, section
483.430.

(c) The local county mental health authority or the state developmental disability
authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
nursing facility if the individual does not meet the nursing facility level of care criteria or
needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
purposes of this section, "specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal Regulations, title
42, section 483.440 (a)(1).

(d) The determination of the need for nursing facility level of care must be made
according to criteria new text begin established in sections 144.0724, subdivision 11, and 256B.092,
using forms new text end developed by the commissioner. In assessing a person's needs, consultation
team members shall have a physician available for consultation and shall consider the
assessment of the individual's attending physician, if any. The individual's physician must
be included if the physician chooses to participate. Other personnel may be included on
the team as deemed appropriate by the county.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 41.

Minnesota Statutes 2008, section 256B.0911, subdivision 5, is amended to
read:

Subd. 5.

Administrative activity.

The commissioner shall deleted text begin minimize the number
of forms required in the provision of long-term care consultation services and shall
limit the screening document to items necessary for community support plan approval,
reimbursement, program planning, evaluation, and policy development deleted text end new text begin streamline the
processes required to provide the services in this section and shall implement integrated
solutions to automate the business processes to the extent necessary for community support
plan approval, reimbursement, program planning, evaluation, and policy development new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 42.

Minnesota Statutes 2008, section 256B.0911, subdivision 6, is amended to
read:

Subd. 6.

Payment for long-term care consultation services.

(a) The total payment
for each county must be paid monthly by certified nursing facilities in the county. The
monthly amount to be paid by each nursing facility for each fiscal year must be determined
by dividing the county's annual allocation for long-term care consultation services by 12
to determine the monthly payment and allocating the monthly payment to each nursing
facility based on the number of licensed beds in the nursing facility. Payments to counties
in which there is no certified nursing facility must be made by increasing the payment
rate of the two facilities located nearest to the county seat.

(b) The commissioner shall include the total annual payment determined under
paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
according to section 256B.431, subdivision 2b, paragraph (g).

(c) In the event of the layaway, delicensure and decertification, or removal from
layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
the per diem payment amount in paragraph (b) and may adjust the monthly payment
amount in paragraph (a). The effective date of an adjustment made under this paragraph
shall be on or after the first day of the month following the effective date of the layaway,
delicensure and decertification, or removal from layaway.

(d) Payments for long-term care consultation services are available to the county
or counties to cover staff salaries and expenses to provide the services described in
subdivision 1a. The county shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provide long-term care consultation
services while meeting the state's long-term care outcomes and objectives as defined in
section 256B.0917, subdivision 1. The county shall be accountable for meeting local
objectives as approved by the commissioner in the biennial home and community-based
services quality assurance plan on a form provided by the commissioner.

(e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.

(f) The commissioner of human services shall amend the Minnesota medical
assistance plan to include reimbursement for the local consultation teams.

(g) The county may bill, as case management services, assessments, support
planning, and follow-along provided to persons determined to be eligible for case
management under Minnesota health care programs. No individual or family member
shall be charged for an initial assessment or initial support plan development provided
under subdivision 3a or 3b.

new text begin (h) The commissioner shall develop an alternative payment methodology for
long-term care consultation services that includes the funding available under this
subdivision, and sections 256B.092 and 256B.0659. In developing the new payment
methodology, the commissioner shall consider the maximization of federal funding for
this activity.
new text end

Sec. 43.

Minnesota Statutes 2008, section 256B.0911, subdivision 7, is amended to
read:

Subd. 7.

Reimbursement for certified nursing facilities.

(a) Medical assistance
reimbursement for nursing facilities shall be authorized for a medical assistance recipient
only if a preadmission screening has been conducted prior to admission or the county has
authorized an exemption. Medical assistance reimbursement for nursing facilities shall
not be provided for any recipient who the local screener has determined does not meet the
level of care criteria for nursing facility placement new text begin in section 144.0724, subdivision 11, new text end or,
if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
mental illness is approved by the local mental health authority or an admission for a
recipient with developmental disability is approved by the state developmental disability
authority.

(b) The nursing facility must not bill a person who is not a medical assistance
recipient for resident days that preceded the date of completion of screening activities as
required under subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed
resident days in the nursing facility resident day totals reported to the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 44.

Minnesota Statutes 2008, section 256B.0913, subdivision 4, is amended to
read:

Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a) Funding for services under the alternative care program is available to persons who
meet the following criteria:

(1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, but for the provision of services under the alternative care program new text begin . Effective
January 1, 2011, this determination must be made according to the criteria established in
section 144.0724, subdivision 11 new text end ;

(2) the person is age 65 or older;

(3) the person would be eligible for medical assistance within 135 days of admission
to a nursing facility;

(4) the person is not ineligible for the payment of long-term care services by the
medical assistance program due to an asset transfer penalty under section 256B.0595 or
equity interest in the home exceeding $500,000 as stated in section 256B.056;

(5) the person needs long-term care services that are not funded through other state
or federal funding;

(6) new text begin except for individuals described in clause (7), new text end the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
does not prohibit the alternative care client from payment for additional services, but in no
case may the cost of additional services purchased under this section exceed the difference
between the client's monthly service limit defined under section 256B.0915, subdivision
3, and the alternative care program monthly service limit defined in this paragraph. If
care-related supplies and equipment or environmental modifications and adaptations are or
will be purchased for an alternative care services recipient, the costs may be prorated on a
monthly basis for up to 12 consecutive months beginning with the month of purchase.
If the monthly cost of a recipient's other alternative care services exceeds the monthly
limit established in this paragraph, the annual cost of the alternative care services shall be
determined. In this event, the annual cost of alternative care services shall not exceed 12
times the monthly limit described in this paragraph; deleted text begin and
deleted text end

(7) new text begin for individuals assigned a case mix classification A as described under section
256B.0915, subdivision 3a, paragraph (a), with (i) no dependencies in activities of daily
living, (ii) only one dependency in bathing, dressing, grooming, or walking, or (iii) a
dependency score of less than three if eating is the only dependency as determined by an
assessment performed under section 256B.0911, the monthly cost of alternative care
services funded by the program cannot exceed $600 per month for all new participants
enrolled in the program on or after July 1, 2009. This monthly limit shall be applied to
all other participants who meet this criteria at reassessment. This monthly limit shall be
increased annually as described in section 256B.0915, subdivision 3a, paragraph (a). This
monthly limit does not prohibit the alternative care client from payment for additional
services, but in no case may the cost of additional services purchased exceed the difference
between the client's monthly service limit defined in this clause and the limit described in
clause (6) for case mix classification A; and
new text end

new text begin (8) new text end the person is making timely payments of the assessed monthly fee.

A person is ineligible if payment of the fee is over 60 days past due, unless the person
agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee payments.

The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(b) Alternative care funding under this subdivision is not available for a person
who is a medical assistance recipient or who would be eligible for medical assistance
without a spenddown or waiver obligation. A person whose initial application for medical
assistance and the elderly waiver program is being processed may be served under the
alternative care program for a period up to 60 days. If the individual is found to be eligible
for medical assistance, medical assistance must be billed for services payable under the
federally approved elderly waiver plan and delivered from the date the individual was
found eligible for the federally approved elderly waiver plan. Notwithstanding this
provision, alternative care funds may not be used to pay for any service the cost of which:
(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation;
or (iii) is used to pay a medical assistance income spenddown for a person who is eligible
to participate in the federally approved elderly waiver program under the special income
standard provision.

(c) Alternative care funding is not available for a person who resides in a licensed
nursing home, certified boarding care home, hospital, or intermediate care facility, except
for case management services which are provided in support of the discharge planning
process for a nursing home resident or certified boarding care home resident to assist with
a relocation process to a community-based setting.

(d) Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
year for which alternative care eligibility is determined, who would be eligible for the
elderly waiver with a waiver obligation.

Sec. 45.

Minnesota Statutes 2008, section 256B.0915, subdivision 3a, is amended to
read:

Subd. 3a.

Elderly waiver cost limits.

(a) The monthly limit for the cost of
waivered services to an individual elderly waiver client new text begin except for individuals described
in paragraph (b) new text end shall be the weighted average monthly nursing facility rate of the case
mix resident class to which the elderly waiver client would be assigned under Minnesota
Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance
as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing home
rate determination is implemented. Effective on the first day of the state fiscal year in
which the resident assessment system as described in section 256B.438 for nursing home
rate determination is implemented and the first day of each subsequent state fiscal year, the
monthly limit for the cost of waivered services to an individual elderly waiver client shall
be the rate of the case mix resident class to which the waiver client would be assigned
under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the
previous state fiscal year, adjusted by the greater of any legislatively adopted home and
community-based services percentage rate increase or the average statewide percentage
increase in nursing facility payment rates.

(b) new text begin The monthly limit for the cost of waivered services to an individual elderly
waiver client assigned to a case mix classification A under paragraph (a) with (i) no
dependencies in activities of daily living, (ii) only one dependency in bathing, dressing,
grooming, or walking, or (iii) a dependency score of less than three if eating is the only
dependency, shall be the lower of the case mix classification amount for case mix A as
determined under paragraph (a) or the case mix classification amount for case mix A
effective on October 1, 2008, per month for all new participants enrolled in the program
on or after July 1, 2009. This monthly limit shall be applied to all other participants
who meet this criteria at reassessment. This monthly limit shall be increased annually as
described in paragraph (a).
new text end

new text begin (c) new text end If extended medical supplies and equipment or environmental modifications are
or will be purchased for an elderly waiver client, the costs may be prorated for up to
12 consecutive months beginning with the month of purchase. If the monthly cost of a
recipient's waivered services exceeds the monthly limit established in paragraph (a) new text begin or (b) new text end ,
the annual cost of all waivered services shall be determined. In this event, the annual cost
of all waivered services shall not exceed 12 times the monthly limit of waivered services
as described in paragraph (a) new text begin or (b) new text end .

Sec. 46.

Minnesota Statutes 2008, section 256B.0915, subdivision 3e, is amended to
read:

Subd. 3e.

Customized living service rate.

(a) Payment for customized living
services shall be a monthly rate deleted text begin negotiated and deleted text end authorized by the lead agency within the
parameters established by the commissioner. The payment agreement must delineate the
deleted text begin services that have been customized for each recipient and specify the deleted text end amount of each
new text begin component service included in the recipient's customized living new text end service deleted text begin to be provided deleted text end new text begin
plan new text end . The lead agency shall ensure that there is a documented need deleted text begin for all deleted text end new text begin within the
parameters established by the commissioner for all component customized living new text end services
authorized. deleted text begin Customized living services must not include rent or raw food costs.
deleted text end

new text begin (b) new text end The deleted text begin negotiated deleted text end payment rate must be based on new text begin the amount of component new text end services
to be provided new text begin utilizing component rates established by the commissioner. Counties and
tribes shall use tools issued by the commissioner to develop and document customized
living service plans and rates new text end .

deleted text begin Negotiated deleted text end new text begin (c) Component service new text end rates must not exceed payment rates for
comparable elderly waiver or medical assistance services and must reflect economies of
scale. new text begin Customized living services must not include rent or raw food costs.
new text end

deleted text begin (b) deleted text end new text begin (d) new text end The individualized monthly deleted text begin negotiated deleted text end new text begin authorized new text end payment for new text begin the
new text end customized living deleted text begin services deleted text end new text begin service plan new text end shall not exceed deleted text begin the nonfederal share, in effect
on July 1 of the state fiscal year for which the rate limit is being calculated, deleted text end new text begin 50 percent new text end
of the greater of either the statewide or any of the geographic groups' weighted average
monthly nursing facility rate of the case mix resident class to which the elderly waiver
eligible client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,
less the maintenance needs allowance as described in subdivision 1d, paragraph (a), until
the July 1 of the state fiscal year in which the resident assessment system as described
in section 256B.438 for nursing home rate determination is implemented. Effective on
July 1 of the state fiscal year in which the resident assessment system as described in
section 256B.438 for nursing home rate determination is implemented and July 1 of each
subsequent state fiscal year, the individualized monthly deleted text begin negotiated deleted text end new text begin authorized new text end payment
for the services described in this clause shall not exceed the limit deleted text begin described in this clause deleted text end
which was in effect on June 30 of the previous state fiscal year deleted text begin and which has been
adjusted by the greater of any legislatively adopted home and community-based services
cost-of-living percentage increase or any legislatively adopted statewide percent rate
increase for nursing facilities deleted text end new text begin updated annually based on legislatively adopted changes to
all service rate maximums for home and community-based service providers new text end .

deleted text begin (c) deleted text end new text begin (e) new text end Customized living services are delivered by a provider licensed by the
Department of Health as a class A or class F home care provider and provided in a
building that is registered as a housing with services establishment under chapter 144D.

Sec. 47.

Minnesota Statutes 2008, section 256B.0915, subdivision 3h, is amended to
read:

Subd. 3h.

Service rate limits; 24-hour customized living services.

new text begin (a) new text end The
payment deleted text begin rates deleted text end new text begin rate new text end for 24-hour customized living services is a monthly rate deleted text begin negotiated
and deleted text end authorized by the lead agency within the parameters established by the commissioner
of human services. The payment agreement must delineate the deleted text begin services that have been
customized for each recipient and specify the deleted text end amount of each new text begin component service included
in each recipient's customized living new text end service deleted text begin to be provided deleted text end new text begin plan new text end . The lead agency
shall ensure that there is a documented need new text begin within the parameters established by the
commissioner new text end for all new text begin component customized living new text end services authorized. The lead agency
shall not authorize 24-hour customized living services unless there is a documented need
for 24-hour supervision.

new text begin (b) new text end For purposes of this section, "24-hour supervision" means that the recipient
requires assistance due to needs related to one or more of the following:

(1) intermittent assistance with toileting new text begin , positioning, new text end or transferring;

(2) cognitive or behavioral issues;

(3) a medical condition that requires clinical monitoring; or

(4) deleted text begin other conditions or needs as defined by the commissioner of human services deleted text end new text begin for
all new participants enrolled in the program on or after January 1, 2011, and all other
participants at their first reassessment after January 1, 2011, dependency in at least two
of the following activities of daily living as determined by assessment under section
256B.0911: bathing; dressing; grooming; walking; or eating; and needs medication
management and at least 50 hours of service per month new text end . The lead agency shall ensure that
the frequency and mode of supervision of the recipient and the qualifications of staff
providing supervision are described and meet the needs of the recipient. deleted text begin Customized
living services must not include rent or raw food costs.
deleted text end

new text begin (c) new text end The deleted text begin negotiated deleted text end payment rate for 24-hour customized living services must be
based on new text begin the amount of component new text end services to be provided new text begin utilizing component rates
established by the commissioner. Counties and tribes will use tools issued by the
commissioner to develop and document customized living plans and authorize rates new text end .

deleted text begin Negotiated deleted text end new text begin (d) Component service new text end rates must not exceed payment rates for
comparable elderly waiver or medical assistance services and must reflect economies
of scale.

new text begin (e) new text end The individually deleted text begin negotiated deleted text end new text begin authorized new text end 24-hour customized living payments,
in combination with the payment for other elderly waiver services, including case
management, must not exceed the recipient's community budget cap specified in
subdivision 3a. new text begin Customized living services must not include rent or raw food costs.
new text end

new text begin (f) The individually authorized 24-hour customized living payment rates shall not
exceed the 95 percentile of statewide monthly authorizations for 24-hour customized
living services in effect and in the Medicaid management information systems on March
31, 2009, for each case mix resident class under Minnesota Rules, parts 9549.0050
to 9549.0059, to which elderly waiver service clients are assigned. When there are
fewer than 50 authorizations in effect in the case mix resident class, the commissioner
shall multiply the calculated service payment rate maximum for the A classification by
the standard weight for that classification under Minnesota Rules, parts 9549.0050 to
9549.0059, to determine the applicable payment rate maximum. Service payment rate
maximums shall be updated annually based on legislatively adopted changes to all service
rates for home and community-based service providers.
new text end

new text begin (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner
may establish an alternative payment rate system for 24-hour customized living services
by approving a single hourly rate for direct services provided in establishments, which
meet the following criteria:
new text end

new text begin (1) are registered as housing with services establishments with a capacity of 12 or
fewer residents; and
new text end

new text begin (2) are licensed as adult foster care or as a board and lodge establishment.
new text end

Sec. 48.

Minnesota Statutes 2008, section 256B.0915, subdivision 5, is amended to
read:

Subd. 5.

Assessments and reassessments for waiver clients.

new text begin (a) new text end Each client shall
receive an initial assessment of strengths, informal supports, and need for services in
accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a client
served under the elderly waiver must be conducted at least every 12 months and at other
times when the case manager determines that there has been significant change in the
client's functioning. This may include instances where the client is discharged from the
hospital. new text begin There must be a determination that the client requires a nursing facility level of
care as defined in section 144.0724, subdivision 11, at initial and subsequent assessments
to initiate and maintain participation in the waiver program.
new text end

new text begin (b) Regardless of other assessments identified in section 144.0724, subdivision
4, as appropriate to determine nursing facility level of care for purposes of medical
assistance payment for nursing facility services, only face-to-face assessments conducted
according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
level of care determination will be accepted for purposes of initial and ongoing access to
waiver service payment.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 49.

Minnesota Statutes 2008, section 256B.0915, is amended by adding a
subdivision to read:

new text begin Subd. 10. new text end

new text begin Waiver payment rates; managed care organizations. new text end

new text begin The
commissioner shall adjust the elderly waiver capitation payment rates for managed care
organizations paid under section 256B.69, subdivisions 6a and 23, to reflect the maximum
service rate limits for customized living services and 24-hour customized living services
under subdivisions 3e and 3h for the contract period beginning October 1, 2009. Medical
assistance rates paid to customized living providers by managed care organizations
under this section shall not exceed the maximum service rate limits determined by the
commissioner under subdivisions 3e and 3h.
new text end

Sec. 50.

Minnesota Statutes 2008, section 256B.0917, is amended by adding a
subdivision to read:

new text begin Subd. 14. new text end

new text begin Essential community supports grants. new text end

new text begin (a) The purpose of the essential
community supports grant program is to provide targeted services to persons 65 years and
older who need essential community support, but whose needs do not meet the level of
care required for nursing facility placement under section 144.0724, subdivision 11.
new text end

new text begin (b) Within the limits of the appropriation and not to exceed $400 per person per
month, funding must be available to a person who:
new text end

new text begin (1) is age 65 or older;
new text end

new text begin (2) is not eligible for medical assistance;
new text end

new text begin (3) would otherwise be financially eligible for the alternative care program under
section 256B.0913, subdivision 4;
new text end

new text begin (4) has received a community assessment under section 256B.0911, subdivision 3a
or 3b, and does not require the level of care provided in a nursing facility;
new text end

new text begin (5) has a community support plan; and
new text end

new text begin (6) has been determined by a community assessment under section 256B.0911,
subdivision 3a or 3b, to be a person who would require provision of at least one of the
following services, as defined in the approved elderly waiver plan, in order to maintain
their community residence:
new text end

new text begin (i) caregiver support;
new text end

new text begin (ii) homemaker;
new text end

new text begin (iii) chore; or
new text end

new text begin (iv) a personal emergency response device or system.
new text end

new text begin (c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination as part of their community support plan.
new text end

new text begin (d) A person who has been determined to be eligible for an essential community
support grant must be reassessed at least annually and continue to meet the criteria in
paragraph (b) to remain eligible for an essential community support grant.
new text end

new text begin (e) The commissioner shall allocate grants to counties and tribes under contract with
the department based upon the historic use of the medical assistance elderly waiver and
alternative care grant programs and other criteria as determined by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 51.

Minnesota Statutes 2008, section 256B.092, subdivision 8a, is amended to
read:

Subd. 8a.

County concurrence.

(a) If the county of financial responsibility wishes
to place a person in another county for services, the county of financial responsibility shall
seek concurrence from the proposed county of service and the placement shall be made
cooperatively between the two counties. Arrangements shall be made between the two
counties for ongoing social service, including annual reviews of the person's individual
service plan. The county where services are provided may not make changes in the
person's service plan without approval by the county of financial responsibility.

(b) When a person has been screened and authorized for services in an intermediate
care facility for persons with developmental disabilities or for home and community-based
services for persons with developmental disabilities, the case manager shall assist that
person in identifying a service provider who is able to meet the needs of the person
according to the person's individual service plan. If the identified service is to be provided
in a county other than the county of financial responsibility, the county of financial
responsibility shall request concurrence of the county where the person is requesting to
receive the identified services. The county of service may refuse to concur if:

(1) it can demonstrate that the provider is unable to provide the services identified in
the person's individual service plan as services that are needed and are to be provided; new text begin or
new text end

(2) in the case of an intermediate care facility for persons with developmental
disabilities, there has been no authorization for admission by the admission review team
as required in section 256B.0926 deleted text begin ; or
deleted text end

deleted text begin (3) in the case of home and community-based services for persons with
developmental disabilities, the county of service can demonstrate that the prospective
provider has failed to substantially comply with the terms of a past contract or has had a
prior contract terminated within the last 12 months for failure to provide adequate services,
or has received a notice of intent to terminate the contract deleted text end .

(c) The county of service shall notify the county of financial responsibility of
concurrence or refusal to concur no later than 20 working days following receipt of the
written request. Unless other mutually acceptable arrangements are made by the involved
county agencies, the county of financial responsibility is responsible for costs of social
services and the costs associated with the development and maintenance of the placement.
The county of service may request that the county of financial responsibility purchase
case management services from the county of service or from a contracted provider
of case management when the county of financial responsibility is not providing case
management as defined in this section and rules adopted under this section, unless other
mutually acceptable arrangements are made by the involved county agencies. Standards
for payment limits under this section may be established by the commissioner. Financial
disputes between counties shall be resolved as provided in section 256G.09.

Sec. 52.

Minnesota Statutes 2008, section 256B.092, is amended by adding a
subdivision to read:

new text begin Subd. 11. new text end

new text begin Residential support services. new text end

new text begin (a) Upon federal approval, there is
established a new service called residential support that is available on the CAC, CADI,
DD, and TBI waivers. Existing waiver service descriptions must be modified to the extent
necessary to ensure there is no duplication between other services. Residential support
services must be provided by vendors licensed as a community residential setting as
defined in section 245A.11, subdivision 8.
new text end

new text begin (b) Residential support services must meet the following criteria:
new text end

new text begin (1) providers of residential support services must own or control the residential site;
new text end

new text begin (2) the residential site must not be the primary residence of the license holder;
new text end

new text begin (3) the residential site must have a designated program supervisor responsible for
program oversight, development, and implementation of policies and procedures;
new text end

new text begin (4) the provider of residential support services must provide supervision, training,
and assistance as described in the person's community support plan; and
new text end

new text begin (5) the provider of residential support services must meet the requirements of
licensure and additional requirements of the person's community support plan.
new text end

new text begin (c) Providers of residential support services that meet the definition in paragraph (a)
must be registered using a process determined by the commissioner beginning July 1, 2009.
new text end

Sec. 53.

new text begin [256B.0948] FOSTER CARE RATE LIMITS.
new text end

new text begin The commissioner shall decrease by five percent rates for adult foster care and
supportive living services that are reimbursed under section 256B.092 or 256B.49, and
are above 95 percent of the statewide rate for the service. The reduction in rates shall
take into account acuity of individuals served based on the methodology used to allocate
dollars to local lead agency budgets. Lead agency contracts for services specified in
this section shall be amended to implement these rate changes for services rendered on
or after July 1, 2009. The commissioner shall make corresponding reductions to waiver
allocations and capitated rates.
new text end

Sec. 54.

Minnesota Statutes 2008, section 256B.37, subdivision 1, is amended to read:

Subdivision 1.

Subrogation.

Upon furnishing medical assistance new text begin services under this
chapter or alternative care services under section 256B.0913 new text end to any person who has private
accident or health care coverage, or receives or has a right to receive health or medical care
from any type of organization or entity, or has a cause of action arising out of an occurrence
that necessitated the payment of medical assistance, the state agency or the state agency's
agent shall be subrogated, to the extent of the cost of medical care furnished, to any rights
the person may have under the terms of the coverage, or against the organization or entity
providing or liable to provide health or medical care, or under the cause of action.

The right of subrogation created in this section includes all portions of the cause
of action, notwithstanding any settlement allocation or apportionment that purports to
dispose of portions of the cause of action not subject to subrogation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 55.

Minnesota Statutes 2008, section 256B.37, subdivision 5, is amended to read:

Subd. 5.

Private benefits to be used first.

Private accident and health care coverage
including Medicare for medical services is primary coverage and must be exhausted before
medical assistance deleted text begin is deleted text end new text begin or alternative care services are new text end paid for medical services including
home health care, personal care assistant services, hospice, new text begin supplies and equipment, new text end or
services covered under a Centers for Medicare and Medicaid Services waiver. When a
person who is otherwise eligible for medical assistance has private accident or health care
coverage, including Medicare or a prepaid health plan, the private health care benefits
available to the person must be used first and to the fullest extent.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 56.

Minnesota Statutes 2008, section 256B.434, subdivision 4, is amended to read:

Subd. 4.

Alternate rates for nursing facilities.

(a) For nursing facilities which
have their payment rates determined under this section rather than section 256B.431, the
commissioner shall establish a rate under this subdivision. The nursing facility must enter
into a written contract with the commissioner.

(b) A nursing facility's case mix payment rate for the first rate year of a facility's
contract under this section is the payment rate the facility would have received under
section 256B.431.

(c) A nursing facility's case mix payment rates for the second and subsequent years
of a facility's contract under this section are the previous rate year's contract payment
rates plus an inflation adjustment and, for facilities reimbursed under this section or
section 256B.431, an adjustment to include the cost of any increase in Health Department
licensing fees for the facility taking effect on or after July 1, 2001. The index for the
inflation adjustment must be based on the change in the Consumer Price Index-All Items
(United States City average) (CPI-U) forecasted by the commissioner of finance's national
economic consultant, as forecasted in the fourth quarter of the calendar year preceding
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. For the rate years beginning on July 1, 1999, July 1, 2000, July 1,
2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007,
July 1, 2008, October 1, 2009, deleted text begin and deleted text end October 1, 2010, new text begin October 1, 2011, October 1, 2012,
and October 1, 2013, new text end this paragraph shall apply only to the property-related payment
rate, except that adjustments to include the cost of any increase in Health Department
licensing fees taking effect on or after July 1, 2001, shall be provided. Beginning in 2005,
adjustment to the property payment rate under this section and section 256B.431 shall be
effective on October 1. In determining the amount of the property-related payment rate
adjustment under this paragraph, the commissioner shall determine the proportion of the
facility's rates that are property-related based on the facility's most recent cost report.

(d) The commissioner shall develop additional incentive-based payments of up to
five percent above a facility's operating payment rate for achieving outcomes specified
in a contract. The commissioner may solicit contract amendments and implement those
which, on a competitive basis, best meet the state's policy objectives. The commissioner
shall limit the amount of any incentive payment and the number of contract amendments
under this paragraph to operate the incentive payments within funds appropriated for this
purpose. The contract amendments may specify various levels of payment for various
levels of performance. Incentive payments to facilities under this paragraph may be in the
form of time-limited rate adjustments or onetime supplemental payments. In establishing
the specified outcomes and related criteria, the commissioner shall consider the following
state policy objectives:

(1) successful diversion or discharge of residents to the residents' prior home or other
community-based alternatives;

(2) adoption of new technology to improve quality or efficiency;

(3) improved quality as measured in the Nursing Home Report Card;

(4) reduced acute care costs; and

(5) any additional outcomes proposed by a nursing facility that the commissioner
finds desirable.

(e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
take action to come into compliance with existing or pending requirements of the life
safety code provisions or federal regulations governing sprinkler systems must receive
reimbursement for the costs associated with compliance if all of the following conditions
are met:

(1) the expenses associated with compliance occurred on or after January 1, 2005,
and before December 31, 2008;

(2) the costs were not otherwise reimbursed under subdivision 4f or section
144A.071 or 144A.073; and

(3) the total allowable costs reported under this paragraph are less than the minimum
threshold established under section 256B.431, subdivision 15, paragraph (e), and
subdivision 16.

The commissioner shall use money appropriated for this purpose to provide to qualifying
nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
2008. Nursing facilities that have spent money or anticipate the need to spend money
to satisfy the most recent life safety code requirements by (1) installing a sprinkler
system or (2) replacing all or portions of an existing sprinkler system may submit to the
commissioner by June 30, 2007, on a form provided by the commissioner the actual
costs of a completed project or the estimated costs, based on a project bid, of a planned
project. The commissioner shall calculate a rate adjustment equal to the allowable
costs of the project divided by the resident days reported for the report year ending
September 30, 2006. If the costs from all projects exceed the appropriation for this
purpose, the commissioner shall allocate the money appropriated on a pro rata basis
to the qualifying facilities by reducing the rate adjustment determined for each facility
by an equal percentage. Facilities that used estimated costs when requesting the rate
adjustment shall report to the commissioner by January 31, 2009, on the use of this
money on a form provided by the commissioner. If the nursing facility fails to provide
the report, the commissioner shall recoup the money paid to the facility for this purpose.
If the facility reports expenditures allowable under this subdivision that are less than
the amount received in the facility's annualized rate adjustment, the commissioner shall
recoup the difference.

Sec. 57.

Minnesota Statutes 2008, section 256B.437, subdivision 6, is amended to read:

Subd. 6.

Planned closure rate adjustment.

(a) The commissioner of human
services shall calculate the amount of the planned closure rate adjustment available under
subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):

(1) the amount available is the net reduction of nursing facility beds multiplied
by $2,080;

(2) the total number of beds in the nursing facility or facilities receiving the planned
closure rate adjustment must be identified;

(3) capacity days are determined by multiplying the number determined under
clause (2) by 365; and

(4) the planned closure rate adjustment is the amount available in clause (1), divided
by capacity days determined under clause (3).

(b) A planned closure rate adjustment under this section is effective on the first day
of the month following completion of closure of the facility designated for closure in the
application and becomes part of the nursing facility's total operating payment rate.

(c) Applicants may use the planned closure rate adjustment to allow for a property
payment for a new nursing facility or an addition to an existing nursing facility or as an
operating payment rate adjustment. Applications approved under this subdivision are
exempt from other requirements for moratorium exceptions under section 144A.073,
subdivisions 2 and 3.

(d) Upon the request of a closing facility, the commissioner must allow the facility a
closure rate adjustment as provided under section 144A.161, subdivision 10.

(e) A facility that has received a planned closure rate adjustment may reassign it
to another facility that is under the same ownership at any time within three years of its
effective date. The amount of the adjustment shall be computed according to paragraph (a).

(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
the commissioner shall recalculate planned closure rate adjustments for facilities that
delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
bed dollar amount. The recalculated planned closure rate adjustment shall be effective
from the date the per bed dollar amount is increased.

new text begin (g) For planned closures approved after June 30, 2009, the commissioner of human
services shall calculate the amount of the planned closure rate adjustment available under
subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).
new text end

Sec. 58.

Minnesota Statutes 2008, section 256B.441, subdivision 51a, is amended to
read:

Subd. 51a.

Exception allowing contracting for specialized care.

(a) new text begin For rate years
beginning on or after October 1, 2009, and prior to October 1, 2016, the commissioner
may negotiate rate adjustments for nursing facilities that provide specialized care and that
receive rate adjustments under subdivision 61. These rate adjustments may restore to
these facilities a portion of the amount of the rate reduction resulting from subdivision
59. The commissioner shall publish a request for proposals and may negotiate these rate
adjustments in accordance with paragraph (c), at a cost to the general fund not to exceed
$150,000 per year.
new text end

new text begin (b) new text end For rate years beginning on or after October 1, 2016, the commissioner may
negotiate increases to the care-related limit for nursing facilities that provide specialized
care, at a cost to the general fund not to exceed $600,000 per year. The commissioner
shall publish a request for proposals annually, and may negotiate increases to the limits
that shall apply for either one or two years before the increase shall be subject to a new
proposal and negotiation. The care-related limit may be increased by up to 50 percent.

deleted text begin (b) deleted text end new text begin (c) new text end In selecting facilities with which to negotiate, the commissioner shall
consider:

(1) the diagnoses or other circumstances of residents in the specialized program that
require care that costs substantially more than the RUG's rates associated with those
residents;

(2) the nature of the specialized program or programs offered to meet the needs
of these individuals; and

(3) outcomes achieved by the specialized program.

Sec. 59.

Minnesota Statutes 2008, section 256B.441, subdivision 53, is amended to
read:

Subd. 53.

Calculation of payment rate for external fixed costs.

The commissioner
shall calculate a payment rate for external fixed costs.

(a) For a facility licensed as a nursing home, the portion related to section
256.9657shall be equal to $8.86. For a facility licensed as both a nursing home and a
boarding care home, the portion related to section 256.9657 shall be equal to $8.86
multiplied by the result of its number of nursing home beds divided by its total number of
licensed beds. new text begin Effective June 1, 2009, for a facility licensed as a nursing home, the portion
related to section 256.9657 shall be equal to $10.06. Effective June 1, 2009, for a facility
licensed as both a nursing home and a boarding care home, the portion related to section
256.9657 shall be equal to $10.06 multiplied by the result of its number of nursing home
beds divided by its total number of licensed beds.
new text end

(b) The portion related to the licensure fee under section 144.122, paragraph (d),
shall be the amount of the fee divided by actual resident days.

(c) The portion related to scholarships shall be determined under section 256B.431,
subdivision 36.

(d) The portion related to long-term care consultation shall be determined according
to section 256B.0911, subdivision 6.

(e) The portion related to development and education of resident and family advisory
councils under section 144A.33 shall be $5 divided by 365.

(f) The portion related to planned closure rate adjustments shall be as determined
under sections 256B.436 and 256B.437, subdivision 6. Planned closure rate adjustments
that take effect before October 1, 2014, shall no longer be included in the payment rate
for external fixed costs beginning October 1, 2016. Planned closure rate adjustments that
take effect on or after October 1, 2014, shall no longer be included in the payment rate
for external fixed costs beginning on October 1 of the first year not less than two years
after their effective date.

(g) The portions related to property insurance, real estate taxes, special assessments,
and payments made in lieu of real estate taxes directly identified or allocated to the nursing
facility shall be the actual amounts divided by actual resident days.

(h) The portion related to the Public Employees Retirement Association shall be
actual costs divided by resident days.

(i) The single bed room incentives shall be as determined under section 256B.431,
subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
no longer be included in the payment rate for external fixed costs beginning October 1,
2016. Single bed room incentives that take effect on or after October 1, 2014, shall no
longer be included in the payment rate for external fixed costs beginning on October 1 of
the first year not less than two years after their effective date.

(j) The payment rate for external fixed costs shall be the sum of the amounts in
paragraphs (a) to (i).

new text begin EFFECTIVE DATE. new text end

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

Sec. 60.

Minnesota Statutes 2008, section 256B.441, is amended by adding a
subdivision to read:

new text begin Subd. 59. new text end

new text begin Single-bed payments for medical assistance recipients. new text end

new text begin Effective
October 1, 2009, a single-room payment rate of 111.5 percent of the established total
payment rate for a resident must be allowed if the resident is a medical assistance recipient
and the single room is considered as a medical necessity for the resident or others who
are affected by the resident's condition. Conditions requiring a single room must be
determined by the resident's attending physician and submitted to the commissioner for
approval or denial on the basis of medical necessity.
new text end

Sec. 61.

Minnesota Statutes 2008, section 256B.441, is amended by adding a
subdivision to read:

new text begin Subd. 60. new text end

new text begin Rebasing not to be implemented. new text end

new text begin Notwithstanding subdivision 55,
for rate years beginning on October 1, 2009, and after, no rate adjustments shall be
implemented under this section. For rate years beginning October 1, 2009, and after,
nursing facility rates shall be determined under section 256B.434.
new text end

Sec. 62.

Minnesota Statutes 2008, section 256B.441, is amended by adding a
subdivision to read:

new text begin Subd. 61. new text end

new text begin Rate adjustments effective October 1, 2009. new text end

new text begin (a) For the rate year
beginning October 1, 2009, nursing facility operating payment rates shall be reduced for
facilities that have the highest operating payment rates within their peer group and facility
type. These rate reductions shall not apply to facilities that are licensed under Minnesota
Rules, parts 9570.2000 to 9570.3400. These rate reductions shall be determined after
application of the phase-in provided in subdivision 55 and the hold harmless provided
in subdivision 56. The commissioner shall calculate the rate reductions in accordance
with paragraphs (b) to (d).
new text end

new text begin (b) Within each peer group and facility type determine the operating payment rate at
the 64th percentile at a resource utilization group (RUGs) weight of 1.00.
new text end

new text begin (c) Each nursing facility with an operating payment rate greater than the 64th
percentile at a RUGs weight of 1.00 shall have the difference between its rates at a RUGS
weight of 1.00 and the 64th percentile amount determined in paragraph (b) reduced by
an amount equal to the sum of:
new text end

new text begin (1) 25 percent of the first $5 of the difference;
new text end

new text begin (2) 35 percent of the amount of the difference that exceeds $5 but is less than $10;
new text end

new text begin (3) 45 percent of the amount of the difference that exceeds $10 but is less than $15;
new text end

new text begin (4) 55 percent of the amount of the difference that exceeds $15 but is less than
$20; and
new text end

new text begin (5) 65 percent of the amount of the difference that exceeds $20.
new text end

new text begin (d) The reductions computed in paragraph (c), clauses (1) to (5), shall be apportioned
to the direct care per diem, the other care-related per diem, the other operating per diem,
and the efficiency incentive in accordance with clauses (1) to (3):
new text end

new text begin (1) the commissioner shall determine the percentage of the operating payment rate
determined in subdivisions 55 and 56, at a RUGs weight of 1.00 for October 1, 2009, that
is for the direct care per diem, the other care-related per diem, the other operating per
diem, and the efficiency incentive;
new text end

new text begin (2) the percentages determined in clause (1) shall be multiplied by the operating
payment rate reduction determined in paragraph (c); and
new text end

new text begin (3) for each RUGs level, the operating payment rate shall be reduced by the sum
of items (i) and (ii):
new text end

new text begin (i) the direct care rate reduction determined for a RUGs weight of 1.00 determined
in clause (2) multiplied by the corresponding weight in subdivision 14; and
new text end

new text begin (ii) the other care-related per diem, the other operating per diem, and the efficiency
incentive rate reductions determined for a RUGs weight of 1.00 determined in clause (2).
new text end

new text begin (e) Notwithstanding the provisions of section 256B.48, subdivision 1, paragraph
(a), a nursing facility that receives a rate reduction under this subdivision may continue to
charge private paying residents the rate in effect on September 30, 2009. This paragraph
expires on the effective date of any nursing facility rate adjustment that increases the
medical assistance rate to a level greater than the rate in effect on September 30, 2009.
new text end

Sec. 63.

Minnesota Statutes 2008, section 256B.49, subdivision 12, is amended to read:

Subd. 12.

Informed choice.

Persons who are determined likely to require the level
of care provided in a nursing facility new text begin as determined under sections 144.0724, subdivision
11, and 256B.0911, new text end or hospital shall be informed of the home and community-based
support alternatives to the provision of inpatient hospital services or nursing facility
services. Each person must be given the choice of either institutional or home and
community-based services using the provisions described in section 256B.77, subdivision
2, paragraph (p).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 64.

Minnesota Statutes 2008, section 256B.49, subdivision 13, is amended to read:

Subd. 13.

Case management.

(a) Each recipient of a home and community-based
waiver shall be provided case management services by qualified vendors as described
in the federally approved waiver application. The case management service activities
provided will include:

(1) assessing the needs of the individual within 20 working days of a recipient's
request;

(2) developing the written individual service plan within ten working days after the
assessment is completed;

(3) informing the recipient or the recipient's legal guardian or conservator of service
options;

(4) assisting the recipient in the identification of potential service providers;

(5) assisting the recipient to access services;

(6) coordinating, evaluating, and monitoring of the services identified in the service
plan;

(7) completing the annual reviews of the service plan; and

(8) informing the recipient or legal representative of the right to have assessments
completed and service plans developed within specified time periods, and to appeal county
action or inaction under section 256.045, subdivision 3 new text begin , including the determination of
nursing facility level of care new text end .

(b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including
assessments, reassessments, and care plan development.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 65.

Minnesota Statutes 2008, section 256B.49, subdivision 14, is amended to read:

Subd. 14.

Assessment and reassessment.

(a) Assessments of each recipient's
strengths, informal support systems, and need for services shall be completed within
20 working days of the recipient's request. Reassessment of each recipient's strengths,
support systems, and need for services shall be conducted at least every 12 months and at
other times when there has been a significant change in the recipient's functioning.

(b) new text begin There must be a determination that the client requires a hospital level of care or a
nursing facility level of care as defined in section 144.0724, subdivision 11, at initial and
subsequent assessments to initiate and maintain participation in the waiver program.
new text end

new text begin (c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only face-to-face assessments conducted according
to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be accepted for
purposes of initial and ongoing access to waiver services payment.
new text end

new text begin (d) new text end Persons with developmental disabilities who apply for services under the nursing
facility level waiver programs shall be screened for the appropriate level of care according
to section 256B.092.

deleted text begin (c) deleted text end new text begin (e) new text end Recipients who are found eligible for home and community-based services
under this section before their 65th birthday may remain eligible for these services after
their 65th birthday if they continue to meet all other eligibility factors.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 66.

Minnesota Statutes 2008, section 256B.49, is amended by adding a
subdivision to read:

new text begin Subd. 22. new text end

new text begin Residential support services. new text end

new text begin For the purposes of this section, the
provisions of section 256B.092, subdivision 11, are controlling.
new text end

Sec. 67.

new text begin [256B.4912] HOME AND COMMUNITY-BASED WAIVERS;
PROVIDERS AND PAYMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Provider qualifications. new text end

new text begin For the home and community-based
waivers providing services to seniors and individuals with disabilities, the commissioner
shall establish:
new text end

new text begin (1) agreements with enrolled waiver service providers to ensure providers meet
qualifications defined in the waiver plans;
new text end

new text begin (2) regular reviews of provider qualifications; and
new text end

new text begin (3) processes to gather the necessary information to determine provider
qualifications.
new text end

new text begin By July 1, 2010, staff that provide direct contact, as defined in section 245C.02, subdivision
11, that are employees of waiver service providers must meet the requirements of chapter
245C prior to providing waiver services and as part of ongoing enrollment. Upon federal
approval, this requirement must also apply to consumer-directed community supports.
new text end

new text begin Subd. 2. new text end

new text begin Rate-setting methodologies. new text end

new text begin The commissioner shall establish
statewide rate-setting methodologies that meet federal waiver requirements for home
and community-based waiver services for individuals with disabilities. The rate-setting
methodologies must abide by the principles of transparency and equitability across the
state. The methodologies must involve a uniform process of structuring rates for each
service and must promote quality and participant choice.
new text end

Sec. 68.

Minnesota Statutes 2008, section 256B.5012, is amended by adding a
subdivision to read:

new text begin Subd. 8. new text end

new text begin ICF/MR rate decreases effective July 1, 2009. new text end

new text begin Effective July 1, 2009,
the commissioner shall decrease each facility reimbursed under this section operating
payment adjustments equal to 3.0 percent of the operating payment rates in effect on June
30, 2009. For each facility, the commissioner shall implement the rate reduction, based on
occupied beds, using the percentage specified in this subdivision multiplied by the total
payment rate, including the variable rate but excluding the property-related payment rate,
in effect on the preceding date. The total rate reduction shall include the adjustment
provided in section 256B.502, subdivision 7.
new text end

Sec. 69.

Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed care contracts which were in effect on June
30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to services to
medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
of its contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B, 256D, and 256L, established after the effective date of a contract
with the commissioner take effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1, 2003, the commissioner
shall withhold five percent of managed care plan payments under this section for the
prepaid medical assistance and general assistance medical care programs pending
completion of performance targets. Each performance target must be quantifiable,
objective, measurable, and reasonably attainable, except in the case of a performance
target based on a federal or state law or rule. Criteria for assessment of each performance
target must be outlined in writing prior to the contract effective date. The managed
care plan must demonstrate, to the commissioner's satisfaction, that the data submitted
regarding attainment of the performance target is accurate. The commissioner shall
periodically change the administrative measures used as performance targets in order
to improve plan performance across a broader range of administrative services. The
performance targets must include measurement of plan efforts to contain spending
on health care services and administrative activities. The commissioner may adopt
plan-specific performance targets that take into account factors affecting only one plan,
including characteristics of the plan's enrollee population. The withheld funds must be
returned no sooner than July of the following year if performance targets in the contract
are achieved. The commissioner may exclude special demonstration projects under
subdivision 23. A managed care plan or a county-based purchasing plan under section
256B.692 may include as admitted assets under section 62D.044 any amount withheld
under this paragraph that is reasonably expected to be returned.

(d)(1) Effective for services rendered on or after January 1, 2009, the commissioner
shall withhold three percent of managed care plan payments under this section for the
prepaid medical assistance and general assistance medical care programs. The withheld
funds must be returned no sooner than July 1 and no later than July 31 of the following
year. The commissioner may exclude special demonstration projects under subdivision 23.

(2) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under
this paragraph. The return of the withhold under this paragraph is not subject to the
requirements of paragraph (c).

new text begin (e) Effective for services provided on or after January 1, 2010, the commissioner
shall require that managed care plans use the fee-for-service medical assistance assessment
and authorization processes, forms, timelines, standards, documentation, and data
reporting requirements, protocols, billing processes, and policies for all personal care
assistance services under section 256B.0659.
new text end

Sec. 70.

Minnesota Statutes 2008, section 626.556, subdivision 3c, is amended to read:

Subd. 3c.

Local welfare agency, Department of Human Services or Department
of Health responsible for assessing or investigating reports of maltreatment.

(a)
The county local welfare agency is the agency responsible for assessing or investigating
allegations of maltreatment in child foster care, family child care, deleted text begin and deleted text end legally unlicensed
child care deleted text begin and in deleted text end new text begin , new text end juvenile correctional facilities licensed under section 241.021 located
in the local welfare agency's county new text begin , and unlicensed personal care assistance provider
organizations providing services and receiving reimbursements under chapter 256B new text end .

(b) The Department of Human Services is the agency responsible for assessing or
investigating allegations of maltreatment in facilities licensed under chapters 245A and
245B, except for child foster care and family child care.

(c) The Department of Health is the agency responsible for assessing or investigating
allegations of child maltreatment in facilities licensed under sections 144.50 to 144.58 deleted text begin ,
and in unlicensed home health care deleted text end new text begin and 144A.46 new text end .

(d) The commissioners of human services, public safety, and education must
jointly submit a written report by January 15, 2007, to the education policy and finance
committees of the legislature recommending the most efficient and effective allocation
of agency responsibility for assessing or investigating reports of maltreatment and must
specifically address allegations of maltreatment that currently are not the responsibility
of a designated agency.

Sec. 71.

Minnesota Statutes 2008, section 626.5572, subdivision 13, is amended to
read:

Subd. 13.

Lead agency.

"Lead agency" is the primary administrative agency
responsible for investigating reports made under section 626.557.

(a) The Department of Health is the lead agency for the facilities which are licensed
or are required to be licensed as hospitals, home care providers, nursing homes, residential
care homes, or boarding care homes.

(b) The Department of Human Services is the lead agency for the programs licensed
or required to be licensed as adult day care, adult foster care, programs for people with
developmental disabilities, mental health programs, new text begin or new text end chemical health programs deleted text begin , or
personal care provider organizations deleted text end .

(c) The county social service agency or its designee is the lead agency for all other
reports new text begin , including personal care provider organizations under section 256B.0659 new text end .

Sec. 72. new text begin COLA COMPENSATION REQUIREMENTS.
new text end

new text begin Effective July 1, 2009, providers who received rate increases under Laws 2007,
chapter 147, article 7, section 71, as amended by Laws 2008, chapter 363, article 15,
section 17, and Minnesota Statutes, section 256B.5012, subdivision 7, for state fiscal years
2008 and 2009 are no longer required to continue or retain employee compensation or
wage-related increases required by those sections. This paragraph shall not apply to
employees covered by a collective bargaining agreement.
new text end

Sec. 73. new text begin PROVIDER RATE AND GRANT REDUCTIONS.
new text end

new text begin (a) The commissioner of human services shall decrease grants, allocations,
reimbursement rates, or rate limits, as applicable, by 3.0 percent effective July 1, 2009, for
services rendered on or after that date. County or tribal contracts for services specified
in this section must be amended to pass through these rate reductions within 60 days of
the effective date of the decrease and must be retroactive from the effective date of the
rate decrease.
new text end

new text begin (b) The annual rate decreases described in this section must be provided to:
new text end

new text begin (1) home and community-based waivered services for persons with developmental
disabilities or related conditions, including consumer-directed community supports, under
Minnesota Statutes, section 256B.501;
new text end

new text begin (2) home and community-based waivered services for the elderly, including
consumer-directed community supports, under Minnesota Statutes, section 256B.0915;
new text end

new text begin (3) waivered services under community alternatives for disabled individuals,
including consumer-directed community supports, under Minnesota Statutes, section
256B.49;
new text end

new text begin (4) community alternative care waivered services, including consumer-directed
community supports, under Minnesota Statutes, section 256B.49;
new text end

new text begin (5) traumatic brain injury waivered services, including consumer-directed
community supports, under Minnesota Statutes, section 256B.49;
new text end

new text begin (6) nursing services and home health services under Minnesota Statutes, section
256B.0625, subdivision 6a;
new text end

new text begin (7) personal care services and qualified professional supervision of personal care
services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
new text end

new text begin (8) private duty nursing services under Minnesota Statutes, section 256B.0625,
subdivision 7;
new text end

new text begin (9) day training and habilitation services for adults with developmental disabilities
or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
additional cost of rate adjustments on day training and habilitation services, provided as a
social service under Minnesota Statutes, section 256M.60;
new text end

new text begin (10) alternative care services under Minnesota Statutes, section 256B.0913;
new text end

new text begin (11) the group residential housing supplementary service rate under Minnesota
Statutes, section 256I.05, subdivision 1a;
new text end

new text begin (12) semi-independent living services (SILS) under Minnesota Statutes, section
252.275, including SILS funding under county social services grants formerly funded
under Minnesota Statutes, chapter 256I;
new text end

new text begin (13) community support services for deaf and hard-of-hearing adults with mental
illness who use or wish to use sign language as their primary means of communication
under Minnesota Statutes, section 256.01, subdivision 2; and deaf and hard-of-hearing
grants under Minnesota Statutes, sections 256C.233 and 256C.25; Laws 1985, chapter 9;
and Laws 1997, First Special Session chapter 5, section 20;
new text end

new text begin (14) physical therapy services under Minnesota Statutes, sections 256B.0625,
subdivision 8, and 256D.03, subdivision 4;
new text end

new text begin (15) occupational therapy services under Minnesota Statutes, sections 256B.0625,
subdivision 8a, and 256D.03, subdivision 4;
new text end

new text begin (16) speech-language therapy services under Minnesota Statutes, section 256D.03,
subdivision 4, and Minnesota Rules, part 9505.0390;
new text end

new text begin (17) respiratory therapy services under Minnesota Statutes, section 256D.03,
subdivision 4, and Minnesota Rules, part 9505.0295;
new text end

new text begin (18) consumer support grants under Minnesota Statutes, section 256.476;
new text end

new text begin (19) family support grants under Minnesota Statutes, section 252.32;
new text end

new text begin (20) aging grants under Minnesota Statutes, sections 256.975 to 256.977, 256B.0917,
and 256B.0928;
new text end

new text begin (21) disability linkage line grants under Minnesota Statutes, section 256.01,
subdivision 24; and
new text end

new text begin (22) housing access grants under Minnesota Statutes, section 256B.0658.
new text end

new text begin (c) A managed care plan receiving state payments for the services in this section
must include these decreases in their payments to providers effective on October 1
following the effective date of the rate decrease.
new text end

Sec. 74. new text begin RESULTS OF CHANGES TO THE PERSONAL CARE ASSISTANCE
PROGRAM.
new text end

new text begin The commissioner of human services must provide data to the legislative committees
with jurisdiction over health and human services policy and finance by January 15, 2010,
on the training developed and delivered for all types of participants in the personal
care assistance program, audit and financial integrity measures and results, information
developed for consumers and responsible parties, and quality assurance measures and
results.
new text end

Sec. 75. new text begin DEVELOPMENT OF ALTERNATIVE SERVICES.
new text end

new text begin The commissioner of human services, in consultation with advocates, consumers,
and legislators, shall develop alternative services to personal care assistance services for
persons with mental health and other behavioral challenges who can benefit from other
services that more appropriately meet their needs and assist them in living independently
in the community. In the development of these services, the commissioner shall:
new text end

new text begin (1) take into consideration ways in which these alternative services will qualify for
federal financial participation; and
new text end

new text begin (2) analyze a variety of alternatives, including but not limited to a 1915(i) state
plan option.
new text end

new text begin The commissioner shall report to the legislature by January 15, 2011, with plans for
implementation of these services by July 1, 2011.
new text end

Sec. 76. new text begin 30-DAY NOTICE REQUIRED.
new text end

new text begin Notwithstanding any contrary provision in law, persons impacted by amendments
in this article to Minnesota Statutes, sections 256B.0625, subdivision 19c; 256B.0655,
subdivision 4; 256B.0659; and 256B.0911, subdivision 1, must be given a 30-day notice
of action by the commissioner. This section expires July 1, 2011.
new text end

Sec. 77. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin Subdivision 1. new text end

new text begin Renumbering of Minnesota Statutes, section 256B.0652,
authorization and review of home care services. new text end

new text begin (a) The revisor of statutes shall
renumber each section of Minnesota Statutes listed in column A with the number in
column B.
new text end

new text begin Column A new text end	new text begin Column B new text end
new text begin 256B.0652, subdivision 3 new text end	new text begin 256B.0652, subdivision 14 new text end
new text begin 256B.0651, subdivision 6, paragraph (a) new text end	new text begin 256B.0652, subdivision 3 new text end
new text begin 256B.0651, subdivision 6, paragraph (b) new text end	new text begin 256B.0652, subdivision 4 new text end
new text begin 256B.0651, subdivision 6, paragraph (c) new text end	new text begin 256B.0652, subdivision 7 new text end
new text begin 256B.0651, subdivision 7, paragraph (a) new text end	new text begin 256B.0652, subdivision 8 new text end
new text begin 256B.0651, subdivision 7, paragraph (b) new text end	new text begin 256B.0652, subdivision 14 new text end
new text begin 256B.0651, subdivision 8 new text end	new text begin 256B.0652, subdivision 9 new text end
new text begin 256B.0651, subdivision 9 new text end	new text begin 256B.0652, subdivision 10 new text end
new text begin 256B.0651, subdivision 11 new text end	new text begin 256B.0652, subdivision 11 new text end
new text begin 256B.0654, subdivision 2 new text end	new text begin 256B.0652, subdivision 5 new text end
new text begin 256B.0655, subdivision 4 new text end	new text begin 256B.0652, subdivision 6 new text end

new text begin (b) The revisor of statutes shall make necessary cross-reference changes in statutes
and rules consistent with the renumbering in paragraph (a). The Department of Human
Services shall assist the revisor with any cross-reference changes. The revisor may make
changes necessary to correct the punctuation, grammar, or structure of the remaining text
to conform with the intent of the renumbering in paragraph (a).
new text end

new text begin Subd. 2. new text end

new text begin Renumbering personal care assistance services. new text end

new text begin The revisor of statutes
shall replace any reference to Minnesota Statutes, section 256B.0655 with section
256B.0659, wherever it appears in statutes or rules. The revisor shall correct any cross
reference changes that are necessary as a result of this section. The Department of Human
Services shall assist the revisor in making these changes, and if necessary, shall draft a
corrections bill with changes for introduction in the 2010 legislative session. The revisor
may make changes to punctuation, grammar, or sentence structure to preserve the integrity
of statutes and effectuate the intention of this section.
new text end

Sec. 78. new text begin REPEALER.
new text end

new text begin (a) Minnesota Statutes 2008, sections 256B.19, subdivision 1d; and 256B.431,
subdivision 23, new text end new text begin are repealed effective May 1, 2009.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2008, section 256B.0951, new text end new text begin is repealed effective July 1, 2009.
new text end

new text begin (c) new text end new text begin Minnesota Statutes 2008, sections 256B.0655, subdivisions 1, 1a, 1b, 1c, 1d, 1e,
1f, 1g, 1h, 1i, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, and 13; and 256B.071, subdivisions 1, 2, 3,
and 4, new text end new text begin are repealed.
new text end

ARTICLE 2

MFIP/CHILD CARE/ADULT SUPPORTS/FRAUD PREVENTION

Section 1.

Minnesota Statutes 2008, section 119B.09, subdivision 7, is amended to read:

Subd. 7.

Date of eligibility for assistance.

(a) The date of eligibility for child
care assistance under this chapter is the later of the date the application was signed; the
beginning date of employment, education, or training; the date the infant is born for
applicants to the at-home infant care program; or the date a determination has been made
that the applicant is a participant in employment and training services under Minnesota
Rules, part 3400.0080, or chapter 256J.

(b) Payment ceases for a family under the at-home infant child care program when a
family has used a total of 12 months of assistance as specified under section 119B.035.
Payment of child care assistance for employed persons on MFIP is effective the date of
employment or the date of MFIP eligibility, whichever is later. Payment of child care
assistance for MFIP or DWP participants in employment and training services is effective
the date of commencement of the services or the date of MFIP or DWP eligibility,
whichever is later. Payment of child care assistance for transition year child care must be
made retroactive to the date of eligibility for transition year child care.

new text begin (c) Notwithstanding paragraph (b), payment of child care assistance for participants
eligible under section 119B.05 may only be made retroactive for a maximum of six
months from the date of application for child care assistance.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2009.
new text end

Sec. 2.

Minnesota Statutes 2008, section 119B.13, subdivision 6, is amended to read:

Subd. 6.

Provider payments.

(a) Counties or the state shall make vendor payments
to the child care provider or pay the parent directly for eligible child care expenses.

(b) If payments for child care assistance are made to providers, the provider shall
bill the county for services provided within ten days of the end of the service period. If
bills are submitted within ten days of the end of the service period, a county or the state
shall issue payment to the provider of child care under the child care fund within 30 days
of receiving a bill from the provider. Counties or the state may establish policies that
make payments on a more frequent basis.

(c) deleted text begin All bills deleted text end new text begin If a provider has received an authorization of care and been issued a
billing form for an eligible family, the bill new text end must be submitted within 60 days of the last
date of service on the bill. A county may pay a bill submitted more than 60 days after
the last date of service if the provider shows good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county
error. A county may not pay any bill submitted more than a year after the last date of
service on the bill.

(d) new text begin If a provider provided care for a time period without receiving an authorization
of care and a billing form for an eligible family, payment of child care assistance may only
be made retroactively for a maximum of six months from the date the provider is issued
an authorization of care and billing form.
new text end

new text begin (e) new text end A county may stop payment issued to a provider or may refuse to pay a bill
submitted by a provider if:

(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms; or

(2) a county finds by a preponderance of the evidence that the provider intentionally
gave the county materially false information on the provider's billing forms.

deleted text begin (e) deleted text end new text begin (f) new text end A county's payment policies must be included in the county's child care plan
under section 119B.08, subdivision 3. If payments are made by the state, in addition to
being in compliance with this subdivision, the payments must be made in compliance
with section 16A.124.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2009.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256.983, subdivision 1, is amended to read:

Subdivision 1.

Programs established.

Within the limits of available appropriations,
the commissioner of human services shall require the maintenance of budget neutral
fraud prevention investigation programs in the counties participating in the fraud
prevention investigation project established under this section. If funds are sufficient,
the commissioner may also extend fraud prevention investigation programs to other
counties provided the expansion is budget neutral to the state. new text begin Under any expansion, the
commissioner has the final authority in decisions regarding the creation and realignment
of individual county or regional operations.
new text end

Sec. 4.

Minnesota Statutes 2008, section 256I.03, subdivision 7, is amended to read:

Subd. 7.

Countable income.

"Countable income" means all income received by an
applicant or recipient less any applicable exclusions or disregards. For a recipient of any
cash benefit from the SSI program, countable income means the SSI benefit limit in effect
at the time the person is in a GRH deleted text begin setting less $20 deleted text end , less the medical assistance personal
needs allowance. If the SSI limit has been reduced for a person due to events occurring
prior to the persons entering the GRH setting, countable income means actual income less
any applicable exclusions and disregards.

Sec. 5.

Minnesota Statutes 2008, section 256J.24, subdivision 5, is amended to read:

Subd. 5.

MFIP transitional standard.

The MFIP transitional standard is based
on the number of persons in the assistance unit eligible for both food and cash assistance
unless the restrictions in subdivision 6 on the birth of a child apply. The following table
represents the transitional standards effective deleted text begin October 1, 2007 deleted text end new text begin April 1, 2009 new text end .

Number of Eligible People

Transitional Standard

Cash Portion

Food Portion

1	deleted text begin $391 deleted text end new text begin $428 new text end :	$250	deleted text begin $141 deleted text end new text begin $178 new text end
2	deleted text begin $698 deleted text end new text begin $764 new text end :	$437	deleted text begin $261 deleted text end new text begin $327 new text end
3	deleted text begin $910 deleted text end new text begin $1,005 new text end :	$532	deleted text begin $378 deleted text end new text begin $473 new text end
4	deleted text begin $1,091 deleted text end new text begin $1,217 new text end :	$621	deleted text begin $470 deleted text end new text begin $596 new text end
5	deleted text begin $1,245 deleted text end new text begin $1,393 new text end :	$697	deleted text begin $548 deleted text end new text begin $696 new text end
6	deleted text begin $1,425 deleted text end new text begin $1,602 new text end :	$773	deleted text begin $652 deleted text end new text begin $829 new text end
7	deleted text begin $1,553 deleted text end new text begin $1,748 new text end :	$850	deleted text begin $703 deleted text end new text begin $898 new text end
8	deleted text begin $1,713 deleted text end new text begin $1,934 new text end :	$916	deleted text begin $797 deleted text end new text begin $1,018 new text end
9	deleted text begin $1,871 deleted text end new text begin $2,119 new text end :	$980	deleted text begin $891 deleted text end new text begin $1,139 new text end
10	deleted text begin $2,024 deleted text end new text begin $2,298 new text end :	$1,035	deleted text begin $989 deleted text end new text begin $1,263 new text end
over 10	add deleted text begin $151 deleted text end new text begin $178 new text end :	$53	deleted text begin $98 deleted text end new text begin $125 new text end
per additional member.

The commissioner shall annually publish in the State Register the transitional
standard for an assistance unit sizes 1 to 10 including a breakdown of the cash and food
portions.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from April 1, 2009.
new text end

Sec. 6.

Minnesota Statutes 2008, section 256J.42, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Temporary suspension of time limit. new text end

new text begin (a) The months of MFIP cash
assistance received from July 1, 2009, through June 30, 2011, do not count toward the
60-month time limit in subdivision 1.
new text end

new text begin (b) The months of assistance received under this subdivision are state funded.
new text end

Sec. 7.

Minnesota Statutes 2008, section 256J.425, subdivision 2, is amended to read:

Subd. 2.

Ill or incapacitated.

(a) An assistance unit subject to the time limit in
section 256J.42, subdivision 1, is eligible to receive months of assistance under a hardship
extension if the participant who reached the time limit belongs to any of the following
groups:

(1) participants who are suffering from an illness, injury, or incapacity which
has been certified by a qualified professional when the illness, injury, or incapacity is
expected to continue for more than 30 days and deleted text begin prevents the person from obtaining or
retaining employment deleted text end new text begin severely limits the person's ability to obtain or maintain suitable
employment new text end . These participants must follow the treatment recommendations of the
qualified professional certifying the illness, injury, or incapacity;

(2) participants whose presence in the home is required as a caregiver because of
the illness, injury, or incapacity of another member in the assistance unit, a relative in the
household, or a foster child in the household when the illness or incapacity and the need
for a person to provide assistance in the home has been certified by a qualified professional
and is expected to continue for more than 30 days; or

(3) caregivers with a child or an adult in the household who meets the disability or
medical criteria for home care services under section 256B.0651, subdivision 1, paragraph
(c), or a home and community-based waiver services program under chapter 256B, or
meets the criteria for severe emotional disturbance under section 245.4871, subdivision
6, or for serious and persistent mental illness under section 245.462, subdivision 20,
paragraph (c). Caregivers in this category are presumed to be prevented from obtaining
or retaining employment.

(b) An assistance unit receiving assistance under a hardship extension under this
subdivision may continue to receive assistance as long as the participant meets the criteria
in paragraph (a), clause (1), (2), or (3).

Sec. 8.

Minnesota Statutes 2008, section 256J.425, subdivision 3, is amended to read:

Subd. 3.

