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SF 800

Conference Committee Report - 90th Legislature (2017 - 2018) Posted on 05/08/2017 10:17pm

KEY: stricken = removed, old language.
underscored = added, new language.
1.1CONFERENCE COMMITTEE REPORT ON S.F. No. 800
1.2A bill for an act
1.3relating to human services finance and policy; appropriating money for human
1.4services and health-related programs; modifying various provisions governing
1.5community supports, housing, continuing care, health care, managed care
1.6organizations, health insurance, direct care and treatment, children and families,
1.7chemical and mental health services, Department of Human Services operations,
1.8Department of Health policy, and health licensing boards; establishing a license
1.9for substance abuse disorder treatment; authorizing transfers; providing for
1.10supplemental rates; modifying reimbursement rates and premium scales; making
1.11forecast adjustments; providing for audits; establishing crumb rubber playground
1.12moratorium; authorizing pilot projects and studies; requiring reports; establishing
1.13a legislative commission; making technical and terminology changes;amending
1.14Minnesota Statutes 2016, sections 3.972, by adding a subdivision; 13.32, by adding
1.15a subdivision; 13.46, subdivisions 1, 2, 4; 13.69, subdivision 1; 13.84, subdivision
1.165; 62A.04, subdivision 1; 62A.21, subdivision 2a; 62A.3075; 62D.105, subdivisions
1.171, 2; 62E.04, subdivision 11; 62E.05, subdivision 1; 62E.06, by adding a
1.18subdivision; 62M.07; 62U.02; 62V.05, subdivision 12; 103I.101, subdivisions 2,
1.195; 103I.111, subdivisions 6, 7, 8; 103I.205; 103I.301; 103I.501; 103I.505; 103I.515;
1.20103I.535, subdivisions 3, 6, by adding a subdivision; 103I.541; 103I.545,
1.21subdivisions 1, 2; 103I.711, subdivision 1; 103I.715, subdivision 2; 119B.011, by
1.22adding subdivisions; 119B.02, subdivision 5; 119B.09, subdivision 9a; 119B.125,
1.23subdivisions 4, 6; 119B.13, subdivisions 1, 6; 119B.16, subdivisions 1, 1a, 1b, by
1.24adding subdivisions; 144.05, subdivision 6; 144.0724, subdivisions 4, 6; 144.122;
1.25144.1501, subdivision 2; 144.551, subdivision 1; 144A.071, subdivision 4d;
1.26144A.351; 144A.472, subdivision 7; 144A.474, subdivision 11; 144A.4799,
1.27subdivision 3; 144A.70, subdivision 6, by adding a subdivision; 144D.04,
1.28subdivision 2, by adding a subdivision; 144D.06; 145.4716, subdivision 2; 145.986,
1.29subdivision 1a; 146B.02, subdivisions 2, 5, 8, by adding subdivisions; 146B.03,
1.30subdivisions 6, 7; 146B.07, subdivision 4; 146B.10, subdivision 1; 147.01,
1.31subdivision 7; 147.02, subdivision 1; 147.03, subdivision 1; 147B.08, by adding
1.32a subdivision; 147C.40, by adding a subdivision; 148.5194, subdivision 7; 148.6402,
1.33subdivision 4; 148.6405; 148.6408, subdivision 2; 148.6410, subdivision 2;
1.34148.6412, subdivision 2; 148.6415; 148.6418, subdivisions 1, 2, 4, 5; 148.6420,
1.35subdivisions 1, 3, 5; 148.6423; 148.6425, subdivisions 2, 3; 148.6428; 148.6443,
1.36subdivisions 5, 6, 7, 8; 148.6445, subdivisions 1, 10; 148.6448; 157.16, subdivision
1.371; 214.01, subdivision 2; 245.4889, subdivision 1; 245.91, subdivisions 4, 6;
1.38245.97, subdivision 6; 245A.02, subdivision 2b, by adding a subdivision; 245A.03,
1.39subdivisions 2, 7; 245A.04, subdivision 14; 245A.06, subdivision 2; 245A.07,
1.40subdivision 3; 245A.11, by adding subdivisions; 245A.191; 245A.50, subdivision
1.415; 245D.03, subdivision 1; 245D.04, subdivision 3; 245D.071, subdivision 3;
1.42245D.11, subdivision 4; 245D.24, subdivision 3; 245E.01, by adding a subdivision;
2.1245E.02, subdivisions 1, 3, 4; 245E.03, subdivisions 2, 4; 245E.04; 245E.05,
2.2subdivision 1; 245E.06, subdivisions 1, 2, 3; 245E.07, subdivision 1; 252.27,
2.3subdivision 2a; 252.41, subdivision 3; 253B.10, subdivision 1; 253B.22, subdivision
2.41; 254A.01; 254A.02, subdivisions 2, 3, 5, 6, 8, 10, by adding subdivisions;
2.5254A.03; 254A.035, subdivision 1; 254A.04; 254A.08; 254A.09; 254A.19,
2.6subdivision 3; 254B.01, subdivision 3, by adding a subdivision; 254B.03,
2.7subdivision 2; 254B.04, subdivisions 1, 2b; 254B.05, subdivisions 1, 1a, 5;
2.8254B.051; 254B.07; 254B.08; 254B.09; 254B.12, subdivision 2; 254B.13,
2.9subdivision 2a; 256.01, subdivision 41, by adding a subdivision; 256.045,
2.10subdivision 3; 256.969, subdivisions 2b, 4b, by adding a subdivision; 256.975,
2.11subdivision 7, by adding a subdivision; 256.98, subdivision 8; 256B.04,
2.12subdivisions 21, 22; 256B.056, subdivision 5c; 256B.0621, subdivision 10;
2.13256B.0625, subdivisions 3b, 7, 20, 45a, 57, 64, by adding subdivisions; 256B.0659,
2.14subdivisions 1, 2, 11, 21, by adding a subdivision; 256B.072; 256B.0755,
2.15subdivisions 1, 3, 4, by adding a subdivision; 256B.0911, subdivisions 1a, 3a, 4d,
2.16by adding subdivisions; 256B.0915, subdivisions 1, 1a, 3a, 3e, 3h, 5, by adding
2.17subdivisions; 256B.092, subdivision 4; 256B.0922, subdivision 1; 256B.0924, by
2.18adding a subdivision; 256B.0943, subdivision 13; 256B.0945, subdivisions 2, 4;
2.19256B.196, subdivision 2; 256B.431, subdivisions 10, 16, 30; 256B.434, subdivisions
2.204, 4f; 256B.49, subdivisions 11, 15; 256B.4913, subdivision 4a, by adding a
2.21subdivision; 256B.4914, subdivisions 2, 3, 5, 6, 7, 8, 9, 10, 16; 256B.493,
2.22subdivisions 1, 2, by adding a subdivision; 256B.50, subdivision 1b; 256B.5012,
2.23by adding a subdivision; 256B.69, subdivision 9e; 256B.76, subdivisions 1, 2;
2.24256B.766; 256B.85, subdivisions 3, 5, 6; 256C.23, subdivision 2, by adding
2.25subdivisions; 256C.233, subdivisions 1, 2; 256C.24, subdivisions 1, 2, by adding
2.26a subdivision; 256C.261; 256D.44, subdivisions 4, 5; 256E.30, subdivision 2;
2.27256I.03, subdivision 8; 256I.04, subdivisions 1, 2d, 2g, 3; 256I.05, subdivisions
2.281a, 1c, 1e, 1j, 1m, 8, by adding subdivisions; 256I.06, subdivisions 2, 8; 256J.24,
2.29subdivision 5; 256J.45, subdivision 2; 256L.03, subdivisions 1, 1a, 5; 256L.15,
2.30subdivision 2; 256P.06, subdivision 2; 256R.02, subdivisions 4, 18; 256R.07, by
2.31adding a subdivision; 256R.10, by adding a subdivision; 256R.37; 256R.40,
2.32subdivision 5; 256R.41; 256R.47; 256R.49, subdivision 1; 260C.451, subdivision
2.336; 317A.811, subdivision 1, by adding a subdivision; 327.15, subdivision 3;
2.34609.5315, subdivision 5c; 626.556, subdivisions 2, 3, 3c, 10d, 10j; Laws 2009,
2.35chapter 101, article 1, section 12; Laws 2012, chapter 247, article 6, section 2,
2.36subdivision 2; Laws 2013, chapter 108, article 15, section 2, subdivision 2; Laws
2.372014, chapter 312, article 23, section 9, subdivision 8, by adding a subdivision;
2.38Laws 2015, chapter 71, article 14, section 3, subdivision 2, as amended; Laws
2.392017, chapter 2, article 1, sections 1, subdivision 3; 2, subdivision 4, by adding a
2.40subdivision; 3; 5; 7; article 2, section 13; proposing coding for new law in
2.41Minnesota Statutes, chapters 62J; 62K; 62Q; 119B; 144; 144D; 145; 147A; 148;
2.42245; 245A; 256; 256B; 256I; 256N; 256R; 317A; 448; proposing coding for new
2.43law as Minnesota Statutes, chapters 144H; 245G; repealing Minnesota Statutes
2.442016, sections 13.468; 147A.21; 147B.08, subdivisions 1, 2, 3; 147C.40,
2.45subdivisions 1, 2, 3, 4; 148.6402, subdivision 2; 148.6450; 245A.1915; 245A.192;
2.46254A.02, subdivision 4; 256B.0659, subdivision 22; 256B.19, subdivision 1c;
2.47256B.4914, subdivision 16; 256B.64; 256C.23, subdivision 3; 256C.233,
2.48subdivision 4; 256C.25, subdivisions 1, 2; 256J.626, subdivision 5; Laws 2014,
2.49chapter 312, article 23, section 9, subdivision 5; Minnesota Rules, parts 5600.2500;
2.509530.6405, subparts 1, 1a, 2, 3, 4, 5, 6, 7, 7a, 8, 9, 10, 11, 12, 13, 14, 14a, 15, 15a,
2.5116, 17, 17a, 17b, 17c, 18, 20, 21; 9530.6410; 9530.6415; 9530.6420; 9530.6422;
2.529530.6425; 9530.6430; 9530.6435; 9530.6440; 9530.6445; 9530.6450; 9530.6455;
2.539530.6460; 9530.6465; 9530.6470; 9530.6475; 9530.6480; 9530.6485; 9530.6490;
2.549530.6495; 9530.6500; 9530.6505.
3.1May 8, 2017
3.2The Honorable Michelle L. Fischbach
3.3President of the Senate
3.4The Honorable Kurt L. Daudt
3.5Speaker of the House of Representatives
3.6We, the undersigned conferees for S.F. No. 800 report that we have agreed upon the
3.7items in dispute and recommend as follows:
3.8That the House recede from its amendments and that S.F. No. 800 be further amended
3.9as follows:
3.10Delete everything after the enacting clause and insert:

3.11"ARTICLE 1
3.12COMMUNITY SUPPORTS

3.13    Section 1. Minnesota Statutes 2016, section 144A.351, subdivision 1, is amended to read:
3.14    Subdivision 1. Report requirements. The commissioners of health and human services,
3.15with the cooperation of counties and in consultation with stakeholders, including persons
3.16who need or are using long-term care services and supports, lead agencies, regional entities,
3.17senior, disability, and mental health organization representatives, service providers, and
3.18community members shall prepare a report to the legislature by August 15, 2013, and
3.19biennially thereafter, regarding the status of the full range of long-term care services and
3.20supports for the elderly and children and adults with disabilities and mental illnesses in
3.21Minnesota. Any amounts appropriated for this report are available in either year of the
3.22biennium. The report shall address:
3.23    (1) demographics and need for long-term care services and supports in Minnesota;
3.24    (2) summary of county and regional reports on long-term care gaps, surpluses, imbalances,
3.25and corrective action plans;
3.26    (3) status of long-term care services and related mental health services, housing options,
3.27and supports by county and region including:
3.28    (i) changes in availability of the range of long-term care services and housing options;
3.29    (ii) access problems, including access to the least restrictive and most integrated services
3.30and settings, regarding long-term care services; and
3.31    (iii) comparative measures of long-term care services availability, including serving
3.32people in their home areas near family, and changes over time; and
4.1    (4) recommendations regarding goals for the future of long-term care services and
4.2supports, policy and fiscal changes, and resource development and transition needs.

4.3    Sec. 2. Minnesota Statutes 2016, section 245D.03, subdivision 1, is amended to read:
4.4    Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of home
4.5and community-based services to persons with disabilities and persons age 65 and older
4.6pursuant to this chapter. The licensing standards in this chapter govern the provision of
4.7basic support services and intensive support services.
4.8(b) Basic support services provide the level of assistance, supervision, and care that is
4.9necessary to ensure the health and welfare of the person and do not include services that
4.10are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
4.11person. Basic support services include:
4.12(1) in-home and out-of-home respite care services as defined in section 245A.02,
4.13subdivision 15, and under the brain injury, community alternative care, community access
4.14for disability inclusion, developmental disability, and elderly waiver plans, excluding
4.15out-of-home respite care provided to children in a family child foster care home licensed
4.16under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
4.17holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8,
4.18or successor provisions; and section 245D.061 or successor provisions, which must be
4.19stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000,
4.20subpart 4;
4.21(2) adult companion services as defined under the brain injury, community access for
4.22disability inclusion, and elderly waiver plans, excluding adult companion services provided
4.23under the Corporation for National and Community Services Senior Companion Program
4.24established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
4.25(3) personal support as defined under the developmental disability waiver plan;
4.26(4) 24-hour emergency assistance, personal emergency response as defined under the
4.27community access for disability inclusion and developmental disability waiver plans;
4.28(5) night supervision services as defined under the brain injury waiver plan; and
4.29(6) homemaker services as defined under the community access for disability inclusion,
4.30brain injury, community alternative care, developmental disability, and elderly waiver plans,
4.31excluding providers licensed by the Department of Health under chapter 144A and those
4.32providers providing cleaning services only; and
5.1(7) individual community living support under section 256B.0915, subdivision 3j.
5.2(c) Intensive support services provide assistance, supervision, and care that is necessary
5.3to ensure the health and welfare of the person and services specifically directed toward the
5.4training, habilitation, or rehabilitation of the person. Intensive support services include:
5.5(1) intervention services, including:
5.6(i) behavioral support services as defined under the brain injury and community access
5.7for disability inclusion waiver plans;
5.8(ii) in-home or out-of-home crisis respite services as defined under the developmental
5.9disability waiver plan; and
5.10(iii) specialist services as defined under the current developmental disability waiver
5.11plan;
5.12(2) in-home support services, including:
5.13(i) in-home family support and supported living services as defined under the
5.14developmental disability waiver plan;
5.15(ii) independent living services training as defined under the brain injury and community
5.16access for disability inclusion waiver plans; and
5.17(iii) semi-independent living services; and
5.18(iv) individualized home supports services as defined under the brain injury, community
5.19alternative care, and community access for disability inclusion waiver plans;
5.20(3) residential supports and services, including:
5.21(i) supported living services as defined under the developmental disability waiver plan
5.22provided in a family or corporate child foster care residence, a family adult foster care
5.23residence, a community residential setting, or a supervised living facility;
5.24(ii) foster care services as defined in the brain injury, community alternative care, and
5.25community access for disability inclusion waiver plans provided in a family or corporate
5.26child foster care residence, a family adult foster care residence, or a community residential
5.27setting; and
5.28(iii) residential services provided to more than four persons with developmental
5.29disabilities in a supervised living facility, including ICFs/DD;
5.30(4) day services, including:
5.31(i) structured day services as defined under the brain injury waiver plan;
6.1(ii) day training and habilitation services under sections 252.41 to 252.46, and as defined
6.2under the developmental disability waiver plan; and
6.3(iii) prevocational services as defined under the brain injury and community access for
6.4disability inclusion waiver plans; and
6.5(5) supported employment as defined under the brain injury, developmental disability,
6.6and community access for disability inclusion waiver plans employment exploration services
6.7as defined under the brain injury, community alternative care, community access for disability
6.8inclusion, and developmental disability waiver plans;
6.9(6) employment development services as defined under the brain injury, community
6.10alternative care, community access for disability inclusion, and developmental disability
6.11waiver plans; and
6.12(7) employment support services as defined under the brain injury, community alternative
6.13care, community access for disability inclusion, and developmental disability waiver plans.
6.14EFFECTIVE DATE.(a) The amendment to paragraphs (b) and (c), clause (2), is
6.15effective the day following final enactment.
6.16(b) The amendments to paragraph (c), clauses (5) to (7), are effective upon federal
6.17approval. The commissioner of human services shall notify the revisor of statutes when
6.18federal approval is obtained.

6.19    Sec. 3. Minnesota Statutes 2016, section 252.41, subdivision 3, is amended to read:
6.20    Subd. 3. Day training and habilitation services for adults with developmental
6.21disabilities. (a) "Day training and habilitation services for adults with developmental
6.22disabilities" means services that:
6.23(1) include supervision, training, assistance, and supported employment, center-based
6.24work-related activities, or other community-integrated activities designed and implemented
6.25in accordance with the individual service and individual habilitation plans required under
6.26Minnesota Rules, parts 9525.0004 to 9525.0036, to help an adult reach and maintain the
6.27highest possible level of independence, productivity, and integration into the community;
6.28and
6.29(2) are provided by a vendor licensed under sections 245A.01 to 245A.16 and 252.28,
6.30subdivision 2
, to provide day training and habilitation services.
6.31(b) Day training and habilitation services reimbursable under this section do not include
6.32special education and related services as defined in the Education of the Individuals with
7.1Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
7.2or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
7.3States Code, title 29, section 720, as amended.
7.4(c) Day training and habilitation services do not include employment exploration,
7.5employment development, or employment support services as defined in the home and
7.6community-based services waivers for people with disabilities authorized under sections
7.7256B.092 and 256B.49.
7.8EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
7.9of human services shall notify the revisor of statutes when federal approval is obtained.

7.10    Sec. 4. [256.477] SELF-ADVOCACY GRANTS.
7.11(a) The commissioner shall make available a grant for the purposes of establishing and
7.12maintaining a statewide self-advocacy network for persons with intellectual and
7.13developmental disabilities. The self-advocacy network shall:
7.14(1) ensure that persons with intellectual and developmental disabilities are informed of
7.15their rights in employment, housing, transportation, voting, government policy, and other
7.16issues pertinent to the intellectual and developmental disability community;
7.17(2) provide public education and awareness of the civil and human rights issues persons
7.18with intellectual and developmental disabilities face;
7.19(3) provide funds, technical assistance, and other resources for self-advocacy groups
7.20across the state; and
7.21(4) organize systems of communications to facilitate an exchange of information between
7.22self-advocacy groups.
7.23(b) An organization receiving a grant under paragraph (a) must be an organization
7.24governed by people with intellectual and developmental disabilities that administers a
7.25statewide network of disability groups in order to maintain and promote self-advocacy
7.26services and supports for persons with intellectual and developmental disabilities throughout
7.27the state.

7.28    Sec. 5. Minnesota Statutes 2016, section 256B.0625, subdivision 6a, is amended to read:
7.29    Subd. 6a. Home health services. Home health services are those services specified in
7.30Minnesota Rules, part 9505.0295 and sections 256B.0651 and 256B.0653. Medical assistance
7.31covers home health services at a recipient's home residence or in the community where
8.1normal life activities take the recipient. Medical assistance does not cover home health
8.2services for residents of a hospital, nursing facility, or intermediate care facility, unless the
8.3commissioner of human services has authorized skilled nurse visits for less than 90 days
8.4for a resident at an intermediate care facility for persons with developmental disabilities,
8.5to prevent an admission to a hospital or nursing facility or unless a resident who is otherwise
8.6eligible is on leave from the facility and the facility either pays for the home health services
8.7or forgoes the facility per diem for the leave days that home health services are used. Home
8.8health services must be provided by a Medicare certified home health agency. All nursing
8.9and home health aide services must be provided according to sections 256B.0651 to
8.10256B.0653 .

8.11    Sec. 6. Minnesota Statutes 2016, section 256B.0625, subdivision 31, is amended to read:
8.12    Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical
8.13supplies and equipment. Separate payment outside of the facility's payment rate shall be
8.14made for wheelchairs and wheelchair accessories for recipients who are residents of
8.15intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
8.16and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
8.17and limitations as coverage for recipients who do not reside in institutions. A wheelchair
8.18purchased outside of the facility's payment rate is the property of the recipient.
8.19(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
8.20must enroll as a Medicare provider.
8.21(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
8.22or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
8.23requirement if:
8.24(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
8.25or medical supply;
8.26(2) the vendor serves ten or fewer medical assistance recipients per year;
8.27(3) the commissioner finds that other vendors are not available to provide same or similar
8.28durable medical equipment, prosthetics, orthotics, or medical supplies; and
8.29(4) the vendor complies with all screening requirements in this chapter and Code of
8.30Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
8.31the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
8.32and Medicaid Services approved national accreditation organization as complying with the
9.1Medicare program's supplier and quality standards and the vendor serves primarily pediatric
9.2patients.
9.3(d) Durable medical equipment means a device or equipment that:
9.4(1) can withstand repeated use;
9.5(2) is generally not useful in the absence of an illness, injury, or disability; and
9.6(3) is provided to correct or accommodate a physiological disorder or physical condition
9.7or is generally used primarily for a medical purpose.
9.8(e) Electronic tablets may be considered durable medical equipment if the electronic
9.9tablet will be used as an augmentative and alternative communication system as defined
9.10under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
9.11be locked in order to prevent use not related to communication.
9.12(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
9.13locked to prevent use not as an augmentative communication device, a recipient of waiver
9.14services may use an electronic tablet for a use not related to communication when the
9.15recipient has been authorized under the waiver to receive one or more additional applications
9.16that can be loaded onto the electronic tablet, such that allowing the additional use prevents
9.17the purchase of a separate electronic tablet with waiver funds.
9.18(g) An order or prescription for medical supplies, equipment, or appliances must meet
9.19the requirements in Code of Federal Regulations, title 42, part 470.

9.20    Sec. 7. Minnesota Statutes 2016, section 256B.0653, subdivision 2, is amended to read:
9.21    Subd. 2. Definitions. For the purposes of this section, the following terms have the
9.22meanings given.
9.23(a) "Assessment" means an evaluation of the recipient's medical need for home health
9.24agency services by a registered nurse or appropriate therapist that is conducted within 30
9.25days of a request.
9.26(b) "Home care therapies" means occupational, physical, and respiratory therapy and
9.27speech-language pathology services provided in the home by a Medicare certified home
9.28health agency.
9.29(c) "Home health agency services" means services delivered in the recipient's home
9.30residence, except as specified in section 256B.0625, by a home health agency to a recipient
9.31with medical needs due to illness, disability, or physical conditions in settings permitted
9.32under section 256B.0625, subdivision 6a.
10.1(d) "Home health aide" means an employee of a home health agency who completes
10.2medically oriented tasks written in the plan of care for a recipient.
10.3(e) "Home health agency" means a home care provider agency that is Medicare-certified.
10.4(f) "Occupational therapy services" mean the services defined in Minnesota Rules, part
10.59505.0390.
10.6(g) "Physical therapy services" mean the services defined in Minnesota Rules, part
10.79505.0390.
10.8(h) "Respiratory therapy services" mean the services defined in chapter 147C.
10.9(i) "Speech-language pathology services" mean the services defined in Minnesota Rules,
10.10part 9505.0390.
10.11(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
10.12required due to a recipient's medical condition that can only be safely provided by a
10.13professional nurse to restore and maintain optimal health.
10.14(k) "Store-and-forward technology" means telehomecare services that do not occur in
10.15real time via synchronous transmissions such as diabetic and vital sign monitoring.
10.16(l) "Telehomecare" means the use of telecommunications technology via live, two-way
10.17interactive audiovisual technology which may be augmented by store-and-forward
10.18technology.
10.19(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to deliver
10.20a skilled nurse visit to a recipient located at a site other than the site where the nurse is
10.21located and is used in combination with face-to-face skilled nurse visits to adequately meet
10.22the recipient's needs.