Hard-to-employ participants.

new text begin (a) new text end An assistance unit subject to the time
limit in section 256J.42, subdivision 1, is eligible to receive months of assistance under
a hardship extension if the participant who reached the time limit belongs to any of the
following groups:

(1) a person who is diagnosed by a licensed physician, psychological practitioner,
or other qualified professional, as developmentally disabled or mentally ill, and deleted text begin that
condition prevents the person from obtaining or retaining unsubsidized employment deleted text end new text begin the
condition severely limits the person's ability to obtain or maintain suitable employment new text end ;

(2) a person who:

(i) has been assessed by a vocational specialist or the county agency to be
unemployable for purposes of this subdivision; or

(ii) has an IQ below 80 who has been assessed by a vocational specialist or a county
agency to be employable, but deleted text begin not at a level that makes the participant eligible for an
extension under subdivision 4 deleted text end new text begin the condition severely limits the person's ability to obtain or
maintain suitable employment new text end . The determination of IQ level must be made by a qualified
professional. In the case of a non-English-speaking person: (A) the determination must
be made by a qualified professional with experience conducting culturally appropriate
assessments, whenever possible; (B) the county may accept reports that identify an
IQ range as opposed to a specific score; (C) these reports must include a statement of
confidence in the results;

(3) a person who is determined by a qualified professional to be learning disabled,
and the deleted text begin disability deleted text end new text begin condition new text end severely limits the person's ability to obtain deleted text begin , perform, deleted text end or
maintain suitable employment. For purposes of the initial approval of a learning disability
extension, the determination must have been made or confirmed within the previous 12
months. In the case of a non-English-speaking person: (i) the determination must be made
by a qualified professional with experience conducting culturally appropriate assessments,
whenever possible; and (ii) these reports must include a statement of confidence in the
results. If a rehabilitation plan for a participant extended as learning disabled is developed
or approved by the county agency, the plan must be incorporated into the employment
plan. However, a rehabilitation plan does not replace the requirement to develop and
comply with an employment plan under section 256J.521; or

(4) a person who has been granted a family violence waiver, and who is complying
with an employment plan under section 256J.521, subdivision 3.

new text begin (b) For purposes of this section, "severely limits the person's ability to obtain or
maintain suitable employment" means that a qualified professional has determined that the
person's condition prevents the person from working 20 or more hours per week.
new text end

Sec. 9.

Minnesota Statutes 2008, section 256J.425, is amended by adding a subdivision
to read:

new text begin Subd. 3a. new text end

new text begin Temporary hardship. new text end

new text begin A participant who has reached the 60-month time
limit under section 256J.42, and does not qualify for an extension under subdivision 2, 3,
4, or 5, may receive MFIP assistance under a temporary hardship extension between July
1, 2009, and June 30, 2011. To receive a temporary hardship extension, the participant
must meet the MFIP eligibility criteria in chapter 256J, except that the requirement that
the participant be in compliance in the 60th month does not apply. Sanction provisions in
subdivisions 6 and 7 apply to participants extended under this subdivision.
new text end

Sec. 10.

Minnesota Statutes 2008, section 256J.425, subdivision 4, is amended to read:

Subd. 4.

Employed participants.

(a) An assistance unit subject to the time limit
under section 256J.42, subdivision 1, is eligible to receive assistance under a hardship
extension if the participant who reached the time limit belongs to:

(1) a one-parent assistance unit in which the participant is participating in work
activities for at least 30 hours per week, of which an average of at least 25 hours per week
every month are spent participating in employment;

(2) a two-parent assistance unit in which the participants are participating in work
activities for at least 55 hours per week, of which an average of at least 45 hours per week
every month are spent participating in employment; or

(3) an assistance unit in which a participant is participating in employment for fewer
hours than those specified in clause (1), and the participant submits verification from a
qualified professional, in a form acceptable to the commissioner, stating that the number
of hours the participant may work is limited due to illness or disability, as long as the
participant is participating in employment for at least the number of hours specified by the
qualified professional. The participant must be following the treatment recommendations
of the qualified professional providing the verification. The commissioner shall develop a
form to be completed and signed by the qualified professional, documenting the diagnosis
and any additional information necessary to document the functional limitations of the
participant that limit work hours. If the participant is part of a two-parent assistance unit,
the other parent must be treated as a one-parent assistance unit for purposes of meeting the
work requirements under this subdivision.

(b) For purposes of this section, employment means:

(1) unsubsidized employment under section 256J.49, subdivision 13, clause (1);

(2) subsidized employment under section 256J.49, subdivision 13, clause (2);

(3) on-the-job training under section 256J.49, subdivision 13, clause (2);

(4) an apprenticeship under section 256J.49, subdivision 13, clause (1);

(5) supported work under section 256J.49, subdivision 13, clause (2);

(6) a combination of clauses (1) to (5); deleted text begin or
deleted text end

(7) child care under section 256J.49, subdivision 13, clause (7), if it is in combination
with paid employment new text begin ; or
new text end

new text begin (8) unpaid work under section 256J.49, subdivision 13, clause (3), if it is combined
with job search for up to 12 months in duration new text end .

(c) If a participant is complying with a child protection plan under chapter 260C,
the number of hours required under the child protection plan count toward the number
of hours required under this subdivision.

(d) The county shall provide the opportunity for subsidized employment to
participants needing that type of employment within available appropriations.

(e) To be eligible for a hardship extension for employed participants under this
subdivision, a participant must be in compliance for at least ten out of the 12 months
the participant received MFIP immediately preceding the participant's 61st month on
assistance. If ten or fewer months of eligibility for TANF assistance remain at the time the
participant from another state applies for assistance, the participant must be in compliance
every month.

(f) The employment plan developed under section 256J.521, subdivision 2, for
participants under this subdivision must contain at least the minimum number of hours
specified in paragraph (a) for the purpose of meeting the requirements for an extension
under this subdivision. The job counselor and the participant must sign the employment
plan to indicate agreement between the job counselor and the participant on the contents
of the plan.

(g) Participants who fail to meet the requirements in paragraph (a), without good
cause under section 256J.57, shall be sanctioned or permanently disqualified under
subdivision 6. Good cause may only be granted for that portion of the month for which
the good cause reason applies. Participants must meet all remaining requirements in the
approved employment plan or be subject to sanction or permanent disqualification.

(h) If the noncompliance with an employment plan is due to the involuntary loss of
employment, the participant is exempt from the hourly employment requirement under
this subdivision for one month. Participants must meet all remaining requirements in the
approved employment plan or be subject to sanction or permanent disqualification. This
exemption is available to each participant two times in a 12-month period.

Sec. 11.

Minnesota Statutes 2008, section 256J.46, subdivision 1, is amended to read:

Subdivision 1.

Participants not complying with program requirements.

(a)
A participant who fails without good cause under section 256J.57 to comply with the
requirements of this chapter, and who is not subject to a sanction under subdivision 2,
shall be subject to a sanction as provided in this subdivision. Prior to the imposition of
a sanction, a county agency shall provide a notice of intent to sanction under section
256J.57, subdivision 2, and, when applicable, a notice of adverse action as provided
in section 256J.31.

(b) A sanction under this subdivision becomes effective the month following the
month in which a required notice is given. A sanction must not be imposed when a
participant comes into compliance with the requirements for orientation under section
256J.45 prior to the effective date of the sanction. A sanction must not be imposed
when a participant comes into compliance with the requirements for employment and
training services under sections 256J.515 to 256J.57 ten days prior to the effective date
of the sanction. For purposes of this subdivision, each month that a participant fails to
comply with a requirement of this chapter shall be considered a separate occurrence of
noncompliance. If both participants in a two-parent assistance unit are out of compliance
at the same time, it is considered one occurrence of noncompliance.

(c) Sanctions for noncompliance shall be imposed as follows:

(1) For the first occurrence of noncompliance by a participant in an assistance unit,
the assistance unit's grant shall be reduced by ten percent of the MFIP standard of need
for an assistance unit of the same size with the residual grant paid to the participant. The
reduction in the grant amount must be in effect for a minimum of one month and shall be
removed in the month following the month that the participant returns to compliance.

(2) For a second, third, fourth, fifth, or sixth occurrence of noncompliance by a
participant in an assistance unit, the assistance unit's shelter costs shall be vendor paid
up to the amount of the cash portion of the MFIP grant for which the assistance unit is
eligible. At county option, the assistance unit's utilities may also be vendor paid up to
the amount of the cash portion of the MFIP grant remaining after vendor payment of the
assistance unit's shelter costs. The residual amount of the grant after vendor payment, if
any, must be reduced by an amount equal to 30 percent of the MFIP standard of need for an
assistance unit of the same size before the residual grant is paid to the assistance unit. The
reduction in the grant amount must be in effect for a minimum of one month and shall be
removed in the month following the month that the participant in a one-parent assistance
unit returns to compliance. In a two-parent assistance unit, the grant reduction must
be in effect for a minimum of one month and shall be removed in the month following
the month both participants return to compliance. The vendor payment of shelter costs
and, if applicable, utilities shall be removed six months after the month in which the
participant or participants return to compliance. If an assistance unit is sanctioned under
this clause, the participant's case file must be reviewed to determine if the employment
plan is still appropriate.

(d) For a seventh occurrence of noncompliance by a participant in an assistance unit,
or when the participants in a two-parent assistance unit have a total of seven occurrences
of noncompliance, the county agency shall close the MFIP assistance unit's financial
assistance case, both the cash and food portions, and redetermine the family's continued
eligibility for food support payments. The MFIP case must remain closed for a minimum
of one full month. Before the case is closed, new text begin the county agency or employment services
provider must assess the participant and determine if information is available that the
participant may be eligible for family stabilization services based on the criteria in
section 256J.575, subdivision 3. new text end The county agency must new text begin also new text end review the participant's
case to determine if the employment plan is still appropriate and attempt to meet with
the participant face-to-face. The participant may bring an advocate to the face-to-face
meeting. If a face-to-face meeting is not conducted, the county agency must send the
participant a written notice that includes the information required under clause (1).

(1) During the face-to-face meeting, the county agency must:

(i) determine whether the continued noncompliance can be explained and mitigated
by providing a needed preemployment activity, as defined in section 256J.49, subdivision
13, clause (9);

(ii) determine whether the participant qualifies for a good cause exception under
section 256J.57, or if the sanction is for noncooperation with child support requirements,
determine if the participant qualifies for a good cause exemption under section 256.741,
subdivision 10;

(iii) determine whether the work activities in the employment plan are appropriate
based on the criteria in section 256J.521, subdivision 2 or 3;

(iv) determine whether the participant qualifies for the family violence waiver;

(v) inform the participant of the participant's sanction status and explain the
consequences of continuing noncompliance;

(vi) identify other resources that may be available to the participant to meet the
needs of the family; and

(vii) inform the participant of the right to appeal under section 256J.40.

(2) If the lack of an identified activity or service can explain the noncompliance, the
county must work with the participant to provide the identified activity.

(3) The grant must be restored to the full amount for which the assistance unit is
eligible retroactively to the first day of the month in which the participant was found to lack
preemployment activities or to qualify for a family violence waiver new text begin , family stabilization
services, new text end or for a good cause exemption under section 256.741, subdivision 10, or 256J.57.

(e) For the purpose of applying sanctions under this section, only occurrences of
noncompliance that occur after July 1, 2003, shall be considered. If the participant is in
30 percent sanction in the month this section takes effect, that month counts as the first
occurrence for purposes of applying the sanctions under this section, but the sanction
shall remain at 30 percent for that month.

(f) An assistance unit whose case is closed under paragraph (d) or (g), may
reapply for MFIP and shall be eligible if the participant complies with MFIP program
requirements and demonstrates compliance for up to one month. No assistance shall be
paid during this period.

(g) An assistance unit whose case has been closed for noncompliance, that reapplies
under paragraph (f), is subject to sanction under paragraph (c), clause (2), for a first
occurrence of noncompliance. Any subsequent occurrence of noncompliance shall result
in case closure under paragraph (d).

Sec. 12.

Minnesota Statutes 2008, section 256J.49, subdivision 1, is amended to read:

Subdivision 1.

Scope.

The terms used in sections deleted text begin 256J.50 deleted text end new text begin 256J.425 new text end to 256J.72 have
the meanings given them in this section.

Sec. 13.

Minnesota Statutes 2008, section 256J.521, subdivision 2, is amended to read:

Subd. 2.

Employment plan; contents.

(a) Based on the assessment under
subdivision 1, the job counselor and the participant must develop an employment plan
that includes participation in activities and hours that meet the requirements of section
256J.55, subdivision 1. The purpose of the employment plan is to identify for each
participant the most direct path to unsubsidized employment and any subsequent steps that
support long-term economic stability. The employment plan should be developed using
the highest level of activity appropriate for the participant. Activities must be chosen from
clauses (1) to (6), which are listed in order of preference. Notwithstanding this order of
preference for activities, priority must be given for activities related to a family violence
waiver when developing the employment plan. The employment plan must also list the
specific steps the participant will take to obtain employment, including steps necessary
for the participant to progress from one level of activity to another, and a timetable for
completion of each step. Levels of activity include:

(1) unsubsidized employment;

(2) job search;

(3) subsidized employment or unpaid work experience;

(4) unsubsidized employment and job readiness education or job skills training;

(5) unsubsidized employment or unpaid work experience and activities related to
a family violence waiver or preemployment needs; and

(6) activities related to a family violence waiver or preemployment needs.

(b) Participants who are determined to possess sufficient skills such that the
participant is likely to succeed in obtaining unsubsidized employment must job search at
least 30 hours per week for up to six weeks and accept any offer of suitable employment.
The remaining hours necessary to meet the requirements of section 256J.55, subdivision
1, may be met through participation in other work activities under section 256J.49,
subdivision 13. The participant's employment plan must specify, at a minimum: (1)
whether the job search is supervised or unsupervised; (2) support services that will
be provided; and (3) how frequently the participant must report to the job counselor.
Participants who are unable to find suitable employment after six weeks must meet
with the job counselor to determine whether other activities in paragraph (a) should be
incorporated into the employment plan. Job search activities which are continued after six
weeks must be structured and supervised.

(c) deleted text begin Beginning July 1, 2004, activities and hourly requirements in the employment
plan may be adjusted as necessary to accommodate the personal and family circumstances
of participants identified under section 256J.561, subdivision 2, paragraph (d). Participants
who no longer meet the provisions of section 256J.561, subdivision 2, paragraph (d),
must meet with the job counselor within ten days of the determination to revise the
employment plan.
deleted text end

deleted text begin (d) deleted text end Participants who are determined to have barriers to obtaining or retaining
employment that will not be overcome during six weeks of job search under paragraph (b)
must work with the job counselor to develop an employment plan that addresses those
barriers by incorporating appropriate activities from paragraph (a), clauses (1) to (6).
The employment plan must include enough hours to meet the participation requirements
in section 256J.55, subdivision 1, unless a compelling reason to require fewer hours
is noted in the participant's file.

deleted text begin (e) deleted text end new text begin (d) new text end The job counselor and the participant must sign the employment plan to
indicate agreement on the contents.

deleted text begin (f) deleted text end new text begin (e) new text end Except as provided under paragraph deleted text begin (g) deleted text end new text begin (f) new text end , failure to develop or comply with
activities in the plan, or voluntarily quitting suitable employment without good cause, will
result in the imposition of a sanction under section 256J.46.

deleted text begin (g) deleted text end new text begin (f) new text end When a participant fails to meet the agreed upon hours of participation in paid
employment because the participant is not eligible for holiday pay and the participant's
place of employment is closed for a holiday, the job counselor shall not impose a sanction
or increase the hours of participation in any other activity, including paid employment, to
offset the hours that were missed due to the holiday.

deleted text begin (h) deleted text end new text begin (g) new text end Employment plans must be reviewed at least every three months to determine
whether activities and hourly requirements should be revised. The job counselor is
encouraged to allow participants who are participating in at least 20 hours of work
activities to also participate in education and training activities in order to meet the federal
hourly participation rates.

Sec. 14.

Minnesota Statutes 2008, section 256J.53, subdivision 1, is amended to read:

Subdivision 1.

Length of program.

deleted text begin In order for deleted text end A postsecondary education or
training program deleted text begin to be an deleted text end approved new text begin as a new text end work activity as defined in section 256J.49,
subdivision 13, clause (6), deleted text begin it must be a program lasting 24 months or less deleted text end new text begin may include
associate and baccalaureate programs new text end , and the participant must meet the requirements of
subdivisions 2, 3, and 5.

Sec. 15.

Minnesota Statutes 2008, section 256J.545, is amended to read:

256J.545 FAMILY VIOLENCE WAIVER CRITERIA.

(a) In order to qualify for a family violence waiver, an individual must provide
documentation of past or current family violence which may prevent the individual from
participating in certain employment activities.

(b) The following items may be considered acceptable documentation or verification
of family violence:

(1) police, government agency, or court records;

(2) a statement from a battered women's shelter staff with knowledge of the
circumstances deleted text begin or credible evidence that supports the sworn statement deleted text end ;

(3) a statement from a sexual assault or domestic violence advocate with knowledge
of the circumstances deleted text begin or credible evidence that supports the sworn statement deleted text end ; or

(4) a statement from professionals from whom the applicant or recipient has sought
assistance for the abuse.

(c) A claim of family violence may also be documented by a sworn statement from
the applicant or participant and a sworn statement from any other person with knowledge
of the circumstances or credible evidence that supports the client's statement.

Sec. 16.

Minnesota Statutes 2008, section 256J.561, subdivision 2, is amended to read:

Subd. 2.

Participation requirements.

(a) All MFIP caregivers, except caregivers
who meet the criteria in subdivision 3, must deleted text begin participate in employment services deleted text end new text begin develop an
individualized employment plan that identifies the activities the participant is required to
participate in and the required hours of participation new text end . deleted text begin Except as specified in paragraphs (b)
to (d), the employment plan must meet the requirements of section 256J.521, subdivision
2, contain allowable work activities, as defined in section 256J.49, subdivision 13, and,
include at a minimum, the number of participation hours required under section 256J.55,
subdivision 1.
deleted text end

deleted text begin (b) Minor caregivers and caregivers who are less than age 20 who have not
completed high school or obtained a GED are required to comply with section 256J.54.
deleted text end

deleted text begin (c) A participant who has a family violence waiver shall develop and comply with
an employment plan under section 256J.521, subdivision 3.
deleted text end

deleted text begin (d) As specified in section 256J.521, subdivision 2, paragraph (c), a participant who
meets any one of the following criteria may work with the job counselor to develop an
employment plan that contains less than the number of participation hours under section
256J.55, subdivision 1. Employment plans for participants covered under this paragraph
must be tailored to recognize the special circumstances of caregivers and families
including limitations due to illness or disability and caregiving needs:
deleted text end

deleted text begin (1) a participant who is age 60 or older;
deleted text end

deleted text begin (2) a participant who has been diagnosed by a qualified professional as suffering
from an illness or incapacity that is expected to last for 30 days or more, including a
pregnant participant who is determined to be unable to obtain or retain employment due
to the pregnancy; or
deleted text end

deleted text begin (3) a participant who is determined by a qualified professional as being needed in
the home to care for an ill or incapacitated family member, including caregivers with a
child or an adult in the household who meets the disability or medical criteria for home
care services under section 256B.0651, subdivision 1, paragraph (c), or a home and
community-based waiver services program under chapter 256B, or meets the criteria for
severe emotional disturbance under section 245.4871, subdivision 6, or for serious and
persistent mental illness under section 245.462, subdivision 20, paragraph (c).
deleted text end

deleted text begin (e) For participants covered under paragraphs (c) and (d), the county shall review
the participant's employment services status every three months to determine whether
conditions have changed. When it is determined that the participant's status is no longer
covered under paragraph (c) or (d), the county shall notify the participant that a new or
revised employment plan is needed. The participant and job counselor shall meet within
ten days of the determination to revise the employment plan.
deleted text end

new text begin (b) Participants who meet the eligibility requirements in section 256J.575,
subdivision 3, must develop a family stabilization services plan that meets the
requirements in section 256J.575, subdivision 5.
new text end

new text begin (c) Minor caregivers and caregivers who are less than age 20 who have not
completed high school or obtained a GED must develop an education plan that meets the
requirements in section 256J.54.
new text end

new text begin (d) Participants with a family violence waiver must develop an employment plan
that meets the requirements in section 256J.521, which cover the provisions in section
256J.575, subdivision 5.
new text end

new text begin (e) All other participants must develop an employment plan that meets the
requirements of section 256J.521, subdivision 2, and contains allowable work activities,
as defined in section 256J.49, subdivision 13. The employment plan must include, at a
minimum, the number of participation hours required under section 256J.55, subdivision 1.
new text end

Sec. 17.

Minnesota Statutes 2008, section 256J.561, subdivision 3, is amended to read:

Subd. 3.

Child under 12 deleted text begin weeks deleted text end new text begin months new text end of age.

(a) A participant who has a
natural born child who is less than 12 deleted text begin weeks deleted text end new text begin months new text end of age who meets the criteria in this
subdivision is not required to participate in employment services until the child reaches
12 deleted text begin weeks deleted text end new text begin months new text end of age. To be eligible for this provision, the assistance unit must not
have already used this provision or the previously allowed child under age one exemption.
However, an assistance unit that has an approved child under age one exemption at the
time this provision becomes effective may continue to use that exemption until the child
reaches one year of age.

(b) The provision in paragraph (a) ends the first full month after the child reaches
12 deleted text begin weeks deleted text end new text begin months new text end of age. This provision is available only once in a caregiver's lifetime.
In a two-parent household, only one parent shall be allowed to use this provision. The
participant and job counselor must meet within ten days after the child reaches 12 deleted text begin weeks deleted text end new text begin
months new text end of age to revise the participant's employment plan.

Sec. 18.

Minnesota Statutes 2008, section 256J.57, subdivision 1, is amended to read:

Subdivision 1.

Good cause for failure to comply.

The county agency shall not
impose the sanction under section 256J.46 if it determines that the participant has good
cause for failing to comply with the requirements of sections 256J.515 to 256J.57. Good
cause exists when:

(1) appropriate child care is not available;

(2) the job does not meet the definition of suitable employment;

(3) the participant is ill or injured;

(4) a member of the assistance unit, a relative in the household, or a foster child in
the household is ill and needs care by the participant that prevents the participant from
complying with the employment plan;

(5) the participant is unable to secure necessary transportation;

(6) the participant is in an emergency situation that prevents compliance with the
employment plan;

(7) the schedule of compliance with the employment plan conflicts with judicial
proceedings;

(8) a mandatory MFIP meeting is scheduled during a time that conflicts with a
judicial proceeding or a meeting related to a juvenile court matter, or a participant's work
schedule;

(9) the participant is already participating in acceptable work activities;

(10) the employment plan requires an educational program for a caregiver under age
20, but the educational program is not available;

(11) activities identified in the employment plan are not available;

(12) the participant is willing to accept suitable employment, but suitable
employment is not available; deleted text begin or
deleted text end

(13) the participant documents other verifiable impediments to compliance with the
employment plan beyond the participant's control new text begin ; or
new text end

new text begin (14) the documentation needed to determine if a participant is eligible for family
stabilization services is not available, but there is information that the participant may
qualify and the participant is cooperating with the county or employment service provider's
efforts to obtain the documentation necessary to determine eligibility new text end .

The job counselor shall work with the participant to reschedule mandatory meetings
for individuals who fall under clauses (1), (3), (4), (5), (6), (7), and (8).

Sec. 19.

Minnesota Statutes 2008, section 256J.575, subdivision 3, is amended to read:

Subd. 3.

Eligibility.

(a) The following MFIP or diversionary work program (DWP)
participants are eligible for the services under this section:

(1) a participant who meets the requirements for or has been granted a hardship
extension under section 256J.425, subdivision 2 or 3, except that it is not necessary for
the participant to have reached or be approaching 60 months of eligibility for this section
to apply;

(2) a participant who is applying for Supplemental Security Income or Social
Security disability insurance; deleted text begin and
deleted text end

(3) a participant who is a noncitizen who has been in the United States for 12 or
fewer months new text begin ; and
new text end

new text begin (4) a participant who is age 60 or older new text end .

(b) Families must meet all other eligibility requirements for MFIP established in
this chapter. Families are eligible for financial assistance to the same extent as if they
were participating in MFIP.

(c) A participant under paragraph (a), clause (3), must be provided with English as a
second language opportunities and skills training for up to 12 months. After 12 months,
the case manager and participant must determine whether the participant should continue
with English as a second language classes or skills training, or both, and continue to
receive family stabilization services.

new text begin (d) If a county agency or employment services provider has information that
an MFIP participant may meet the eligibility criteria set forth in this subdivision, the
county agency or employment services provider must assist the participant in obtaining
the documentation necessary to determine eligibility. Until necessary documentation is
obtained, the participant must be treated as an eligible participant under subdivisions 5 to 7.
new text end

Sec. 20.

Minnesota Statutes 2008, section 256J.575, subdivision 4, is amended to read:

Subd. 4.

Universal participation.

All caregivers must participate in family
stabilization services as defined in subdivision 2 new text begin , except for caregivers exempt under
section 256J.561, subdivision 3 new text end .

Sec. 21.

Minnesota Statutes 2008, section 256J.575, subdivision 6, is amended to read:

Subd. 6.

Cooperation with services requirements.

(a) deleted text begin To be eligible, deleted text end A participant
new text begin who is eligible for family stabilization services under this section new text end shall comply with
paragraphs (b) to (d).

(b) Participants shall engage in family stabilization plan services for the appropriate
number of hours per week that the activities are scheduled and available, unless good
cause exists for not doing so, as defined in section 256J.57, subdivision 1. The appropriate
number of hours must be based on the participant's plan.

(c) The case manager shall review the participant's progress toward the goals in the
family stabilization plan every six months to determine whether conditions have changed,
including whether revisions to the plan are needed.

(d) A participant's requirement to comply with any or all family stabilization plan
requirements under this subdivision is excused when the case management services,
training and educational services, or family support services identified in the participant's
family stabilization plan are unavailable for reasons beyond the control of the participant,
including when money appropriated is not sufficient to provide the services.

Sec. 22.

Minnesota Statutes 2008, section 256J.575, subdivision 7, is amended to read:

Subd. 7.

Sanctions.

(a) new text begin The county agency or employment services provider must
follow the requirements of this subdivision at the time the county agency or employment
services provider has information that an MFIP recipient may meet the eligibility criteria
in subdivision 3.
new text end

new text begin (b) new text end The financial assistance grant of a participating family is reduced according to
section 256J.46, if a participating adult fails without good cause to comply or continue
to comply with the family stabilization plan requirements in this subdivision, unless
compliance has been excused under subdivision 6, paragraph (d).

deleted text begin (b) deleted text end new text begin (c) new text end Given the purpose of the family stabilization services in this section and the
nature of the underlying family circumstances that act as barriers to both employment and
full compliance with program requirements, there must be a review by the county agency
prior to imposing a sanction to determine whether the plan was appropriated to the needs
of the participant and family deleted text begin , and deleted text end new text begin . There must be a current assessment by a behavioral
health or medical professional confirming new text end that the participant in all ways had the ability to
comply with the plan deleted text begin , as confirmed by a behavioral health or medical professional deleted text end .

deleted text begin (c) deleted text end new text begin (d) new text end Prior to the imposition of a sanction, the county agency or employment
services provider shall review the participant's case to determine if the family stabilization
plan is still appropriate and meet with the participant face-to-face. deleted text begin The participant may
bring an advocate deleted text end new text begin The county agency or employment services provider must inform the
participant of the right to bring an advocate new text end to the face-to-face meeting.

During the face-to-face meeting, the county agency shall:

(1) determine whether the continued noncompliance can be explained and mitigated
by providing a needed family stabilization service, as defined in subdivision 2, paragraph
(d);

(2) determine whether the participant qualifies for a good cause exception under
section 256J.57, or if the sanction is for noncooperation with child support requirements,
determine if the participant qualifies for a good cause exemption under section 256.741,
subdivision 10;

(3) determine whether activities in the family stabilization plan are appropriate
based on the family's circumstances;

(4) explain the consequences of continuing noncompliance;

(5) identify other resources that may be available to the participant to meet the
needs of the family; and

(6) inform the participant of the right to appeal under section 256J.40.

If the lack of an identified activity or service can explain the noncompliance, the
county shall work with the participant to provide the identified activity.

(d) If the participant fails to come to the face-to-face meeting, the case manager or a
designee shall attempt at least one home visit. If a face-to-face meeting is not conducted,
the county agency shall send the participant a written notice that includes the information
under paragraph (c).

(e) After the requirements of paragraphs (c) and (d) are met and prior to imposition
of a sanction, the county agency shall provide a notice of intent to sanction under section
256J.57, subdivision 2, and, when applicable, a notice of adverse action under section
256J.31.

(f) Section 256J.57 applies to this section except to the extent that it is modified
by this subdivision.

Sec. 23.

Minnesota Statutes 2008, section 256J.621, is amended to read:

256J.621 WORK PARTICIPATION CASH BENEFITS.

(a) Effective October 1, 2009, upon exiting the diversionary work program (DWP)
or upon terminating the Minnesota family investment program with earnings, a participant
who is employed may be eligible for work participation cash benefits of deleted text begin $75 deleted text end new text begin $50 new text end per
month to assist in meeting the family's basic needs as the participant continues to move
toward self-sufficiency.

(b) To be eligible for work participation cash benefits, the participant shall not
receive MFIP or diversionary work program assistance during the month and the
participant or participants must meet the following work requirements:

(1) if the participant is a single caregiver and has a child under six years of age, the
participant must be employed at least 87 hours per month;

(2) if the participant is a single caregiver and does not have a child under six years of
age, the participant must be employed at least 130 hours per month; or

(3) if the household is a two-parent family, at least one of the parents must be
employed an average of at least 130 hours per month.

Whenever a participant exits the diversionary work program or is terminated from
MFIP and meets the other criteria in this section, work participation cash benefits are
available for up to 24 consecutive months.

(c) Expenditures on the program are maintenance of effort state funds new text begin under
a separate state program new text end for participants under paragraph (b), clauses (1) and (2).
Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort
funds. Months in which a participant receives work participation cash benefits under this
section do not count toward the participant's MFIP 60-month time limit.

Sec. 24.

Minnesota Statutes 2008, section 256J.626, subdivision 7, is amended to read:

Subd. 7.

Performance base funds.

(a) new text begin For the purpose of this section, the following
terms have the meanings given.
new text end

new text begin (1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota
TANF and separate state program caseload has fallen relative to federal fiscal year 2005
based on caseload data from October 1 to September 30.
new text end

new text begin (2) "TANF participation rate target" means a 50 percent participation rate reduced by
the CRC for the previous year.
new text end

new text begin (b) new text end For calendar year deleted text begin 2009 deleted text end new text begin 2010 new text end and yearly thereafter, each county and tribe will be
allocated 95 percent of their initial calendar year allocation. Counties and tribes will be
allocated additional funds based on performance as follows:

(1) a county or tribe that achieves deleted text begin a 50 percent deleted text end new text begin the new text end TANF participation rate new text begin target new text end
or a five percentage point improvement over the previous year's TANF participation rate
under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive
months for the most recent year for which the measurements are available, will receive an
additional allocation equal to 2.5 percent of its initial allocation; deleted text begin and
deleted text end

(2) a county or tribe that performs within or above its range of expected performance
on the annualized three-year self-support index under section 256J.751, subdivision 2,
clause (6), will receive an additional allocation equal to 2.5 percent of its initial allocation;
and

(3) a county or tribe that does not achieve deleted text begin a 50 percent deleted text end new text begin the new text end TANF participation rate new text begin
target new text end or a five percentage point improvement over the previous year's TANF participation
rate under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive
months for the most recent year for which the measurements are available, will not
receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear
improvement plan with the commissioner; or

(4) a county or tribe that does not perform within or above its range of expected
performance on the annualized three-year self-support index under section 256J.751,
subdivision 2, clause (6), will not receive an additional allocation equal to 2.5 percent
of its initial allocation until after negotiating a multiyear improvement plan with the
commissioner.

deleted text begin (b) deleted text end new text begin (c) new text end For calendar year 2009 and yearly thereafter, performance-based funds for
a federally approved tribal TANF program in which the state and tribe have in place
a contract under section 256.01, addressing consolidated funding, will be allocated as
follows:

(1) a tribe that achieves the participation rate approved in its federal TANF plan
using the average of 12 consecutive months for the most recent year for which the
measurements are available, will receive an additional allocation equal to 2.5 percent of
its initial allocation; and

(2) a tribe that performs within or above its range of expected performance on the
annualized three-year self-support index under section 256J.751, subdivision 2, clause (6),
will receive an additional allocation equal to 2.5 percent of its initial allocation; or

(3) a tribe that does not achieve the participation rate approved in its federal TANF
plan using the average of 12 consecutive months for the most recent year for which the
measurements are available, will not receive an additional allocation equal to 2.5 percent
of its initial allocation until after negotiating a multiyear improvement plan with the
commissioner; or

(4) a tribe that does not perform within or above its range of expected performance
on the annualized three-year self-support index under section 256J.751, subdivision
2, clause (6), will not receive an additional allocation equal to 2.5 percent until after
negotiating a multiyear improvement plan with the commissioner.

deleted text begin (c) deleted text end new text begin (d) new text end Funds remaining unallocated after the performance-based allocations
in paragraph deleted text begin (a) deleted text end new text begin (b) new text end are available to the commissioner for innovation projects under
subdivision 5.

deleted text begin (d) deleted text end (1) If available funds are insufficient to meet county and tribal allocations under
paragraph deleted text begin (a) deleted text end new text begin (b) new text end , the commissioner may make available for allocation funds that are
unobligated and available from the innovation projects through the end of the current
biennium.

(2) If after the application of clause (1) funds remain insufficient to meet county
and tribal allocations under paragraph deleted text begin (a) deleted text end new text begin (b) new text end , the commissioner must proportionally
reduce the allocation of each county and tribe with respect to their maximum allocation
available under paragraph deleted text begin (a) deleted text end new text begin (b) new text end .

Sec. 25.

Minnesota Statutes 2008, section 256J.95, subdivision 3, is amended to read:

Subd. 3.

Eligibility for diversionary work program.

(a) Except for the categories
of family units listed below, all family units who apply for cash benefits and who
meet MFIP eligibility as required in sections 256J.11 to 256J.15 are eligible and must
participate in the diversionary work program. Family units that are not eligible for the
diversionary work program include:

(1) child only cases;

(2) a single-parent family unit that includes a child under 12 deleted text begin weeks deleted text end new text begin months new text end of age.
A parent is eligible for this exception once in a parent's lifetime and is not eligible if
the parent has already used the previously allowed child under age one exemption from
MFIP employment services;

(3) a minor parent without a high school diploma or its equivalent;

(4) an 18- or 19-year-old caregiver without a high school diploma or its equivalent
who chooses to have an employment plan with an education option;

(5) a caregiver age 60 or over;

(6) family units with a caregiver who received DWP benefits in the 12 months prior
to the month the family applied for DWP, except as provided in paragraph (c);

(7) family units with a caregiver who received MFIP within the 12 months prior to
the month the family unit applied for DWP;

(8) a family unit with a caregiver who received 60 or more months of TANF
assistance;

(9) a family unit with a caregiver who is disqualified from DWP or MFIP due to
fraud; and

(10) refugees and asylees as defined in Code of Federal Regulations, title 45, part
400, subpart d, section 400.43, who arrived in the United States in the 12 months prior to
the date of application for family cash assistance.

(b) A two-parent family must participate in DWP unless both caregivers meet the
criteria for an exception under paragraph (a), clauses (1) through (5), or the family unit
includes a parent who meets the criteria in paragraph (a), clause (6), (7), (8), (9), or (10).

(c) Once DWP eligibility is determined, the four months run consecutively. If a
participant leaves the program for any reason and reapplies during the four-month period,
the county must redetermine eligibility for DWP.

Sec. 26.

Minnesota Statutes 2008, section 256J.95, subdivision 11, is amended to read:

Subd. 11.

Universal participation required.

(a) All DWP caregivers, except
caregivers who meet the criteria in paragraph (d), are required to participate in DWP
employment services. Except as specified in paragraphs (b) and (c), employment plans
under DWP must, at a minimum, meet the requirements in section 256J.55, subdivision 1.

(b) A caregiver who is a member of a two-parent family that is required to participate
in DWP who would otherwise be ineligible for DWP under subdivision 3 may be allowed
to develop an employment plan under section 256J.521, subdivision 2, deleted text begin paragraph (c), deleted text end that
may contain alternate activities and reduced hours.

(c) A participant who is a victim of family violence shall be allowed to develop an
employment plan under section 256J.521, subdivision 3. A claim of family violence must
be documented by the applicant or participant by providing a sworn statement which is
supported by collateral documentation in section 256J.545, paragraph (b).

(d) One parent in a two-parent family unit that has a natural born child under 12
deleted text begin weeks deleted text end new text begin months new text end of age is not required to have an employment plan until the child reaches 12
deleted text begin weeks deleted text end new text begin months new text end of age unless the family unit has already used the exclusion under section
256J.561, subdivision 3, or the previously allowed child under age one exemption under
section 256J.56, paragraph (a), clause (5).

(e) The provision in paragraph (d) ends the first full month after the child reaches 12
deleted text begin weeks deleted text end new text begin months new text end of age. This provision is allowable only once in a caregiver's lifetime. In a
two-parent household, only one parent shall be allowed to use this category.

(f) The participant and job counselor must meet within ten working days after the
child reaches 12 deleted text begin weeks deleted text end new text begin months new text end of age to revise the participant's employment plan. The
employment plan for a family unit that has a child under 12 deleted text begin weeks deleted text end new text begin months new text end of age that has
already used the exclusion in section 256J.561 or the previously allowed child under
age one exemption under section 256J.56, paragraph (a), clause (5), must be tailored to
recognize the caregiving needs of the parent.

Sec. 27.

Minnesota Statutes 2008, section 256J.95, subdivision 13, is amended to read:

Subd. 13.

Immediate referral to employment services.

Within one working day of
determination that the applicant is eligible for the diversionary work program, but before
benefits are issued to or on behalf of the family unit, the county shall refer all caregivers to
employment services. The referral to the DWP employment services must be in writing
and must contain the following information:

(1) notification that, as part of the application process, applicants are required to
develop an employment plan or the DWP application will be denied;

(2) the employment services provider name and phone number;

(3) deleted text begin the date, time, and location of the scheduled employment services interview;
deleted text end

deleted text begin (4) deleted text end the immediate availability of supportive services, including, but not limited to,
child care, transportation, and other work-related aid; and

deleted text begin (5) deleted text end new text begin (4) new text end the rights, responsibilities, and obligations of participants in the program,
including, but not limited to, the grounds for good cause, the consequences of refusing or
failing to participate fully with program requirements, and the appeal process.

Sec. 28. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256I.06, subdivision 9, new text end new text begin is repealed.
new text end

ARTICLE 3

SERVICES FOR PERSONS WITH DISABILITIES

Section 1.

Minnesota Statutes 2008, section 245A.10, subdivision 3, is amended to
read:

Subd. 3.

Application fee for initial license or certification.

(a) For fees required
under subdivision 1, an applicant for an initial license or certification issued by the
commissioner shall submit a $500 application fee with each new application required
under this subdivision. The application fee shall not be prorated, is nonrefundable, and
is in lieu of the annual license or certification fee that expires on December 31. The
commissioner shall not process an application until the application fee is paid.

(b) Except as provided in clauses (1) to (3), an applicant shall apply for a license
to provide services at a specific location.

(1) For a license to provide waivered services to persons with developmental
disabilities or related conditions, an applicant shall submit an application for each county
in which the waivered services will be provided. new text begin Upon licensure, the license holder may
provide services to persons in that county plus no more than three persons at any one time
in each of up to ten additional counties. A license holder in one county may not provide
services under the home and community-based waiver for persons with developmental
disabilities to more than three people in a second county without holding a separate license
for that second county. Applicants or licensees providing services under this clause to
not more than three persons, remain subject to the inspection fees established in section
245A.10, subdivision 2, for each location.
new text end

(2) For a license to provide semi-independent living services to persons with
developmental disabilities or related conditions, an applicant shall submit a single
application to provide services statewide.

(3) For a license to provide independent living assistance for youth under section
245A.22, an applicant shall submit a single application to provide services statewide.

Sec. 2.

Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision
to read:

new text begin Subd. 7a. new text end

new text begin Alternate overnight supervision technology; adult foster care license.
new text end

new text begin (a) The commissioner may grant an applicant or license holder an adult foster care license
for a residence that does not have a caregiver in the residence during normal sleeping
hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, but uses
monitoring technology to alert the license holder when an incident occurs that may
jeopardize the health, safety, or rights of a foster care recipient. The applicant or license
holder must comply with all other requirements under Minnesota Rules, parts 9555.5105
to 9555.6265, and the requirements under this subdivision. The license printed by the
commissioner must state in bold and large font:
new text end

new text begin (1) that staff are not present on-site overnight; and
new text end

new text begin (2) the telephone number of the county's common entry point for making reports of
suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
new text end

new text begin (b) Applications for a license under this section must be submitted directly to
the Department of Human Services licensing division. The licensing division must
immediately notify the host county and lead county contract agency and the host county
licensing agency. The licensing division must collaborate with the county licensing
agency in the review of the application and the licensing of the program.
new text end

new text begin (c) Before a license is issued by the commissioner, and for the duration of the
license, the applicant or license holder must establish, maintain, and document the
implementation of written policies and procedures addressing the requirements in
paragraphs (d) through (f).
new text end

new text begin (d) The applicant or license holder must have policies and procedures that:
new text end

new text begin (1) establish characteristics of target populations that will be admitted into the home,
and characteristics of populations that will not be accepted into the home;
new text end

new text begin (2) explain the discharge process when a foster care recipient requires overnight
supervision or other services that cannot be provided by the license holder due to the
limited hours that the license holder is on-site;
new text end

new text begin (3) describe the types of events to which the program will respond with a physical
presence when those events occur in the home during time when staff are not on-site, and
how the license holder's response plan meets the requirements in paragraph (e), clause
(1) or (2);
new text end

new text begin (4) establish a process for documenting a review of the implementation and
effectiveness of the response protocol for the response required under paragraph (e),
clause (1) or (2). The documentation must include:
new text end

new text begin (i) a description of the triggering incident;
new text end

new text begin (ii) the date and time of the triggering incident;
new text end

new text begin (iii) the time of the response or responses under paragraph (e), clause (1) or (2);
new text end

new text begin (iv) whether the response met the resident's needs;
new text end

new text begin (v) whether the existing policies and response protocols were followed; and
new text end

new text begin (vi) whether the existing policies and protocols are adequate or need modification.
new text end

new text begin When no physical presence response is completed for a three-month period, the
license holder's written policies and procedures must require a physical presence response
drill be to conducted for which the effectiveness of the response protocol under paragraph
(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
new text end

new text begin (5) establish that emergency and nonemergency phone numbers are posted in a
prominent location in a common area of the home where they can be easily observed by a
person responding to an incident who is not otherwise affiliated with the home.
new text end

new text begin (e) The license holder must document and include in the license application which
response alternative under clause (1) or (2) is in place for responding to situations that
present a serious risk to the health, safety, or rights of people receiving foster care services
in the home:
new text end

new text begin (1) response alternative (1) requires only the technology to provide an electronic
notification or alert to the license holder that an event is underway that requires a response.
Under this alternative, no more than ten minutes will pass before the license holder will be
physically present on-site to respond to the situation; or
new text end

new text begin (2) response alternative (2) requires the electronic notification and alert system
under alternative (1), but more than ten minutes may pass before the license holder is
present on-site to respond to the situation. Under alternative (2), all of the following
conditions are met:
new text end

new text begin (i) the license holder has a written description of the interactive technological
applications that will assist the licenser holder in communicating with and assessing the
needs related to care, health, and safety of the foster care recipients. This interactive
technology must permit the license holder to remotely assess the well being of the foster
care recipient without requiring the initiation or participation by the foster care recipient.
Requiring the foster care recipient to initiate a telephone call or answer a telephone call
does not meet this requirement;
new text end

new text begin (ii) the license holder documents how the remote license holder is qualified and
capable of meeting the needs of the foster care recipients and assessing foster care
recipients' needs under item (i) during the absence of the license holder on-site;
new text end

new text begin (iii) the license holder maintains written procedures to dispatch emergency response
personnel to the site in the event of an identified emergency; and
new text end

new text begin (iv) each foster care recipient's individualized plan of care, individual service plan
under section 256B.092, subdivision 1b, if required, or individual resident placement
agreement under Minnesota Rules, part 9555.5105, subpart 19, if required, identifies the
maximum response time, which may be greater than ten minutes, for the license holder
to be on-site for that foster care recipient.
new text end

new text begin (f) All placement agreements, individual service agreements, and plans applicable
to the foster care recipient must clearly state that the adult foster care license category is
a program without the presence of a caregiver in the residence during normal sleeping
hours; the protocols in place for responding to situations that present a serious risk to
health, safety, or rights of foster care recipients under paragraph (e), clause (1) or (2); and a
signed informed consent from each foster care recipient or the person's legal representative
documenting the person's or legal representative's agreement with placement in the
program. If electronic monitoring technology is used in the home, the informed consent
form must also explain the following:
new text end

new text begin (1) how any electronic monitoring is incorporated into the alternative supervision
system;
new text end

new text begin (2) the backup system for any electronic monitoring in times of electrical outages or
other equipment malfunctions;
new text end

new text begin (3) how the license holder is trained on the use of the technology;
new text end

new text begin (4) the event types and license holder response times established under paragraph (e);
new text end

new text begin (5) how the license holder protects the foster care recipient's privacy related to
electronic monitoring and related to any electronically recorded data generated by the
monitoring system. The consent form must explain where and how the electronically
recorded data is stored, with whom it will be shared, and how long it is retained; and
new text end

new text begin (6) the risks and benefits of the alternative overnight supervision system.
new text end

new text begin The written explanations under clauses (1) to (6) may be accomplished through
cross-references to other policies and procedures as long as they are explained to the
person giving consent, and the person giving consent is offered a copy.
new text end

new text begin (g) Nothing in this section requires the applicant or license holder to develop or
maintain separate or duplicative polices, procedures, documentation, consent forms, or
individual plans that may be required for other licensing standards, if the requirements of
this section are incorporated into those documents.
new text end

new text begin (h) The commissioner may grant variances to the requirements of this section
according to section 245A.04, subdivision 9.
new text end

new text begin (i) For the purposes of paragraphs (d) through (h), license holder has the meaning
under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
contractors affiliated with the license holder.
new text end

Sec. 3.

Minnesota Statutes 2008, section 245A.16, subdivision 3, is amended to read:

Subd. 3.

Recommendations to commissioner.

The county or private agency
shall not make recommendations to the commissioner regarding licensure without first
conducting an inspection, and for deleted text begin adult foster care, deleted text end family adult day services deleted text begin , deleted text end and family
child care, a background study of the applicant under chapter 245C. The county or private
agency must forward its recommendation to the commissioner regarding the appropriate
licensing action within 20 working days of receipt of a completed application.

Sec. 4.

Minnesota Statutes 2008, section 245C.04, subdivision 1, is amended to read:

Subdivision 1.

Licensed programs.

(a) The commissioner shall conduct a
background study of an individual required to be studied under section 245C.03,
subdivision 1, at least upon application for initial license for all license types.

(b) The commissioner shall conduct a background study of an individual required to
be studied under section 245C.03, subdivision 1, at reapplication for a license for deleted text begin adult
foster care, deleted text end family adult day services deleted text begin , deleted text end and family child care.

(c) The commissioner is not required to conduct a study of an individual at the time
of reapplication for a license if the individual's background study was completed by the
commissioner of human services for an adult foster care license holder that is also:

(1) registered under chapter 144D; or

(2) licensed to provide home and community-based services to people with
disabilities at the foster care location and the license holder does not reside in the foster
care residence; and

(3) the following conditions are met:

(i) a study of the individual was conducted either at the time of initial licensure or
when the individual became affiliated with the license holder;

(ii) the individual has been continuously affiliated with the license holder since
the last study was conducted; and

(iii) the last study of the individual was conducted on or after October 1, 1995.

(d) From July 1, 2007, to June 30, 2009, the commissioner of human services shall
conduct a study of an individual required to be studied under section 245C.03, at the
time of reapplication for a child foster care license. The county or private agency shall
collect and forward to the commissioner the information required under section 245C.05,
subdivisions 1, paragraphs (a) and (b), and 5, paragraphs (a) and (b). The background
study conducted by the commissioner of human services under this paragraph must
include a review of the information required under section 245C.08, subdivisions 1,
paragraph (a), clauses (1) to (5), 3, and 4.

(e) The commissioner of human services shall conduct a background study of an
individual specified under section 245C.03, subdivision 1, paragraph (a), clauses (2)
to (6), who is newly affiliated with a child foster care license holder. The county or
private agency shall collect and forward to the commissioner the information required
under section 245C.05, subdivisions 1 and 5. The background study conducted by the
commissioner of human services under this paragraph must include a review of the
information required under section 245C.08, subdivisions 1, 3, and 4.

(f) new text begin From January 1, 2010, to December 31, 2012, unless otherwise specified in
paragraph (c), the commissioner shall conduct a study of an individual required to be
studied under section 245C.03, at the time of reapplication for an adult foster care license.
The county shall collect and forward to the commissioner the information required under
section 245C.05, subdivision 1, paragraphs (a) and (b), and subdivision 5, paragraphs (a)
and (b). The background study conducted by the commissioner under this paragraph
must include a review of the information required under section 245C.08, subdivision 1,
paragraph (a), clauses (1) to (5), and subdivisions 3 and 4.
new text end

new text begin (g) The commissioner shall conduct a background study of an individual specified
under section 245C.03, subdivision 1, paragraph (a), clauses (2) to (6), who is newly
affiliated with an adult foster care license holder. The county shall collect and forward
to the commissioner the information required under section 245C.05, subdivision 1,
paragraphs (a) and (b), and subdivision 5, paragraphs (a) and (b). The background
study conducted by the commissioner under this paragraph must include a review of
the information required under section 245C.08, subdivision 1, paragraph (a), and
subdivisions 3 and 4.
new text end

new text begin (h) new text end Applicants for licensure, license holders, and other entities as provided in this
chapter must submit completed background study forms to the commissioner before
individuals specified in section 245C.03, subdivision 1, begin positions allowing direct
contact in any licensed program.

deleted text begin (g) deleted text end new text begin (i) new text end For purposes of this section, a physician licensed under chapter 147 is
considered to be continuously affiliated upon the license holder's receipt from the
commissioner of health or human services of the physician's background study results.

Sec. 5.

Minnesota Statutes 2008, section 245C.05, subdivision 4, is amended to read:

Subd. 4.

Electronic transmission.

For background studies conducted by the
Department of Human Services, the commissioner shall implement a system for the
electronic transmission of:

(1) background study information to the commissioner;

(2) background study results to the license holder; deleted text begin and
deleted text end

(3) background study results to county and private agencies for background studies
conducted by the commissioner for child foster care new text begin ; and
new text end

new text begin (4) background study results to county agencies for background studies conducted
by the commissioner for adult foster care new text end .

Sec. 6.

Minnesota Statutes 2008, section 245C.08, subdivision 2, is amended to read:

Subd. 2.

Background studies conducted by a county agency.

(a) For a background
study conducted by a county agency for deleted text begin adult foster care, deleted text end family adult day services deleted text begin , deleted text end and
family child care services, the commissioner shall review:

(1) information from the county agency's record of substantiated maltreatment
of adults and the maltreatment of minors;

(2) information from juvenile courts as required in subdivision 4 for individuals
listed in section 245C.03, subdivision 1, clauses (2), (5), and (6); and

(3) information from the Bureau of Criminal Apprehension.

(b) If the individual has resided in the county for less than five years, the study shall
include the records specified under paragraph (a) for the previous county or counties of
residence for the past five years.

(c) Notwithstanding expungement by a court, the county agency may consider
information obtained under paragraph (a), clause (3), unless the commissioner received
notice of the petition for expungement and the court order for expungement is directed
specifically to the commissioner.

Sec. 7.

Minnesota Statutes 2008, section 245C.10, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Adult foster care services. new text end

new text begin The commissioner shall recover the cost
of background studies required under section 245C.03, subdivision 1, for the purposes
of adult foster care licensing, through a fee of no more than $20 per study charged to
the license holder. The fees collected under this subdivision are appropriated to the
commissioner for the purpose of conducting background studies.
new text end

Sec. 8.

Minnesota Statutes 2008, section 245C.17, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Notice to county agency. new text end

new text begin For studies on individuals related to a license to
provide adult foster care, the commissioner shall also provide a notice of the background
study results to the county agency that initiated the background study.
new text end

Sec. 9.

Minnesota Statutes 2008, section 245C.20, is amended to read:

245C.20 LICENSE HOLDER RECORD KEEPING.

A licensed program shall document the date the program initiates a background
study under this chapter in the program's personnel files. When a background study is
completed under this chapter, a licensed program shall maintain a notice that the study
was undertaken and completed in the program's personnel files. new text begin Except when background
studies are initiated through the commissioner's online system, new text end if a licensed program
has not received a response from the commissioner under section 245C.17 within 45
days of initiation of the background study request, the licensed program must contact the
deleted text begin commissioner deleted text end new text begin human services licensing division new text end to inquire about the status of the study. new text begin If
a license holder initiates a background study under the commissioner's online system, but
the background study subject's name does not appear in the list of active or recent studies
initiated by that license holder, the license holder must either contact the human services
licensing division or resubmit the background study information online for that individual.
new text end

Sec. 10.

Minnesota Statutes 2008, section 245C.21, subdivision 1a, is amended to read:

Subd. 1a.

Submission of reconsideration request deleted text begin to county or private agency deleted text end .

(a) For disqualifications related to studies conducted by county agencies new text begin for family child
care and family adult day services new text end , and for disqualifications related to studies conducted
by the commissioner for child foster care new text begin and adult foster care new text end , the individual shall
submit the request for reconsideration to the county deleted text begin or private deleted text end agency that initiated the
background study.

(b) new text begin For disqualifications related to studies conducted by the commissioner for child
foster care, the individual shall submit the request for reconsideration to the private agency
that initiated the background study.
new text end

new text begin (c) new text end A reconsideration request shall be submitted within 30 days of the individual's
receipt of the disqualification notice or the time frames specified in subdivision 2,
whichever time frame is shorter.

deleted text begin (c) deleted text end new text begin (d) new text end The county or private agency shall forward the individual's request for
reconsideration and provide the commissioner with a recommendation whether to set aside
the individual's disqualification.

Sec. 11.

Minnesota Statutes 2008, section 245C.23, subdivision 2, is amended to read:

Subd. 2.

Commissioner's notice of disqualification that is not set aside.

(a) The
commissioner shall notify the license holder of the disqualification and order the license
holder to immediately remove the individual from any position allowing direct contact
with persons receiving services from the license holder if:

(1) the individual studied does not submit a timely request for reconsideration
under section 245C.21;

(2) the individual submits a timely request for reconsideration, but the commissioner
does not set aside the disqualification for that license holder under section 245C.22;

(3) an individual who has a right to request a hearing under sections 245C.27 and
256.045, or 245C.28 and chapter 14 for a disqualification that has not been set aside, does
not request a hearing within the specified time; or

(4) an individual submitted a timely request for a hearing under sections 245C.27
and 256.045, or 245C.28 and chapter 14, but the commissioner does not set aside the
disqualification under section 245A.08, subdivision 5, or 256.045.

(b) If the commissioner does not set aside the disqualification under section 245C.22,
and the license holder was previously ordered under section 245C.17 to immediately
remove the disqualified individual from direct contact with persons receiving services or
to ensure that the individual is under continuous, direct supervision when providing direct
contact services, the order remains in effect pending the outcome of a hearing under
sections 245C.27 and 256.045, or 245C.28 and chapter 14.

(c) For background studies related to child foster care, the commissioner shall
also notify the county or private agency that initiated the study of the results of the
reconsideration.

new text begin (d) For background studies related to adult foster care, the commissioner shall also
notify the county that initiated the study of the results of the reconsideration.
new text end

Sec. 12.

Minnesota Statutes 2008, section 256B.5011, subdivision 2, is amended to
read:

Subd. 2.

Contract provisions.

(a) The service contract with each intermediate
care facility must include provisions for:

(1) modifying payments when significant changes occur in the needs of the
consumers;

(2) deleted text begin the establishment and use of a quality improvement plan. Using criteria and
options for performance measures developed by the commissioner, each intermediate care
facility must identify a minimum of one performance measure on which to focus its efforts
for quality improvement during the contract period;
deleted text end

deleted text begin (3) deleted text end appropriate and necessary statistical information required by the commissioner;

deleted text begin (4) deleted text end new text begin (3) new text end annual aggregate facility financial information; and

deleted text begin (5) deleted text end new text begin (4) new text end additional requirements for intermediate care facilities not meeting the
standards set forth in the service contract.

(b) The commissioner of human services and the commissioner of health, in
consultation with representatives from counties, advocacy organizations, and the provider
community, shall review the consolidated standards under chapter 245B and the supervised
living facility rule under Minnesota Rules, chapter 4665, to determine what provisions
in Minnesota Rules, chapter 4665, may be waived by the commissioner of health for
intermediate care facilities in order to enable facilities to implement the performance
measures in their contract and provide quality services to residents without a duplication
of or increase in regulatory requirements.

Sec. 13. new text begin COMMON SERVICE MENU FOR HOME AND COMMUNITY-BASED
WAIVER PROGRAMS.
new text end

new text begin The commissioner of human services shall confer with representatives of recipients,
advocacy groups, counties, providers, and health plans to develop and update a common
service menu for home and community-based waiver programs. The commissioner may
consult with existing stakeholder groups convened under the commissioner's authority to
meet all or part of the requirements of this section.
new text end

Sec. 14. new text begin INTERMEDIATE CARE FACILITIES FOR PERSONS WITH
DEVELOPMENTAL DISABILITIES REPORT.
new text end

new text begin The commissioner of human services shall also consult with intermediate care
facilities for persons with developmental disabilities providers and advocates to
monitor progress made in response to the commissioner's December 15, 2008, report
to the legislature regarding intermediate care facilities for persons with developmental
disabilities.
new text end

ARTICLE 4

STATE-OPERATED SERVICES/MINNESOTA SEX OFFENDER PROGRAM

Section 1.

Minnesota Statutes 2008, section 246.50, subdivision 5, is amended to read:

Subd. 5.

Cost of care.

"Cost of care" means the commissioner's charge for services
provided to any person admitted to a state facility.

For purposes of this subdivision, "charge for services" means the deleted text begin cost of services,
treatment, maintenance, bonds issued for capital improvements, depreciation of buildings
and equipment, and indirect costs related to the operation of state facilities. The
commissioner may determine the charge for services on an anticipated average per diem
basis as an all inclusive charge per facility, per disability group, or per treatment program.
The commissioner may determine a charge per service, using a method that includes direct
and indirect costs deleted text end new text begin usual and customary fee charged for services provided to clients. The
usual and customary fee shall be established in a manner required to appropriately bill
services to all payers and shall include the costs related to the operations of any program
offered by the state new text end .

Sec. 2.

Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision
to read:

new text begin Subd. 10. new text end

new text begin State-operated community-based program. new text end

new text begin "State-operated
community-based program" means any program operated in the community including
community behavioral health hospitals, crisis centers, residential facilities, outpatient
services, and other community-based services developed and operated by the state and
under the commissioner's control.
new text end

Sec. 3.

Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision
to read:

new text begin Subd. 11. new text end

new text begin Health plan company. new text end

new text begin "Health plan company" has the meaning given it
in section 62Q.01, subdivision 4, and also includes a demonstration provider as defined in
section 256B.69, subdivision 2, paragraph (b), a county or group of counties participating
in county-based purchasing according to section 256B.692, and a children's mental health
collaborative under contract to provide medical assistance for individuals enrolled in
the prepaid medical assistance and MinnesotaCare programs under sections 245.493 to
245.495.
new text end

Sec. 4.

Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Clients in state-operated community-based programs; determination.
new text end

new text begin The commissioner shall determine available health plan coverage from a health plan
company for services provided to clients admitted to a state-operated community-based
program. If the health plan coverage requires a co-pay or deductible, or if there is no
available health plan coverage, the commissioner shall determine or redetermine, what
part of the noncovered cost of care, if any, the client is able to pay. If the client is unable to
pay the uncovered cost of care, the commissioner shall determine the client's relatives'
ability to pay. The client and relatives shall provide to the commissioner documents and
proof necessary to determine the client and relatives' ability to pay. Failure to provide the
commissioner with sufficient information to determine ability to pay may make the client
or relatives liable for the full cost of care until the time when sufficient information is
provided. If it is determined that the responsible party does not have the ability to pay,
the commissioner shall waive payment of the portion that exceeds ability to pay under
the determination.
new text end

Sec. 5.

Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision
to read:

new text begin Subd. 1b. new text end

new text begin Clients served by regional treatment centers or nursing homes;
determination. new text end

new text begin The commissioner shall determine or redetermine, if necessary, what part
of the cost of care, if any, a client served in regional treatment centers or nursing homes
operated by state-operated services, is able to pay. If the client is unable to pay the full cost
of care, the commissioner shall determine if the client's relatives have the ability to pay.
The client and relatives shall provide to the commissioner documents and proof necessary
to determine the client and relatives' ability to pay. Failure to provide the commissioner
with sufficient information to determine ability to pay may make the client or relatives
liable for the full cost of care until the time when sufficient information is provided. No
parent shall be liable for the cost of care given a client at a regional treatment center after
the client has reached the age of 18 years.
new text end

Sec. 6.

Minnesota Statutes 2008, section 246.511, is amended to read:

246.511 RELATIVE RESPONSIBILITY.

Except for chemical dependency services paid for with funds provided under chapter
254B, a client's relatives shall not, pursuant to the commissioner's authority under section
246.51, be ordered to pay more than deleted text begin ten percent of the cost of deleted text end new text begin the following: (1) for
services provided in a community-based service, the noncovered cost of care as determined
under the ability to pay determination; and (2) for services provided at a regional treatment
center operated by state-operated services, 20 percent of the cost of new text end care, unless they
reside outside the state. Parents of children in state facilities shall have their responsibility
to pay determined according to section 252.27, subdivision 2, or in rules adopted under
chapter 254B if the cost of care is paid under chapter 254B. The commissioner may
accept voluntary payments in excess of deleted text begin ten deleted text end new text begin 20 new text end percent. The commissioner may require
full payment of the full per capita cost of care in state facilities for clients whose parent,
parents, spouse, guardian, or conservator do not reside in Minnesota.

Sec. 7.

Minnesota Statutes 2008, section 246.52, is amended to read:

246.52 PAYMENT FOR CARE; ORDER; ACTION.

The commissioner shall issue an order to the client or the guardian of the estate, if
there be one, and relatives determined able to pay requiring them to pay deleted text begin monthly deleted text end to the
state of Minnesota the amounts so determined the total of which shall not exceed the full
cost of care. Such order shall specifically state the commissioner's determination and shall
be conclusive unless appealed from as herein provided. When a client or relative fails to
pay the amount due hereunder the attorney general, upon request of the commissioner,
may institute, or direct the appropriate county attorney to institute, civil action to recover
such amount.

Sec. 8.

Minnesota Statutes 2008, section 246.54, subdivision 2, is amended to read:

Subd. 2.

Exceptions.

(a) Subdivision 1 does not apply to services provided at the
Minnesota Security Hospital, the Minnesota sex offender program, or the Minnesota
extended treatment options program. For services at deleted text begin these deleted text end new text begin the Minnesota security hospital
and the Minnesota sex offender new text end facilities, a county's payment shall be made from the
county's own sources of revenue and payments shall be paid as follows: payments to the
state from the county shall equal ten percent of the cost of care, as determined by the
commissioner, for each day, or the portion thereof, that the client spends at the facility.
deleted text begin If payments received by the state under sections 246.50 to 246.53 exceed 90 percent of
the cost of care, the county shall be responsible for paying the state only the remaining
amount. The county shall not be entitled to reimbursement from the client, the client's
estate, or from the client's relatives, except as provided in section 246.53. deleted text end

(b) new text begin For services at the Minnesota extended treatment options program, a county's
payment shall be made from the county's own sources of revenue and payments shall equal
a percentage of the cost of care, as determined by the commissioner, for each day, or the
portion thereof, that the client spends at the program according to the following schedule:
new text end

new text begin (1) ten percent for the first 90 days;
new text end new text begin new text end

new text begin (2) 20 percent for days 91 to 270; and
new text end

new text begin (3) 50 percent for any days over 271.
new text end

new text begin If payments received by the state under sections 246.50 to 246.53 exceed 90 percent of the
cost of care for days zero to 90, 80 percent for days 91 to 270, or 50 percent for any days
over 271, the county shall be responsible for paying the state only the remaining amount.
The county shall not be entitled to reimbursement from the client, the client's estate, or
from the client's relatives, except as provided in section 246.53.
new text end

new text begin (c) new text end Regardless of the facility to which the client is committed, subdivision 1 does not
apply to the following individuals:

(1) clients who are committed as mentally ill and dangerous under section 253B.02,
subdivision 17;

(2) clients who are committed as sexual psychopathic personalities under section
253B.02, subdivision 18b; and

(3) clients who are committed as sexually dangerous persons under section 253B.02,
subdivision 18c.

For each of the individuals in clauses (1) to (3), the payment by the county to the state
shall equal ten percent of the cost of care for each day as determined by the commissioner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010.
new text end

Sec. 9.

Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Client. new text end

new text begin "Client" means a person who is admitted to the Minnesota sex
offender program or subject to a court hold order under section 253B.185 for the purpose
of assessment, diagnosis, care, treatment, supervision, or other services provided by the
Minnesota sex offender program.
new text end

Sec. 10.

Minnesota Statutes 2008, section 246B.01, is amended by adding a
subdivision to read:

new text begin Subd. 1b. new text end

new text begin Client's county. new text end

new text begin "Client's county" means the county of the client's
legal settlement for poor relief purposes at the time of commitment. If the client has no
legal settlement for poor relief in this state, it means the county of commitment, except
that when a client with no legal settlement for poor relief is committed while serving a
sentence at a penal institution, it means the county from which the client was sentenced.
new text end

Sec. 11.

Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Cost of care. new text end

new text begin "Cost of care" means the commissioner's charge for housing
and treatment services provided to any person admitted to the Minnesota sex offender
program.
new text end

new text begin For purposes of this subdivision, "charge for housing and treatment services" means
the cost of services, treatment, maintenance, bonds issued for capital improvements,
depreciation of buildings and equipment, and indirect costs related to the operation of
state facilities. The commissioner may determine the charge for services on an anticipated
average per diem basis as an all-inclusive charge per facility.
new text end

Sec. 12.