10.23    Sec. 8. Minnesota Statutes 2016, section 256B.0653, subdivision 3, is amended to read:
10.24    Subd. 3. Home health aide visits. (a) Home health aide visits must be provided by a
10.25certified home health aide using a written plan of care that is updated in compliance with
10.26Medicare regulations. A home health aide shall provide hands-on personal care, perform
10.27simple procedures as an extension of therapy or nursing services, and assist in instrumental
10.28activities of daily living as defined in section 256B.0659, including assuring that the person
10.29gets to medical appointments if identified in the written plan of care. Home health aide
10.30visits must may be provided in the recipient's home or in the community where normal life
10.31activities take the recipient.
11.1    (b) All home health aide visits must have authorization under section 256B.0652. The
11.2commissioner shall limit home health aide visits to no more than one visit per day per
11.3recipient.
11.4    (c) Home health aides must be supervised by a registered nurse or an appropriate therapist
11.5when providing services that are an extension of therapy.

11.6    Sec. 9. Minnesota Statutes 2016, section 256B.0653, subdivision 4, is amended to read:
11.7    Subd. 4. Skilled nurse visit services. (a) Skilled nurse visit services must be provided
11.8by a registered nurse or a licensed practical nurse under the supervision of a registered nurse,
11.9according to the written plan of care and accepted standards of medical and nursing practice
11.10according to chapter 148. Skilled nurse visit services must be ordered by a physician and
11.11documented in a plan of care that is reviewed and approved by the ordering physician at
11.12least once every 60 days. All skilled nurse visits must be medically necessary and provided
11.13in the recipient's home residence or in the community where normal life activities take the
11.14recipient, except as allowed under section 256B.0625, subdivision 6a.
11.15(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of up
11.16to two visits per day per recipient. All visits must be based on assessed needs.
11.17(c) Telehomecare skilled nurse visits are allowed when the recipient's health status can
11.18be accurately measured and assessed without a need for a face-to-face, hands-on encounter.
11.19All telehomecare skilled nurse visits must have authorization and are paid at the same
11.20allowable rates as face-to-face skilled nurse visits.
11.21(d) The provision of telehomecare must be made via live, two-way interactive audiovisual
11.22technology and may be augmented by utilizing store-and-forward technologies. Individually
11.23identifiable patient data obtained through real-time or store-and-forward technology must
11.24be maintained as health records according to sections 144.291 to 144.298. If the video is
11.25used for research, training, or other purposes unrelated to the care of the patient, the identity
11.26of the patient must be concealed.
11.27(e) Authorization for skilled nurse visits must be completed under section 256B.0652.
11.28A total of nine face-to-face skilled nurse visits per calendar year do not require authorization.
11.29All telehomecare skilled nurse visits require authorization.

12.1    Sec. 10. Minnesota Statutes 2016, section 256B.0653, subdivision 5, is amended to read:
12.2    Subd. 5. Home care therapies. (a) Home care therapies include the following: physical
12.3therapy, occupational therapy, respiratory therapy, and speech and language pathology
12.4therapy services.
12.5(b) Home care therapies must be:
12.6(1) provided in the recipient's residence or in the community where normal life activities
12.7take the recipient after it has been determined the recipient is unable to access outpatient
12.8therapy;
12.9(2) prescribed, ordered, or referred by a physician and documented in a plan of care and
12.10reviewed, according to Minnesota Rules, part 9505.0390;
12.11(3) assessed by an appropriate therapist; and
12.12(4) provided by a Medicare-certified home health agency enrolled as a Medicaid provider
12.13agency.
12.14(c) Restorative and specialized maintenance therapies must be provided according to
12.15Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be used
12.16as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
12.17(d) For both physical and occupational therapies, the therapist and the therapist's assistant
12.18may not both bill for services provided to a recipient on the same day.

12.19    Sec. 11. Minnesota Statutes 2016, section 256B.0653, subdivision 6, is amended to read:
12.20    Subd. 6. Noncovered home health agency services. The following are not eligible for
12.21payment under medical assistance as a home health agency service:
12.22(1) telehomecare skilled nurses services that is communication between the home care
12.23nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
12.24mail, or a consultation between two health care practitioners;
12.25(2) the following skilled nurse visits:
12.26(i) for the purpose of monitoring medication compliance with an established medication
12.27program for a recipient;
12.28(ii) administering or assisting with medication administration, including injections,
12.29prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
12.30determined and documented by the registered nurse, the need can be met by an available
13.1pharmacy or the recipient or a family member is physically and mentally able to
13.2self-administer or prefill a medication;
13.3(iii) services done for the sole purpose of supervision of the home health aide or personal
13.4care assistant;
13.5(iv) services done for the sole purpose to train other home health agency workers;
13.6(v) services done for the sole purpose of blood samples or lab draw when the recipient
13.7is able to access these services outside the home; and
13.8(vi) Medicare evaluation or administrative nursing visits required by Medicare;
13.9(3) home health aide visits when the following activities are the sole purpose for the
13.10visit: companionship, socialization, household tasks, transportation, and education; and
13.11(4) home care therapies provided in other settings such as a clinic, day program, or as
13.12an inpatient or when the recipient can access therapy outside of the recipient's residence;
13.13and
13.14(5) home health agency services without qualifying documentation of a face-to-face
13.15encounter as specified in subdivision 7.

13.16    Sec. 12. Minnesota Statutes 2016, section 256B.0653, is amended by adding a subdivision
13.17to read:
13.18    Subd. 7. Face-to-face encounter. (a) A face-to-face encounter by a qualifying provider
13.19must be completed for all home health services regardless of the need for prior authorization,
13.20except when providing a onetime perinatal visit by skilled nursing. The face-to-face encounter
13.21may occur through telemedicine as defined in section 256B.0625, subdivision 3b. The
13.22encounter must be related to the primary reason the recipient requires home health services
13.23and must occur within the 90 days before or the 30 days after the start of services. The
13.24face-to-face encounter may be conducted by one of the following practitioners, licensed in
13.25Minnesota:
13.26(1) a physician;
13.27(2) a nurse practitioner or clinical nurse specialist;
13.28(3) a certified nurse midwife; or
13.29(4) a physician assistant.
13.30(b) The allowed nonphysician practitioner, as described in this subdivision, performing
13.31the face-to-face encounter must communicate the clinical findings of that face-to-face
14.1encounter to the ordering physician. Those clinical findings must be incorporated into a
14.2written or electronic document included in the recipient's medical record. To assure clinical
14.3correlation between the face-to-face encounter and the associated home health services, the
14.4physician responsible for ordering the services must:
14.5(1) document that the face-to-face encounter, which is related to the primary reason the
14.6recipient requires home health services, occurred within the required time period; and
14.7(2) indicate the practitioner who conducted the encounter and the date of the encounter.
14.8(c) For home health services requiring authorization, including prior authorization, home
14.9health agencies must retain the qualifying documentation of a face-to-face encounter as part
14.10of the recipient health service record, and submit the qualifying documentation to the
14.11commissioner or the commissioner's designee upon request.

14.12    Sec. 13. Minnesota Statutes 2016, section 256B.0659, subdivision 1, is amended to read:
14.13    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
14.14paragraphs (b) to (r) (s) have the meanings given unless otherwise provided in text.
14.15    (b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
14.16positioning, eating, and toileting.
14.17    (c) "Behavior," effective January 1, 2010, means a category to determine the home care
14.18rating and is based on the criteria found in this section. "Level I behavior" means physical
14.19aggression towards self, others, or destruction of property that requires the immediate
14.20response of another person.
14.21    (d) "Complex health-related needs," effective January 1, 2010, means a category to
14.22determine the home care rating and is based on the criteria found in this section.
14.23(e) "Complex personal care assistance services" means personal care assistance services:
14.24(1) for a person who qualifies for ten hours or more of personal care assistance services
14.25per day; and
14.26(2) provided by a personal care assistant who is qualified to provide complex personal
14.27assistance services under subdivision 11, paragraph (d).
14.28    (e) (f) "Critical activities of daily living," effective January 1, 2010, means transferring,
14.29mobility, eating, and toileting.
14.30    (f) (g) "Dependency in activities of daily living" means a person requires assistance to
14.31begin and complete one or more of the activities of daily living.
15.1    (g) (h) "Extended personal care assistance service" means personal care assistance
15.2services included in a service plan under one of the home and community-based services
15.3waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49, which
15.4exceed the amount, duration, and frequency of the state plan personal care assistance services
15.5for participants who:
15.6    (1) need assistance provided periodically during a week, but less than daily will not be
15.7able to remain in their homes without the assistance, and other replacement services are
15.8more expensive or are not available when personal care assistance services are to be reduced;
15.9or
15.10    (2) need additional personal care assistance services beyond the amount authorized by
15.11the state plan personal care assistance assessment in order to ensure that their safety, health,
15.12and welfare are provided for in their homes.
15.13    (h) (i) "Health-related procedures and tasks" means procedures and tasks that can be
15.14delegated or assigned by a licensed health care professional under state law to be performed
15.15by a personal care assistant.
15.16    (i) (j) "Instrumental activities of daily living" means activities to include meal planning
15.17and preparation; basic assistance with paying bills; shopping for food, clothing, and other
15.18essential items; performing household tasks integral to the personal care assistance services;
15.19communication by telephone and other media; and traveling, including to medical
15.20appointments and to participate in the community.
15.21    (j) (k) "Managing employee" has the same definition as Code of Federal Regulations,
15.22title 42, section 455.
15.23    (k) (l) "Qualified professional" means a professional providing supervision of personal
15.24care assistance services and staff as defined in section 256B.0625, subdivision 19c.
15.25    (l) (m) "Personal care assistance provider agency" means a medical assistance enrolled
15.26provider that provides or assists with providing personal care assistance services and includes
15.27a personal care assistance provider organization, personal care assistance choice agency,
15.28class A licensed nursing agency, and Medicare-certified home health agency.
15.29    (m) (n) "Personal care assistant" or "PCA" means an individual employed by a personal
15.30care assistance agency who provides personal care assistance services.
15.31    (n) (o) "Personal care assistance care plan" means a written description of personal care
15.32assistance services developed by the personal care assistance provider according to the
15.33service plan.
16.1    (o) (p) "Responsible party" means an individual who is capable of providing the support
16.2necessary to assist the recipient to live in the community.
16.3    (p) (q) "Self-administered medication" means medication taken orally, by injection,
16.4nebulizer, or insertion, or applied topically without the need for assistance.
16.5    (q) (r) "Service plan" means a written summary of the assessment and description of the
16.6services needed by the recipient.
16.7    (r) (s) "Wages and benefits" means wages and salaries, the employer's share of FICA
16.8taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
16.9reimbursement, health and dental insurance, life insurance, disability insurance, long-term
16.10care insurance, uniform allowance, and contributions to employee retirement accounts.
16.11EFFECTIVE DATE.This section is effective July 1, 2018.

16.12    Sec. 14. Minnesota Statutes 2016, section 256B.0659, subdivision 2, is amended to read:
16.13    Subd. 2. Personal care assistance services; covered services. (a) The personal care
16.14assistance services eligible for payment include services and supports furnished to an
16.15individual, as needed, to assist in:
16.16(1) activities of daily living;
16.17(2) health-related procedures and tasks;
16.18(3) observation and redirection of behaviors; and
16.19(4) instrumental activities of daily living.
16.20(b) Activities of daily living include the following covered services:
16.21(1) dressing, including assistance with choosing, application, and changing of clothing
16.22and application of special appliances, wraps, or clothing;
16.23(2) grooming, including assistance with basic hair care, oral care, shaving, applying
16.24cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
16.25except for recipients who are diabetic or have poor circulation;
16.26(3) bathing, including assistance with basic personal hygiene and skin care;
16.27(4) eating, including assistance with hand washing and application of orthotics required
16.28for eating, transfers, and feeding;
16.29(5) transfers, including assistance with transferring the recipient from one seating or
16.30reclining area to another;
17.1(6) mobility, including assistance with ambulation, including use of a wheelchair.
17.2Mobility does not include providing transportation for a recipient;
17.3(7) positioning, including assistance with positioning or turning a recipient for necessary
17.4care and comfort; and
17.5(8) toileting, including assistance with helping recipient with bowel or bladder elimination
17.6and care including transfers, mobility, positioning, feminine hygiene, use of toileting
17.7equipment or supplies, cleansing the perineal area, inspection of the skin, and adjusting
17.8clothing.
17.9(c) Health-related procedures and tasks include the following covered services:
17.10(1) range of motion and passive exercise to maintain a recipient's strength and muscle
17.11functioning;
17.12(2) assistance with self-administered medication as defined by this section, including
17.13reminders to take medication, bringing medication to the recipient, and assistance with
17.14opening medication under the direction of the recipient or responsible party, including
17.15medications given through a nebulizer;
17.16(3) interventions for seizure disorders, including monitoring and observation; and
17.17(4) other activities considered within the scope of the personal care service and meeting
17.18the definition of health-related procedures and tasks under this section.
17.19(d) A personal care assistant may provide health-related procedures and tasks associated
17.20with the complex health-related needs of a recipient if the procedures and tasks meet the
17.21definition of health-related procedures and tasks under this section and the personal care
17.22assistant is trained by a qualified professional and demonstrates competency to safely
17.23complete the procedures and tasks. Delegation of health-related procedures and tasks and
17.24all training must be documented in the personal care assistance care plan and the recipient's
17.25and personal care assistant's files. A personal care assistant must not determine the medication
17.26dose or time for medication.
17.27(e) Effective January 1, 2010, for a personal care assistant to provide the health-related
17.28procedures and tasks of tracheostomy suctioning and services to recipients on ventilator
17.29support there must be:
17.30(1) delegation and training by a registered nurse, certified or licensed respiratory therapist,
17.31or a physician;
17.32(2) utilization of clean rather than sterile procedure;
18.1(3) specialized training about the health-related procedures and tasks and equipment,
18.2including ventilator operation and maintenance;
18.3(4) individualized training regarding the needs of the recipient; and
18.4(5) supervision by a qualified professional who is a registered nurse.
18.5(f) Effective January 1, 2010, a personal care assistant may observe and redirect the
18.6recipient for episodes where there is a need for redirection due to behaviors. Training of
18.7the personal care assistant must occur based on the needs of the recipient, the personal care
18.8assistance care plan, and any other support services provided.
18.9(g) Instrumental activities of daily living under subdivision 1, paragraph (i) (j).
18.10EFFECTIVE DATE.This section is effective July 1, 2018.

18.11    Sec. 15. Minnesota Statutes 2016, section 256B.0659, subdivision 11, is amended to read:
18.12    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant must
18.13meet the following requirements:
18.14    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
18.15age with these additional requirements:
18.16    (i) supervision by a qualified professional every 60 days; and
18.17    (ii) employment by only one personal care assistance provider agency responsible for
18.18compliance with current labor laws;
18.19    (2) be employed by a personal care assistance provider agency;
18.20    (3) enroll with the department as a personal care assistant after clearing a background
18.21study. Except as provided in subdivision 11a, before a personal care assistant provides
18.22services, the personal care assistance provider agency must initiate a background study on
18.23the personal care assistant under chapter 245C, and the personal care assistance provider
18.24agency must have received a notice from the commissioner that the personal care assistant
18.25is:
18.26    (i) not disqualified under section 245C.14; or
18.27    (ii) is disqualified, but the personal care assistant has received a set aside of the
18.28disqualification under section 245C.22;
18.29    (4) be able to effectively communicate with the recipient and personal care assistance
18.30provider agency;
19.1    (5) be able to provide covered personal care assistance services according to the recipient's
19.2personal care assistance care plan, respond appropriately to recipient needs, and report
19.3changes in the recipient's condition to the supervising qualified professional or physician;
19.4    (6) not be a consumer of personal care assistance services;
19.5    (7) maintain daily written records including, but not limited to, time sheets under
19.6subdivision 12;
19.7    (8) effective January 1, 2010, complete standardized training as determined by the
19.8commissioner before completing enrollment. The training must be available in languages
19.9other than English and to those who need accommodations due to disabilities. Personal care
19.10assistant training must include successful completion of the following training components:
19.11basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
19.12roles and responsibilities of personal care assistants including information about assistance
19.13with lifting and transfers for recipients, emergency preparedness, orientation to positive
19.14behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
19.15training components, the personal care assistant must demonstrate the competency to provide
19.16assistance to recipients;
19.17    (9) complete training and orientation on the needs of the recipient; and
19.18    (10) be limited to providing and being paid for up to 275 hours per month of personal
19.19care assistance services regardless of the number of recipients being served or the number
19.20of personal care assistance provider agencies enrolled with. The number of hours worked
19.21per day shall not be disallowed by the department unless in violation of the law.
19.22    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
19.23for the guardian services and meets the criteria for personal care assistants in paragraph (a).
19.24    (c) Persons who do not qualify as a personal care assistant include parents, stepparents,
19.25and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
19.26providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
19.27a residential setting.
19.28(d) A personal care assistant is qualified to provide complex personal care assistance
19.29services as defined in subdivision 1, paragraph (e), if the personal care assistant:
19.30(1) provides services according to the care plan in subdivision 7 to an individual described
19.31in subdivision 1, paragraph (e), clause (1); and
19.32(2) satisfies the current requirements of Medicare for training and competency or
19.33competency evaluation of home health aides or nursing assistants, as provided by Code of
20.1Federal Regulations, title 42, section 483.151 or 484.36, or alternative, comparable,
20.2state-approved training and competency requirements.
20.3EFFECTIVE DATE.This section is effective July 1, 2018.

20.4    Sec. 16. Minnesota Statutes 2016, section 256B.0659, is amended by adding a subdivision
20.5to read:
20.6    Subd. 17a. Rate for complex personal care assistance services. The rate paid to a
20.7provider for complex personal care assistance services shall be 110 percent of the rate paid
20.8for personal care assistance services.
20.9EFFECTIVE DATE.This section is effective July 1, 2018.

20.10    Sec. 17. Minnesota Statutes 2016, section 256B.0659, subdivision 21, is amended to read:
20.11    Subd. 21. Requirements for provider enrollment of personal care assistance provider
20.12agencies. (a) All personal care assistance provider agencies must provide, at the time of
20.13enrollment, reenrollment, and revalidation as a personal care assistance provider agency in
20.14a format determined by the commissioner, information and documentation that includes,
20.15but is not limited to, the following:
20.16    (1) the personal care assistance provider agency's current contact information including
20.17address, telephone number, and e-mail address;
20.18    (2) proof of surety bond coverage. Upon new enrollment, or if the provider's Medicaid
20.19revenue in the previous calendar year is up to and including $300,000, the provider agency
20.20must purchase a surety bond of $50,000. If the Medicaid revenue in the previous year is
20.21over $300,000, the provider agency must purchase a surety bond of $100,000. The surety
20.22bond must be in a form approved by the commissioner, must be renewed annually, and must
20.23allow for recovery of costs and fees in pursuing a claim on the bond;
20.24    (3) proof of fidelity bond coverage in the amount of $20,000;
20.25    (4) proof of workers' compensation insurance coverage;
20.26    (5) proof of liability insurance;
20.27    (6) a description of the personal care assistance provider agency's organization identifying
20.28the names of all owners, managing employees, staff, board of directors, and the affiliations
20.29of the directors, owners, or staff to other service providers;
20.30    (7) a copy of the personal care assistance provider agency's written policies and
20.31procedures including: hiring of employees; training requirements; service delivery; and
21.1employee and consumer safety including process for notification and resolution of consumer
21.2grievances, identification and prevention of communicable diseases, and employee
21.3misconduct;
21.4    (8) copies of all other forms the personal care assistance provider agency uses in the
21.5course of daily business including, but not limited to:
21.6    (i) a copy of the personal care assistance provider agency's time sheet if the time sheet
21.7varies from the standard time sheet for personal care assistance services approved by the
21.8commissioner, and a letter requesting approval of the personal care assistance provider
21.9agency's nonstandard time sheet;
21.10    (ii) the personal care assistance provider agency's template for the personal care assistance
21.11care plan; and
21.12    (iii) the personal care assistance provider agency's template for the written agreement
21.13in subdivision 20 for recipients using the personal care assistance choice option, if applicable;
21.14    (9) a list of all training and classes that the personal care assistance provider agency
21.15requires of its staff providing personal care assistance services;
21.16    (10) documentation that the personal care assistance provider agency and staff have
21.17successfully completed all the training required by this section, including the requirements
21.18under subdivision 11, paragraph (d), if complex personal care assistance services are provided
21.19and submitted for payment;
21.20    (11) documentation of the agency's marketing practices;
21.21    (12) disclosure of ownership, leasing, or management of all residential properties that
21.22is used or could be used for providing home care services;
21.23    (13) documentation that the agency will use the following percentages of revenue
21.24generated from the medical assistance rate paid for personal care assistance services for
21.25employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
21.26care assistance choice option and 72.5 percent of revenue from other personal care assistance
21.27providers. The revenue generated by the qualified professional and the reasonable costs
21.28associated with the qualified professional shall not be used in making this calculation; and
21.29    (14) effective May 15, 2010, documentation that the agency does not burden recipients'
21.30free exercise of their right to choose service providers by requiring personal care assistants
21.31to sign an agreement not to work with any particular personal care assistance recipient or
21.32for another personal care assistance provider agency after leaving the agency and that the
22.1agency is not taking action on any such agreements or requirements regardless of the date
22.2signed.
22.3    (b) Personal care assistance provider agencies shall provide the information specified
22.4in paragraph (a) to the commissioner at the time the personal care assistance provider agency
22.5enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
22.6the information specified in paragraph (a) from all personal care assistance providers
22.7beginning July 1, 2009.
22.8    (c) All personal care assistance provider agencies shall require all employees in
22.9management and supervisory positions and owners of the agency who are active in the
22.10day-to-day management and operations of the agency to complete mandatory training as
22.11determined by the commissioner before enrollment of the agency as a provider. Employees
22.12in management and supervisory positions and owners who are active in the day-to-day
22.13operations of an agency who have completed the required training as an employee with a
22.14personal care assistance provider agency do not need to repeat the required training if they
22.15are hired by another agency, if they have completed the training within the past three years.
22.16By September 1, 2010, the required training must be available with meaningful access
22.17according to title VI of the Civil Rights Act and federal regulations adopted under that law
22.18or any guidance from the United States Health and Human Services Department. The
22.19required training must be available online or by electronic remote connection. The required
22.20training must provide for competency testing. Personal care assistance provider agency
22.21billing staff shall complete training about personal care assistance program financial
22.22management. This training is effective July 1, 2009. Any personal care assistance provider
22.23agency enrolled before that date shall, if it has not already, complete the provider training
22.24within 18 months of July 1, 2009. Any new owners or employees in management and
22.25supervisory positions involved in the day-to-day operations are required to complete
22.26mandatory training as a requisite of working for the agency. Personal care assistance provider
22.27agencies certified for participation in Medicare as home health agencies are exempt from
22.28the training required in this subdivision. When available, Medicare-certified home health
22.29agency owners, supervisors, or managers must successfully complete the competency test.

22.30    Sec. 18. Minnesota Statutes 2016, section 256B.0911, subdivision 1a, is amended to read:
22.31    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
22.32    (a) Until additional requirements apply under paragraph (b), "long-term care consultation
22.33services" means:
23.1    (1) intake for and access to assistance in identifying services needed to maintain an
23.2individual in the most inclusive environment;
23.3    (2) providing recommendations for and referrals to cost-effective community services
23.4that are available to the individual;
23.5    (3) development of an individual's person-centered community support plan;
23.6    (4) providing information regarding eligibility for Minnesota health care programs;
23.7    (5) face-to-face long-term care consultation assessments, which may be completed in a
23.8hospital, nursing facility, intermediate care facility for persons with developmental disabilities
23.9(ICF/DDs), regional treatment centers, or the person's current or planned residence;
23.10    (6) determination of home and community-based waiver and other service eligibility as
23.11required under sections 256B.0913, 256B.0915, and 256B.49, including level of care
23.12determination for individuals who need an institutional level of care as determined under
23.13subdivision 4e, based on assessment and community support plan development, appropriate
23.14referrals to obtain necessary diagnostic information, and including an eligibility determination
23.15for consumer-directed community supports;
23.16    (7) providing recommendations for institutional placement when there are no
23.17cost-effective community services available;
23.18    (8) providing access to assistance to transition people back to community settings after
23.19institutional admission; and
23.20(9) providing information about competitive employment, with or without supports, for
23.21school-age youth and working-age adults and referrals to the Disability Linkage Line and
23.22Disability Benefits 101 to ensure that an informed choice about competitive employment
23.23can be made. For the purposes of this subdivision, "competitive employment" means work
23.24in the competitive labor market that is performed on a full-time or part-time basis in an
23.25integrated setting, and for which an individual is compensated at or above the minimum
23.26wage, but not less than the customary wage and level of benefits paid by the employer for
23.27the same or similar work performed by individuals without disabilities.
23.28(b) Upon statewide implementation of lead agency requirements in subdivisions 2b, 2c,
23.29and 3a, "long-term care consultation services" also means:
23.30(1) service eligibility determination for state plan home care services identified in:
23.31(i) section 256B.0625, subdivisions 7, 19a, and 19c;
23.32(ii) consumer support grants under section 256.476; or
24.1(iii) section 256B.85;
24.2(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
24.3determination of eligibility for case management services available under sections 256B.0621,
24.4subdivision 2
, paragraph (4), and 256B.0924 and Minnesota Rules, part 9525.0016;
24.5(3) determination of institutional level of care, home and community-based service
24.6waiver, and other service eligibility as required under section 256B.092, determination of
24.7eligibility for family support grants under section 252.32, semi-independent living services
24.8under section 252.275, and day training and habilitation services under section 256B.092;
24.9and
24.10(4) obtaining necessary diagnostic information to determine eligibility under clauses (2)
24.11and (3).
24.12    (c) "Long-term care options counseling" means the services provided by the linkage
24.13lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and also
24.14includes telephone assistance and follow up once a long-term care consultation assessment
24.15has been completed.
24.16    (d) "Minnesota health care programs" means the medical assistance program under this
24.17chapter and the alternative care program under section 256B.0913.
24.18    (e) "Lead agencies" means counties administering or tribes and health plans under
24.19contract with the commissioner to administer long-term care consultation assessment and
24.20support planning services.
24.21(f) "Person-centered planning" is a process that includes the active participation of a
24.22person in the planning of the person's services, including in making meaningful and informed
24.23choices about the person's own goals, talents, and objectives, as well as making meaningful
24.24and informed choices about the services the person receives. For the purposes of this section,
24.25"informed choice" means a voluntary choice of services by a person from all available
24.26service options based on accurate and complete information concerning all available service
24.27options and concerning the person's own preferences, abilities, goals, and objectives. In
24.28order for a person to make an informed choice, all available options must be developed and
24.29presented to the person to empower the person to make decisions.

24.30    Sec. 19. Minnesota Statutes 2016, section 256B.0911, subdivision 2b, is amended to read:
24.31    Subd. 2b. MnCHOICES certified assessors. (a) Each lead agency shall use certified
24.32assessors who have completed MnCHOICES training and the certification processes
24.33determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
25.1best practices in assessment and support planning including person-centered planning
25.2principals principles and have a common set of skills that must ensure consistency and
25.3equitable access to services statewide. A lead agency may choose, according to departmental
25.4policies, to contract with a qualified, certified assessor to conduct assessments and
25.5reassessments on behalf of the lead agency. Certified assessors must use person-centered
25.6planning principles to conduct an interview that identifies what is important to the person,
25.7the person's needs for supports, health and safety concerns, and the person's abilities, interests,
25.8and goals.
25.9    Certified assessors are responsible for:
25.10(1) ensuring persons are offered objective, unbiased access to resources;
25.11(2) ensuring persons have the needed information to support informed choice, including
25.12where and how they choose to live and the opportunity to pursue desired employment;
25.13(3) determining level of care and eligibility for long-term services and supports;
25.14(4) using the information gathered from the interview to develop a person-centered
25.15community support plan that reflects identified needs and support options within the context
25.16of values, interests, and goals important to the person; and
25.17(5) providing the person with a community support plan that summarizes the person's
25.18assessment findings, support options, and agreed-upon next steps.
25.19    (b) MnCHOICES certified assessors are persons with a minimum of a bachelor's degree
25.20in social work, nursing with a public health nursing certificate, or other closely related field
25.21with at least one year of home and community-based experience, or a registered nurse with
25.22at least two years of home and community-based experience who has received training and
25.23certification specific to assessment and consultation for long-term care services in the state.

25.24    Sec. 20. Minnesota Statutes 2016, section 256B.0911, is amended by adding a subdivision
25.25to read:
25.26    Subd. 3f. Long-term care reassessments and community support plan updates.
25.27Face-to-face reassessments must be conducted annually or as required by federal and state
25.28laws and rules. Reassessments build upon all previous assessments conducted and include
25.29a review of needs and services to identify any changes. Reassessments provide information
25.30to support the person's informed choice and opportunities to express choice regarding
25.31activities that contribute to quality of life, as well as information and opportunity to identify
25.32goals related to desired employment, community activities, and preferred living environment.
25.33Reassessments allow for a review of the current support plan's effectiveness, monitoring of
26.1services, and the development of an updated person-centered community support plan.
26.2Reassessments verify continued eligibility or offer alternatives as warranted and provide
26.3an opportunity for quality assurance of service delivery.

26.4    Sec. 21. Minnesota Statutes 2016, section 256B.0911, subdivision 4d, is amended to read:
26.5    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a) It is the
26.6policy of the state of Minnesota to ensure that individuals with disabilities or chronic illness
26.7are served in the most integrated setting appropriate to their needs and have the necessary
26.8information to make informed choices about home and community-based service options.
26.9    (b) Individuals under 65 years of age who are admitted to a Medicaid-certified nursing
26.10facility must be screened prior to admission according to the requirements outlined in section
26.11256.975 , subdivisions 7a to 7c. This shall be provided by the Senior LinkAge Line as
26.12required under section 256.975, subdivision 7.
26.13    (c) Individuals under 65 years of age who are admitted to nursing facilities with only a
26.14telephone screening must receive a face-to-face assessment from the long-term care
26.15consultation team member of the county in which the facility is located or from the recipient's
26.16county case manager within 40 calendar days of admission the timeline established by the
26.17commissioner, based on review of data.
26.18    (d) At the face-to-face assessment, the long-term care consultation team member or
26.19county case manager must perform the activities required under subdivision 3b.
26.20    (e) For individuals under 21 years of age, a screening interview which recommends
26.21nursing facility admission must be face-to-face and approved by the commissioner before
26.22the individual is admitted to the nursing facility.
26.23    (f) In the event that an individual under 65 years of age is admitted to a nursing facility
26.24on an emergency basis, the Senior LinkAge Line must be notified of the admission on the
26.25next working day, and a face-to-face assessment as described in paragraph (c) must be
26.26conducted within 40 calendar days of admission the timeline established by the commissioner,
26.27based on review of data.
26.28    (g) At the face-to-face assessment, the long-term care consultation team member or the
26.29case manager must present information about home and community-based options, including
26.30consumer-directed options, so the individual can make informed choices. If the individual
26.31chooses home and community-based services, the long-term care consultation team member
26.32or case manager must complete a written relocation plan within 20 working days of the
26.33visit. The plan shall describe the services needed to move out of the facility and a time line
27.1for the move which is designed to ensure a smooth transition to the individual's home and
27.2community.
27.3    (h) An individual under 65 years of age residing in a nursing facility shall receive a
27.4face-to-face assessment at least every 12 months to review the person's service choices and
27.5available alternatives unless the individual indicates, in writing, that annual visits are not
27.6desired. In this case, the individual must receive a face-to-face assessment at least once
27.7every 36 months for the same purposes.
27.8    (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay county
27.9agencies directly for face-to-face assessments for individuals under 65 years of age who
27.10are being considered for placement or residing in a nursing facility.
27.11(j) Funding for preadmission screening follow-up shall be provided to the Disability
27.12Linkage Line for the under-60 population by the Department of Human Services to cover
27.13options counseling salaries and expenses to provide the services described in subdivisions
27.147a to 7c. The Disability Linkage Line shall employ, or contract with other agencies to
27.15employ, within the limits of available funding, sufficient personnel to provide preadmission
27.16screening follow-up services and shall seek to maximize federal funding for the service as
27.17provided under section 256.01, subdivision 2, paragraph (dd).

27.18    Sec. 22. Minnesota Statutes 2016, section 256B.0911, subdivision 5, is amended to read:
27.19    Subd. 5. Administrative activity. (a) The commissioner shall streamline the processes,
27.20including timelines for when assessments need to be completed, required to provide the
27.21services in this section and shall implement integrated solutions to automate the business
27.22processes to the extent necessary for community support plan approval, reimbursement,
27.23program planning, evaluation, and policy development.
27.24(b) The commissioner of human services shall work with lead agencies responsible for
27.25conducting long-term consultation services to modify the MnCHOICES application and
27.26assessment policies to create efficiencies while ensuring federal compliance with medical
27.27assistance and long-term services and supports eligibility criteria.

27.28    Sec. 23. Minnesota Statutes 2016, section 256B.0921, is amended to read:
27.29256B.0921 HOME AND COMMUNITY-BASED SERVICES INCENTIVE POOL.
27.30    The commissioner of human services shall develop an initiative to provide incentives
27.31for innovation in: (1) achieving integrated competitive employment,; (2) achieving integrated
27.32competitive employment for youth under age 25 upon their graduation from school; (3)
28.1living in the most integrated setting,; and (4) other outcomes determined by the commissioner.
28.2The commissioner shall seek requests for proposals and shall contract with one or more
28.3entities to provide incentive payments for meeting identified outcomes. The initial requests
28.4for proposals must be issued by October 1, 2016.

28.5    Sec. 24. Minnesota Statutes 2016, section 256B.4913, subdivision 4a, is amended to read:
28.6    Subd. 4a. Rate stabilization adjustment. (a) For purposes of this subdivision,
28.7"implementation period" means the period beginning January 1, 2014, and ending on the
28.8last day of the month in which the rate management system is populated with the data
28.9necessary to calculate rates for substantially all individuals receiving home and
28.10community-based waiver services under sections 256B.092 and 256B.49. "Banding period"
28.11means the time period beginning on January 1, 2014, and ending upon the expiration of the
28.1212-month period defined in paragraph (c), clause (5).
28.13(b) For purposes of this subdivision, the historical rate for all service recipients means
28.14the individual reimbursement rate for a recipient in effect on December 1, 2013, except
28.15that:
28.16(1) for a day service recipient who was not authorized to receive these waiver services
28.17prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
28.18changed providers on or after January 1, 2014, the historical rate must be the weighted
28.19average authorized rate for the provider number in the county of service, effective December
28.201, 2013; or
28.21(2) for a unit-based service with programming or a unit-based service without
28.22programming recipient who was not authorized to receive these waiver services prior to
28.23January 1, 2014; added a new service or services on or after January 1, 2014; or changed
28.24providers on or after January 1, 2014, the historical rate must be the weighted average
28.25authorized rate for each provider number in the county of service, effective December 1,
28.262013; or
28.27(3) for residential service recipients who change providers on or after January 1, 2014,
28.28the historical rate must be set by each lead agency within their county aggregate budget
28.29using their respective methodology for residential services effective December 1, 2013, for
28.30determining the provider rate for a similarly situated recipient being served by that provider.
28.31(c) The commissioner shall adjust individual reimbursement rates determined under this
28.32section so that the unit rate is no higher or lower than:
28.33(1) 0.5 percent from the historical rate for the implementation period;
29.1(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately
29.2following the time period of clause (1);
29.3(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately
29.4following the time period of clause (2);
29.5(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately
29.6following the time period of clause (3);
29.7(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately
29.8following the time period of clause (4); and
29.9(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
29.10following the time period of clause (5). During this banding rate period, the commissioner
29.11shall not enforce any rate decrease or increase that would otherwise result from the end of
29.12the banding period. The commissioner shall, upon enactment, seek federal approval for the
29.13addition of this banding period; and
29.14(7) one percent from the rate in effect in clause (6) for the 12-month period immediately
29.15following the time period of clause (6).
29.16(d) The commissioner shall review all changes to rates that were in effect on December
29.171, 2013, to verify that the rates in effect produce the equivalent level of spending and service
29.18unit utilization on an annual basis as those in effect on October 31, 2013.
29.19(e) By December 31, 2014, the commissioner shall complete the review in paragraph
29.20(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.
29.21(f) During the banding period, the Medicaid Management Information System (MMIS)
29.22service agreement rate must be adjusted to account for change in an individual's need. The
29.23commissioner shall adjust the Medicaid Management Information System (MMIS) service
29.24agreement rate by:
29.25(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
29.26individual with variables reflecting the level of service in effect on December 1, 2013;
29.27(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
29.28individual with variables reflecting the updated level of service at the time of application;
29.29and
29.30(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
29.31service agreement rate, the difference between the values in clauses (1) and (2).
30.1(g) This subdivision must not apply to rates for recipients served by providers new to a
30.2given county after January 1, 2014. Providers of personal supports services who also acted
30.3as fiscal support entities must be treated as new providers as of January 1, 2014.
30.4EFFECTIVE DATE.(a) The amendment to paragraph (b) is effective the day following
30.5final enactment.
30.6(b) The amendment to paragraph (c) is effective upon federal approval. The commissioner
30.7of human services shall notify the revisor of statutes when federal approval is obtained.

30.8    Sec. 25. Minnesota Statutes 2016, section 256B.4913, is amended by adding a subdivision
30.9to read:
30.10    Subd. 7. New services. (a) A service added to section 256B.4914 after January 1, 2014,
30.11is not subject to rate stabilization adjustment in this section.
30.12(b) Employment support services authorized after January 1, 2018, under the new
30.13employment support services definition according to the home and community-based services
30.14waivers for people with disabilities under sections 256B.092 and 256B.49 are not subject
30.15to rate stabilization adjustment in this section.
30.16EFFECTIVE DATE.This section is effective the day following final enactment.

30.17    Sec. 26. Minnesota Statutes 2016, section 256B.4914, subdivision 2, is amended to read:
30.18    Subd. 2. Definitions. (a) For purposes of this section, the following terms have the
30.19meanings given them, unless the context clearly indicates otherwise.
30.20(b) "Commissioner" means the commissioner of human services.
30.21(c) "Component value" means underlying factors that are part of the cost of providing
30.22services that are built into the waiver rates methodology to calculate service rates.
30.23(d) "Customized living tool" means a methodology for setting service rates that delineates
30.24and documents the amount of each component service included in a recipient's customized
30.25living service plan.
30.26(e) "Disability waiver rates system" means a statewide system that establishes rates that
30.27are based on uniform processes and captures the individualized nature of waiver services
30.28and recipient needs.
30.29(f) "Individual staffing" means the time spent as a one-to-one interaction specific to an
30.30individual recipient by staff to provide direct support and assistance with activities of daily
30.31living, instrumental activities of daily living, and training to participants, and is based on
31.1the requirements in each individual's coordinated service and support plan under section
31.2245D.02, subdivision 4b ; any coordinated service and support plan addendum under section
31.3245D.02, subdivision 4c ; and an assessment tool. Provider observation of an individual's
31.4needs must also be considered.
31.5(g) "Lead agency" means a county, partnership of counties, or tribal agency charged
31.6with administering waivered services under sections 256B.092 and 256B.49.
31.7(h) "Median" means the amount that divides distribution into two equal groups, one-half
31.8above the median and one-half below the median.
31.9(i) "Payment or rate" means reimbursement to an eligible provider for services provided
31.10to a qualified individual based on an approved service authorization.
31.11(j) "Rates management system" means a Web-based software application that uses a
31.12framework and component values, as determined by the commissioner, to establish service
31.13rates.
31.14(k) "Recipient" means a person receiving home and community-based services funded
31.15under any of the disability waivers.
31.16(l) "Shared staffing" means time spent by employees, not defined under paragraph (f),
31.17providing or available to provide more than one individual with direct support and assistance
31.18with activities of daily living as defined under section 256B.0659, subdivision 1, paragraph
31.19(b); instrumental activities of daily living as defined under section 256B.0659, subdivision
31.201, paragraph (i); ancillary activities needed to support individual services; and training to
31.21participants, and is based on the requirements in each individual's coordinated service and
31.22support plan under section 245D.02, subdivision 4b; any coordinated service and support
31.23plan addendum under section 245D.02, subdivision 4c; an assessment tool; and provider
31.24observation of an individual's service need. Total shared staffing hours are divided
31.25proportionally by the number of individuals who receive the shared service provisions.
31.26(m) "Staffing ratio" means the number of recipients a service provider employee supports
31.27during a unit of service based on a uniform assessment tool, provider observation, case
31.28history, and the recipient's services of choice, and not based on the staffing ratios under
31.29section 245D.31.
31.30    (n) "Unit of service" means the following:
31.31    (1) for residential support services under subdivision 6, a unit of service is a day. Any
31.32portion of any calendar day, within allowable Medicaid rules, where an individual spends
31.33time in a residential setting is billable as a day;
32.1    (2) for day services under subdivision 7:
32.2    (i) for day training and habilitation services, a unit of service is either:
32.3    (A) a day unit of service is defined as six or more hours of time spent providing direct
32.4services and transportation; or
32.5    (B) a partial day unit of service is defined as fewer than six hours of time spent providing
32.6direct services and transportation; and
32.7    (C) for new day service recipients after January 1, 2014, 15 minute units of service must
32.8be used for fewer than six hours of time spent providing direct services and transportation;
32.9    (ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
32.10day unit of service is six or more hours of time spent providing direct services;
32.11    (iii) for prevocational services, a unit of service is a day or an hour. A day unit of service
32.12is six or more hours of time spent providing direct service;
32.13    (3) for unit-based services with programming under subdivision 8:
32.14    (i) for supported living services, a unit of service is a day or 15 minutes. When a day
32.15rate is authorized, any portion of a calendar day where an individual receives services is
32.16billable as a day; and
32.17    (ii) for all other services, a unit of service is 15 minutes; and
32.18    (4) for unit-based services without programming under subdivision 9:
32.19    (i) for respite services, a unit of service is a day or 15 minutes. When a day rate is
32.20authorized, any portion of a calendar day when an individual receives services is billable
32.21as a day; and
32.22    (ii) for all other services, a unit of service is 15 minutes.
32.23EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
32.24of human services shall notify the revisor of statutes when federal approval is obtained.

32.25    Sec. 27. Minnesota Statutes 2016, section 256B.4914, subdivision 3, is amended to read:
32.26    Subd. 3. Applicable services. Applicable services are those authorized under the state's
32.27home and community-based services waivers under sections 256B.092 and 256B.49,
32.28including the following, as defined in the federally approved home and community-based
32.29services plan:
32.30(1) 24-hour customized living;
33.1(2) adult day care;
33.2(3) adult day care bath;
33.3(4) behavioral programming;
33.4(5) companion services;
33.5(6) customized living;
33.6(7) day training and habilitation;
33.7(8) housing access coordination;
33.8(9) independent living skills;
33.9(10) in-home family support;
33.10(11) night supervision;
33.11(12) personal support;
33.12(13) prevocational services;
33.13(14) residential care services;
33.14(15) residential support services;
33.15(16) respite services;
33.16(17) structured day services;
33.17(18) supported employment services;
33.18(19) (18) supported living services;
33.19(20) (19) transportation services; and
33.20(20) individualized home supports;
33.21(21) independent living skills specialist services;
33.22(22) employment exploration services;
33.23(23) employment development services;
33.24(24) employment support services; and
33.25(21) (25) other services as approved by the federal government in the state home and
33.26community-based services plan.
33.27EFFECTIVE DATE.(a) Clause (20) is effective the day following final enactment.
34.1(b) Clauses (21) to (24) are effective upon federal approval. The commissioner of human
34.2services shall notify the revisor of statutes when federal approval is obtained.