Minnesota Statutes 2008, section 246B.01, is amended by adding a
subdivision to read:

new text begin Subd. 2b. new text end

new text begin Local social services agency. new text end

new text begin "Local social services agency" means the
local social services agency of the client's county as defined in subdivision 1b and of the
county of commitment, and any other local social services agency possessing information
regarding, or requested by the commissioner to investigate, the financial circumstances
of a client.
new text end

Sec. 13.

new text begin [246B.07] PAYMENT FOR CARE AND TREATMENT:
DETERMINATION.
new text end

new text begin Subdivision 1. new text end

new text begin Procedures. new text end

new text begin The commissioner shall determine or redetermine, if
necessary, what amount of the cost of care, if any, the client is able to pay. The client shall
provide to the commissioner documents and proof necessary to determine the ability to
pay. Failure to provide the commissioner with sufficient information to determine ability
to pay may make the client liable for the full cost of care until the time when sufficient
information is provided.
new text end

new text begin Subd. 2. new text end

new text begin Rules. new text end

new text begin The commissioner shall use the standards in section 246.51,
subdivision 2, to determine the client's liability for the care provided by the Minnesota sex
offender program.
new text end

new text begin Subd. 3. new text end

new text begin Applicability. new text end

new text begin The commissioner may recover, under sections 246B.07 to
246B.10, the cost of any care provided by the Minnesota sex offender program.
new text end

Sec. 14.

new text begin [246B.08] PAYMENT FOR CARE; ORDER; ACTION.
new text end

new text begin The commissioner shall issue an order to the client or the guardian of the estate, if
there is one, requiring the client or guardian to pay to the state the amounts determined, the
total of which must not exceed the full cost of care. The order must specifically state the
commissioner's determination and must be conclusive, unless appealed. If a client fails to
pay the amount due, the attorney general, upon request of the commissioner, may institute,
or direct the appropriate county attorney to institute a civil action to recover the amount.
new text end

Sec. 15.

new text begin [246B.09] CLAIM AGAINST ESTATE OF DECEASED CLIENT.
new text end

new text begin Subdivision 1. new text end

new text begin Client's estate. new text end

new text begin Upon the death of a client, or a former client, the
total cost of care provided to the client, less the amount actually paid toward the cost of
care by the client, must be filed by the commissioner as a claim against the estate of the
client with the court having jurisdiction to probate the estate, and all proceeds collected
by the state in the case must be divided between the state and county in proportion to
the cost of care each has borne.
new text end

new text begin Subd. 2. new text end

new text begin Preferred status. new text end

new text begin An estate claim in subdivision 1 must be considered an
expense of the last illness for purposes of section 524.3-805.
new text end

new text begin If the commissioner determines that the property or estate of a client is not more
than needed to care for and maintain the spouse and minor or dependent children of a
deceased client, the commissioner has the power to compromise the claim of the state in a
manner deemed just and proper.
new text end

new text begin Subd. 3. new text end

new text begin Exception from statute of limitations. new text end

new text begin Any statute of limitations that
limits the commissioner in recovering the cost of care obligation incurred by a client or
former client must not apply to any claim against an estate made under this section to
recover cost of care.
new text end

Sec. 16.

new text begin [246B.10] LIABILITY OF COUNTY; REIMBURSEMENT.
new text end

new text begin The client's county shall pay to the state a portion of the cost of care provided in
the Minnesota sex offender program to a client who has legally settled in that county. A
county's payment must be made from the county's own sources of revenue and payments
must equal ten percent of the cost of care, as determined by the commissioner, for each
day or portion of a day, that the client spends at the facility. If payments received by the
state under this chapter exceed 90 percent of the cost of care, the county is responsible
for paying the state the remaining amount. The county is not entitled to reimbursement
from the client, the client's estate, or from the client's relatives, except as provided in
section 246B.07.
new text end

Sec. 17.

Minnesota Statutes 2008, section 252.025, subdivision 7, is amended to read:

Subd. 7.

Minnesota extended treatment options.

The commissioner shall develop
by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have
developmental disabilities and exhibit severe behaviors which present a risk to public
safety. This program new text begin is statewide and new text end must provide specialized residential services in
Cambridge and an array of deleted text begin community support deleted text end new text begin community-based new text end services deleted text begin statewide deleted text end new text begin with
sufficient levels of care and a sufficient number of specialists to ensure that individuals
referred to the program receive the appropriate care new text end .

Sec. 18. new text begin REQUIRING THE DEVELOPMENT OF COMMUNITY-BASED
MENTAL HEALTH SERVICES FOR PATIENTS COMMITTED TO THE
ANOKA-METRO REGIONAL TREATMENT CENTER.
new text end

new text begin In consultation with community partners, the commissioner of human services
shall develop an array of community-based services to transform the current services
now provided to patients at the Anoka-Metro Regional Treatment Center. The
community-based services may be provided in facilities with 16 or fewer beds, and must
provide the appropriate level of care for the patients being admitted to the facilities. The
planning for this transition must be completed by October 1, 2009, with an initial report
to the committee chairs of health and human services by November 30, 2009, and a
semiannual report on progress until the transition is completed. The commissioner of
human services shall solicit interest from stakeholders and potential community partners.
The individuals working in the community-based services facilities under this section are
state employees supervised by the commissioner of human services.
new text end

Sec. 19. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, sections 246.51, subdivision 1; and 246.53, subdivision
3, new text end new text begin are repealed.
new text end

ARTICLE 5

DEPARTMENT OF HEALTH

Section 1.

Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:

Subdivision 1.

Designation.

(a) The commissioner shall designate essential
community providers. The criteria for essential community provider designation shall be
the following:

(1) a demonstrated ability to integrate applicable supportive and stabilizing services
with medical care for uninsured persons and high-risk and special needs populations,
underserved, and other special needs populations; and

(2) a commitment to serve low-income and underserved populations by meeting the
following requirements:

(i) has nonprofit status in accordance with chapter 317A;

(ii) has tax exempt status in accordance with the Internal Revenue Service Code,
section 501(c)(3);

(iii) charges for services on a sliding fee schedule based on current poverty income
guidelines; and

(iv) does not restrict access or services because of a client's financial limitation;

(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
government, an Indian health service unit, or a community health board as defined in
chapter 145A;

(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
conditions; deleted text begin or
deleted text end

(5) a sole community hospital. For these rural hospitals, the essential community
provider designation applies to all health services provided, including both inpatient and
outpatient services. For purposes of this section, "sole community hospital" means a
rural hospital that:

(i) is eligible to be classified as a sole community hospital according to Code
of Federal Regulations, title 42, section 412.92, or is located in a community with a
population of less than 5,000 and located more than 25 miles from a like hospital currently
providing acute short-term services;

(ii) has experienced net operating income losses in two of the previous three
most recent consecutive hospital fiscal years for which audited financial information is
available; and

(iii) consists of 40 or fewer licensed beds new text begin ; or
new text end

new text begin (6) a birthing center licensed under section 144.566 new text end .

(b) Prior to designation, the commissioner shall publish the names of all applicants
in the State Register. The public shall have 30 days from the date of publication to submit
written comments to the commissioner on the application. No designation shall be made
by the commissioner until the 30-day period has expired.

(c) The commissioner may designate an eligible provider as an essential community
provider for all the services offered by that provider or for specific services designated by
the commissioner.

(d) For the purpose of this subdivision, supportive and stabilizing services include at
a minimum, transportation, child care, cultural, and linguistic services where appropriate.

Sec. 2.

Minnesota Statutes 2008, section 103I.208, subdivision 2, is amended to read:

Subd. 2.

Permit fee.

The permit fee to be paid by a property owner is:

(1) for a water supply well that is not in use under a maintenance permit, $175
annually;

(2) for construction of a monitoring well, $215, which includes the state core
function fee;

(3) for a monitoring well that is unsealed under a maintenance permit, $175 annually;

(4) new text begin for a monitoring well owned by a federal agency, state agency, or local unit of
government that is unsealed under a maintenance permit, $50 annually. "Local unit of
government" means a statutory or home rule charter city, town, county, or soil and water
conservation district, watershed district, and organization formed for the joint exercise
of powers under section 471.59, a board of health or community health board, or other
special purpose district or authority with local jurisdiction in water and related land
resources management;
new text end

new text begin (5) new text end for monitoring wells used as a leak detection device at a single motor fuel retail
outlet, a single petroleum bulk storage site excluding tank farms, or a single agricultural
chemical facility site, the construction permit fee is $215, which includes the state core
function fee, per site regardless of the number of wells constructed on the site, and
the annual fee for a maintenance permit for unsealed monitoring wells is $175 per site
regardless of the number of monitoring wells located on site;

deleted text begin (5) deleted text end new text begin (6) new text end for a groundwater thermal exchange device, in addition to the notification fee
for water supply wells, $215, which includes the state core function fee;

deleted text begin (6) deleted text end new text begin (7) new text end for a vertical heat exchanger new text begin with less than ten tons of heating/cooling
capacity new text end , $215;

new text begin (8) for a vertical heat exchanger with ten to 50 tons of heating/cooling capacity, $425;
new text end

new text begin (9) for a vertical heat exchanger with greater than 50 tons of heating/cooling
capacity, $650;
new text end

deleted text begin (7) deleted text end new text begin (10) new text end for a dewatering well that is unsealed under a maintenance permit, $175
annually for each dewatering well, except a dewatering project comprising more than five
dewatering wells shall be issued a single permit for $875 annually for dewatering wells
recorded on the permit; and

deleted text begin (8) deleted text end new text begin (11) new text end for an elevator boring, $215 for each boring.

Sec. 3.

Minnesota Statutes 2008, section 144.121, subdivision 1a, is amended to read:

Subd. 1a.

Fees for ionizing radiation-producing equipment.

new text begin (a) new text end A facility with
ionizing radiation-producing equipment must pay an annual initial or annual renewal
registration fee consisting of a base facility fee of deleted text begin $66 deleted text end new text begin $100 new text end and an additional fee for
each radiation source, as follows:

(1)	medical or veterinary equipment		$	deleted text begin 53 deleted text end new text begin 100 new text end
(2)	dental x-ray equipment		$	deleted text begin 33 deleted text end new text begin 40 new text end
deleted text begin (3) deleted text end	deleted text begin accelerator deleted text end		deleted text begin $ deleted text end	deleted text begin 66 deleted text end
deleted text begin (4) deleted text end	deleted text begin radiation therapy equipment deleted text end		deleted text begin $ deleted text end	deleted text begin 66 deleted text end
deleted text begin (5) deleted text end new text begin (3) new text end	x-ray equipment not used on humans or animals		$	deleted text begin 53 deleted text end new text begin 100 new text end
deleted text begin (6) deleted text end new text begin (4) new text end	devices with sources of ionizing radiation not used on humans or animals		$	deleted text begin 53 deleted text end new text begin 100 new text end

new text begin (b) A facility with radiation therapy and accelerator equipment must pay an annual
registration fee of $500. A facility with an industrial accelerator must pay an annual
registration fee of $150.
new text end

new text begin (c) Electron microscopy equipment is exempt from the registration fee requirements
of this section.
new text end

Sec. 4.

Minnesota Statutes 2008, section 144.121, subdivision 1b, is amended to read:

Subd. 1b.

Penalty fee for late registration.

Applications for initial or renewal
registrations submitted to the commissioner after the time specified by the commissioner
shall be accompanied by deleted text begin a penalty fee of $20 deleted text end new text begin an amount equal to 25 percent of the fee
due new text end in addition to the fees prescribed in subdivision 1a.

Sec. 5.

Minnesota Statutes 2008, section 144.122, is amended to read:

144.122 LICENSE, PERMIT, AND SURVEY FEES.

(a) The state commissioner of health, by rule, may prescribe procedures and fees
for filing with the commissioner as prescribed by statute and for the issuance of original
and renewal permits, licenses, registrations, and certifications issued under authority of
the commissioner. The expiration dates of the various licenses, permits, registrations,
and certifications as prescribed by the rules shall be plainly marked thereon. Fees may
include application and examination fees and a penalty fee for renewal applications
submitted after the expiration date of the previously issued permit, license, registration,
and certification. The commissioner may also prescribe, by rule, reduced fees for permits,
licenses, registrations, and certifications when the application therefor is submitted
during the last three months of the permit, license, registration, or certification period.
Fees proposed to be prescribed in the rules shall be first approved by the Department of
Finance. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be
in an amount so that the total fees collected by the commissioner will, where practical,
approximate the cost to the commissioner in administering the program. All fees collected
shall be deposited in the state treasury and credited to the state government special revenue
fund unless otherwise specifically appropriated by law for specific purposes.

(b) The commissioner may charge a fee for voluntary certification of medical
laboratories and environmental laboratories, and for environmental and medical laboratory
services provided by the department, without complying with paragraph (a) or chapter 14.
Fees charged for environment and medical laboratory services provided by the department
must be approximately equal to the costs of providing the services.

(c) The commissioner may develop a schedule of fees for diagnostic evaluations
conducted at clinics held by the services for children with disabilities program. All
receipts generated by the program are annually appropriated to the commissioner for use
in the maternal and child health program.

(d) The commissioner shall set license fees for hospitals and nursing homes that are
not boarding care homes at the following levels:

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and American Osteopathic Association (AOA) hospitals	deleted text begin $7,555 deleted text end new text begin $7,655 new text end plus deleted text begin $13 deleted text end new text begin $16 new text end per bed
Non-JCAHO and non-AOA hospitals	deleted text begin $5,180 deleted text end new text begin $5,280 new text end plus deleted text begin $247 deleted text end new text begin $250 new text end per bed
Nursing home	$183 plus $91 per bed

The commissioner shall set license fees for outpatient surgical centers, boarding care
homes, and supervised living facilities at the following levels:

Outpatient surgical centers	deleted text begin $3,349 deleted text end new text begin $3,712 new text end
Boarding care homes	$183 plus $91 per bed
Supervised living facilities	$183 plus $91 per bed.

(e) Unless prohibited by federal law, the commissioner of health shall charge
applicants the following fees to cover the cost of any initial certification surveys required
to determine a provider's eligibility to participate in the Medicare or Medicaid program:

Prospective payment surveys for hospitals	$	900
Swing bed surveys for nursing homes	$	1,200
Psychiatric hospitals	$	1,400
Rural health facilities	$	1,100
Portable x-ray providers	$	500
Home health agencies	$	1,800
Outpatient therapy agencies	$	800
End stage renal dialysis providers	$	2,100
Independent therapists	$	800
Comprehensive rehabilitation outpatient facilities	$	1,200
Hospice providers	$	1,700
Ambulatory surgical providers	$	1,800
Hospitals	$	4,200
Other provider categories or additional resurveys required to complete initial certification	Actual surveyor costs: average surveyor cost x number of hours for the survey process.

These fees shall be submitted at the time of the application for federal certification
and shall not be refunded. All fees collected after the date that the imposition of fees is not
prohibited by federal law shall be deposited in the state treasury and credited to the state
government special revenue fund.

Sec. 6.

Minnesota Statutes 2008, section 144.1222, subdivision 1a, is amended to read:

Subd. 1a.

Fees.

All plans and specifications for public pool and spa construction,
installation, or alteration or requests for a variance that are submitted to the commissioner
according to Minnesota Rules, part 4717.3975, shall be accompanied by the appropriate
fees. All public pool construction plans submitted for review after January 1, 2009,
must be certified by a professional engineer registered in the state of Minnesota. If the
commissioner determines, upon review of the plans, that inadequate fees were paid, the
necessary additional fees shall be paid before plan approval. For purposes of determining
fees, a project is defined as a proposal to construct or install a public pool, spa, special
purpose pool, or wading pool and all associated water treatment equipment and drains,
gutters, decks, water recreation features, spray pads, and those design and safety features
that are within five feet of any pool or spa. The commissioner shall charge the following
fees for plan review and inspection of public pools and spas and for requests for variance
from the public pool and spa rules:

(1) each pool, deleted text begin $800 deleted text end new text begin $1,500 new text end ;

(2) each spa pool, deleted text begin $500 deleted text end new text begin $800 new text end ;

(3) each slide, deleted text begin $400 deleted text end new text begin $600 new text end ;

(4) projects valued at $250,000 or more, the greater of the sum of the fees in clauses
(1), (2), and (3) or 0.5 percent of the documented estimated project cost to a maximum
fee of deleted text begin $10,000 deleted text end new text begin $15,000 new text end ;

(5) alterations to an existing pool without changing the size or configuration of
the pool, deleted text begin $400 deleted text end new text begin $600 new text end ;

(6) removal or replacement of pool disinfection equipment only, deleted text begin $75 deleted text end new text begin $100 new text end ; and

(7) request for variance from the public pool and spa rules, $500.

Sec. 7.

Minnesota Statutes 2008, section 144.1501, subdivision 2, is amended to read:

Subd. 2.

Creation of account.

(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:

(1) for medical residents 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 deleted text begin who agree deleted text end new text begin agreeing new text end to practice in a Minnesota nursing home deleted text begin or deleted text end new text begin , an new text end
intermediate care facility for persons with developmental disability new text begin , or in a hospital
pediatric psychiatric unit new text end 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;

(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 who agree to practice in designated rural areas; and

(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 51, chapter 303.

(b) Appropriations made to the account do not cancel and are available until
expended, except that at the end of each biennium, any remaining balance in the account
that is not committed by contract and not needed to fulfill existing commitments shall
cancel to the fund.

Sec. 8.

Minnesota Statutes 2008, section 144.226, subdivision 4, is amended to read:

Subd. 4.

Vital records surcharge.

(a) In addition to any fee prescribed under
subdivision 1, there is a nonrefundable surcharge of $2 for each certified and noncertified
birth, stillbirth, or death record, and for a certification that the record cannot be found.
The local or state registrar shall forward this amount to the commissioner of finance to
be deposited into the state government special revenue fund. This surcharge shall not be
charged under those circumstances in which no fee for a birth, stillbirth, or death record is
permitted under subdivision 1, paragraph (a).

(b) Effective August 1, 2005, deleted text begin to June 30, 2009, deleted text end the surcharge in paragraph (a) deleted text begin shall
be deleted text end new text begin is new text end $4.

Sec. 9.

new text begin [144.566] BIRTHING CENTERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following definitions
have the meanings given to them.
new text end

new text begin (b) "Birthing center" means a health care facility licensed for the primary purpose
of performing low-risk deliveries that is not a hospital or in a hospital and where
births are planned to occur away from the mother's usual residence following a normal
uncomplicated pregnancy.
new text end

new text begin (c) "Licensed traditional midwife" means a midwife who is licensed under chapter
147D.
new text end

new text begin (d) "Low-risk pregnancy" means a normal, uncomplicated prenatal course as
determined by documentation of adequate prenatal care and the anticipation of a normal
uncomplicated labor and birth, as defined by reasonable and generally accepted criteria
adopted by professional groups for maternal, fetal, and neonatal health care, and
generally accepted by the health care providers to whom they apply and approved by
the commissioner as reasonable.
new text end

new text begin Subd. 2. new text end

new text begin License required. new text end

new text begin (a) Effective January 1, 2011, no birthing center shall
be established, operated, or maintained in the state without first obtaining a license from
the commissioner of health according to this section. The license is effective for one year
following the date of issuance.
new text end

new text begin (b) A license issued under this section is not transferable or assignable and is subject
to suspension or revocation at any time for failure to comply with this section.
new text end

new text begin (c) A birthing center licensed under this section shall not assert, represent, offer,
provide, or imply that the center is or may render care or services other than the services it
is permitted to render within the scope of the license issued.
new text end

new text begin (d) The license must be conspicuously posted in an area where patients are admitted.
new text end

new text begin Subd. 3. new text end

new text begin Application. new text end

new text begin An application for a license to operate a birthing center and
the applicable fee under subdivision 7 must be submitted to the commissioner on a form
provided by the commissioner and must contain:
new text end

new text begin (1) the name of the applicant;
new text end

new text begin (2) the location of the birthing center;
new text end

new text begin (3) the name of the person in charge of the center;
new text end

new text begin (4) documentation that the standards described under subdivision 5 have been
met; and
new text end

new text begin (5) any other information the commissioner deems necessary.
new text end

new text begin Subd. 4. new text end

new text begin Suspension, revocation, and refusal to renew. new text end

new text begin The commissioner may
refuse to grant or renew, or may suspend or revoke, a license on any of the grounds
described under section 144.55, subdivision 6, and the applicant or licensee is entitled to
notice and a hearing as described under section 144.55, subdivision 7.
new text end

new text begin Subd. 5. new text end

new text begin Standards for licensure. new text end

new text begin (a) To be eligible for licensure under this section,
a birthing center must meet the following requirements:
new text end

new text begin (1) a governing body or person must be clearly identified as being legally responsible
for setting policies and procedures and ensuring that they are implemented;
new text end

new text begin (2) care must be provided by a physician, advanced practice registered nurse, or
licensed traditional midwife during labor, birth, and puerperium;
new text end

new text begin (3) an obstetrician and pediatrician must be on call and available to provide medical
guidance at all times;
new text end

new text begin (4) procedures must be in place to transfer a patient within 30 minutes from the time
of diagnosis of an emergency to an acute care hospital capable of providing obstetrical and
neonatal services;
new text end

new text begin (5) the birthing center must be equipped to initiate emergency procedures
in life-threatening events to the mother and baby including, but not limited to,
cardiopulmonary resuscitation (CPR) equipment, oxygen, positive pressure mask,
suction, intravenous medications, and equipment for maintaining infant temperature and
ventilation; and
new text end

new text begin (6) the birthing center must maintain a quality assurance program.
new text end

new text begin (b) The center must have procedures in place specifying criteria by which risk status
will be established and applied to each woman at admission and during labor. Before
admitting a patient, the birthing center must fully inform each woman seeking care on
the benefits and risks of the services available at the center and each woman must sign a
written informed consent indicating that she has received this information.
new text end

new text begin Subd. 6. new text end

new text begin Limitations of services. new text end

new text begin The following limitations apply to the services
performed at a birthing center:
new text end

new text begin (1) surgical procedures must be limited to those normally accomplished during an
uncomplicated birth, including episiotomy and repair;
new text end

new text begin (2) no abortions may be performed; and
new text end

new text begin (3) no general or conduction anesthesia may be performed.
new text end

new text begin Subd. 7. new text end

new text begin Fees. new text end

new text begin The annual license fee for a birthing center is $3,900, and shall be
collected and deposited according to section 144.122.
new text end

new text begin Subd. 8. new text end

new text begin Inspections. new text end

new text begin The commissioner shall annually conduct an inspection of
each licensed birthing center for the purpose of determining compliance with this section
and any rules promulgated under subdivision 9.
new text end

new text begin Subd. 9. new text end

new text begin Rules. new text end

new text begin The commissioner may promulgate rules necessary to implement
this section.
new text end

Sec. 10.

Minnesota Statutes 2008, section 144.72, subdivision 1, is amended to read:

Subdivision 1.

deleted text begin Permits deleted text end new text begin License required new text end .

The state commissioner of health is
authorized to issue deleted text begin permits for the operation of youth camps which are required to obtain
the permits deleted text end new text begin a license according to chapter 157 new text end .

Sec. 11.

Minnesota Statutes 2008, section 144.72, subdivision 3, is amended to read:

Subd. 3.

Issuance of deleted text begin permits deleted text end new text begin license new text end .

If the commissioner should determine from
the application that the health and safety of the persons using the camp will be properly
safeguarded, the commissioner may, prior to actual inspection of the camp, issue the
deleted text begin permit deleted text end new text begin license new text end in writing. deleted text begin No fee shall be charged for the permit. deleted text end The deleted text begin permit deleted text end new text begin license new text end shall
be posted in a conspicuous place on the premises occupied by the camp.

Sec. 12.

Minnesota Statutes 2008, section 144.9501, is amended by adding a
subdivision to read:

new text begin Subd. 8a. new text end

new text begin Disclosure pamphlet. new text end

new text begin "Disclosure pamphlet" means the EPA pamphlet
titled "Renovate Right: Important Lead Hazard Information for Families, Child Care
Providers and Schools" developed under section 406(a) of the Toxic Substance Control
Act.
new text end

Sec. 13.

Minnesota Statutes 2008, section 144.9501, subdivision 22b, is amended to
read:

Subd. 22b.

Lead sampling technician.

"Lead sampling technician" means an
individual who performs clearance inspections for deleted text begin nonabatement or nonorder lead hazard
reduction deleted text end new text begin renovation new text end sites deleted text begin , deleted text end new text begin and new text end lead dust sampling deleted text begin in other settings, or visual assessment
for deteriorated paint deleted text end new text begin for nonabatement sites new text end , and who is registered with the commissioner
under section 144.9505.

Sec. 14.

Minnesota Statutes 2008, section 144.9501, subdivision 26a, is amended to
read:

Subd. 26a.

Regulated lead work.

(a) "Regulated lead work" means:

(1) abatement;

(2) interim controls;

(3) a clearance inspection;

(4) a lead hazard screen;

(5) a lead inspection;

(6) a lead risk assessment;

(7) lead project designer services;

(8) lead sampling technician services; deleted text begin or
deleted text end

(9) swab team services new text begin ;
new text end

new text begin (10) renovation activities; or
new text end

new text begin (11) activities performed to comply with lead orders issued by a board of health new text end .

(b) Regulated lead work does not include new text begin abatement, interim controls, swab team
services, or renovation activities that disturb painted surfaces that total no more than new text end :

(1) deleted text begin activities such as remodeling, renovation, installation, rehabilitation, or
landscaping activities, the primary intent of which is to remodel, repair, or restore a
structure or dwelling, rather than to permanently eliminate lead hazards, even though these
activities may incidentally result in a reduction in lead hazards; or
deleted text end

deleted text begin (2) interim control activities that are not performed as a result of a lead order and
that do not disturb painted surfaces that total more than:
deleted text end

deleted text begin (i) deleted text end 20 square feet (two square meters) on exterior surfaces; new text begin or
new text end

deleted text begin (ii) deleted text end new text begin (2) new text end deleted text begin two deleted text end new text begin six new text end square feet ( deleted text begin 0.2 deleted text end new text begin 0.6 new text end square meters) in an interior room deleted text begin ; or
deleted text end

deleted text begin (iii) ten percent of the total surface area on an interior or exterior type of component
with a small surface area deleted text end .

Sec. 15.

Minnesota Statutes 2008, section 144.9501, is amended by adding a
subdivision to read:

new text begin Subd. 26b. new text end

new text begin Renovation. new text end

new text begin "Renovation" means the modification of any affected
property that results in the disturbance of painted surfaces, unless that activity is performed
as an abatement. A renovation performed for the purpose of converting a building or part
of a building into an affected property is a renovation under this subdivision.
new text end

Sec. 16.

Minnesota Statutes 2008, section 144.9505, subdivision 1g, is amended to
read:

Subd. 1g.

Certified lead firm.

deleted text begin A person within the state intending to directly
perform or cause to be performed through subcontracting or similar delegation any
regulated lead work shall first obtain certification from the commissioner deleted text end new text begin A person who
employs individuals to perform regulated lead work outside of the person's property must
obtain certification as a lead firm new text end . The certificate must be in writing, contain an expiration
date, be signed by the commissioner, and give the name and address of the person to
whom it is issued. The certification fee is $100, is nonrefundable, and must be submitted
with each application. The certificate or a copy of the certificate must be readily available
at the worksite for review by the contracting entity, the commissioner, and other public
health officials charged with the health, safety, and welfare of the state's citizens.

Sec. 17.

Minnesota Statutes 2008, section 144.9505, subdivision 4, is amended to read:

Subd. 4.

Notice of regulated lead work.

(a) At least five working days before
starting work at each regulated lead worksite, the person performing the regulated lead
work shall give written notice to the commissioner and the appropriate board of health.

(b) This provision does not apply to lead hazard screen, lead inspection, lead risk
assessment, lead sampling technician, new text begin renovation, new text end or lead project design activities.

Sec. 18.

Minnesota Statutes 2008, section 144.9508, subdivision 2, is amended to read:

Subd. 2.

Regulated lead work standards and methods.

(a) The commissioner
shall adopt rules establishing regulated lead work standards and methods in accordance
with the provisions of this section, for lead in paint, dust, drinking water, and soil in
a manner that protects public health and the environment for all residences, including
residences also used for a commercial purpose, child care facilities, playgrounds, and
schools.

(b) In the rules required by this section, the commissioner shall require lead hazard
reduction of intact paint only if the commissioner finds that the intact paint is on a
chewable or lead-dust producing surface that is a known source of actual lead exposure to
a specific individual. The commissioner shall prohibit methods that disperse lead dust into
the air that could accumulate to a level that would exceed the lead dust standard specified
under this section. The commissioner shall work cooperatively with the commissioner
of administration to determine which lead hazard reduction methods adopted under this
section may be used for lead-safe practices including prohibited practices, preparation,
disposal, and cleanup. The commissioner shall work cooperatively with the commissioner
of the Pollution Control Agency to develop disposal procedures. In adopting rules under
this section, the commissioner shall require the best available technology for regulated
lead work methods, paint stabilization, and repainting.

(c) The commissioner of health shall adopt regulated lead work standards and
methods for lead in bare soil in a manner to protect public health and the environment.
The commissioner shall adopt a maximum standard of 100 parts of lead per million in
bare soil. The commissioner shall set a soil replacement standard not to exceed 25 parts
of lead per million. Soil lead hazard reduction methods shall focus on erosion control
and covering of bare soil.

(d) The commissioner shall adopt regulated lead work standards and methods for
lead in dust in a manner to protect the public health and environment. Dust standards
shall use a weight of lead per area measure and include dust on the floor, on the window
sills, and on window wells. Lead hazard reduction methods for dust shall focus on dust
removal and other practices which minimize the formation of lead dust from paint, soil, or
other sources.

(e) The commissioner shall adopt lead hazard reduction standards and methods for
lead in drinking water both at the tap and public water supply system or private well
in a manner to protect the public health and the environment. The commissioner may
adopt the rules for controlling lead in drinking water as contained in Code of Federal
Regulations, title 40, part 141. Drinking water lead hazard reduction methods may include
an educational approach of minimizing lead exposure from lead in drinking water.

(f) The commissioner of the Pollution Control Agency shall adopt rules to ensure that
removal of exterior lead-based coatings from residences and steel structures by abrasive
blasting methods is conducted in a manner that protects health and the environment.

(g) All regulated lead work standards shall provide reasonable margins of safety that
are consistent with more than a summary review of scientific evidence and an emphasis on
overprotection rather than underprotection when the scientific evidence is ambiguous.

(h) No unit of local government shall have an ordinance or regulation governing
regulated lead work standards or methods for lead in paint, dust, drinking water, or soil
that require a different regulated lead work standard or method than the standards or
methods established under this section.

(i) Notwithstanding paragraph (h), the commissioner may approve the use by a unit
of local government of an innovative lead hazard reduction method which is consistent
in approach with methods established under this section.

(j) The commissioner shall adopt rules for issuing lead orders required under section
144.9504, rules for notification of abatement or interim control activities requirements,
and other rules necessary to implement sections 144.9501 to 144.9512.

new text begin (k) The commissioners shall adopt rules consistent with section 402(c)(3) of the
Toxic Substances Control Act to ensure that renovation is a pre-1978 affected property
where a child or pregnant female resides is conducted in a manner that protects health
and the environment.
new text end

new text begin (l) The commissioner shall adopt rules consistent with sections 406(a) and 406(b) of
the Toxic Substances Control Act.
new text end

Sec. 19.

Minnesota Statutes 2008, section 144.9508, subdivision 3, is amended to read:

Subd. 3.

Licensure and certification.

The commissioner shall adopt rules to
license lead supervisors, lead workers, lead project designers, lead inspectors, deleted text begin and deleted text end lead
risk assessors new text begin , and lead sampling technicians new text end . The commissioner shall also adopt rules
requiring certification of firms that perform regulated lead work deleted text begin and rules requiring
registration of lead sampling technicians deleted text end . The commissioner shall require periodic renewal
of licenses deleted text begin , deleted text end new text begin and new text end certificates deleted text begin , and registrations deleted text end and shall establish the renewal periods.

Sec. 20.

Minnesota Statutes 2008, section 144.9508, subdivision 4, is amended to read:

Subd. 4.

Lead training course.

The commissioner shall establish by rule
requirements for training course providers and the renewal period for each lead-related
training course required for certification or licensure. The commissioner shall establish
criteria in rules for the content and presentation of training courses intended to qualify
trainees for licensure under subdivision 3. The commissioner shall establish criteria
in rules for the content and presentation of training courses for lead deleted text begin interim control
workers deleted text end new text begin renovation and lead sampling technicians new text end . Training course permit fees shall be
nonrefundable and must be submitted with each application in the amount of $500 for an
initial training course, $250 for renewal of a permit for an initial training course, $250 for
a refresher training course, and $125 for renewal of a permit of a refresher training course.

Sec. 21.

Minnesota Statutes 2008, section 144.97, subdivision 2, is amended to read:

Subd. 2.

deleted text begin Certification deleted text end new text begin Accreditation new text end .

deleted text begin "Certification" means written
acknowledgment of a laboratory's demonstrated capability to perform tests for a specific
purpose deleted text end new text begin "Accreditation" means written acknowledgment that a laboratory has the
policies, procedures, equipment, and practices to produce reliable data in the analysis of
environmental samples new text end .

Sec. 22.

Minnesota Statutes 2008, section 144.97, subdivision 4, is amended to read:

Subd. 4.

deleted text begin Contract deleted text end new text begin Commercial new text end laboratory.

" deleted text begin Contract deleted text end new text begin Commercial new text end laboratory"
means a laboratory that performs tests on samples on a contract or fee-for-service basis.

Sec. 23.

Minnesota Statutes 2008, section 144.97, is amended by adding a subdivision
to read:

new text begin Subd. 5a. new text end

new text begin Field of testing. new text end

new text begin "Field of testing" means the combination of analyte,
method, matrix, and test category for which a laboratory may hold accreditation.
new text end

Sec. 24.

Minnesota Statutes 2008, section 144.97, subdivision 6, is amended to read:

Subd. 6.

Laboratory.

"Laboratory" means the state, a person, corporation, or other
entity, including governmental, that examines, analyzes, or tests samples new text begin in a specified
physical location new text end .

Sec. 25.

Minnesota Statutes 2008, section 144.97, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Test category. new text end

new text begin "Test category" means the combination of program and
category as provided by section 144.98, subdivisions 3, paragraph (b), clauses (1) to (10),
and 3a, paragraph (a), clauses (1) to (5).
new text end

Sec. 26.

Minnesota Statutes 2008, section 144.98, subdivision 1, is amended to read:

Subdivision 1.

Authorization.

The commissioner of health deleted text begin may certify deleted text end new text begin shall
accredit environmental new text end laboratories deleted text begin that test environmental samples deleted text end new text begin according to national
standards developed using a consensus process as established by Circular A-119,
published by the United States Office of Management and Budget new text end .

Sec. 27.

Minnesota Statutes 2008, section 144.98, subdivision 2, is amended to read:

Subd. 2.

Rules new text begin and standards new text end .

The commissioner may adopt rules to deleted text begin implement
this section, including: deleted text end new text begin carry out the commissioner's responsibilities under the national
standards specified in subdivisions 1 and 2a.
new text end

deleted text begin (1) procedures, requirements, and fee adjustments for laboratory certification,
including provisional status and recertification;
deleted text end

deleted text begin (2) standards and fees for certificate approval, suspension, and revocation;
deleted text end

deleted text begin (3) standards for environmental samples;
deleted text end

deleted text begin (4) analysis methods that assure reliable test results;
deleted text end

deleted text begin (5) laboratory quality assurance, including internal quality control, proficiency
testing, and personnel training; and
deleted text end

deleted text begin (6) criteria for recognition of certification programs of other states and the federal
government.
deleted text end

Sec. 28.

Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Standards. new text end

new text begin The commissioner shall accredit laboratories according to
the most current environmental laboratory accreditation standards under subdivision 1
and as accepted by the accreditation bodies recognized by the National Environmental
Laboratory Accreditation Program, NELAP, of the NELAC Institute.
new text end

Sec. 29.

Minnesota Statutes 2008, section 144.98, subdivision 3, is amended to read:

Subd. 3.

new text begin Annual new text end fees.

(a) An application for deleted text begin certification deleted text end new text begin accreditation new text end under
subdivision deleted text begin 1 deleted text end new text begin 6 new text end must be accompanied by the deleted text begin biennial fee deleted text end new text begin annual fees new text end specified in this
subdivision. The deleted text begin fees are for deleted text end new text begin annual fees include new text end :

(1) base deleted text begin certification deleted text end new text begin accreditation new text end fee, deleted text begin $1,600 deleted text end new text begin $1,500 new text end ;

(2) sample preparation techniques deleted text begin fees deleted text end new text begin fee new text end , deleted text begin $100 deleted text end new text begin $200 new text end per technique; deleted text begin and
deleted text end

(3) new text begin an administrative fee for laboratories located outside this state, $3,750; and
new text end

new text begin (4) new text end test category deleted text begin certification deleted text end fees deleted text begin : deleted text end new text begin .
new text end

deleted text begin Test Category deleted text end	deleted text begin Certification Fee deleted text end
deleted text begin Clean water program bacteriology deleted text end	deleted text begin $800 deleted text end
deleted text begin Safe drinking water program bacteriology deleted text end	deleted text begin $800 deleted text end
deleted text begin Clean water program inorganic chemistry deleted text end	deleted text begin $800 deleted text end
deleted text begin Safe drinking water program inorganic chemistry deleted text end	deleted text begin $800 deleted text end
deleted text begin Clean water program chemistry metals deleted text end	deleted text begin $1,200 deleted text end
deleted text begin Safe drinking water program chemistry metals deleted text end	deleted text begin $1,200 deleted text end
deleted text begin Resource conservation and recovery program chemistry metals deleted text end	deleted text begin $1,200 deleted text end
deleted text begin Clean water program volatile organic compounds deleted text end	deleted text begin $1,500 deleted text end
deleted text begin Safe drinking water program volatile organic compounds deleted text end	deleted text begin $1,500 deleted text end
deleted text begin Resource conservation and recovery program volatile organic compounds deleted text end	deleted text begin $1,500 deleted text end
deleted text begin Underground storage tank program volatile organic compounds deleted text end	deleted text begin $1,500 deleted text end
deleted text begin Clean water program other organic compounds deleted text end	deleted text begin $1,500 deleted text end
deleted text begin Safe drinking water program other organic compounds deleted text end	deleted text begin $1,500 deleted text end
deleted text begin Resource conservation and recovery program other organic compounds deleted text end	deleted text begin $1,500 deleted text end
deleted text begin Clean water program radiochemistry deleted text end	deleted text begin $2,500 deleted text end
deleted text begin Safe drinking water program radiochemistry deleted text end	deleted text begin $2,500 deleted text end
deleted text begin Resource conservation and recovery program agricultural contaminants deleted text end	deleted text begin $2,500 deleted text end
deleted text begin Resource conservation and recovery program emerging contaminants deleted text end	deleted text begin $2,500 deleted text end

(b) deleted text begin Laboratories located outside of this state that require an on-site inspection shall be
assessed an additional $3,750 fee. deleted text end new text begin For the programs in subdivision 3a, the commissioner
may accredit laboratories for fields of testing under the categories listed in clauses (1) to
(10) upon completion of the application requirements provided by subdivision 6 and
receipt of the fees for each category under each program that accreditation is requested.
The categories offered and related fees include:
new text end

new text begin (1) microbiology, $450;
new text end

new text begin (2) inorganics, $450;
new text end

new text begin (3) metals, $1,000;
new text end

new text begin (4) volatile organics, $1,300;
new text end

new text begin (5) other organics, $1,300;
new text end

new text begin (6) radiochemistry, $1,500;
new text end

new text begin (7) emerging contaminants, $1,500;
new text end

new text begin (8) agricultural contaminants, $1,250;
new text end

new text begin (9) toxicity (bioassay), $1,000; and
new text end

new text begin (10) physical characterization, $250.
new text end

(c) The total deleted text begin biennial certification deleted text end new text begin annual new text end fee includes the base fee, the sample
preparation techniques fees, the test category fees new text begin per program new text end , and, when applicable, deleted text begin the
on-site inspection fee deleted text end new text begin an administrative fee for out-of-state laboratories new text end .

deleted text begin (d) Fees must be set so that the total fees support the laboratory certification program.
Direct costs of the certification service include program administration, inspections, the
agency's general support costs, and attorney general costs attributable to the fee function.
deleted text end

deleted text begin (e) A change fee shall be assessed if a laboratory requests additional analytes
or methods at any time other than when applying for or renewing its certification. The
change fee is equal to the test category certification fee for the analyte.
deleted text end

deleted text begin (f) A variance fee shall be assessed if a laboratory requests and is granted a variance
from a rule adopted under this section. The variance fee is $500 per variance.
deleted text end

deleted text begin (g) Refunds or credits shall not be made for analytes or methods requested but
not approved.
deleted text end

deleted text begin (h) Certification of a laboratory shall not be awarded until all fees are paid.
deleted text end

Sec. 30.

Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision
to read:

new text begin Subd. 3a. new text end

new text begin Available programs, categories, and analytes. new text end

new text begin (a) The commissioner
shall accredit laboratories that test samples under the following programs:
new text end

new text begin (1) the clean water program, such as compliance monitoring under the federal Clean
Water Act, and ambient monitoring of surface and ground water, or analysis of biological
tissue;
new text end

new text begin (2) the safe drinking water program, including compliance monitoring under the
federal Safe Drinking Water Act, and the state requirements for monitoring private wells;
new text end

new text begin (3) the resource conservation and recovery program, including federal and state
requirements for monitoring solid and hazardous wastes, biological tissue, leachates, and
ground water monitoring wells not intended as drinking water sources;
new text end

new text begin (4) the underground storage tank program; and
new text end

new text begin (5) the clean air program, including air and emissions testing under the federal Clean
Air Act, and state and federal requirements for vapor intrusion monitoring.
new text end

new text begin (b) The commissioner shall maintain and publish a list of analytes available for
accreditation. The list must be reviewed at least once every six months and the changes
published in the State Register and posted on the program's Web site. The commissioner
shall publish the notification of changes and review comments on the changes no less than
30 days from the date the list is published.
new text end

Sec. 31.

Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision
to read:

new text begin Subd. 3b. new text end

new text begin Additional fees. new text end

new text begin (a) Laboratories located outside of this state that require
an on-site assessment more frequent than once every two years must pay an additional
assessed fee of $3,000 per assessment for each additional on-site assessment conducted.
The laboratory must pay the fee within 15 business days of receiving the commissioner's
notification that an on-site assessment is required. The commissioner may conduct
additional on-site assessments to determine a laboratory's continued compliance with
the standards provided in subdivision 2a.
new text end

new text begin (b) A late fee of $200 shall be added to the annual fee for accredited laboratories
submitting renewal applications to the commissioner after November 1.
new text end

new text begin (c) A change fee shall be assessed if a laboratory requests additional fields of testing
at any time other than when initially applying for or renewing its accreditation. A change
fee does not apply for applications to add fields of testing for new analytes in response
to the published notice under subdivision 3a, paragraph (b), if the laboratory holds valid
accreditation for the changed test category and applies for additional analytes within the
same test category. The change fee is equal to the applicable test category fee for the
field of testing requested. An application that requests accreditation of multiple fields of
testing within a test category requires a single payment of the applicable test category fee
per application submitted.
new text end

new text begin (d) A variance fee shall be assessed if a laboratory requests a variance from a
standard provided in subdivision 2a. The variance fee is $500 per variance.
new text end

new text begin (e) The commissioner shall assess a fee for changes to laboratory information
regarding ownership, name, address, or personnel. Laboratories must submit changes
through the application process under subdivision 6. The information update fee is $250
per application.
new text end

new text begin (f) Fees must be set so that the total fees support the laboratory accreditation
program. Direct costs of the accreditation service include program administration,
assessments, the agency's general support costs, and attorney general costs attributable
to the fee function.
new text end

Sec. 32.

Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision
to read:

new text begin Subd. 3c. new text end

new text begin Refunds and nonpayment. new text end

new text begin Refunds or credits shall not be made for
applications received but not approved. Accreditation of a laboratory shall not be awarded
until all fees are paid.
new text end

Sec. 33.

Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Application. new text end

new text begin (a) Laboratories seeking accreditation must apply on a form
provided by the commissioner, include the laboratory's procedures and quality manual,
and pay the applicable fees.
new text end

new text begin (b) Laboratories may be fixed-base or mobile. The commissioner shall accredit
mobile laboratories individually and require a vehicle identification number, license
plate number, or other uniquely identifying information in addition to the application
requirements of paragraph (a).
new text end

new text begin (c) Laboratories maintained on separate properties, even though operated under the
same management or ownership, must apply separately. Laboratories with more than one
building on the same or adjoining properties do not need to submit a separate application.
new text end

new text begin (d) The commissioner may accredit laboratories located out-of-state. Accreditation
for out-of-state laboratories may be obtained directly from the commissioner following
the requirements in paragraph (a), or out-of-state laboratories may be accredited through
a reciprocal agreement if the laboratory:
new text end

new text begin (1) is accredited by a NELAP-recognized accreditation body for those fields of
testing in which the laboratory requests accreditation from the commissioner;
new text end

new text begin (2) submits an application and documentation according to this subdivision; and
new text end

new text begin (3) submits a current copy of the laboratory's unexpired accreditation from a
NELAP-recognized accreditation body showing the fields of accreditation for which the
laboratory is currently accredited.
new text end

new text begin (e) Under the conflict of interest determinations provided in section 43A.38,
subdivision 6, clause (a), the commissioner shall not accredit governmental laboratories
operated by agencies of the executive branch of the state. If accreditation is required,
laboratories operated by agencies of the executive branch of the state must apply for
accreditation through any other NELAP-recognized accreditation body.
new text end

Sec. 34.

Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision
to read:

new text begin Subd. 6a. new text end

new text begin Implementation and effective date. new text end

new text begin All laboratories must comply with
standards under this section by July 1, 2009. Fees under subdivisions 3 and 3b apply to
applications received and accreditations issued after June 30, 2009. Accreditations issued
on or after June 30, 2009, shall expire upon their current expiration date.
new text end

Sec. 35.

Minnesota Statutes 2008, section 144.98, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Initial accreditation and annual accreditation renewal. new text end

new text begin (a) The
commissioner shall issue or renew accreditation after receipt of the completed application
and documentation required in this section, provided the laboratory maintains compliance
with the standards specified in subdivision 2a, and attests to the compliance on the
application form.
new text end

new text begin (b) The commissioner shall prorate the fees in subdivision 3 for laboratories
applying for accreditation after December 31. The fees are prorated on a quarterly basis
beginning with the quarter in which the commissioner receives the completed application
from the laboratory.
new text end

new text begin (c) Applications for renewal of accreditation must be received by November 1 and
no earlier than October 1 of each year. The commissioner shall send annual renewal
notices to laboratories 90 days before expiration. Failure to receive a renewal notice does
not exempt laboratories from meeting the annual November 1 renewal date.
new text end

new text begin (d) The commissioner shall issue all accreditations for the calendar year for which
the application is made, and the accreditation shall expire on December 31 of that year.
new text end

new text begin (e) The accreditation of any laboratory that fails to submit a renewal application
and fees to the commissioner expires automatically on December 31 without notice or
further proceeding. Any person who operates a laboratory as accredited after expiration of
accreditation or without having submitted an application and paid the fees is in violation
of the provisions of this section and is subject to enforcement action under sections
144.989 to 144.993, the Health Enforcement Consolidation Act. A laboratory with expired
accreditation may reapply under subdivision 6.
new text end

Sec. 36.

Minnesota Statutes 2008, section 144.99, subdivision 1, is amended to read:

Subdivision 1.

Remedies available.

The provisions of chapters 103I and 157 and
sections 115.71 to 115.77; 144.12, subdivision 1, paragraphs (1), (2), (5), (6), (10), (12),
(13), (14), and (15); 144.1201 to 144.1204; 144.121; 144.1222; 144.35; 144.381 to
144.385; 144.411 to 144.417; 144.495; 144.71 to 144.74; 144.9501 to 144.9512; 144.992;
new text begin 144.97 to 144.98; new text end 326.70 to 326.785; 327.10 to 327.131; and 327.14 to 327.28 and all
rules, orders, stipulation agreements, settlements, compliance agreements, licenses,
registrations, certificates, and permits adopted or issued by the department or under any
other law now in force or later enacted for the preservation of public health may, in
addition to provisions in other statutes, be enforced under this section.

Sec. 37.

Minnesota Statutes 2008, section 148.6445, is amended by adding a
subdivision to read:

new text begin Subd. 2a. new text end

new text begin Duplicate license fee. new text end

new text begin The fee for a duplicate license is $25.
new text end

Sec. 38.

Minnesota Statutes 2008, section 153A.17, is amended to read:

153A.17 EXPENSES; FEES.

The expenses for administering the certification requirements including the
complaint handling system for hearing aid dispensers in sections 153A.14 and 153A.15
and the Consumer Information Center under section 153A.18 must be paid from initial
application and examination fees, renewal fees, penalties, and fines. All fees are
nonrefundable. The new text begin initial and annual renewal new text end certificate application fee is deleted text begin $350 deleted text end new text begin $700 new text end ,
the examination fee is deleted text begin $250 deleted text end new text begin $500 new text end for the written portion and deleted text begin $250 deleted text end new text begin $500 new text end for the practical
portion each time one or the other is taken deleted text begin , and deleted text end new text begin . For persons meeting the requirements of
section 148.515, subdivision 2, the fee for the practical portion of the hearing instrument
dispensing examination is $250 each time it is taken. new text end The trainee application fee is
$200. new text begin Effective July 1, 2009, a surcharge of $550 shall be paid at the time of certification
application or renewal until June 30, 2011, to recover the commissioner's accumulated
direct expenditures for administering the requirements of this chapter. new text end The penalty fee for
late submission of a renewal application is $200. The fee for verification of certification
to other jurisdictions or entities is $25. All fees, penalties, and fines received must be
deposited in the state government special revenue fund. The commissioner may prorate
the certification fee for new applicants based on the number of quarters remaining in
the annual certification period.

Sec. 39.

Minnesota Statutes 2008, section 157.15, is amended by adding a subdivision
to read:

new text begin Subd. 20. new text end

new text begin Youth camp. new text end

new text begin "Youth camp" has the meaning given in section 144.71,
subdivision 2.
new text end

Sec. 40.

Minnesota Statutes 2008, section 157.16, is amended to read:

157.16 LICENSES REQUIRED; FEES.

Subdivision 1.

License required annually.

A license is required annually for every
person, firm, or corporation engaged in the business of conducting a food and beverage
service establishment, new text begin youth camp, new text end hotel, motel, lodging establishment, public pool, or
resort. Any person wishing to operate a place of business licensed in this section shall
first make application, pay the required fee specified in this section, and receive approval
for operation, including plan review approval. deleted text begin Seasonal and temporary food stands and deleted text end
Special event food stands are not required to submit plans. Nonprofit organizations
operating a special event food stand with multiple locations at an annual one-day event
shall be issued only one license. Application shall be made on forms provided by the
commissioner and shall require the applicant to state the full name and address of the
owner of the building, structure, or enclosure, the lessee and manager of the food and
beverage service establishment, hotel, motel, lodging establishment, public pool, or resort;
the name under which the business is to be conducted; and any other information as may
be required by the commissioner to complete the application for license.

Subd. 2.

License renewal.

Initial and renewal licenses for all food and beverage
service establishments, new text begin youth camps, new text end hotels, motels, lodging establishments, public pools,
and resorts shall be issued deleted text begin for the calendar year for which application is made and shall
expire on December 31 of such year deleted text end new text begin on an annual basis new text end . Any person who operates a place
of business after the expiration date of a license or without having submitted an application
and paid the fee shall be deemed to have violated the provisions of this chapter and shall
be subject to enforcement action, as provided in the Health Enforcement Consolidation
Act, sections 144.989 to 144.993. In addition, a penalty of deleted text begin $50 deleted text end new text begin $60 new text end shall be added to the
total of the license fee for any food and beverage service establishment operating without
a license as a mobile food unit, a seasonal temporary or seasonal permanent food stand, or
a special event food stand, and a penalty of deleted text begin $100 deleted text end new text begin $120 new text end shall be added to the total of the
license fee for all restaurants, food carts, hotels, motels, lodging establishments, new text begin youth
camps, new text end public pools, and resorts operating without a license for a period of up to 30 days.
A late fee of deleted text begin $300 deleted text end new text begin $360 new text end shall be added to the license fee for establishments operating more
than 30 days without a license.

Subd. 2a.

Food manager certification.

An applicant for certification or certification
renewal as a food manager must submit to the commissioner a deleted text begin $28 deleted text end new text begin $35 new text end nonrefundable
certification fee payable to the Department of Health. new text begin The commissioner shall issue a
duplicate certificate to replace a lost, destroyed, or mutilated certificate if the applicant
submits a completed application on a form provided by the commissioner for a duplicate
certificate and pays $20 to the department for the cost of duplication.
new text end

Subd. 3.

Establishment fees; definitions.

(a) The following fees are required
for food and beverage service establishments, new text begin youth camps, new text end hotels, motels, lodging
establishments, public pools, and resorts licensed under this chapter. Food and beverage
service establishments must pay the highest applicable fee under paragraph (d), clause
(1), (2), (3), or (4), and establishments serving alcohol must pay the highest applicable
fee under paragraph (d), clause (6) or (7). The license fee for new operators previously
licensed under this chapter for the same calendar year is one-half of the appropriate annual
license fee, plus any penalty that may be required. The license fee for operators opening
on or after October 1 is one-half of the appropriate annual license fee, plus any penalty
that may be required.

(b) All food and beverage service establishments, except special event food stands,
and all hotels, motels, lodging establishments, public pools, and resorts shall pay an
annual base fee of $150.

(c) A special event food stand shall pay a flat fee of deleted text begin $40 deleted text end new text begin $50 new text end annually. "Special event
food stand" means a fee category where food is prepared or served in conjunction with
celebrations, county fairs, or special events from a special event food stand as defined
in section 157.15.

(d) In addition to the base fee in paragraph (b), each food and beverage service
establishment, other than a special event food stand, and each hotel, motel, lodging
establishment, public pool, and resort shall pay an additional annual fee for each fee
category, additional food service, or required additional inspection specified in this
paragraph:

(1) Limited food menu selection, deleted text begin $50 deleted text end new text begin $60 new text end . "Limited food menu selection" means a
fee category that provides one or more of the following:

(i) prepackaged food that receives heat treatment and is served in the package;

(ii) frozen pizza that is heated and served;

(iii) a continental breakfast such as rolls, coffee, juice, milk, and cold cereal;

(iv) soft drinks, coffee, or nonalcoholic beverages; or

(v) cleaning for eating, drinking, or cooking utensils, when the only food served
is prepared off site.

(2) Small establishment, including boarding establishments, deleted text begin $100 deleted text end new text begin $120 new text end . "Small
establishment" means a fee category that has no salad bar and meets one or more of
the following:

(i) possesses food service equipment that consists of no more than a deep fat fryer, a
grill, two hot holding containers, and one or more microwave ovens;

(ii) serves dipped ice cream or soft serve frozen desserts;

(iii) serves breakfast in an owner-occupied bed and breakfast establishment;

(iv) is a boarding establishment; or

(v) meets the equipment criteria in clause (3), item (i) or (ii), and has a maximum
patron seating capacity of not more than 50.

(3) Medium establishment, deleted text begin $260 deleted text end new text begin $310 new text end . "Medium establishment" means a fee
category that meets one or more of the following:

(i) possesses food service equipment that includes a range, oven, steam table, salad
bar, or salad preparation area;

(ii) possesses food service equipment that includes more than one deep fat fryer,
one grill, or two hot holding containers; or

(iii) is an establishment where food is prepared at one location and served at one or
more separate locations.

Establishments meeting criteria in clause (2), item (v), are not included in this fee
category.

(4) Large establishment, deleted text begin $460 deleted text end new text begin $540 new text end . "Large establishment" means either:

(i) a fee category that (A) meets the criteria in clause (3), items (i) or (ii), for a
medium establishment, (B) seats more than 175 people, and (C) offers the full menu
selection an average of five or more days a week during the weeks of operation; or

(ii) a fee category that (A) meets the criteria in clause (3), item (iii), for a medium
establishment, and (B) prepares and serves 500 or more meals per day.

(5) Other food and beverage service, including food carts, mobile food units,
seasonal temporary food stands, and seasonal permanent food stands, deleted text begin $50 deleted text end new text begin $60 new text end .

(6) Beer or wine table service, deleted text begin $50 deleted text end new text begin $60 new text end . "Beer or wine table service" means a fee
category where the only alcoholic beverage service is beer or wine, served to customers
seated at tables.

(7) Alcoholic beverage service, other than beer or wine table service, deleted text begin $135 deleted text end new text begin $165 new text end .

"Alcohol beverage service, other than beer or wine table service" means a fee
category where alcoholic mixed drinks are served or where beer or wine are served from
a bar.

(8) Lodging per sleeping accommodation unit, deleted text begin $8 deleted text end new text begin $10 new text end , including hotels, motels,
lodging establishments, and resorts, up to a maximum of deleted text begin $800 deleted text end new text begin $1,000 new text end . "Lodging per
sleeping accommodation unit" means a fee category including the number of guest rooms,
cottages, or other rental units of a hotel, motel, lodging establishment, or resort; or the
number of beds in a dormitory.

(9) First public pool, deleted text begin $180 deleted text end new text begin $325 new text end ; each additional public pool, deleted text begin $100 deleted text end new text begin $175 new text end . "Public
pool" means a fee category that has the meaning given in section 144.1222, subdivision 4.

(10) First spa, deleted text begin $110 deleted text end new text begin $175 new text end ; each additional spa, deleted text begin $50 deleted text end new text begin $100 new text end . "Spa pool" means a fee
category that has the meaning given in Minnesota Rules, part 4717.0250, subpart 9.

(11) Private sewer or water, deleted text begin $50 deleted text end new text begin $60 new text end . "Individual private water" means a fee
category with a water supply other than a community public water supply as defined in
Minnesota Rules, chapter 4720. "Individual private sewer" means a fee category with an
individual sewage treatment system which uses subsurface treatment and disposal.

(12) Additional food service, deleted text begin $130 deleted text end new text begin $150 new text end . "Additional food service" means a location
at a food service establishment, other than the primary food preparation and service area,
used to prepare or serve food to the public.

(13) Additional inspection fee, deleted text begin $300 deleted text end new text begin $360 new text end . "Additional inspection fee" means a
fee to conduct the second inspection each year for elementary and secondary education
facility school lunch programs when required by the Richard B. Russell National School
Lunch Act.

(e) A fee deleted text begin of $350 deleted text end for review of deleted text begin the deleted text end construction plans must accompany the initial
license application for restaurants, hotels, motels, lodging establishments, deleted text begin or deleted text end resorts deleted text begin with
five or more sleeping units. deleted text end new text begin , seasonal food stands, and mobile food units. The fee for
this construction plan review is as follows: new text end

new text begin Service Area new text end	new text begin Type new text end	new text begin Fee new text end
new text begin Food new text end	new text begin limited food menu new text end	new text begin $275 new text end
	new text begin small establishment new text end	new text begin $400 new text end
	new text begin medium establishment new text end	new text begin $450 new text end
	new text begin large food establishment new text end	new text begin $500 new text end
	new text begin additional food service new text end	new text begin $150 new text end
new text begin Transient food service new text end	new text begin food cart new text end	new text begin $250 new text end
	new text begin seasonal permanent food stand new text end	new text begin $250 new text end
	new text begin seasonal temporary food stand new text end	new text begin $250 new text end
	new text begin mobile food unit new text end	new text begin $350 new text end
new text begin Alcohol new text end	new text begin beer or wine table service new text end	new text begin $150 new text end
	new text begin alcohol service from bar new text end	new text begin $250 new text end
new text begin Lodging new text end	new text begin < 25 rooms new text end	new text begin $375 new text end
	new text begin ≥ 25 to < 100 rooms new text end	new text begin $400 new text end
	new text begin ≥ 100 rooms new text end	new text begin $500 new text end
	new text begin < five cabins new text end	new text begin $350 new text end
	new text begin ≥ five to < ten cabins new text end	new text begin $400 new text end
	new text begin ≥ ten cabins new text end	new text begin $450 new text end

(f) When existing food and beverage service establishments, hotels, motels, lodging
establishments, deleted text begin or deleted text end resorts new text begin , seasonal food stands, and mobile food units new text end are extensively
remodeled, a fee deleted text begin of $250 deleted text end must be submitted with the remodeling plans. deleted text begin A fee of $250
must be submitted for new construction or remodeling for a restaurant with a limited food
menu selection, a seasonal permanent food stand, a mobile food unit, or a food cart, or for
a hotel, motel, resort, or lodging establishment addition of less than five sleeping units. deleted text end new text begin
The fee for this construction plan review is as follows: new text end

new text begin Service Area new text end	new text begin Type new text end	new text begin Fee new text end
new text begin Food new text end	new text begin limited food menu new text end	new text begin $250 new text end
	new text begin small establishment new text end	new text begin $300 new text end
	new text begin medium establishment new text end	new text begin $350 new text end
	new text begin large food establishment new text end	new text begin $400 new text end
	new text begin additional food service new text end	new text begin $150 new text end
new text begin Transient food service new text end	new text begin food cart new text end	new text begin $250 new text end
	new text begin seasonal permanent food stand new text end	new text begin $250 new text end
	new text begin seasonal temporary food stand new text end	new text begin $250 new text end
	new text begin mobile food unit new text end	new text begin $250 new text end
new text begin Alcohol new text end	new text begin beer or wine table service new text end	new text begin $150 new text end
	new text begin alcohol service from bar new text end	new text begin $250 new text end
new text begin Lodging new text end	new text begin < 25 rooms new text end	new text begin $250 new text end
	new text begin ≥ 25 to < 100 rooms new text end	new text begin $300 new text end
	new text begin ≥ 100 rooms new text end	new text begin $450 new text end
	new text begin < five cabins new text end	new text begin $250 new text end
	new text begin ≥ five to < ten cabins new text end	new text begin $350 new text end
	new text begin ≥ ten cabins new text end	new text begin $400 new text end

(g) deleted text begin Seasonal temporary food stands and deleted text end Special event food stands are not required to
submit construction or remodeling plans for review.

new text begin (h) Youth camp fee, $500.
new text end

Subd. 3a.

Statewide hospitality fee.

Every person, firm, or corporation that
operates a licensed boarding establishment, food and beverage service establishment,
seasonal temporary or permanent food stand, special event food stand, mobile food unit,
food cart, resort, hotel, motel, or lodging establishment in Minnesota must submit to the
commissioner a $35 annual statewide hospitality fee for each licensed activity. The fee
for establishments licensed by the Department of Health is required at the same time the
licensure fee is due. For establishments licensed by local governments, the fee is due by
July 1 of each year.

Subd. 4.

Posting requirements.

Every food and beverage service establishment, new text begin
youth camp, new text end hotel, motel, lodging establishment, public pool, or resort must have the
license posted in a conspicuous place at the establishment. new text begin Mobile food units, food carts,
and seasonal temporary food stands shall be issued decals with the initial license and each
calendar year with license renewals. The current license year decal must be placed on the
unit or stand in a location determined by the commissioner. Decals are not transferable. new text end

Sec. 41.

Minnesota Statutes 2008, section 157.22, is amended to read:

157.22 EXEMPTIONS.

This chapter deleted text begin shall not be construed to deleted text end new text begin does not new text end apply to:

(1) interstate carriers under the supervision of the United States Department of
Health and Human Services;

(2) any building constructed and primarily used for religious worship;

(3) any building owned, operated, and used by a college or university in accordance
with health regulations promulgated by the college or university under chapter 14;

(4) any person, firm, or corporation whose principal mode of business is licensed
under sections 28A.04 and 28A.05, is exempt at that premises from licensure as a food
or beverage establishment; provided that the holding of any license pursuant to sections
28A.04 and 28A.05 shall not exempt any person, firm, or corporation from the applicable
provisions of this chapter or the rules of the state commissioner of health relating to
food and beverage service establishments;

(5) family day care homes and group family day care homes governed by sections
245A.01 to 245A.16;

(6) nonprofit senior citizen centers for the sale of home-baked goods;

(7) fraternal or patriotic organizations that are tax exempt under section 501(c)(3),
501(c)(4), 501(c)(6), 501(c)(7), 501(c)(10), or 501(c)(19) of the Internal Revenue Code of
1986, or organizations related to or affiliated with such fraternal or patriotic organizations.
Such organizations may organize events at which home-prepared food is donated by
organization members for sale at the events, provided:

(i) the event is not a circus, carnival, or fair;

(ii) the organization controls the admission of persons to the event, the event agenda,
or both; and

(iii) the organization's licensed kitchen is not used in any manner for the event;

(8) food not prepared at an establishment and brought in by individuals attending a
potluck event for consumption at the potluck event. An organization sponsoring a potluck
event under this clause may advertise the potluck event to the public through any means.
Individuals who are not members of an organization sponsoring a potluck event under this
clause may attend the potluck event and consume the food at the event. Licensed food
establishments other than schools cannot be sponsors of potluck events. A school may
sponsor and hold potluck events in areas of the school other than the school's kitchen,
provided that the school's kitchen is not used in any manner for the potluck event. For
purposes of this clause, "school" means a public school as defined in section 120A.05,
subdivisions 9, 11, 13, and 17, or a nonpublic school, church, or religious organization
at which a child is provided with instruction in compliance with sections 120A.22 and
120A.24. Potluck event food shall not be brought into a licensed food establishment
kitchen; deleted text begin and deleted text end

(9) a home school in which a child is provided instruction at home new text begin ; and
new text end

new text begin (10) concession stands operated in conjunction with school-sponsored events on
school property are exempt from the 21-day restriction new text end .

Sec. 42.

Minnesota Statutes 2008, section 327.14, is amended by adding a subdivision
to read:

new text begin Subd. 9. new text end

new text begin Special event recreational camping area. new text end

new text begin "Special event recreational
camping area" means a recreational camping area which operates no more than two times
annually and for no more than 14 consecutive days.
new text end

Sec. 43.

Minnesota Statutes 2008, section 327.15, is amended to read:

327.15 LICENSE REQUIRED; RENEWAL; deleted text begin PLANS FOR EXPANSION deleted text end new text begin new text end new text begin FEES new text end .

new text begin Subdivision 1. new text end

new text begin License required; plan review. new text end

No person, firm or corporation shall
establish, maintain, conduct or operate a manufactured home park or recreational camping
area within this state without first obtaining deleted text begin a deleted text end new text begin an annual new text end license therefor from the state
Department of Health. new text begin Any person wishing to obtain a license shall first make application,
pay the required fee specified in this section, and receive approval for operation, including
plan review approval. Application shall be made on forms provided by the commissioner
and shall require the applicant to state the full name and address of the owner of the
manufactured home park or recreational camping area, the name under which the business
is to be conducted, and any other information as may be required by the commissioner
to complete the application for license. new text end Any person, firm, or corporation desiring to
operate either a manufactured home park or a recreational camping area on the same site
in connection with the other, need only obtain one license. deleted text begin A license shall expire and be
renewed as prescribed by the commissioner pursuant to section 144.122. deleted text end The license shall
state the number of manufactured home sites and recreational camping sites allowed
according to state commissioner of health approval. deleted text begin No renewal license shall be issued if
the number of sites specified in the application exceeds those of the original application deleted text end new text begin
The number of licensed sites shall not be increased new text end unless the plans for expansion deleted text begin or
the construction for expansion deleted text end are new text begin submitted and the expansion new text end first approved by the
Department of Health. deleted text begin Any manufactured home park or recreational camping area located
in more than one municipality shall be dealt with as two separate manufactured home
parks or camping areas. deleted text end The license shall be conspicuously displayed in the office of the
manufactured home park or camping area. The license is not transferable as to new text begin person
or new text end place.

new text begin Subd. 2. new text end

new text begin License renewal. new text end

new text begin Initial and renewal licenses for all manufactured home
parks and recreational camping areas shall be issued annually and shall have an expiration
date included on the license. Any person who operates a manufactured home park or
recreational camping area after the expiration date of a license or without having submitted
an application and paid the fee shall be deemed to have violated the provisions of this
chapter and shall be subject to enforcement action, as provided in the Health Enforcement
Consolidation Act, sections 144.989 to 144.993. In addition, a penalty of $120 shall
be added to the total of the license fee for any manufactured home park or recreational
camping area operating without a license for a period of up to 30 days. A late fee of $360
shall be added to the license fee for any manufactured home park or recreational camping
area operating more than 30 days without a license.
new text end

new text begin Subd. 3. new text end

new text begin Fees, manufactured home parks and recreational camping areas. new text end

new text begin (a)
The following fees are required for manufactured home parks and recreational camping
areas licensed under this chapter. Recreational camping areas and manufactured home
parks must pay the highest applicable fee under paragraph (c). The license fee for new
operators of a manufactured home park or recreational camping area previously licensed
under this chapter for the same calendar year is one-half of the appropriate annual license
fee, plus any penalty that may be required. The license fee for operators opening on
or after October 1 is one-half of the appropriate annual license fee, plus any penalty
that may be required.
new text end

new text begin (b) All manufactured home parks and recreational camping areas, except special
event recreational camping areas, shall pay an annual base fee of $150 plus $4 for each
licensed site, except that any operator of a manufactured home park or recreational
camping area who is licensed under section 157.16 for the same location shall not be
required to pay the base fee.
new text end

new text begin (c) In addition to the fee in paragraph (b), each manufactured home park or
recreational camping area shall pay an additional annual fee for each fee category
specified in this paragraph:
new text end

new text begin (1) Manufactured home parks and recreational camping areas with public swimming
pools and spas shall pay the appropriate fees specified in section 157.16.
new text end

new text begin (2) Individual private sewer or water, $60. "Individual private water" means a fee
category with a water supply other than a community public water supply as defined in
Minnesota Rules, chapter 4720. "Individual private sewer" means a fee category with an
individual sewage treatment system which uses subsurface treatment and disposal.
new text end

new text begin (d) The following fees must accompany a plan review application for initial
construction of a manufactured home park or recreational camping area:
new text end

new text begin (1) for initial construction of less than 25 sites, $375;
new text end

new text begin (2) for initial construction of 25 to less than 100 sites, $400; and
new text end

new text begin (3) for initial construction of 100 or more sites, $500.
new text end

new text begin (e) The following fees must accompany a plan review application when an existing
manufactured home park or recreational camping area is expanded:
new text end

new text begin (1) for expansion of less than 25 sites, $250;
new text end

new text begin (2) for expansion of 25 and less than 100 sites, $300; and
new text end

new text begin (3) for expansion of 100 or more sites, $450.
new text end

new text begin Subd. 4. new text end

new text begin Fees, special event recreational camping areas. new text end

new text begin (a) The following fees
are required for special event recreational camping areas licensed under this chapter.
new text end

new text begin (b) All special event recreational camping areas shall pay an annual fee of $150 plus
$1 for each licensed site.
new text end

new text begin (c) A special event recreational camping area shall pay a late fee of $360 for failing
to obtain a license prior to operating.
new text end

new text begin (d) The following fees must accompany a plan review application for initial
construction of a special event recreational camping area:
new text end

new text begin (1) for initial construction of less than 25 special event recreational camping sites,
$375;
new text end

new text begin (2) for initial construction of 25 to less than 100 sites, $400; and
new text end

new text begin (3) for initial construction of 100 or more sites, $500.
new text end

new text begin (e) The following fees must accompany a plan review application for expansion of a
special event recreational camping area:
new text end

new text begin (1) for expansion of less than 25 sites, $250;
new text end

new text begin (2) for expansion of 25 and less than 100 sites, $300; and
new text end

new text begin (3) for expansion of 100 or more sites, $450.
new text end

Sec. 44.

Minnesota Statutes 2008, section 327.16, is amended to read:

327.16 deleted text begin LICENSE deleted text end new text begin PLAN REVIEW new text end APPLICATION.

Subdivision 1.

Made to state Department of Health.

The new text begin plan review new text end application
for deleted text begin license to operate and maintain deleted text end a manufactured home park or recreational camping
area shall be made to the state Department of Health, at such office and in such manner
as may be prescribed by that department.

Subd. 2.

Contents.

The deleted text begin applicant for a primary license or annual license shall make
application in writing deleted text end new text begin plan review application shall be made new text end upon a form provided by the
state Department of Health setting forth:

(1) The full name and address of the applicant or applicants, or names and addresses
of the partners if the applicant is a partnership, or the names and addresses of the officers
if the applicant is a corporation.

(2) A legal description of the site, lot, field, or tract of land upon which the applicant
proposes to operate and maintain a manufactured home park or recreational camping area.

(3) The proposed and existing facilities on and about the site, lot, field, or tract of
land for the proposed construction or alteration and maintaining of a sanitary community
building for toilets, urinals, sinks, wash basins, slop-sinks, showers, drains, laundry
facilities, source of water supply, sewage, garbage and waste disposal; except that no
toilet facilities shall be required in any manufactured home park which permits only
manufactured homes equipped with toilet facilities discharging to water carried sewage
disposal systems; and method of fire and storm protection.

(4) The proposed method of lighting the structures and site, lot, field, or tract of land
upon which the manufactured home park or recreational camping area is to be located.

(5) The calendar months of the year which the applicant will operate the
manufactured home park or recreational camping area.

(6) Plans and drawings for new construction or alteration, including buildings, wells,
plumbing and sewage disposal systems.

Subd. 3.

deleted text begin Fees; deleted text end Approval.

The application for deleted text begin the primary license deleted text end new text begin plan review new text end shall
be submitted with all plans and specifications enumerated in subdivision 2, deleted text begin and payment
of a fee in an amount prescribed by the state commissioner of health pursuant to section
144.122 deleted text end and shall be accompanied by an approved zoning permit from the municipality or
county wherein the park is to be located, or a statement from the municipality or county
that it does not require an approved zoning permit. deleted text begin The fee for the annual license shall be
in an amount prescribed by the state commissioner of health pursuant to section 144.122.
All license fees paid to the commissioner of health shall be turned over to the state
treasury. deleted text end The fee submitted for the deleted text begin primary license deleted text end new text begin plan review new text end shall be retained by the
state even though the proposed project is not approved and a license is denied.

When construction has been completed in accordance with approved plans and
specifications the state commissioner of health shall promptly cause the manufactured
home park or recreational camping area and appurtenances thereto to be inspected. When
the inspection and report has been made and the state commissioner of health finds that
all requirements of sections 327.10, 327.11, 327.14 to 327.28, and such conditions of
health and safety as the state commissioner of health may require, have been met by
the applicant, the state commissioner of health shall forthwith issue the deleted text begin primary deleted text end license
in the name of the state.

Subd. 4.

deleted text begin Sanitary facilities deleted text end new text begin Compliance with current state law new text end .

deleted text begin During the
pendency of the application for such primary license any change in the sanitary or safety
facilities of the intended manufactured home park or recreational camping area shall be
immediately reported in writing to the state Department of Health through the office
through which the application was made. If no objection is made by the state Department
of Health to such change in such sanitary or safety facilities within 60 days of the date
such change is reported, it shall be deemed to have the approval of the state Department of
Health. deleted text end new text begin Any manufactured home park or recreational camping area must be constructed
and operated according to all applicable state electrical, fire, plumbing, and building codes.
new text end

Subd. 5.

Permit.

When the plans and specifications have been approved, the state
Department of Health shall issue an approval report permitting the applicant to construct
or make alterations upon a manufactured home park or recreational camping area and the
appurtenances thereto according to the plans and specifications presented.

Such approval does not relieve the applicant from securing building permits in
municipalities that require permits or from complying with any other municipal ordinance
or ordinances, applicable thereto, not in conflict with this statute.

Subd. 6.

Denial of construction.

If the application to construct or make alterations
upon a manufactured home park or recreational camping area and the appurtenances
thereto or a deleted text begin primary deleted text end license to operate and maintain the same is denied by the state
commissioner of health, the commissioner shall so state in writing giving the reason
or reasons for denying the application. If the objections can be corrected the applicant
may amend the application and resubmit it for approval, and if denied the applicant may
appeal from the decision of the state commissioner of health as provided in section
144.99, subdivision 10.

Sec. 45.

Minnesota Statutes 2008, section 327.20, subdivision 1, is amended to read:

Subdivision 1.

Rules.

No domestic animals or house pets of occupants of
manufactured home parks or recreational camping areas shall be allowed to run at large,
or commit any nuisances within the limits of a manufactured home park or recreational
camping area. Each manufactured home park or recreational camping area licensed under
the provisions of sections 327.10, 327.11, new text begin and new text end 327.14 to 327.28 shall, among other things,
provide for the following deleted text begin , in the manner hereinafter specified deleted text end :

(1) A responsible attendant or caretaker shall be in charge of every manufactured
home park or recreational camping area at all times, who shall maintain the park or
area, and its facilities and equipment in a clean, orderly and sanitary condition. In any
manufactured home park containing more than 50 lots, the attendant, caretaker, or other
responsible park employee, shall be readily available at all times in case of emergency.

(2) All manufactured home parks shall be well drained and be located so that the
drainage of the park area will not endanger any water supply. No wastewater from
manufactured homes or recreational camping vehicles shall be deposited on the surface of
the ground. All sewage and other water carried wastes shall be discharged into a municipal
sewage system whenever available. When a municipal sewage system is not available, a
sewage disposal system acceptable to the state commissioner of health shall be provided.

(3) No manufactured home shall be located closer than three feet to the side lot lines
of a manufactured home park, if the abutting property is improved property, or closer than
ten feet to a public street or alley. Each individual site shall abut or face on a driveway
or clear unoccupied space of not less than 16 feet in width, which space shall have
unobstructed access to a public highway or alley. There shall be an open space of at least
ten feet between the sides of adjacent manufactured homes including their attachments
and at least three feet between manufactured homes when parked end to end. The space
between manufactured homes may be used for the parking of motor vehicles and other
property, if the vehicle or other property is parked at least ten feet from the nearest
adjacent manufactured home position. The requirements of this paragraph shall not apply
to recreational camping areas and variances may be granted by the state commissioner
of health in manufactured home parks when the variance is applied for in writing and in
the opinion of the commissioner the variance will not endanger the health, safety, and
welfare of manufactured home park occupants.

(4) An adequate supply of water of safe, sanitary quality shall be furnished at each
manufactured home park or recreational camping area. The source of the water supply
shall first be approved by the state Department of Health.

(5) All plumbing shall be installed in accordance with the rules of the state
commissioner of labor and industry and the provisions of the Minnesota Plumbing Code.

(6) In the case of a manufactured home park with less than ten manufactured homes,
a plan for the sheltering or the safe evacuation to a safe place of shelter of the residents of
the park in times of severe weather conditions, such as tornadoes, high winds, and floods.
The shelter or evacuation plan shall be developed with the assistance and approval of
the municipality where the park is located and shall be posted at conspicuous locations
throughout the park. The park owner shall provide each resident with a copy of the
approved shelter or evacuation plan, as provided by section 327C.01, subdivision 1c.
Nothing in this paragraph requires the Department of Health to review or approve any
shelter or evacuation plan developed by a park. Failure of a municipality to approve a plan
submitted by a park shall not be grounds for action against the park by the Department of
Health if the park has made a good faith effort to develop the plan and obtain municipal
approval.

(7) A manufactured home park with ten or more manufactured homes, licensed prior
to March 1, 1988, shall provide a safe place of shelter for park residents or a plan for the
evacuation of park residents to a safe place of shelter within a reasonable distance of the
park for use by park residents in times of severe weather, including tornadoes and high
winds. The shelter or evacuation plan must be approved by the municipality by March 1,
1989. The municipality may require the park owner to construct a shelter if it determines
that a safe place of shelter is not available within a reasonable distance from the park. A
copy of the municipal approval and the plan shall be submitted by the park owner to the
Department of Health. The park owner shall provide each resident with a copy of the
approved shelter or evacuation plan, as provided by section 327C.01, subdivision 1c.

(8) A manufactured home park with ten or more manufactured homes, receiving
deleted text begin a primary deleted text end new text begin an initial new text end license after March 1, 1988, must provide the type of shelter required
by section 327.205, except that for manufactured home parks established as temporary,
emergency housing in a disaster area declared by the President of the United States or
the governor, an approved evacuation plan may be provided in lieu of a shelter for a
period not exceeding 18 months.

(9) For the purposes of this subdivision, "park owner" and "resident" have the
deleted text begin meaning deleted text end new text begin meanings new text end given them in section 327C.01.

Sec. 46.

Minnesota Statutes 2008, section 327.20, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Special event recreational camping areas. new text end

new text begin Each special event camping
area licensed under sections 327.10, 327.11, and 327.14 to 327.28 is subject to this section.
new text end

new text begin (1) Recreational camping vehicles and tents, including attachments, must be
separated from each other and other structures by at least seven feet.
new text end

new text begin (2) A minimum area of 300 square feet per site must be provided and the total
number of sites must not exceed one site for every 300 square feet of usable land area.
new text end

new text begin (3) Each site must abut or face a driveway or clear unoccupied space of at least 16
feet in width, which space must have unobstructed access to a public roadway.
new text end

new text begin (4) If no approved on-site water supply system is available, hauled water may be
used, provided that persons using hauled water comply with Minnesota Rules, parts
4720.4000 to 4720.4600.
new text end

new text begin (5) Nonburied sewer lines may be permitted provided they are of approved materials,
watertight, and properly maintained.
new text end

new text begin (6) If a sanitary dumping station is not provided on-site, arrangements must be
made with a licensed sewage pumper to service recreational camping vehicle holding
tanks as needed.
new text end

new text begin (7) Toilet facilities must be provided consisting of toilets connected to an approved
sewage disposal system, portable toilets, or approved, properly constructed privies.
new text end

new text begin (8) Toilets must be provided in the ratio of one toilet for each sex for each 150 sites.
new text end

new text begin (9) Toilets must be not more than 400 feet from any site.
new text end

new text begin (10) If a central building or buildings are provided with running water, then toilets
and hand-washing lavatories must be provided in the building or buildings that meet the
requirements of this subdivision.
new text end

new text begin (11) Showers, if provided, must be provided in the ratio of one shower for each sex
for each 250 sites. Showerheads must be provided, where running water is available, for
each camping event exceeding two nights.
new text end

new text begin (12) Central toilet and shower buildings, if provided, must be constructed with
adequate heating, ventilation, and lighting, and floors of impervious material sloped
to drain. Walls must be of a washable material. Permanent facilities must meet the
requirements of the Americans with Disabilities Act.
new text end

new text begin (13) An adequate number of durable, covered, watertight containers must be
provided for all garbage and refuse. Garbage and refuse must be collected as often as
necessary to prevent nuisance conditions.
new text end

new text begin (14) Campgrounds must be located in areas free of poison ivy or other noxious
weeds considered detrimental to health. Sites must not be located in areas of tall grass or
weeds and sites must be adequately drained.
new text end

new text begin (15) Campsites for recreational vehicles may not be located on inclines of greater
than eight percent grade or one inch drop per lineal foot.
new text end

new text begin (16) A responsible attendant or caretaker must be available on-site at all times during
the operation of any special event recreational camping area that has 50 or more sites.
new text end

Sec. 47. new text begin MINNESOTA COLORECTAL CANCER PREVENTION
DEMONSTRATION PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner of health shall award grants
to Hennepin County Medical Center and MeritCare Bemidji for a colorectal screening
demonstration project to provide screening to uninsured and underinsured women and
men. The project shall expire December 31, 2010.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility. new text end

new text begin To be eligible for colorectal screening under this demonstration
project, an applicant must:
new text end

new text begin (1) be at least 50 years of age, or under the age of 50 and at high risk for colon cancer;
new text end

new text begin (2) be uninsured, or if insured, have coverage that does not cover the full cost of
colorectal cancer screenings;
new text end

new text begin (3) not be eligible for medical assistance, general assistance medical care, or
MinnesotaCare programs; and
new text end

new text begin (4) have a gross family income at or below 250 percent of the federal poverty level.
new text end

new text begin Subd. 3. new text end

new text begin Services. new text end

new text begin Services provided under this project shall include:
new text end

new text begin (1) colorectal cancer screening, according to standard practices of medicine, or
guidelines provided by the Institute for Clinical Systems Improvement or the American
Cancer Society;
new text end

new text begin (2) follow-up services for abnormal tests; and
new text end

new text begin (3) diagnostic services to determine the extent and proper course of treatment.
new text end

new text begin Subd. 4. new text end

new text begin Project evaluation. new text end

new text begin The commissioner of health shall evaluate the
demonstration project and make recommendations for increasing the number of persons in
Minnesota who receive recommended colon cancer screening. The commissioner of health
shall submit the evaluation and recommendations to the legislature by January 15, 2011.
new text end

Sec. 48. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2008, sections 103I.112; 144.9501, subdivision 17b; and
327.14, subdivisions 5 and 6, new text end new text begin are repealed.
new text end

new text begin (b) new text end new text begin Minnesota Rules, part 4626.2015, subpart 9, new text end new text begin is repealed.
new text end

ARTICLE 6

TECHNICAL

Section 1.

Minnesota Statutes 2008, section 125A.744, subdivision 3, is amended to
read:

Subd. 3.

Implementation.

Consistent with section 256B.0625, subdivision 26,
school districts may enroll as medical assistance providers or subcontractors and bill
the Department of Human Services under the medical assistance fee for service claims
processing system for special education services which are covered services under chapter
256B, which are provided in the school setting for a medical assistance recipient, and for
whom the district has secured informed consent consistent with section 13.05, subdivision
4, paragraph (d), and section 256B.77, subdivision 2, paragraph (p), to bill for each type
of covered service. School districts shall be reimbursed by the commissioner of human
services for the federal share of individual education plan health-related services that
qualify for reimbursement by medical assistance, minus up to five percent retained by the
commissioner of human services for administrative costs, not to exceed $350,000 per
fiscal year. The commissioner may withhold up to five percent of each payment to a
school district. Following the end of each fiscal year, the commissioner shall settle up with
each school district in order to ensure that collections from each district for departmental
administrative costs are made on a pro rata basis according to federal earnings for these
services in each district. A school district is not eligible to enroll as a home care provider
or a personal care provider organization for purposes of billing home care services under
sections 256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end until the commissioner
of human services issues a bulletin instructing county public health nurses on how to
assess for the needs of eligible recipients during school hours. To use private duty nursing
services or personal care services at school, the recipient or responsible party must provide
written authorization in the care plan identifying the chosen provider and the daily amount
of services to be used at school.

Sec. 2.

Minnesota Statutes 2008, section 144A.46, subdivision 1, is amended to read:

Subdivision 1.

License required.

(a) A home care provider may not operate in the
state without a current license issued by the commissioner of health. A home care provider
may hold a separate license for each class of home care licensure.

(b) Within ten days after receiving an application for a license, the commissioner
shall acknowledge receipt of the application in writing. The acknowledgment must
indicate whether the application appears to be complete or whether additional information
is required before the application will be considered complete. Within 90 days after
receiving a complete application, the commissioner shall either grant or deny the license.
If an applicant is not granted or denied a license within 90 days after submitting a
complete application, the license must be deemed granted. An applicant whose license has
been deemed granted must provide written notice to the commissioner before providing a
home care service.

(c) Each application for a home care provider license, or for a renewal of a license,
shall be accompanied by a fee to be set by the commissioner under section 144.122.

(d) The commissioner of health, in consultation with the commissioner of human
services, shall provide recommendations to the legislature by February 15, 2009, for
provider standards for personal care assistant services as described in section deleted text begin 256B.0655 deleted text end new text begin
256B.0659 new text end .

Sec. 3.

Minnesota Statutes 2008, section 176.011, subdivision 9, is amended to read:

Subd. 9.

Employee.

"Employee" means any person who performs services for
another for hire including the following:

(1) an alien;

(2) a minor;

(3) a sheriff, deputy sheriff, police officer, firefighter, county highway engineer, and
peace officer while engaged in the enforcement of peace or in the pursuit or capture of a
person charged with or suspected of crime;

(4) a person requested or commanded to aid an officer in arresting or retaking a
person who has escaped from lawful custody, or in executing legal process, in which
cases, for purposes of calculating compensation under this chapter, the daily wage of the
person shall be the prevailing wage for similar services performed by paid employees;

(5) a county assessor;

(6) an elected or appointed official of the state, or of a county, city, town, school
district, or governmental subdivision in the state. An officer of a political subdivision
elected or appointed for a regular term of office, or to complete the unexpired portion of a
regular term, shall be included only after the governing body of the political subdivision
has adopted an ordinance or resolution to that effect;

(7) an executive officer of a corporation, except those executive officers excluded
by section 176.041;

(8) a voluntary uncompensated worker, other than an inmate, rendering services in
state institutions under the commissioners of human services and corrections similar to
those of officers and employees of the institutions, and whose services have been accepted
or contracted for by the commissioner of human services or corrections as authorized by
law. In the event of injury or death of the worker, the daily wage of the worker, for the
purpose of calculating compensation under this chapter, shall be the usual wage paid at
the time of the injury or death for similar services in institutions where the services are
performed by paid employees;

(9) a voluntary uncompensated worker engaged in emergency management as
defined in section 12.03, subdivision 4, who is:

(i) registered with the state or any political subdivision of it, according to the
procedures set forth in the state or political subdivision emergency operations plan; and

(ii) acting under the direction and control of, and within the scope of duties approved
by, the state or political subdivision.

The daily wage of the worker, for the purpose of calculating compensation under this
chapter, shall be the usual wage paid at the time of the injury or death for similar services
performed by paid employees;

(10) a voluntary uncompensated worker participating in a program established by a
local social services agency. For purposes of this clause, "local social services agency"
means any agency established under section 393.01. In the event of injury or death of the
worker, the wage of the worker, for the purpose of calculating compensation under this
chapter, shall be the usual wage paid in the county at the time of the injury or death for
similar services performed by paid employees working a normal day and week;

(11) a voluntary uncompensated worker accepted by the commissioner of natural
resources who is rendering services as a volunteer pursuant to section 84.089. The daily
wage of the worker for the purpose of calculating compensation under this chapter, shall
be the usual wage paid at the time of injury or death for similar services performed by
paid employees;

(12) a voluntary uncompensated worker in the building and construction industry
who renders services for joint labor-management nonprofit community service projects.
The daily wage of the worker for the purpose of calculating compensation under this
chapter shall be the usual wage paid at the time of injury or death for similar services
performed by paid employees;

(13) a member of the military forces, as defined in section 190.05, while in state
active service, as defined in section 190.05, subdivision 5a. The daily wage of the member
for the purpose of calculating compensation under this chapter shall be based on the
member's usual earnings in civil life. If there is no evidence of previous occupation or
earning, the trier of fact shall consider the member's earnings as a member of the military
forces;

(14) a voluntary uncompensated worker, accepted by the director of the Minnesota
Historical Society, rendering services as a volunteer, pursuant to chapter 138. The daily
wage of the worker, for the purposes of calculating compensation under this chapter,
shall be the usual wage paid at the time of injury or death for similar services performed
by paid employees;

(15) a voluntary uncompensated worker, other than a student, who renders services
at the Minnesota State Academy for the Deaf or the Minnesota State Academy for the
Blind, and whose services have been accepted or contracted for by the commissioner of
education, as authorized by law. In the event of injury or death of the worker, the daily
wage of the worker, for the purpose of calculating compensation under this chapter, shall
be the usual wage paid at the time of the injury or death for similar services performed in
institutions by paid employees;

(16) a voluntary uncompensated worker, other than a resident of the veterans home,
who renders services at a Minnesota veterans home, and whose services have been
accepted or contracted for by the commissioner of veterans affairs, as authorized by law.
In the event of injury or death of the worker, the daily wage of the worker, for the purpose
of calculating compensation under this chapter, shall be the usual wage paid at the time of
the injury or death for similar services performed in institutions by paid employees;

(17) a worker performing services under section deleted text begin 256B.0655 deleted text end new text begin 256B.0659 new text end for a
recipient in the home of the recipient or in the community under section 256B.0625,
subdivision 19a, who is paid from government funds through a fiscal intermediary under
section deleted text begin 256B.0655, subdivision 7 deleted text end new text begin 256B.0659, subdivision 33 new text end . For purposes of maintaining
workers' compensation insurance, the employer of the worker is as designated in law
by the commissioner of the Department of Human Services, notwithstanding any other
law to the contrary;

(18) students enrolled in and regularly attending the Medical School of the
University of Minnesota in the graduate school program or the postgraduate program. The
students shall not be considered employees for any other purpose. In the event of the
student's injury or death, the weekly wage of the student for the purpose of calculating
compensation under this chapter, shall be the annualized educational stipend awarded to
the student, divided by 52 weeks. The institution in which the student is enrolled shall
be considered the "employer" for the limited purpose of determining responsibility for
paying benefits under this chapter;

(19) a faculty member of the University of Minnesota employed for an academic
year is also an employee for the period between that academic year and the succeeding
academic year if:

(a) the member has a contract or reasonable assurance of a contract from the
University of Minnesota for the succeeding academic year; and

(b) the personal injury for which compensation is sought arises out of and in the
course of activities related to the faculty member's employment by the University of
Minnesota;

(20) a worker who performs volunteer ambulance driver or attendant services is an
employee of the political subdivision, nonprofit hospital, nonprofit corporation, or other
entity for which the worker performs the services. The daily wage of the worker for the
purpose of calculating compensation under this chapter shall be the usual wage paid at the
time of injury or death for similar services performed by paid employees;

(21) a voluntary uncompensated worker, accepted by the commissioner of
administration, rendering services as a volunteer at the Department of Administration. In
the event of injury or death of the worker, the daily wage of the worker, for the purpose of
calculating compensation under this chapter, shall be the usual wage paid at the time of the
injury or death for similar services performed in institutions by paid employees;

(22) a voluntary uncompensated worker rendering service directly to the Pollution
Control Agency. The daily wage of the worker for the purpose of calculating compensation
payable under this chapter is the usual going wage paid at the time of injury or death for
similar services if the services are performed by paid employees;

(23) a voluntary uncompensated worker while volunteering services as a first
responder or as a member of a law enforcement assistance organization while acting
under the supervision and authority of a political subdivision. The daily wage of the
worker for the purpose of calculating compensation payable under this chapter is the
usual going wage paid at the time of injury or death for similar services if the services
are performed by paid employees;

(24) a voluntary uncompensated member of the civil air patrol rendering service on
the request and under the authority of the state or any of its political subdivisions. The
daily wage of the member for the purposes of calculating compensation payable under this
chapter is the usual going wage paid at the time of injury or death for similar services if
the services are performed by paid employees; and

(25) a Minnesota Responds Medical Reserve Corps volunteer, as provided in
sections 145A.04 and 145A.06, responding at the request of or engaged in training
conducted by the commissioner of health. The daily wage of the volunteer for the purposes
of calculating compensation payable under this chapter is established in section 145A.06.
A person who qualifies under this clause and who may also qualify under another clause
of this subdivision shall receive benefits in accordance with this clause.

If it is difficult to determine the daily wage as provided in this subdivision, the trier
of fact may determine the wage upon which the compensation is payable.

Sec. 4.

Minnesota Statutes 2008, section 245C.03, subdivision 2, is amended to read:

Subd. 2.

Personal care provider organizations.

The commissioner shall conduct
background studies on any individual required under sections 256B.0651 deleted text begin and 256B.0653 deleted text end
to 256B.0656 new text begin and 256B.0659 new text end to have a background study completed under this chapter.

Sec. 5.

Minnesota Statutes 2008, section 245C.04, subdivision 3, is amended to read:

Subd. 3.

Personal care provider organizations.

(a) The commissioner shall
conduct a background study of an individual required to be studied under section 245C.03,
subdivision 2, at least upon application for initial enrollment under sections 256B.0651
deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end .

(b) Organizations required to initiate background studies under sections 256B.0651
deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end for individuals described in section 245C.03,
subdivision 2, must submit a completed background study form to the commissioner
before those individuals begin a position allowing direct contact with persons served
by the organization.

Sec. 6.

Minnesota Statutes 2008, section 245C.10, subdivision 3, is amended to read:

Subd. 3.

Personal care provider organizations.

The commissioner shall recover
the cost of background studies initiated by a personal care provider organization under
sections 256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end through a fee of no
more than $20 per study charged to the organization responsible for submitting the
background study form. The fees collected under this subdivision are appropriated to the
commissioner for the purpose of conducting background studies.

Sec. 7.

Minnesota Statutes 2008, section 256B.04, subdivision 16, is amended to read:

Subd. 16.

Personal care services.

(a) Notwithstanding any contrary language in
this paragraph, the commissioner of human services and the commissioner of health shall
jointly promulgate rules to be applied to the licensure of personal care services provided
under the medical assistance program. The rules shall consider standards for personal care
services that are based on the World Institute on Disability's recommendations regarding
personal care services. These rules shall at a minimum consider the standards and
requirements adopted by the commissioner of health under section 144A.45, which the
commissioner of human services determines are applicable to the provision of personal
care services, in addition to other standards or modifications which the commissioner of
human services determines are appropriate.

The commissioner of human services shall establish an advisory group including
personal care consumers and providers to provide advice regarding which standards or
modifications should be adopted. The advisory group membership must include not less
than 15 members, of which at least 60 percent must be consumers of personal care services
and representatives of recipients with various disabilities and diagnoses and ages. At least
51 percent of the members of the advisory group must be recipients of personal care.

The commissioner of human services may contract with the commissioner of health
to enforce the jointly promulgated licensure rules for personal care service providers.

Prior to final promulgation of the joint rule the commissioner of human services
shall report preliminary findings along with any comments of the advisory group and a
plan for monitoring and enforcement by the Department of Health to the legislature by
February 15, 1992.

Limits on the extent of personal care services that may be provided to an individual
must be based on the cost-effectiveness of the services in relation to the costs of inpatient
hospital care, nursing home care, and other available types of care. The rules must
provide, at a minimum:

(1) that agencies be selected to contract with or employ and train staff to provide and
supervise the provision of personal care services;

(2) that agencies employ or contract with a qualified applicant that a qualified
recipient proposes to the agency as the recipient's choice of assistant;

(3) that agencies bill the medical assistance program for a personal care service
by a personal care assistant and supervision by a qualified professional supervising the
personal care assistant unless the recipient selects the fiscal agent option under section
deleted text begin 256B.0655, subdivision 7 deleted text end new text begin 256B.0659, subdivision 33 new text end ;

(4) that agencies establish a grievance mechanism; and

(5) that agencies have a quality assurance program.

(b) The commissioner may waive the requirement for the provision of personal care
services through an agency in a particular county, when there are less than two agencies
providing services in that county and shall waive the requirement for personal care
assistants required to join an agency for the first time during 1993 when personal care
services are provided under a relative hardship waiver under Minnesota Statutes 1992,
section 256B.0627, subdivision 4, paragraph (b), clause (7), and at least two agencies
providing personal care services have refused to employ or contract with the independent
personal care assistant.

Sec. 8.

Minnesota Statutes 2008, section 256B.055, subdivision 12, is amended to read:

Subd. 12.

Disabled children.

(a) A person is eligible for medical assistance if the
person is under age 19 and qualifies as a disabled individual under United States Code,
title 42, section 1382c(a), and would be eligible for medical assistance under the state
plan if residing in a medical institution, and the child requires a level of care provided in
a hospital, nursing facility, or intermediate care facility for persons with developmental
disabilities, for whom home care is appropriate, provided that the cost to medical
assistance under this section is not more than the amount that medical assistance would pay
for if the child resides in an institution. After the child is determined to be eligible under
this section, the commissioner shall review the child's disability under United States Code,
title 42, section 1382c(a) and level of care defined under this section no more often than
annually and may elect, based on the recommendation of health care professionals under
contract with the state medical review team, to extend the review of disability and level of
care up to a maximum of four years. The commissioner's decision on the frequency of
continuing review of disability and level of care is not subject to administrative appeal
under section 256.045. The county agency shall send a notice of disability review to the
enrollee six months prior to the date the recertification of disability is due. Nothing in this
subdivision shall be construed as affecting other redeterminations of medical assistance
eligibility under this chapter and annual cost-effective reviews under this section.

(b) For purposes of this subdivision, "hospital" means an institution as defined
in section 144.696, subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part
4640.3600, and licensed pursuant to sections 144.50 to 144.58. For purposes of this
subdivision, a child requires a level of care provided in a hospital if the child is determined
by the commissioner to need an extensive array of health services, including mental health
services, for an undetermined period of time, whose health condition requires frequent
monitoring and treatment by a health care professional or by a person supervised by a
health care professional, who would reside in a hospital or require frequent hospitalization
if these services were not provided, and the daily care needs are more complex than
a nursing facility level of care.

A child with serious emotional disturbance requires a level of care provided in a
hospital if the commissioner determines that the individual requires 24-hour supervision
because the person exhibits recurrent or frequent suicidal or homicidal ideation or
behavior, recurrent or frequent psychosomatic disorders or somatopsychic disorders that
may become life threatening, recurrent or frequent severe socially unacceptable behavior
associated with psychiatric disorder, ongoing and chronic psychosis or severe, ongoing
and chronic developmental problems requiring continuous skilled observation, or severe
disabling symptoms for which office-centered outpatient treatment is not adequate, and
which overall severely impact the individual's ability to function.

(c) For purposes of this subdivision, "nursing facility" means a facility which
provides nursing care as defined in section 144A.01, subdivision 5, licensed pursuant to
sections 144A.02 to 144A.10, which is appropriate if a person is in active restorative
treatment; is in need of special treatments provided or supervised by a licensed nurse; or
has unpredictable episodes of active disease processes requiring immediate judgment
by a licensed nurse. For purposes of this subdivision, a child requires the level of care
provided in a nursing facility if the child is determined by the commissioner to meet
the requirements of the preadmission screening assessment document under section
256B.0911 and the home care independent rating document under section deleted text begin 256B.0655,
subdivision 4, clause (3) deleted text end new text begin 256B.0659 new text end , adjusted to address age-appropriate standards for
children age 18 and under, pursuant to section deleted text begin 256B.0655, subdivision 3 deleted text end new text begin 256B.0659 new text end .

(d) For purposes of this subdivision, "intermediate care facility for persons with
developmental disabilities" or "ICF/MR" means a program licensed to provide services to
persons with developmental disabilities under section 252.28, and chapter 245A, and a
physical plant licensed as a supervised living facility under chapter 144, which together
are certified by the Minnesota Department of Health as meeting the standards in Code of
Federal Regulations, title 42, part 483, for an intermediate care facility which provides
services for persons with developmental disabilities who require 24-hour supervision
and active treatment for medical, behavioral, or habilitation needs. For purposes of this
subdivision, a child requires a level of care provided in an ICF/MR if the commissioner
finds that the child has a developmental disability in accordance with section 256B.092,
is in need of a 24-hour plan of care and active treatment similar to persons with
developmental disabilities, and there is a reasonable indication that the child will need
ICF/MR services.

(e) For purposes of this subdivision, a person requires the level of care provided
in a nursing facility if the person requires 24-hour monitoring or supervision and a plan
of mental health treatment because of specific symptoms or functional impairments
associated with a serious mental illness or disorder diagnosis, which meet severity criteria
for mental health established by the commissioner and published in March 1997 as
the Minnesota Mental Health Level of Care for Children and Adolescents with Severe
Emotional Disorders.

(f) The determination of the level of care needed by the child shall be made by
the commissioner based on information supplied to the commissioner by the parent or
guardian, the child's physician or physicians, and other professionals as requested by the
commissioner. The commissioner shall establish a screening team to conduct the level of
care determinations according to this subdivision.

(g) If a child meets the conditions in paragraph (b), (c), (d), or (e), the commissioner
must assess the case to determine whether:

(1) the child qualifies as a disabled individual under United States Code, title 42,
section 1382c(a), and would be eligible for medical assistance if residing in a medical
institution; and

(2) the cost of medical assistance services for the child, if eligible under this
subdivision, would not be more than the cost to medical assistance if the child resides in a
medical institution to be determined as follows:

(i) for a child who requires a level of care provided in an ICF/MR, the cost of
care for the child in an institution shall be determined using the average payment rate
established for the regional treatment centers that are certified as ICF's/MR;

(ii) for a child who requires a level of care provided in an inpatient hospital setting
according to paragraph (b), cost-effectiveness shall be determined according to Minnesota
Rules, part 9505.3520, items F and G; and

(iii) for a child who requires a level of care provided in a nursing facility according
to paragraph (c) or (e), cost-effectiveness shall be determined according to Minnesota
Rules, part 9505.3040, except that the nursing facility average rate shall be adjusted to
reflect rates which would be paid for children under age 16. The commissioner may
authorize an amount up to the amount medical assistance would pay for a child referred to
the commissioner by the preadmission screening team under section 256B.0911.

(h) Children eligible for medical assistance services under section 256B.055,
subdivision 12, as of June 30, 1995, must be screened according to the criteria in this
subdivision prior to January 1, 1996. Children found to be ineligible may not be removed
from the program until January 1, 1996.

Sec. 9.

Minnesota Statutes 2008, section 256B.0621, subdivision 2, is amended to read:

Subd. 2.

Targeted case management; definitions.

For purposes of subdivisions 3
to 10, the following terms have the meanings given them:

(1) "home care service recipients" means those individuals receiving the following
services under sections 256B.0651 to 256B.0656 new text begin and 256B.0659 new text end : skilled nursing visits,
home health aide visits, private duty nursing, personal care assistants, or therapies
provided through a home health agency;

(2) "home care targeted case management" means the provision of targeted case
management services for the purpose of assisting home care service recipients to gain
access to needed services and supports so that they may remain in the community;

(3) "institutions" means hospitals, consistent with Code of Federal Regulations, title
42, section 440.10; regional treatment center inpatient services, consistent with section
245.474; nursing facilities; and intermediate care facilities for persons with developmental
disabilities;

(4) "relocation targeted case management" includes the provision of both county
targeted case management and public or private vendor service coordination services
for the purpose of assisting recipients to gain access to needed services and supports if
they choose to move from an institution to the community. Relocation targeted case
management may be provided during the lesser of:

(i) the last 180 consecutive days of an eligible recipient's institutional stay; or

(ii) the limits and conditions which apply to federal Medicaid funding for this
service; and

(5) "targeted case management" means case management services provided to help
recipients gain access to needed medical, social, educational, and other services and
supports.

Sec. 10.

Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to
read:

Subd. 19a.

Personal care assistant services.

Medical assistance covers personal
care assistant services in a recipient's home. To qualify for personal care assistant services,
recipients or responsible parties must be able to identify the recipient's needs, direct and
evaluate task accomplishment, and provide for health and safety. Approved hours may be
used outside the home when normal life activities take them outside the home. To use
personal care assistant services at school, the recipient or responsible party must provide
written authorization in the care plan identifying the chosen provider and the daily amount
of services to be used at school. Total hours for services, whether actually performed
inside or outside the recipient's home, cannot exceed that which is otherwise allowed for
personal care assistant services in an in-home setting according to sections 256B.0651 deleted text begin and
256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end . Medical assistance does not cover personal care
assistant services for residents of a hospital, nursing facility, intermediate care facility,
health care facility licensed by the commissioner of health, or unless a resident who is
otherwise eligible is on leave from the facility and the facility either pays for the personal
care assistant services or forgoes the facility per diem for the leave days that personal care
assistant services are used. All personal care assistant services must be provided according
to sections 256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end . Personal care
assistant services may not be reimbursed if the personal care assistant is the spouse or legal
guardian of the recipient or the parent of a recipient under age 18, or the responsible party
or the foster care provider of a recipient who cannot direct the recipient's own care unless,
in the case of a foster care provider, a county or state case manager visits the recipient as
needed, but not less than every six months, to monitor the health and safety of the recipient
and to ensure the goals of the care plan are met. Parents of adult recipients, adult children
of the recipient or adult siblings of the recipient may be reimbursed for personal care
assistant services, if they are granted a waiver under sections 256B.0651 deleted text begin and 256B.0653 deleted text end
to 256B.0656 new text begin and 256B.0659 new text end . Notwithstanding the provisions of section deleted text begin 256B.0655,
subdivision 2, paragraph (b), clause (4) deleted text end new text begin 256B.0659 new text end , the noncorporate legal guardian or
conservator of an adult, who is not the responsible party and not the personal care provider
organization, may be granted a hardship waiver under sections 256B.0651 deleted text begin and 256B.0653 deleted text end
to 256B.0656 new text begin and 256B.0659 new text end , to be reimbursed to provide personal care assistant services
to the recipient, and shall not be considered to have a service provider interest for purposes
of participation on the screening team under section 256B.092, subdivision 7.

Sec. 11.

Minnesota Statutes 2008, section 256B.0651, subdivision 13, is amended to
read:

Subd. 13.

Recovery of excessive payments.

The commissioner shall seek
monetary recovery from providers of payments made for services which exceed the
limits established in this section and sections deleted text begin 256B.0653 deleted text end new text begin 256B.0652 new text end to 256B.0656 new text begin and
256B.0659 new text end . This subdivision does not apply to services provided to a recipient at the
previously authorized level pending an appeal under section 256.045, subdivision 10.

Sec. 12.

Minnesota Statutes 2008, section 256B.0652, subdivision 3, is amended to
read:

Subd. 3.

Assessment and prior authorization process.

Effective January 1, 1996,
for purposes of providing informed choice, coordinating of local planning decisions, and
streamlining administrative requirements, the assessment and prior authorization process
for persons receiving both home care and home and community-based waivered services
for persons with developmental disabilities shall meet the requirements of sections
256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end with the following exceptions:

(a) Upon request for home care services and subsequent assessment by the public
health nurse under sections 256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end ,
the public health nurse shall participate in the screening process, as appropriate, and,
if home care services are determined to be necessary, participate in the development
of a service plan coordinating the need for home care and home and community-based
waivered services with the assigned county case manager, the recipient of services, and
the recipient's legal representative, if any.

(b) The public health nurse shall give prior authorization for home care services
to the extent that home care services are:

(1) medically necessary;

(2) chosen by the recipient and their legal representative, if any, from the array of
home care and home and community-based waivered services available;

(3) coordinated with other services to be received by the recipient as described
in the service plan; and

(4) provided within the county's reimbursement limits for home care and home and
community-based waivered services for persons with developmental disabilities.

(c) If the public health agency is or may be the provider of home care services to the
recipient, the public health agency shall provide the commissioner of human services with
a written plan that specifies how the assessment and prior authorization process will be
held separate and distinct from the provision of services.

Sec. 13.

Minnesota Statutes 2008, section 256B.0657, subdivision 2, is amended to
read:

Subd. 2.

Eligibility.

(a) The self-directed supports option is available to a person
who:

(1) is a recipient of medical assistance as determined under sections 256B.055,
256B.056, and 256B.057, subdivision 9;

(2) is eligible for personal care assistant services under section deleted text begin 256B.0655 deleted text end new text begin
256B.0659 new text end ;

(3) lives in the person's own apartment or home, which is not owned, operated, or
controlled by a provider of services not related by blood or marriage;

(4) has the ability to hire, fire, supervise, establish staff compensation for, and
manage the individuals providing services, and to choose and obtain items, related
services, and supports as described in the participant's plan. If the recipient is not able to
carry out these functions but has a legal guardian or parent to carry them out, the guardian
or parent may fulfill these functions on behalf of the recipient; and

(5) has not been excluded or disenrolled by the commissioner.

(b) The commissioner may disenroll or exclude recipients, including guardians and
parents, under the following circumstances:

(1) recipients who have been restricted by the Primary Care Utilization Review
Committee may be excluded for a specified time period;

(2) recipients who exit the self-directed supports option during the recipient's
service plan year shall not access the self-directed supports option for the remainder of
that service plan year; and

(3) when the department determines that the recipient cannot manage recipient
responsibilities under the program.

Sec. 14.

Minnesota Statutes 2008, section 256B.0657, subdivision 6, is amended to
read:

Subd. 6.

Services covered.

(a) Services covered under the self-directed supports
option include:

(1) personal care assistant services under section deleted text begin 256B.0655 deleted text end new text begin 256B.0659 new text end ; and

(2) items, related services, and supports, including assistive technology, that increase
independence or substitute for human assistance to the extent expenditures would
otherwise be used for human assistance.

(b) Items, supports, and related services purchased under this option shall not be
considered home care services for the purposes of section 144A.43.

Sec. 15.

Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to
read:

Subd. 8.

Self-directed budget requirements.

The budget for the provision of the
self-directed service option shall be equal to the greater of either:

(1) the annual amount of personal care assistant services under section deleted text begin 256B.0655 deleted text end
new text begin 256B.0659 new text end that the recipient has used in the most recent 12-month period; or

(2) the amount determined using the consumer support grant methodology under
section 256.476, subdivision 11, except that the budget amount shall include the federal
and nonfederal share of the average service costs.

Sec. 16.

Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:

Subd. 17.

Cost of services and supports.

(a) The commissioner shall ensure
that the average per capita expenditures estimated in any fiscal year for home and
community-based waiver recipients does not exceed the average per capita expenditures
that would have been made to provide institutional services for recipients in the absence
of the waiver.

(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
need-based methods for allocating to local agencies the home and community-based
waivered service resources available to support recipients with disabilities in need of
the level of care provided in a nursing facility or a hospital. The commissioner shall
allocate resources to single counties and county partnerships in a manner that reflects
consideration of:

(1) an incentive-based payment process for achieving outcomes;

(2) the need for a state-level risk pool;

(3) the need for retention of management responsibility at the state agency level; and

(4) a phase-in strategy as appropriate.

(c) Until the allocation methods described in paragraph (b) are implemented, the
annual allowable reimbursement level of home and community-based waiver services
shall be the greater of:

(1) the statewide average payment amount which the recipient is assigned under the
waiver reimbursement system in place on June 30, 2001, modified by the percentage of
any provider rate increase appropriated for home and community-based services; or

(2) an amount approved by the commissioner based on the recipient's extraordinary
needs that cannot be met within the current allowable reimbursement level. The
increased reimbursement level must be necessary to allow the recipient to be discharged
from an institution or to prevent imminent placement in an institution. The additional
reimbursement may be used to secure environmental modifications; assistive technology
and equipment; and increased costs for supervision, training, and support services
necessary to address the recipient's extraordinary needs. The commissioner may approve
an increased reimbursement level for up to one year of the recipient's relocation from an
institution or up to six months of a determination that a current waiver recipient is at
imminent risk of being placed in an institution.

(d) Beginning July 1, 2001, medically necessary private duty nursing services
will be authorized under this section as complex and regular care according to sections
256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end . The rate established by the
commissioner for registered nurse or licensed practical nurse services under any home and
community-based waiver as of January 1, 2001, shall not be reduced.

Sec. 17.

Minnesota Statutes 2008, section 256B.501, subdivision 4a, is amended to
read:

Subd. 4a.

Inclusion of home care costs in waiver rates.

The commissioner
shall adjust the limits of the established average daily reimbursement rates for waivered
services to include the cost of home care services that may be provided to waivered
services recipients. This adjustment must be used to maintain or increase services and
shall not be used by county agencies for inflation increases for waivered services vendors.
Home care services referenced in this section are those listed in section 256B.0651,
subdivision 2. The average daily reimbursement rates established in accordance with
the provisions of this subdivision apply only to the combined average, daily costs of
waivered and home care services and do not change home care limitations under sections
256B.0651 deleted text begin and 256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end . Waivered services recipients
receiving home care as of June 30, 1992, shall not have the amount of their services
reduced as a result of this section.

Sec. 18.

Minnesota Statutes 2008, section 256G.02, subdivision 6, is amended to read:

Subd. 6.

Excluded time.

"Excluded time" means:

(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter
other than an emergency shelter, halfway house, foster home, semi-independent living
domicile or services program, residential facility offering care, board and lodging facility
or other institution for the hospitalization or care of human beings, as defined in section
144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's shelter,
or correctional facility; or any facility based on an emergency hold under sections
253B.05, subdivisions 1 and 2, and 253B.07, subdivision 6;

(b) any period an applicant spends on a placement basis in a training and habilitation
program, including a rehabilitation facility or work or employment program as defined
in section 268A.01; or receiving personal care assistant services pursuant to section
deleted text begin 256B.0655, subdivision 2 deleted text end new text begin 256B.0659 new text end ; semi-independent living services provided under
section 252.275, and Minnesota Rules, parts 9525.0500 to 9525.0660; day training and
habilitation programs and assisted living services; and

(c) any placement for a person with an indeterminate commitment, including
independent living.

Sec. 19.

Minnesota Statutes 2008, section 256I.05, subdivision 1a, is amended to read:

Subd. 1a.

Supplementary service rates.

(a) Subject to the provisions of section
256I.04, subdivision 3, the county agency may negotiate a payment not to exceed $426.37
for other services necessary to provide room and board provided by the group residence
if the residence is licensed by or registered by the Department of Health, or licensed by
the Department of Human Services to provide services in addition to room and board,
and if the provider of services is not also concurrently receiving funding for services for
a recipient under a home and community-based waiver under title XIX of the Social
Security Act; or funding from the medical assistance program under section deleted text begin 256B.0655,
subdivision 2 deleted text end new text begin 256B.0659 new text end , for personal care services for residents in the setting; or residing
in a setting which receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000.
If funding is available for other necessary services through a home and community-based
waiver, or personal care services under section deleted text begin 256B.0655, subdivision 2 deleted text end new text begin 256B.0659 new text end ,
then the GRH rate is limited to the rate set in subdivision 1. Unless otherwise provided
in law, in no case may the supplementary service rate exceed $426.37. The registration
and licensure requirement does not apply to establishments which are exempt from state
licensure because they are located on Indian reservations and for which the tribe has
prescribed health and safety requirements. Service payments under this section may be
prohibited under rules to prevent the supplanting of federal funds with state funds. The
commissioner shall pursue the feasibility of obtaining the approval of the Secretary of
Health and Human Services to provide home and community-based waiver services under
title XIX of the Social Security Act for residents who are not eligible for an existing home
and community-based waiver due to a primary diagnosis of mental illness or chemical
dependency and shall apply for a waiver if it is determined to be cost-effective.

(b) The commissioner is authorized to make cost-neutral transfers from the GRH
fund for beds under this section to other funding programs administered by the department
after consultation with the county or counties in which the affected beds are located.
The commissioner may also make cost-neutral transfers from the GRH fund to county
human service agencies for beds permanently removed from the GRH census under a plan
submitted by the county agency and approved by the commissioner. The commissioner
shall report the amount of any transfers under this provision annually to the legislature.

(c) The provisions of paragraph (b) do not apply to a facility that has its
reimbursement rate established under section 256B.431, subdivision 4, paragraph (c).

Sec. 20.

Minnesota Statutes 2008, section 256J.45, subdivision 3, is amended to read:

Subd. 3.

Good cause exemptions for not attending orientation.

(a) The county
agency shall not impose the sanction under section 256J.46 if it determines that the
participant has good cause for failing to attend orientation. Good cause exists when:

(1) appropriate child care is not available;

(2) the participant is ill or injured;

(3) a family member is ill and needs care by the participant that prevents the
participant from attending orientation. For a caregiver with a child or adult in the
household who meets the disability or medical criteria for home care services under
section deleted text begin 256B.0655, subdivision 1c deleted text end new text begin 256B.0659 new text end , or a home and community-based waiver
services program under chapter 256B, or meets the criteria for severe emotional
disturbance under section 245.4871, subdivision 6, or for serious and persistent mental
illness under section 245.462, subdivision 20, paragraph (c), good cause also exists when
an interruption in the provision of those services occurs which prevents the participant
from attending orientation;

(4) the caregiver is unable to secure necessary transportation;

(5) the caregiver is in an emergency situation that prevents orientation attendance;

(6) the orientation conflicts with the caregiver's work, training, or school schedule; or

(7) the caregiver documents other verifiable impediments to orientation attendance
beyond the caregiver's control.

(b) Counties must work with clients to provide child care and transportation
necessary to ensure a caregiver has every opportunity to attend orientation.

Sec. 21.

Minnesota Statutes 2008, section 604A.33, subdivision 1, is amended to read:

Subdivision 1.

Application.

This section applies to residential treatment programs
for children or group homes for children licensed under chapter 245A, residential
services and programs for juveniles licensed under section 241.021, providers licensed
pursuant to sections 144A.01 to 144A.33 or sections 144A.43 to 144A.47, personal care
provider organizations under section deleted text begin 256B.0655, subdivision 1g deleted text end new text begin 256B.0659 new text end , providers
of day training and habilitation services under sections 252.40 to 252.46, board and
lodging facilities licensed under chapter 157, intermediate care facilities for persons with
developmental disabilities, and other facilities licensed to provide residential services to
persons with developmental disabilities.

Sec. 22.

Minnesota Statutes 2008, section 609.232, subdivision 11, is amended to read:

Subd. 11.

Vulnerable adult.

"Vulnerable adult" means any person 18 years of
age or older who:

(1) is a resident inpatient of a facility;

(2) receives services at or from a facility required to be licensed to serve adults
under sections 245A.01 to 245A.15, except that a person receiving outpatient services for
treatment of chemical dependency or mental illness, or one who is committed as a sexual
psychopathic personality or as a sexually dangerous person under chapter 253B, is not
considered a vulnerable adult unless the person meets the requirements of clause (4);

(3) receives services from a home care provider required to be licensed under section
144A.46; or from a person or organization that exclusively offers, provides, or arranges
for personal care assistant services under the medical assistance program as authorized
under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651 deleted text begin , and
256B.0653 deleted text end to 256B.0656 new text begin and 256B.0659 new text end ; or

(4) regardless of residence or whether any type of service is received, possesses a
physical or mental infirmity or other physical, mental, or emotional dysfunction:

(i) that impairs the individual's ability to provide adequately for the individual's
own care without assistance, including the provision of food, shelter, clothing, health
care, or supervision; and

(ii) because of the dysfunction or infirmity and the need for assistance, the individual
has an impaired ability to protect the individual from maltreatment.

Sec. 23.

Minnesota Statutes 2008, section 626.5572, subdivision 6, is amended to read:

Subd. 6.

Facility.

(a) "Facility" means a hospital or other entity required to be
licensed under sections 144.50 to 144.58; a nursing home required to be licensed to
serve adults under section 144A.02; a residential or nonresidential facility required to
be licensed to serve adults under sections 245A.01 to 245A.16; a home care provider
licensed or required to be licensed under section 144A.46; a hospice provider licensed
under sections 144A.75 to 144A.755; or a person or organization that exclusively offers,
provides, or arranges for personal care assistant services under the medical assistance
program as authorized under sections 256B.04, subdivision 16, 256B.0625, subdivision
19a, 256B.0651 deleted text begin , and 256B.0653 deleted text end to 256B.0656 new text begin , and 256B.0659 new text end .

(b) For home care providers and personal care attendants, the term "facility" refers
to the provider or person or organization that exclusively offers, provides, or arranges for
personal care services, and does not refer to the client's home or other location at which
services are rendered.

Sec. 24.

Minnesota Statutes 2008, section 626.5572, subdivision 21, is amended to
read:

Subd. 21.

Vulnerable adult.

"Vulnerable adult" means any person 18 years of
age or older who:

(1) is a resident or inpatient of a facility;

(2) receives services at or from a facility required to be licensed to serve adults
under sections 245A.01 to 245A.15, except that a person receiving outpatient services for
treatment of chemical dependency or mental illness, or one who is served in the Minnesota
sex offender program on a court-hold order for commitment, or is committed as a sexual
psychopathic personality or as a sexually dangerous person under chapter 253B, is not
considered a vulnerable adult unless the person meets the requirements of clause (4);

(3) receives services from a home care provider required to be licensed under section
144A.46; or from a person or organization that exclusively offers, provides, or arranges
for personal care assistant services under the medical assistance program as authorized
under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, deleted text begin and deleted text end
256B.0653 to 256B.0656 new text begin , and 256B.0659 new text end ; or

(4) regardless of residence or whether any type of service is received, possesses a
physical or mental infirmity or other physical, mental, or emotional dysfunction:

(i) that impairs the individual's ability to provide adequately for the individual's
own care without assistance, including the provision of food, shelter, clothing, health
care, or supervision; and

(ii) because of the dysfunction or infirmity and the need for assistance, the individual
has an impaired ability to protect the individual from maltreatment.

ARTICLE 7

MENTAL HEALTH

Section 1.

Minnesota Statutes 2008, section 256B.0625, subdivision 47, is amended to
read:

Subd. 47.

Treatment foster care services.

Effective July 1, deleted text begin 2007 deleted text end new text begin 2011 new text end , and subject
to federal approval, medical assistance covers treatment foster care services according to
section 256B.0946.

Sec. 2.

Minnesota Statutes 2008, section 256B.0943, subdivision 12, is amended to
read:

Subd. 12.

Excluded services.

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

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 3. new text begin STATE-COUNTY CHEMICAL HEALTH CARE HOME PILOT
PROJECT.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; purpose. new text end

new text begin There is established a state-county
chemical health care home pilot project. The purpose of the pilot project is for the
Department of Human Services and counties to authentically and creatively work in
partnership to redesign the current chemical health service delivery system in a way
that promotes greater accountability, productivity, and results in the delivery of state
chemical dependency services. The pilot project or projects must look to provide
appropriate flexibility in a way that ensures timely access to needed services as well
as better aligning systems and services to offer the most appropriate level of chemical
health care services to the client. This may include, but is not limited to, looking into new
governance agreements, performance agreements, or service level agreements. Pilot
projects must maintain eligibility requirements for the consolidated chemical dependency
treatment fund, continue to meet the requirements of Minnesota Rules, parts 9530.6600 to
9530.6655 (also known as Rule 25) and Minnesota Rules, parts 9530.6405 to 9530.6505
(also known as Rule 31), and must not put at risk current and future federal funding toward
chemical health-related services in the state of Minnesota.
new text end

new text begin Subd. 2. new text end

new text begin Workgroup; report. new text end

new text begin A workgroup must be convened on or before July
15, 2009, consisting of representatives from the Department of Human Services and
potential participating counties to develop draft proposals for pilot projects meeting the
requirements of this section. The workgroup shall report back to the legislative committees
with jurisdiction over chemical health by January 15, 2010, for potential approval of one
metro and one nonmetro county pilot project to be implemented beginning July 10, 2010.
new text end

new text begin Subd. 3. new text end

new text begin Report. new text end

new text begin The Department of Human Services shall evaluate the efficacy and
feasibility of the pilot projects and report the results of that evaluation to the legislative
committees having jurisdiction over chemical health by June 30, 2011. Expansion of pilot
projects may occur only if the department's report finds the pilot projects effective.
new text end

new text begin Subd. 4. new text end

new text begin Expiration. new text end

new text begin This section expires June 30, 2012.
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 8

HEALTH-RELATED FEES

Section 1.

Minnesota Statutes 2008, section 148.108, is amended to read:

148.108 FEES.

Subdivision 1.

Fees.

In addition to the fees established in Minnesota Rules, chapter
2500, new text begin and according to sections 148.05, 148.06, 148.07, and 148.10, subdivisions 2 and 3,
new text end the board is authorized to charge the fees in this section.

Subd. 2.

deleted text begin Annual renewal of inactive acupuncture registration deleted text end new text begin License and
registration fees new text end .

deleted text begin The annual renewal of an inactive acupuncture registration fee is $25. deleted text end new text begin
License and registration fees are as follows:
new text end

new text begin (1) for a license application fee, $300;
new text end

new text begin (2) for a license active renewal fee, $220;
new text end

new text begin (3) for a license inactive renewal fee, $165;
new text end

new text begin (4) for an acupuncture initial registration fee, $125;
new text end

new text begin (5) for an acupuncture active registration renewal fee, $75;
new text end

new text begin (6) for an acupuncture registration reinstatement fee, $50;
new text end

new text begin (7) for an acupuncture inactive registration renewal fee, $25;
new text end

new text begin (8) for an animal chiropractic registration fee, $125;
new text end

new text begin (9) for an animal chiropractic active registration renewal fee, $75; and
new text end

new text begin (10) for an animal chiropractic inactive registration renewal fee, $25.
new text end

deleted text begin Subd. 3. deleted text end

deleted text begin Acupuncture reinstatement. deleted text end

deleted text begin The acupuncture reinstatement fee is $50.
deleted text end

Sec. 2.

Minnesota Statutes 2008, section 148D.180, subdivision 1, is amended to read:

Subdivision 1.

Application fees.

Application fees for licensure are as follows:

(1) for a licensed social worker, $45;

(2) for a licensed graduate social worker, $45;

(3) for a licensed independent social worker, deleted text begin $90 deleted text end new text begin $45 new text end ;

(4) for a licensed independent clinical social worker, deleted text begin $90 deleted text end new text begin $45 new text end ;

(5) for a temporary license, $50; and

(6) for a licensure by endorsement, deleted text begin $150 deleted text end new text begin $85 new text end .

The fee for criminal background checks is the fee charged by the Bureau of Criminal
Apprehension. The criminal background check fee must be included with the application
fee as required pursuant to section 148D.055.

Sec. 3.

Minnesota Statutes 2008, section 148D.180, subdivision 2, is amended to read:

Subd. 2.

License fees.

License fees are as follows:

(1) for a licensed social worker, deleted text begin $115.20 deleted text end new text begin $81 new text end ;

(2) for a licensed graduate social worker, deleted text begin $201.60 deleted text end new text begin $144 new text end ;

(3) for a licensed independent social worker, deleted text begin $302.40 deleted text end new text begin $216 new text end ;

(4) for a licensed independent clinical social worker, deleted text begin $331.20 deleted text end new text begin $238.50 new text end ;

(5) for an emeritus license, $43.20; and

(6) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.

If the licensee's initial license term is less or more than 24 months, the required
license fees must be prorated proportionately.

Sec. 4.

Minnesota Statutes 2008, section 148D.180, subdivision 3, is amended to read:

Subd. 3.

Renewal fees.

Renewal fees for licensure are as follows:

(1) for a licensed social worker, deleted text begin $115.20 deleted text end new text begin $81 new text end ;

(2) for a licensed graduate social worker, deleted text begin $201.60 deleted text end new text begin $144 new text end ;

(3) for a licensed independent social worker, deleted text begin $302.40 deleted text end new text begin $216 new text end ; and

(4) for a licensed independent clinical social worker, deleted text begin $331.20 deleted text end new text begin $238.50 new text end .

Sec. 5.

Minnesota Statutes 2008, section 148D.180, subdivision 5, is amended to read:

Subd. 5.

Late fees.

Late fees are as follows:

(1) renewal late fee, deleted text begin one-half deleted text end new text begin one-fourth new text end of the renewal fee specified in subdivision
3; and

(2) supervision plan late fee, $40.

Sec. 6.

Minnesota Statutes 2008, section 148E.180, subdivision 1, is amended to read:

Subdivision 1.

Application fees.

Application fees for licensure are as follows:

(1) for a licensed social worker, $45;

(2) for a licensed graduate social worker, $45;

(3) for a licensed independent social worker, deleted text begin $90 deleted text end new text begin $45 new text end ;

(4) for a licensed independent clinical social worker, deleted text begin $90 deleted text end new text begin $45 new text end ;

(5) for a temporary license, $50; and

(6) for a licensure by endorsement, deleted text begin $150 deleted text end new text begin $85 new text end .

The fee for criminal background checks is the fee charged by the Bureau of Criminal
Apprehension. The criminal background check fee must be included with the application
fee as required according to section 148E.055.

Sec. 7.

Minnesota Statutes 2008, section 148E.180, subdivision 2, is amended to read:

Subd. 2.