34.3    Sec. 28. Minnesota Statutes 2016, section 256B.4914, subdivision 5, is amended to read:
34.4    Subd. 5. Base wage index and standard component values. (a) The base wage index
34.5is established to determine staffing costs associated with providing services to individuals
34.6receiving home and community-based services. For purposes of developing and calculating
34.7the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
34.8occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
34.9the most recent edition of the Occupational Handbook must be used. The base wage index
34.10must be calculated as follows:
34.11(1) for residential direct care staff, the sum of:
34.12(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
34.13health aide (SOC code 39-9021); 30 percent of the median wage for nursing aide assistant
34.14(SOC code 31-1012 31-1014); and 20 percent of the median wage for social and human
34.15services aide (SOC code 21-1093); and
34.16(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
34.17(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
34.18(SOC code 39-9021); 20 percent of the median wage for nursing aide assistant (SOC code
34.1931-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
34.2029-2053); and 20 percent of the median wage for social and human services aide (SOC code
34.2121-1093);
34.22(2) for day services, 20 percent of the median wage for nursing aide assistant (SOC code
34.2331-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
34.2429-2053); and 60 percent of the median wage for social and human services aide (SOC code
34.2521-1093);
34.26(3) for residential asleep-overnight staff, the wage will be $7.66 per hour is the minimum
34.27wage in Minnesota for large employers, except in a family foster care setting, the wage is
34.28$2.80 per hour 36 percent of the minimum wage in Minnesota for large employers;
34.29(4) for behavior program analyst staff, 100 percent of the median wage for mental health
34.30counselors (SOC code 21-1014);
34.31(5) for behavior program professional staff, 100 percent of the median wage for clinical
34.32counseling and school psychologist (SOC code 19-3031);
35.1(6) for behavior program specialist staff, 100 percent of the median wage for psychiatric
35.2technicians (SOC code 29-2053);
35.3(7) for supportive living services staff, 20 percent of the median wage for nursing aide
35.4assistant (SOC code 31-1012 31-1014); 20 percent of the median wage for psychiatric
35.5technician (SOC code 29-2053); and 60 percent of the median wage for social and human
35.6services aide (SOC code 21-1093);
35.7(8) for housing access coordination staff, 50 100 percent of the median wage for
35.8community and social services specialist (SOC code 21-1099); and 50 percent of the median
35.9wage for social and human services aide (SOC code 21-1093);
35.10(9) for in-home family support staff, 20 percent of the median wage for nursing aide
35.11(SOC code 31-1012); 30 percent of the median wage for community social service specialist
35.12(SOC code 21-1099); 40 percent of the median wage for social and human services aide
35.13(SOC code 21-1093); and ten percent of the median wage for psychiatric technician (SOC
35.14code 29-2053);
35.15(10) for individualized home supports services staff, 40 percent of the median wage for
35.16community social service specialist (SOC code 21-1099); 50 percent of the median wage
35.17for social and human services aide (SOC code 21-1093); and ten percent of the median
35.18wage for psychiatric technician (SOC code 29-2053);
35.19(11) for independent living skills staff, 40 percent of the median wage for community
35.20social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
35.21human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
35.22technician (SOC code 29-2053);
35.23(12) for independent living skills specialist staff, 100 percent of mental health and
35.24substance abuse social worker (SOC code 21-1023);
35.25(11) (13) for supported employment support services staff, 20 50 percent of the median
35.26wage for nursing aide rehabilitation counselor (SOC code 31-1012 21-1015); 20 percent of
35.27the median wage for psychiatric technician (SOC code 29-2053); and 60 50 percent of the
35.28median wage for community and social and human services aide specialist (SOC code
35.2921-1093 21-1099);
35.30(14) for employment exploration services staff, 50 percent of the median wage for
35.31rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
35.32community and social services specialist (SOC code 21-1099);
36.1(15) for employment development services staff, 50 percent of the median wage for
36.2education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
36.3of the median wage for community and social services specialist (SOC code 21-1099);
36.4(12) (16) for adult companion staff, 50 percent of the median wage for personal and
36.5home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
36.6orderlies, and attendants assistant (SOC code 31-1012 31-1014);
36.7(13) (17) for night supervision staff, 20 percent of the median wage for home health
36.8aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
36.9aide (SOC code 39-9021); 20 percent of the median wage for nursing aide assistant (SOC
36.10code 31-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC
36.11code 29-2053); and 20 percent of the median wage for social and human services aide (SOC
36.12code 21-1093);
36.13(14) (18) for respite staff, 50 percent of the median wage for personal and home care
36.14aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies,
36.15and attendants assistant (SOC code 31-1012 31-1014);
36.16(15) (19) for personal support staff, 50 percent of the median wage for personal and
36.17home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
36.18orderlies, and attendants assistant (SOC code 31-1012 31-1014);
36.19(16) (20) for supervisory staff, the basic wage is $17.43 per hour, 100 percent of the
36.20median wage for community and social services specialist (SOC code 21-1099), with the
36.21exception of the supervisor of behavior professional, behavior analyst, and behavior
36.22specialists, which must be $30.75 per hour is 100 percent of the median wage for clinical
36.23counseling and school psychologist (SOC code 19-3031);
36.24(17) (21) for registered nurse staff, the basic wage is $30.82 per hour, 100 percent of
36.25the median wage for registered nurses (SOC code 29-1141); and
36.26(18) (22) for licensed practical nurse staff, the basic wage is $18.64 per hour 100 percent
36.27of the median wage for licensed practical nurses (SOC code 29-2061).
36.28(b) Component values for residential support services are:
36.29(1) supervisory span of control ratio: 11 percent;
36.30(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
36.31(3) employee-related cost ratio: 23.6 percent;
36.32(4) general administrative support ratio: 13.25 percent;
37.1(5) program-related expense ratio: 1.3 percent; and
37.2(6) absence and utilization factor ratio: 3.9 percent.
37.3(c) Component values for family foster care are:
37.4(1) supervisory span of control ratio: 11 percent;
37.5(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
37.6(3) employee-related cost ratio: 23.6 percent;
37.7(4) general administrative support ratio: 3.3 percent;
37.8(5) program-related expense ratio: 1.3 percent; and
37.9(6) absence factor: 1.7 percent.
37.10(d) Component values for day services for all services are:
37.11(1) supervisory span of control ratio: 11 percent;
37.12(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
37.13(3) employee-related cost ratio: 23.6 percent;
37.14(4) program plan support ratio: 5.6 percent;
37.15(5) client programming and support ratio: ten percent;
37.16(6) general administrative support ratio: 13.25 percent;
37.17(7) program-related expense ratio: 1.8 percent; and
37.18(8) absence and utilization factor ratio: 3.9 9.4 percent.
37.19(e) Component values for unit-based services with programming are:
37.20(1) supervisory span of control ratio: 11 percent;
37.21(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
37.22(3) employee-related cost ratio: 23.6 percent;
37.23(4) program plan supports ratio: 3.1 15.5 percent;
37.24(5) client programming and supports ratio: 8.6 4.7 percent;
37.25(6) general administrative support ratio: 13.25 percent;
37.26(7) program-related expense ratio: 6.1 percent; and
37.27(8) absence and utilization factor ratio: 3.9 percent.
38.1(f) Component values for unit-based services without programming except respite are:
38.2(1) supervisory span of control ratio: 11 percent;
38.3(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
38.4(3) employee-related cost ratio: 23.6 percent;
38.5(4) program plan support ratio: 3.1 7.0 percent;
38.6(5) client programming and support ratio: 8.6 2.3 percent;
38.7(6) general administrative support ratio: 13.25 percent;
38.8(7) program-related expense ratio: 6.1 2.9 percent; and
38.9(8) absence and utilization factor ratio: 3.9 percent.
38.10(g) Component values for unit-based services without programming for respite are:
38.11(1) supervisory span of control ratio: 11 percent;
38.12(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
38.13(3) employee-related cost ratio: 23.6 percent;
38.14(4) general administrative support ratio: 13.25 percent;
38.15(5) program-related expense ratio: 6.1 2.9 percent; and
38.16(6) absence and utilization factor ratio: 3.9 percent.
38.17(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
38.18(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
38.19Statistics available on December 31, 2016. The commissioner shall publish these updated
38.20values and load them into the rate management system. This adjustment occurs every five
38.21years. For adjustments in 2021 and beyond, the commissioner shall use the data available
38.22on December 31 of the calendar year five years prior. On January 1, 2022, and every two
38.23years thereafter, the commissioner shall update the base wage index in paragraph (a) based
38.24on the most recently available wage data by SOC from the Bureau of Labor Statistics. The
38.25commissioner shall publish these updated values and load them into the rate management
38.26system.
38.27(i) On July 1, 2017, the commissioner shall update the framework components in
38.28paragraphs (b) to (g) paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f),
38.29clause (5); subdivision 6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17),
38.30for changes in the Consumer Price Index. The commissioner will adjust these values higher
39.1or lower by the percentage change in the Consumer Price Index-All Items, United States
39.2city average (CPI-U) from January 1, 2014, to January 1, 2017. The commissioner shall
39.3publish these updated values and load them into the rate management system. This adjustment
39.4occurs every five years. For adjustments in 2021 and beyond, the commissioner shall use
39.5the data available on January 1 of the calendar year four years prior and January 1 of the
39.6current calendar year. On January 1, 2022, and every two years thereafter, the commissioner
39.7shall update the framework components in paragraph (d), clause (5); paragraph (e), clause
39.8(5); and paragraph (f), clause (5); subdivision 6, clauses (8) and (9); and subdivision 7,
39.9clauses (10), (16), and (17), for changes in the Consumer Price Index. The commissioner
39.10shall adjust these values higher or lower by the percentage change in the CPI-U from the
39.11date of the previous update to the date of the data most recently available prior to the
39.12scheduled update. The commissioner shall publish these updated values and load them into
39.13the rate management system.
39.14(j) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
39.15Price Index items are unavailable in the future, the commissioner shall recommend to the
39.16legislature codes or items to update and replace missing component values.
39.17(k) The commissioner must ensure that wage values and component values in subdivisions
39.185 to 9 reflect the cost to provide the service. As determined by the commissioner, in
39.19consultation with stakeholders identified in section 256B.4913, subdivision 5, a provider
39.20enrolled to provide services with rates determined under this section must submit requested
39.21cost data to the commissioner to support research on the cost of providing services that have
39.22rates determined by the disability waiver rates system. Requested cost data may include,
39.23but is not limited to:
39.24(1) worker wage costs;
39.25(2) benefits paid;
39.26(3) supervisor wage costs;
39.27(4) executive wage costs;
39.28(5) vacation, sick, and training time paid;
39.29(6) taxes, workers' compensation, and unemployment insurance costs paid;
39.30(7) administrative costs paid;
39.31(8) program costs paid;
39.32(9) transportation costs paid;
40.1(10) vacancy rates; and
40.2(11) other data relating to costs required to provide services requested by the
40.3commissioner.
40.4(l) At least once in any five-year period, a provider must submit cost data for a fiscal
40.5year that ended not more than 18 months prior to the submission date. The commissioner
40.6shall provide each provider a 90-day notice prior to its submission due date. If a provider
40.7fails to submit required reporting data, the commissioner shall provide notice to providers
40.8that have not provided required data 30 days after the required submission date, and a second
40.9notice for providers who have not provided required data 60 days after the required
40.10submission date. The commissioner shall temporarily suspend payments to the provider if
40.11cost data is not received 90 days after the required submission date. Withheld payments
40.12shall be made once data is received by the commissioner.
40.13(m) The commissioner shall conduct a random validation of data submitted under
40.14paragraph (k) to ensure data accuracy. The commissioner shall analyze cost documentation
40.15in paragraph (k) and provide recommendations for adjustments to cost components.
40.16(n) The commissioner shall analyze cost documentation in paragraph (k) and, in
40.17consultation with stakeholders identified in section 256B.4913, subdivision 5, may submit
40.18recommendations on component values and inflationary factor adjustments to the chairs
40.19and ranking minority members of the legislative committees with jurisdiction over human
40.20services every four years beginning January 1, 2020. The commissioner shall make
40.21recommendations in conjunction with reports submitted to the legislature according to
40.22subdivision 10, paragraph (e). The commissioner shall release business cost data in an
40.23aggregate form, and business cost data from individual providers shall not be released except
40.24as provided for in current law.
40.25(o) The commissioner, in consultation with stakeholders identified in section 256B.4913,
40.26subdivision 5, shall develop and implement a process for providing training and technical
40.27assistance necessary to support provider submission of cost documentation required under
40.28paragraph (k).
40.29EFFECTIVE DATE.(a) The amendments to paragraphs (a) to (g) are effective January
40.301, 2018, except the amendment to paragraph (d), clause (8), which is effective January 1,
40.312019, and the amendment to paragraph (a), clause (10), which is effective the day following
40.32final enactment.
40.33(b) The amendments to paragraphs (h) to (o) are effective the day following final
40.34enactment.

41.1    Sec. 29. Minnesota Statutes 2016, section 256B.4914, subdivision 6, is amended to read:
41.2    Subd. 6. Payments for residential support services. (a) Payments for residential support
41.3services, as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
41.4must be calculated as follows:
41.5(1) determine the number of shared staffing and individual direct staff hours to meet a
41.6recipient's needs provided on site or through monitoring technology;
41.7(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
41.8Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
41.95. This is defined as the direct-care rate;
41.10(3) for a recipient requiring customization for deaf and hard-of-hearing language
41.11accessibility under subdivision 12, add the customization rate provided in subdivision 12
41.12to the result of clause (2). This is defined as the customized direct-care rate;
41.13(4) multiply the number of shared and individual direct staff hours provided on site or
41.14through monitoring technology and nursing hours by the appropriate staff wages in
41.15subdivision 5, paragraph (a), or the customized direct-care rate;
41.16(5) multiply the number of shared and individual direct staff hours provided on site or
41.17through monitoring technology and nursing hours by the product of the supervision span
41.18of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
41.19wage in subdivision 5, paragraph (a), clause (16) (20);
41.20(6) combine the results of clauses (4) and (5), excluding any shared and individual direct
41.21staff hours provided through monitoring technology, and multiply the result by one plus
41.22the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
41.23clause (2). This is defined as the direct staffing cost;
41.24(7) for employee-related expenses, multiply the direct staffing cost, excluding any shared
41.25and individual direct staff hours provided through monitoring technology, by one plus the
41.26employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
41.27(8) for client programming and supports, the commissioner shall add $2,179; and
41.28(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
41.29customized for adapted transport, based on the resident with the highest assessed need.
41.30(b) The total rate must be calculated using the following steps:
42.1(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any shared
42.2and individual direct staff hours provided through monitoring technology that was excluded
42.3in clause (7);
42.4(2) sum the standard general and administrative rate, the program-related expense ratio,
42.5and the absence and utilization ratio;
42.6(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
42.7payment amount; and
42.8(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
42.9adjust for regional differences in the cost of providing services.
42.10(c) The payment methodology for customized living, 24-hour customized living, and
42.11residential care services must be the customized living tool. Revisions to the customized
42.12living tool must be made to reflect the services and activities unique to disability-related
42.13recipient needs.
42.14(d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
42.15meet or exceed the days of service used to convert service agreements in effect on December
42.161, 2013, and must not result in a reduction in spending or service utilization due to conversion
42.17during the implementation period under section 256B.4913, subdivision 4a. If during the
42.18implementation period, an individual's historical rate, including adjustments required under
42.19section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
42.20determined in this subdivision, the number of days authorized for the individual is 365.
42.21(e) The number of days authorized for all individuals enrolling after January 1, 2014,
42.22in residential services must include every day that services start and end.

42.23    Sec. 30. Minnesota Statutes 2016, section 256B.4914, subdivision 7, is amended to read:
42.24    Subd. 7. Payments for day programs. Payments for services with day programs
42.25including adult day care, day treatment and habilitation, prevocational services, and structured
42.26day services must be calculated as follows:
42.27(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
42.28(i) the staffing ratios for the units of service provided to a recipient in a typical week
42.29must be averaged to determine an individual's staffing ratio; and
42.30(ii) the commissioner, in consultation with service providers, shall develop a uniform
42.31staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
43.1(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
43.2Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
43.35;
43.4(3) for a recipient requiring customization for deaf and hard-of-hearing language
43.5accessibility under subdivision 12, add the customization rate provided in subdivision 12
43.6to the result of clause (2). This is defined as the customized direct-care rate;
43.7(4) multiply the number of day program direct staff hours and nursing hours by the
43.8appropriate staff wage in subdivision 5, paragraph (a), or the customized direct-care rate;
43.9(5) multiply the number of day direct staff hours by the product of the supervision span
43.10of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate supervision
43.11wage in subdivision 5, paragraph (a), clause (16) (20);
43.12(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
43.13employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
43.14(2). This is defined as the direct staffing rate;
43.15(7) for program plan support, multiply the result of clause (6) by one plus the program
43.16plan support ratio in subdivision 5, paragraph (d), clause (4);
43.17(8) for employee-related expenses, multiply the result of clause (7) by one plus the
43.18employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
43.19(9) for client programming and supports, multiply the result of clause (8) by one plus
43.20the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
43.21(10) for program facility costs, add $19.30 per week with consideration of staffing ratios
43.22to meet individual needs;
43.23(11) for adult day bath services, add $7.01 per 15 minute unit;
43.24(12) this is the subtotal rate;
43.25(13) sum the standard general and administrative rate, the program-related expense ratio,
43.26and the absence and utilization factor ratio;
43.27(14) divide the result of clause (12) by one minus the result of clause (13). This is the
43.28total payment amount;
43.29(15) adjust the result of clause (14) by a factor to be determined by the commissioner
43.30to adjust for regional differences in the cost of providing services;
44.1(16) for transportation provided as part of day training and habilitation for an individual
44.2who does not require a lift, add:
44.3(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
44.4a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
44.5vehicle with a lift;
44.6(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
44.7a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
44.8vehicle with a lift;
44.9(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
44.10a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
44.11vehicle with a lift; or
44.12(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
44.13$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
44.14with a lift;
44.15(17) for transportation provided as part of day training and habilitation for an individual
44.16who does require a lift, add:
44.17(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
44.18lift, and $15.05 for a shared ride in a vehicle with a lift;
44.19(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
44.20lift, and $28.16 for a shared ride in a vehicle with a lift;
44.21(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
44.22lift, and $58.76 for a shared ride in a vehicle with a lift; or
44.23(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
44.24and $80.93 for a shared ride in a vehicle with a lift.

44.25    Sec. 31. Minnesota Statutes 2016, section 256B.4914, subdivision 8, is amended to read:
44.26    Subd. 8. Payments for unit-based services with programming. Payments for unit-based
44.27services with programming, including behavior programming, housing access coordination,
44.28in-home family support, independent living skills training, independent living skills specialist
44.29services, individualized home supports, hourly supported living services, employment
44.30exploration services, employment development services, and supported employment support
44.31services provided to an individual outside of any day or residential service plan must be
45.1calculated as follows, unless the services are authorized separately under subdivision 6 or
45.27:
45.3    (1) determine the number of units of service to meet a recipient's needs;
45.4    (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
45.5Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
45.65;
45.7    (3) for a recipient requiring customization for deaf and hard-of-hearing language
45.8accessibility under subdivision 12, add the customization rate provided in subdivision 12
45.9to the result of clause (2). This is defined as the customized direct-care rate;
45.10    (4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
45.115, paragraph (a), or the customized direct-care rate;
45.12    (5) multiply the number of direct staff hours by the product of the supervision span of
45.13control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
45.14wage in subdivision 5, paragraph (a), clause (16) (20);
45.15    (6) combine the results of clauses (4) and (5), and multiply the result by one plus the
45.16employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), clause
45.17(2). This is defined as the direct staffing rate;
45.18    (7) for program plan support, multiply the result of clause (6) by one plus the program
45.19plan supports ratio in subdivision 5, paragraph (e), clause (4);
45.20    (8) for employee-related expenses, multiply the result of clause (7) by one plus the
45.21employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
45.22    (9) for client programming and supports, multiply the result of clause (8) by one plus
45.23the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
45.24    (10) this is the subtotal rate;
45.25    (11) sum the standard general and administrative rate, the program-related expense ratio,
45.26and the absence and utilization factor ratio;
45.27    (12) divide the result of clause (10) by one minus the result of clause (11). This is the
45.28total payment amount;
45.29    (13) for supported employment support services provided in a shared manner, divide
45.30the total payment amount in clause (12) by the number of service recipients, not to exceed
45.31three six. For independent living skills training and individualized home supports provided
46.1in a shared manner, divide the total payment amount in clause (12) by the number of service
46.2recipients, not to exceed two; and
46.3    (14) adjust the result of clause (13) by a factor to be determined by the commissioner
46.4to adjust for regional differences in the cost of providing services.
46.5EFFECTIVE DATE.This section is effective the day following final enactment.

46.6    Sec. 32. Minnesota Statutes 2016, section 256B.4914, subdivision 9, is amended to read:
46.7    Subd. 9. Payments for unit-based services without programming. Payments for
46.8unit-based services without programming, including night supervision, personal support,
46.9respite, and companion care provided to an individual outside of any day or residential
46.10service plan must be calculated as follows unless the services are authorized separately
46.11under subdivision 6 or 7:
46.12(1) for all services except respite, determine the number of units of service to meet a
46.13recipient's needs;
46.14(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
46.15Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
46.16(3) for a recipient requiring customization for deaf and hard-of-hearing language
46.17accessibility under subdivision 12, add the customization rate provided in subdivision 12
46.18to the result of clause (2). This is defined as the customized direct care rate;
46.19(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
46.205 or the customized direct care rate;
46.21(5) multiply the number of direct staff hours by the product of the supervision span of
46.22control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
46.23wage in subdivision 5, paragraph (a), clause (16) (20);
46.24(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
46.25employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
46.26(2). This is defined as the direct staffing rate;
46.27(7) for program plan support, multiply the result of clause (6) by one plus the program
46.28plan support ratio in subdivision 5, paragraph (f), clause (4);
46.29(8) for employee-related expenses, multiply the result of clause (7) by one plus the
46.30employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
47.1(9) for client programming and supports, multiply the result of clause (8) by one plus
47.2the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
47.3(10) this is the subtotal rate;
47.4(11) sum the standard general and administrative rate, the program-related expense ratio,
47.5and the absence and utilization factor ratio;
47.6(12) divide the result of clause (10) by one minus the result of clause (11). This is the
47.7total payment amount;
47.8(13) for respite services, determine the number of day units of service to meet an
47.9individual's needs;
47.10(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
47.11Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
47.12(15) for a recipient requiring deaf and hard-of-hearing customization under subdivision
47.1312, add the customization rate provided in subdivision 12 to the result of clause (14). This
47.14is defined as the customized direct care rate;
47.15(16) multiply the number of direct staff hours by the appropriate staff wage in subdivision
47.165, paragraph (a);
47.17(17) multiply the number of direct staff hours by the product of the supervisory span of
47.18control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
47.19wage in subdivision 5, paragraph (a), clause (16) (20);
47.20(18) combine the results of clauses (16) and (17), and multiply the result by one plus
47.21the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
47.22clause (2). This is defined as the direct staffing rate;
47.23(19) for employee-related expenses, multiply the result of clause (18) by one plus the
47.24employee-related cost ratio in subdivision 5, paragraph (g), clause (3);
47.25(20) this is the subtotal rate;
47.26(21) sum the standard general and administrative rate, the program-related expense ratio,
47.27and the absence and utilization factor ratio;
47.28(22) divide the result of clause (20) by one minus the result of clause (21). This is the
47.29total payment amount; and
47.30(23) adjust the result of clauses (12) and (22) by a factor to be determined by the
47.31commissioner to adjust for regional differences in the cost of providing services.

48.1    Sec. 33. Minnesota Statutes 2016, section 256B.4914, subdivision 10, is amended to read:
48.2    Subd. 10. Updating payment values and additional information. (a) From January
48.31, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
48.4procedures to refine terms and adjust values used to calculate payment rates in this section.
48.5(b) No later than July 1, 2014, the commissioner shall, within available resources, begin
48.6to conduct research and gather data and information from existing state systems or other
48.7outside sources on the following items:
48.8(1) differences in the underlying cost to provide services and care across the state; and
48.9(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
48.10units of transportation for all day services, which must be collected from providers using
48.11the rate management worksheet and entered into the rates management system; and
48.12(3) the distinct underlying costs for services provided by a license holder under sections
48.13245D.05 , 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
48.14by a license holder certified under section 245D.33.
48.15(c) Beginning January 1, 2014, through December 31, 2018, using a statistically valid
48.16set of rates management system data, the commissioner, in consultation with stakeholders,
48.17shall analyze for each service the average difference in the rate on December 31, 2013, and
48.18the framework rate at the individual, provider, lead agency, and state levels. The
48.19commissioner shall issue semiannual reports to the stakeholders on the difference in rates
48.20by service and by county during the banding period under section 256B.4913, subdivision
48.214a
. The commissioner shall issue the first report by October 1, 2014, and the final report
48.22shall be issued by December 31, 2018.
48.23(d) No later than July 1, 2014, the commissioner, in consultation with stakeholders, shall
48.24begin the review and evaluation of the following values already in subdivisions 6 to 9, or
48.25issues that impact all services, including, but not limited to:
48.26(1) values for transportation rates for day services;
48.27(2) values for transportation rates in residential services;
48.28(3) (2) values for services where monitoring technology replaces staff time;
48.29(4) (3) values for indirect services;
48.30(5) (4) values for nursing;
48.31(6) component values for independent living skills;
49.1(7) component values for family foster care that reflect licensing requirements;
49.2(8) adjustments to other components to replace the budget neutrality factor;
49.3(9) remote monitoring technology for nonresidential services;
49.4(10) values for basic and intensive services in residential services;
49.5(11) (5) values for the facility use rate in day services, and the weightings used in the
49.6day service ratios and adjustments to those weightings;
49.7(12) (6) values for workers' compensation as part of employee-related expenses;
49.8(13) (7) values for unemployment insurance as part of employee-related expenses;
49.9(14) a component value to reflect costs for individuals with rates previously adjusted
49.10for the inclusion of group residential housing rate 3 costs, only for any individual enrolled
49.11as of December 31, 2013; and
49.12(15) (8) any changes in state or federal law with an a direct impact on the underlying
49.13cost of providing home and community-based services.; and
49.14(9) outcome measures, determined by the commissioner, for home and community-based
49.15services rates determined under this section.
49.16(e) The commissioner shall report to the chairs and the ranking minority members of
49.17the legislative committees and divisions with jurisdiction over health and human services
49.18policy and finance with the information and data gathered under paragraphs (b) to (d) on
49.19the following dates:
49.20(1) January 15, 2015, with preliminary results and data;
49.21(2) January 15, 2016, with a status implementation update, and additional data and
49.22summary information;
49.23(3) January 15, 2017, with the full report; and
49.24(4) January 15, 2019 2020, with another full report, and a full report once every four
49.25years thereafter.
49.26(f) Based on the commissioner's evaluation of the information and data collected in
49.27paragraphs (b) to (d), the commissioner shall make recommendations to the legislature by
49.28January 15, 2015, to address any issues identified during the first year of implementation.
49.29After January 15, 2015, the commissioner may make recommendations to the legislature
49.30to address potential issues.
50.1(g) (f) The commissioner shall implement a regional adjustment factor to all rate
50.2calculations in subdivisions 6 to 9, effective no later than January 1, 2015. Beginning July
50.31, 2017, the commissioner shall renew analysis and implement changes to the regional
50.4adjustment factors when adjustments required under subdivision 5, paragraph (h), occur.
50.5Prior to implementation, the commissioner shall consult with stakeholders on the
50.6methodology to calculate the adjustment.
50.7(h) (g) The commissioner shall provide a public notice via LISTSERV in October of
50.8each year beginning October 1, 2014, containing information detailing legislatively approved
50.9changes in:
50.10(1) calculation values including derived wage rates and related employee and
50.11administrative factors;
50.12(2) service utilization;
50.13(3) county and tribal allocation changes; and
50.14(4) information on adjustments made to calculation values and the timing of those
50.15adjustments.
50.16The information in this notice must be effective January 1 of the following year.
50.17(i) No later than July 1, 2016, the commissioner shall develop and implement, in
50.18consultation with stakeholders, a methodology sufficient to determine the shared staffing
50.19levels necessary to meet, at a minimum, health and welfare needs of individuals who will
50.20be living together in shared residential settings, and the required shared staffing activities
50.21described in subdivision 2, paragraph (l). This determination methodology must ensure
50.22staffing levels are adaptable to meet the needs and desired outcomes for current and
50.23prospective residents in shared residential settings.
50.24(j) (h) When the available shared staffing hours in a residential setting are insufficient
50.25to meet the needs of an individual who enrolled in residential services after January 1, 2014,
50.26or insufficient to meet the needs of an individual with a service agreement adjustment
50.27described in section 256B.4913, subdivision 4a, paragraph (f), then individual staffing hours
50.28shall be used.
50.29(i) The commissioner shall study the underlying cost of absence and utilization for day
50.30services. Based on the commissioner's evaluation of the data collected under this paragraph,
50.31the commissioner shall make recommendations to the legislature by January 15, 2018, for
50.32changes, if any, to the absence and utilization factor ratio component value for day services.
51.1(j) Beginning July 1, 2017, the commissioner shall collect transportation and trip
51.2information for all day services through the rates management system.
51.3EFFECTIVE DATE.This section is effective the day following final enactment.

51.4    Sec. 34. Minnesota Statutes 2016, section 256B.4914, subdivision 16, is amended to read:
51.5    Subd. 16. Budget neutrality adjustments. (a) The commissioner shall use the following
51.6adjustments to the rate generated by the framework to assure budget neutrality until the rate
51.7information is available to implement paragraph (b). The rate generated by the framework
51.8shall be multiplied by the appropriate factor, as designated below:
51.9(1) for residential services: 1.003;
51.10(2) for day services: 1.000;
51.11(3) for unit-based services with programming: 0.941; and
51.12(4) for unit-based services without programming: 0.796.
51.13(b) Within 12 months of January 1, 2014, the commissioner shall compare estimated
51.14spending for all home and community-based waiver services under the new payment rates
51.15defined in subdivisions 6 to 9 with estimated spending for the same recipients and services
51.16under the rates in effect on July 1, 2013. This comparison must distinguish spending under
51.17each of subdivisions 6, 7, 8, and 9. The comparison must be based on actual recipients and
51.18services for one or more service months after the new rates have gone into effect. The
51.19commissioner shall consult with the commissioner of management and budget on this
51.20analysis to ensure budget neutrality. If estimated spending under the new rates for services
51.21under one or more subdivisions differs in this comparison by 0.3 percent or more, the
51.22commissioner shall assure aggregate budget neutrality across all service areas by adjusting
51.23the budget neutrality factor in paragraph (a) in each subdivision so that total estimated
51.24spending for each subdivision under the new rates matches estimated spending under the
51.25rates in effect on July 1, 2013.
51.26(c) A service rate developed using values in subdivision 5, paragraph (a), clause (10),
51.27is not subject to budget neutrality adjustments.
51.28EFFECTIVE DATE.This section is effective the day following final enactment.

52.1    Sec. 35. Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
52.2to read:
52.3    Subd. 1a. Culturally affirmative. "Culturally affirmative" describes services that are
52.4designed and delivered within the context of the culture, language, and life experiences of
52.5a person who is deaf, a person who is deafblind, and a person who is hard-of-hearing.

52.6    Sec. 36. Minnesota Statutes 2016, section 256C.23, subdivision 2, is amended to read:
52.7    Subd. 2. Deaf. "Deaf" means a hearing loss of such severity that the individual must
52.8depend primarily on visual communication such as American Sign Language or other signed
52.9language, visual and manual means of communication such as signing systems in English
52.10or Cued Speech, writing, lip speech reading, manual communication, and gestures.

52.11    Sec. 37. Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
52.12to read:
52.13    Subd. 2c. Interpreting services. "Interpreting services" means services that include:
52.14(1) interpreting between a spoken language, such as English, and a visual language, such
52.15as American Sign Language;
52.16(2) interpreting between a spoken language and a visual representation of a spoken
52.17language, such as Cued Speech and signing systems in English;
52.18(3) interpreting within one language where the interpreter uses natural gestures and
52.19silently repeats the spoken message, replacing some words or phrases to give higher visibility
52.20on the lips;
52.21(4) interpreting using low vision or tactile methods for persons who have a combined
52.22hearing and vision loss or are deafblind; and
52.23(5) interpreting from one communication mode or language into another communication
52.24mode or language that is linguistically and culturally appropriate for the participants in the
52.25communication exchange.

52.26    Sec. 38. Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
52.27to read:
52.28    Subd. 6. Real-time captioning. "Real-time captioning" means a method of captioning
52.29in which a caption is simultaneously prepared and displayed or transmitted at the time of
52.30origination by specially trained real-time captioners.

53.1    Sec. 39. Minnesota Statutes 2016, section 256C.233, subdivision 1, is amended to read:
53.2    Subdivision 1. Deaf and Hard-of-Hearing Services Division. The commissioners of
53.3human services, education, employment and economic development, and health shall create
53.4a distinct and separate organizational unit to be known as advise the commissioner of human
53.5services on the activities of the Deaf and Hard-of-Hearing Services Division to address.
53.6This division addresses the developmental, social, educational, and occupational and
53.7social-emotional needs of persons who are deaf, persons who are deafblind, and persons
53.8who are hard-of-hearing persons through a statewide network of collaborative services and
53.9by coordinating the promulgation of public policies, regulations, legislation, and programs
53.10affecting advocates on behalf of and provides information and training about how to best
53.11serve persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing
53.12persons. An interdepartmental management team shall advise the activities of the Deaf and
53.13Hard-of-Hearing Services Division. The commissioner of human services shall coordinate
53.14the work of the interagency management team advisers and receive legislative appropriations
53.15for the division.

53.16    Sec. 40. Minnesota Statutes 2016, section 256C.233, subdivision 2, is amended to read:
53.17    Subd. 2. Responsibilities. The Deaf and Hard-of-Hearing Services Division shall:
53.18(1) establish and maintain a statewide network of regional service centers culturally
53.19affirmative services for Minnesotans who are deaf, Minnesotans who are deafblind, and
53.20Minnesotans who are hard-of-hearing Minnesotans;
53.21(2) assist work across divisions within the Departments Department of Human Services,
53.22Education, and Employment and Economic Development to coordinate the promulgation
53.23and implementation of public policies, regulations, legislation, programs, and services
53.24affecting as well as with other agencies and counties, to ensure that there is an understanding
53.25of:
53.26(i) the communication challenges faced by persons who are deaf, persons who are
53.27deafblind, and persons who are hard-of-hearing persons;
53.28(ii) the best practices for accommodating and mitigating communication challenges;
53.29and
53.30(iii) the legal requirements for providing access to and effective communication with
53.31persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing; and
53.32(3) provide a coordinated system of assess the supply and demand statewide interpreting
53.33or for interpreter referral services. and real-time captioning services, implement strategies
54.1to provide greater access to these services in areas without sufficient supply, and build the
54.2base of service providers across the state;
54.3(4) maintain a statewide information resource that includes contact information and
54.4professional certification credentials of interpreting service providers and real-time captioning
54.5service providers;
54.6(5) provide culturally affirmative mental health services to persons who are deaf, persons
54.7who are deafblind, and persons who are hard-of-hearing who:
54.8(i) use a visual language such as American Sign Language or a tactile form of a language;
54.9or
54.10(ii) otherwise need culturally affirmative therapeutic services;
54.11(6) research and develop best practices and recommendations for emerging issues;
54.12(7) provide as much information as practicable on the division's stand-alone Web site
54.13in American Sign Language; and
54.14(8) report to the chairs and ranking minority members of the legislative committees with
54.15jurisdiction over human services biennially, beginning on January 1, 2019, on the following:
54.16(i) the number of regional service center staff, the location of the office of each staff
54.17person, other service providers with which they are colocated, the number of people served
54.18by each staff person and a breakdown of whether each person was served on-site or off-site,
54.19and for those served off-site, a list of locations where services were delivered and the number
54.20who were served in-person and the number who were served via technology;
54.21(ii) the amount and percentage of the division budget spent on reasonable
54.22accommodations for staff;
54.23(iii) the number of people who use demonstration equipment and consumer evaluations
54.24of the experience;
54.25(iv) the number of training sessions provided by division staff, the topics covered, the
54.26number of participants, and consumer evaluations, including a breakdown by delivery
54.27method such as in-person or via technology;
54.28(v) the number of training sessions hosted at a division location provided by another
54.29service provider, the topics covered, the number of participants, and consumer evaluations,
54.30including a breakdown by delivery method such as in-person or via technology;
54.31(vi) for each grant awarded, the amount awarded to the grantee and a summary of the
54.32grantee's results, including consumer evaluations of the services or products provided;
55.1(vii) the number of people on waiting lists for any services provided by division staff
55.2or for services or equipment funded through grants awarded by the division;
55.3(viii) the amount of time staff spent driving to appointments to deliver direct one-to-one
55.4client services in locations outside of the regional service centers;
55.5(ix) the amount spent on mileage reimbursement and the number of clients who received
55.6mileage reimbursement for traveling to the regional service centers for services; and
55.7(x) the regional needs and feedback on addressing service gaps identified by the advisory
55.8committees.

55.9    Sec. 41. Minnesota Statutes 2016, section 256C.24, subdivision 1, is amended to read:
55.10    Subdivision 1. Location. The Deaf and Hard-of-Hearing Services Division shall establish
55.11up to eight at least six regional service centers for persons who are deaf and persons who
55.12are hard-of-hearing persons. The centers shall be distributed regionally to provide access
55.13for persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing
55.14persons in all parts of the state.

55.15    Sec. 42. Minnesota Statutes 2016, section 256C.24, subdivision 2, is amended to read:
55.16    Subd. 2. Responsibilities. Each regional service center shall:
55.17(1) serve as a central entry point for establish connections and collaborations and explore
55.18co-locating with other public and private entities providing services to persons who are
55.19deaf, persons who are deafblind, and persons who are hard-of-hearing persons in need of
55.20services and make referrals to the services needed in the region;
55.21(2) for those in need of services, assist in coordinating services between service providers
55.22and persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing,
55.23and the persons' families, and make referrals to the services needed;
55.24(2) (3) employ staff trained to work with persons who are deaf, persons who are deafblind,
55.25and persons who are hard-of-hearing persons;
55.26(3) (4) if adequate services are not available from another public or private service
55.27provider in the region, provide to all individual assistance to persons who are deaf, persons
55.28who are deafblind, and persons who are hard-of-hearing persons access to interpreter services
55.29which are necessary to help them obtain services, and the persons' families. Individual
55.30culturally affirmative assistance may be provided using technology only in areas of the state
55.31where a person has access to sufficient quality telecommunications or broadband services
56.1to allow effective communication. When a person who is deaf, a person who is deafblind,
56.2or a person who is hard-of-hearing does not have access to sufficient telecommunications
56.3or broadband service, individual assistance shall be available in person;
56.4(5) identify regional training needs, work with deaf and hard-of-hearing services training
56.5staff, and collaborate with others to deliver training for persons who are deaf, persons who
56.6are deafblind, and persons who are hard-of-hearing, and the persons' families, and other
56.7service providers about subjects including the persons' rights under the law, American Sign
56.8Language, and the impact of hearing loss and options for accommodating it;
56.9(4) implement a plan to provide loaned equipment and resource materials to deaf,
56.10deafblind, and hard-of-hearing (6) have a mobile or permanent lab where persons who are
56.11deaf, persons who are deafblind, and persons who are hard-of-hearing can try a selection
56.12of modern assistive technology and equipment to determine what would best meet the
56.13persons' needs;
56.14(5) cooperate with responsible departments and administrative authorities to provide
56.15access for deaf, deafblind, and hard-of-hearing persons to services provided by state, county,
56.16and regional agencies;
56.17(6) (7) collaborate with the Resource Center for the Deaf and Hard-of-Hearing Persons,
56.18other divisions of the Department of Education, and local school districts to develop and
56.19deliver programs and services for families with children who are deaf, children who are
56.20deafblind, or children who are hard-of-hearing children and to support school personnel
56.21serving these children;
56.22(7) when possible, (8) provide training to the social service or income maintenance staff
56.23employed by counties or by organizations with whom counties contract for services to
56.24ensure that communication barriers which prevent persons who are deaf, persons who are
56.25deafblind, and persons who are hard-of-hearing persons from using services are removed;
56.26(8) when possible, (9) provide training to state and regional human service agencies in
56.27the region regarding program access for persons who are deaf, persons who are deafblind,
56.28and persons who are hard-of-hearing persons; and
56.29(9) (10) assess the ongoing need and supply of services for persons who are deaf, persons
56.30who are deafblind, and persons who are hard-of-hearing persons in all parts of the state,
56.31annually consult with the division's advisory committees to identify regional needs and
56.32solicit feedback on addressing service gaps, and cooperate with public and private service
56.33providers to develop these services.;
57.1(11) provide culturally affirmative mental health services to persons who are deaf,
57.2persons who are deafblind, and persons who are hard-of-hearing who:
57.3(i) use a visual language such as American Sign Language or a tactile form of a language;
57.4or
57.5(ii) otherwise need culturally affirmative therapeutic services; and
57.6(12) establish partnerships with state and regional entities statewide that have the
57.7technological capacity to provide Minnesotans with virtual access to the division's services
57.8and division-sponsored training via technology.

57.9    Sec. 43. Minnesota Statutes 2016, section 256C.261, is amended to read:
57.10256C.261 SERVICES FOR PERSONS WHO ARE DEAFBLIND PERSONS.
57.11    (a) The commissioner of human services shall combine the existing biennial base level
57.12funding for deafblind services into a single grant program. At least 35 percent of the total
57.13funding is awarded for services and other supports to deafblind children and their families
57.14and at least 25 percent is awarded for services and other supports to deafblind adults. use
57.15at least 35 percent of the deafblind services biennial base level grant funding for services
57.16and other supports for a child who is deafblind and the child's family. The commissioner
57.17shall use at least 25 percent of the deafblind services biennial base level grant funding for
57.18services and other supports for an adult who is deafblind.
57.19    The commissioner shall award grants for the purposes of:
57.20    (1) providing services and supports to individuals persons who are deafblind; and
57.21    (2) developing and providing training to counties and the network of senior citizen
57.22service providers. The purpose of the training grants is to teach counties how to use existing
57.23programs that capture federal financial participation to meet the needs of eligible persons
57.24who are deafblind persons and to build capacity of senior service programs to meet the
57.25needs of seniors with a dual sensory hearing and vision loss.
57.26    (b) The commissioner may make grants:
57.27    (1) for services and training provided by organizations; and
57.28    (2) to develop and administer consumer-directed services.
57.29(c) Consumer-directed services shall be provided in whole by grant-funded providers.
57.30The deaf and hard-of-hearing regional service centers shall not provide any aspect of a
57.31grant-funded consumer-directed services program.
58.1    (c) (d) Any entity that is able to satisfy the grant criteria is eligible to receive a grant
58.2under paragraph (a).
58.3    (d) (e) Deafblind service providers may, but are not required to, provide intervenor
58.4services as part of the service package provided with grant funds under this section.

58.5    Sec. 44. EXPANSION OF CONSUMER-DIRECTED COMMUNITY SUPPORTS
58.6BUDGET METHODOLOGY EXCEPTION.
58.7(a) No later than September 30, 2017, if necessary, the commissioner of human services
58.8shall submit an amendment to the Centers for Medicare and Medicaid Services for the home
58.9and community-based services waivers authorized under Minnesota Statutes, sections
58.10256B.092 and 256B.49, to expand the exception to the consumer-directed community
58.11supports budget methodology under Laws 2015, chapter 71, article 7, section 54, to provide
58.12up to 30 percent more funds for either:
58.13(1) consumer-directed community supports participants who have a coordinated service
58.14and support plan which identifies the need for an increased amount of services or supports
58.15under consumer-directed community supports than the amount they are currently receiving
58.16under the consumer-directed community supports budget methodology:
58.17(i) to increase the amount of time a person works or otherwise improves employment
58.18opportunities;
58.19(ii) to plan a transition to, move to, or live in a setting described in Minnesota Statutes,
58.20section 256D.44, subdivision 5, paragraph (f), clause (1), item (ii), or paragraph (g); or
58.21(iii) to develop and implement a positive behavior support plan; or
58.22(2) home and community-based waiver participants who are currently using licensed
58.23providers for (i) employment supports or services during the day; or (ii) residential services,
58.24either of which cost more annually than the person would spend under a consumer-directed
58.25community supports plan for any or all of the supports needed to meet the goals identified
58.26in paragraph (a), clause (1), items (i), (ii), and (iii).
58.27(b) The exception under paragraph (a), clause (1), is limited to those persons who can
58.28demonstrate that they will have to discontinue using consumer-directed community supports
58.29and accept other non-self-directed waiver services because their supports needed for the
58.30goals described in paragraph (a), clause (1), items (i), (ii), and (iii), cannot be met within
58.31the consumer-directed community supports budget limits.
59.1(c) The exception under paragraph (a), clause (2), is limited to those persons who can
59.2demonstrate that, upon choosing to become a consumer-directed community supports
59.3participant, the total cost of services, including the exception, will be less than the cost of
59.4current waiver services.
59.5EFFECTIVE DATE.The exception under this section is effective October 1, 2017, or
59.6upon federal approval, whichever is later. Notwithstanding any other law to the contrary,
59.7the exception in Laws 2016, chapter 144, section 1, remains in effect until the exception
59.8under Laws 2015, chapter 71, article 7, section 54, or under this section becomes effective,
59.9whichever occurs first. The commissioner of human services shall notify the revisor of
59.10statutes when federal approval is obtained.

59.11    Sec. 45. CONSUMER-DIRECTED COMMUNITY SUPPORTS BUDGET
59.12METHODOLOGY EXCEPTION FOR PERSONS LEAVING INSTITUTIONS AND
59.13CRISIS RESIDENTIAL SETTINGS.
59.14(a) By September 30, 2017, the commissioner shall establish an institutional and crisis
59.15bed consumer-directed community supports budget exception process in the home and
59.16community-based services waivers under Minnesota Statutes, sections 256B.092 and
59.17256B.49. This budget exception process shall be available for any individual who:
59.18(1) is not offered available and appropriate services within 60 days since approval for
59.19discharge from the individual's current institutional setting; and
59.20(2) requires services that are more expensive than appropriate services provided in a
59.21noninstitutional setting using the consumer-directed community supports option.
59.22(b) Institutional settings for purposes of this exception include intermediate care facilities
59.23for persons with developmental disabilities; nursing facilities; acute care hospitals; Anoka
59.24Metro Regional Treatment Center; Minnesota Security Hospital; and crisis beds. The budget
59.25exception shall be limited to no more than the amount of appropriate services provided in
59.26a noninstitutional setting as determined by the lead agency managing the individual's home
59.27and community-based services waiver. The lead agency shall notify the Department of
59.28Human Services of the budget exception.
59.29EFFECTIVE DATE.This section is effective the day following final enactment.