License fees.

License fees are as follows:

(1) for a licensed social worker, deleted text begin $115.20 deleted text end new text begin $81 new text end ;

(2) for a licensed graduate social worker, deleted text begin $201.60 deleted text end new text begin $144 new text end ;

(3) for a licensed independent social worker, deleted text begin $302.40 deleted text end new text begin $216 new text end ;

(4) for a licensed independent clinical social worker, deleted text begin $331.20 deleted text end new text begin $238.50 new text end ;

(5) for an emeritus license, $43.20; and

(6) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.

If the licensee's initial license term is less or more than 24 months, the required
license fees must be prorated proportionately.

Sec. 8.

Minnesota Statutes 2008, section 148E.180, subdivision 3, is amended to read:

Subd. 3.

Renewal fees.

Renewal fees for licensure are as follows:

(1) for a licensed social worker, deleted text begin $115.20 deleted text end new text begin $81 new text end ;

(2) for a licensed graduate social worker, deleted text begin $201.60 deleted text end new text begin $144 new text end ;

(3) for a licensed independent social worker, deleted text begin $302.40 deleted text end new text begin $216 new text end ; and

(4) for a licensed independent clinical social worker, deleted text begin $331.20 deleted text end new text begin $238.50 new text end .

Sec. 9.

Minnesota Statutes 2008, section 148E.180, subdivision 5, is amended to read:

Subd. 5.

Late fees.

Late fees are as follows:

(1) renewal late fee, deleted text begin one-half deleted text end new text begin one-fourth new text end of the renewal fee specified in subdivision
3; and

(2) supervision plan late fee, $40.

Sec. 10.

Minnesota Statutes 2008, section 152.126, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

For purposes of this section, the terms defined in this
subdivision have the meanings given.

(a) "Board" means the Minnesota State Board of Pharmacy established under
chapter 151.

(b) "Controlled substances" means those substances listed in section 152.02,
subdivisions 3 deleted text begin and 4 deleted text end new text begin to 5 new text end , and those substances defined by the board pursuant to section
152.02, subdivisions 7, 8, and 12.

(c) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision
30. Dispensing does not include the direct administering of a controlled substance to a
patient by a licensed health care professional.

(d) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription. For the purposes of this section, a dispenser does not
include a licensed hospital pharmacy that distributes controlled substances for inpatient
hospital care or a veterinarian who is dispensing prescriptions under section 156.18.

(e) "Prescriber" means a licensed health care professional who is authorized to
prescribe a controlled substance under section 152.12, subdivision 1.

(f) "Prescription" has the meaning given in section 151.01, subdivision 16.

Sec. 11.

Minnesota Statutes 2008, section 152.126, subdivision 2, is amended to read:

Subd. 2.

Prescription electronic reporting system.

(a) The board shall establish
by January 1, 2010, an electronic system for reporting the information required under
subdivision 4 for all controlled substances dispensed within the state.

(b) The board may contract with a vendor for the purpose of obtaining technical
assistance in the design, implementation, new text begin operation, new text end and maintenance of the electronic
reporting system. deleted text begin The vendor's role shall be limited to providing technical support to the
board concerning the software, databases, and computer systems required to interface with
the existing systems currently used by pharmacies to dispense prescriptions and transmit
prescription data to other third parties.
deleted text end

Sec. 12.

new text begin [156.011] LICENSE, APPLICATION, AND EXAMINATION FEES.
new text end

new text begin Subdivision 1. new text end

new text begin Application fee. new text end

new text begin A person applying for a license to practice
veterinary medicine in Minnesota or applying for a permit to take the national veterinary
medical examination must pay a $60 nonrefundable application fee to the board. Persons
submitting concurrent applications for licensure and a national examination permit shall
pay only one application fee.
new text end

new text begin Subd. 2. new text end

new text begin Examination fees. new text end

new text begin (a) An applicant for veterinary licensure in Minnesota
must successfully pass the Minnesota Veterinary Jurisprudence Examination. The fee for
this examination is $60, payable to the board.
new text end

new text begin (b) An applicant participating in the national veterinary licensing examination must
complete a separate application for the national examination and submit the application
to the board for approval. Payment for the national examination must be made by the
applicant to the national board examination committee.
new text end

Sec. 13.

new text begin [156.012] INITIAL AND RENEWAL FEE.
new text end

new text begin Subdivision 1. new text end

new text begin Required for licensure. new text end

new text begin A person now licensed to practice
veterinary medicine in this state, or who becomes licensed by the Board of Veterinary
Medicine to engage in the practice, shall pay an initial fee or a biennial license renewal
fee if the person wishes to practice veterinary medicine in the coming two-year period
or remain licensed as a veterinarian. A licensure period begins on March 1 and expires
the last day of February two years later. A licensee with an even-numbered license shall
renew by March 1 of even-numbered years and a licensee with an odd-numbered license
shall renew by March 1 of odd-numbered years.
new text end

new text begin Subd. 2. new text end

new text begin Amount. new text end

new text begin The initial licensure fee and the biennial renewal fee is $280
and must be paid to the executive director of the board. By January 1 of the first year
for which the biennial renewal fee is due, the board shall issue a renewal application to
a current licensee to the last address maintained in the board file. Failure to receive this
notice does not relieve the licensee of the obligation to pay renewal fees so that they are
received by the board on or before the renewal date of March 1.
new text end

new text begin Initial licenses issued after the start of the licensure renewal period are valid only
until the end of the period.
new text end

new text begin Subd. 3. new text end

new text begin Date due. new text end

new text begin A licensee must apply for a renewal license on or before March
1 of the first year of the biennial license renewal period. A renewal license is valid
from March 1 through the last day of February of the last year of the two-year license
renewal period. An application postmarked no later than the last day of February must be
considered to have been received on March 1.
new text end

new text begin Subd. 4. new text end

new text begin Late renewal penalty. new text end

new text begin An applicant for renewal must pay a late renewal
penalty of $140 in addition to the renewal fee if the application for renewal is received
after March 1 of the licensure renewal period. A renewed license issued after March 1 of
the licensure renewal period is valid only to the end of the period regardless of when the
renewal fee is received.
new text end

new text begin Subd. 5. new text end

new text begin Reinstatement fee. new text end

new text begin An applicant for license renewal whose license
has previously been suspended by official board action for nonrenewal must pay a
reinstatement fee of $60 in addition to the $280 renewal fee and the $140 late renewal
penalty.
new text end

new text begin Subd. 6. new text end

new text begin Penalty for failure to pay. new text end

new text begin Within 30 days after the renewal date, a
licensee who has not renewed the license must be notified by letter sent to the last known
address of the licensee in the file of the board that the renewal is overdue and that failure
to pay the current fee and current late fee within 60 days after the renewal date will result
in suspension of the license. A second notice must be sent by registered or certified mail at
least seven days before a board meeting occurring 60 days or more after the renewal date
to a licensee who has not paid the renewal fee and late fee.
new text end

new text begin Subd. 7. new text end

new text begin Suspension. new text end

new text begin The board, by means of a roll call vote, shall suspend the
license of a licensee whose license renewal is at least 60 days overdue and to whom
notification has been sent as provided in subpart 5. Failure of a licensee to receive
notification is not grounds for later challenge by the licensee of the suspension. The
former licensee must be notified by registered or certified letter within seven days of the
board action. The suspended status placed on a license may be removed only on payment
of renewal fees and late penalty fees for each licensure period or part of a period that the
license was not renewed. A licensee who fails to renew a license for five years or more
must meet the criteria of section 156.071, for relicensure.
new text end

new text begin Subd. 8. new text end

new text begin Inactive license. new text end

new text begin (a) A person holding a current active license to practice
veterinary medicine in Minnesota may, at the time of the person's next biennial license
renewal date, renew the license as an inactive license at one-half the renewal fee of an
active license. The license may be continued in an inactive status by renewal on a biennial
basis at one-half the regular license fee.
new text end

new text begin (b) A person holding an inactive license is not permitted to practice veterinary
medicine in Minnesota and remains under the disciplinary authority of the board.
new text end

new text begin (c) A person may convert a current inactive license to an active license upon
application to and approval by the board. The application must include:
new text end

new text begin (1) documentation of licensure in good standing and of having met continuing
education requirements of current state of practice, or documentation of having met
Minnesota continuing education requirements retroactive to the date of licensure
inactivation;
new text end

new text begin (2) certification by the applicant that the applicant is not currently under disciplinary
orders or investigation for acts that could result in disciplinary action in any other
jurisdiction; and
new text end

new text begin (3) payment of a fee equal to the full difference between an inactive and active
license if converting during the first year of the biennial license cycle or payment of a fee
equal to one-half the difference between an inactive and an active license if converting
during the second year of the license cycle.
new text end

new text begin (d) Deadline for renewal of an inactive license is March 1 of the first year of the
biennial license renewal period. A late renewal penalty of one-half the inactive renewal
fee must be paid if renewal is received after March 1.
new text end

Sec. 14.

Minnesota Statutes 2008, section 156.015, is amended to read:

156.015 new text begin MISCELLANEOUS new text end FEES.

Subdivision 1.

Verification of licensure.

The board may charge a fee of $25 per
license verification to a licensee for verification of licensure status provided to other
veterinary licensing boards.

Subd. 2.

Continuing education review.

The board may charge a fee of $50 per
submission to a sponsor for review and approval of individual continuing education
seminars, courses, wet labs, and lectures. This fee does not apply to continuing education
sponsors that already meet the criteria for preapproval under Minnesota Rules, part
9100.1000, subpart 3, item A.

new text begin Subd. 3. new text end

new text begin Temporary license fee. new text end

new text begin A person meeting the requirements for issuance
of a temporary permit to practice veterinary medicine under section 156.073, pending
examination, who desires a temporary permit shall pay a fee of $60 to the board.
new text end

new text begin Subd. 4. new text end

new text begin Duplicate license. new text end

new text begin A person requesting issuance of a duplicate or
replacement license shall pay a fee of $15 to the board.
new text end

new text begin Subd. 5. new text end

new text begin Mailing examination and reference materials. new text end

new text begin An applicant who resides
outside the Twin Cities metropolitan area may request to take the Minnesota Veterinary
Jurisprudence Examination by mail. The fee for mailing the examination and reference
materials is $15.
new text end

Sec. 15. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Rules, parts 9100.0400, subparts 1 and 3; 9100.0500; and 9100.0600, new text end new text begin
are repealed.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2008, section 148D.180, subdivision 8, new text end new text begin is repealed.
new text end

ARTICLE 9

BODY ART TECHNICIANS AND ESTABLISHMENTS

Section 1.

new text begin [146B.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin The terms defined in this section apply to this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Aftercare. new text end

new text begin "Aftercare" means written instructions given to a client,
specific to the procedure rendered, on caring for the body art and surrounding area. These
instructions must include information on when to seek medical treatment.
new text end

new text begin Subd. 3. new text end

new text begin Antiseptic. new text end

new text begin "Antiseptic" means an agent that destroys disease-causing
microorganisms on human skin or mucosa.
new text end

new text begin Subd. 4. new text end

new text begin Apprentice. new text end

new text begin "Apprentice" means an individual working under the direct
supervision of a licensed technician in a licensed body art establishment according to
the requirements under section 146B.04.
new text end

new text begin Subd. 5. new text end

new text begin Body art. new text end

new text begin "Body art" means physical body adornment using, but not
limited to, the following techniques: body piercing, tattooing, micropigmentation, and
cosmetic tattooing. This definition of body art does not include piercing of the outer
perimeter or lobe of the ear using a presterilized single-use stud-and-clasp ear piercing
system. This definition of body art does not include practices that are part of a medical
procedure performed by board-certified medical or dental personnel including, but not
limited to, implants under the skin.
new text end

new text begin Subd. 6. new text end

new text begin Body art establishment. new text end

new text begin "Body art establishment" means any place or
premise, whether public or private, temporary or permanent in nature or location, where
the practice of body art, whether or not for profit, is performed.
new text end

new text begin Subd. 7. new text end

new text begin Body piercing. new text end

new text begin "Body piercing" means the penetration or puncturing of
human skin by any method for the purpose of inserting jewelry or other objects in or
through the human body. This definition does not include any procedure performed by
a licensed or registered health professional if the procedure is within the professional's
scope of practice.
new text end

new text begin Subd. 8. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of health.
new text end

new text begin Subd. 9. new text end

new text begin Contaminated waste. new text end

new text begin "Contaminated waste" means: any liquid or
semiliquid blood or other potentially infectious materials; contaminated items that would
release blood or other potentially infectious materials in a liquid or semiliquid state
if compressed; items that are caked with dried blood or other potentially infectious
materials and are capable of releasing these materials during handling; and sharps and any
wastes containing blood and other potentially infectious materials, as defined in Code of
Federal Regulations, title 29, section 1910.1030, known as "Occupational Exposure to
Bloodborne Pathogens."
new text end

new text begin Subd. 10. new text end

new text begin Department. new text end

new text begin "Department" means the Department of Health.
new text end

new text begin Subd. 11. new text end

new text begin Disinfection. new text end

new text begin "Disinfection" means the destruction of disease-causing
microorganisms on inanimate objects or surfaces, rendering the objects safe for use or
handling.
new text end

new text begin Subd. 12. new text end

new text begin Equipment. new text end

new text begin "Equipment" means all machinery, including fixtures,
containers, vessels, tools, devices, implements, furniture, display and storage areas, sinks,
and all other apparatus and appurtenances used in the operation of a body art establishment.
new text end

new text begin Subd. 13. new text end

new text begin Establishment plan. new text end

new text begin "Establishment plan" means a scale drawing of the
establishment's layout illustrating how the establishment complies with the requirements
of this chapter.
new text end

new text begin Subd. 14. new text end

new text begin Guest artist. new text end

new text begin "Guest artist" means an individual who performs body art
procedures according to the requirements under section 146B.04.
new text end

new text begin Subd. 15. new text end

new text begin Hand sink. new text end

new text begin "Hand sink" means a room equipped with hot and cold water
held under pressure, used solely for washing hands, wrists, arms, or other portions of
the body.
new text end

new text begin Subd. 16. new text end

new text begin Hot water. new text end

new text begin "Hot water" means water at a temperature of at least 110
degrees Fahrenheit.
new text end

new text begin Subd. 17. new text end

new text begin Jewelry. new text end

new text begin "Jewelry" means any personal ornament inserted into a newly
pierced area.
new text end

new text begin Subd. 18. new text end

new text begin Liquid chemical germicide. new text end

new text begin "Liquid chemical germicide" means a
tuberculocidal disinfectant or sanitizer registered with the Environmental Protection
Agency.
new text end

new text begin Subd. 19. new text end

new text begin Operator. new text end

new text begin "Operator" means any individual who controls, operates,
or manages body art activities at a body art establishment and who is responsible for
compliance with these regulations, whether actually performing body art activities or not.
new text end

new text begin Subd. 20. new text end

new text begin Procedure area. new text end

new text begin "Procedure area" means the physical space or room used
solely for conducting body art procedures.
new text end

new text begin Subd. 21. new text end

new text begin Procedure surface. new text end

new text begin "Procedure surface" means the surface area of
furniture or accessories that may come into contact with the client's clothed or unclothed
body during a body art procedure and the area of the client's skin where the body art
procedure is to be performed and the surrounding area, or any other associated work
area requiring sanitizing.
new text end

new text begin Subd. 22. new text end

new text begin Sanitization. new text end

new text begin "Sanitization" means a process of reducing the numbers of
microorganisms on clean surfaces and equipment to a safe level.
new text end

new text begin Subd. 23. new text end

new text begin Safe level. new text end

new text begin "Safe level" means not more than 50 colonies of
microorganisms per four square inches of equipment or procedure surface.
new text end

new text begin Subd. 24. new text end

new text begin Sharps. new text end

new text begin "Sharps" means any object, sterile or contaminated, that may
purposefully or accidentally cut or penetrate the skin or mucosa including, but not limited
to, presterilized singe-use needles, scalpel blades, and razor blades.
new text end

new text begin Subd. 25. new text end

new text begin Sharps container. new text end

new text begin "Sharps container" means a closed, puncture-resistant,
leak-proof container, labeled with the international biohazard symbol, that is used for
handling, storage, transportation, and disposal.
new text end

new text begin Subd. 26. new text end

new text begin Single use. new text end

new text begin "Single use" means products or items intended for onetime
use which are disposed of after use on a client. This definition includes, but is not limited
to, cotton swabs or balls, tissues or paper products, paper or plastic cups, gauze and
sanitary coverings, razors, piercing needles, tattoo needles, scalpel blades, stencils, ink
cups, and protective gloves.
new text end

new text begin Subd. 27. new text end

new text begin Standard precautions or universal precautions. new text end

new text begin "Standard precautions
or universal precautions" means the guidelines and controls published by the Centers for
Disease Control and Prevention (CDC) as "guidelines for prevention of transmission
of human immunodeficiency virus and hepatitis B virus to health care and public
safety workers" in Morbidity and Mortality Weekly Report (MMWR), June 23, 1989,
Vol. 38, No. S-6, and as "recommendation for preventing transmission of human
immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive
procedures," in MMWR, July 12, 1991, Vol. 40, No. RR-Subd. T.
new text end

new text begin Subd. 28. new text end

new text begin Sterilization. new text end

new text begin "Sterilization" means a process resulting in the destruction
of all forms of microbial life, including highly resistant bacterial spores.
new text end

new text begin Subd. 29. new text end

new text begin Tattooing. new text end

new text begin "Tattooing" means any method of placing ink or other
pigments into or under the skin or mucosa with needles or any other instruments used to
puncture the skin, resulting in permanent coloration of the skin or mucosa. This definition
includes cosmetic tattooing and micropigmentation.
new text end

new text begin Subd. 30. new text end

new text begin Technician. new text end

new text begin "Technician" means any individual who conducts or
practices body art procedures at a body art establishment.
new text end

new text begin Subd. 31. new text end

new text begin Temporary body art establishment. new text end

new text begin "Temporary body art establishment"
means any place or premise operating at a fixed location where an operator performs body
art procedures for no more than 21 days in conjunction with a single event or celebration.
new text end

Sec. 2.

new text begin [146B.02] ESTABLISHMENT LICENSE PROCEDURES.
new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin Beginning January 1, 2010, no person acting generally
or jointly with any other person may maintain, own, or operate a body art establishment
in the state without an establishment license issued by the commissioner in accordance
with this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Requirements. new text end

new text begin (a) Each application for an establishment license must be
submitted to the commissioner on a form provided by the commissioner accompanied
with the applicable fee required under section 146B.10. The application must contain:
new text end

new text begin (1) the name of the owner and operator of the establishment;
new text end

new text begin (2) certificates of compliance with all applicable local and state codes;
new text end

new text begin (3) a description of the general nature of the business;
new text end

new text begin (4) a copy of a to-scale drawing of the establishment's layout that provides sufficient
detail to ensure compliance with the requirements of this chapter; and
new text end

new text begin (5) any other relevant information deemed necessary by the commissioner.
new text end

new text begin (b) Upon approval, the commissioner shall issue an establishment license. The
license is valid commencing on the date of issuance for three years after which time the
license may be renewed upon approval by the commissioner.
new text end

new text begin Subd. 3. new text end

new text begin Inspection. new text end

new text begin (a) Before issuing an initial license or renewing a license, the
commissioner shall conduct an inspection of the body art establishment and a review of
any records necessary to ensure that the standards required under this chapter are met.
new text end

new text begin (b) If the establishment seeking licensure is new construction or if a licensed
establishment is remodeling, the commissioner shall inspect the establishment at least
once during the construction or remodeling process to ensure that construction is in
conformance with this chapter.
new text end

new text begin (c) The commissioner shall have the authority to enter the premises to make the
inspection. Refusal to permit an inspection constitutes valid grounds for licensure denial
or revocation.
new text end

new text begin Subd. 4. new text end

new text begin Location restricted. new text end

new text begin No person may perform body art procedures at
any location other than a body art establishment licensed under this chapter except as
permitted under subdivisions 6 and 8.
new text end

new text begin Subd. 5. new text end

new text begin Transfer and display of license. new text end

new text begin A body art establishment license must
be issued to a specific person and location and is not transferable. A valid license must
be prominently displayed onsite.
new text end

new text begin Subd. 6. new text end

new text begin Temporary events permit. new text end

new text begin (a) An owner or operator of a temporary
body establishment shall submit an application for a temporary events permit to the
commissioner at least 14 days before the start of the event. The application must include
the specific days and hours of operation. The owner or operator shall comply with the
requirements of this chapter.
new text end

new text begin (b) The temporary events permit must be prominently displayed at the location.
new text end

new text begin (c) The temporary events permit, if approved, must be valid for the specified dates
and hours listed on the application. No temporary events permit may be issued for longer
than a 21-day period.
new text end

new text begin Subd. 7. new text end

new text begin Establishment information. new text end

new text begin The following information must be kept on
file for two years on the premises of the establishment and must be made available for
inspection upon request by the commissioner:
new text end

new text begin (1) a description of all body art procedures performed by the establishment;
new text end

new text begin (2) an inventory of instruments, body jewelry, sharps, inks, or pigments used for all
procedures, including the names of manufacturers and serial and lot numbers, if available;
new text end

new text begin (3) copies of the spore tests conducted in the sterilizer; and
new text end

new text begin (4) the following information for each technician, apprentice, or guest artist
employed or performing body art procedures in the establishment:
new text end

new text begin (i) name;
new text end

new text begin (ii) home address;
new text end

new text begin (iii) home telephone number;
new text end

new text begin (iv) date of birth;
new text end

new text begin (v) copy of an identification photo;
new text end

new text begin (vi) duties performed; and
new text end

new text begin (vii) license number or apprenticeship or guest artist registration number.
new text end

new text begin Subd. 8. new text end

new text begin Exception. new text end

new text begin (a) Any body art establishment located within a county or
municipal jurisdiction that has enacted an ordinance that establishes licensure for body art
establishments operating within the jurisdiction shall be exempt from this chapter if the
provisions of the ordinance meet or exceed the provisions of this chapter.
new text end

new text begin (b) Any technician, apprentice, or guest artist employed by or performing body art
procedures in the establishment must be licensed or registered as required under this
chapter.
new text end

Sec. 3.

new text begin [146B.03] LICENSURE FOR BODY ART TECHNICIANS.
new text end

new text begin Subdivision 1. new text end

new text begin Licensure required. new text end

new text begin Effective January 1, 2010, no individual may
perform body art procedures unless the individual holds a valid technician license issued
by the commissioner under this chapter, except as provided in subdivision 3.
new text end

new text begin Subd. 2. new text end

new text begin Designation. new text end

new text begin No individual may use the title of "tattooist," "tattoo artist,"
"body piercer," "body piercing artist," or other letters or titles in connection with that
individual's name which in any way represents that the individual is engaged in the
practice of tattooing or body piercing, or authorized to do so, unless the individual is
licensed and authorized to perform body art procedures under this chapter.
new text end

new text begin Subd. 3. new text end

new text begin Exceptions. new text end

new text begin (a) The following individuals may perform body art
procedures within the scope of their practice without a technician's license:
new text end

new text begin (1) a physician licensed under chapter 147;
new text end

new text begin (2) a nurse licensed under sections 148.171 to 148.285;
new text end

new text begin (3) a chiropractor licensed under chapter 148;
new text end

new text begin (4) an acupuncturist licensed under chapter 147B;
new text end

new text begin (5) a physician assistant licensed under chapter 147A; or
new text end

new text begin (6) a dental professional licensed or registered under chapter 150A.
new text end

new text begin (b) An individual registered as an apprentice or guest artist under section 146B.04
may perform body art procedures in accordance with the requirements of section 146B.04
without a technician's license.
new text end

new text begin Subd. 4. new text end

new text begin Licensure requirements. new text end

new text begin (a) An applicant for licensure under this section
shall submit to the commissioner on a form provided by the commissioner:
new text end

new text begin (1) proof that the applicant is over the age of 18;
new text end

new text begin (2) all fees required under section 146B.10;
new text end

new text begin (3) proof of completing a minimum of 200 hours of supervised training as an
apprentice under section 146B.04;
new text end

new text begin (4) proof of having satisfactorily completed a course approved by the commissioner
on bloodborne pathogens, the prevention of disease transmission, infection control, and
aseptic technique. Courses to be considered for approval by the commissioner may
include those administered by one of the following:
new text end

new text begin (i) the American Red Cross;
new text end

new text begin (ii) United States Occupational Safety and Health Administration (OSHA); or
new text end

new text begin (iii) the Alliance of Professional Tattooists; and
new text end

new text begin (5) any other relevant information requested by the commissioner.
new text end

new text begin (b) Until January 1, 2011, the supervised training requirement under paragraph (a),
clause (3), shall be waived by the commissioner if the applicant submits evidence to
the commissioner that the applicant has, at a minimum, 200 hours of performing body
art procedures within the last five years.
new text end

new text begin Subd. 5. new text end

new text begin Action on licensure applications. new text end

new text begin The commissioner shall notify the
applicant in writing of the action taken on the application. If licensure is denied, the
applicant must be notified of the determination and the grounds for it, and the applicant
may request a hearing on the determination by filing a written statement with the
commissioner within 20 days after receipt of the notice of denial. After the hearing, the
commissioner shall notify the applicant in writing of the decision.
new text end

new text begin Subd. 6. new text end

new text begin License by reciprocity. new text end

new text begin The commissioner shall issue a technician's
license to a person who holds a current license, certification, or registration from another
state if the commissioner determines that the standards for licensure, certification, or
registration in the other jurisdiction meets or exceeds the requirements for licensure stated
in this chapter and a letter is received from that jurisdiction stating that the applicant
is in good standing.
new text end

new text begin Subd. 7. new text end

new text begin Licensure term; renewal. new text end

new text begin A technician's license is valid for one year from
the date of issuance and may be renewed upon payment of the renewal fee established
under section 146B.10.
new text end

new text begin Subd. 8. new text end

new text begin Transfer and display of license. new text end

new text begin A license issued under this section is
not transferable to another individual. A valid license must be located at the site and
available to the public upon request.
new text end

Sec. 4.

new text begin [146B.04] APPRENTICESHIP AND GUEST ARTISTS.
new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin Before an individual may begin an apprenticeship or work
as a guest artist, a licensed technician shall register the apprentice or guest artist with the
commissioner by submitting the name of the apprentice or guest artist to the commissioner
on a form provided by the commissioner. The form must include:
new text end

new text begin (1) the name of the apprentice or guest artist;
new text end

new text begin (2) the name of the licensed technician supervising the apprenticeship or sponsoring
the guest artist;
new text end

new text begin (3) proof of having satisfactorily completed a course approved by the commissioner
on bloodborne pathogens, the prevention of disease transmission, infection control, and
aseptic technique; and
new text end

new text begin (4) the starting and anticipated completion dates of the apprenticeship or the dates
the guest artist will be working.
new text end

new text begin Subd. 2. new text end

new text begin Supervision. new text end

new text begin An apprentice shall complete a minimum of 200 hours of
training under the direct supervision of a licensed technician. For purposes of this chapter,
"direct supervision" means that a licensed technician is present when the apprentice is
performing body art procedures.
new text end

new text begin Subd. 3. new text end

new text begin Guest artists. new text end

new text begin A guest artist may not conduct body art procedures for more
than 30 days per calendar year per licensed establishment. If the guest artist exceeds this
time period, the guest artist shall apply for a technician's license.
new text end

Sec. 5.

new text begin [146B.05] GROUNDS FOR EMERGENCY CLOSURE.
new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin If any of the following conditions exist, the owner or
operator of a licensed establishment may be ordered by the commissioner to discontinue
all operations of a licensed body art establishment:
new text end

new text begin (1) evidence of a sewage backup in an area of the body art establishment where
body art activities are conducted;
new text end

new text begin (2) lack of potable, plumbed, or hot or cold water to the extent that handwashing or
toilet facilities are not operational;
new text end

new text begin (3) lack of electricity or gas service to the extent that handwashing, lighting, or
toilet facilities are not operational;
new text end

new text begin (4) significant damage to the body art establishment due to tornado, fire, flood,
or another disaster;
new text end

new text begin (5) evidence of an infestation of rodents or other vermin;
new text end

new text begin (6) evidence of contamination, filthy conditions, untrained staff, or poor personal
hygiene;
new text end

new text begin (7) evidence of existence of a public health nuisance;
new text end

new text begin (8) use of instruments or jewelry that are not sterile;
new text end

new text begin (9) failure to maintain required records;
new text end

new text begin (10) failure to use gloves as required;
new text end

new text begin (11) failure to properly dispose of sharps, blood or body fluids, or items contaminated
by blood or body fluids;
new text end

new text begin (12) failure to properly report complaints of potential bloodborne pathogen
transmission to the commissioner; or
new text end

new text begin (13) evidence of a positive spore test on the sterilizer.
new text end

new text begin Subd. 2. new text end

new text begin Reopening requirements. new text end

new text begin Prior to reopening, the establishment shall
submit to the commissioner satisfactory proof that the problem condition causing the
need for the emergency closure has been corrected or removed by the operator of the
establishment. A body art establishment may not reopen without the written approval of
the commissioner.
new text end

Sec. 6.

new text begin [146B.06] STANDARDS FOR HEALTH AND SAFETY.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment standards. new text end

new text begin (a) Except as permitted under subdivision
2, the body art establishment must meet the health and safety standards in this subdivision
before a licensed technician may conduct body art procedures at the establishment.
new text end

new text begin (b) There must be no less than 45 square feet of floor space for each procedure
area in the body art establishment.
new text end

new text begin (c) The procedure area must be separated from the bathroom, retail sales area, hair
salon area, or any other area that may cause potential contamination of work surfaces.
new text end

new text begin (d) For clients requesting privacy, at a minimum, a divider, curtain, or partition must
be provided to separate multiple procedure areas.
new text end

new text begin (e) All procedure surfaces must be smooth, nonabsorbent, and easily cleanable.
new text end

new text begin (f) The establishment must have a readily accessible hand sink that is not in a
restroom, does not require access through a door, and is equipped with:
new text end

new text begin (1) potable hot and cold running water under pressure;
new text end

new text begin (2) liquid hand soap;
new text end

new text begin (3) single-use paper towels; and
new text end

new text begin (4) a garbage can with a foot-operated lid or with no lid.
new text end

new text begin (g) The establishment must have at least one available bathroom equipped with a
toilet and a hand sink, which must be supplied with:
new text end

new text begin (1) potable hot and cold running water under pressure;
new text end

new text begin (2) liquid hand soap;
new text end

new text begin (3) single-use paper towels or a mechanical hand drier or blower;
new text end

new text begin (4) a garbage can with a foot-operated lid or with no lid;
new text end

new text begin (5) a self-closing door; and
new text end

new text begin (6) adequate ventilation.
new text end

new text begin (h) An artificial light source equivalent to 20-foot candles at three feet above the
floor.
new text end

new text begin (i) At least 100-foot candles of light must be provided at the level where body
art procedures are performed, where sterilization takes place, and where instruments
and sharps are assembled.
new text end

new text begin (j) All ceilings in the body art establishment must be in good condition.
new text end

new text begin (k) All walls and floors must be free of open holes or cracks and be washable.
new text end

new text begin (l) All facilities within the establishment must be maintained in a clean and sanitary
condition and in good working order.
new text end

new text begin (m) No animals shall be allowed in the procedure area, unless the animal is a
service animal.
new text end

new text begin Subd. 2. new text end

new text begin Establishment exception. new text end

new text begin (a) Any establishment that is operating as a
body art establishment on August 1, 2009, is exempt from any health and safety standard
required under subdivision 1 that would require remodeling in order to comply including,
but not limited to, adding a new procedure area, plumbing changes, or expanding existing
space. If the establishment proceeds with any remodeling plans after August 1, 2009, the
remodeling must meet all health and safety standards required under subdivision 1.
new text end

new text begin (b) An exemption from any of the standards in subdivision 1 must be approved by
the commissioner.
new text end

new text begin Subd. 3. new text end

new text begin Standards for equipment, instruments, and supplies. new text end

new text begin (a) Equipment,
instruments, and supplies must comply with the health and safety standards in this
subdivision before a licensed technician may conduct body art procedures.
new text end

new text begin (b) Jewelry used as part of a body piercing procedure must be made of surgical
implant-grade stainless steel, solid 14-karat or 18-karat white or yellow gold, niobium,
titanium, or platinum, or a dense low-porosity plastic.
new text end

new text begin (c) Jewelry used as part of a body piercing procedure must be free of nicks,
scratches, or irregular surfaces and must be properly sterilized before use.
new text end

new text begin (d) Reusable instruments must be thoroughly washed to remove all organic matter,
rinsed, and sterilized before and after use.
new text end

new text begin (e) Needles must be single-use needles and sterilized before use.
new text end

new text begin (f) Sterilization must be conducted using steam heat or chemical vapor.
new text end

new text begin (g) Steam heat sterilization units must be operated according to the manufacturer's
specifications.
new text end

new text begin (h) At least once a month, but not to exceed 30 days between tests, a spore test must
be conducted on the sterilizer to ensure that it is working properly. If a positive spore test
result is received, the sterilizer may not be used until a negative result is obtained.
new text end

new text begin (i) All inks and other pigments used in a body art procedure must be specifically
manufactured for tattoo procedures. Approved inks and pigments may be diluted with
distilled water or alcohol.
new text end

new text begin (j) Immediately before applying a tattoo, the quantity of the ink needed must be
transferred from the ink bottle and placed into single-use paper or plastic cups immediately
before applying the tattoo. Upon completion of the tattoo, the single-use cups and their
contents must be discarded.
new text end

new text begin (k) All tables, chairs, furniture, or other procedure surfaces that may be exposed to
blood or body fluids during the tattooing or body piercing procedure must be cleanable
and must be sanitized after each client with a liquid chemical germicide.
new text end

new text begin (l) Single-use towels or wipes must be provided to the client. These towels must be
dispensed in a manner that precludes contamination and disposed of in a washable garbage
container with a foot-operated lid or with no lid and a liner.
new text end

new text begin (m) All bandages and surgical dressings used must be sterile or bulk-packaged
clean and stored in a clean, closed container.
new text end

new text begin (n) All equipment and instruments must be maintained in good working order and in
a clean and sanitary condition.
new text end

new text begin (o) All instruments and supplies must be stored clean and dry in covered containers.
new text end

new text begin (p) Single-use disposable barriers must be provided on all equipment that cannot be
sterilized as part of the procedure as required under this section including, but not limited
to, spray bottles, procedure light fixture handles, and tattoo machines.
new text end

new text begin Subd. 4. new text end

new text begin Standards for body art procedures. new text end

new text begin (a) Body art procedures must comply
with the health and safety standards in this subdivision.
new text end

new text begin (b) The skin area subject to a body art procedure must be thoroughly cleaned
with soap and water, rinsed thoroughly, and swabbed with an antiseptic solution. Only
single-use towels or wipes may be used to clean the skin.
new text end

new text begin (c) Whenever it is necessary to shave the skin, a new disposable razor must be
used for each client.
new text end

new text begin (d) No body art procedure may be performed on any area of the skin where there is
an evident infection, irritation, or open wound.
new text end

new text begin (e) Single-use gloves of adequate size and quality to preserve dexterity must be
used for touching clients, for handling sterile instruments, or for handling blood or body
fluids. Nonlatex gloves must be provided for use with clients or employees who request
them. Gloves must be changed if a glove becomes damaged or comes in contact with
any nonclean surface or objects or with a third person. At a minimum, gloves must be
discarded after the completion of a procedure on a client. Hands and wrists must be
washed before putting on a clean pair of gloves and after removing a pair of gloves.
Gloves may not be reused.
new text end

new text begin Subd. 5. new text end

new text begin Standards for technicians. new text end

new text begin (a) Technicians must comply with the health
and safety standards in this subdivision.
new text end

new text begin (b) Technicians must scrub their hands and wrists thoroughly for 20 seconds before
and after performing a body art procedure. Technicians must also wash hands after contact
with the client receiving the procedure or after contact with potentially contaminated
materials.
new text end

new text begin (c) Technicians must wear clean clothing and use a disposable barrier, such as an
apron, when performing body art procedures.
new text end

new text begin (d) A technician may not smoke, eat, or drink while performing body art procedures.
new text end

new text begin Subd. 6. new text end

new text begin Contamination standards. new text end

new text begin (a) Infectious waste and sharps must be
managed according to sections 116.76 to 116.83 and must be disposed of by an approved
infectious waste hauler at a site permitted to accept the waste, according to Minnesota
Rules, parts 7035.9100 to 7035.9150. Sharps ready for disposal must be disposed of
in an approved sharps container.
new text end

new text begin (b) Contaminated waste that may release liquid blood or body fluids when
compressed or that may release dried blood or body fluids when handled must be placed in
an approved red bag that is marked with the international biohazard symbol.
new text end

new text begin (c) Contaminated waste that does not release liquid blood or body fluids when
compressed or handled may be placed in a covered receptacle and disposed of through
normal approved disposal methods.
new text end

new text begin (d) Storage of contaminated waste onsite must not exceed the period specified by
Code of Federal Regulations, title 29, section 1910.1030.
new text end

Sec. 7.

new text begin [146B.07] PROFESSIONAL STANDARDS.
new text end

new text begin Subdivision 1. new text end

new text begin Standard practice. new text end

new text begin (a) A technician shall require proof of age
before performing any body art procedure on a client. Proof of age must be established
by one of the following methods:
new text end

new text begin (1) a valid driver's license or identification card issued by the state of Minnesota or
another state that includes a photograph and date of birth of the individual;
new text end

new text begin (2) a valid military identification card issued by the United States Department of
Defense;
new text end

new text begin (3) a valid passport;
new text end

new text begin (4) a resident alien card; or
new text end

new text begin (5) a tribal identification card.
new text end

new text begin (b) No technician shall tattoo or pierce any individual under the age of 18 years
unless the individual provides a notarized parental consent or the individual's parent or
legal guardian is present. The consent must include both the custodial and noncustodial
parents, where applicable. Nipple and genital piercing or tattooing is prohibited on an
individual under the age of 18 years regardless of parental consent.
new text end

new text begin (c) Before performing any body art procedure, the technician must provide the client
with a disclosure and authorization form that indicates whether the client has:
new text end

new text begin (1) diabetes;
new text end

new text begin (2) a history of hemophilia;
new text end

new text begin (3) a history of skin diseases, skin lesions, or skin sensitivities to soap or
disinfectants;
new text end

new text begin (4) a history of epilepsy, seizures, fainting, or narcolepsy;
new text end

new text begin (5) any condition that requires the client to take medications such as anticoagulants
that thin the blood or interfere with blood clotting; or
new text end

new text begin (6) any other information that would aid the technician in the body art procedure
process evaluation.
new text end

new text begin The technician shall ask the client to sign and date the disclosure and authorization form
confirming that the information listed on the form was provided.
new text end

new text begin (d) No technician shall perform body art procedures on any individual who appears
to be under the influence of alcohol, controlled substances as defined in section 152.01,
subdivision 4, or hazardous substances as defined in rules adopted under chapter 182.
new text end

new text begin (e) No technician shall perform body art procedures while under the influence of
alcohol, controlled substances as defined under section 152.01, subdivision 4, or hazardous
substances as defined in the rules adopted under chapter 182.
new text end

new text begin (f) No technician shall administer anesthetic injections or other medications.
new text end

new text begin Subd. 2. new text end

new text begin Informed consent. new text end

new text begin Before performing a body art procedure, the technician
shall obtain from the client a signed and dated informed consent form. The consent form
must disclose:
new text end

new text begin (1) that a tattoo is considered permanent and may only be removed with a surgical
procedure and that any effective removal may leave scarring; and
new text end

new text begin (2) that a piercing may leave scarring.
new text end

new text begin Subd. 3. new text end

new text begin Client record maintenance. new text end

new text begin For each client, the body art establishment
operator shall maintain proper records of each procedure. The records of the procedure
must be kept for two years and must be available for inspection by the commissioner upon
request. The record must include the following:
new text end

new text begin (1) the date of the procedure;
new text end

new text begin (2) the information on the required picture identification showing the name, age,
and current address of the client;
new text end

new text begin (3) a copy of the release form signed and dated by the client required under
subdivision 1, paragraph (c);
new text end

new text begin (4) a description of the body art procedure performed;
new text end

new text begin (5) the name and license number of the technician performing the procedure;
new text end

new text begin (6) a copy of the consent form required under subdivision 2; and
new text end

new text begin (7) if the client is under the age of 18 years, a copy of the consent form signed by the
parents as required under subdivision 1.
new text end

new text begin Subd. 4. new text end

new text begin Aftercare. new text end

new text begin A technician shall provide each client with verbal and
written instructions for the care of the tattooed or pierced site upon the completion of
the procedure. The written instructions must advise the client to consult a health care
professional at the first sign of infection.
new text end

new text begin Subd. 5. new text end

new text begin State, county, and municipal public health regulations. new text end

new text begin An operator
and technician shall comply with all applicable state, county, and municipal requirements
regarding public health.
new text end

new text begin Subd. 6. new text end

new text begin Notification. new text end

new text begin The operator of the body art establishment shall immediately
notify the commissioner or local health authority of any reports they receive of a potential
bloodborne pathogen transmission.
new text end

Sec. 8.

new text begin [146B.08] INVESTIGATION PROCESS AND GROUNDS FOR
DISCIPLINARY ACTION.
new text end

new text begin Subdivision 1. new text end

new text begin Investigations of complaints. new text end

new text begin The commissioner may initiate an
investigation upon receiving a signed complaint or other signed written communication
that alleges or implies that an individual or establishment has violated this chapter or the
rules adopted according to this chapter. According to section 214.13, subdivision 6, in
the receipt, investigation, and hearing of a complaint that alleges or implies an individual
or establishment has violated this chapter, the commissioner shall follow the procedures
in section 214.10.
new text end

new text begin Subd. 2. new text end

new text begin Rights of applicants and licensees. new text end

new text begin The rights of an applicant denied
licensure are stated in section 146B.03, subdivision 5. A licensee may not be subjected to
disciplinary action under this section without first having an opportunity for a contested
case hearing under chapter 14.
new text end

new text begin Subd. 3. new text end

new text begin Grounds for disciplinary action by commissioner. new text end

new text begin The commissioner
may take any of the disciplinary actions listed in subdivision 4 on proof that a technician
or an operator of an establishment has:
new text end

new text begin (1) intentionally submitted false or misleading information to the commissioner;
new text end

new text begin (2) failed, within 30 days, to provide information in response to a written request,
via certified mail, by the commissioner;
new text end

new text begin (3) violated any provision of this chapter;
new text end

new text begin (4) failed to perform services with reasonable judgment, skill, or safety due to the
use of alcohol or drugs, or other physical or mental impairment;
new text end

new text begin (5) aided or abetted another person in violating any provision of this chapter;
new text end

new text begin (6) been or is being disciplined by another jurisdiction, if any of the grounds for the
discipline are the same or substantially equivalent to those under this chapter;
new text end

new text begin (7) not cooperated with the commissioner in an investigation conducted according to
subdivision 1;
new text end

new text begin (8) advertised in a manner that is false or misleading;
new text end

new text begin (9) engaged in conduct likely to deceive, defraud, or harm the public;
new text end

new text begin (10) demonstrated a willful or careless disregard for the health, welfare, or safety
of a client;
new text end

new text begin (11) obtained money, property, or services from a client through harassment, duress,
deception, or fraud; or
new text end

new text begin (12) failed to refer a client for medical evaluation or to other health care professionals
when appropriate or when a client indicated symptoms associated with diseases that
could be medically or surgically treated.
new text end

new text begin Subd. 4. new text end

new text begin Disciplinary actions. new text end

new text begin If the commissioner finds that a technician or
an operator of an establishment should be disciplined according to subdivision 3, the
commissioner may take any one or more of the following actions:
new text end

new text begin (1) refuse to grant or renew licensure;
new text end

new text begin (2) suspend licensure for a period not exceeding one year;
new text end

new text begin (3) revoke licensure;
new text end

new text begin (4) take any reasonable lesser action against an individual upon proof that the
individual has violated this chapter new text end new text begin ; or
new text end

new text begin (5) impose, for each violation, a civil penalty not exceeding $10,000 that deprives
the licensee of any economic advantage gained by the violation and that reimburses the
department for costs of the investigation and proceedings resulting in disciplinary action,
including the amount paid for services of the Office of Administrative Hearings, the
amount paid for services of the Office of the Attorney General, attorney fees, court
reporters, witnesses, reproduction of records, department staff time, and expenses incurred
by department staff.
new text end

new text begin Subd. 5. new text end

new text begin Consequences of disciplinary actions. new text end

new text begin Upon the suspension or revocation
of licensure, the technician or establishment shall cease to:
new text end

new text begin (1) perform body art procedures;
new text end

new text begin (2) use titles protected under this chapter; and
new text end

new text begin (3) represent to the public that the technician or establishment is licensed by the
commissioner.
new text end

new text begin Subd. 6. new text end

new text begin Reinstatement requirements after disciplinary action. new text end

new text begin A technician
who has had licensure suspended may petition on forms provided by the commissioner
for reinstatement following the period of suspension specified by the commissioner. The
requirements of section 146B.03 for renewing licensure must be met before licensure
may be reinstated.
new text end

Sec. 9.

new text begin [146B.09] COUNTY OR MUNICIPAL REGULATION.
new text end

new text begin Nothing in this chapter preempts or supersedes any county or municipal ordinances
relating to land use, building and construction requirements, nuisance control, or the
licensing of commercial enterprises in general.
new text end

Sec. 10.

new text begin [146B.10] FEES.
new text end

new text begin Subdivision 1. new text end

new text begin Annual licensing fees. new text end

new text begin (a) The fee for the initial technician licensure
and annual licensure renewal is $100.
new text end

new text begin (b) The fee for the establishment licensure is $1,000.
new text end

new text begin (c) The fee for a temporary body art establishment permit renewal is $75.
new text end

new text begin Subd. 2. new text end

new text begin Penalty for late renewals. new text end

new text begin The penalty fee for late submission for renewal
applications is $75.
new text end

new text begin Subd. 3. new text end

new text begin Deposit. new text end

new text begin Fees collected by the commissioner under this section must be
deposited in the state government special revenue fund.
new text end

ARTICLE 10

HEALTH CARE

Section 1.

Minnesota Statutes 2008, section 60A.092, subdivision 2, is amended to
read:

Subd. 2.

Licensed assuming insurer.

Reinsurance is ceded to an assuming insurer
if the assuming insurer is licensed to transact insurance or reinsurance in this state. new text begin For
purposes of reinsuring any health risk, an insurer is defined under section 62A.63.
new text end

Sec. 2.

Minnesota Statutes 2008, section 62D.03, subdivision 4, is amended to read:

Subd. 4.

Application requirements.

Each application for a certificate of authority
shall be verified by an officer or authorized representative of the applicant, and shall be
in a form prescribed by the commissioner of health. Each application shall include the
following:

(a) a copy of the basic organizational document, if any, of the applicant and of
each major participating entity; such as the articles of incorporation, or other applicable
documents, and all amendments thereto;

(b) a copy of the bylaws, rules and regulations, or similar document, if any, and all
amendments thereto which regulate the conduct of the affairs of the applicant and of
each major participating entity;

(c) a list of the names, addresses, and official positions of the following:

(1) all members of the board of directors, or governing body of the local government
unit, and the principal officers and shareholders of the applicant organization; and

(2) all members of the board of directors, or governing body of the local government
unit, and the principal officers of the major participating entity and each shareholder
beneficially owning more than ten percent of any voting stock of the major participating
entity;

The commissioner may by rule identify persons included in the term "principal
officers";

(d) a full disclosure of the extent and nature of any contract or financial arrangements
between the following:

(1) the health maintenance organization and the persons listed in clause (c)(1);

(2) the health maintenance organization and the persons listed in clause (c)(2);

(3) each major participating entity and the persons listed in clause (c)(1) concerning
any financial relationship with the health maintenance organization; and

(4) each major participating entity and the persons listed in clause (c)(2) concerning
any financial relationship with the health maintenance organization;

(e) the name and address of each participating entity and the agreed upon duration of
each contract or agreement;

(f) a copy of the form of each contract binding the participating entities and the
health maintenance organization. Contractual provisions shall be consistent with the
purposes of sections 62D.01 to 62D.30, in regard to the services to be performed under the
contract, the manner in which payment for services is determined, the nature and extent
of responsibilities to be retained by the health maintenance organization, the nature and
extent of risk sharing permissible, and contractual termination provisions;

(g) a copy of each contract binding major participating entities and the health
maintenance organization. Contract information filed with the commissioner shall be
confidential and subject to the provisions of section 13.37, subdivision 1, clause (b), upon
the request of the health maintenance organization.

Upon initial filing of each contract, the health maintenance organization shall file
a separate document detailing the projected annual expenses to the major participating
entity in performing the contract and the projected annual revenues received by the entity
from the health maintenance organization for such performance. The commissioner
shall disapprove any contract with a major participating entity if the contract will result
in an unreasonable expense under section 62D.19. The commissioner shall approve or
disapprove a contract within 30 days of filing.

Within 120 days of the anniversary of the implementation of each contract, the
health maintenance organization shall file a document detailing the actual expenses
incurred and reported by the major participating entity in performing the contract in the
preceding year and the actual revenues received from the health maintenance organization
by the entity in payment for the performance;

(h) a statement generally describing the health maintenance organization, its health
maintenance contracts and separate health service contracts, facilities, and personnel,
including a statement describing the manner in which the applicant proposes to provide
enrollees with comprehensive health maintenance services and separate health services;

(i) a copy of the form of each evidence of coverage to be issued to the enrollees;

(j) a copy of the form of each individual or group health maintenance contract
and each separate health service contract which is to be issued to enrollees or their
representatives;

(k) financial statements showing the applicant's assets, liabilities, and sources of
financial support. If the applicant's financial affairs are audited by independent certified
public accountants, a copy of the applicant's most recent certified financial statement
may be deemed to satisfy this requirement;

(l) a description of the proposed method of marketing the plan, a schedule of
proposed charges, and a financial plan which includes a three-year projection of the
expenses and income and other sources of future capital;

(m) a statement reasonably describing the geographic area or areas to be served and
the type or types of enrollees to be served;

(n) a description of the complaint procedures to be utilized as required under section
62D.11;

(o) a description of the procedures and programs to be implemented to meet the
requirements of section 62D.04, subdivision 1, clauses (b) and (c) and to monitor the
quality of health care provided to enrollees;

(p) a description of the mechanism by which enrollees will be afforded an
opportunity to participate in matters of policy and operation under section 62D.06;

(q) a copy of any agreement between the health maintenance organization and
an insurer deleted text begin or deleted text end new text begin , including any new text end nonprofit health service corporation new text begin or another health
maintenance organization, new text end regarding reinsurance, stop-loss coverage, insolvency
coverage, or any other type of coverage for potential costs of health services, as authorized
in sections 62D.04, subdivision 1, clause (f), 62D.05, subdivision 3, and 62D.13;

(r) a copy of the conflict of interest policy which applies to all members of the board
of directors and the principal officers of the health maintenance organization, as described
in section 62D.04, subdivision 1, paragraph (g). All currently licensed health maintenance
organizations shall also file a conflict of interest policy with the commissioner within 60
days after August 1, 1990, or at a later date if approved by the commissioner;

(s) a copy of the statement that describes the health maintenance organization's prior
authorization administrative procedures; and

(t) other information as the commissioner of health may reasonably require to be
provided.

Sec. 3.

Minnesota Statutes 2008, section 62D.05, subdivision 3, is amended to read:

Subd. 3.

Contracts; health services.

A health maintenance organization may
contract with providers of health care services to render the services the health maintenance
organization has promised to provide under the terms of its health maintenance contracts,
may, subject to section 62D.12, subdivision 11, enter into separate prepaid dental contracts,
or other separate health service contracts, may, subject to the limitations of section
62D.04, subdivision 1, clause (f), contract with insurance companies deleted text begin and deleted text end new text begin , including
new text end nonprofit health service plan corporations new text begin or other health maintenance organizations,
new text end for insurance, indemnity or reimbursement of its cost of providing health care services
for enrollees or against the risks incurred by the health maintenance organization, may
contract with insurance companies and nonprofit health service plan corporations for
insolvency insurance coverage, and may contract with insurance companies and nonprofit
health service plan corporations to insure or cover the enrollees' costs and expenses in the
health maintenance organization, including the customary prepayment amount and any
co-payment obligations new text begin , and may contract to provide reinsurance or insolvency insurance
coverage to health insurers or nonprofit health service plan corporations new text end .

Sec. 4.

Minnesota Statutes 2008, section 62J.692, subdivision 7, is amended to read:

Subd. 7.

Transfers from the commissioner of human services.

deleted text begin (a) The amount
transferred according to section 256B.69, subdivision 5c, paragraph (a), clause (1), shall
be distributed by the commissioner annually to clinical medical education programs that
meet the qualifications of subdivision 3 based on the formula in subdivision 4, paragraph
(a) deleted text end new text begin Of the amount transferred according to section 256B.69, subdivision 5c, paragraph (a),
clauses (1) to (4), $21,714,000 shall be distributed as follows:
new text end

new text begin (1) $2,157,000 shall be distributed by the commissioner to the University of
Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40;
new text end

new text begin (2) $1,035,360 shall be distributed by the commissioner to the Hennepin County
Medical Center for clinical medical education;
new text end

new text begin (3) $17,400,000 shall be distributed by the commissioner to the University of
Minnesota Board of Regents for purposes of medial education;
new text end

new text begin (4) $1,121,640 shall be distributed by the commissioner to clinical medical education
dental innovation grants in accordance with subdivision 7a; and
new text end

new text begin (5) the remainder of the amount transferred according to section 256B.69,
subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to
clinical medical education programs that meet the qualifications of subdivision 3 based on
the formula in subdivision 4, paragraph (a) new text end .

deleted text begin (b) Fifty percent of the amount transferred according to section 256B.69, subdivision
5c, paragraph (a), clause (2), shall be distributed by the commissioner to the University of
Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40. Of
the remaining amount transferred according to section 256B.69, subdivision 5c, paragraph
(a), clause (2), 24 percent of the amount shall be distributed by the commissioner to
the Hennepin County Medical Center for clinical medical education. The remaining 26
percent of the amount transferred shall be distributed by the commissioner in accordance
with subdivision 7a. If the federal approval is not obtained for the matching funds under
section 256B.69, subdivision 5c, paragraph (a), clause (2), 100 percent of the amount
transferred under this paragraph shall be distributed by the commissioner to the University
of Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40.
deleted text end

deleted text begin (c) The amount transferred according to section 256B.69, subdivision 5c, paragraph
(a), clauses (3) and (4), shall be distributed by the commissioner upon receipt to the
University of Minnesota Board of Regents for the purposes of clinical graduate medical
education.
deleted text end

Sec. 5.

Minnesota Statutes 2008, section 125A.744, subdivision 3, is amended to read:

Subd. 3.

Implementation.

Consistent with section 256B.0625, subdivision 26,
school districts may enroll as medical assistance providers or subcontractors and bill
the Department of Human Services under the medical assistance fee for service claims
processing system for special education services which are covered services under chapter
256B, which are provided in the school setting for a medical assistance recipient, and for
whom the district has secured informed consent consistent with section 13.05, subdivision
4, paragraph (d), and section 256B.77, subdivision 2, paragraph (p), to bill for each type
of covered service. School districts shall be reimbursed by the commissioner of human
services for the federal share of individual education plan health-related services that
qualify for reimbursement by medical assistance, minus up to five percent retained by the
commissioner of human services for administrative costs deleted text begin , not to exceed $350,000 per
fiscal year deleted text end . The commissioner may withhold up to five percent of each payment to a
school district. Following the end of each fiscal year, the commissioner shall settle up with
each school district in order to ensure that collections from each district for departmental
administrative costs are made on a pro rata basis according to federal earnings for these
services in each district. A school district is not eligible to enroll as a home care provider
or a personal care provider organization for purposes of billing home care services under
sections 256B.0651 and 256B.0653 to 256B.0656 until the commissioner of human
services issues a bulletin instructing county public health nurses on how to assess for the
needs of eligible recipients during school hours. To use private duty nursing services or
personal care services at school, the recipient or responsible party must provide written
authorization in the care plan identifying the chosen provider and the daily amount
of services to be used at school.

Sec. 6.

Minnesota Statutes 2008, section 256.01, subdivision 2b, is amended to read:

Subd. 2b.

Performance payments.

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

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

Sec. 7.

Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:

new text begin Subd. 18a. new text end

new text begin Public Assistance Reporting Information System. new text end

new text begin (a) Effective
October 1, 2009, the commissioner shall comply with the federal requirements in Public
Law 110-379 in implementing the Public Assistance Reporting Information System
(PARIS) to determine eligibility for all individuals applying for:
new text end

new text begin (1) health care benefits under chapters 256B, 256D, and 256L; and
new text end

new text begin (2) public benefits under chapters 119B, 256D, 256I, and the supplemental nutrition
assistance program.
new text end

new text begin (b) The commissioner shall determine eligibility under paragraph (a) by performing
data matches, including matching with medical assistance, cash, child care, and
supplemental assistance programs operated by other states.
new text end

Sec. 8.

Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:

new text begin Subd. 18b. new text end

new text begin Protections for American Indians. new text end

new text begin Effective February 18, 2009, the
commissioner shall comply with the federal requirements in the American Recovery and
Reinvestment Act of 2009, Public Law 111-5, section 5006, regarding American Indians.
new text end

Sec. 9.

Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:

new text begin Subd. 29. new text end

new text begin State medical review team. new text end

new text begin (a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team under
section 256B.055, subdivision 7, paragraph (b), and section 256B.057, subdivision 9,
paragraph (j), the commissioner shall review all medical evidence submitted by counties
with a referral and seek additional information from providers, applicants, or enrollees to
support the determination of disability where necessary.
new text end

new text begin (b) Prior to a denial or withdrawal of a requested determination of disability due
to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is
necessary and appropriate to a determination of disability and (2) assist applicants and
enrollees to obtain the evidence, including, but not limited to, medical examinations
and electronic medical records.
new text end

new text begin (c) The commissioner shall provide the chairs of the legislative committees with
jurisdiction over health and human services finance and budget the following information
on the activities of the state medical review team by February 1, 2010, and annually
thereafter:
new text end

new text begin (1) the number of applications to the state medical review team that were denied,
approved, or withdrawn;
new text end

new text begin (2) the average length of time from receipt of the application to a decision;
new text end

new text begin (3) the number of appeals and appeal results;
new text end

new text begin (4) for applicants, their age, health coverage at the time of application, hospitalization
history within three months of application, and whether an application for Social Security
or Supplemental Security Income benefits is pending; and
new text end

new text begin (5) specific information on the medical certification, licensure, or other credentials
of the person or persons performing the medical review determinations and length of
time in that position.
new text end

Sec. 10.

new text begin [256.964] DENTAL CARE PILOT PROJECTS.
new text end

new text begin Subdivision 1. new text end

new text begin Urgent dental care services. new text end

new text begin The commissioner shall authorize a
pilot project to reduce the total cost to the state for dental services provided to enrollees
of the state public health care programs by reducing hospital emergency room costs
for preventable or nonemergency dental services. As part of the project, a community
dental clinic or dental provider, in collaboration with a hospital emergency room, shall
provide urgent care dental services as an alternative to the hospital emergency room for
nonemergency dental care. The project participants shall establish a process to divert a
patient presenting at the emergency room for nonemergency dental care to the dental
community clinic or to an appropriate dental provider. The commissioner may establish
special payment rates for urgent care services provided and may change or waive existing
payment policies in order to adequately reimburse providers for providing cost-effective
alternative services in an outpatient or urgent care setting. The commissioner may
establish a project in conjunction with the initiative authorized under section 256.963.
new text end

new text begin Subd. 2. new text end

new text begin Dental care in nursing facilities. new text end

new text begin (a) The commissioner shall establish
a pilot project to improve access to on-site dental services for residents of nursing
facilities. The pilot project must demonstrate methods of reducing total costs to the state
by providing more cost-effective delivery of dental services, including new workforce
roles, enhanced caregiver assistance with daily oral care, periodic assessment and triage of
dental problems, care coordination and provision of comprehensive year round on-site
dental services. As part of the pilot project, the commissioner may:
new text end

new text begin (1) establish a special pilot project funding model for dental services provided that
waives existing reimbursement policies; and
new text end

new text begin (2) contract with a single on-site dental provider to provide services to residents
of pilot project nursing facilities.
new text end

new text begin (b) The commissioner shall evaluate the effectiveness of the pilot project on
cost-savings and health outcomes.
new text end

new text begin Subd. 3. new text end

new text begin Dental health care homes. new text end

new text begin The commissioner shall establish a pilot
project under which dental providers shall be paid a care coordination fee to coordinate
dental care for patients with existing dental disease and for whom the total cost of dental
care for the patients can be reduced through better prevention, coordination of services, use
of cost-effective treatments and settings, and reducing utilization of hospital emergency
rooms and reductions in hospitalizations for medical problems linked with oral infections.
new text end

Sec. 11.

new text begin [256.9652] E-PRESCRIBING INITIATIVE.
new text end

new text begin (a) The commissioner shall implement a demonstration project that incorporates
e-prescribing applications with a clinical information database in order to increase
patient safety and efficiencies and reduce medication errors, duplication of therapies,
and eliminate waste.
new text end

new text begin (b) The commissioner shall identify providers who are currently using e-prescribing
and ensure that each provider has the ability through e-prescribing software to receive
the following:
new text end

new text begin (1) a patient's specific medication history for the last 100 days;
new text end

new text begin (2) the preferred drug list and formulary verification;
new text end

new text begin (3) prescription details; and
new text end

new text begin (4) drug interaction alerts.
new text end

new text begin (c) Beginning January 1, 2010, each provider identified by the commissioner shall
use the e-prescribing applications for each prescription.
new text end

new text begin (d) Beginning January 1, 2011, the commissioner shall ensure that any provider
using e-prescribing has access to the applications identified in paragraph (b).
new text end

Sec. 12.

Minnesota Statutes 2008, section 256.969, subdivision 2b, is amended to read:

Subd. 2b.

Operating payment rates.

In determining operating payment rates for
admissions occurring on or after the rate year beginning January 1, 1991, and every two
years after, or more frequently as determined by the commissioner, the commissioner shall
obtain operating data from an updated base year and establish operating payment rates
per admission for each hospital based on the cost-finding methods and allowable costs of
the Medicare program in effect during the base year. Rates under the general assistance
medical care, medical assistance, and MinnesotaCare programs shall not be rebased to
more current data on January 1, 1997, January 1, 2005, deleted text begin and deleted text end for the first 24 months of the
rebased period beginning January 1, 2009 new text begin , and for the first three months of the rebased
period beginning January 1, 2011. From April 1, 2011, to March 31, 2012, rates shall be
rebased at 72.5 percent of full value. Effective April 1, 2012, rates shall be rebased at full
value new text end . The base year operating payment rate per admission is standardized by the case
mix index and adjusted by the hospital cost index, relative values, and disproportionate
population adjustment. The cost and charge data used to establish operating rates shall
only reflect inpatient services covered by medical assistance and shall not include property
cost information and costs recognized in outlier payments.

Sec. 13.

Minnesota Statutes 2008, section 256.969, subdivision 3a, is amended to read:

Subd. 3a.

Payments.

(a) Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695, in addition to third party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. This payment limitation
shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991. Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and
may merge the payment rates while maintaining separate provider numbers. The operating
and property base rates per admission or per day shall be derived from the best Medicare
and claims data available when rates are established. The commissioner shall determine
the best Medicare and claims data, taking into consideration variables of recency of the
data, audit disposition, settlement status, and the ability to set rates in a timely manner.
The commissioner shall notify hospitals of payment rates by December 1 of the year
preceding the rate year. The rate setting data must reflect the admissions data used to
establish relative values. Base year changes from 1981 to the base year established for the
rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
1. The commissioner may adjust base year cost, relative value, and case mix index data
to exclude the costs of services that have been discontinued by the October 1 of the year
preceding the rate year or that are paid separately from inpatient services. Inpatient stays
that encompass portions of two or more rate years shall have payments established based
on payment rates in effect at the time of admission unless the date of admission preceded
the rate year in effect by six months or more. In this case, operating payment rates for
services rendered during the rate year in effect and established based on the date of
admission shall be adjusted to the rate year in effect by the hospital cost index.

(b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.

(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, and
facilities defined under subdivision 16 are excluded from this paragraph.

(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after July 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent
from the current statutory rates. Mental health services within diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
assistance does not include general assistance medical care. Payments made to managed
care plans shall be reduced for services provided on or after January 1, 2006, to reflect
this reduction.

(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2009, through June 30, 2009, to reflect this reduction.

(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
1.9 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2009, through June 30, 2010, to reflect this reduction.

(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.79 percent
from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Payments made to managed care plans shall be reduced for services provided on or after
July 1, 2010, to reflect this reduction.

new text begin (h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
payment for fee-for-service admissions occurring on or after July 1, 2009, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
one percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.
new text end

Sec. 14.

Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
to read:

new text begin Subd. 3b. new text end

new text begin Nonpayment for hospital-acquired conditions and for certain
treatments. new text end

new text begin (a) The commissioner must not make medical assistance payments to a
hospital for any costs of care that result from a condition listed in paragraph (c), if the
condition was hospital acquired.
new text end

new text begin (b) For purposes of this subdivision, a condition is hospital acquired if it is not
identified by the hospital as present on admission. For purposes of this subdivision,
medical assistance includes general assistance medical care and MinnesotaCare.
new text end

new text begin (c) The prohibition in paragraph (a) applies to payment for each hospital-acquired
condition listed in this paragraph that is represented by an ICD-9-CM diagnosis code and
is designated as a complicating condition or a major complicating condition:
new text end

new text begin (1) foreign object retained after surgery (ICD-9-CM codes 998.4 or 998.7);
new text end

new text begin (2) air embolism (ICD-9-CM code 999.1);
new text end

new text begin (3) blood incompatibility (ICD-9-CM code 999.6);
new text end

new text begin (4) pressure ulcers stage III or IV (ICD-9-CM codes 707.23 or 707.24);
new text end

new text begin (5) falls and trauma, including fracture, dislocation, intracranial injury, crushing
injury, burn, and electric shock (ICD-9-CM codes with these ranges on the complicating
condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929;
940-949; and 991-994);
new text end

new text begin (6) catheter-associated urinary tract infection (ICD-9-CM code 996.64);
new text end

new text begin (7) vascular catheter-associated infection (ICD-9-CM code 999.31);
new text end

new text begin (8) manifestations of poor glycemic control (ICD-9-CM codes 249.10; 249.11;
249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and
251.0);
new text end

new text begin (9) surgical site infection (ICD-9-CM codes 996.67 or 998.59) following certain
orthopedic procedures (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07;
81.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and
81.85);
new text end

new text begin (10) surgical site infection (ICD-9-CM code 998.59) following bariatric surgery
(procedure codes 44.38; 44.39; or 44.95) for a principal diagnosis of morbid obesity
(ICD-9-CM code 278.01);
new text end

new text begin (11) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary
artery bypass graft (procedure codes 36.10 to 36.19); and
new text end

new text begin (12) deep vein thrombosis (ICD-9-CM codes 453.40 to 453.42) or pulmonary
embolism (ICD-9-CM codes 415.11 or 415.91) following total knee replacement
(procedure code 81.54) or hip replacement (procedure codes 00.85 to 00.87 or 81.51
to 81.52).
new text end

new text begin (d) The prohibition in paragraph (a) applies to any additional payments that result
from a hospital-acquired condition listed in paragraph (c), including, but not limited to,
additional treatment or procedures, readmission to the facility after discharge, increased
length of stay, change to a higher diagnostic category, or transfer to another hospital. In
the event of a transfer to another hospital, the hospital where the condition listed under
paragraph (c) was acquired is responsible for any costs incurred at the hospital to which
the patient is transferred.
new text end

new text begin (e) A hospital shall not bill a recipient of services for any payment disallowed under
this subdivision.
new text end

Sec. 15.

Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
to read:

new text begin Subd. 28. new text end

new text begin Temporary rate increase for qualifying hospitals. new text end

new text begin For the period
from April 1, 2009, to September 30, 2010, for each hospital with a medical assistance
utilization rate equal to or greater than 25 percent during the base year, the commissioner
shall provide an equal percentage rate increase for each medical assistance admission. The
commissioner shall estimate the percentage rate increase using as the state share of the
increase the amount available under section 256B.199, paragraph (d). The commissioner
shall settle up payments to qualifying hospitals based on actual payments under that
section and actual hospital admissions.
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. 16.

new text begin [256B.032] ELIGIBLE VENDORS OF MEDICAL CARE.
new text end

new text begin (a) Effective January 1, 2011, the commissioner shall establish performance
thresholds for health care providers included in the provider peer grouping system
developed by the commissioner of health under section 62U.04. The thresholds shall be
set at the 10th percentile of the combined cost and quality measure used for provider peer
grouping, and separate thresholds shall be set for hospital and physician services.
new text end

new text begin (b) Beginning January 1, 2012, any health care provider with a combined cost and
quality score below the threshold set in paragraph (a) shall be prohibited from enrolling
as a vendor of medical care in the medical assistance, general assistance medical care,
or MinnesotaCare programs, and shall not be eligible for direct payments under those
programs or for payments made by managed care plans under their contracts with the
commissioner under section 256B.69 or 256L.12. A health care provider that is prohibited
from enrolling as a vendor or receiving payments under this paragraph may reenroll
effective January 1 of any subsequent year if the provider's most recent combined cost and
quality score exceeds the threshold established in paragraph (a).
new text end

new text begin (c) Notwithstanding paragraph (b), a provider may continue to participate as a vendor
or as part of a managed care plan provider network if the commissioner determines that a
contract with the provider is necessary to ensure adequate access to health care services.
new text end

new text begin (d) By January 15, 2013, the commissioner shall report to the legislature on the
impact of this section. The commissioner's report shall include information on:
new text end

new text begin (1) the providers falling below the thresholds as of January 1, 2012;
new text end

new text begin (2) the volume of services and cost of care provided to enrollees in the medical
assistance, general assistance medical care, or MinnesotaCare programs in the 12 months
prior to January 1, 2012, by providers falling below the thresholds;
new text end

new text begin (3) providers who fell below the thresholds but continued to be eligible vendors
under paragraph (c);
new text end

new text begin (4) the estimated cost savings achieved by not contracting with providers who do
not meet the performance thresholds; and
new text end

new text begin (5) recommendations for increasing the threshold levels of performance over time.
new text end

Sec. 17.

Minnesota Statutes 2008, section 256B.055, subdivision 7, is amended to read:

Subd. 7.

Aged, blind, or disabled persons.

new text begin (a) new text end Medical assistance may be paid for
a person who meets the categorical eligibility requirements of the supplemental security
income program or, who would meet those requirements except for excess income or
assets, and who meets the other eligibility requirements of this section.

new text begin (b) Following a determination that the applicant is not aged or blind and does not
meet any other category of eligibility for medical assistance and has not been determined
disabled by the Social Security Administration, applicants under this subdivision shall be
referred to the commissioner's state medical review team for a determination of disability.
Disability shall be determined according to the rules of title XVI and title XIX of the
Social Security Act and pertinent rules and policies of the Social Security Administration.
new text end

Sec. 18.

Minnesota Statutes 2008, section 256B.056, subdivision 3, is amended to read:

Subd. 3.

Asset limitations for individuals and families.

To be eligible for medical
assistance, a person must not individually own more than $3,000 in assets, or if a member
of a household with two family members, husband and wife, or parent and child, the
household must not own more than $6,000 in assets, plus $200 for each additional legal
dependent. In addition to these maximum amounts, an eligible individual or family may
accrue interest on these amounts, but they must be reduced to the maximum at the time
of an eligibility redetermination. The accumulation of the clothing and personal needs
allowance according to section 256B.35 must also be reduced to the maximum at the
time of the eligibility redetermination. The value of assets that are not considered in
determining eligibility for medical assistance is the value of those assets excluded under
the supplemental security income program for aged, blind, and disabled persons, with
the following exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business that the local agency
determines are necessary to the person's ability to earn an income are not considered new text begin . A
bank account that contains income or assets, or is used to pay personal expenses is not
considered a capital or operating asset of a trade or business new text end ;

(3) motor vehicles are excluded to the same extent excluded by the supplemental
security income program;

(4) assets designated as burial expenses are excluded to the same extent excluded by
the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses; and

(5) effective upon federal approval, for a person who no longer qualifies as an
employed person with a disability due to loss of earnings, assets allowed while eligible
for medical assistance under section 256B.057, subdivision 9, are not considered for 12
months, beginning with the first month of ineligibility as an employed person with a
disability, to the extent that the person's total assets remain within the allowed limits of
section 256B.057, subdivision 9, paragraph (c).

new text begin The assets specified in clauses (1) to (4) must be disclosed to the local agency at the
time of application and at the time of an eligibility redetermination, and must be verified
upon request of the local agency.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 19.

Minnesota Statutes 2008, section 256B.056, subdivision 3b, is amended to
read:

Subd. 3b.

Treatment of trusts.

(a) A "medical assistance qualifying trust" is a
revocable or irrevocable trust, or similar legal device, established on or before August
10, 1993, by a person or the person's spouse under the terms of which the person
receives or could receive payments from the trust principal or income and the trustee
has discretion in making payments to the person from the trust principal or income.
Notwithstanding that definition, a medical assistance qualifying trust does not include:
(1) a trust set up by will; (2) a trust set up before April 7, 1986, solely to benefit a person
with a developmental disability living in an intermediate care facility for persons with
developmental disabilities; or (3) a trust set up by a person with payments made by the
Social Security Administration pursuant to the United States Supreme Court decision in
Sullivan v. Zebley, 110 S. Ct. 885 (1990). The maximum amount of payments that a
trustee of a medical assistance qualifying trust may make to a person under the terms of
the trust is considered to be available assets to the person, without regard to whether the
trustee actually makes the maximum payments to the person and without regard to the
purpose for which the medical assistance qualifying trust was established.

(b) new text begin Except as provided in paragraphs (c) and (d), new text end trusts established after August 10,
1993, are treated according to section 13611(b) of the Omnibus Budget Reconciliation
Act of 1993 (OBRA), Public Law 103-66.

new text begin (c) For purposes of paragraph (d), a pooled trust means a trust established under
United States Code, title 42, section 1396p(d)(4)(C).
new text end

new text begin (d) A beneficiary's interest in a pooled trust is considered an available asset unless
the trust provides that upon the death of the beneficiary or termination of the trust during
the beneficiary's lifetime, whichever is sooner, the department receives any amount up
to the amount of medical assistance benefits paid on behalf of the beneficiary remaining
in the beneficiary's trust account after a deduction for reasonable administrative fees
and expenses and an additional remainder amount. The retained remainder amount
of the subaccount must not exceed ten percent of the account value at the time of the
beneficiary's death or termination of the trust and must only be used for the benefit of
disabled individuals who have a beneficiary interest in the pooled trust.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for pooled trust accounts established
on or after January 1, 2011.
new text end

Sec. 20.

Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to
read:

Subd. 3c.

Asset limitations for families and children.

A household of two or more
persons must not own more than $20,000 in total net assets, and a household of one
person must not own more than $10,000 in total net assets. In addition to these maximum
amounts, an eligible individual or family may accrue interest on these amounts, but they
must be reduced to the maximum at the time of an eligibility redetermination. The value of
assets that are not considered in determining eligibility for medical assistance for families
and children is the value of those assets excluded under the AFDC state plan as of July 16,
1996, as required by the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business up to $200,000 are not
considered new text begin , except that a bank account that contains personal income or assets, or is used to
pay personal expenses, is not considered a capital or operating asset of a trade or business new text end ;

(3) one motor vehicle is excluded for each person of legal driving age who is
employed or seeking employment;

(4) one burial plot and all other burial expenses equal to the supplemental security
income program asset limit are not considered for each individual;

(5) court-ordered settlements up to $10,000 are not considered;

(6) individual retirement accounts and funds are not considered; and

(7) assets owned by children are not considered.

new text begin The assets specified in clauses (1) to (7) must be disclosed to the local agency at the
time of application and at the time of an eligibility redetermination, and must be verified
upon request of the local agency.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 21.

Minnesota Statutes 2008, section 256B.056, subdivision 3d, is amended to
read:

Subd. 3d.

Reduction of excess assets.

Assets in excess of the limits in subdivisions
3 to 3c may be reduced to allowable limits as follows:

(a) Assets may be reduced in any of the three calendar months before the month
of application in which the applicant seeks coverage by deleted text begin :
deleted text end

deleted text begin (1) designating burial funds up to $1,500 for each applicant, spouse, and MA-eligible
dependent child; and
deleted text end

deleted text begin (2) deleted text end paying deleted text begin health service deleted text end bills new text begin for health services that are new text end incurred in the retroactive
period for which the applicant seeks eligibility, starting with the oldest bill. After assets
are reduced to allowable limits, eligibility begins with the next dollar of MA-covered
health services incurred in the retroactive period. Applicants reducing assets under this
subdivision who also have excess income shall first spend excess assets to pay health
service bills and may meet the income spenddown on remaining bills.

(b) Assets may be reduced beginning the month of application by deleted text begin :
deleted text end

deleted text begin (1) deleted text end paying bills for health services new text begin that are incurred during the period specified in
Minnesota Rules, part 9505.0090, subpart 2, new text end that would otherwise be paid by medical
assistance deleted text begin ; and deleted text end new text begin . After assets are reduced to allowable limits, eligibility begins with the
next dollar of medical assistance covered health services incurred in the period. Applicants
reducing assets under this subdivision who also have excess income shall first spend excess
assets to pay health service bills and may meet the income spenddown on remaining bills.
new text end

deleted text begin (2) using any means other than a transfer of assets for less than fair market value as
defined in section 256B.0595, subdivision 1, paragraph (b).
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 22.

Minnesota Statutes 2008, section 256B.057, subdivision 9, is amended to read:

Subd. 9.

Employed persons with disabilities.

(a) Medical assistance may be paid
for a person who is employed and who:

(1) meets the definition of disabled under the supplemental security income program;

(2) is at least 16 but less than 65 years of age;

(3) meets the asset limits in paragraph (c); and

(4) effective November 1, 2003, pays a premium and other obligations under
paragraph (e).

Any spousal income or assets shall be disregarded for purposes of eligibility and premium
determinations.

(b) After the month of enrollment, a person enrolled in medical assistance under
this subdivision who:

(1) is temporarily unable to work and without receipt of earned income due to a
medical condition, as verified by a physician, may retain eligibility for up to four calendar
months; or

(2) effective January 1, 2004, loses employment for reasons not attributable to the
enrollee, may retain eligibility for up to four consecutive months after the month of job
loss. To receive a four-month extension, enrollees must verify the medical condition or
provide notification of job loss. All other eligibility requirements must be met and the
enrollee must pay all calculated premium costs for continued eligibility.

(c) For purposes of determining eligibility under this subdivision, a person's assets
must not exceed $20,000, excluding:

(1) all assets excluded under section 256B.056;

(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
Keogh plans, and pension plans; and

(3) medical expense accounts set up through the person's employer.

(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65
earned income disregard. To be eligible, a person applying for medical assistance under
this subdivision must have earned income above the disregard level.

(2) Effective January 1, 2004, to be considered earned income, Medicare, Social
Security, and applicable state and federal income taxes must be withheld. To be eligible,
a person must document earned income tax withholding.

(e)(1) A person whose earned and unearned income is equal to or greater than 100
percent of federal poverty guidelines for the applicable family size must pay a premium
to be eligible for medical assistance under this subdivision. The premium shall be based
on the person's gross earned and unearned income and the applicable family size using a
sliding fee scale established by the commissioner, which begins at one percent of income
at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income
for those with incomes at or above 300 percent of the federal poverty guidelines. Annual
adjustments in the premium schedule based upon changes in the federal poverty guidelines
shall be effective for premiums due in July of each year.

(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for
medical assistance under this subdivision. An enrollee shall pay the greater of a $35
premium or the premium calculated in clause (1).

(3) Effective November 1, 2003, all enrollees who receive unearned income must
pay one-half of one percent of unearned income in addition to the premium amount.

(4) Effective November 1, 2003, for enrollees whose income does not exceed 200
percent of the federal poverty guidelines and who are also enrolled in Medicare, the
commissioner must reimburse the enrollee for Medicare Part B premiums under section
256B.0625, subdivision 15, paragraph (a).

(5) 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.

(f) A person's eligibility and premium shall be determined by the local county
agency. Premiums must be paid to the commissioner. All premiums are dedicated to
the commissioner.

(g) Any required premium shall be determined at application and redetermined at
the enrollee's six-month income review or when a change in income or household size is
reported. Enrollees must report any change in income or household size within ten days
of when the change occurs. A decreased premium resulting from a reported change in
income or household size shall be effective the first day of the next available billing month
after the change is reported. Except for changes occurring from annual cost-of-living
increases, a change resulting in an increased premium shall not affect the premium amount
until the next six-month review.

(h) Premium payment is due upon notification from the commissioner of the
premium amount required. Premiums may be paid in installments at the discretion of
the commissioner.

(i) Nonpayment of the premium shall result in denial or termination of medical
assistance unless the person demonstrates good cause for nonpayment. Good cause exists
if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
D, are met. Except when an installment agreement is accepted by the commissioner,
all persons disenrolled for nonpayment of a premium must pay any past due premiums
as well as current premiums due prior to being reenrolled. Nonpayment shall include
payment with a returned, refused, or dishonored instrument. The commissioner may
require a guaranteed form of payment as the only means to replace a returned, refused,
or dishonored instrument.

new text begin (j) Following a determination that the applicant is not aged or blind and does not
meet any other category of eligibility for medical assistance and has not been determined
disabled by the Social Security Administration, applicants under this subdivision shall be
referred to the commissioner's state medical review team for a determination of disability.
Disability shall be determined according to the rules of title XVI and title XIX of the
Social Security Act and pertinent rules and policies of the Social Security Administration.
new text end

Sec. 23.

Minnesota Statutes 2008, section 256B.057, is amended by adding a
subdivision to read:

new text begin Subd. 11. new text end

new text begin Treatment for colorectal cancer. new text end

new text begin (a) Medical assistance shall be paid for
an individual who:
new text end

new text begin (1) has been screened for colorectal cancer by the colorectal cancer prevention
demonstration project;
new text end

new text begin (2) according to the individual's treating health professional, needs treatment for
colorectal cancer;
new text end

new text begin (3) meets income eligibility guidelines for the colorectal cancer prevention
demonstration project;
new text end

new text begin (4) is under the age of 65; and
new text end

new text begin (5) is not otherwise eligible for medical assistance or other creditable coverage as
defined under United States Code, title 42, section 1396a(aa).
new text end

new text begin (b) Medical assistance provided under this subdivision shall be limited to services
provided during the period that the individual receives treatment for colorectal cancer.
new text end

new text begin (c) An individual meeting the criteria in paragraph (a) is eligible for medical
assistance without meeting the eligibility criteria relating to income and assets in section
256B.056, subdivisions 1a to 5b.
new text end

new text begin (d) This subdivision expires December 31, 2010.
new text end

Sec. 24.

Minnesota Statutes 2008, section 256B.0575, is amended to read:

256B.0575 AVAILABILITY OF INCOME FOR INSTITUTIONALIZED
PERSONS.

new text begin Subdivision 1. new text end

new text begin Income deductions. new text end

When an institutionalized person is determined
eligible for medical assistance, the income that exceeds the deductions in paragraphs (a)
and (b) must be applied to the cost of institutional care.

(a) The following amounts must be deducted from the institutionalized person's
income in the following order:

(1) the personal needs allowance under section 256B.35 or, for a veteran who
does not have a spouse or child, or a surviving spouse of a veteran having no child, the
amount of an improved pension received from the veteran's administration not exceeding
$90 per month;

(2) the personal allowance for disabled individuals under section 256B.36;

(3) if the institutionalized person has a legally appointed guardian or conservator,
five percent of the recipient's gross monthly income up to $100 as reimbursement for
guardianship or conservatorship services;

(4) a monthly income allowance determined under section 256B.058, subdivision
2, but only to the extent income of the institutionalized spouse is made available to the
community spouse;

(5) a monthly allowance for children under age 18 which, together with the net
income of the children, would provide income equal to the medical assistance standard
for families and children according to section 256B.056, subdivision 4, for a family size
that includes only the minor children. This deduction applies only if the children do not
live with the community spouse and only to the extent that the deduction is not included
in the personal needs allowance under section 256B.35, subdivision 1, as child support
garnished under a court order;

(6) a monthly family allowance for other family members, equal to one-third of the
difference between 122 percent of the federal poverty guidelines and the monthly income
for that family member;

(7) reparations payments made by the Federal Republic of Germany and reparations
payments made by the Netherlands for victims of Nazi persecution between 1940 and
1945;

(8) all other exclusions from income for institutionalized persons as mandated by
federal law; and

(9) amounts for reasonable expenses new text begin as specified in subdivision 2, new text end incurred for
necessary medical or remedial care for the institutionalized person that are new text begin recognized
under state law, new text end not medical assistance covered expenses new text begin , new text end and deleted text begin that are deleted text end not subject to
payment by a third party.

deleted text begin Reasonable expenses are limited to expenses that have not been previously used as a
deduction from income and are incurred during the enrollee's current period of eligibility,
including retroactive months associated with the current period of eligibility, for medical
assistance payment of long-term care services.
deleted text end

For purposes of clause (6), "other family member" means a person who resides
with the community spouse and who is a minor or dependent child, dependent parent, or
dependent sibling of either spouse. "Dependent" means a person who could be claimed as
a dependent for federal income tax purposes under the Internal Revenue Code.

(b) Income shall be allocated to an institutionalized person for a period of up to three
calendar months, in an amount equal to the medical assistance standard for a family
size of one if:

(1) a physician certifies that the person is expected to reside in the long-term care
facility for three calendar months or less;

(2) if the person has expenses of maintaining a residence in the community; and

(3) if one of the following circumstances apply:

(i) the person was not living together with a spouse or a family member as defined in
paragraph (a) when the person entered a long-term care facility; or

(ii) the person and the person's spouse become institutionalized on the same date, in
which case the allocation shall be applied to the income of one of the spouses.

For purposes of this paragraph, a person is determined to be residing in a licensed nursing
home, regional treatment center, or medical institution if the person is expected to remain
for a period of one full calendar month or more.

new text begin Subd. 2. new text end

new text begin Reasonable expenses. new text end

new text begin For the purposes of subdivision 1, paragraph (a),
clause (9), reasonable expenses are limited to expenses that have not been previously used
as a deduction from income and were not:
new text end

new text begin (1) for long-term care expenses incurred during a period of ineligibility as defined in
section 256B.0595, subdivision 2;
new text end

new text begin (2) incurred more than three months before the month of application associated with
the current period of eligibility;
new text end

new text begin (3) for expenses incurred by a recipient that are duplicative of services that are
covered under chapter 256B; or
new text end

new text begin (4) nursing facility expenses incurred without a timely assessment as required under
section 256B.0911.
new text end

Sec. 25.

Minnesota Statutes 2008, section 256B.0595, subdivision 1, is amended to
read:

Subdivision 1.

Prohibited transfers.

(a) For transfers of assets made on or before
August 10, 1993, if an institutionalized person or the institutionalized person's spouse has
given away, sold, or disposed of, for less than fair market value, any asset or interest
therein, except assets other than the homestead that are excluded under the supplemental
security program, within 30 months before or any time after the date of institutionalization
if the person has been determined eligible for medical assistance, or within 30 months
before or any time after the date of the first approved application for medical assistance
if the person has not yet been determined eligible for medical assistance, the person is
ineligible for long-term care services for the period of time determined under subdivision
2.

(b) Effective for transfers made after August 10, 1993, an institutionalized person, an
institutionalized person's spouse, or any person, court, or administrative body with legal
authority to act in place of, on behalf of, at the direction of, or upon the request of the
institutionalized person or institutionalized person's spouse, may not give away, sell, or
dispose of, for less than fair market value, any asset or interest therein, except assets other
than the homestead that are excluded under the Supplemental Security Income program,
for the purpose of establishing or maintaining medical assistance eligibility. This applies
to all transfers, including those made by a community spouse after the month in which
the institutionalized spouse is determined eligible for medical assistance. For purposes of
determining eligibility for long-term care services, any transfer of such assets within 36
months before or any time after an institutionalized person requests medical assistance
payment of long-term care services, or 36 months before or any time after a medical
assistance recipient becomes an institutionalized person, for less than fair market value
may be considered. Any such transfer is presumed to have been made for the purpose
of establishing or maintaining medical assistance eligibility and the institutionalized
person is ineligible for long-term care services for the period of time determined under
subdivision 2, unless the institutionalized person furnishes convincing evidence to
establish that the transaction was exclusively for another purpose, or unless the transfer is
permitted under subdivision 3 or 4. In the case of payments from a trust or portions of a
trust that are considered transfers of assets under federal law, or in the case of any other
disposal of assets made on or after February 8, 2006, any transfers made within 60 months
before or any time after an institutionalized person requests medical assistance payment of
long-term care services and within 60 months before or any time after a medical assistance
recipient becomes an institutionalized person, may be considered.

(c) This section applies to transfers, for less than fair market value, of income
or assets, including assets that are considered income in the month received, such as
inheritances, court settlements, and retroactive benefit payments or income to which the
institutionalized person or the institutionalized person's spouse is entitled but does not
receive due to action by the institutionalized person, the institutionalized person's spouse,
or any person, court, or administrative body with legal authority to act in place of, on
behalf of, at the direction of, or upon the request of the institutionalized person or the
institutionalized person's spouse.

(d) This section applies to payments for care or personal services provided by a
relative, unless the compensation was stipulated in a notarized, written agreement which
was in existence when the service was performed, the care or services directly benefited
the person, and the payments made represented reasonable compensation for the care
or services provided. A notarized written agreement is not required if payment for the
services was made within 60 days after the service was provided.

(e) This section applies to the portion of any asset or interest that an institutionalized
person, an institutionalized person's spouse, or any person, court, or administrative body
with legal authority to act in place of, on behalf of, at the direction of, or upon the request
of the institutionalized person or the institutionalized person's spouse, transfers to any
annuity that exceeds the value of the benefit likely to be returned to the institutionalized
person or institutionalized person's spouse while alive, based on estimated life expectancy
as determined according to the current actuarial tables published by the Office of the
Chief Actuary of the Social Security Administration. The commissioner may adopt rules
reducing life expectancies based on the need for long-term care. This section applies to an
annuity purchased on or after March 1, 2002, that:

(1) is not purchased from an insurance company or financial institution that is
subject to licensing or regulation by the Minnesota Department of Commerce or a similar
regulatory agency of another state;

(2) does not pay out principal and interest in equal monthly installments; or

(3) does not begin payment at the earliest possible date after annuitization.

(f) Effective for transactions, including the purchase of an annuity, occurring on or
after February 8, 2006, by or on behalf of an institutionalized person who has applied for
or is receiving long-term care services or the institutionalized person's spouse shall be
treated as the disposal of an asset for less than fair market value unless the department is
named a preferred remainder beneficiary as described in section 256B.056, subdivision
11. Any subsequent change to the designation of the department as a preferred remainder
beneficiary shall result in the annuity being treated as a disposal of assets for less than
fair market value. The amount of such transfer shall be the maximum amount the
institutionalized person or the institutionalized person's spouse could receive from the
annuity or similar financial instrument. Any change in the amount of the income or
principal being withdrawn from the annuity or other similar financial instrument at the
time of the most recent disclosure shall be deemed to be a transfer of assets for less than
fair market value unless the institutionalized person or the institutionalized person's spouse
demonstrates that the transaction was for fair market value. In the event a distribution
of income or principal has been improperly distributed or disbursed from an annuity or
other retirement planning instrument of an institutionalized person or the institutionalized
person's spouse, a cause of action exists against the individual receiving the improper
distribution for the cost of medical assistance services provided or the amount of the
improper distribution, whichever is less.

(g) Effective for transactions, including the purchase of an annuity, occurring on
or after February 8, 2006, by or on behalf of an institutionalized person applying for or
receiving long-term care services shall be treated as a disposal of assets for less than fair
market value unless it is:

(i) an annuity described in subsection (b) or (q) of section 408 of the Internal
Revenue Code of 1986; or

(ii) purchased with proceeds from:

(A) an account or trust described in subsection (a), (c), or (p) of section 408 of the
Internal Revenue Code;

(B) a simplified employee pension within the meaning of section 408(k) of the
Internal Revenue Code; or

(C) a Roth IRA described in section 408A of the Internal Revenue Code; or

(iii) an annuity that is irrevocable and nonassignable; is actuarially sound as
determined in accordance with actuarial publications of the Office of the Chief Actuary of
the Social Security Administration; and provides for payments in equal amounts during
the term of the annuity, with no deferral and no balloon payments made.

(h) For purposes of this section, long-term care services include services in a nursing
facility, services that are eligible for payment according to section 256B.0625, subdivision
2, because they are provided in a swing bed, intermediate care facility for persons with
developmental disabilities, and home and community-based services provided pursuant
to sections 256B.0915, 256B.092, and 256B.49. For purposes of this subdivision and
subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient
in a nursing facility or in a swing bed, or intermediate care facility for persons with
developmental disabilities or who is receiving home and community-based services under
sections 256B.0915, 256B.092, and 256B.49.

(i) This section applies to funds used to purchase a promissory note, loan, or
mortgage unless the note, loan, or mortgage:

(1) has a repayment term that is actuarially sound;

(2) provides for payments to be made in equal amounts during the term of the loan,
with no deferral and no balloon payments made; and

(3) prohibits the cancellation of the balance upon the death of the lender.

In the case of a promissory note, loan, or mortgage that does not meet an exception
in clauses (1) to (3), the value of such note, loan, or mortgage shall be the outstanding
balance due as of the date of the institutionalized person's request for medical assistance
payment of long-term care services.

(j) This section applies to the purchase of a life estate interest in another person's
home unless the purchaser resides in the home for a period of at least one year after the
date of purchase.

new text begin (k) This section applies to transfers into a pooled trust that qualifies under United
States Code, title 42, section 1396p(d)(4)(C), by:
new text end

new text begin (1) a person age 65 or older or the person's spouse; or
new text end

new text begin (2) any person, court, or administrative body with legal authority to act in place
of, on behalf of, at the direction of, or upon the request of a person age 65 or older or
the person's spouse.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011.
new text end

Sec. 26.

Minnesota Statutes 2008, section 256B.0595, subdivision 2, is amended to
read:

Subd. 2.

Period of ineligibility new text begin for long-term care services new text end .

(a) For any
uncompensated transfer occurring on or before August 10, 1993, the number of months
of ineligibility for long-term care services shall be the lesser of 30 months, or the
uncompensated transfer amount divided by the average medical assistance rate for nursing
facility services in the state in effect on the date of application. The amount used to
calculate the average medical assistance payment rate shall be adjusted each July 1 to
reflect payment rates for the previous calendar year. The period of ineligibility begins
with the month in which the assets were transferred. If the transfer was not reported to
the local agency at the time of application, and the applicant received long-term care
services during what would have been the period of ineligibility if the transfer had been
reported, a cause of action exists against the transferee for the cost of long-term care
services provided during the period of ineligibility, or for the uncompensated amount of
the transfer, whichever is less. The uncompensated transfer amount is the fair market
value of the asset at the time it was given away, sold, or disposed of, less the amount of
compensation received.

(b) For uncompensated transfers made after August 10, 1993, the number of months
of ineligibility for long-term care services shall be the total uncompensated value of the
resources transferred divided by the average medical assistance rate for nursing facility
services in the state in effect on the date of application. The amount used to calculate
the average medical assistance payment rate shall be adjusted each July 1 to reflect
payment rates for the previous calendar year. The period of ineligibility begins with the
first day of the month after the month in which the assets were transferred except that
if one or more uncompensated transfers are made during a period of ineligibility, the
total assets transferred during the ineligibility period shall be combined and a penalty
period calculated to begin on the first day of the month after the month in which the first
uncompensated transfer was made. If the transfer was reported to the local agency after
the date that advance notice of a period of ineligibility that affects the next month could
be provided to the recipient and the recipient received medical assistance services or the
transfer was not reported to the local agency, and the applicant or recipient received
medical assistance services during what would have been the period of ineligibility if
the transfer had been reported, a cause of action exists against the transferee for that
portion of long-term care services provided during the period of ineligibility, or for the
uncompensated amount of the transfer, whichever is less. The uncompensated transfer
amount is the fair market value of the asset at the time it was given away, sold, or disposed
of, less the amount of compensation received. Effective for transfers made on or after
March 1, 1996, involving persons who apply for medical assistance on or after April 13,
1996, no cause of action exists for a transfer unless:

(1) the transferee knew or should have known that the transfer was being made by a
person who was a resident of a long-term care facility or was receiving that level of care in
the community at the time of the transfer;

(2) the transferee knew or should have known that the transfer was being made to
assist the person to qualify for or retain medical assistance eligibility; or

(3) the transferee actively solicited the transfer with intent to assist the person to
qualify for or retain eligibility for medical assistance.

(c) For uncompensated transfers made on or after February 8, 2006, the period
of ineligibility:

(1) for uncompensated transfers by or on behalf of individuals receiving medical
assistance payment of long-term care services, begins the first day of the month following
advance notice of the deleted text begin penalty deleted text end period new text begin of ineligibility new text end , but no later than the first day of the
month that follows three full calendar months from the date of the report or discovery
of the transfer; or

(2) for uncompensated transfers by individuals requesting medical assistance
payment of long-term care services, begins the date on which the individual is eligible
for medical assistance under the Medicaid state plan and would otherwise be receiving
long-term care services based on an approved application for such care but for the
deleted text begin application of the penalty deleted text end period new text begin of ineligibility resulting from the uncompensated
transfer new text end ; and

(3) cannot begin during any other period of ineligibility.

(d) If a calculation of a deleted text begin penalty deleted text end period new text begin of ineligibility new text end results in a partial month,
payments for long-term care services shall be reduced in an amount equal to the fraction.

(e) In the case of multiple fractional transfers of assets in more than one month for
less than fair market value on or after February 8, 2006, the period of ineligibility is
calculated by treating the total, cumulative, uncompensated value of all assets transferred
during all months on or after February 8, 2006, as one transfer.

new text begin (f) A period of ineligibility established under paragraph (c) may be eliminated if
all of the assets transferred for less than fair market value used to calculate the period of
ineligibility, or cash equal to the value of the assets at the time of the transfer, are returned
within 12 months after the date the period of ineligibility begins. A period of ineligibility
must not be adjusted if less than the full amounts of the transferred assets or the full cash
values of the transferred assets are returned.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for periods of ineligibility established
on or after January 1, 2011.
new text end

Sec. 27.

Minnesota Statutes 2008, section 256B.06, subdivision 4, is amended to read:

Subd. 4.

Citizenship requirements.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Beginning December 1, 1996, qualified noncitizens who do not meet one of the
criteria in items (i) to (v) are eligible for medical assistance without federal financial
participation as described in paragraph (j). new text begin Notwithstanding paragraph (j), beginning
July 1, 2010, children and pregnant women who are qualified noncitizens, as described
in paragraph (b), are eligible for medical assistance with federal financial participation
as provided by the federal Children's Health Insurance Program Reauthorization Act of
2009, Public Law 111-3.
new text end

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

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

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

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

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

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

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

(i) new text begin Beginning July 1, 2009, new text end pregnant noncitizens who are undocumented,
nonimmigrants, or deleted text begin eligible for medical assistance as described in paragraph (j), and who
are not covered by a group health plan or health insurance coverage according to Code of
Federal Regulations, title 42, section 457.310, deleted text end new text begin lawfully present as designated in paragraph
(e), new text end and who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance through the period of pregnancy, including labor and delivery, new text begin and 60
days postpartum, new text end to the extent federal funds are available under title XXI of the Social
Security Act, and the state children's health insurance program deleted text begin , followed by 60 days
postpartum without federal financial participation deleted text end .

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

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2009.
new text end

Sec. 28.

Minnesota Statutes 2008, section 256B.06, subdivision 5, is amended to read:

Subd. 5.

Deeming of sponsor income and resources.

When determining eligibility
for any federal or state funded medical assistance under this section, the income
and resources of all noncitizens shall be deemed to include their sponsors' income
and resources as required under the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules. This section is effective May 1, 1997. new text begin Beginning
July 1, 2010, sponsor deeming does not apply to pregnant women and children who are
qualified noncitizens, as described in section 256B.06, subdivision 4, paragraph (b).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 29.

Minnesota Statutes 2008, section 256B.0625, subdivision 3, is amended to
read:

Subd. 3.

Physicians' services.

new text begin (a) new text end Medical assistance covers physicians' services.

new text begin (b) new text end Rates paid for anesthesiology services provided by physicians shall new text begin only be paid
if the physician directly performs the services. Rates for anesthesiology services that
are directly provided by the physician shall new text end be new text begin paid new text end according to the formula utilized in
the Medicare program and shall use a conversion factor "at percentile of calendar year
set by legislature."

new text begin (c) Medical assistance does not cover physicians' services related to the provision of
care related to a treatment reportable under section 144.7065, subdivision 2, clauses (1),
(2), (3), and (5), and subdivision 7, clause (1).
new text end

new text begin (d) Medical assistance does not cover physicians' services related to the provision of
care (1) for which hospital reimbursement is prohibited under section 256.969, subdivision
3b, paragraph (c), or (2) reportable under section 144.7065, subdivisions 2 to 7, if the
physicians' services are billed by a physician who delivered care that contributed to or
caused the adverse health care event or hospital-acquired condition.
new text end

new text begin (e) The payment limitations in this subdivision shall also apply to MinnesotaCare
and general assistance medical care.
new text end

new text begin (f) A physician shall not bill a recipient of services for any payment disallowed
under this subdivision.
new text end

Sec. 30.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 9a. new text end

new text begin Dental services for children. new text end

new text begin (a) Medical assistance covers dental
services for children with the following limits:
new text end

new text begin (1) the application of sealants are limited to permanent teeth and to once every
five years;
new text end

new text begin (2) the application of fluoride varnish is limited to once every six months; and
new text end

new text begin (3) posterior and anterior restorations shall be reimbursed at the amalgam rate
regardless of the materials used.
new text end

new text begin (b) Dental services provided under this subdivision shall be reimbursed on a
fee-for-service basis in accordance with section 256B.76.
new text end

Sec. 31.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 9b. new text end

new text begin Dental services for adult recipients. new text end

new text begin (a) Medical assistance covers
the following dental services for adults:
new text end

new text begin (1) diagnostic services limited to:
new text end

new text begin (i) a comprehensive examination, once every five years;
new text end

new text begin (ii) a periodic examination, once per year;
new text end

new text begin (iii) a limited examination, once every two years;
new text end

new text begin (iv) bitewing x-rays, once every two years;
new text end

new text begin (v) periapical x-rays; and
new text end

new text begin (vi) panoramic x-rays, once every five years; or in conjunction with a posterior
extraction, a scheduled outpatient facility procedure, or as medically necessary for
diagnosis and follow up of oral and maxillofacial pathology and trauma. Panoramic x-rays
may be taken once every two years for patients who cannot cooperate for intraoral film
due to a developmental disability or medical condition that does not allow for intraoral
film placement;
new text end

new text begin (2) preventive services limited to:
new text end

new text begin (i) prophylaxis, once per year;
new text end

new text begin (ii) the application of fluoride varnish, once per year;
new text end

new text begin (3) posterior and anterior restorations, reimbursed at the amalgam rate regardless of
the material used;
new text end

new text begin (4) endodontic services limited to root canals on the anterior and premolars only;
new text end

new text begin (5) periodontic services limited to full-mouth debridement, once every five years;
new text end

new text begin (6) prosthodontics: dentures or partials are limited to one set every six years;
new text end

new text begin (7) oral surgery is limited to biopsies, extractions, incisions, and the drainage of
abscesses; and
new text end

new text begin (8) palliative treatment and sedative fillings for relief of pain.
new text end

new text begin (b) In addition to the services specified in paragraph (a), medical assistance covers
the following services if provided in an outpatient hospital setting or free-standing
ambulatory surgical center as part of outpatient dental surgery:
new text end

new text begin (1) diagnostic services limited to full-mouth survey, once every five years;
new text end

new text begin (2) periodontics services limited to periodental scaling and root planing, once every
two years; and
new text end

new text begin (3) general anesthesia.
new text end

new text begin (c) Dental services provided under this subdivision shall be reimbursed on a
fee-for-service basis in accordance with section 256B.76.
new text end

Sec. 32.

Minnesota Statutes 2008, section 256B.0625, subdivision 11, is amended to
read:

Subd. 11.

Nurse anesthetist services.

Medical assistance covers nurse anesthetist
services. Rates paid for anesthesiology services provided by new text begin a new text end certified registered nurse
deleted text begin anesthetists deleted text end new text begin anesthetist under the direction of a physician new text end shall be according to the formula
utilized in the Medicare program and shall use the conversion factor that is used by the
Medicare program. new text begin Rates paid for anesthesiology services provided by a nondirected
certified registered nurse anesthetist who is not directed by an anesthesiologist shall be
the same rate as paid under subdivision 3, paragraph (b).
new text end

Sec. 33.

Minnesota Statutes 2008, section 256B.0625, subdivision 13, is amended to
read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs
when specifically used to enhance fertility, if prescribed by a licensed practitioner and
dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance
program as a dispensing physician, or by a physician new text begin , physician assistant, new text end or a nurse
practitioner employed by or under contract with a community health board as defined in
section 145A.02, subdivision 5, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.

(c) Medical assistance covers the following over-the-counter drugs when prescribed
by a licensed practitioner or by a licensed pharmacist who meets standards established by
the commissioner, in consultation with the board of pharmacy: antacids, acetaminophen,
family planning products, aspirin, insulin, products for the treatment of lice, vitamins for
adults with documented vitamin deficiencies, vitamins for children under the age of seven
and pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the formulary committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions,
or disorders, and this determination shall not be subject to the requirements of chapter
14. A pharmacist may prescribe over-the-counter medications as provided under this
paragraph for purposes of receiving reimbursement under Medicaid. When prescribing
over-the-counter drugs under this paragraph, licensed pharmacists must consult with the
recipient to determine necessity, provide drug counseling, review drug therapy for potential
adverse interactions, and make referrals as needed to other health care professionals.

(d) Effective January 1, 2006, medical assistance shall not cover drugs that
are coverable under Medicare Part D as defined in the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e),
for individuals eligible for drug coverage as defined in the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section
1860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the
drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this
subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code,
title 42, section 1396r-8(d)(2)(E), shall not be covered.

Sec. 34.

Minnesota Statutes 2008, section 256B.0625, subdivision 13e, is amended to
read:

Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment
shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee;
the maximum allowable cost set by the federal government or by the commissioner plus
the fixed dispensing fee; or the usual and customary price charged to the public. The
amount of payment basis must be reduced to reflect all discount amounts applied to the
charge by any 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 pharmacy dispensing fee shall be $3.65, except that the dispensing fee
for intravenous solutions which must be compounded by the pharmacist shall be $8 per
bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral
nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral
nutritional products dispensed in quantities greater than one liter. Actual acquisition
cost includes quantity and other special discounts except time and cash discounts.
Effective July 1, deleted text begin 2008 deleted text end new text begin 2009 new text end , the actual acquisition cost of a drug shall be estimated by the
commissioner, at average wholesale price minus deleted text begin 14 deleted text end new text begin 15 new text end percent. The actual acquisition
cost of antihemophilic factor drugs shall be estimated at the average wholesale price
minus 30 percent. The maximum allowable cost of a multisource drug may be set by the
commissioner and it shall be comparable to, but no higher than, the maximum amount
paid by other third-party payors in this state who have maximum allowable cost programs.
Establishment of the amount of payment for drugs shall not be subject to the requirements
of the Administrative Procedure Act.

(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
to pharmacists for legend drug prescriptions dispensed to residents of long-term care
facilities when a unit dose blister card system, approved by the department, is used. Under
this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.
The National Drug Code (NDC) from the drug container used to fill the blister card must
be identified on the claim to the department. The unit dose blister card containing the
drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700,
that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider
will be required to credit the department for the actual acquisition cost of all unused
drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
manufacturer's unopened package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.

(c) Whenever a generically equivalent product is available, payment shall be on the
basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost
established by the commissioner.

(d) 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 or the amount established for Medicare by the United States Department of
Health and Human Services pursuant to title XVIII, section 1847a of the federal Social
Security Act.

(e) The commissioner may negotiate lower reimbursement rates for specialty
pharmacy products than the rates 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, 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 this paragraph. 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 reimbursement rate to prevent access to care issues.

Sec. 35.

Minnesota Statutes 2008, section 256B.0625, subdivision 13h, is amended to
read:

Subd. 13h.

Medication therapy management services.

(a) Medical assistance
and general assistance medical care cover medication therapy management services for
a recipient taking four or more prescriptions to treat or prevent two or more chronic
medical conditions, or a recipient with a drug therapy problem that is identified or prior
authorized by the commissioner that has resulted or is likely to result in significant
nondrug program costs. The commissioner may cover medical therapy management
services under MinnesotaCare if the commissioner determines this is cost-effective. For
purposes of this subdivision, "medication therapy management" means the provision
of the following pharmaceutical care services by a licensed pharmacist to optimize the
therapeutic outcomes of the patient's medications:

(1) performing or obtaining necessary assessments of the patient's health status;

(2) formulating a medication treatment plan;

(3) monitoring and evaluating the patient's response to therapy, including safety
and effectiveness;

(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;

(5) documenting the care delivered and communicating essential information to
the patient's other primary care providers;

(6) providing verbal education and training designed to enhance patient
understanding and appropriate use of the patient's medications;

(7) providing information, support services, and resources designed to enhance
patient adherence with the patient's therapeutic regimens; and

(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.

Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.

(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:

(1) have a valid license issued under chapter 151;

(2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;

(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the
setting, or in home settings, excluding long-term care and group homes, if the service is
ordered by the provider-directed care coordination team; and

(4) make use of an electronic patient record system that meets state standards.

(c) For purposes of reimbursement for medication therapy management services,
the commissioner may enroll individual pharmacists as medical assistance and general
assistance medical care providers. The commissioner may also establish contact
requirements between the pharmacist and recipient, including limiting the number of
reimbursable consultations per recipient.

deleted text begin (d) The commissioner, after receiving recommendations from professional medical
associations, professional pharmacy associations, and consumer groups, shall convene
an 11-member Medication Therapy Management Advisory Committee to advise
the commissioner on the implementation and administration of medication therapy
management services. The committee shall be comprised of: two licensed physicians;
two licensed pharmacists; two consumer representatives; two health plan company
representatives; and three members with expertise in the area of medication therapy
management, who may be licensed physicians or licensed pharmacists. The committee is
governed by section 15.059, except that committee members do not receive compensation
or reimbursement for expenses. The advisory committee expires on June 30, 2007.
deleted text end

deleted text begin (e) The commissioner shall evaluate the effect of medication therapy management
on quality of care, patient outcomes, and program costs, and shall include a description
of any savings generated in the medical assistance and general assistance medical care
programs that can be attributable to this coverage. The evaluation shall be submitted to
the legislature by December 15, 2007. The commissioner may contract with a vendor
or an academic institution that has expertise in evaluating health care outcomes for the
purpose of completing the evaluation.
deleted text end

new text begin (d) The commissioner shall establish a pilot project for an intensive medication
therapy management program for patients identified by the commissioner with multiple
chronic conditions and a high number of medications who are at high risk of preventable
hospitalizations, emergency room use, medication complications, and suboptimal
treatment outcomes due to medication-related problems. For purposes of the pilot
project, medication therapy management services may be provided in a patient's home
or community setting, in addition to other authorized settings. The commissioner may
waive existing payment policies and establish special payment rates for the pilot project.
The pilot project must be designed to produce a net savings to the state compared to the
estimated costs that would otherwise be incurred for similar patients without the program.
new text end

Sec. 36.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 13i. new text end

new text begin Collaborative psychiatric consultation. new text end

new text begin (a) Within the available
appropriations, the commissioner shall establish a collaborative psychiatric consultation
service to be available via telephone, interactive video, e-mail, facsimile, or other means
of communication to primary care practitioners, including pediatricians. The service shall
include child and adolescent psychiatrists was well as adult psychiatrists. The first priority
for this service shall be to provide the consultations required under paragraph (b).
new text end

new text begin (b) The commissioner shall require prior authorization and a collaborative
psychiatric consultation for attention deficit/hyperactivity disorder (ADHD) and attention
deficit disorder (ADD) medication and psychotropic medication prescribed to children
under the following circumstances:
new text end

new text begin (1) prior authorization and a collaborative consultation from a
commissioner-approved provider shall be required when ADD or ADHD medication is
prescribed to children under five years of age;
new text end

new text begin (2) a collaborative consultation from a commissioner-approved provider shall be
required when ADD or ADHD medication is prescribed for children five years of age
and under 18 years of age for ADHD medications if the prescribed amount exceeds the
following dosages:
new text end

new text begin (i) methylphenidates 120 mg/day;
new text end

new text begin (ii) dexmethylphenidates 60 mg/day;
new text end

new text begin (iii) amphetamines 60 mg/day; and
new text end

new text begin (iv) Strattera 120 mg/day.
new text end

new text begin The commissioner shall periodically review the list of medications included in this
paragraph and update the medications and dosages listed as needed, in accordance with
the requirements in subdivision 13f, paragraph (b);
new text end

new text begin (3) prior authorization and a collaborative consultation from a
commissioner-approved provider shall be required when more than one type of medication
identified in clause (2) is prescribed at one time to a child under the age of 18; and
new text end

new text begin (4) a collaborative consultation from a commissioner-approved provider shall be
required if any of the following conditions apply:
new text end

new text begin (i) the absence of a DSM-IV diagnosis in the child's claim record;
new text end

new text begin (ii) five or more psychotropic medications prescribed concomitantly after 60 days;
new text end

new text begin (iii) two or more concomitant antipsychotic medications after 60 days;
new text end

new text begin (iv) three or more concomitant mood stabilizer medications for a mental health
diagnosis after 60 days;
new text end

new text begin (v) the prescribed psychotropic medication is not consistent with appropriate care
for the child's diagnosed mental disorder or with documented target symptoms associated
with a therapeutic response to the medication prescribed; and
new text end

new text begin (vi) psychotropic medications prescribed for children under five years of age.
new text end

new text begin The commissioner may establish threshold amounts for identified psychotropic
medications that, if exceeded, may require a collaborative consultation from a
commissioner-approved provider.
new text end

Sec. 37.

Minnesota Statutes 2008, section 256B.0625, subdivision 17, is amended to
read:

Subd. 17.

Transportation costs.

(a) Medical assistance covers new text begin medical
new text end transportation costs incurred solely for obtaining emergency medical care or transportation
costs incurred by eligible persons in obtaining emergency or nonemergency medical
care when paid directly to an ambulance company, common carrier, or other recognized
providers of transportation services. new text begin Medical transportation must be provided by:
new text end

new text begin (1) an ambulance, as defined in section 144E.001, subdivision 2;
new text end

new text begin (2) special transportation; or
new text end

new text begin (3) common carrier including, but not limited to, bus, taxicab, other commercial
carrier, or private automobile.
new text end

(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
transportation, or private automobile.

The commissioner may use an order by the recipient's attending physician to certify that
the recipient requires special transportation services. Special transportation deleted text begin includes deleted text end new text begin
providers shall perform new text end driver-assisted deleted text begin service to deleted text end new text begin services for new text end eligible individuals.
Driver-assisted service includes passenger pickup at and return to the individual's
residence or place of business, assistance with admittance of the individual to the medical
facility, and assistance in passenger securement or in securing of wheelchairs or stretchers
in the vehicle. Special transportation providers must obtain written documentation
from the health care service provider who is serving the recipient being transported,
identifying the time that the recipient arrived. Special transportation providers may not
bill for separate base rates for the continuation of a trip beyond the original destination.
Special transportation providers must take recipients to the nearest appropriate health
care provider, using the most direct route deleted text begin available deleted text end . The deleted text begin maximum deleted text end new text begin minimum new text end medical
assistance reimbursement rates for special transportation services are:

(1) new text begin (i) new text end $17 for the base rate and $1.35 per mile for new text begin special transportation new text end services to
eligible persons who need a wheelchair-accessible van;

deleted text begin (2) deleted text end new text begin (ii) new text end $11.50 for the base rate and $1.30 per mile for new text begin special transportation new text end services
to eligible persons who do not need a wheelchair-accessible van; and

deleted text begin (3) deleted text end new text begin (iii) new text end $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip,
for new text begin special transportation new text end services to eligible persons who need a stretcher-accessible
vehicle new text begin ;
new text end

new text begin (2) the base rates for special transportation services in areas defined under RUCA
to be super rural shall be equal to the reimbursement rate established in clause (1) plus
11.3 percent; and
new text end

new text begin (3) for special transportation services in areas defined under RUCA to be rural
or super rural areas:
new text end

new text begin (i) for a trip equal to 17 miles or less, mileage reimbursement shall be equal to 125
percent of the respective mileage rate in clause (1); and
new text end

new text begin (ii) for a trip between 18 and 50 miles, mileage reimbursement shall be equal to
112.5 percent of the respective mileage rate in clause (1).
new text end

new text begin (c) For purposes of reimbursement rates for special transportation services under
paragraph (b), the zip code of the recipient's place of residence shall determine whether
the urban, rural, or super rural reimbursement rate applies new text end .

new text begin (d) For purposes of this subdivision, "rural urban commuting area" or "RUCA"
means a census-tract based classification system under which a geographical area is
determined to be urban, rural, or super rural.
new text end

Sec. 38.

Minnesota Statutes 2008, section 256B.0625, subdivision 17a, is amended to
read:

Subd. 17a.

Payment for ambulance services.

new text begin Medical assistance covers
ambulance services. Providers shall bill ambulance services according to Medicare
criteria. Nonemergency ambulance services shall not be paid as emergencies. new text end Effective
for services rendered on or after July 1, 2001, medical assistance payments for ambulance
services shall be paid at the Medicare reimbursement rate or at the medical assistance
payment rate in effect on July 1, 2000, whichever is greater.

Sec. 39.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 18b. new text end

new text begin Broker dispatching prohibition. new text end

new text begin The commissioner shall not use a
broker or coordinator for any purpose related to transportation services under subdivision
18.
new text end

Sec. 40.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 25a. new text end

new text begin Prior authorization of diagnostic imaging services. new text end

new text begin (a) Effective
January 1, 2010, the commissioner shall require prior authorization or decision support
for the ordering providers at the time the service is ordered for the following outpatient
diagnostic imaging services: computerized tomography (CT), magnetic resonance
imaging (MRI), magnetic resonance angiography (MRA), positive emission tomography
(PET), cardiac imaging and ultrasound diagnostic imaging.
new text end

new text begin (b) Prior authorization under this subdivision is not required for diagnostic imaging
services performed as part of a hospital emergency room visit, inpatient hospitalization, or
if concurrent with or on the same day as an urgent care facility visit.
new text end

new text begin (c) This subdivision does not apply to services provided to recipients who are
enrolled in Medicare, the prepaid medical assistance program, the prepaid general
assistance medical care program, or the MinnesotaCare program.
new text end

new text begin (d) The commissioner may contract with a private entity to provide the prior
authorization or decision support required under this subdivision. The contracting entity
must incorporate clinical guidelines that are based on evidence-based medical literature, if
available. By January 1, 2012, the contracting entity shall report to the commissioner the
results of prior authorization or decision support.
new text end

Sec. 41.

Minnesota Statutes 2008, section 256B.0625, subdivision 26, is amended to
read:

Subd. 26.

Special education services.

(a) Medical assistance covers medical
services identified in a recipient's individualized education plan and covered under the
medical assistance state plan. Covered services include occupational therapy, physical
therapy, speech-language therapy, clinical psychological services, nursing services,
school psychological services, school social work services, personal care assistants
serving as management aides, assistive technology devices, transportation services,
health assessments, and other services covered under the medical assistance state plan.
Mental health services eligible for medical assistance reimbursement must be provided or
coordinated through a children's mental health collaborative where a collaborative exists if
the child is included in the collaborative operational target population. The provision or
coordination of services does not require that the individual education plan be developed
by the collaborative.

The services may be provided by a Minnesota school district that is enrolled as a
medical assistance provider or its subcontractor, and only if the services meet all the
requirements otherwise applicable if the service had been provided by a provider other
than a school district, in the following areas: medical necessity, physician's orders,
documentation, personnel qualifications, and prior authorization requirements. The
nonfederal share of costs for services provided under this subdivision is the responsibility
of the local school district as provided in section 125A.74. Services listed in a child's
individual education plan are eligible for medical assistance reimbursement only if those
services meet criteria for federal financial participation under the Medicaid program.

(b) Approval of health-related services for inclusion in the individual education plan
does not require prior authorization for purposes of reimbursement under this chapter.
The commissioner may require physician review and approval of the plan not more than
once annually or upon any modification of the individual education plan that reflects a
change in health-related services.

(c) Services of a speech-language pathologist provided under this section are covered
notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:

(1) holds a masters degree in speech-language pathology;

(2) is licensed by the Minnesota Board of Teaching as an educational
speech-language pathologist; and

(3) either has a certificate of clinical competence from the American Speech and
Hearing Association, has completed the equivalent educational requirements and work
experience necessary for the certificate or has completed the academic program and is
acquiring supervised work experience to qualify for the certificate.

(d) Medical assistance coverage for medically necessary services provided under
other subdivisions in this section may not be denied solely on the basis that the same or
similar services are covered under this subdivision.

(e) The commissioner shall develop and implement package rates, bundled rates, or
per diem rates for special education services under which separately covered services are
grouped together and billed as a unit in order to reduce administrative complexity.

(f) The commissioner shall develop a cost-based payment structure for payment
of these services. new text begin The commissioner shall reimburse claims submitted based on an
interim rate, and shall settle at a final rate once the department has determined it. The
commissioner shall notify the school district of the final rate. The school district has 60
days to appeal the final rate. To appeal the final rate, the school district shall file a written
appeal request to the commissioner within 60 days of the date the final rate determination
was mailed. The appeal request shall specify (1) the disputed items and (2) the name and
address of the person to contact regarding the appeal.
new text end

(g) Effective July 1, 2000, medical assistance services provided under an individual
education plan or an individual family service plan by local school districts shall not count
against medical assistance authorization thresholds for that child.

(h) Nursing services as defined in section 148.171, subdivision 15, and provided
as an individual education plan health-related service, are eligible for medical assistance
payment if they are otherwise a covered service under the medical assistance program.
Medical assistance covers the administration of prescription medications by a licensed
nurse who is employed by or under contract with a school district when the administration
of medications is identified in the child's individualized education plan. The simple
administration of medications alone is not covered under medical assistance when
administered by a provider other than a school district or when it is not identified in the
child's individualized education plan.

Sec. 42.

Minnesota Statutes 2008, section 256B.0751, subdivision 7, is amended to
read:

Subd. 7.

Outreach.

Beginning July 1, 2009, the commissioner shall deleted text begin encourage deleted text end
new text begin require new text end state health care program enrollees who have a complex or chronic condition to
select a primary care clinic with clinicians who have been certified as health care homes new text begin ,
if there are two or more primary care clinics with clinicians who have been certified as
health care homes available to the enrollee new text end .

Sec. 43.

new text begin [256B.0756] PODIATRY-DIRECTED WOUND CARE FOR
DIABETICS.
new text end

new text begin (a) The commissioner shall implement a demonstration project for enrollees in
medical assistance or general assistance medical care who have or are at risk of developing
diabetes. The project shall be designed as a podiatry-directed wound care program that
focuses on the prevention and care of diabetic-related wounds in order to reduce wound
treatment costs and prevent amputations.
new text end

new text begin (b) The commissioner, in consultation with the Minnesota Podiatric Medical
Association, shall develop the request for proposals to be submitted by providers or
groups of providers by November 1, 2009, for implementation by January 1, 2010. The
proposals must incorporate:
new text end

new text begin (1) health care provider education and training;
new text end

new text begin (2) patient education and training;
new text end

new text begin (3) patient evaluation and assessments;
new text end

new text begin (4) new wound diagnostic, treatment, and prevention technologies using best
practices in wound treatment;
new text end

new text begin (5) an electronic reporting system for patient measurement, monitoring, and
reporting; and
new text end

new text begin (6) a process for documenting patient compliance and satisfaction.
new text end

new text begin (c) The commissioner may establish minimum standards for quality care that must
be met by participating providers and must establish quality measurements for the project.
new text end

new text begin (d) The project shall provide podiatric wound care to at least 1,000 enrollees for
a two-year period. To the extent possible, the commissioner shall include enrollees
throughout the state.
new text end

new text begin (e) The commissioner shall report to the legislature by January 15, 2013, the status
of the demonstration project, including the number of patients, patient compliance,
patient satisfaction, amputation data, and cost-savings data related to drug utilization and
treatment-related costs.
new text end

new text begin (f) The commissioner shall seek any federal waivers necessary to obtain federal
matching funds.
new text end

Sec. 44.

Minnesota Statutes 2008, section 256B.08, is amended by adding a
subdivision to read:

new text begin Subd. 4. new text end

new text begin Social Security data. new text end

new text begin The commissioner shall accept data received from
the Social Security Administration as an application for medical assistance in accordance
with United States Code, title 42, section 1396u-5(a).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010.
new text end

Sec. 45.

Minnesota Statutes 2008, section 256B.15, subdivision 1, is amended to read:

Subdivision 1.

Policy and applicability.

(a) It is the policy of this state that
individuals or couples, either or both of whom participate in the medical assistance
program, use their own assets to pay their share of the total cost of their care during or
after their enrollment in the program according to applicable federal law and the laws of
this state. The following provisions apply:

(1) subdivisions 1c to 1k shall not apply to claims arising under this section which
are presented under section 525.313;

(2) the provisions of subdivisions 1c to 1k expanding the interests included in an
estate for purposes of recovery under this section give effect to the provisions of United
States Code, title 42, section 1396p, governing recoveries, but do not give rise to any
express or implied liens in favor of any other parties not named in these provisions;

(3) the continuation of a recipient's life estate or joint tenancy interest in real
property after the recipient's death for the purpose of recovering medical assistance under
this section modifies common law principles holding that these interests terminate on
the death of the holder;

(4) all laws, rules, and regulations governing or involved with a recovery of medical
assistance shall be liberally construed to accomplish their intended purposes;

(5) a deceased recipient's life estate and joint tenancy interests continued under this
section shall be owned by the remaindermen or surviving joint tenants as their interests
may appear on the date of the recipient's death. They shall not be merged into the
remainder interest or the interests of the surviving joint tenants by reason of ownership.
They shall be subject to the provisions of this section. Any conveyance, transfer, sale,
assignment, or encumbrance by a remainderman, a surviving joint tenant, or their heirs,
successors, and assigns shall be deemed to include all of their interest in the deceased
recipient's life estate or joint tenancy interest continued under this section; and

(6) the provisions of subdivisions 1c to 1k continuing a recipient's joint tenancy
interests in real property after the recipient's death do not apply to a homestead owned
of record, on the date the recipient dies, by the recipient and the recipient's spouse as
joint tenants with a right of survivorship. Homestead means the real property occupied
by the surviving joint tenant spouse as their sole residence on the date the recipient dies
and classified and taxed to the recipient and surviving joint tenant spouse as homestead
property for property tax purposes in the calendar year in which the recipient dies. For
purposes of this exemption, real property the recipient and their surviving joint tenant
spouse purchase solely with the proceeds from the sale of their prior homestead, own
of record as joint tenants, and qualify as homestead property under section 273.124 in
the calendar year in which the recipient dies and prior to the recipient's death shall be
deemed to be real property classified and taxed to the recipient and their surviving joint
tenant spouse as homestead property in the calendar year in which the recipient dies.
The surviving spouse, or any person with personal knowledge of the facts, may provide
an affidavit describing the homestead property affected by this clause and stating facts
showing compliance with this clause. The affidavit shall be prima facie evidence of the
facts it states.

(b) For purposes of this section, "medical assistance" includes the medical assistance
program under this chapter and the general assistance medical care program under chapter
256D and alternative care for nonmedical assistance recipients under section 256B.0913.

(c) new text begin For purposes of this section, beginning January 1, 2010, "medical assistance"
does not include Medicare cost-sharing benefits in accordance with United States Code,
title 42, section 1396p.
new text end

new text begin (d) new text end All provisions in this subdivision, and subdivisions 1d, 1f, 1g, 1h, 1i, and 1j,
related to the continuation of a recipient's life estate or joint tenancy interests in real
property after the recipient's death for the purpose of recovering medical assistance, are
effective only for life estates and joint tenancy interests established on or after August 1,
2003. For purposes of this paragraph, medical assistance does not include alternative care.

Sec. 46.

Minnesota Statutes 2008, section 256B.15, subdivision 1a, is amended to read:

Subd. 1a.

Estates subject to claims.

new text begin (a) new text end If a person receives any medical assistance
hereunder, on the person's death, if single, or on the death of the survivor of a married
couple, either or both of whom received medical assistance, or as otherwise provided
for in this section, the total amount paid for medical assistance rendered for the person
and spouse shall be filed as a claim against the estate of the person or the estate of the
surviving spouse in the court having jurisdiction to probate the estate or to issue a decree
of descent according to sections 525.31 to 525.313.

new text begin (b) For the purposes of this section, the person's estate must consist of:
new text end

new text begin (1) the person's probate estate;
new text end

new text begin (2) all of the person's interests or proceeds of those interests in real property the
person owned as a life tenant or as a joint tenant with a right of survivorship at the time of
the person's death;
new text end

new text begin (3) all of the person's interests or proceeds of those interests in securities the person
owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time
of the person's death, to the extent the interests or proceeds of those interests become part
of the probate estate under section 524.6-307;
new text end

new text begin (4) all of the person's interests in joint accounts, multiple-party accounts, and
pay-on-death accounts, brokerage accounts, investment accounts, or the proceeds of
those accounts, as provided under sections 524.6-201 to 524.6-214 at the time of the
person's death to the extent the interests become part of the probate estate under section
524.6-207; and
new text end

new text begin (5) assets conveyed to a survivor, heir, or assign of the person through survivorship,
living trust, or other arrangements.
new text end

new text begin (c) For the purpose of this section and recovery in a surviving spouse's estate for
medical assistance paid for a predeceased spouse, the estate must consist of all of the legal
title and interests the deceased individual's predeceased spouse had in jointly owned or
marital property at the time of the spouse's death, as defined in subdivision 2b, and the
proceeds of those interests, that passed to the deceased individual or another individual, a
survivor, an heir, or an assign of the predeceased spouse through a joint tenancy, tenancy
in common, survivorship, life estate, living trust, or other arrangement. A deceased
recipient who, at death, owned the property jointly with the surviving spouse shall have
an interest in the entire property.
new text end

new text begin (d) For the purpose of recovery in a single person's estate or the estate of a survivor
of a married couple, "other arrangement" includes any other means by which title to
all or any part of the jointly owned or marital property or interest passed from the
predeceased spouse to another including, but not limited to, transfers between spouses that
are permitted, prohibited, or penalized for purposes of medical assistance.
new text end

new text begin (e) new text end A claim shall be filed if medical assistance was rendered for either or both
persons under one of the following circumstances:

deleted text begin (a) deleted text end new text begin (1) new text end the person was over 55 years of age, and received services under this chapter;

deleted text begin (b) deleted text end new text begin (2) new text end the person resided in a medical institution for six months or longer, received
services under this chapter, and, at the time of institutionalization or application for
medical assistance, whichever is later, the person could not have reasonably been expected
to be discharged and returned home, as certified in writing by the person's treating
physician. For purposes of this section only, a "medical institution" means a skilled
nursing facility, intermediate care facility, intermediate care facility for persons with
developmental disabilities, nursing facility, or inpatient hospital; or

deleted text begin (c) deleted text end new text begin (3) new text end the person received general assistance medical care services under chapter
256D.

new text begin (f) new text end The claim shall be considered an expense of the last illness of the decedent for the
purpose of section 524.3-805. new text begin Notwithstanding any law or rule to the contrary, a state or
county agency with a claim under this section must be a creditor under section 524.6-307. new text end
Any statute of limitations that purports to limit any county agency or the state agency,
or both, to recover for medical assistance granted hereunder shall not apply to any claim
made hereunder for reimbursement for any medical assistance granted hereunder. Notice
of the claim shall be given to all heirs and devisees of the decedent whose identity can be
ascertained with reasonable diligence. The notice must include procedures and instructions
for making an application for a hardship waiver under subdivision 5; time frames for
submitting an application and determination; and information regarding appeal rights and
procedures. Counties are entitled to one-half of the nonfederal share of medical assistance
collections from estates that are directly attributable to county effort. Counties are entitled
to ten percent of the collections for alternative care directly attributable to county effort.

Sec. 47.

Minnesota Statutes 2008, section 256B.15, subdivision 1h, is amended to read:

Subd. 1h.

Estates of specific persons receiving medical assistance.

(a) For
purposes of this section, paragraphs (b) to deleted text begin (k) deleted text end new text begin (j) new text end apply if a person received medical
assistance for which a claim may be filed under this section and died single, or the
surviving spouse of the couple and was not survived by any of the persons described
in subdivisions 3 and 4.

(b) deleted text begin For purposes of this section, the person's estate consists of: (1) the person's
probate estate; (2) all of the person's interests or proceeds of those interests in real property
the person owned as a life tenant or as a joint tenant with a right of survivorship at the
time of the person's death; (3) all of the person's interests or proceeds of those interests in
securities the person owned in beneficiary form as provided under sections 524.6-301 to
524.6-311 at the time of the person's death, to the extent they become part of the probate
estate under section 524.6-307; (4) all of the person's interests in joint accounts, multiple
party accounts, and pay on death accounts, or the proceeds of those accounts, as provided
under sections 524.6-201 to 524.6-214 at the time of the person's death to the extent
they become part of the probate estate under section 524.6-207; and (5) the person's
legal title or interest at the time of the person's death in real property transferred under
a transfer on death deed under section 507.071, or in the proceeds from the subsequent
sale of the person's interest in the real property. Notwithstanding any law or rule to the
contrary, a state or county agency with a claim under this section shall be a creditor under
section 524.6-307.
deleted text end

deleted text begin (c) deleted text end Notwithstanding any law or rule to the contrary, the person's life estate or joint
tenancy interest in real property not subject to a medical assistance lien under sections
514.980 to 514.985 on the date of the person's death shall not end upon the person's death
and shall continue as provided in this subdivision. The life estate in the person's estate
shall be that portion of the interest in the real property subject to the life estate that is equal
to the life estate percentage factor for the life estate as listed in the Life Estate Mortality
Table of the health care program's manual for a person who was the age of the medical
assistance recipient on the date of the person's death. The joint tenancy interest in real
property in the estate shall be equal to the fractional interest the person would have owned
in the jointly held interest in the property had they and the other owners held title to the
property as tenants in common on the date the person died.

deleted text begin (d) deleted text end new text begin (c) new text end The court upon its own motion, or upon motion by the personal representative
or any interested party, may enter an order directing the remaindermen or surviving joint
tenants and their spouses, if any, to sign all documents, take all actions, and otherwise
fully cooperate with the personal representative and the court to liquidate the decedent's
life estate or joint tenancy interests in the estate and deliver the cash or the proceeds of
those interests to the personal representative and provide for any legal and equitable
sanctions as the court deems appropriate to enforce and carry out the order, including an
award of reasonable attorney fees.

deleted text begin (e) deleted text end new text begin (d) new text end The personal representative may make, execute, and deliver any conveyances
or other documents necessary to convey the decedent's life estate or joint tenancy interest
in the estate that are necessary to liquidate and reduce to cash the decedent's interest or
for any other purposes.

deleted text begin (f) deleted text end new text begin (e) new text end Subject to administration, all costs, including reasonable attorney fees,
directly and immediately related to liquidating the decedent's life estate or joint tenancy
interest in the decedent's estate, shall be paid from the gross proceeds of the liquidation
allocable to the decedent's interest and the net proceeds shall be turned over to the personal
representative and applied to payment of the claim presented under this section.

deleted text begin (g) deleted text end new text begin (f) new text end The personal representative shall bring a motion in the district court in which
the estate is being probated to compel the remaindermen or surviving joint tenants to
account for and deliver to the personal representative all or any part of the proceeds of any
sale, mortgage, transfer, conveyance, or any disposition of real property allocable to the
decedent's life estate or joint tenancy interest in the decedent's estate, and do everything
necessary to liquidate and reduce to cash the decedent's interest and turn the proceeds of
the sale or other disposition over to the personal representative. The court may grant any
legal or equitable relief including, but not limited to, ordering a partition of real estate
under chapter 558 necessary to make the value of the decedent's life estate or joint tenancy
interest available to the estate for payment of a claim under this section.

deleted text begin (h) deleted text end new text begin (g) new text end Subject to administration, the personal representative shall use all of the cash
or proceeds of interests to pay an allowable claim under this section. The remaindermen
or surviving joint tenants and their spouses, if any, may enter into a written agreement
with the personal representative or the claimant to settle and satisfy obligations imposed at
any time before or after a claim is filed.

deleted text begin (i) deleted text end new text begin (h) new text end The personal representative may, at their discretion, provide any or all of the
other owners, remaindermen, or surviving joint tenants with an affidavit terminating the
decedent's estate's interest in real property the decedent owned as a life tenant or as a joint
tenant with others, if the personal representative determines in good faith that neither the
decedent nor any of the decedent's predeceased spouses received any medical assistance
for which a claim could be filed under this section, or if the personal representative has
filed an affidavit with the court that the estate has other assets sufficient to pay a claim, as
presented, or if there is a written agreement under paragraph deleted text begin (h) deleted text end new text begin (g) new text end , or if the claim, as
allowed, has been paid in full or to the full extent of the assets the estate has available
to pay it. The affidavit may be recorded in the office of the county recorder or filed in
the Office of the Registrar of Titles for the county in which the real property is located.
Except as provided in section 514.981, subdivision 6, when recorded or filed, the affidavit
shall terminate the decedent's interest in real estate the decedent owned as a life tenant or a
joint tenant with others. The affidavit shall:

(1) be signed by the personal representative;

(2) identify the decedent and the interest being terminated;

(3) give recording information sufficient to identify the instrument that created the
interest in real property being terminated;

(4) legally describe the affected real property;

(5) state that the personal representative has determined that neither the decedent
nor any of the decedent's predeceased spouses received any medical assistance for which
a claim could be filed under this section;

(6) state that the decedent's estate has other assets sufficient to pay the claim, as
presented, or that there is a written agreement between the personal representative and
the claimant and the other owners or remaindermen or other joint tenants to satisfy the
obligations imposed under this subdivision; and

(7) state that the affidavit is being given to terminate the estate's interest under this
subdivision, and any other contents as may be appropriate.

The recorder or registrar of titles shall accept the affidavit for recording or filing. The
affidavit shall be effective as provided in this section and shall constitute notice even if it
does not include recording information sufficient to identify the instrument creating the
interest it terminates. The affidavit shall be conclusive evidence of the stated facts.

deleted text begin (j) deleted text end new text begin (i) new text end The holder of a lien arising under subdivision 1c shall release the lien at
the holder's expense against an interest terminated under paragraph deleted text begin (h) deleted text end new text begin (g) new text end to the extent
of the termination.

deleted text begin (k) deleted text end new text begin (j) new text end If a lien arising under subdivision 1c is not released under paragraph deleted text begin (j) deleted text end new text begin (i) new text end ,
prior to closing the estate, the personal representative shall deed the interest subject to the
lien to the remaindermen or surviving joint tenants as their interests may appear. Upon
recording or filing, the deed shall work a merger of the recipient's life estate or joint
tenancy interest, subject to the lien, into the remainder interest or interest the decedent and
others owned jointly. The lien shall attach to and run with the property to the extent of
the decedent's interest at the time of the decedent's death.

Sec. 48.

Minnesota Statutes 2008, section 256B.15, subdivision 2, is amended to read:

Subd. 2.

Limitations on claims.

The claim shall include only the total amount
of medical assistance rendered after age 55 or during a period of institutionalization
described in subdivision 1a, deleted text begin clause (b) deleted text end new text begin paragraph (e) new text end , and the total amount of general
assistance medical care rendered, and shall not include interest. Claims that have been
allowed but not paid shall bear interest according to section 524.3-806, paragraph (d). A
claim against the estate of a surviving spouse who did not receive medical assistance, for
medical assistance rendered for the predeceased spouse, new text begin shall be payable from the full
value of all of the predeceased spouse's assets and interests that are part of the surviving
spouse's estate under subdivisions 1a and 2b. Recovery of medical assistance expenses in
the nonrecipient surviving spouse's estate new text end is limited to the value of the assets of the estate
that were marital property or jointly owned property at any time during the marriage. new text begin The
claim is not payable from the value of assets or proceeds of assets in the estate attributable
to a predeceased spouse whom the individual married after the death of the predeceased
recipient spouse for whom the claim is filed or from assets and the proceeds of assets in the
estate which the nonrecipient decedent spouse acquired with assets which were not marital
property or jointly owned property after the death of the predeceased recipient spouse. new text end
Claims for alternative care shall be net of all premiums paid under section 256B.0913,
subdivision 12, on or after July 1, 2003, and shall be limited to services provided on or
after July 1, 2003. new text begin Claims against marital property shall be limited to claims against
recipients who died on or after July 1, 2009.
new text end

Sec. 49.

Minnesota Statutes 2008, section 256B.15, is amended by adding a
subdivision to read:

new text begin Subd. 2b. new text end

new text begin Controlling provisions. new text end

new text begin (a) For purposes of this subdivision and
subdivisions 1a and 2, paragraphs (b) to (d) apply.
new text end

new text begin (b) At the time of death of a recipient spouse and solely for purpose of recovery of
medical assistance benefits received, a predeceased recipient spouse shall have a legal
title or interest in the undivided whole of all of the property which the recipient and the
recipient's surviving spouse owned jointly or which was marital property at any time
during their marriage regardless of the form of ownership and regardless of whether
it was owned or titled in the names of one or both the recipient and the recipient's
spouse. Title and interest in the property of a predeceased recipient spouse shall not end
or extinguish upon the person's death and shall continue for the purpose of allowing
recovery of medical assistance in the estate of the surviving spouse. Upon the death of
the predeceased recipient spouse, title and interest in the predeceased spouse's property
shall vest in the surviving spouse by operation of law and without the necessity for any
probate or decree of descent proceedings and shall continue to exist after the death of the
predeceased spouse and the surviving spouse to permit recovery of medical assistance.
The recipient spouse and the surviving spouse of a deceased recipient spouse shall not
encumber, disclaim, transfer, alienate, hypothecate, or otherwise divest themselves of
these interests before or upon death.
new text end

new text begin (c) For purposes of this section, "marital property" includes any and all real or
personal property of any kind or interests in such property the predeceased recipient
spouse and their spouse, or either of them, owned at the time of their marriage to each
other or acquired during their marriage regardless of whether it was owned or titled in
the names of one or both of them. If either or both spouses of a married couple received
medical assistance, all property owned during the marriage or which either or both spouses
acquired during their marriage shall be presumed to be marital property for purposes of
recovering medical assistance unless there is clear and convincing evidence to the contrary.
new text end

new text begin (d) The agency responsible for the claim for medical assistance for a recipient spouse
may, at its discretion, release specific real and personal property from the provisions of
this section. The release shall extinguish the interest created under paragraph (b) in the
land it describes upon filing or recording. The release need not be attested, certified, or
acknowledged as a condition of filing or recording and shall be filed or recorded in the
office of the county recorder or registrar of titles, as appropriate, in the county where the
real property is located. The party to whom the release is given shall be responsible for
paying all fees and costs necessary to record and file the release. If the property described
in the release is registered property, the registrar of titles shall accept it for recording and
shall record it on the certificate of title for each parcel of property described in the release.
If the property described in the release is abstract property, the recorder shall accept it
for filing and file it in the county's grantor-grantee indexes and any tract index the county
maintains for each parcel of property described in the release.
new text end

Sec. 50.

Minnesota Statutes 2008, section 256B.15, is amended by adding a
subdivision to read:

new text begin Subd. 9. new text end

new text begin Commissioner's intervention. new text end

new text begin The commissioner shall be permitted to
intervene as a party in any proceeding involving recovery of medical assistance upon
filing a notice of intervention and serving such notice on the other parties.
new text end

Sec. 51.

new text begin [256B.196] INTERGOVERNMENTAL TRANSFERS; HOSPITAL
PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Federal approval required. new text end

new text begin This section is contingent on federal
approval of the intergovernmental transfers and payments authorized under this section.
This section is also contingent on current payment by the government entities of the
intergovernmental transfers under this section.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner's duties. new text end

new text begin (a) For the purposes of this subdivision and
subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
services upper payment limit for nonstate government hospitals. The commissioner shall
then determine the amount of a supplemental payment to Hennepin County Medical
Center and Regions Hospital for these services that would increase medical assistance
spending in this category to the aggregate upper payment limit for all nonstate government
hospitals in Minnesota. In making this determination, the commissioner shall allot the
available increases between Hennepin County Medical Center and Regions Hospital
based on the ratio of medical assistance fee-for-service outpatient hospital payments to
the two facilities. The commissioner shall adjust this allotment as necessary based on
federal approvals, the amount of intergovernmental transfers received from Hennepin and
Ramsey Counties, and other factors, in order to maximize the additional total payments.
The commissioner shall inform Hennepin County and Ramsey County of the periodic
intergovernmental transfers necessary to match federal Medicaid payments available
under this subdivision in order to make supplementary medical assistance payments to
Hennepin County Medical Center and Regions Hospital equal to an amount that when
combined with existing medical assistance payments to nonstate governmental hospitals
would increase total payments to hospitals in this category for outpatient services to
the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to Hennepin County Medical Center and Regions Hospital.
new text end

new text begin (b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians affiliated with Hennepin County Medical
Center and with Regions Hospital. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County and
Ramsey County of the periodic intergovernmental transfers necessary to match the federal
Medicaid payments available under this subdivision in order to make supplementary
payments to physicians affiliated with Hennepin County Medical Center and Regions
Hospital equal to the difference between the established medical assistance payment for
physician services and the upper payment limit. Upon receipt of these periodic transfers,
the commissioner shall make supplementary payments to physicians of Hennepin Faculty
Associates and HealthPartners.
new text end

new text begin (c) Beginning January 1, 2010, Hennepin County and Ramsey County shall each
make monthly intergovernmental transfers to the commissioner in an amount determined
by each county. The commissioner shall increase the medical assistance capitation
payments to Metropolitan Health Plan and HealthPartners by an amount equal to the
annual value of the monthly transfers plus federal financial participation.
new text end

new text begin (d) The commissioner shall inform Hennepin County and Ramsey County on an
ongoing basis of the need for any changes needed in the intergovernmental transfers
in order to continue the payments under paragraphs (a) to (c), at their maximum level,
including increases in upper payment limits, changes in the federal Medicaid match, and
other factors.
new text end

new text begin (e) The payments in paragraphs (a) to (c) shall be implemented independently of
each other, subject to federal approval and to the receipt of transfers under subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Intergovernmental transfers. new text end

new text begin Based on the determination by the
commissioner under subdivision 2, Hennepin County and Ramsey County shall make
periodic intergovernmental transfers to the commissioner for the purposes of subdivision
2, paragraphs (a) to (c). All of the intergovernmental transfers made by Hennepin County
shall be used to match federal payments to Hennepin County Medical Center under
subdivision 2, paragraph (a); to physicians affiliated with Hennepin Faculty Associates
under subdivision 2, paragraph (b); and to Metropolitan Health Plan under subdivision
2, paragraph (c). All of the intergovernmental transfers made by Ramsey County shall
be used to match federal payments to Regions Hospital under subdivision 2, paragraph
(a); to physicians affiliated with HealthPartners under subdivision 2, paragraph (b); and to
HealthPartners under subdivision 2, paragraph (c).
new text end

new text begin Subd. 4. new text end

new text begin Adjustments permitted. new text end

new text begin (a) The commissioner may adjust the
intergovernmental transfers under subdivision 3 and the payments under subdivision
2, based on the commissioner's determination of Medicare upper payment limits,
hospital-specific charge limits, hospital-specific limitations on disproportionate share
payments, medical inflation, actuarial certification, and cost-effectiveness for purposes
of federal waivers. Any adjustments must be made on a proportional basis. The
commissioner may make adjustments under this subdivision only after consultation
with the affected counties and hospitals. All payments under subdivision 2 and all
intergovernmental transfers under subdivision 3 are limited to amounts available after all
other base rates, adjustments, and supplemental payments in chapter 256B are calculated.
new text end

new text begin (b) The ratio of medical assistance payments specified in subdivision 2 to the
voluntary intergovernmental transfers specified in subdivision 3 shall not be reduced
except as provided under paragraph (a).
new text end

new text begin Subd. 5. new text end

new text begin Recession period. new text end

new text begin Each type of intergovernmental transfer in subdivision
2, paragraphs (a) to (d), for payment periods from October 1, 2008, through December
31, 2010, is voluntary on the part of Hennepin and Ramsey Counties, meaning that the
transfer must be agreed to, in writing, by the counties prior to any payments being issued.
One agreement on each type of transfer shall cover the entire recession period.
new text end

Sec. 52.

Minnesota Statutes 2008, section 256B.199, is amended to read:

256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.

(a) Effective July 1, 2007, the commissioner shall apply for federal matching funds
for the expenditures in paragraphs (b) and (c).

(b) The commissioner shall apply for federal matching funds for certified public
expenditures as follows:

(1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions
Hospital, the University of Minnesota, and Fairview-University Medical Center shall
report quarterly to the commissioner beginning June 1, 2007, payments made during the
second previous quarter that may qualify for reimbursement under federal law;

(2) based on these reports, the commissioner shall apply for federal matching
funds. These funds are appropriated to the commissioner for the payments under section
256.969, subdivision 27; and

(3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform
the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
hospital payment money expected to be available in the current federal fiscal year.

(c) The commissioner shall apply for federal matching funds for general assistance
medical care expenditures as follows:

(1) for hospital services occurring on or after July 1, 2007, general assistance medical
care expenditures for fee-for-service inpatient and outpatient hospital payments made by
the department shall be used to apply for federal matching funds, except as limited below:

(i) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and

(ii) general assistance medical care expenditures may be considered only to the extent
of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and

(2) all hospitals must provide any necessary expenditure, cost, and revenue
information required by the commissioner as necessary for purposes of obtaining federal
Medicaid matching funds for general assistance medical care expenditures.

new text begin (d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the American Recovery and Reinvestment Act of 2009. These funds shall
be made available as the state share of payments under section 256.969, subdivision 28.
The entities required to report certified public expenditures under paragraph (b), clause
(1), shall report additional certified public expenditures as necessary under this paragraph.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 53.

Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed care contracts which were in effect on June
30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to services to
medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
of its contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B, 256D, and 256L, established after the effective date of a contract
with the commissioner take effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1, 2003, the commissioner shall
withhold five percent of managed care plan payments under this section new text begin and county-based
purchasing plan's payment rate under section 256B.692 new text end for the prepaid medical assistance
and general assistance medical care programs pending completion of performance targets.
Each performance target must be quantifiable, objective, measurable, and reasonably
attainable, except in the case of a performance target based on a federal or state law or rule.
Criteria for assessment of each performance target must be outlined in writing prior to the
contract effective date. The managed care plan must demonstrate, to the commissioner's
satisfaction, that the data submitted regarding attainment of the performance target is
accurate. The commissioner shall periodically change the administrative measures used
as performance targets in order to improve plan performance across a broader range of
administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23. deleted text begin A managed care plan or a county-based purchasing plan
under section 256B.692 may include as admitted assets under section 62D.044 any amount
withheld under this paragraph that is reasonably expected to be returned.
deleted text end

(d) deleted text begin (1) deleted text end Effective for services rendered on or after January 1, 2009, the commissioner
shall withhold three percent of managed care plan payments under this section new text begin and
county-based purchasing plan payments under section 256B.692 new text end for the prepaid medical
assistance and general assistance medical care programs. The withheld funds must be
returned no sooner than July 1 and no later than July 31 of the following year. The
commissioner may exclude special demonstration projects under subdivision 23.

deleted text begin (2) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under
this paragraph. deleted text end The return of the withhold under this paragraph is not subject to the
requirements of paragraph (c).

new text begin (e) Effective for services rendered on or after January 1, 2010, the commissioner
shall include as part of the performance targets described in paragraph (c) a reduction in
the health plan's emergency room utilization rate for state health care program enrollees
by a measurable rate of five percent from the plan's utilization rate for state health care
program enrollees for the previous calendar year.
new text end

new text begin The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
rate was achieved.
new text end

new text begin The withhold described in this paragraph shall continue for each consecutive contract
period until the managed care plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the managed care plan's emergency room
utilization rate for state health care program enrollees for calendar year 2008.
new text end

new text begin (f) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
subdivision that is reasonably expected to be returned.
new text end

Sec. 54.

Minnesota Statutes 2008, section 256B.69, subdivision 5c, is amended to read:

Subd. 5c.

Medical education and research fund.

(a) Except as provided in
paragraph (c), the commissioner of human services shall transfer each year to the medical
education and research fund established under section 62J.692, the following:

(1) an amount equal to the reduction in the prepaid medical assistance and prepaid
general assistance medical care payments as specified in this clause. Until January 1,
2002, the county medical assistance and general assistance medical care capitation base
rate prior to plan specific adjustments and after the regional rate adjustments under section
256B.69, subdivision 5b, is reduced 6.3 percent for Hennepin County, two percent for
the remaining metropolitan counties, and no reduction for nonmetropolitan Minnesota
counties; and after January 1, 2002, the county medical assistance and general assistance
medical care capitation base rate prior to plan specific adjustments is reduced 6.3 percent
for Hennepin County, two percent for the remaining metropolitan counties, and 1.6 percent
for nonmetropolitan Minnesota counties. Nursing facility and elderly waiver payments
and demonstration project payments operating under subdivision 23 are excluded from
this reduction. The amount calculated under this clause shall not be adjusted for periods
already paid due to subsequent changes to the capitation payments;

(2) beginning July 1, 2003, deleted text begin $2,157,000 deleted text end new text begin $4,314,000 new text end from the capitation rates paid
under this section deleted text begin plus any federal matching funds on this amount deleted text end ;

(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
paid under this section; and

(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
under this section.

(b) This subdivision shall be effective upon approval of a federal waiver which
allows federal financial participation in the medical education and research fund. new text begin Effective
July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4),
shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first
reduce the amounts otherwise required to be transferred under paragraph (a), clauses
(2) to (4). Any excess following this reduction shall proportionally reduce the transfers
under paragraph (a), clause (1).
new text end

(c) Effective July 1, 2003, the amount reduced from the prepaid general assistance
medical care payments under paragraph (a), clause (1), shall be transferred to the general
fund.

new text begin (d) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall
transfer $21,714,000 each fiscal year to the medical education and research fund. The
balance of the transfers under paragraph (a) shall be transferred to the medical education
and research fund no earlier than July 1 of the following fiscal year.
new text end

Sec. 55.

Minnesota Statutes 2008, section 256B.69, subdivision 5f, is amended to read:

Subd. 5f.

Capitation rates.

new text begin (a) new text end Beginning July 1, 2002, the capitation rates paid
under this section are increased by $12,700,000 per year. Beginning July 1, 2003, the
capitation rates paid under this section are increased by $4,700,000 per year.

new text begin (b) Beginning July 1, 2009, the capitation rates paid under this section are increased
each year by the lesser of $21,714,000 or an amount equal to the difference between the
estimated value of the reductions described in subdivision 5c, paragraph (a), clause (1),
and the amount of the limit described in subdivision 5c, paragraph (b).
new text end

Sec. 56.

Minnesota Statutes 2008, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) new text begin Except as provided in paragraph (c), new text end each
demonstration provider shall be responsible for the health care coordination for eligible
individuals. Demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections 256B.02,
subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered to
enrollees. Notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section shall provide relocation
service coordination to enrolled persons age 65 and over;

(2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated 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; and

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.

(b) Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
care and social service practitioners to provide services to enrollees. A demonstration
provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the claim.

new text begin (c) A demonstration provider shall not authorize, arrange, or provide dental services
listed under section 256B.0625; 256D.03, subdivision 4; or 256L.03, as part of the
comprehensive health care services that are required to be provided by the demonstration
provider under this section. Dental services shall be reimbursed on a fee-for-service basis.
new text end

Sec. 57.

Minnesota Statutes 2008, section 256B.69, subdivision 23, is amended to read:

Subd. 23.

Alternative services; elderly and disabled persons.

(a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations and may contract with
Medicare-approved special needs plans to provide Medicaid services. Medicare funds and
services shall be administered according to the terms and conditions of the federal contract
and demonstration provisions. For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations,
with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1,
items B and C, which do not apply to persons enrolling in demonstrations under this
section. An initial open enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450
to 9500.1464. When a person is enrolled in a health plan under these demonstrations and
the health plan's participation is subsequently terminated for any reason, the person shall
be provided an opportunity to select a new health plan and shall have the right to change
health plans within the first 60 days of enrollment in the second health plan. Persons
required to participate in health plans under this section who fail to make a choice of
health plan shall not be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
the commissioner may contract with managed care organizations, including counties, to
serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
disabled persons only. For persons with a primary diagnosis of developmental disability,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with a primary diagnosis of developmental disabilities, serious and persistent
mental illness, or serious emotional disturbance, without approval of the county board of
the county in which the demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for developmental
disabilities, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by the
federal government. Case management and active treatment must be individualized and
developed in accordance with a person-centered plan. Costs under these projects may not
exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
and until four years after the pilot project implementation date, subcontractor participation
in the long-term care developmental disability pilot is limited to a nonprofit long-term
care system providing ICF/MR services, home and community-based waiver services,
and in-home services to no more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
prior to expansion of the developmental disability pilot project. This paragraph expires
four years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.

(e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. The process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas of
the state. Until July 1, 2009, expansion for MnDHO projects that include home and
community-based services is limited to the two projects and service areas in effect on
March 1, 2006. Enrollment in integrated MnDHO programs that include home and
community-based services shall remain voluntary. Costs for home and community-based
services included under MnDHO must not exceed costs that would have been incurred
under the fee-for-service program. new text begin In determining MnDHO payment rates and risk
adjustment methods, the commissioner must consider the methods used to determine
county allocations for home and community-based program participants. If necessary to
reduce MnDHO rates to comply with this provision, the commissioner must implement
successive overall rate-to-rate reductions not including any other reductions provided by
law. The rate reductions must not exceed ten percent in any calendar year. new text end In developing
program specifications for expansion of integrated programs, the commissioner shall
involve and consult the state-level stakeholder group established in subdivision 28,
paragraph (d), including consultation on whether and how to include home and
community-based waiver programs. Plans for further expansion of MnDHO projects shall
be presented to the chairs of the house of representatives and senate committees with
jurisdiction over health and human services policy and finance by February 1, 2007.

(g) Notwithstanding section 256B.0261, health plans providing services under this
section are responsible for home care targeted case management and relocation targeted
case management. Services must be provided according to the terms of the waivers and
contracts approved by the federal government.

Sec. 58.

Minnesota Statutes 2008, section 256B.69, is amended by adding a
subdivision to read:

new text begin Subd. 29. new text end

new text begin Birthing centers. new text end

new text begin As a condition of participating in the prepaid
medical assistance program, prepaid general assistance medical care program, or the
MinnesotaCare program under section 256B.69, 256B.692, 256D.03, or 256L.12, a
managed care plan or county-based purchasing plan must either contract with or establish
a birthing center for the provision of obstetric services that are covered under section
256B.0625 and are provided by a birthing center. The birthing center must be licensed
under section 144.566.
new text end

Sec. 59.

new text begin [256B.756] REIMBURSEMENT RATES FOR BIRTHS.
new text end

new text begin Subdivision 1. new text end

new text begin Facility rate. new text end

new text begin (a) Notwithstanding section 256.969, effective for
services provided on or after October 1, 2009, the facility payment rate shall be:
new text end

new text begin (1) no greater than $4,187 for the following diagnosis-related groups, as they fall
within the diagnostic categories:
new text end

new text begin (i) 371 cesarean section without complicating diagnosis; and
new text end

new text begin (ii) 372 vaginal delivery with complicating diagnosis; and
new text end

new text begin (2) no greater than $1,650 for the following diagnosis group as it falls within the
following diagnostic category: 373 vaginal delivery without complicating diagnosis. This
rate applies only if the woman's enrollment date in medical assistance, general assistance
medical care, or the MinnesotaCare program was at least 45 days before the date the
service was provided. If the enrollment date is within 45 days of the service, then the
payment rate shall be the rate identified in clause (1).
new text end

new text begin (b) The rates described in this subdivision do not include newborn care.
new text end

new text begin Subd. 2. new text end

new text begin Provider rate. new text end

new text begin Notwithstanding section 256B.76, effective for services
provided on or after October 1, 2009, the payment rate for professional services related to
labor, delivery, antepartum, and postpartum care when provided for any of the diagnostic
categories identified in subdivision 1, paragraph (a), clause (1), shall be no greater than
$982 per birth.
new text end

new text begin Subd. 3. new text end

new text begin Application. new text end

new text begin Payments made to managed care plans and county-based
purchasing plans under section 256B.69, 256B.692, or 256L.12 shall be reduced
for services provided on or after October 1, 2009, to reflect the rates established in
subdivisions 1 and 2.
new text end

new text begin Subd. 4. new text end

new text begin Prior authorization. new text end

new text begin Prior authorization shall not be required before
reimbursement is paid for a cesarean section delivery.
new text end

Sec. 60.

Minnesota Statutes 2008, section 256B.76, subdivision 1, is amended to read:

Subdivision 1.

Physician reimbursement.

(a) Effective for services rendered on
or after October 1, 1992, the commissioner shall make payments for physician services
as follows:

(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care,"
"critical care," cesarean delivery and pharmacologic management provided to psychiatric
patients, and level three codes for enhanced services for prenatal high risk, shall be paid
at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
30, 1992. If the rate on any procedure code within these categories is different than the
rate that would have been paid under the methodology in section 256B.74, subdivision 2,
then the larger rate shall be paid;

(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and

(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect
on September 30, 1992.

(b) Effective for services rendered on or after January 1, 2000, payment rates for
physician and professional services shall be increased by three percent over the rates
in effect on December 31, 1999, except for home health agency and family planning
agency services. The increases in this paragraph shall be implemented January 1, 2000,
for managed care.

new text begin (c) Effective for services rendered on or after July 1, 2009, payment rates for
physician and professional services shall be reduced by five percent over the rates in
effect on June 30, 2009. This reduction does not apply to office or other outpatient
services (procedure codes 99201 to 99215), preventive medicine services (procedure
codes 99381 to 99412) and family planning services billed by the following primary care
specialties: general practice, internal medicine, pediatrics, geriatrics, family practice, or
by an advanced practice registered nurse or physician assistant practicing in pediatrics,
geriatrics, or family practice. Effective October 1, 2009, payments made to managed care
plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12
shall reflect the payment reduction described in this paragraph.
new text end

Sec. 61.

new text begin [256B.766] REIMBURSEMENT FOR BASIC CARE SERVICES.
new text end

new text begin (a) Effective for services provided on or after July 1, 2009, total payments for basic
care services, shall be reduced by three percent, prior to third-party liability and spenddown
calculation. Payments made to managed care plans and county-based purchasing plans
shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.
new text end

new text begin (b) This section does not apply to physician and professional services, inpatient
hospital services, family planning services, mental health services, dental services,
prescription drugs, and medical transportation.
new text end

Sec. 62.

new text begin [256B.767] PATIENT-CENTERED DECISION MAKING.
new text end

new text begin (a) Effective January 1, 2010, the commissioner of human services shall require
active participation in a patient-centered decision-making process before authorization is
approved or payment reimbursement is provided for any of the following:
new text end

new text begin (1) a surgical procedure for the following conditions: abnormal uterine bleeding;
benign prostate enlargement; chronic back pain; early stage of breast and prostate cancers;
gastroesophageal reflux disease; hemorrhoids; spinal stenosis; temporomandibular joint
dysfunction; ulcerative colitis; urinary incontinence; uterine fibroids; or varicose veins; and
new text end

new text begin (2) bypass surgery for coronary disease; angioplasty for stable coronary artery
disease; or total hip replacement.
new text end

new text begin (b) A list of these procedures shall be published in the State Register by October 1,
2009. The list shall be reviewed no less than every two years by the commissioner, in
consultation with the commissioner of health. The commissioner shall hold a public forum
and receive public comment prior to any changes to the list provided in paragraph (a).
Any changes made shall be published in the State Register.
new text end

new text begin (c) Prior to receiving authorization or reimbursement for the procedures identified
under this section, a health care provider must certify that the patient has participated in a
patient-centered decision-making process. The format for this certification and the process
for coordination between providers shall be developed by the Health Services Policy
Committee under section 256B.0625, subdivision 3c.
new text end

new text begin (d) For purposes of this section, "patient-centered decision-making process" means a
process that involves directed interaction with the patient to assist the patient in arriving at
an informed objective health care decision regarding the surgical procedure that is both
informed and consistent with the patient's preference and values. The interaction may be
conducted by a health care provider or through the electronic use of decision aids. If
decision aids are used in the process, the aids must meet the criteria established by the
International Patients Decision Aids Standards Collaboration or the Cochrane Decision
Aid Registry.
new text end

new text begin (e) This section does not apply if any of the procedures identified in this section are
performed under an emergency situation.
new text end

Sec. 63.

Minnesota Statutes 2008, section 256D.03, subdivision 4, is amended to read:

Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is
eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation agencies;

(4) prescription drugs and other products recommended through the process
established in section 256B.0625, subdivision 13;

(5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;

(6) eyeglasses and eye examinations provided by a physician or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical assistance program;

(13) podiatric services;

(14) dental services as covered under the medical assistance program;

(15) mental health services covered under chapter 256B;

(16) prescribed medications for persons who have been diagnosed as mentally ill as
necessary to prevent more restrictive institutionalization;

(17) medical supplies and equipment, and Medicare premiums, coinsurance and
deductible payments;

(18) medical equipment not specifically listed in this paragraph when the use of
the equipment will prevent the need for costlier services that are reimbursable under
this subdivision;

(19) services performed by a certified pediatric nurse practitioner, a certified family
nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an inpatient basis is not included
as part of the cost for inpatient services included in the operating payment rate, and (3) the
service is within the scope of practice of the nurse practitioner's license as a registered
nurse, as defined in section 148.171;

(20) services of a certified public health nurse or a registered nurse practicing in
a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171;

(21) telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b;

(22) care coordination and patient education services provided by a community
health worker according to section 256B.0625, subdivision 49; and

(23) regardless of the number of employees that an enrolled health care provider
may have, sign language interpreter services when provided by an enrolled health care
provider during the course of providing a direct, person-to-person covered health care
service to an enrolled recipient who has a hearing loss and uses interpreting services.

(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
to inpatient hospital services, including physician services provided during the inpatient
hospital stay. A $1,000 deductible is required for each inpatient hospitalization.

(b) Effective August 1, 2005, sex reassignment surgery is not covered under this
subdivision.

(c) In order to contain costs, the commissioner of human services shall select
vendors of medical care who can provide the most economical care consistent with high
medical standards and shall where possible contract with organizations on a prepaid
capitation basis to provide these services. The commissioner shall consider proposals by
counties and vendors for prepaid health plans, competitive bidding programs, block grants,
or other vendor payment mechanisms designed to provide services in an economical
manner or to control utilization, with safeguards to ensure that necessary services are
provided. Before implementing prepaid programs in counties with a county operated or
affiliated public teaching hospital or a hospital or clinic operated by the University of
Minnesota, the commissioner shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the patients served by
the hospital, provided the terms of participation in the program are competitive with the
terms of other participants considering the nature of the population served. Payment for
services provided pursuant to this subdivision shall be as provided to medical assistance
vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
payments made during fiscal year 1990 and later years, the commissioner shall consult
with an independent actuary in establishing prepayment rates, but shall retain final control
over the rate methodology.

(d) Effective January 1, 2008, drug coverage under general assistance medical
care is limited to prescription drugs that:

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

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

(e) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
co-payments for services provided on or after October 1, 2003, and before January 1, 2009:

(1) $25 for eyeglasses;

(2) $25 for nonemergency visits to a hospital-based emergency room;

(3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness; and

(4) 50 percent coinsurance on restorative dental services.

(f) Recipients eligible under subdivision 3, paragraph (a), shall include the following
co-payments for services provided on or after January 1, 2009:

(1) $25 for nonemergency visits to a hospital-based emergency room; and

(2) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $7 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness.

(g) MS 2007 Supp [Expired]

(h) Effective January 1, 2009, co-payments shall be limited to one per day per
provider for nonemergency visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all co-payments in this subdivision.
The general assistance medical care reimbursement to the provider shall be reduced by the
amount of the co-payment, except that reimbursement for prescription drugs shall not be
reduced once a recipient has reached the $7 per month maximum for prescription drug
co-payments. The provider collects the co-payment from the recipient. Providers may not
deny services to recipients who are unable to pay the co-payment.

(i) General assistance medical care reimbursement to fee-for-service providers
and payments to managed care plans shall not be increased as a result of the removal of
the co-payments effective January 1, 2009.

(j) Any county may, from its own resources, provide medical payments for which
state payments are not made.

(k) Chemical dependency services that are reimbursed under chapter 254B must not
be reimbursed under general assistance medical care.

(l) The maximum payment for new vendors enrolled in the general assistance
medical care program after the base year shall be determined from the average usual and
customary charge of the same vendor type enrolled in the base year.

(m) The conditions of payment for services under this subdivision are the same
as the conditions specified in rules adopted under chapter 256B governing the medical
assistance program, unless otherwise provided by statute or rule.

(n) Inpatient and outpatient payments shall be reduced by five percent, effective July
1, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (l).

(o) Payments for all other health services except inpatient, outpatient, and pharmacy
services shall be reduced by five percent, effective July 1, 2003.

(p) Payments to managed care plans shall be reduced by five percent for services
provided on or after October 1, 2003.

(q) A hospital receiving a reduced payment as a result of this section may apply the
unpaid balance toward satisfaction of the hospital's bad debts.

(r) Fee-for-service payments for nonpreventive visits shall be reduced by $3 for
services provided on or after January 1, 2006. For purposes of this subdivision, a visit
means an episode of service which is required because of a recipient's symptoms,
diagnosis, or established illness, and which is delivered in an ambulatory setting by
a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
audiologist, optician, or optometrist.

(s) Payments to managed care plans shall not be increased as a result of the removal
of the $3 nonpreventive visit co-payment effective January 1, 2006.

(t) Payments for mental health services added as covered benefits after December
31, 2007, are not subject to the reductions in paragraphs (l), (n), (o), and (p).

new text begin (u) Effective for services provided on or after July 1, 2009, total payment rates for
basic care services shall be reduced by three percent, in accordance with section 256B.766.
Payments made to managed care plans shall be reduced for services provided on or after
October 1, 2009, to reflect this reduction.
new text end

new text begin (v) Effective for services provided on or after July 1, 2009, payment rates for
physician and professional services shall be reduced as described under section 256B.76,
subdivision 1, paragraph (c). Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.
new text end

Sec. 64.

Minnesota Statutes 2008, section 256L.03, subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

"Covered health services" means
the health services reimbursed under chapter 256B, with the exception of inpatient
hospital services, special education services, private duty nursing services, adult dental
care services other than services covered under section 256B.0625, subdivision deleted text begin 9 deleted text end new text begin 9b new text end ,
orthodontic services, nonemergency medical transportation services, personal care
assistant and case management services, nursing home or intermediate care facilities
services, inpatient mental health services, and chemical dependency services.

No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.

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

Sec. 65.

Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:

Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than 275 percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $57,500.

(e) Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.

new text begin (f) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
8, are exempt from the eligibility requirements of this subdivision.
new text end

Sec. 66.

Minnesota Statutes 2008, section 256L.04, is amended by adding a subdivision
to read:

new text begin Subd. 1b. new text end

new text begin Children with family income greater than 275 percent of federal
poverty guidelines. new text end

new text begin Children with family income greater than 275 percent of federal
poverty guidelines for the applicable family size shall be eligible for MinnesotaCare. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.
new text end

Sec. 67.

Minnesota Statutes 2008, section 256L.04, subdivision 7a, is amended to read:

Subd. 7a.

Ineligibility.

deleted text begin Applicants deleted text end new text begin Adults new text end whose income is greater than the limits
established under this section may not enroll in the MinnesotaCare program.

Sec. 68.

Minnesota Statutes 2008, section 256L.04, subdivision 10a, is amended to
read:

Subd. 10a.

Sponsor's income and resources deemed available; documentation.

When determining eligibility for any federal or state benefits under sections 256L.01 to
256L.18, the income and resources of all noncitizens whose sponsor signed an affidavit of
support as defined under United States Code, title 8, section 1183a, shall be deemed to
include their sponsors' income and resources as defined in the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, title IV, Public Law 104-193, sections
421 and 422, and subsequently set out in federal rules. To be eligible for the program,
noncitizens must provide documentation of their immigration status. new text begin Beginning July
1, 2010, or upon federal approval, whichever is later, sponsor deeming does not apply
to pregnant women and children who are qualified noncitizens, as described in section
256B.06, subdivision 4, paragraph (b).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, or upon federal
approval, whichever is later. The commissioner shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 69.

Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:

Subd. 3.

Effective date of coverage.

(a) The effective date of coverage is the
first day of the month following the month in which eligibility is approved and the first
premium payment has been received. As provided in section 256B.057, coverage for
newborns is automatic from the date of birth and must be coordinated with other health
coverage. The effective date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the month of placement. The effective date
of coverage for other new members added to the family is the first day of the month
following the month in which the change is reported. All eligibility criteria must be met
by the family at the time the new family member is added. The income of the new family
member is included with the family's gross income and the adjusted premium begins in
the month the new family member is added.

(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.

(c) Benefits are not available until the day following discharge if an enrollee is
hospitalized on the first day of coverage.

(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
256L.18 are secondary to a plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost avoidance techniques to
ensure coordination of any other health coverage for eligible persons. The commissioner
shall identify eligible persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.

(e) The effective date of coverage for single adults and households with no children
formerly enrolled in general assistance medical care and enrolled in MinnesotaCare
according to section 256D.03, subdivision 3, is the first day of the month following the
last day of general assistance medical care coverage.

new text begin (f) The effective date of coverage for children eligible under section 256L.07,
subdivision 8, is the first day of the month following the date of termination from foster
care or release from a juvenile residential correctional facility.
new text end

Sec. 70.

Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner. The
commissioner may establish criteria and timelines for sites to forward applications to the
commissioner or county agencies. The premium for the new period of eligibility must be
received as provided in section 256L.06 in order for eligibility to continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.

(d) deleted text begin An enrollee deleted text end new text begin Notwithstanding paragraph (e), an enrollee new text end who fails to submit
renewal forms and related documentation necessary for verification of continued eligibility
in a timely manner shall remain eligible for one additional month beyond the end of the
current eligibility period before being disenrolled. The enrollee remains responsible for
MinnesotaCare premiums for the additional month.

new text begin (e) Children in families with family income equal to or below 275 percent of federal
poverty guidelines who fail to submit renewal forms and related documentation necessary
for verification of continued eligibility in a timely manner shall remain eligible for the
program. The commissioner shall use the means described in subdivision 2 or any other
means available to verify family income. If the commissioner determines that there has
been a change in income in which premium payment is required to remain enrolled, the
commissioner shall notify the family of the premium payment, and that the children
will be disenrolled if the premium payment is not received effective the first day of the
calendar month following the calendar month for which the premium is due.
new text end

new text begin (f) For children enrolled in MinnesotaCare under section 256L.07, subdivision 8, the
first period of renewal begins the month the enrollee turns 21 years of age.
new text end

Sec. 71.

Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Delayed verification. new text end

new text begin On the basis of information provided on the
application, a child whose family gross income is less than 90 percent of the applicable
income standard shall be determined eligible beginning in the month of application. The
child must provide all required verifications within 60 days' notice of the eligibility
determination or eligibility shall be terminated. Applicants who are terminated for failure
to provide all required verifications are not eligible to apply for coverage using the delayed
verification procedures specified in this subdivision for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 72.

Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:

Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than deleted text begin 150 deleted text end new text begin 200 new text end percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. deleted text begin Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.
deleted text end

deleted text begin Families deleted text end new text begin Parents new text end enrolled in MinnesotaCare under section 256L.04, subdivision 1,
whose income increases above 275 percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
7, whose income increases above 200 percent of the federal poverty guidelines or 250
percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
the program and shall be disenrolled by the commissioner. For persons disenrolled under
this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
following the month in which the commissioner determines that the income of a family or
individual exceeds program income limits.

(b) deleted text begin Notwithstanding paragraph (a), deleted text end Children may remain enrolled in MinnesotaCare
if deleted text begin ten percent of deleted text end their deleted text begin gross individual or deleted text end gross family income as defined in section
256L.01, subdivision 4, is deleted text begin less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment deleted text end new text begin greater
than 275 percent of federal poverty guidelines new text end . The premium for children remaining
eligible under this deleted text begin clause deleted text end new text begin paragraph new text end shall be the maximum premium determined under
section 256L.15, subdivision 2, paragraph (b).

(c) Notwithstanding deleted text begin paragraphs deleted text end new text begin paragraph new text end (a) deleted text begin and (b) deleted text end , parents are not eligible for
MinnesotaCare if gross household income exceeds $57,500 for the 12-month period
of eligibility.

Sec. 73.

Minnesota Statutes 2008, section 256L.07, subdivision 2, is amended to read:

Subd. 2.

Must not have access to employer-subsidized coverage.

(a) To be
eligible, a family or individual must not have access to subsidized health coverage through
an employer and must not have had access to employer-subsidized coverage through
a current employer for 18 months prior to application or reapplication. A family or
individual whose employer-subsidized coverage is lost due to an employer terminating
health care coverage as an employee benefit during the previous 18 months is not eligible.

(b) This subdivision does not apply to a family or individual who was enrolled
in MinnesotaCare within six months or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
employee benefit. new text begin This subdivision does not apply to children with family gross incomes
that are equal to or less than 200 percent of federal poverty guidelines.
new text end

(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent. The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.

Sec. 74.

Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:

Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text begin or for at least four
months prior to application and renewal deleted text end . new text begin Children with family gross incomes equal to or
greater than 200 percent of federal poverty guidelines, and adults, must have had no health
coverage for at least four months prior to application and renewal. new text end Children enrolled in the
original children's health plan and children in families with income equal to or less than
deleted text begin 150 deleted text end new text begin 200 new text end percent of the federal poverty guidelines, who have other health insurance, are
eligible if the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.

(c) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

(e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.

Sec. 75.

Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Automatic eligibility for certain children. new text end

new text begin Any child who was residing
in foster care or a juvenile residential correctional facility on the child's 18th birthday is
automatically deemed eligible for MinnesotaCare upon termination or release until the
child reaches the age of 21, and is exempt from the requirements of this section and
section 256L.15. Any child eligible under this subdivision must fill out an application and
must submit a renewal every 12 months.
new text end

Sec. 76.

Minnesota Statutes 2008, section 256L.11, subdivision 1, is amended to read:

Subdivision 1.

Medical assistance rate to be used.

new text begin (a) new text end Payment to providers under
sections 256L.01 to 256L.11 shall be at the same rates and conditions established for
medical assistance, except as provided in subdivisions 2 to 6.

new text begin (b) Effective for services provided on or after July 1, 2009, total payments for basic
care services shall be reduced by three percent, in accordance with section 256B.766.
Payments made to managed care plans shall be reduced for services provided on or after
October 1, 2009, to reflect this reduction.
new text end

Sec. 77.

Minnesota Statutes 2008, section 256L.12, subdivision 7, is amended to read:

Subd. 7.

Managed care plan vendor requirements.

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 new text begin with
the exception of dental services, which shall be provided on a fee-for-service basis new text end ;

(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.

Sec. 78.

Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:

Subd. 9.

Rate setting; performance withholds.

(a) Rates will be prospective,
per capita, where possible. The commissioner may allow health plans to arrange for
inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
an independent actuary to determine appropriate rates.

(b) deleted text begin For services rendered on or after January 1, 2003, to December 31, 2003, the
commissioner shall withhold .5 percent of managed care plan payments under this section
pending completion of performance targets. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year if performance targets
in the contract are achieved. A managed care plan may include as admitted assets under
section 62D.044 any amount withheld under this paragraph that is reasonably expected
to be returned.
deleted text end

deleted text begin (c) deleted text end For services rendered on or after January 1, 2004, the commissioner shall
withhold five percent of managed care plan payments new text begin and county-based purchasing
plan payments new text end under this section pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the
contract effective date. The managed care plan must demonstrate, to the commissioner's
satisfaction, that the data submitted regarding attainment of the performance target is
accurate. The commissioner shall periodically change the administrative measures used
as performance targets in order to improve plan performance across a broader range of
administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, such as characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July 1 and no later than July 31 of the
following calendar year if performance targets in the contract are achieved. deleted text begin A managed
care plan or a county-based purchasing plan under section 256B.692 may include as
admitted assets under section 62D.044 any amount withheld under this paragraph that is
reasonably expected to be returned. deleted text end

new text begin (c) For services rendered on or after January 1, 2010, the commissioner shall
withhold an additional three percent of managed care plan payments under this section.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of the
following calendar year. The return of the withhold under this paragraph is not subject to
the requirements of paragraph (b).
new text end

new text begin (d) Effective for services rendered on or after January 1, 2010, the commissioner
shall include as part of the performance targets described in paragraph (b) a reduction in
the plan's emergency room utilization rate for state health care program enrollees by a
measurable rate of five percent from the plan's utilization rate for the previous calendar
year.
new text end

new text begin The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following calendar year if the managed care plan or county-based purchasing
plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
rate was achieved.
new text end

new text begin The withhold described in this paragraph shall continue for each consecutive contract
period until the managed care plan's emergency room utilization rate for state health care
program enrollees is reduced by 25 percent of the managed care plan's emergency room
utilization rate for state health care program enrollees for calendar year 2008.
new text end

new text begin (e) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.
new text end

Sec. 79.

Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:

Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay to
obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
on the enrollee's monthly gross individual or family income. The sliding fee scale must
contain separate tables based on enrollment of one, two, or three or more persons. Until
June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
individual or family income for individuals or families with incomes below the limits for
the medical assistance program for families and children in effect on January 1, 1999, and
proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
8.8 percent. These percentages are matched to evenly spaced income steps ranging from
the medical assistance income limit for families and children in effect on January 1, 1999,
to 275 percent of the federal poverty guidelines for the applicable family size, up to a
family size of five. The sliding fee scale for a family of five must be used for families of
more than five. The sliding fee scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income after enrollment, premiums
shall be adjusted at the time the change in income is reported.

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

(c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d) with the exception that children in families
with income at or below deleted text begin 150 deleted text end new text begin 200 new text end percent of the federal poverty guidelines shall pay
deleted text begin a monthly premium of $4 deleted text end new text begin no premiums new text end . For purposes of paragraph (d), "minimum"
means a monthly premium of $4.

(d) The following premium scale is established for individuals and families with
gross family incomes of 300 percent of the federal poverty guidelines or less:

Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
0-45%	minimum
46-54%	1.1%
55-81%	1.6%
82-109%	2.2%
110-136%	2.9%
137-164%	3.6%
165-191%	4.6%
192-219%	5.6%
220-248%	6.5%
249-274%	7.2%
275-300%	8.0%

Sec. 80.

Minnesota Statutes 2008, section 256L.15, subdivision 3, is amended to read:

Subd. 3.

Exceptions to sliding scale.

Children in families with income at or below
deleted text begin 150 deleted text end new text begin 200 new text end percent of the federal poverty guidelines new text begin shall new text end pay deleted text begin a deleted text end new text begin no new text end monthly deleted text begin premium of
$4 deleted text end new text begin premiums new text end .

Sec. 81.

Minnesota Statutes 2008, section 256L.17, subdivision 5, is amended to read:

Subd. 5.

Exemption.

This section does not apply to pregnant women new text begin or children new text end .
For purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.

Sec. 82.

Minnesota Statutes 2008, section 501B.89, is amended by adding a
subdivision to read:

new text begin Subd. 4. new text end

new text begin Annual filing requirement for supplemental needs trusts. new text end

new text begin (a) A trustee
of a trust under subdivision 3 and United States Code, title 42, section 1396p(d)(4)(A) or
(C), shall submit to the commissioner of human services, at the time of a beneficiary's
request for medical assistance, the following information about the trust:
new text end

new text begin (1) a copy of the trust instrument; and
new text end

new text begin (2) an inventory of the beneficiary's trust account assets and the value of those assets.
new text end

new text begin (b) A trustee of a trust under subdivision 3 and United States Code, title 42, section
1396p(d)(4)(A) or (C), shall submit an accounting of the beneficiary's trust account to the
commissioner of human services at least annually until the trust, or the beneficiary's
interest in the trust, terminates. Accountings are due on the anniversary of the execution
date of the trust unless another annual date is established by the terms of the trust. The
accounting must include the following information for the accounting period:
new text end

new text begin (1) an inventory of trust assets and the value of those assets at the beginning of the
accounting period;
new text end

new text begin (2) additions to the trust during the accounting period and the source of those
additions;
new text end

new text begin (3) itemized distributions from the trust during the accounting period, including the
purpose of the distributions and to whom the distributions were made;
new text end

new text begin (4) an inventory of trust assets and the value of those assets at the end of the
accounting period; and
new text end

new text begin (5) changes to the trust instrument during the accounting period.
new text end

new text begin (c) For the purpose of paragraph (b), an accounting period is 12 months unless an
accounting period of a different length is permitted by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for applications for medical
assistance and renewals of medical assistance submitted on or after July 1, 2009.
new text end

Sec. 83.

Minnesota Statutes 2008, section 519.05, is amended to read:

519.05 LIABILITY OF HUSBAND AND WIFE.

(a) A spouse is not liable to a creditor for any debts of the other spouse. Where
husband and wife are living together, they shall be jointly and severally liable for
necessary medical services that have been furnished to either spouse, new text begin including any claims
arising under section 246.53, 256B.15, 256D.16, or 261.04, new text end and necessary household
articles and supplies furnished to and used by the family. Notwithstanding this paragraph,
in a proceeding under chapter 518 the court may apportion such debt between the spouses.

(b) Either spouse may close a credit card account or other unsecured consumer line
of credit on which both spouses are contractually liable, by giving written notice to the
creditor.

Sec. 84.

Laws 2003, First Special Session chapter 14, article 13C, section 2, subdivision
1, as amended by Laws 2004, chapter 272, article 2, section 2, is amended to read:

Subdivision 1. Total Appropriation

$

3,848,049,000

$

4,135,780,000

Summary by Fund
General	3,301,811,000	3,561,055,000
State Government Special Revenue	534,000	534,000
Health Care Access	273,723,000	302,272,000
Federal TANF	270,425,000	270,363,000
Lottery Cash Flow	1,556,000	1,556,000

[FEDERAL CONTINGENCY
APPROPRIATION.] (a) Federal Medicaid
funds made available under title IV of
the federal Jobs and Growth Tax Relief
Reconciliation Act of 2003 are appropriated
to the commissioner of human services
for use in the state's medical assistance
and MinnesotaCare programs. The
commissioners of human services and
finance shall report to the legislative advisory
committee on the additional federal Medicaid
matching funds that will be available to the
state.

(b) Because of the availability of these funds,
the following policies shall become effective:

(1) medical assistance and MinnesotaCare
eligibility and local financial participation
changes provided for in this act may be
implemented prior to September 2, 2003, or
may be delayed as necessary to maximize
the use of federal funds received under
title IV of the Jobs and Growth Tax Relief
Reconciliation Act of 2003;

(2) the aggregate cap on the services
identified in Minnesota Statutes, section
256L.035, paragraph (a), clause (3), shall
be increased from $2,000 to $5,000. This
increase shall expire at the end of fiscal year
2007. Funds may be transferred from the
general fund to the health care access fund as
necessary to implement this provision; and

(3) the following payment shifts shall not be
implemented:

(i) MFIP payment shift found in subdivision
11;

(ii) the county payment shift found in
subdivision 1; and

(iii) the delay in medical assistance
and general assistance medical care
fee-for-service payments found in
subdivision 6.

(c) Notwithstanding section 14, paragraphs
(a) and (b) shall expire June 30, 2007.

[RECEIPTS FOR SYSTEMS PROJECTS.]
Appropriations and federal receipts for
information system projects for MAXIS,
PRISM, MMIS, and SSIS must be deposited
in the state system account authorized in
Minnesota Statutes, section 256.014. Money
appropriated for computer projects approved
by the Minnesota office of technology,
funded by the legislature, and approved
by the commissioner of finance may be
transferred from one project to another
and from development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in
the appropriation for these projects does
not cancel but is available for ongoing
development and operations.

[GIFTS.] Notwithstanding Minnesota
Statutes, chapter 7, the commissioner may
accept on behalf of the state additional
funding from sources other than state funds
for the purpose of financing the cost of
assistance program grants or nongrant
administration. All additional funding is
appropriated to the commissioner for use as
designated by the grantor of funding.

[SYSTEMS CONTINUITY.] In the event of
disruption of technical systems or computer
operations, the commissioner may use
available grant appropriations to ensure
continuity of payments for maintaining the
health, safety, and well-being of clients
served by programs administered by the
department of human services. Grant funds
must be used in a manner consistent with the
original intent of the appropriation.

[NONFEDERAL SHARE TRANSFERS.]
The nonfederal share of activities for which
federal administrative reimbursement is
appropriated to the commissioner may be
transferred to the special revenue fund.

[TANF FUNDS APPROPRIATED TO
OTHER ENTITIES.] Any expenditures from
the TANF block grant shall be expended
in accordance with the requirements and
limitations of part A of title IV of the
Social Security Act, as amended, and any
other applicable federal requirement or
limitation. Prior to any expenditure of these
funds, the commissioner shall assure that
funds are expended in compliance with the
requirements and limitations of federal law
and that any reporting requirements of federal
law are met. It shall be the responsibility
of any entity to which these funds are
appropriated to implement a memorandum
of understanding with the commissioner
that provides the necessary assurance of
compliance prior to any expenditure of funds.
The commissioner shall receipt TANF funds
appropriated to other state agencies and
coordinate all related interagency accounting
transactions necessary to implement these
appropriations. Unexpended TANF funds
appropriated to any state, local, or nonprofit
entity cancel at the end of the state fiscal
year unless appropriating language permits
otherwise.

[TANF FUNDS TRANSFERRED TO
OTHER FEDERAL GRANTS.] The
commissioner must authorize transfers
from TANF to other federal block grants so
that funds are available to meet the annual
expenditure needs as appropriated. Transfers
may be authorized prior to the expenditure
year with the agreement of the receiving
entity. Transferred funds must be expended
in the year for which the funds were
appropriated unless appropriation language
permits otherwise. In accelerating transfer
authorizations, the commissioner must aim to
preserve the future potential transfer capacity
from TANF to other block grants.

[TANF MAINTENANCE OF EFFORT.]
(a) In order to meet the basic maintenance
of effort (MOE) requirements of the TANF
block grant specified under Code of Federal
Regulations, title 45, section 263.1, the
commissioner may only report nonfederal
money expended for allowable activities
listed in the following clauses as TANF/MOE
expenditures:

(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;

(2) the child care assistance programs
under Minnesota Statutes, sections 119B.03
and 119B.05, and county child care
administrative costs under Minnesota
Statutes, section 119B.15;

(3) state and county MFIP administrative
costs under Minnesota Statutes, chapters
256J and 256K;

(4) state, county, and tribal MFIP
employment services under Minnesota
Statutes, chapters 256J and 256K;

(5) expenditures made on behalf of
noncitizen MFIP recipients who qualify
for the medical assistance without federal
financial participation program under
Minnesota Statutes, section 256B.06,
subdivision 4, paragraphs (d), (e), and (j);
and

(6) qualifying working family credit
expenditures under Minnesota Statutes,
section 290.0671.

(b) The commissioner shall ensure that
sufficient qualified nonfederal expenditures
are made each year to meet the state's
TANF/MOE requirements. For the activities
listed in paragraph (a), clauses (2) to
(6), the commissioner may only report
expenditures that are excluded from the
definition of assistance under Code of
Federal Regulations, title 45, section 260.31.

(c) By August 31 of each year, the
commissioner shall make a preliminary
calculation to determine the likelihood
that the state will meet its annual federal
work participation requirement under Code
of Federal Regulations, title 45, sections
261.21 and 261.23, after adjustment for any
caseload reduction credit under Code of
Federal Regulations, title 45, section 261.41.
If the commissioner determines that the
state will meet its federal work participation
rate for the federal fiscal year ending that
September, the commissioner may reduce the
expenditure under paragraph (a), clause (1),
to the extent allowed under Code of Federal
Regulations, title 45, section 263.1(a)(2).

(d) For fiscal years beginning with state
fiscal year 2003, the commissioner shall
assure that the maintenance of effort used
by the commissioner of finance for the
February and November forecasts required
under Minnesota Statutes, section 16A.103,
contains expenditures under paragraph (a),
clause (1), equal to at least 25 percent of
the total required under Code of Federal
Regulations, title 45, section 263.1.

(e) If nonfederal expenditures for the
programs and purposes listed in paragraph
(a) are insufficient to meet the state's
TANF/MOE requirements, the commissioner
shall recommend additional allowable
sources of nonfederal expenditures to the
legislature, if the legislature is or will be in
session to take action to specify additional
sources of nonfederal expenditures for
TANF/MOE before a federal penalty is
imposed. The commissioner shall otherwise
provide notice to the legislative commission
on planning and fiscal policy under paragraph
(g).

(f) If the commissioner uses authority
granted under section 11, or similar authority
granted by a subsequent legislature, to
meet the state's TANF/MOE requirement
in a reporting period, the commissioner
shall inform the chairs of the appropriate
legislative committees about all transfers
made under that authority for this purpose.

(g) If the commissioner determines that
nonfederal expenditures under paragraph
(a) are insufficient to meet TANF/MOE
expenditure requirements, and if the
legislature is not or will not be in
session to take timely action to avoid a
federal penalty, the commissioner may
report nonfederal expenditures from
other allowable sources as TANF/MOE
expenditures after the requirements of this
paragraph are met. The commissioner
may report nonfederal expenditures
in addition to those specified under
paragraph (a) as nonfederal TANF/MOE
expenditures, but only ten days after the
commissioner of finance has first submitted
the commissioner's recommendations for
additional allowable sources of nonfederal
TANF/MOE expenditures to the members of
the legislative commission on planning and
fiscal policy for their review.

(h) The commissioner of finance shall not
incorporate any changes in federal TANF
expenditures or nonfederal expenditures for
TANF/MOE that may result from reporting
additional allowable sources of nonfederal
TANF/MOE expenditures under the interim
procedures in paragraph (g) into the February
or November forecasts required under
Minnesota Statutes, section 16A.103, unless
the commissioner of finance has approved
the additional sources of expenditures under
paragraph (g).

(i) Minnesota Statutes, section 256.011,
subdivision 3, which requires that federal
grants or aids secured or obtained under that
subdivision be used to reduce any direct
appropriations provided by law, do not apply
if the grants or aids are federal TANF funds.

(j) Notwithstanding section 14, paragraph
(a), clauses (1) to (6), and paragraphs (b) to
(j) expire June 30, 2007.

[WORKING FAMILY CREDIT
EXPENDITURES AS TANF MOE.]
The commissioner may claim as TANF
maintenance of effort up to the following
amounts of working family credit
expenditures for the following fiscal years:

(1) fiscal year 2004, $7,013,000;

(2) fiscal year 2005, $25,133,000;

(3) fiscal year 2006, $6,942,000; and

(4) fiscal year 2007, $6,707,000.

[FISCAL YEAR 2003 APPROPRIATIONS
CARRYFORWARD.] Effective the day
following final enactment, notwithstanding
Minnesota Statutes, section 16A.28, or any
other law to the contrary, state agencies and
constitutional offices may carry forward
unexpended and unencumbered nongrant
operating balances from fiscal year 2003
general fund appropriations into fiscal year
2004 to offset general budget reductions.

[TRANSFER OF GRANT BALANCES.]
Effective the day following final enactment,
the commissioner of human services,
with the approval of the commissioner of
finance and after notification of the chair
of the senate health, human services and
corrections budget division and the chair
of the house of representatives health
and human services finance committee,
may transfer unencumbered appropriation
balances for the biennium ending June 30,
2003, in fiscal year 2003 among the MFIP,
MFIP child care assistance under Minnesota
Statutes, section 119B.05, general assistance,
general assistance medical care, medical
assistance, Minnesota supplemental aid,
and group residential housing programs,
and the entitlement portion of the chemical
dependency consolidated treatment fund, and
between fiscal years of the biennium.