60.1    Sec. 46. CONSUMER-DIRECTED COMMUNITY SUPPORTS REVISED BUDGET
60.2METHODOLOGY REPORT.
60.3(a) The commissioner of human services, in consultation with stakeholders and others
60.4including representatives of lead agencies, home and community-based services waiver
60.5participants using consumer-directed community supports, advocacy groups, state agencies,
60.6the Institute on Community Integration at the University of Minnesota, and service and
60.7financial management providers, shall develop a revised consumer-directed community
60.8supports budget methodology. The new methodology shall be based on (1) the costs of
60.9providing services as reflected by the wage and other relevant components incorporated in
60.10the disability waiver rate formulas under Minnesota Statutes, chapter 256B, and (2)
60.11state-to-county waiver-funding methodologies. The new methodology should develop
60.12individual consumer-directed community supports budgets comparable to those provided
60.13for similar needs individuals if paying for non-consumer-directed community supports
60.14waiver services.
60.15(b) By December 15, 2018, the commissioner shall report a revised consumer-directed
60.16community supports budget methodology, including proposed legislation and funding
60.17necessary to implement the new methodology, to the chairs and ranking minority members
60.18of the house of representatives and senate committees with jurisdiction over health and
60.19human services.
60.20EFFECTIVE DATE.This section is effective the day following final enactment.

60.21    Sec. 47. FEDERAL WAIVER AMENDMENTS.
60.22The commissioner of human services shall submit necessary waiver amendments to the
60.23Centers for Medicare and Medicaid Services to add employment exploration services,
60.24employment development services, and employment support services to the home and
60.25community-based services waivers authorized under Minnesota Statutes, sections 256B.092
60.26and 256B.49. The commissioner shall also submit necessary waiver amendments to remove
60.27community-based employment services from day training and habilitation and prevocational
60.28services. The commissioner shall submit all necessary waiver amendments by October 1,
60.292017.
60.30EFFECTIVE DATE.This section is effective the day following final enactment.

61.1    Sec. 48. TRANSPORTATION STUDY.
61.2The commissioner of human services, with cooperation from lead agencies and in
61.3consultation with stakeholders, shall conduct a study to identify opportunities to increase
61.4access to transportation services for an individual who receives home and community-based
61.5services. The commissioner shall submit a report with recommendations to the chairs and
61.6ranking minority members of the legislative committees with jurisdiction over human
61.7services by January 15, 2019. The report shall:
61.8(1) study all aspects of the current transportation service network, including the fleet
61.9available, the different rate-setting methods currently used, methods that an individual uses
61.10to access transportation, and the diversity of available provider agencies;
61.11(2) identify current barriers for an individual accessing transportation and for a provider
61.12providing waiver services transportation in the marketplace;
61.13(3) identify efficiencies and collaboration opportunities to increase available
61.14transportation, including transportation funded by medical assistance, and available regional
61.15transportation and transit options;
61.16(4) study transportation solutions in other states for delivering home and community-based
61.17services;
61.18(5) study provider costs required to administer transportation services;
61.19(6) make recommendations for coordinating and increasing transportation accessibility
61.20across the state; and
61.21(7) make recommendations for the rate setting of waivered transportation.
61.22EFFECTIVE DATE.This section is effective the day following final enactment.

61.23    Sec. 49. DIRECTION TO COMMISSIONER; TELECOMMUNICATION
61.24EQUIPMENT PROGRAM.
61.25The commissioner of human services shall work in consultation with the Commission
61.26of Deaf, Deafblind, and Hard-of-Hearing Minnesotans to provide recommendations by
61.27January 15, 2018, to the chairs and ranking minority members of the house of representatives
61.28and senate committees with jurisdiction over human services to modernize the
61.29telecommunication equipment program. The recommendations must address:
61.30(1) types of equipment and supports the program should provide to ensure people with
61.31communication difficulties have equitable access to telecommunications services;
62.1(2) additional services the program should provide, such as education about technology
62.2options that can improve a person's access to telecommunications services; and
62.3(3) how the current program's service delivery structure might be improved to better
62.4meet the needs of people with communication disabilities.
62.5The commissioner shall also provide draft legislative language to accomplish the
62.6recommendations. Final recommendations, the final report, and draft legislative language
62.7must be approved by both the commissioner and the chair of the Commission of Deaf,
62.8Deafblind, and Hard-of-Hearing Minnesotans.

62.9    Sec. 50. DIRECTION TO COMMISSIONER; BILLING FOR MENTAL HEALTH
62.10SERVICES.
62.11By January 1, 2018, the commissioner of human services shall report to the chairs and
62.12ranking minority members of the house of representatives and senate committees with
62.13jurisdiction over deaf and hard-of-hearing services on the potential costs and benefits of the
62.14Deaf and Hard-of-Hearing Services Division billing for the cost of providing mental health
62.15services.

62.16    Sec. 51. DIRECTION TO COMMISSIONER; MnCHOICES ASSESSMENT TOOL.
62.17The commissioner of human services shall work with lead agencies responsible for
62.18conducting long-term consultation services under Minnesota Statutes, section 256B.0911,
62.19to modify the MnCHOICES assessment tool and related policies to:
62.20(1) reduce assessment times;
62.21(2) create efficiencies within the tool and within practice and policy for conducting
62.22assessments and support planning;
62.23(3) implement policy changes reducing the frequency and depth of assessment and
62.24reassessment, while ensuring federal compliance with medical assistance and disability
62.25waiver eligibility requirements; and
62.26(4) evaluate alternative payment methods.

62.27    Sec. 52. RANDOM MOMENT TIME STUDY EVALUATION REQUIRED.
62.28The commissioner of human services shall evaluate the random moment time study
62.29methodology for reimbursement of costs associated with county duties required under
62.30Minnesota Statutes, section 256B.0911. The study must determine whether random moment
62.31is efficient and effective in supporting functions of assessment and support planning and
63.1the purpose under Minnesota Statutes, section 256B.0911, subdivision 1. The commissioner
63.2shall submit a report to the chairs and ranking minority members of the house of
63.3representatives and senate committees with jurisdiction over health and human services by
63.4January 15, 2019. The report must provide recommendations for changes to payment
63.5methodologies and functions related to assessment, eligibility determination, and support
63.6planning.

63.7    Sec. 53. REPEALER.
63.8(a) Minnesota Statutes 2016, sections 144A.351, subdivision 2; 256C.23, subdivision
63.93; 256C.233, subdivision 4; and 256C.25, subdivisions 1 and 2, are repealed.
63.10(b) Minnesota Statutes 2016, section 256B.4914, subdivision 16, is repealed effective
63.11January 1, 2018.
63.12(c) Laws 2012, chapter 247, article 4, section 47, as amended by Laws 2014, chapter
63.13312, article 27, section 72, Laws 2015, chapter 71, article 7, section 58, Laws 2016, chapter
63.14144, section 1; and Laws 2015, chapter 71, article 7, section 54, are repealed upon the
63.15effective date of section 44.

63.16ARTICLE 2
63.17HOUSING

63.18    Section 1. Minnesota Statutes 2016, section 144D.04, subdivision 2, is amended to read:
63.19    Subd. 2. Contents of contract. A housing with services contract, which need not be
63.20entitled as such to comply with this section, shall include at least the following elements in
63.21itself or through supporting documents or attachments:
63.22(1) the name, street address, and mailing address of the establishment;
63.23(2) the name and mailing address of the owner or owners of the establishment and, if
63.24the owner or owners is not a natural person, identification of the type of business entity of
63.25the owner or owners;
63.26(3) the name and mailing address of the managing agent, through management agreement
63.27or lease agreement, of the establishment, if different from the owner or owners;
63.28(4) the name and address of at least one natural person who is authorized to accept service
63.29of process on behalf of the owner or owners and managing agent;
64.1(5) a statement describing the registration and licensure status of the establishment and
64.2any provider providing health-related or supportive services under an arrangement with the
64.3establishment;
64.4(6) the term of the contract;
64.5(7) a description of the services to be provided to the resident in the base rate to be paid
64.6by resident, including a delineation of the portion of the base rate that constitutes rent and
64.7a delineation of charges for each service included in the base rate;
64.8(8) a description of any additional services, including home care services, available for
64.9an additional fee from the establishment directly or through arrangements with the
64.10establishment, and a schedule of fees charged for these services;
64.11(9) a description of the process through which the contract may be modified, amended,
64.12or terminated, including whether a move to a different room or sharing a room would be
64.13required in the event that the tenant can no longer pay the current rent;
64.14(10) a description of the establishment's complaint resolution process available to residents
64.15including the toll-free complaint line for the Office of Ombudsman for Long-Term Care;
64.16(11) the resident's designated representative, if any;
64.17(12) the establishment's referral procedures if the contract is terminated;
64.18(13) requirements of residency used by the establishment to determine who may reside
64.19or continue to reside in the housing with services establishment;
64.20(14) billing and payment procedures and requirements;
64.21(15) a statement regarding the ability of residents a resident to receive services from
64.22service providers with whom the establishment does not have an arrangement;
64.23(16) a statement regarding the availability of public funds for payment for residence or
64.24services in the establishment; and
64.25(17) a statement regarding the availability of and contact information for long-term care
64.26consultation services under section 256B.0911 in the county in which the establishment is
64.27located.
64.28EFFECTIVE DATE.This section is effective the day following final enactment.

65.1    Sec. 2. Minnesota Statutes 2016, section 144D.04, is amended by adding a subdivision to
65.2read:
65.3    Subd. 2a. Additional contract requirements. (a) For a resident receiving one or more
65.4health-related services from the establishment's arranged home care provider, as defined in
65.5section 144D.01, subdivision 6, the contract must include the requirements in paragraph
65.6(b). A restriction of a resident's rights under this subdivision is allowed only if determined
65.7necessary for health and safety reasons identified by the home care provider's registered
65.8nurse in an initial assessment or reassessment, as defined under section 144A.4791,
65.9subdivision 8, and documented in the written service plan under section 144A.4791,
65.10subdivision 9. Any restrictions of those rights for people served under sections 256B.0915
65.11and 256B.49 must be documented in the resident's coordinated service and support plan
65.12(CSSP), as defined under sections 256B.0915, subdivision 6 and 256B.49, subdivision 15.
65.13(b) The contract must include a statement:
65.14(1) regarding the ability of a resident to furnish and decorate the resident's unit within
65.15the terms of the lease;
65.16(2) regarding the resident's right to access food at any time;
65.17(3) regarding a resident's right to choose the resident's visitors and times of visits;
65.18(4) regarding the resident's right to choose a roommate if sharing a unit; and
65.19(5) notifying the resident of the resident's right to have and use a lockable door to the
65.20resident's unit. The landlord shall provide the locks on the unit. Only a staff member with
65.21a specific need to enter the unit shall have keys, and advance notice must be given to the
65.22resident before entrance, when possible.
65.23EFFECTIVE DATE.This section is effective the day following final enactment.

65.24    Sec. 3. Minnesota Statutes 2016, section 245A.03, subdivision 7, is amended to read:
65.25    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an initial license
65.26for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
65.27foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
65.28for a physical location that will not be the primary residence of the license holder for the
65.29entire period of licensure. If a license is issued during this moratorium, and the license
65.30holder changes the license holder's primary residence away from the physical location of
65.31the foster care license, the commissioner shall revoke the license according to section
66.1245A.07 . The commissioner shall not issue an initial license for a community residential
66.2setting licensed under chapter 245D. Exceptions to the moratorium include:
66.3(1) foster care settings that are required to be registered under chapter 144D;
66.4(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
66.5community residential setting licenses replacing adult foster care licenses in existence on
66.6December 31, 2013, and determined to be needed by the commissioner under paragraph
66.7(b);
66.8(3) new foster care licenses or community residential setting licenses determined to be
66.9needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
66.10or regional treatment center; restructuring of state-operated services that limits the capacity
66.11of state-operated facilities; or allowing movement to the community for people who no
66.12longer require the level of care provided in state-operated facilities as provided under section
66.13256B.092 , subdivision 13, or 256B.49, subdivision 24;
66.14(4) new foster care licenses or community residential setting licenses determined to be
66.15needed by the commissioner under paragraph (b) for persons requiring hospital level care;
66.16or
66.17(5) new foster care licenses or community residential setting licenses determined to be
66.18needed by the commissioner for the transition of people from personal care assistance to
66.19the home and community-based services. When approving an exception under this paragraph,
66.20the commissioner shall consider the resource need determination process in paragraph (h),
66.21the availability of foster care licensed beds in the geographic area in which the licensee
66.22seeks to operate, the results of a person's choices during their annual assessment and service
66.23plan review, and the recommendation of the local county board. The determination by the
66.24commissioner is final and not subject to appeal;
66.25(6) new foster care licenses or community residential setting licenses determined to be
66.26needed by the commissioner for the transition of people from the residential care waiver
66.27services to foster care services. This exception applies only when:
66.28(i) the person's case manager provided the person with information about the choice of
66.29service, service provider, and location of service to help the person make an informed choice;
66.30and
66.31(ii) the person's foster care services are less than or equal to the cost of the person's
66.32services delivered in the residential care waiver service setting as determined by the lead
66.33agency; or
67.1(7) new foster care licenses or community residential setting licenses for people receiving
67.2services under chapter 245D and residing in an unlicensed setting before May 1, 2017, and
67.3for which a license is required. This exception does not apply to people living in their own
67.4home. For purposes of this clause, there is a presumption that a foster care or community
67.5residential setting license is required for services provided to three or more people in a
67.6dwelling unit when the setting is controlled by the provider. A license holder subject to this
67.7exception may rebut the presumption that a license is required by seeking a reconsideration
67.8of the commissioner's determination. The commissioner's disposition of a request for
67.9reconsideration is final and not subject to appeal under chapter 14. The exception is available
67.10until June 30, 2018. This exception is available when:
67.11(i) the person's case manager provided the person with information about the choice of
67.12service, service provider, and location of service, including in the person's home, to help
67.13the person make an informed choice; and
67.14(ii) the person's services provided in the licensed foster care or community residential
67.15setting are less than or equal to the cost of the person's services delivered in the unlicensed
67.16setting as determined by the lead agency.
67.17(b) The commissioner shall determine the need for newly licensed foster care homes or
67.18community residential settings as defined under this subdivision. As part of the determination,
67.19the commissioner shall consider the availability of foster care capacity in the area in which
67.20the licensee seeks to operate, and the recommendation of the local county board. The
67.21determination by the commissioner must be final. A determination of need is not required
67.22for a change in ownership at the same address.
67.23(c) When an adult resident served by the program moves out of a foster home that is not
67.24the primary residence of the license holder according to section 256B.49, subdivision 15,
67.25paragraph (f), or the adult community residential setting, the county shall immediately
67.26inform the Department of Human Services Licensing Division. The department shall may
67.27decrease the statewide licensed capacity for adult foster care settings where the physical
67.28location is not the primary residence of the license holder, or for adult community residential
67.29settings, if the voluntary changes described in paragraph (e) are not sufficient to meet the
67.30savings required by reductions in licensed bed capacity under Laws 2011, First Special
67.31Session chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide long-term
67.32care residential services capacity within budgetary limits. Implementation of the statewide
67.33licensed capacity reduction shall begin on July 1, 2013. The commissioner shall delicense
67.34up to 128 beds by June 30, 2014, using the needs determination process. Prior to any
67.35involuntary reduction of licensed capacity, the commissioner shall consult with lead agencies
68.1and license holders to determine which adult foster care settings, where the physical location
68.2is not the primary residence of the license holder, or community residential settings, are
68.3licensed for up to five beds, but have operated at less than full capacity for 12 or more
68.4months as of March 1, 2014. The settings that meet these criteria must be the first to be
68.5considered for an involuntary decrease in statewide licensed capacity, up to a maximum of
68.635 beds. If more than 35 beds are identified that meet these criteria, the commissioner shall
68.7prioritize the selection of those beds to be closed based on the length of time the beds have
68.8been vacant. The longer a bed has been vacant, the higher priority it must be given for
68.9closure. Under this paragraph, the commissioner has the authority to reduce unused licensed
68.10capacity of a current foster care program, or the community residential settings, to accomplish
68.11the consolidation or closure of settings. Under this paragraph, the commissioner has the
68.12authority to manage statewide capacity, including adjusting the capacity available to each
68.13county and adjusting statewide available capacity, to meet the statewide needs identified
68.14through the process in paragraph (e). A decreased licensed capacity according to this
68.15paragraph is not subject to appeal under this chapter.
68.16(d) Residential settings that would otherwise be subject to the decreased license capacity
68.17established in paragraph (c) shall be exempt if the license holder's beds are occupied by
68.18residents whose primary diagnosis is mental illness and the license holder is certified under
68.19the requirements in subdivision 6a or section 245D.33.
68.20(e) A resource need determination process, managed at the state level, using the available
68.21reports required by section 144A.351, and other data and information shall be used to
68.22determine where the reduced capacity required determined under paragraph (c) section
68.23256B.493 will be implemented. The commissioner shall consult with the stakeholders
68.24described in section 144A.351, and employ a variety of methods to improve the state's
68.25capacity to meet the informed decisions of those people who want to move out of corporate
68.26foster care or community residential settings, long-term care service needs within budgetary
68.27limits, including seeking proposals from service providers or lead agencies to change service
68.28type, capacity, or location to improve services, increase the independence of residents, and
68.29better meet needs identified by the long-term care services and supports reports and statewide
68.30data and information. By February 1, 2013, and August 1, 2014, and each following year,
68.31the commissioner shall provide information and data and targets on the overall capacity of
68.32licensed long-term care services and supports, actions taken under this subdivision to manage
68.33statewide long-term care services and supports resources, and any recommendations for
68.34change to the legislative committees with jurisdiction over health and human services budget.
69.1    (f) At the time of application and reapplication for licensure, the applicant and the license
69.2holder that are subject to the moratorium or an exclusion established in paragraph (a) are
69.3required to inform the commissioner whether the physical location where the foster care
69.4will be provided is or will be the primary residence of the license holder for the entire period
69.5of licensure. If the primary residence of the applicant or license holder changes, the applicant
69.6or license holder must notify the commissioner immediately. The commissioner shall print
69.7on the foster care license certificate whether or not the physical location is the primary
69.8residence of the license holder.
69.9    (g) License holders of foster care homes identified under paragraph (f) that are not the
69.10primary residence of the license holder and that also provide services in the foster care home
69.11that are covered by a federally approved home and community-based services waiver, as
69.12authorized under section 256B.0915, 256B.092, or 256B.49, must inform the human services
69.13licensing division that the license holder provides or intends to provide these waiver-funded
69.14services.
69.15(h) The commissioner may adjust capacity to address needs identified in section
69.16144A.351. Under this authority, the commissioner may approve new licensed settings or
69.17delicense existing settings. Delicensing of settings will be accomplished through a process
69.18identified in section 256B.493. Annually, by August 1, the commissioner shall provide
69.19information and data on capacity of licensed long-term services and supports, actions taken
69.20under the subdivision to manage statewide long-term services and supports resources, and
69.21any recommendations for change to the legislative committees with jurisdiction over the
69.22health and human services budget.
69.23(i) The commissioner must notify a license holder when its corporate foster care or
69.24community residential setting licensed beds are reduced under this section. The notice of
69.25reduction of licensed beds must be in writing and delivered to the license holder by certified
69.26mail or personal service. The notice must state why the licensed beds are reduced and must
69.27inform the license holder of its right to request reconsideration by the commissioner. The
69.28license holder's request for reconsideration must be in writing. If mailed, the request for
69.29reconsideration must be postmarked and sent to the commissioner within 20 calendar days
69.30after the license holder's receipt of the notice of reduction of licensed beds. If a request for
69.31reconsideration is made by personal service, it must be received by the commissioner within
69.3220 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
69.33    (j) The commissioner shall not issue an initial license for children's residential treatment
69.34services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
69.35for a program that Centers for Medicare and Medicaid Services would consider an institution
70.1for mental diseases. Facilities that serve only private pay clients are exempt from the
70.2moratorium described in this paragraph. The commissioner has the authority to manage
70.3existing statewide capacity for children's residential treatment services subject to the
70.4moratorium under this paragraph and may issue an initial license for such facilities if the
70.5initial license would not increase the statewide capacity for children's residential treatment
70.6services subject to the moratorium under this paragraph.

70.7    Sec. 4. Minnesota Statutes 2016, section 245A.04, subdivision 14, is amended to read:
70.8    Subd. 14. Policies and procedures for program administration required and
70.9enforceable. (a) The license holder shall develop program policies and procedures necessary
70.10to maintain compliance with licensing requirements under Minnesota Statutes and Minnesota
70.11Rules.
70.12    (b) The license holder shall:
70.13    (1) provide training to program staff related to their duties in implementing the program's
70.14policies and procedures developed under paragraph (a);
70.15    (2) document the provision of this training; and
70.16    (3) monitor implementation of policies and procedures by program staff.
70.17    (c) The license holder shall keep program policies and procedures readily accessible to
70.18staff and index the policies and procedures with a table of contents or another method
70.19approved by the commissioner.
70.20(d) An adult foster care license holder that provides foster care services to a resident
70.21under section 256B.0915 must annually provide a copy of the resident termination policy
70.22under section 245A.11, subdivision 11, to a resident covered by the policy.

70.23    Sec. 5. Minnesota Statutes 2016, section 245A.11, is amended by adding a subdivision to
70.24read:
70.25    Subd. 9. Adult foster care bedrooms. (a) A resident receiving services must have a
70.26choice of roommate. Each roommate must consent in writing to sharing a bedroom with
70.27one another. The license holder is responsible for notifying a resident of the resident's right
70.28to request a change of roommate.
70.29(b) The license holder must provide a lock for each resident's bedroom door, unless
70.30otherwise indicated for the resident's health, safety, or well-being. A restriction on the use
70.31of the lock must be documented and justified in the resident's individual abuse prevention
71.1plan required by sections 245A.65, subdivision 2, paragraph (b), and 626.557, subdivision
71.214.For a resident served under section 256B.0915, the case manager must be part of the
71.3interdisciplinary team under section 245A.65, subdivision 2, paragraph (b).
71.4EFFECTIVE DATE.This section is effective the day following final enactment.

71.5    Sec. 6. Minnesota Statutes 2016, section 245A.11, is amended by adding a subdivision to
71.6read:
71.7    Subd. 10. Adult foster care resident rights. (a) The license holder shall ensure that a
71.8resident and a resident's legal representative are given, at admission:
71.9(1) an explanation and copy of the resident's rights specified in paragraph (b);
71.10(2) a written summary of the Vulnerable Adults Protection Act prepared by the
71.11department; and
71.12(3) the name, address, and telephone number of the local agency to which a resident or
71.13a resident's legal representative may submit an oral or written complaint.
71.14(b) Adult foster care resident rights include the right to:
71.15(1) have daily, private access to and use of a non-coin-operated telephone for local and
71.16long-distance telephone calls made collect or paid for by the resident;
71.17(2) receive and send, without interference, uncensored, unopened mail or electronic
71.18correspondence or communication;
71.19(3) have use of and free access to common areas in the residence and the freedom to
71.20come and go from the residence at will;
71.21(4) have privacy for visits with the resident's spouse, next of kin, legal counsel, religious
71.22adviser, or others, according to section 363A.09 of the Human Rights Act, including privacy
71.23in the resident's bedroom;
71.24(5) keep, use, and access the resident's personal clothing and possessions as space permits,
71.25unless this right infringes on the health, safety, or rights of another resident or household
71.26member, including the right to access the resident's personal possessions at any time;
71.27(6) choose the resident's visitors and time of visits and participate in activities of
71.28commercial, religious, political, and community groups without interference if the activities
71.29do not infringe on the rights of another resident or household member;
71.30(7) if married, privacy for visits by the resident's spouse, and, if both spouses are residents
71.31of the adult foster home, the residents have the right to share a bedroom and bed;
72.1(8) privacy, including use of the lock on the resident's bedroom door or unit door. A
72.2resident's privacy must be respected by license holders, caregivers, household members,
72.3and volunteers by knocking on the door of a resident's bedroom or bathroom and seeking
72.4consent before entering, except in an emergency;
72.5(9) furnish and decorate the resident's bedroom or living unit;
72.6(10) engage in chosen activities and have an individual schedule supported by the license
72.7holder that meets the resident's preferences;
72.8(11) freedom and support to access food at any time;
72.9(12) have personal, financial, service, health, and medical information kept private, and
72.10be advised of disclosure of this information by the license holder;
72.11(13) access records and recorded information about the resident according to applicable
72.12state and federal law, regulation, or rule;
72.13(14) be free from maltreatment;
72.14(15) be treated with courtesy and respect and receive respectful treatment of the resident's
72.15property;
72.16(16) reasonable observance of cultural and ethnic practice and religion;
72.17(17) be free from bias and harassment regarding race, gender, age, disability, spirituality,
72.18and sexual orientation;
72.19(18) be informed of and use the license holder's grievance policy and procedures,
72.20including how to contact the highest level of authority in the program;
72.21(19) assert the resident's rights personally, or have the rights asserted by the resident's
72.22family, authorized representative, or legal representative, without retaliation; and
72.23(20) give or withhold written informed consent to participate in any research or
72.24experimental treatment.
72.25(c) A restriction of a resident's rights under paragraph (b), clauses (1) to (4), (6), (8),
72.26(10), and (11), is allowed only if determined necessary to ensure the health, safety, and
72.27well-being of the resident. Any restriction of a resident's right must be documented and
72.28justified in the resident's individual abuse prevention plan required by sections 245A.65,
72.29subdivision 2, paragraph (b) and 626.557, subdivision 14. For a resident served under section
72.30256B.0915, the case manager must be part of the interdisciplinary team under section
72.31245A.65, subdivision 2, paragraph (b). The restriction must be implemented in the least
73.1restrictive manner necessary to protect the resident and provide support to reduce or eliminate
73.2the need for the restriction.
73.3EFFECTIVE DATE.This section is effective the day following final enactment.

73.4    Sec. 7. Minnesota Statutes 2016, section 245A.11, is amended by adding a subdivision to
73.5read:
73.6    Subd. 11. Adult foster care service termination for elderly waiver participants. (a)
73.7This subdivision applies to foster care services for a resident served under section 256B.0915.
73.8(b) The foster care license holder must establish policies and procedures for service
73.9termination that promote continuity of care and service coordination with the resident and
73.10the case manager and with another licensed caregiver, if any, who also provides support to
73.11the resident. The policy must include the requirements specified in paragraphs (c) to (h).
73.12(c) The license holder must allow a resident to remain in the program and cannot terminate
73.13services unless:
73.14(1) the termination is necessary for the resident's health, safety, and well-being and the
73.15resident's needs cannot be met in the facility;
73.16(2) the safety of the resident or another resident in the program is endangered and positive
73.17support strategies were attempted and have not achieved and effectively maintained safety
73.18for the resident or another resident in the program;
73.19(3) the health, safety, and well-being of the resident or another resident in the program
73.20would otherwise be endangered;
73.21(4) the program was not paid for services;
73.22(5) the program ceases to operate; or
73.23(6) the resident was terminated by the lead agency from waiver eligibility.
73.24(d) Before giving notice of service termination, the license holder must document the
73.25action taken to minimize or eliminate the need for termination. The action taken by the
73.26license holder must include, at a minimum:
73.27(1) consultation with the resident's interdisciplinary team to identify and resolve issues
73.28leading to a notice of service termination; and
73.29(2) a request to the case manager or other professional consultation or intervention
73.30services to support the resident in the program. This requirement does not apply to a notice
73.31of service termination issued under paragraph (c), clause (4) or (5).
74.1(e) If, based on the best interests of the resident, the circumstances at the time of notice
74.2were such that the license holder was unable to take the action specified in paragraph (d),
74.3the license holder must document the specific circumstances and the reason the license
74.4holder was unable to take the action.
74.5(f) The license holder must notify the resident or the resident's legal representative and
74.6the case manager in writing of the intended service termination. The notice must include:
74.7(1) the reason for the action;
74.8(2) except for service termination under paragraph (c), clause (4) or (5), a summary of
74.9the action taken to minimize or eliminate the need for termination and the reason the action
74.10failed to prevent the termination;
74.11(3) the resident's right to appeal the service termination under section 256.045, subdivision
74.123, paragraph (a); and
74.13(4) the resident's right to seek a temporary order staying the service termination according
74.14to the procedures in section 256.045, subdivision 4a, or subdivision 6, paragraph (c).
74.15(g) Notice of the proposed service termination must be given at least 30 days before
74.16terminating a resident's service.
74.17(h) After the resident receives the notice of service termination and before the services
74.18are terminated, the license holder must:
74.19(1) work with the support team or expanded support team to develop reasonable
74.20alternatives to support continuity of care and to protect the resident;
74.21(2) provide information requested by the resident or case manager; and
74.22(3) maintain information about the service termination, including the written notice of
74.23service termination, in the resident's record.
74.24EFFECTIVE DATE.This section is effective the day following final enactment.

74.25    Sec. 8. Minnesota Statutes 2016, section 245D.04, subdivision 3, is amended to read:
74.26    Subd. 3. Protection-related rights. (a) A person's protection-related rights include the
74.27right to:
74.28(1) have personal, financial, service, health, and medical information kept private, and
74.29be advised of disclosure of this information by the license holder;
74.30(2) access records and recorded information about the person in accordance with
74.31applicable state and federal law, regulation, or rule;
75.1(3) be free from maltreatment;
75.2(4) be free from restraint, time out, seclusion, restrictive intervention, or other prohibited
75.3procedure identified in section 245D.06, subdivision 5, or successor provisions, except for:
75.4(i) emergency use of manual restraint to protect the person from imminent danger to self
75.5or others according to the requirements in section 245D.061 or successor provisions; or (ii)
75.6the use of safety interventions as part of a positive support transition plan under section
75.7245D.06, subdivision 8 , or successor provisions;
75.8(5) receive services in a clean and safe environment when the license holder is the owner,
75.9lessor, or tenant of the service site;
75.10(6) be treated with courtesy and respect and receive respectful treatment of the person's
75.11property;
75.12(7) reasonable observance of cultural and ethnic practice and religion;
75.13(8) be free from bias and harassment regarding race, gender, age, disability, spirituality,
75.14and sexual orientation;
75.15(9) be informed of and use the license holder's grievance policy and procedures, including
75.16knowing how to contact persons responsible for addressing problems and to appeal under
75.17section 256.045;
75.18(10) know the name, telephone number, and the Web site, e-mail, and street addresses
75.19of protection and advocacy services, including the appropriate state-appointed ombudsman,
75.20and a brief description of how to file a complaint with these offices;
75.21(11) assert these rights personally, or have them asserted by the person's family,
75.22authorized representative, or legal representative, without retaliation;
75.23(12) give or withhold written informed consent to participate in any research or
75.24experimental treatment;
75.25(13) associate with other persons of the person's choice;
75.26(14) personal privacy, including the right to use the lock on the person's bedroom or unit
75.27door; and
75.28(15) engage in chosen activities; and
75.29(16) access to the person's personal possessions at any time, including financial resources.
76.1(b) For a person residing in a residential site licensed according to chapter 245A, or
76.2where the license holder is the owner, lessor, or tenant of the residential service site,
76.3protection-related rights also include the right to:
76.4(1) have daily, private access to and use of a non-coin-operated telephone for local calls
76.5and long-distance calls made collect or paid for by the person;
76.6(2) receive and send, without interference, uncensored, unopened mail or electronic
76.7correspondence or communication;
76.8(3) have use of and free access to common areas in the residence and the freedom to
76.9come and go from the residence at will; and
76.10(4) choose the person's visitors and time of visits and have privacy for visits with the
76.11person's spouse, next of kin, legal counsel, religious advisor adviser, or others, in accordance
76.12with section 363A.09 of the Human Rights Act, including privacy in the person's bedroom.;
76.13(5) the freedom and support to access food at any time;
76.14(6) the freedom to furnish and decorate the person's bedroom or living unit;
76.15(7) a setting that is clean and free from accumulation of dirt, grease, garbage, peeling
76.16paint, mold, vermin, and insects;
76.17(8) a setting that is free from hazards that threaten the person's health or safety;
76.18(9) a setting that meets state and local building and zoning definitions of a dwelling unit
76.19in a residential occupancy; and
76.20(10) have access to potable water and three nutritionally balanced meals and nutritious
76.21snacks between meals each day.
76.22(c) Restriction of a person's rights under paragraph (a), clauses (13) to (15) (16), or
76.23paragraph (b) is allowed only if determined necessary to ensure the health, safety, and
76.24well-being of the person. Any restriction of those rights must be documented in the person's
76.25coordinated service and support plan or coordinated service and support plan addendum.
76.26The restriction must be implemented in the least restrictive alternative manner necessary
76.27to protect the person and provide support to reduce or eliminate the need for the restriction
76.28in the most integrated setting and inclusive manner. The documentation must include the
76.29following information:
76.30(1) the justification for the restriction based on an assessment of the person's vulnerability
76.31related to exercising the right without restriction;
76.32(2) the objective measures set as conditions for ending the restriction;
77.1(3) a schedule for reviewing the need for the restriction based on the conditions for
77.2ending the restriction to occur semiannually from the date of initial approval, at a minimum,
77.3or more frequently if requested by the person, the person's legal representative, if any, and
77.4case manager; and
77.5(4) signed and dated approval for the restriction from the person, or the person's legal
77.6representative, if any. A restriction may be implemented only when the required approval
77.7has been obtained. Approval may be withdrawn at any time. If approval is withdrawn, the
77.8right must be immediately and fully restored.
77.9EFFECTIVE DATE.This section is effective the day following final enactment.

77.10    Sec. 9. Minnesota Statutes 2016, section 245D.071, subdivision 3, is amended to read:
77.11    Subd. 3. Assessment and initial service planning. (a) Within 15 days of service initiation
77.12the license holder must complete a preliminary coordinated service and support plan
77.13addendum based on the coordinated service and support plan.
77.14(b) Within the scope of services, the license holder must, at a minimum, complete
77.15assessments in the following areas before the 45-day planning meeting:
77.16(1) the person's ability to self-manage health and medical needs to maintain or improve
77.17physical, mental, and emotional well-being, including, when applicable, allergies, seizures,
77.18choking, special dietary needs, chronic medical conditions, self-administration of medication
77.19or treatment orders, preventative screening, and medical and dental appointments;
77.20(2) the person's ability to self-manage personal safety to avoid injury or accident in the
77.21service setting, including, when applicable, risk of falling, mobility, regulating water
77.22temperature, community survival skills, water safety skills, and sensory disabilities; and
77.23(3) the person's ability to self-manage symptoms or behavior that may otherwise result
77.24in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7), suspension
77.25or termination of services by the license holder, or other symptoms or behaviors that may
77.26jeopardize the health and welfare of the person or others.
77.27Assessments must produce information about the person that describes the person's overall
77.28strengths, functional skills and abilities, and behaviors or symptoms. Assessments must be
77.29based on the person's status within the last 12 months at the time of service initiation.
77.30Assessments based on older information must be documented and justified. Assessments
77.31must be conducted annually at a minimum or within 30 days of a written request from the
77.32person or the person's legal representative or case manager. The results must be reviewed
77.33by the support team or expanded support team as part of a service plan review.
78.1(c) Within 45 days of service initiation, the license holder must meet with the person,
78.2the person's legal representative, the case manager, and other members of the support team
78.3or expanded support team to determine the following based on information obtained from
78.4the assessments identified in paragraph (b), the person's identified needs in the coordinated
78.5service and support plan, and the requirements in subdivision 4 and section 245D.07,
78.6subdivision 1a
:
78.7(1) the scope of the services to be provided to support the person's daily needs and
78.8activities;
78.9(2) the person's desired outcomes and the supports necessary to accomplish the person's
78.10desired outcomes;
78.11(3) the person's preferences for how services and supports are provided, including how
78.12the provider will support the person to have control of the person's schedule;
78.13(4) whether the current service setting is the most integrated setting available and
78.14appropriate for the person; and
78.15(5) how services must be coordinated across other providers licensed under this chapter
78.16serving the person and members of the support team or expanded support team to ensure
78.17continuity of care and coordination of services for the person.
78.18EFFECTIVE DATE.This section is effective the day following final enactment.

78.19    Sec. 10. Minnesota Statutes 2016, section 245D.11, subdivision 4, is amended to read:
78.20    Subd. 4. Admission criteria. The license holder must establish policies and procedures
78.21that promote continuity of care by ensuring that admission or service initiation criteria:
78.22(1) is consistent with the service-related rights identified in section 245D.04, subdivisions
78.232
, clauses (4) to (7), and 3, clause (8);
78.24(2) identifies the criteria to be applied in determining whether the license holder can
78.25develop services to meet the needs specified in the person's coordinated service and support
78.26plan;
78.27(3) requires a license holder providing services in a health care facility to comply with
78.28the requirements in section 243.166, subdivision 4b, to provide notification to residents
78.29when a registered predatory offender is admitted into the program or to a potential admission
78.30when the facility was already serving a registered predatory offender. For purposes of this
78.31clause, "health care facility" means a facility licensed by the commissioner as a residential
79.1facility under chapter 245A to provide adult foster care or residential services to persons
79.2with disabilities; and
79.3(4) requires that when a person or the person's legal representative requests services
79.4from the license holder, a refusal to admit the person must be based on an evaluation of the
79.5person's assessed needs and the license holder's lack of capacity to meet the needs of the
79.6person. The license holder must not refuse to admit a person based solely on the type of
79.7residential services the person is receiving, or solely on the person's severity of disability,
79.8orthopedic or neurological handicaps, sight or hearing impairments, lack of communication
79.9skills, physical disabilities, toilet habits, behavioral disorders, or past failure to make progress.
79.10Documentation of the basis for refusal must be provided to the person or the person's legal
79.11representative and case manager upon request.; and
79.12(5) requires the person or the person's legal representative and license holder to sign and
79.13date the residency agreement when the license holder provides foster care or supported
79.14living services under section 245D.03, subdivision 1, paragraph (c), clause (3), item (i) or
79.15(ii), to a person living in a community residential setting defined in section 245D.02,
79.16subdivision 4a; an adult foster home defined in Minnesota Rules, part 9555.5105, subpart
79.175; or a foster family home defined in Minnesota Rules, part 9560.0521, subpart 12. The
79.18residency agreement must include service termination requirements specified in section
79.19245D.10, subdivision 3a, paragraphs (b) to (f). The residency agreement must be reviewed
79.20annually, dated, and signed by the person or the person's legal representative and license
79.21holder.
79.22EFFECTIVE DATE.This section is effective the day following final enactment.

79.23    Sec. 11. Minnesota Statutes 2016, section 245D.24, subdivision 3, is amended to read:
79.24    Subd. 3. Bedrooms. (a) People Each person receiving services must have a choice of
79.25roommate and must mutually consent, in writing, to sharing a bedroom with one another.
79.26No more than two people receiving services may share one bedroom.
79.27(b) A single occupancy bedroom must have at least 80 square feet of floor space with a
79.287-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor
79.29space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and other
79.30habitable rooms by floor-to-ceiling walls containing no openings except doorways and must
79.31not serve as a corridor to another room used in daily living.
79.32(c) A person's personal possessions and items for the person's own use are the only items
79.33permitted to be stored in a person's bedroom.
80.1(d) Unless otherwise documented through assessment as a safety concern for the person,
80.2each person must be provided with the following furnishings:
80.3(1) a separate bed of proper size and height for the convenience and comfort of the
80.4person, with a clean mattress in good repair;
80.5(2) clean bedding appropriate for the season for each person;
80.6(3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal
80.7possessions and clothing; and
80.8(4) a mirror for grooming.
80.9(e) When possible, a person must be allowed to have items of furniture that the person
80.10personally owns in the bedroom, unless doing so would interfere with safety precautions,
80.11violate a building or fire code, or interfere with another person's use of the bedroom. A
80.12person may choose not to have a cabinet, dresser, shelves, or a mirror in the bedroom, as
80.13otherwise required under paragraph (d), clause (3) or (4). A person may choose to use a
80.14mattress other than an innerspring mattress and may choose not to have the mattress on a
80.15mattress frame or support. If a person chooses not to have a piece of required furniture, the
80.16license holder must document this choice and is not required to provide the item. If a person
80.17chooses to use a mattress other than an innerspring mattress or chooses not to have a mattress
80.18frame or support, the license holder must document this choice and allow the alternative
80.19desired by the person.
80.20(f) A person must be allowed to bring personal possessions into the bedroom and other
80.21designated storage space, if such space is available, in the residence. The person must be
80.22allowed to accumulate possessions to the extent the residence is able to accommodate them,
80.23unless doing so is contraindicated for the person's physical or mental health, would interfere
80.24with safety precautions or another person's use of the bedroom, or would violate a building
80.25or fire code. The license holder must allow for locked storage of personal items. Any
80.26restriction on the possession or locked storage of personal items, including requiring a
80.27person to use a lock provided by the license holder, must comply with section 245D.04,
80.28subdivision 3
, paragraph (c), and allow the person to be present if and when the license
80.29holder opens the lock.
80.30(g) A person must be allowed to lock the person's bedroom door. The license holder
80.31must document and assess the physical plant and the environment, and the population served,
80.32and identify the risk factors that require using locked doors, and the specific action taken
80.33to minimize the safety risk to a person receiving services at the site.
81.1EFFECTIVE DATE.This section is effective the day following final enactment.

81.2    Sec. 12. Minnesota Statutes 2016, section 256.045, subdivision 3, is amended to read:
81.3    Subd. 3. State agency hearings. (a) State agency hearings are available for the following:
81.4    (1) any person applying for, receiving or having received public assistance, medical
81.5care, or a program of social services granted by the state agency or a county agency or the
81.6federal Food Stamp Act whose application for assistance is denied, not acted upon with
81.7reasonable promptness, or whose assistance is suspended, reduced, terminated, or claimed
81.8to have been incorrectly paid;
81.9    (2) any patient or relative aggrieved by an order of the commissioner under section
81.10252.27 ;
81.11    (3) a party aggrieved by a ruling of a prepaid health plan;
81.12    (4) except as provided under chapter 245C, any individual or facility determined by a
81.13lead investigative agency to have maltreated a vulnerable adult under section 626.557 after
81.14they have exercised their right to administrative reconsideration under section 626.557;
81.15    (5) any person whose claim for foster care payment according to a placement of the
81.16child resulting from a child protection assessment under section 626.556 is denied or not
81.17acted upon with reasonable promptness, regardless of funding source;
81.18    (6) any person to whom a right of appeal according to this section is given by other
81.19provision of law;
81.20    (7) an applicant aggrieved by an adverse decision to an application for a hardship waiver
81.21under section 256B.15;
81.22    (8) an applicant aggrieved by an adverse decision to an application or redetermination
81.23for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;
81.24    (9) except as provided under chapter 245A, an individual or facility determined to have
81.25maltreated a minor under section 626.556, after the individual or facility has exercised the
81.26right to administrative reconsideration under section 626.556;
81.27    (10) except as provided under chapter 245C, an individual disqualified under sections
81.28245C.14 and 245C.15, following a reconsideration decision issued under section 245C.23,
81.29on the basis of serious or recurring maltreatment; a preponderance of the evidence that the
81.30individual has committed an act or acts that meet the definition of any of the crimes listed
81.31in section 245C.15, subdivisions 1 to 4; or for failing to make reports required under section
81.32626.556, subdivision 3 , or 626.557, subdivision 3. Hearings regarding a maltreatment
82.1determination under clause (4) or (9) and a disqualification under this clause in which the
82.2basis for a disqualification is serious or recurring maltreatment, shall be consolidated into
82.3a single fair hearing. In such cases, the scope of review by the human services judge shall
82.4include both the maltreatment determination and the disqualification. The failure to exercise
82.5the right to an administrative reconsideration shall not be a bar to a hearing under this section
82.6if federal law provides an individual the right to a hearing to dispute a finding of
82.7maltreatment;
82.8    (11) any person with an outstanding debt resulting from receipt of public assistance,
82.9medical care, or the federal Food Stamp Act who is contesting a setoff claim by the
82.10Department of Human Services or a county agency. The scope of the appeal is the validity
82.11of the claimant agency's intention to request a setoff of a refund under chapter 270A against
82.12the debt;
82.13    (12) a person issued a notice of service termination under section 245D.10, subdivision
82.143a, from residential supports and services as defined in section 245D.03, subdivision 1,
82.15paragraph (c), clause (3), that is not otherwise subject to appeal under subdivision 4a; or
82.16    (13) an individual disability waiver recipient based on a denial of a request for a rate
82.17exception under section 256B.4914.; or
82.18(14) a person issued a notice of service termination under section 245A.11, subdivision
82.1911, that is not otherwise subject to appeal under subdivision 4a.
82.20    (b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or (10),
82.21is the only administrative appeal to the final agency determination specifically, including
82.22a challenge to the accuracy and completeness of data under section 13.04. Hearings requested
82.23under paragraph (a), clause (4), apply only to incidents of maltreatment that occur on or
82.24after October 1, 1995. Hearings requested by nursing assistants in nursing homes alleged
82.25to have maltreated a resident prior to October 1, 1995, shall be held as a contested case
82.26proceeding under the provisions of chapter 14. Hearings requested under paragraph (a),
82.27clause (9), apply only to incidents of maltreatment that occur on or after July 1, 1997. A
82.28hearing for an individual or facility under paragraph (a), clauses (4), (9), and (10), is only
82.29available when there is no district court action pending. If such action is filed in district
82.30court while an administrative review is pending that arises out of some or all of the events
82.31or circumstances on which the appeal is based, the administrative review must be suspended
82.32until the judicial actions are completed. If the district court proceedings are completed,
82.33dismissed, or overturned, the matter may be considered in an administrative hearing.
83.1    (c) For purposes of this section, bargaining unit grievance procedures are not an
83.2administrative appeal.
83.3    (d) The scope of hearings involving claims to foster care payments under paragraph (a),
83.4clause (5), shall be limited to the issue of whether the county is legally responsible for a
83.5child's placement under court order or voluntary placement agreement and, if so, the correct
83.6amount of foster care payment to be made on the child's behalf and shall not include review
83.7of the propriety of the county's child protection determination or child placement decision.
83.8    (e) The scope of hearings under paragraph (a), clause clauses (12) and (14), shall be
83.9limited to whether the proposed termination of services is authorized under section 245D.10,
83.10subdivision 3a
, paragraph (b), or 245A.11, subdivision 11, and whether the requirements
83.11of section 245D.10, subdivision 3a, paragraph paragraphs (c) to (e), or 245A.11, subdivision
83.122a, paragraphs (d) to (f), were met. If the appeal includes a request for a temporary stay of
83.13termination of services, the scope of the hearing shall also include whether the case
83.14management provider has finalized arrangements for a residential facility, a program, or
83.15services that will meet the assessed needs of the recipient by the effective date of the service
83.16termination.
83.17    (f) A vendor of medical care as defined in section 256B.02, subdivision 7, or a vendor
83.18under contract with a county agency to provide social services is not a party and may not
83.19request a hearing under this section, except if assisting a recipient as provided in subdivision
83.204.
83.21    (g) An applicant or recipient is not entitled to receive social services beyond the services
83.22prescribed under chapter 256M or other social services the person is eligible for under state
83.23law.
83.24    (h) The commissioner may summarily affirm the county or state agency's proposed
83.25action without a hearing when the sole issue is an automatic change due to a change in state
83.26or federal law.
83.27    (i) Unless federal or Minnesota law specifies a different time frame in which to file an
83.28appeal, an individual or organization specified in this section may contest the specified
83.29action, decision, or final disposition before the state agency by submitting a written request
83.30for a hearing to the state agency within 30 days after receiving written notice of the action,
83.31decision, or final disposition, or within 90 days of such written notice if the applicant,
83.32recipient, patient, or relative shows good cause, as defined in section 256.0451, subdivision
83.3313, why the request was not submitted within the 30-day time limit. The individual filing
83.34the appeal has the burden of proving good cause by a preponderance of the evidence.
84.1EFFECTIVE DATE.This section is effective the day following final enactment.