[TANF APPROPRIATION
CANCELLATION.] Notwithstanding
the provisions of Laws 2000, chapter 488,
article 1, section 16, any prior appropriations
of TANF funds to the department of trade and
economic development or to the job skills
partnership board or any transfers of TANF
funds from another agency to the department
of trade and economic development or to the
job skills partnership board are not available
until expended, and if unobligated as of June
30, 2003, these appropriations or transfers
shall cancel to the TANF fund.

[SHIFT COUNTY PAYMENT.] The
commissioner shall make up to 100 percent
of the calendar year 2005 payments to
counties for developmental disabilities
semi-independent living services grants,
developmental disabilities family support
grants, and adult mental health grants from
fiscal year 2006 appropriations. This is a
onetime payment shift. Calendar year 2006
and future payments for these grants are not
affected by this shift. This provision expires
June 30, 2006.

[CAPITATION RATE INCREASE.] Of
the health care access fund appropriations
to the University of Minnesota in the
higher education omnibus appropriation
bill, deleted text begin $2,157,000 in fiscal year 2004 and
$2,157,000 in fiscal year 2005 are to be used
to increase the capitation payments under deleted text end
new text begin for fiscal years beginning July 1, 2003, and
thereafter, $2,157,000 each year shall be
transferred to the commissioner for purposes
of new text end Minnesota Statutes, section 256B.69.
Notwithstanding the provisions of section
14, this provision shall not expire.

Sec. 85.

Laws 2008, chapter 358, article 3, section 8, the effective date, is amended to
read:

EFFECTIVE DATE.

This section is effective January 1, 2009 deleted text begin , or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained deleted text end .

Sec. 86. new text begin EXCESS SURPLUS.
new text end

new text begin (a) The commissioner of human services, in consultation with the commissioner of
health, shall determine the amount of excess surplus each health maintenance organization
and county-based purchasing plan had as of December 31, 2008. A health maintenance
organization and a county-based purchasing plan shall be determined to have excess
surplus if, as of December 31, 2008, its total adjusted capital met both of the following
conditions:
new text end

new text begin (1) total adjusted capital was greater than the product of 5.5 and the authorized
control level risk-based capital; and
new text end

new text begin (2) total adjusted capital was greater than the sum of the action level risk-based
capital and $100,000,000.
new text end

new text begin (b) Effective for payments made between January 1, 2012, and June 30, 2013,
the commissioner of human services shall reduce the general assistance medical care
capitation rate paid to each health maintenance organization under Minnesota Statutes,
section 256B.69, and to each county-based purchasing plan under Minnesota Statutes,
section 256B.692, by an amount that equals 33 percent of the excess surplus determined in
paragraph (a).
new text end

Sec. 87. new text begin AUTISM SPECTRUM DISORDER TASK FORCE.
new text end

new text begin (a) The Autism Spectrum Disorder Task Force is composed of 15 members,
appointed as follows:
new text end

new text begin (1) two members of the senate appointed by the Subcommittee on Committees of the
Committee on Rules and Administration, one of whom must be a member of the minority;
new text end

new text begin (2) two members of the house of representatives, one from the majority party,
appointed by the speaker of the house, and one from the minority party, appointed by
the minority leader;
new text end

new text begin (3) two members appointed by the legislature, with regard to geographic diversity in
the state, who are parents of children with autism spectrum disorder (ASD); one member
shall be appointed by the senate Subcommittee on Committees of the Committee on
Rules and Administration making appointments for the senate; and one member shall be
appointed by the speaker of the house making the appointments for the house;
new text end

new text begin (4) one member appointed by the Minnesota chapter of the American Academy of
Pediatrics who is a general primary care pediatrician;
new text end

new text begin (5) one member appointed by the Minnesota Academy of Family Medicine who is a
family practice physician;
new text end

new text begin (6) one member appointed by the Minnesota Psychological Association who is a
neuropsychologist;
new text end

new text begin (7) one member appointed by the directors of public school student support services;
new text end

new text begin (8) one member appointed by the Somali American Autism Foundation;
new text end

new text begin (9) one member appointed by the ARC of Minnesota;
new text end

new text begin (10) one member appointed by the Autism Society of Minnesota;
new text end

new text begin (11) one member appointed by the Parent Advocacy Coalition for Educational
Rights; and
new text end

new text begin (12) one member appointed by the Minnesota Council of Health Plans.
new text end

new text begin Appointments must be made by September 1, 2009. The Legislative Coordinating
Commission shall provide meeting space for the task force. The senate member appointed
by the minority leader of the senate shall convene the first meeting of the task force no
later than October 1, 2009. The task force shall elect a chair at the first meeting.
new text end

new text begin (b) If federal or state funding is available, the commissioners of education,
employment and economic development, health, and human services shall provide
assistance to the task force.
new text end

new text begin (c) The task force shall develop recommendations and report on the following topics:
new text end

new text begin (1) ways to improve services provided by all state and political subdivisions;
new text end

new text begin (2) sources of public and private funding available for treatment and ways to
improve efficiency in the use of these funds;
new text end

new text begin (3) methods to improve coordination in the delivery of service between public
and private agencies, health providers, and schools, and to address any geographic
discrepancies in the delivery of services;
new text end

new text begin (4) increasing the availability of and the training for medical providers and educators
who identify and provide services to individuals with ASD; and
new text end

new text begin (5) treatment options supported by peer-reviewed, established scientific research
for individuals with ASD.
new text end

new text begin (d) The task force shall coordinate with existing efforts at the Departments of
Education, Health, Human Services, and Employment and Economic Development
related to ASD.
new text end

new text begin (e) By January 15 of each year, the task force shall provide a report regarding its
findings and consideration of the topics listed under paragraph (c), and the action taken
under paragraph (d), including draft legislation if necessary, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services.
new text end

new text begin (f) This section expires June 30, 2011.
new text end

Sec. 88. new text begin FEDERAL APPROVAL.
new text end

new text begin (a) The commissioner of human services shall seek federal approval, if necessary, to
implement Minnesota Statutes, section 256B.0751, subdivision 7.
new text end

new text begin (b) The commissioner of human services shall resubmit for federal approval the
elimination of depreciation for self-employed farmers in determining income eligibility
for MinnesotaCare passed in Laws 2007, chapter 147, article 5, section 19.
new text end

Sec. 89. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, sections 62Q.80, subdivision 1a; 256.962, subdivision 7;
256B.037; 256B.0625, subdivision 9; 256B.69, subdivision 6c; and 256L.17, subdivision
6, new text end new text begin are repealed.
new text end

ARTICLE 11

FORECAST ADJUSTMENTS

Section 1. new text begin SUMMARY OF APPROPRIATIONS; DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT. new text end

new text begin The dollar amounts shown are added to or, if shown in parentheses, are subtracted
from the appropriations in Laws 2008, chapter 363, from the general fund, or any other
fund named, to the Department of Human Services for the purposes specified in this
article, to be available for the fiscal year indicated for each purpose. The figure "2009"
used in this article means that the appropriation or appropriations listed are available
for the fiscal year ending June 30, 2009.
new text end

						new text begin 2009 new text end
new text begin General new text end					new text begin $ new text end	new text begin (445,130,000) new text end
new text begin Health Care Access new text end					new text begin $ new text end	new text begin (19,460,000) new text end
new text begin TANF new text end					new text begin $ new text end	new text begin (14,404,000) new text end
new text begin Total new text end					new text begin $ new text end	new text begin (478,994,000) new text end

Sec. 2. new text begin COMMISSIONER OF HUMAN SERVICES new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin (478,994,000) new text end

new text begin Appropriations by Fund new text end
		new text begin 2009 new text end
new text begin General new text end		new text begin (445,130,000) new text end
new text begin Health Care Access new text end		new text begin (19,460,000) new text end
new text begin TANF new text end		new text begin (14,404,000) new text end

new text begin Subd. 2. new text end new text begin Revenue and Pass Through new text end

new text begin Appropriations by Fund new text end
new text begin TANF new text end		new text begin 1,107,000 new text end

new text begin Subd. 3. new text end new text begin Children and Economic Assistance Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end		new text begin 27,002,000 new text end
new text begin TANF new text end		new text begin (16,211,000) new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
new text end

new text begin (a) MFIP/DWP Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end		new text begin 17,530,000 new text end
new text begin TANF new text end		new text begin (16,211,000) new text end

new text begin (b) MFIP Child Care Assistance Grants new text end

new text begin 4,933,000 new text end

new text begin (c) General Assistance Grants new text end

new text begin 1,458,000 new text end

new text begin (d) Minnesota Supplemental Aid Grants new text end

new text begin 513,000 new text end

new text begin (e) Group Residential Housing Grants new text end

new text begin 2,568,000 new text end

new text begin Subd. 4. new text end new text begin Basic Health Care Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end		new text begin (224,341,000) new text end
new text begin Health Care Access new text end		new text begin (19,460,000) new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) MinnesotaCare Health Care Access new text end

new text begin (19,460,000) new text end

new text begin (b) Medical Assistance Basic Health Care; Families and Children new text end

new text begin (100,055,000) new text end

new text begin (c) Medical Assistance Basic Health Care; Elderly and Disabled new text end

new text begin (136,795,000) new text end

new text begin (d) General Assistance Medical Care new text end

new text begin 12,539,000 new text end

new text begin Subd. 5. new text end new text begin Continuing Care Grants new text end

new text begin (247,791,000) new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
new text end

new text begin (a) Medical Assistance Long-Term Care Facilities new text end

new text begin (59,204,000) new text end

new text begin (b) Medical Assistance Long-Term Care Waivers new text end

new text begin (168,927,000) new text end

new text begin (c) Chemical Dependency Entitlement Grants new text end

new text begin (19,660,000) new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective the day following final enactment.
new text end

ARTICLE 12

HEALTH AND HUMAN SERVICES APPROPRIATIONS

Section 1. new text begin SUMMARY OF APPROPRIATIONS. new text end

new text begin The amounts shown in this section summarize direct appropriations by fund made
in this article.
new text end

		new text begin 2010 new text end		new text begin 2011 new text end		new text begin Total new text end
General	new text begin $ new text end	new text begin 4,487,921,000 new text end	new text begin $ new text end	new text begin 5,278,322,000 new text end	new text begin $ new text end	new text begin 9,766,243,000 new text end
new text begin State Government Special Revenue new text end		new text begin 67,075,000 new text end		new text begin 61,675,000 new text end		new text begin 128,750,000 new text end
new text begin Health Care Access new text end		new text begin 474,579,000 new text end		new text begin 554,192,000 new text end		new text begin 1,028,771,000 new text end
new text begin Federal TANF new text end		new text begin 295,652,000 new text end		new text begin 285,641,000 new text end		new text begin 581,293,000 new text end
new text begin Lottery Prize new text end		new text begin 1,665,000 new text end		new text begin 1,655,000 new text end		new text begin 3,330,000 new text end
new text begin Total new text end	new text begin $ new text end	new text begin 5,326,892,000 new text end	new text begin $ new text end	new text begin 6,181,495,000 new text end	new text begin $ new text end	new text begin 11,508,387,000 new text end

Sec. 2. new text begin HEALTH AND HUMAN SERVICES APPROPRIATION. new text end

new text begin The sums shown in the columns marked "Appropriations" are appropriated to the
agencies and for the purposes specified in this article. The appropriations are from the
general fund, or another named fund, and are available for the fiscal years indicated
for each purpose. The figures "2010" and "2011" used in this article mean that the
appropriations listed under them are available for the fiscal year ending June 30, 2010, or
June 30, 2011, respectively. "The first year" is fiscal year 2010. "The second year" is fiscal
year 2011. "The biennium" is fiscal years 2010 and 2011. Appropriations for the fiscal
year ending June 30, 2009, are effective the day following final enactment.
new text end

			new text begin APPROPRIATIONS new text end
			new text begin Available for the Year new text end
			new text begin Ending June 30 new text end
				new text begin 2010 new text end		new text begin 2011 new text end

Sec. 3. new text begin HUMAN SERVICES new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 5,073,896,000 new text end

new text begin $ new text end

new text begin 5,929,006,000 new text end

new text begin Appropriations by Fund new text end
	new text begin 2010 new text end	new text begin 2011 new text end
new text begin General new text end	new text begin 4,345,752,000 new text end	new text begin 5,139,485,000 new text end
new text begin State Government Special Revenue new text end	new text begin 5,809,000 new text end	new text begin 565,000 new text end
new text begin Health Care Access new text end	new text begin 436,751,000 new text end	new text begin 513,383,000 new text end
new text begin Federal TANF new text end	new text begin 283,919,000 new text end	new text begin 273,908,000 new text end
new text begin Lottery Prize new text end	new text begin 1,665,000 new text end	new text begin 1,665,000 new text end

new text begin new text begin Receipts for Systems Projects. new text end
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, and SSIS must be deposited
in the state system account authorized in
Minnesota Statutes, section 256.014. Money
appropriated for computer projects approved
by the Minnesota Office of Enterprise
Technology, funded by the legislature, and
approved by the commissioner of finance,
may be transferred from one project to
another and from development to operations
as the commissioner of human services
considers necessary, except that any transfers
to one project that exceed $1,000,000 or
multiple transfers to one project that exceed
$1,000,000 in total require the express
approval of the legislature. Any unexpended
balance in the appropriation for these
projects does not cancel but is available for
ongoing development and operations. Any
computer project with a total cost exceeding
$1,000,000, including, but not limited to, a
replacement for the proposed HealthMatch
system, shall not be commenced without the
express approval of the legislature.
new text end

new text begin HealthMatch Systems Account. In fiscal
year 2010, $3,053,000 shall be transferred
from the HealthMatch systems account in the
special revenue fund to the general fund.
new text end

new text begin Minnesota Joint Underwriting
Association. By June 30, 2010, the
commissioner of finance shall transfer
$6,404,000 in assets of the Minnesota Joint
Underwriting Association under chapter 62I
to the general fund.
new text end

new text begin new text begin Nonfederal Share Transfers. new text end The
nonfederal share of activities for which
federal administrative reimbursement is
appropriated to the commissioner may be
transferred to the special revenue fund.
new text end

new text begin new text begin Local Share Payment Modification
Required for ARRA Compliance. new text end
Effective from July 1, 2009, to December
31, 2010, Hennepin County's monthly
contribution to the nonfederal share of
medical assistance costs must be reduced
to the percentage required on September
1, 2008, to meet federal requirements for
enhanced federal match under the American
Reinvestment and Recovery Act (ARRA)
of 2009. Notwithstanding the requirements
of Minnesota Statutes, section 256B.19,
subdivision 1c, paragraph (d), for the period
beginning July 1, 2009, to December 31,
2010, Hennepin County's monthly payment
under that provision is reduced to $434,688.
new text end

new text begin TANF Maintenance of Effort.
new text end

new text begin (a) In order to meet the basic maintenance
of effort (MOE) requirements of the TANF
block grant specified under Code of Federal
Regulations, title 45, section 263.1, the
commissioner may only report nonfederal
money expended for allowable activities
listed in the following clauses as TANF/MOE
expenditures:
new text end

new text begin (1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
new text end

new text begin (2) the child care assistance programs
under Minnesota Statutes, sections 119B.03
and 119B.05, and county child care
administrative costs under Minnesota
Statutes, section 119B.15;
new text end

new text begin (3) state and county MFIP administrative
costs under Minnesota Statutes, chapters
256J and 256K;
new text end

new text begin (4) state, county, and tribal MFIP
employment services under Minnesota
Statutes, chapters 256J and 256K;
new text end

new text begin (5) expenditures made on behalf of
noncitizen MFIP recipients who qualify
for the medical assistance without federal
financial participation program under
Minnesota Statutes, section 256B.06,
subdivision 4, paragraphs (d), (e), and (j);
and
new text end

new text begin (6) qualifying working family credit
expenditures under Minnesota Statutes,
section 290.0671.
new text end

new text begin (b) The commissioner shall ensure that
sufficient qualified nonfederal expenditures
are made each year to meet the state's
TANF/MOE requirements. For the activities
listed in paragraph (a), clauses (2) to
(6), the commissioner may only report
expenditures that are excluded from the
definition of assistance under Code of
Federal Regulations, title 45, section 260.31.
new text end

new text begin (c) For fiscal years beginning with state
fiscal year 2003, the commissioner shall
ensure that the maintenance of effort used
by the commissioner of finance for the
February and November forecasts required
under Minnesota Statutes, section 16A.103,
contains expenditures under paragraph (a),
clause (1), equal to at least 16 percent of
the total required under Code of Federal
Regulations, title 45, section 263.1.
new text end

new text begin (d) For federal fiscal years beginning on or
after October 1, 2007, the commissioner
may not claim an amount of TANF/MOE in
excess of the 75 percent standard in Code
of Federal Regulations, title 45, section
263.1(a)(2), except:
new text end

new text begin (1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1),
if it is determined by the commissioner
that the state will not meet the TANF work
participation target rate for the current year;
new text end

new text begin (2) to provide any additional amounts
under Code of Federal Regulations, title 45,
section 264.5, that relate to replacement of
TANF funds due to the operation of TANF
penalties; and
new text end

new text begin (3) to provide any additional amounts that
may contribute to avoiding or reducing
TANF work participation penalties through
the operation of the excess MOE provisions
of Code of Federal Regulations, title 45,
section 261.43(a)(2).
new text end

new text begin For the purposes of clauses (1) to (3),
the commissioner may supplement the
MOE claim with working family credit
expenditures to the extent such expenditures
or other qualified expenditures are otherwise
available after considering the expenditures
allowed in this section.
new text end

new text begin (e) Minnesota Statutes, section 256.011,
subdivision 3, which requires that federal
grants or aids secured or obtained under that
subdivision be used to reduce any direct
appropriations provided by law, do not apply
if the grants or aids are federal TANF funds.
new text end

new text begin (f) Notwithstanding any contrary provision
in this article, this provision expires June 30,
2013.
new text end

new text begin new text begin Working Family Credit Expenditures as
TANF/MOE. new text end The commissioner may claim
as TANF/MOE up to $6,707,000 per year of
working family credit expenditures for fiscal
year 2010 through fiscal year 2011.
new text end

new text begin new text begin Working Family Credit Expenditures
to be Claimed for TANF/MOE. new text end The
commissioner may count the following
amounts of working family credit expenditure
as TANF/MOE:
new text end

new text begin (1) fiscal year 2010, $49,792,000;
new text end

new text begin (2) fiscal year 2011, $66,531,000;
new text end

new text begin (3) fiscal year 2012, $15,825,000; and
new text end

new text begin (4) fiscal year 2013, $16,150,000.
new text end

new text begin Notwithstanding any contrary provision in
this article, this rider expires June 30, 2013.
new text end

new text begin new text begin TANF Transfer to Federal Child Care
and Development Fund. new text end The following
TANF fund amounts are appropriated to the
commissioner for the purposes of MFIP and
transition year child care under Minnesota
Statutes, section 119B.05:
new text end

new text begin (1) fiscal year 2010, $6,313,000;
new text end

new text begin (2) fiscal year 2011, $23,321,000;
new text end

new text begin (3) fiscal year 2012, $2,475,000; and
new text end

new text begin (4) fiscal year 2013, $2,180,000.
new text end

new text begin The commissioner shall authorize the
transfer of sufficient TANF funds to the
federal child care and development fund to
meet this appropriation and shall ensure that
all transferred funds are expended according
to federal child care and development fund
regulations.
new text end

new text begin new text begin Food Stamps Employment and Training. new text end
(a) The commissioner shall apply for and
claim the maximum allowable federal
matching funds under United States Code,
title 7, section 2025, paragraph (h), for
state expenditures made on behalf of family
stabilization services participants voluntarily
engaged in food stamp employment and
training activities, where appropriate.
new text end

new text begin (b) Notwithstanding Minnesota Statutes,
sections 256D.051, subdivisions 1a, 6b,
and 6c, and 256J.626, federal food stamps
employment and training funds received
as reimbursement of MFIP consolidated
fund grant expenditures for diversionary
work program participants and child
care assistance program expenditures for
two-parent families must be deposited in the
general fund. The amount of funds must be
limited to $4,340,000 in fiscal year 2010
and $4,340,000 in fiscal years 2011 through
2013, contingent on approval by the federal
Food and Nutrition Service.
new text end

new text begin (c) Consistent with the receipt of these federal
funds, the commissioner may adjust the
level of working family credit expenditures
claimed as TANF maintenance of effort.
Notwithstanding any contrary provision in
this article, this rider expires June 30, 2013.
new text end

new text begin new text begin ARRA Food Support Administration. new text end
The funds available for food support
administration under the American Recovery
and Reinvestment Act (ARRA) of 2009
must be appropriated to the commissioner
for implementing the food support
benefit increases, increased eligibility
determinations, and outreach. Of these
funds, 20 percent shall be allocated to
the commissioner and 80 percent must be
allocated to counties. The commissioner
shall reimburse counties proportionate to
their food support caseload based on data
for the most recent quarter available. Tribal
reimbursement must be made from the state
portion based on a caseload factor equivalent
to that of a county.
new text end

new text begin new text begin Emergency Fund for the TANF Program. new text end
TANF Emergency Contingency funds
available under the American Recovery
and Reinvestment Act of 2009 (Public Law
111-5) are appropriated to the commissioner.
The commissioner must request TANF
Emergency Contingency funds from the
Secretary of the Department of Health
and Human Services to the extent the
commissioner meets or expects to meet
the requirements of section 403(c) of the
Social Security Act. The commissioner must
seek to maximize such grants. The funds
received must be used as appropriated. Each
county must maintain the county's current
level of emergency assistance funding under
the children and community services fund
and use the funds under this paragraph to
supplement existing emergency assistance
funding levels.
new text end

new text begin Subd. 2. new text end new text begin Agency Management new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) Financial Operations new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 3,380,000 new text end	new text begin 3,908,000 new text end
new text begin Health Care Access new text end	new text begin 1,241,000 new text end	new text begin 1,016,000 new text end
new text begin Federal TANF new text end	new text begin 122,000 new text end	new text begin 122,000 new text end

new text begin (b) Legal and Regulatory Operations new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 13,555,000 new text end	new text begin 13,355,000 new text end
new text begin State Government Special Revenue new text end	new text begin 440,000 new text end	new text begin 440,000 new text end
new text begin Health Care Access new text end	new text begin 943,000 new text end	new text begin 943,000 new text end
new text begin Federal TANF new text end	new text begin 100,000 new text end	new text begin 100,000 new text end

new text begin (c) Management Operations new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 4,334,000 new text end	new text begin 4,562,000 new text end
new text begin Health Care Access new text end	new text begin 242,000 new text end	new text begin 242,000 new text end

new text begin Lease Cost Reduction. Base level funding
to the commissioner shall be reduced by
$381,000 in fiscal year 2010, and $153,000
in fiscal year 2011, to reflect a reduction in
lease costs related to the Minnehaha Avenue
building.
new text end

new text begin Base Adjustment. The general fund base is
increased $153,000 in fiscal year 2012 and
$153,000 in fiscal year 2013.
new text end

new text begin (d) Information Technology Operations new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 28,077,000 new text end	new text begin 28,077,000 new text end
new text begin Health Care Access new text end	new text begin 4,856,000 new text end	new text begin 4,868,000 new text end

new text begin Subd. 3. new text end new text begin Revenue and Pass-Through Revenue Expenditures new text end

new text begin 77,303,000 new text end

new text begin 89,773,000 new text end

new text begin This appropriation is from the federal TANF
fund.
new text end

new text begin Subd. 4. new text end new text begin Children and Economic Assistance Grants new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
new text end

new text begin (a) MFIP/DWP Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 74,126,000 new text end	new text begin 117,550,000 new text end
new text begin Federal TANF new text end	new text begin 95,841,000 new text end	new text begin 69,050,000 new text end

new text begin (b) Support Services Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 8,715,000 new text end	new text begin 12,498,000 new text end
new text begin Federal TANF new text end	new text begin 114,961,000 new text end	new text begin 113,511,000 new text end

new text begin Supported Work. Of the TANF
appropriation, $6,400,000 in fiscal year
2011 is to the commissioner for supported
work for MFIP recipients and is available
until expended. Supported work includes
paid transitional work experience and
a continuum of employment assistance,
including outreach and recruitment,
program orientation and intake, testing and
assessment, job development and marketing,
preworksite training, supported worksite
experience, job coaching, and postplacement
follow-up, in addition to extensive case
management and referral services.
new text end

new text begin new text begin TANF Emergency Fund; Nonrecurrent
Short-Term Benefits. new text end TANF Emergency
Contingency fund grants received due to
increases in expenditures for nonrecurrent
short-term benefits must be used to offset the
increase in these expenditures for counties
under the MFIP consolidated fund under
Minnesota Statutes, section 256J.626,
and the diversionary work program. The
commissioner shall develop procedures
to maximize reimbursement of these
expenditures over the TANF emergency fund
base year quarters.
new text end

new text begin Base Adjustment. The general fund base is
decreased $3,783,000 in fiscal year 2012 and
$3,783,000 in fiscal year 2013. The federal
TANF fund base in increased $1,450,000 in
both fiscal year 2012 and fiscal year 2013.
new text end

new text begin (c) MFIP Child Care Assistance Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 51,690,000 new text end	new text begin 42,505,000 new text end
new text begin Federal TANF new text end	new text begin -0- new text end	new text begin 616,000 new text end

new text begin new text begin ARRA Child Care Development Block
Grant Funds. new text end The funds available from the
child care development block grant under
ARRA must be used for MFIP child care to
the extent that those funds are not earmarked
for quality expansion or to improve the
quality of infant and toddler care.
new text end

new text begin (d) Basic Sliding Fee Child Care Assistance Grants new text end

new text begin 39,843,000 new text end

new text begin 44,835,000 new text end

new text begin Child Care Development Fund
Unexpended Balance. In addition to
the amount provided in this section, the
commissioner shall expend $5,244,000 in
fiscal year 2010 from the federal child care
development fund unexpended balance
for basic sliding fee child care under
Minnesota Statutes, section 119B.03. The
commissioner shall ensure that all child
care and development funds are expended
according to the federal child care and
development fund regulations.
new text end

new text begin (e) Child Care Development Grants new text end

new text begin 1,487,000 new text end

new text begin 1,487,000 new text end

new text begin Family, Friend, and Neighbor Grants.
$375,000 in fiscal year 2010 and $375,000
in fiscal year 2011 are appropriated from
the federal child care development fund
required quality set-aside from the American
Recovery and Reinvestment Act of 2009,
Public Law 111-5, funds to the commissioner
consistent with federal regulations for the
purpose of the family, friend, and neighbor
grant program under Minnesota Statutes,
section 119B.232.
new text end

new text begin Quality Rating System. (a) $633,000 in
fiscal year 2010 and $633,000 in fiscal year
2011 are appropriated from the federal child
care development fund required quality
set-aside from the American Recovery and
Reinvestment Act of 2009, Public Law
111-5, funds to the commissioner consistent
with federal regulations for the purpose
of providing grants to provide statewide
provider training to prepare for the Parent
Aware quality star rating system.
new text end

new text begin (b) For the biennium beginning July 1,
2009, $1,384,000 is appropriated from the
federal child care development fund required
quality set-aside from American Recovery
and Reinvestment Act of 2009, Public Law
111-5, funds to the commissioner of human
services consistent with federal regulations
for the purpose of implementing the Parent
Aware quality star rating system pilot in
coordination with the Minnesota Early
Learning Foundation. These funds must be
spent on ratings and evaluations of the Parent
Aware quality star rating system. These
funds must be spent on implementation of
the Parent Aware quality ratings and may not
be used for scholarships or administrative
operations of that organization.
new text end

new text begin (f) Child Support Enforcement Grants new text end

new text begin 3,705,000 new text end

new text begin 3,705,000 new text end

new text begin (g) Children's Services Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 47,533,000 new text end	new text begin 50,498,000 new text end
new text begin Federal TANF new text end	new text begin 340,000 new text end	new text begin 240,000 new text end

new text begin new text begin Base Adjustment. new text end The general fund base is
decreased by $5,371,000 in fiscal year 2012
and increased $8,737,000 in fiscal year 2013.
new text end

new text begin new text begin Privatized Adoption Grants. new text end Federal
reimbursement for privatized adoption grant
and foster care recruitment grant expenditures
is appropriated to the commissioner for
adoption grants and foster care and adoption
administrative purposes.
new text end

new text begin new text begin Adoption Assistance Incentive Grants. new text end
Federal funds available during fiscal year
2010 and fiscal year 2011 for the adoption
incentive grants are appropriated to the
commissioner for these purposes.
new text end

new text begin new text begin Adoption Assistance and Relative Custody
Assistance. new text end The commissioner may transfer
unencumbered appropriation balances for
adoption assistance and relative custody
assistance between fiscal years and between
programs.
new text end

new text begin (h) Children and Community Services Grants new text end

new text begin 67,604,000 new text end

new text begin 67,463,000 new text end

new text begin new text begin Targeted Case Management Temporary
Funding Adjustment. new text end The commissioner
shall recover from each county and tribe
receiving a targeted case management
temporary funding payment in fiscal year
2008 an amount equal to that payment. The
commissioner shall recover one-half of the
funds by February 1, 2010, and the remainder
by February 1, 2011. At the commissioner's
discretion and at the request of a county
or tribe, the commissioner may revise
the payment schedule, but full payment
must not be delayed beyond May 1, 2011.
The commissioner may use the recovery
procedure under Minnesota Statutes, section
256.017, to recover the funds. Recovered
funds must be deposited into the general
fund.
new text end

new text begin (i) General Assistance Grants new text end

new text begin 48,215,000 new text end

new text begin 48,608,000 new text end

new text begin new text begin General Assistance Standard. new text end The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart
from parents or a legal guardian at $203.
The commissioner may reduce this amount
according to Laws 1997, chapter 85, article
3, section 54.
new text end

new text begin Emergency General Assistance. The
amount appropriated for emergency general
assistance funds is limited to no more
than $7,889,812 in fiscal year 2010 and
$7,889,812 in fiscal year 2011. Funds
to counties must be allocated by the
commissioner using the allocation method
specified in Minnesota Statutes, section
256D.06.
new text end

new text begin (j) Minnesota Supplemental Aid Grants new text end

new text begin 33,930,000 new text end

new text begin 35,191,000 new text end

new text begin Emergency Minnesota Supplemental
Aid Funds. The amount appropriated for
emergency Minnesota supplemental aid
funds is limited to no more than $1,100,000
in fiscal year 2010 and $1,100,000 in fiscal
year 2011. Funds to counties must be
allocated by the commissioner using the
allocation method specified in Minnesota
Statutes, section 256D.46.
new text end

new text begin (k) Group Residential Housing Grants new text end

new text begin 111,689,000 new text end

new text begin 113,937,000 new text end

new text begin (l) Children's Mental Health Grants new text end

new text begin 16,885,000 new text end

new text begin 16,882,000 new text end

new text begin new text begin Funding Usage. new text end Up to 75 percent of a fiscal
year's appropriation for children's mental
health grants may be used to fund allocations
in that portion of the fiscal year ending
December 31.
new text end

new text begin (m) Other Children and Economic Assistance Grants new text end

new text begin 16,029,000 new text end

new text begin 13,859,000 new text end

new text begin new text begin Base Adjustment. new text end The general fund base is
increased by $2,324,000 in fiscal year 2012
and $2,324,000 in fiscal year 2013.
new text end

new text begin new text begin Temporary Community Action Grants
Reduction. new text end The community action grants
appropriation is reduced by $1,964,000 in
fiscal year 2011. This is a onetime reduction.
new text end

new text begin ARRA Homeless Youth Funds. To the
extent permitted under federal law, the
commissioner shall delegate $2,500,000
of the Homeless Prevention and Rapid
Re-Housing Program funds provided under
the American Recovery and Reinvestment
Act of 2009, Public Law 111-5, for agencies
providing homelessness prevention and rapid
rehousing services to youth.
new text end

new text begin Senior Nutrition Program Funding. For
state fiscal year 2010, the commissioner
shall expend economic stimulus funding and
federal funding for senior nutrition programs
before expending state funds.
new text end

new text begin Long-Term Homeless Supportive
Service Fund Appropriation. To the
extent permitted under federal law, the
commissioner shall designate $3,000,000
of the Homelessness Prevention and Rapid
Re-Housing Program funds provided under
the American Recovery and Reinvestment
Act of 2009, Public Law, 111-5, to the
long-term homeless service fund under
Minnesota Statutes, section 256K.26. This
appropriation shall become available by July
1, 2009. This paragraph is effective the day
following final enactment.
new text end

new text begin Subd. 5. new text end new text begin Children and Economic Assistance Management new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) Children and Economic Assistance Administration new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 10,318,000 new text end	new text begin 10,308,000 new text end
new text begin Federal TANF new text end	new text begin 496,000 new text end	new text begin 496,000 new text end

new text begin Base Adjustment. The federal TANF base
is increased by $700,000 in fiscal year 2012
and in fiscal year 2013.
new text end

new text begin (b) Children and Economic Assistance Operations new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 648,000 new text end	new text begin 33,423,000 new text end
new text begin Health Care Access new text end	new text begin 361,000 new text end	new text begin 361,000 new text end

new text begin new text begin Financial Institution Data Match and
Payment of Fees. new text end The commissioner is
authorized to allocate up to $310,000 each
year in fiscal years 2010 and 2011 from the
PRISM special revenue account to make
payments to financial institutions in exchange
for performing data matches between account
information held by financial institutions
and the public authority's database of child
support obligors as authorized by Minnesota
Statutes, section 13B.06, subdivision 7.
new text end

new text begin Use of Federal Stabilization Funds. Of
this appropriation, $33,000,000 in fiscal year
2010 is from the fiscal stabilization account
in the federal fund to the commissioner.
This appropriation must not be used for
any activity or service for which federal
reimbursement is claimed. This is a onetime
appropriation.
new text end

new text begin Subd. 6. new text end new text begin Basic Health Care Grants new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
new text end

new text begin (a) MinnesotaCare Grants new text end

new text begin 401,842,000 new text end

new text begin 478,494,000 new text end

new text begin This appropriation is from the health care
access fund.
new text end

new text begin (b) Medical Assistance Basic Health Care Grants - Families and Children new text end

new text begin 752,266,000 new text end

new text begin 956,938,000 new text end

new text begin new text begin Capitation Payments. new text end Effective from
July 1, 2009, to December 31, 2010,
notwithstanding the provisions of Minnesota
Statutes 2008, section 256B.19, subdivision
1c, paragraph (c), the commissioner shall
increase capitation payments made to the
Metropolitan Health Plan under Minnesota
Statutes 2008, section 256B.69, by
$6,800,000 to recognize higher than average
medical education costs. The increased
amount includes federal matching funds.
new text end

new text begin Use of Savings. Any savings derived
from implementation of the prohibition in
Minnesota Statutes, section 256B.032, on the
enrollment of low-quality, high-cost health
care providers as vendors of state health care
program services shall be used to offset on a
pro rata basis the reimbursement reductions
for basic care services in Minnesota Statutes,
section 256B.766.
new text end

new text begin (c) Medical Assistance Basic Health Care Grants - Elderly and Disabled new text end

new text begin 970,156,000 new text end

new text begin 1,134,407,000 new text end

new text begin new text begin Minnesota Disability Health Options.
new text end Notwithstanding Minnesota Statutes, section
256B.69, subdivision 5a, paragraph (b), for
the period beginning July 1, 2009, to June
30, 2011, the monthly enrollment of persons
receiving home and community-based
waivered services under Minnesota
Disability Health Options shall not exceed
1,000. If the budget neutrality provision
in Minnesota Statutes, section 256B.69,
subdivision 23, paragraph (f), is reached
prior to June 30, 2011, the commissioner may
waive this monthly enrollment requirement.
new text end

new text begin new text begin Hospital Fee-for-Service Payment Delay. new text end
Payments from the Medicaid Management
Information System that would otherwise
have been made for inpatient hospital
services for Minnesota health care program
enrollees must be delayed as follows: for
fiscal year 2011, the payments in the month
of June must be included in the first payment
of fiscal year 2012, and for fiscal year 2013,
the payments in the month of June must
be included in the first payment of fiscal
year 2013. The provisions of Minnesota
Statutes, section 16A.124, do not apply to
these delayed payments. Notwithstanding
any contrary provision in this article, this
paragraph expires December 31, 2013.
new text end

new text begin new text begin Nonhospital Fee-for-Service Payment
Delay. new text end Payments from the Medicaid
Management Information System that would
otherwise have been made for nonhospital
acute care services for Minnesota health
care program enrollees must be delayed as
follows: the last payment for fiscal year 2011
must be included in the first payment for
fiscal year 2012, and the last payment for
fiscal year 2013 must be included in the first
payment for fiscal year 2014. This payment
delay must not include nursing facilities,
intermediate care facilities for persons
with developmental disabilities, home and
community-based services, prepaid health
plans, personal care provider organizations,
and home health agencies. The provisions
of Minnesota Statutes, section 16A.124,
do not apply to these delayed payments.
Notwithstanding any contrary provision in
this article, this paragraph expires December
31, 2013.
new text end

new text begin (d) General Assistance Medical Care Grants new text end

new text begin 344,430,000 new text end

new text begin 372,982,000 new text end

new text begin (e) Other Health Care Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 295,000 new text end	new text begin 295,000 new text end
new text begin Health Care Access new text end	new text begin 940,000 new text end	new text begin 940,000 new text end

new text begin Community-Based Health Care
Demonstration Project. Notwithstanding
the provisions of Laws 2007, chapter 147,
article 19, section 3, subdivision 6, paragraph
(e), base level funding to be transferred to the
commissioner of health for the demonstration
project grant described in Minnesota Statutes,
section 62Q.80, subdivision 1a, shall be zero
for fiscal years 2010, 2011, and 2012.
new text end

new text begin Subd. 7. new text end new text begin Health Care Management new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) Health Care Administration new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 8,571,000 new text end	new text begin 8,567,000 new text end
new text begin Health Care Access new text end	new text begin 1,089,000 new text end	new text begin 906,000 new text end

new text begin Medical Education Research Costs. In
fiscal year 2010, $38,000,000 is appropriated
from the general fund to the commissioner
to restore the fiscal year 2009 unallotment
of the transfers under Minnesota Statutes,
section 256B.69, subdivision 5c, paragraph
(a), for the July 1, 2008, through June 30,
2009, period. The commissioner shall
transfer $38,000,000 in fiscal year 2010 to
the medical education research fund.
new text end

new text begin new text begin Base Adjustment. new text end The general fund base is
increased by $40,000 in fiscal year 2012 and
$65,000 in fiscal year 2013.
new text end

new text begin (b) Health Care Operations new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 9,971,000 new text end	new text begin 8,942,000 new text end
new text begin Health Care Access new text end	new text begin 24,487,000 new text end	new text begin 25,613,000 new text end

new text begin new text begin Base Adjustment. new text end The health care access
fund base is increased by $1,434,000 in
fiscal year 2012 and $2,153,000 in fiscal year
2013. The general fund base is decreased by
$237,000 in fiscal year 2012 and $237,000 in
fiscal year 2013.
new text end

new text begin Subd. 8. new text end new text begin Continuing Care Grants new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) Aging and Adult Services Grants new text end

new text begin 13,975,000 new text end

new text begin 15,290,000 new text end

new text begin new text begin Base Adjustment. new text end The general fund base is
increased by $6,748,000 in fiscal year 2012
and $6,702,000 in fiscal year 2013.
new text end

new text begin new text begin Information and Assistance
Reimbursement. new text end Federal administrative
reimbursement obtained from information
and assistance services provided by the
Senior LinkAge or Disability Linkage lines
to people who are identified as eligible for
medical assistance shall be appropriated to
the commissioner for this activity.
new text end

new text begin new text begin Community Service Development Grant
Reduction. new text end Funding for community service
development grants must be reduced by
$240,000 per year for fiscal years 2010 and
2011. This reduction shall not adjust the base
appropriation.
new text end

new text begin (b) Alternative Care Grants new text end

new text begin 50,100,000 new text end

new text begin 48,394,000 new text end

new text begin new text begin Base Adjustment. new text end The general fund base is
decreased by $3,619,000 in fiscal year 2012
and $3,503,000 in fiscal year 2013.
new text end

new text begin new text begin Alternative Care Transfer. new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
new text end

new text begin (c) Medical Assistance Grants; Long-Term Care Facilities. new text end

new text begin 364,352,000 new text end

new text begin 416,483,000 new text end

new text begin (d) Medical Assistance Long-Term Care Waivers and Home Care Grants new text end

new text begin 848,065,000 new text end

new text begin 1,025,510,000 new text end

new text begin new text begin Manage Growth in TBI and CADI
Waivers. new text end During the fiscal years beginning
on July 1, 2009, and July 1, 2010, the
commissioner shall allocate money for home
and community-based waiver programs
under Minnesota Statutes, section 256B.49,
to ensure a reduction in state spending that is
equivalent to limiting the caseload growth of
the TBI waiver to 12.5 allocations per month
each year of the biennium and the CADI
waiver to 95 allocations per month each year
of the biennium. Limits do not apply: (1)
when there is an approved plan for nursing
facility bed closures for individuals under
age 65 who require relocation due to the
bed closure; (2) to fiscal year 2009 waiver
allocations delayed due to unallotment; or (3)
to transfers authorized by the commissioner
from the personal care assistance program
of individuals having a home care rating
of "CS," "MT," or "HL." Priorities for the
allocation of funds must be for individuals
anticipated to be discharged from institutional
settings or who are at imminent risk of a
placement in an institutional setting.
new text end

new text begin new text begin Manage Growth in DD Waiver. new text end The
commissioner shall manage the growth in
the DD waiver by limiting the allocations
included in the February 2009 forecast to 15
additional diversion allocations each month
for the calendar years that begin on January
1, 2010, and January 1, 2011. Additional
allocations must be made available for
transfers authorized by the commissioner
from the personal care program of individuals
having a home care rating of "CS," "MT,"
or "HL."
new text end

new text begin new text begin Adjustment to Lead Agency Waiver
allocations. new text end Prior to the availability of the
alternative license defined in Minnesota
Statutes, section 245A.11, subdivision 8,
the commissioner shall reduce lead agency
waiver allocations for the purposes of
implementing a moratorium on corporate
foster care.
new text end

new text begin Alternatives to Personal Care Assistance
Services. In fiscal year 2012, base level
funding shall be $8,093,000 to implement
alternative services to personal care
assistance services for persons with mental
health and other behavioral challenges
who can benefit from other services that
more appropriately meet their needs and
assist them in living independently in the
community. These services may include, but
not be limited to, a 1915(i) state plan option.
new text end

new text begin (e) Mental Health Grants new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 77,739,000 new text end	new text begin 77,739,000 new text end
new text begin Health Care Access new text end	new text begin 750,000 new text end	new text begin 750,000 new text end
new text begin Lottery Prize new text end	new text begin 1,508,000 new text end	new text begin 1,508,000 new text end

new text begin new text begin Funding Usage. new text end Up to 75 percent of a fiscal
year's appropriation for adult mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
new text end

new text begin (f) Deaf and Hard-of-Hearing Grants new text end

new text begin 1,924,000 new text end

new text begin 1,909,000 new text end

new text begin (g) Chemical Dependency Entitlement Grants new text end

new text begin 110,415,000 new text end

new text begin 121,997,000 new text end

new text begin new text begin Chemical Dependency Maximum Rates. new text end
Chemical dependency rates for providers
under Minnesota Statutes, chapter 254B,
effective from January 1, 2010, to June 30,
2013, must not exceed 185 percent of the
average rate on January 1, 2009, for each
group of vendors with similar attributes.
Payment for services provided by Indian
Health Services or by agencies operated by
Indian tribes for medical assistance-eligible
individuals must be governed by the
applicable federal rate methodology.
new text end

new text begin new text begin Chemical Dependency Special Revenue
Account. new text end For fiscal year 2010, $750,000
must be transferred from the consolidated
chemical dependency treatment fund
administrative account and deposited into the
general fund.
new text end

new text begin (h) Chemical Dependency Nonentitlement Grants new text end

new text begin 1,729,000 new text end

new text begin 1,729,000 new text end

new text begin Base Adjustment. The general fund base is
decreased $3,000 in fiscal year 2012 and in
fiscal year 2013.
new text end

new text begin (i) Other Continuing Care Grants new text end

new text begin 19,095,000 new text end

new text begin 17,388,000 new text end

new text begin new text begin Base Adjustment. new text end The general fund base is
increased $7,487,000 in fiscal year 2012 and
decreased $1,019,000 in fiscal year 2013.
new text end

new text begin new text begin Technology Grants. new text end $650,000 in fiscal
year 2010 and $1,000,000 in fiscal year
2011 are for technology grants, case
consultation, evaluation, and consumer
information grants related to developing and
supporting alternatives to shift-staff foster
care residential service models.
new text end

new text begin new text begin Other Continuing Care Grants; HIV
Grants. new text end Money appropriated for the HIV
drug and insurance grant program in fiscal
year 2010 may be used in either year of the
biennium.
new text end

new text begin Subd. 9. new text end new text begin Continuing Care Management new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 24,640,000 new text end	new text begin 25,285,000 new text end
new text begin State Government Special Revenue new text end	new text begin 125,000 new text end	new text begin 125,000 new text end
new text begin Lottery Prize new text end	new text begin 157,000 new text end	new text begin 157,000 new text end

new text begin Base Adjustment. The general fund base is
decreased $2,632,000 in fiscal year 2012 and
$2,654,000 in fiscal year 2013.
new text end

new text begin Subd. 10. new text end new text begin State-Operated Services new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin new text begin Transfer Authority Related to
State-Operated Services. new text end Money
appropriated to finance state-operated
services may be transferred between the
fiscal years of the biennium with the approval
of the commissioner of finance.
new text end

new text begin new text begin County Past Due Receivables. new text end The
commissioner is authorized to withhold
county federal administrative reimbursement
when the county of financial responsibility
for cost-of-care payments due the state
under Minnesota Statutes, section 246.54
or 253B.045, is 90 days past due. The
commissioner shall deposit the withheld
federal administrative earnings for the county
into the general fund to settle the claims with
the county of financial responsibility. The
process for withholding funds is governed by
Minnesota Statutes, section 256.017.
new text end

new text begin Forecast and Census Data. The
commissioner shall include forecast and
census data for state-operated services and
Minnesota sex offender services with the
November and February budget forecasts.
Notwithstanding any contrary provision in
this article, this paragraph shall not expire.
new text end

new text begin (a) Adult Mental Health Services new text end

new text begin 100,508,000 new text end

new text begin 99,808,000 new text end

new text begin new text begin Appropriation Limitation. new text end No part of
the appropriation in this article to the
commissioner for mental health treatment
services provided by state-operated services
shall be used for the Minnesota sex offender
program.
new text end

new text begin new text begin Community Behavioral Health Hospitals. new text end
Under Minnesota Statutes, section 246.51,
subdivision 1, a determination order for the
clients served in a community behavioral
health hospital operated by the commissioner
of human services is only required when
a client's third-party coverage has been
exhausted.
new text end

new text begin Base Adjustment. The general fund base is
decreased by $500,000 for fiscal year 2012
and by $500,000 for fiscal year 2013.
new text end

new text begin (b) Minnesota Security Hospital and Minnesota Extended Treatment Option Services new text end

new text begin 19,750,000 new text end

new text begin 83,735,000 new text end

new text begin new text begin Minnesota Security Hospital. new text end For the
purposes of enhancing the safety of
the public, improving supervision, and
enhancing community-based mental health
treatment, state-operated services may
establish additional community capacity
for providing treatment and supervision
of clients who have been ordered into a
less restrictive alternative of care from the
state-operated services transitional services
program consistent with Minnesota Statutes,
section 246.014.
new text end

new text begin Use of Federal Stabilization Funds. Of
this appropriation, $63,985,000 in fiscal year
2010 is from the fiscal stabilization account
in the federal fund to the commissioner.
This appropriation must not be used for
any activity or service for which federal
reimbursement is claimed. This is a onetime
appropriation.
new text end

new text begin (c) Minnesota Sex Offender Services new text end

new text begin 46,008,000 new text end

new text begin 59,436,000 new text end

new text begin new text begin Base Adjustment. new text end The general fund base is
decreased by $5,525,000 for fiscal year 2012
and by $7,232,000 for fiscal year 2013.
new text end

new text begin Incarcerated Offenders. Base level
funding for Minnesota sex offender services
is reduced by $836,500 each year of the
biennium for the 50-bed sex offender
treatment program within the Moose Lake
correctional facility in which Department of
Human Services staff from Minnesota sex
offender services provide clinical treatment
to incarcerated offenders. The commissioner
of corrections shall transfer $836,500 per
year of the biennium to the commissioner of
human services for the program under this
paragraph.
new text end

new text begin Use of Federal Stabilization Funds. Of
this appropriation, $16,000,000 in fiscal year
2010 is from the fiscal stabilization account
in the federal fund to the commissioner.
This appropriation must not be used for
any activity or service for which federal
reimbursement is claimed. This is a onetime
appropriation.
new text end

Sec. 4. new text begin COMMISSIONER OF HEALTH new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 163,397,000 new text end

new text begin $ new text end

new text begin 160,917,000 new text end

new text begin Appropriations by Fund new text end
	new text begin 2010 new text end	new text begin 2011 new text end
new text begin General new text end	new text begin 68,291,000 new text end	new text begin 62,800,000 new text end
new text begin State Government Special Revenue new text end	new text begin 45,545,000 new text end	new text begin 45,575,000 new text end
new text begin Health Care Access new text end	new text begin 37,828,000 new text end	new text begin 40,809,000 new text end
new text begin Federal TANF new text end	new text begin 11,733,000 new text end	new text begin 11,733,000 new text end

new text begin Subd. 2. new text end new text begin Community and Family Health new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 44,714,000 new text end	new text begin 39,387,000 new text end
new text begin State Government Special Revenue new text end	new text begin 1,033,000 new text end	new text begin 1,033,000 new text end
new text begin Health Care Access new text end	new text begin 21,642,000 new text end	new text begin 28,719,000 new text end
new text begin Federal TANF new text end	new text begin 11,733,000 new text end	new text begin 11,733,000 new text end

new text begin Funding Usage. new text end new text begin Up to 75 percent of the
fiscal year 2012 appropriation for local public
health grants may be used to fund calendar
year 2011 allocations for this program. The
general fund reduction of $5,193,000 in
fiscal year 2011 for local public health grants
is onetime and the base funding for local
public health grants for fiscal year 2012 is
increased by $5,193,000.
new text end

new text begin TANF Appropriations. new text end new text begin (1) $1,156,000 of
the TANF funds are appropriated each year to
the commissioner for family planning grants
under Minnesota Statutes, section 145.925.
new text end

new text begin (2) $3,579,000 of the TANF funds are
appropriated each year to the commissioner
for home visiting and nutritional services
listed under Minnesota Statutes, section
145.882, subdivision 7, clauses (6) and (7).
Funds must be distributed to community
health boards according to Minnesota
Statutes, section 145A.131, subdivision 1.
new text end

new text begin (3) $2,000,000 of the TANF funds are
appropriated each year to the commissioner
for decreasing racial and ethnic disparities
in infant mortality rates under Minnesota
Statutes, section 145.928, subdivision 7.
new text end

new text begin (4) $4,998,000 of the TANF funds are
appropriated each year to the commissioner
for the family home visiting grant program
according to Minnesota Statutes, section
145A.17. $4,000,000 of the funding must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1. $998,000 of
the funding must be distributed to tribal
governments based on Minnesota Statutes,
section 145A.14, subdivision 2a. The
commissioner may use five percent of
the funds appropriated each fiscal year to
conduct the ongoing evaluations required
under Minnesota Statutes, section 145A.17,
subdivision 7, and may use ten percent of
the funds appropriated each fiscal year to
provide training and technical assistance as
required under Minnesota Statutes, section
145A.17, subdivisions 4 and 5.
new text end

new text begin Base Adjustment. The general fund base
is increased by $10,286,000 for fiscal year
2012 and increased by $5,093,000 for fiscal
year 2013.
new text end

new text begin TANF Carryforward. new text end new text begin Any unexpended
balance of the TANF appropriation in the
first year of the biennium does not cancel but
is available for the second year.
new text end

new text begin Subd. 3. new text end new text begin Policy Quality and Compliance new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 6,857,000 new text end	new text begin 6,693,000 new text end
new text begin State Government Special Revenue new text end	new text begin 14,173,000 new text end	new text begin 14,214,000 new text end
new text begin Health Care Access new text end	new text begin 16,186,000 new text end	new text begin 12,090,000 new text end

new text begin Medical Education and Research Cost
Federal Compliance. new text end new text begin Notwithstanding
Laws 2008, chapter 363, article 18, section
4, subdivision 3, the base level funding
for the commissioner to distribute to the
Mayo Clinic for transitional funding while
federal compliance changes are made to the
medical education and research cost funding
distribution formula shall be $0 for fiscal
years 2010 and 2011.
new text end

new text begin Autism Clinical Research. The
commissioner, in partnership with a
Minnesota research institution, shall apply
for funds available for research grants under
the American Recovery and Reinvestment
Act (ARRA) of 2009 in order to expand
research and treatment of autism spectrum
disorders.
new text end

new text begin new text begin State Loan Repayment Program. new text end In
appropriating the federal stimulus funds,
the commissioner shall give priority in the
distribution of these funds, to the extent
possible under federal requirements to
midlevel mental health practitioners who
practice in the areas of pediatric psychiatry
or mental health.
new text end

new text begin Birthing Centers. new text end new text begin (a) Of the general fund
appropriation, $164,000 in fiscal year 2010 is
to the commissioner for rulemaking activities
for birthing centers. This is a onetime
appropriation.
new text end

new text begin (b) Of the state government special revenue
fund appropriation, $41,000 in fiscal year
2011 is to the commissioner for the birthing
center licensure regulatory requirement
under Minnesota Statutes, section 144.566.
Base level funding for this activity shall be
$131,000 in fiscal year 2012 and $58,000
beginning in fiscal year 2013.
new text end

new text begin Health Information Technology. Of the
health care access fund appropriation for
fiscal year 2010, $2,800,000 is to fund the
revolving loan account under Minnesota
Statutes, section 62J.496. This appropriation
must not be expended prior to the expenditure
of $1,200,000 of existing resources in the
revolving account and unless it is matched
with federal funding under the federal Health
Information Technology for Economic and
Clinical Health (HITECH) Act. This is a
onetime appropriation.
new text end

new text begin Base Adjustment. new text end new text begin The general fund base is
increased $1,000,000 for each of fiscal years
2012 and 2013. The health care access fund
base is decreased $1,140,000 in fiscal year
2012 and $5,274,000 in fiscal year 2013.
new text end

new text begin Subd. 4. new text end new text begin Health Protection new text end

new text begin Appropriations by Fund new text end
new text begin General new text end	new text begin 9,730,000 new text end	new text begin 9,730,000 new text end
new text begin State Government Special Revenue new text end	new text begin 30,339,000 new text end	new text begin 30,328,000 new text end

new text begin Subd. 5. new text end new text begin Administrative Support Services new text end

new text begin 6,990,000 new text end

new text begin 6,990,000 new text end

Sec. 5. new text begin VETERANS AFFAIRS new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 68,425,000 new text end

new text begin $ new text end

new text begin 70,584,000 new text end

new text begin Subd. 2. new text end new text begin Veterans Homes new text end

new text begin 68,425,000 new text end

new text begin 70,584,000 new text end

new text begin Veterans Homes Special Revenue Account.
The general fund appropriations made to
the department may be transferred to a
veterans homes special revenue account in
the special revenue fund in the same manner
as other receipts are deposited according
to Minnesota Statutes, section 198.34, and
are appropriated to the department for the
operation of veterans homes facilities and
programs.
new text end

new text begin Base Reduction. Base level funding for each
year of the biennium is reduced by $200,000
to reflect a reduction in the excessive use of
overtime pay for veterans homes employees.
new text end

new text begin Medicare Certification. Of this
appropriation, the following amounts are
to the commissioner in fiscal year 2011 for
the purposes of Medicare certification of
veterans nursing homes under Minnesota
Statutes, section 198.003, subdivision 7:
new text end

new text begin (1) $259,000 to employ one central
reimbursement billing specialist and 3.5
full-time equivalent senior occupational
therapists. This appropriation shall become
part of base level funding; and
new text end

new text begin (2) $300,000 for billing system software and
systems costs and for training, education,
and implementation costs. This is a onetime
appropriation.
new text end

new text begin Base Adjustment. The general fund base is
decreased by $300,000 for fiscal years 2012
and 2013.
new text end

Sec. 6. new text begin HEALTH-RELATED BOARDS new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 15,017,000 new text end

new text begin $ new text end

new text begin 14,831,000 new text end

new text begin This appropriation is from the state
government special revenue fund.
new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Transfer. In fiscal year 2010, $3,000,000
shall be transferred from the state government
special revenue fund to the general fund.
new text end

new text begin Subd. 2. new text end new text begin Board of Chiropractic Examiners new text end

new text begin 447,000 new text end

new text begin 447,000 new text end

new text begin Subd. 3. new text end new text begin Board of Dentistry new text end

new text begin 1,009,000 new text end

new text begin 1,009,000 new text end

new text begin Subd. 4. new text end new text begin Board of Dietetic and Nutrition Practice new text end

new text begin 105,000 new text end

new text begin 105,000 new text end

new text begin Subd. 5. new text end new text begin Board of Marriage and Family Therapy new text end

new text begin 137,000 new text end

new text begin 137,000 new text end

new text begin Subd. 6. new text end new text begin Board of Medical Practice new text end

new text begin 3,674,000 new text end

new text begin 3,674,000 new text end

new text begin Subd. 7. new text end new text begin Board of Nursing new text end

new text begin 4,217,000 new text end

new text begin 4,219,000 new text end

new text begin Subd. 8. new text end new text begin Board of Nursing Home Administrators new text end

new text begin 1,146,000 new text end

new text begin 958,000 new text end

new text begin new text begin Administrative Services Unit - Operating
Costs. new text end Of this appropriation, $524,000
in fiscal year 2010 and $526,000 in
fiscal year 2011 are for operating costs
of the administrative services unit. The
administrative services unit may receive
and expend reimbursements for services
performed by other agencies.
new text end

new text begin new text begin Administrative Services Unit - Retirement
Costs. new text end Of this appropriation in fiscal year
2010, $201,000 is for onetime retirement
costs in the health-related boards. This
funding may be transferred to the health
boards incurring those costs for their
payment. These funds are available either
year of the biennium.
new text end

new text begin new text begin Administrative Services Unit - Volunteer
Health Care Provider Program. new text end Of this
appropriation, $79,000 in fiscal year 2010
and $89,000 in fiscal year 2011 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
new text end

new text begin new text begin Administrative Services Unit - Contested
Cases and Other Legal Proceedings. new text end Of
this appropriation, $200,000 in fiscal year
2010 and $200,000 in fiscal year 2011
are for costs of contested case hearings
and other unanticipated costs of legal
proceedings involving health-related
boards funded under this section. Upon
certification of a health-related board to the
administrative services unit that the costs
will be incurred and that there is insufficient
money available to pay for the costs out of
money currently available to that board, the
administrative services unit is authorized
to transfer money from this appropriation
to the board for payment of those costs
with the approval of the commissioner of
finance. This appropriation does not cancel.
Any unencumbered and unspent balances
remain available for these expenditures in
subsequent fiscal years.
new text end

new text begin Subd. 9. new text end new text begin Board of Optometry new text end

new text begin 101,000 new text end

new text begin 101,000 new text end

new text begin Subd. 10. new text end new text begin Board of Pharmacy new text end

new text begin 1,413,000 new text end

new text begin 1,413,000 new text end

new text begin Subd. 11. new text end new text begin Board of Physical Therapy new text end

new text begin 295,000 new text end

new text begin 295,000 new text end

new text begin Subd. 12. new text end new text begin Board of Podiatry new text end

new text begin 56,000 new text end

new text begin 56,000 new text end

new text begin Subd. 13. new text end new text begin Board of Psychology new text end

new text begin 806,000 new text end

new text begin 806,000 new text end

new text begin Subd. 14. new text end new text begin Board of Social Work new text end

new text begin 1,022,000 new text end

new text begin 1,022,000 new text end

new text begin Subd. 15. new text end new text begin Board of Veterinary Medicine new text end

new text begin 195,000 new text end

new text begin 195,000 new text end

new text begin Subd. 16. new text end new text begin Board of Behavioral Health and Therapy new text end

new text begin 394,000 new text end

new text begin 394,000 new text end

Sec. 7. new text begin EMERGENCY MEDICAL SERVICES REGULATORY BOARD new text end

new text begin $ new text end

new text begin 3,828,000 new text end

new text begin $ new text end

new text begin 3,828,000 new text end

new text begin Appropriations by Fund new text end
	new text begin 2010 new text end	new text begin 2011 new text end
new text begin General new text end	new text begin 3,124,000 new text end	new text begin 3,124,000 new text end
new text begin State Government Special Revenue new text end	new text begin 704,000 new text end	new text begin 704,000 new text end

new text begin new text begin Longevity Award and Incentive Program. new text end
(a) Of the general fund appropriation,
$700,000 in fiscal year 2010 and $700,000
in fiscal year 2011 are to the board for the
ambulance service personnel longevity award
and incentive program, under Minnesota
Statutes, section 144E.40.
new text end

new text begin (b) In fiscal year 2010, $11,839,000 shall
be transferred from the ambulance service
personnel longevity award and incentive
trust to the general fund.
new text end

new text begin new text begin Health Professional Services Program. new text end
$704,000 in fiscal year 2010 and $704,000 in
fiscal year 2011 from the state government
special revenue fund are for the health
professional services program.
new text end

Sec. 8. new text begin COUNCIL ON DISABILITY new text end

new text begin $ new text end

new text begin 498,000 new text end

new text begin $ new text end

new text begin 498,000 new text end

Sec. 9. new text begin OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES new text end

new text begin $ new text end

new text begin 1,580,000 new text end

new text begin $ new text end

new text begin 1,580,000 new text end

Sec. 10. new text begin OMBUDSPERSON FOR FAMILIES new text end

new text begin $ new text end

new text begin 251,000 new text end

new text begin $ new text end

new text begin 251,000 new text end

Sec. 11. new text begin TRANSFERS.
new text end

new text begin Subdivision 1. new text end

new text begin Grants. new text end

new text begin The commissioner of human services, with the approval
of the commissioner of finance, and after notification of the chairs of the relevant senate
budget division and house of representatives finance division committee, may transfer
unencumbered appropriation balances for the biennium ending June 30, 2011, within
fiscal years among the MFIP, general assistance, general assistance medical care, medical
assistance, MinnesotaCare, MFIP child care assistance under Minnesota Statutes, section
119B.05, Minnesota supplemental aid, and group residential housing programs, and the
entitlement portion of the chemical dependency consolidated treatment fund, and between
fiscal years of the biennium.
new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin Positions, salary money, and nonsalary administrative
money may be transferred within the Departments of Human Services and Health as the
commissioners consider necessary, with the advance approval of the commissioner of
finance. The commissioner shall inform the chairs of the relevant house and senate health
committees quarterly about transfers made under this provision.
new text end

Sec. 12. new text begin 2007 AND 2008 APPROPRIATION AMENDMENTS.
new text end

new text begin (a) Notwithstanding Laws 2007, chapter 147, article 19, section 3, subdivision 4,
paragraph (g), as amended by Laws 2008, chapter 363, article 18, section 7, the TANF
fund base for the Children's Mental Health Pilots is $0 in fiscal year 2011. This paragraph
is effective retroactively from July 1, 2008.
new text end

new text begin (b) The appropriation for patient incentive programs under Laws 2007, chapter 147,
article 19, section 3, subdivision 6, paragraph (e), is canceled. This paragraph is effective
retroactively from July 1, 2007.
new text end

new text begin (c) The onetime general fund base reduction for Child Care Development Grants
under Laws 2008, chapter 363, article 18, section 3, subdivision 4, paragraph (d), is
increased by $4,000. This paragraph is effective retroactively from July 1, 2008.
new text end

new text begin (d) The base for Children Services Grants under Laws 2008, chapter 363, article 18,
section 3, subdivision 4, paragraph (e), is decreased $1,000 in each year of the fiscal year
2010 and 2011 biennium. This paragraph is effective retroactively from July 1, 2008.
new text end

new text begin (e) Notwithstanding Laws 2008, chapter 363, article 18, section 3, subdivision 4, the
general fund base adjustment for Children and Community Services Grants under Laws
2008, chapter 363, article 18, section 3, subdivision 4, paragraph (f), is increased by
$98,000 each year of fiscal years 2010 and 2011. This paragraph is effective retroactively
from July 1, 2008.
new text end

new text begin (f) The base for Other Continuing Care Grants under Laws 2008, chapter 363, article
18, section 3, subdivision 6, paragraph (h), is decreased by $10,000 in fiscal year 2010.
This paragraph is effective retroactively from July 1, 2008.
new text end

new text begin (g) The appropriation for the Community-Based Health Care Demonstration Project
under Minnesota Statutes, section 62Q.80, subdivision 1a, authorized under Laws 2007,
chapter 147, article 19, section 3, subdivision 6, paragraph (e), is canceled. This paragraph
is effective retroactively from July 1, 2007.
new text end

new text begin (h) The appropriation for Section 125 Employer Incentives in Laws 2008, chapter
358, article 5, section 4, subdivision 3, is reduced by $800,000. This paragraph is effective
retroactively from July 1, 2008.
new text end

Sec. 13. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end

new text begin The commissioners of health and human services shall not use indirect cost
allocations to pay for the operational costs of any program for which they are responsible.
new text end

Sec. 14. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2011, unless a
different expiration date is explicit.
new text end

Sec. 15. new text begin EFFECTIVE DATE.
new text end

new text begin The provisions in this article are effective July 1, 2009, unless a different effective
date is specified.
new text end