84.2    Sec. 13. [256B.051] HOUSING SUPPORT SERVICES.
84.3    Subdivision 1. Purpose. Housing support services are established to provide housing
84.4support services to an individual with a disability that limits the individual's ability to obtain
84.5or maintain stable housing. The services support an individual's transition to housing in the
84.6community and increase long-term stability in housing, to avoid future periods of being at
84.7risk of homelessness or institutionalization.
84.8    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in this
84.9subdivision have the meanings given.
84.10(b) "At-risk of homelessness" means (1) an individual that is faced with a set of
84.11circumstances likely to cause the individual to become homeless, or (2) an individual
84.12previously homeless, who will be discharged from a correctional, medical, mental health,
84.13or treatment center, who lacks sufficient resources to pay for housing and does not have a
84.14permanent place to live.
84.15(c) "Commissioner" means the commissioner of human services.
84.16(d) "Homeless" means an individual or family lacking a fixed, adequate nighttime
84.17residence.
84.18(e) "Individual with a disability" means:
84.19(1) an individual who is aged, blind, or disabled as determined by the criteria used by
84.20the title 11 program of the Social Security Act, United States Code, title 42, section 416,
84.21paragraph (i), item (1); or
84.22(2) an individual who meets a category of eligibility under section 256D.05, subdivision
84.231, paragraph (a), clauses (1), (3), (5) to (9), or (14).
84.24(f) "Institution" means a setting as defined in section 256B.0621, subdivision 2, clause
84.25(3), and the Minnesota Security Hospital as defined in section 253.20.
84.26    Subd. 3. Eligibility. An individual with a disability is eligible for housing support services
84.27if the individual:
84.28(1) is 18 years of age or older;
84.29(2) is enrolled in medical assistance;
84.30(3) has an assessment of functional need that determines a need for services due to
84.31limitations caused by the individual's disability;
85.1(4) resides in or plans to transition to a community-based setting as defined in Code of
85.2Federal Regulations, title 42, section 441.301(c); and
85.3(5) has housing instability evidenced by:
85.4(i) being homeless or at-risk of homelessness;
85.5(ii) being in the process of transitioning from, or having transitioned in the past six
85.6months from, an institution or licensed or registered setting;
85.7(iii) being eligible for waiver services under section 256B.0915, 256B.092, or 256B.49;
85.8or
85.9(iv) having been identified by a long-term care consultation under section 256B.0911
85.10as at risk of institutionalization.
85.11    Subd. 4. Assessment requirements. (a) An individual's assessment of functional need
85.12must be conducted by one of the following methods:
85.13(1) an assessor according to the criteria established in section 256B.0911, subdivision
85.143a, using a format established by the commissioner;
85.15(2) documented need for services as verified by a professional statement of need as
85.16defined in section 256I.03, subdivision 12; or
85.17(3) according to the continuum of care coordinated assessment system established in
85.18Code of Federal Regulations, title 24, section 578.3, using a format established by the
85.19commissioner.
85.20(b) An individual must be reassessed within one year of initial assessment, and annually
85.21thereafter.
85.22    Subd. 5. Housing support services. (a) Housing support services include housing
85.23transition services and housing and tenancy sustaining services.
85.24(b) Housing transition services are defined as:
85.25(1) tenant screening and housing assessment;
85.26(2) assistance with the housing search and application process;
85.27(3) identifying resources to cover onetime moving expenses;
85.28(4) ensuring a new living arrangement is safe and ready for move-in;
85.29(5) assisting in arranging for and supporting details of a move; and
85.30(6) developing a housing support crisis plan.
86.1(c) Housing and tenancy sustaining services include:
86.2(1) prevention and early identification of behaviors that may jeopardize continued stable
86.3housing;
86.4(2) education and training on roles, rights, and responsibilities of the tenant and the
86.5property manager;
86.6(3) coaching to develop and maintain key relationships with property managers and
86.7neighbors;
86.8(4) advocacy and referral to community resources to prevent eviction when housing is
86.9at risk;
86.10(5) assistance with housing recertification process;
86.11(6) coordination with the tenant to regularly review, update, and modify housing support
86.12and crisis plan; and
86.13(7) continuing training on being a good tenant, lease compliance, and household
86.14management.
86.15(d) A housing support service may include person-centered planning for people who are
86.16not eligible to receive person-centered planning through any other service, if the
86.17person-centered planning is provided by a consultation service provider that is under contract
86.18with the department and enrolled as a Minnesota health care program.
86.19    Subd. 6. Provider qualifications and duties. A provider eligible for reimbursement
86.20under this section shall:
86.21(1) enroll as a medical assistance Minnesota health care program provider and meet all
86.22applicable provider standards and requirements;
86.23(2) demonstrate compliance with federal and state laws and policies for housing support
86.24services as determined by the commissioner;
86.25(3) comply with background study requirements under chapter 245C and maintain
86.26documentation of background study requests and results; and
86.27(4) directly provide housing support services and not use a subcontractor or reporting
86.28agent.
86.29    Subd. 7. Housing support supplemental service rates. Supplemental service rates for
86.30individuals in settings according to sections 144D.025, 256I.04, subdivision 3, paragraph
86.31(a), clause (3), and 256I.05, subdivision 1g, shall be reduced by one-half over a two-year
87.1period. This reduction only applies to supplemental service rates for individuals eligible for
87.2housing support services under this section.
87.3EFFECTIVE DATE.(a) Subdivisions 1 to 6 are contingent upon federal approval. The
87.4commissioner of human services shall notify the revisor of statutes when federal approval
87.5is obtained.
87.6(b) Subdivision 7 is contingent upon federal approval of subdivisions 1 to 6. The
87.7commissioner of human services shall notify the revisor of statutes when federal approval
87.8is obtained.

87.9    Sec. 14. Minnesota Statutes 2016, section 256B.0911, subdivision 3a, is amended to read:
87.10    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, services
87.11planning, or other assistance intended to support community-based living, including persons
87.12who need assessment in order to determine waiver or alternative care program eligibility,
87.13must be visited by a long-term care consultation team within 20 calendar days after the date
87.14on which an assessment was requested or recommended. Upon statewide implementation
87.15of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
87.16requesting personal care assistance services and home care nursing. The commissioner shall
87.17provide at least a 90-day notice to lead agencies prior to the effective date of this requirement.
87.18Face-to-face assessments must be conducted according to paragraphs (b) to (i).
87.19    (b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
87.20assessors to conduct the assessment. For a person with complex health care needs, a public
87.21health or registered nurse from the team must be consulted.
87.22    (c) The MnCHOICES assessment provided by the commissioner to lead agencies must
87.23be used to complete a comprehensive, person-centered assessment. The assessment must
87.24include the health, psychological, functional, environmental, and social needs of the
87.25individual necessary to develop a community support plan that meets the individual's needs
87.26and preferences.
87.27    (d) The assessment must be conducted in a face-to-face interview with the person being
87.28assessed and the person's legal representative. At the request of the person, other individuals
87.29may participate in the assessment to provide information on the needs, strengths, and
87.30preferences of the person necessary to develop a community support plan that ensures the
87.31person's health and safety. Except for legal representatives or family members invited by
87.32the person, persons participating in the assessment may not be a provider of service or have
87.33any financial interest in the provision of services. For persons who are to be assessed for
88.1elderly waiver customized living services under section 256B.0915, with the permission of
88.2the person being assessed or the person's designated or legal representative, the client's
88.3current or proposed provider of services may submit a copy of the provider's nursing
88.4assessment or written report outlining its recommendations regarding the client's care needs.
88.5The person conducting the assessment must notify the provider of the date by which this
88.6information is to be submitted. This information shall be provided to the person conducting
88.7the assessment prior to the assessment. For a person who is to be assessed for waiver services
88.8under section 256B.092 or 256B.49, with the permission of the person being assessed or
88.9the person's designated legal representative, the person's current provider of services may
88.10submit a written report outlining recommendations regarding the person's care needs prepared
88.11by a direct service employee with at least 20 hours of service to that client. The person
88.12conducting the assessment or reassessment must notify the provider of the date by which
88.13this information is to be submitted. This information shall be provided to the person
88.14conducting the assessment and the person or the person's legal representative, and must be
88.15considered prior to the finalization of the assessment or reassessment.
88.16    (e) The person or the person's legal representative must be provided with a written
88.17community support plan within 40 calendar days of the assessment visit, regardless of
88.18whether the individual is eligible for Minnesota health care programs. The written community
88.19support plan must include:
88.20(1) a summary of assessed needs as defined in paragraphs (c) and (d);
88.21(2) the individual's options and choices to meet identified needs, including all available
88.22options for case management services and providers;
88.23(3) identification of health and safety risks and how those risks will be addressed,
88.24including personal risk management strategies;
88.25(4) referral information; and
88.26(5) informal caregiver supports, if applicable.
88.27For a person determined eligible for state plan home care under subdivision 1a, paragraph
88.28(b), clause (1), the person or person's representative must also receive a copy of the home
88.29care service plan developed by the certified assessor.
88.30(f) A person may request assistance in identifying community supports without
88.31participating in a complete assessment. Upon a request for assistance identifying community
88.32support, the person must be transferred or referred to long-term care options counseling
89.1services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
89.2telephone assistance and follow up.
89.3    (g) The person has the right to make the final decision between institutional placement
89.4and community placement after the recommendations have been provided, except as provided
89.5in section 256.975, subdivision 7a, paragraph (d).
89.6    (h) The lead agency must give the person receiving assessment or support planning, or
89.7the person's legal representative, materials, and forms supplied by the commissioner
89.8containing the following information:
89.9    (1) written recommendations for community-based services and consumer-directed
89.10options;
89.11(2) documentation that the most cost-effective alternatives available were offered to the
89.12individual. For purposes of this clause, "cost-effective" means community services and
89.13living arrangements that cost the same as or less than institutional care. For an individual
89.14found to meet eligibility criteria for home and community-based service programs under
89.15section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
89.16approved waiver plan for each program;
89.17(3) the need for and purpose of preadmission screening conducted by long-term care
89.18options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
89.19nursing facility placement. If the individual selects nursing facility placement, the lead
89.20agency shall forward information needed to complete the level of care determinations and
89.21screening for developmental disability and mental illness collected during the assessment
89.22to the long-term care options counselor using forms provided by the commissioner;
89.23    (4) the role of long-term care consultation assessment and support planning in eligibility
89.24determination for waiver and alternative care programs, and state plan home care, case
89.25management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
89.26and (b);
89.27    (5) information about Minnesota health care programs;
89.28    (6) the person's freedom to accept or reject the recommendations of the team;
89.29    (7) the person's right to confidentiality under the Minnesota Government Data Practices
89.30Act, chapter 13;
89.31    (8) the certified assessor's decision regarding the person's need for institutional level of
89.32care as determined under criteria established in subdivision 4e and the certified assessor's
90.1decision regarding eligibility for all services and programs as defined in subdivision 1a,
90.2paragraphs (a), clause (6), and (b); and
90.3    (9) the person's right to appeal the certified assessor's decision regarding eligibility for
90.4all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
90.5(8), and (b), and incorporating the decision regarding the need for institutional level of care
90.6or the lead agency's final decisions regarding public programs eligibility according to section
90.7256.045, subdivision 3 .
90.8    (i) Face-to-face assessment completed as part of eligibility determination for the
90.9alternative care, elderly waiver, community access for disability inclusion, community
90.10alternative care, and brain injury waiver programs under sections 256B.0913, 256B.0915,
90.11and 256B.49 is valid to establish service eligibility for no more than 60 calendar days after
90.12the date of assessment.
90.13(j) The effective eligibility start date for programs in paragraph (i) can never be prior to
90.14the date of assessment. If an assessment was completed more than 60 days before the
90.15effective waiver or alternative care program eligibility start date, assessment and support
90.16plan information must be updated and documented in the department's Medicaid Management
90.17Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
90.18state plan services, the effective date of eligibility for programs included in paragraph (i)
90.19cannot be prior to the date the most recent updated assessment is completed.
90.20(k) At the time of reassessment, the certified assessor shall assess each person receiving
90.21waiver services currently residing in a community residential setting, or licensed adult foster
90.22care home that is not the primary residence of the license holder, or in which the license
90.23holder is not the primary caregiver, to determine if that person would prefer to be served in
90.24a community-living settings as defined in section 256B.49, subdivision 23. The certified
90.25assessor shall offer the person, through a person-centered planning process, the option to
90.26receive alternative housing and service options.

90.27    Sec. 15. Minnesota Statutes 2016, section 256B.0915, subdivision 1, is amended to read:
90.28    Subdivision 1. Authority. (a) The commissioner is authorized to apply for a home and
90.29community-based services waiver for the elderly, authorized under section 1915(c) of the
90.30Social Security Act, in order to obtain federal financial participation to expand the availability
90.31of services for persons who are eligible for medical assistance. The commissioner may
90.32apply for additional waivers or pursue other federal financial participation which is
90.33advantageous to the state for funding home care services for the frail elderly who are eligible
90.34for medical assistance. The provision of waivered services to elderly and disabled medical
91.1assistance recipients must comply with the criteria for service definitions and provider
91.2standards approved in the waiver.
91.3(b) The commissioner shall comply with the requirements in the federally approved
91.4transition plan for the home and community-based services waivers authorized under this
91.5section.
91.6EFFECTIVE DATE.This section is effective the day following final enactment.

91.7    Sec. 16. Minnesota Statutes 2016, section 256B.092, subdivision 4, is amended to read:
91.8    Subd. 4. Home and community-based services for developmental disabilities. (a)
91.9The commissioner shall make payments to approved vendors participating in the medical
91.10assistance program to pay costs of providing home and community-based services, including
91.11case management service activities provided as an approved home and community-based
91.12service, to medical assistance eligible persons with developmental disabilities who have
91.13been screened under subdivision 7 and according to federal requirements. Federal
91.14requirements include those services and limitations included in the federally approved
91.15application for home and community-based services for persons with developmental
91.16disabilities and subsequent amendments.
91.17(b) Effective July 1, 1995, contingent upon federal approval and state appropriations
91.18made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
91.19section 40, the commissioner of human services shall allocate resources to county agencies
91.20for home and community-based waivered services for persons with developmental disabilities
91.21authorized but not receiving those services as of June 30, 1995, based upon the average
91.22resource need of persons with similar functional characteristics. To ensure service continuity
91.23for service recipients receiving home and community-based waivered services for persons
91.24with developmental disabilities prior to July 1, 1995, the commissioner shall make available
91.25to the county of financial responsibility home and community-based waivered services
91.26resources based upon fiscal year 1995 authorized levels.
91.27(c) Home and community-based resources for all recipients shall be managed by the
91.28county of financial responsibility within an allowable reimbursement average established
91.29for each county. Payments for home and community-based services provided to individual
91.30recipients shall not exceed amounts authorized by the county of financial responsibility.
91.31For specifically identified former residents of nursing facilities, the commissioner shall be
91.32responsible for authorizing payments and payment limits under the appropriate home and
91.33community-based service program. Payment is available under this subdivision only for
92.1persons who, if not provided these services, would require the level of care provided in an
92.2intermediate care facility for persons with developmental disabilities.
92.3(d) The commissioner shall comply with the requirements in the federally approved
92.4transition plan for the home and community-based services waivers for the elderly authorized
92.5under this section.
92.6EFFECTIVE DATE.This section is effective the day following final enactment.

92.7    Sec. 17. Minnesota Statutes 2016, section 256B.49, subdivision 11, is amended to read:
92.8    Subd. 11. Authority. (a) The commissioner is authorized to apply for home and
92.9community-based service waivers, as authorized under section 1915(c) of the Social Security
92.10Act to serve persons under the age of 65 who are determined to require the level of care
92.11provided in a nursing home and persons who require the level of care provided in a hospital.
92.12The commissioner shall apply for the home and community-based waivers in order to:
92.13    (1) promote the support of persons with disabilities in the most integrated settings;
92.14    (2) expand the availability of services for persons who are eligible for medical assistance;
92.15    (3) promote cost-effective options to institutional care; and
92.16    (4) obtain federal financial participation.
92.17    (b) The provision of waivered services to medical assistance recipients with disabilities
92.18shall comply with the requirements outlined in the federally approved applications for home
92.19and community-based services and subsequent amendments, including provision of services
92.20according to a service plan designed to meet the needs of the individual. For purposes of
92.21this section, the approved home and community-based application is considered the necessary
92.22federal requirement.
92.23    (c) The commissioner shall provide interested persons serving on agency advisory
92.24committees, task forces, the Centers for Independent Living, and others who request to be
92.25on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
92.26any effective dates, (1) any substantive changes to the state's disability services program
92.27manual, or (2) changes or amendments to the federally approved applications for home and
92.28community-based waivers, prior to their submission to the federal Centers for Medicare
92.29and Medicaid Services.
92.30    (d) The commissioner shall seek approval, as authorized under section 1915(c) of the
92.31Social Security Act, to allow medical assistance eligibility under this section for children
92.32under age 21 without deeming of parental income or assets.
93.1    (e) The commissioner shall seek approval, as authorized under section 1915(c) of the
93.2Social Act, to allow medical assistance eligibility under this section for individuals under
93.3age 65 without deeming the spouse's income or assets.
93.4(f) The commissioner shall comply with the requirements in the federally approved
93.5transition plan for the home and community-based services waivers authorized under this
93.6section.
93.7EFFECTIVE DATE.This section is effective the day following final enactment.

93.8    Sec. 18. Minnesota Statutes 2016, section 256B.49, subdivision 15, is amended to read:
93.9    Subd. 15. Coordinated service and support plan; comprehensive transitional service
93.10plan; maintenance service plan. (a) Each recipient of home and community-based waivered
93.11services shall be provided a copy of the written coordinated service and support plan which
93.12meets the requirements in section 256B.092, subdivision 1b.
93.13(b) In developing the comprehensive transitional service plan, the individual receiving
93.14services, the case manager, and the guardian, if applicable, will identify the transitional
93.15service plan fundamental service outcome and anticipated timeline to achieve this outcome.
93.16Within the first 20 days following a recipient's request for an assessment or reassessment,
93.17the transitional service planning team must be identified. A team leader must be identified
93.18who will be responsible for assigning responsibility and communicating with team members
93.19to ensure implementation of the transition plan and ongoing assessment and communication
93.20process. The team leader should be an individual, such as the case manager or guardian,
93.21who has the opportunity to follow the recipient to the next level of service.
93.22Within ten days following an assessment, a comprehensive transitional service plan must
93.23be developed incorporating elements of a comprehensive functional assessment and including
93.24short-term measurable outcomes and timelines for achievement of and reporting on these
93.25outcomes. Functional milestones must also be identified and reported according to the
93.26timelines agreed upon by the transitional service planning team. In addition, the
93.27comprehensive transitional service plan must identify additional supports that may assist
93.28in the achievement of the fundamental service outcome such as the development of greater
93.29natural community support, increased collaboration among agencies, and technological
93.30supports.
93.31The timelines for reporting on functional milestones will prompt a reassessment of
93.32services provided, the units of services, rates, and appropriate service providers. It is the
93.33responsibility of the transitional service planning team leader to review functional milestone
94.1reporting to determine if the milestones are consistent with observable skills and that
94.2milestone achievement prompts any needed changes to the comprehensive transitional
94.3service plan.
94.4For those whose fundamental transitional service outcome involves the need to procure
94.5housing, a plan for the recipient to seek the resources necessary to secure the least restrictive
94.6housing possible should be incorporated into the plan, including employment and public
94.7supports such as housing access and shelter needy funding.
94.8(c) Counties and other agencies responsible for funding community placement and
94.9ongoing community supportive services are responsible for the implementation of the
94.10comprehensive transitional service plans. Oversight responsibilities include both ensuring
94.11effective transitional service delivery and efficient utilization of funding resources.
94.12(d) Following one year of transitional services, the transitional services planning team
94.13will make a determination as to whether or not the individual receiving services requires
94.14the current level of continuous and consistent support in order to maintain the recipient's
94.15current level of functioning. Recipients who are determined to have not had a significant
94.16change in functioning for 12 months must move from a transitional to a maintenance service
94.17plan. Recipients on a maintenance service plan must be reassessed to determine if the
94.18recipient would benefit from a transitional service plan at least every 12 months and at other
94.19times when there has been a significant change in the recipient's functioning. This assessment
94.20should consider any changes to technological or natural community supports.
94.21(e) When a county is evaluating denials, reductions, or terminations of home and
94.22community-based services under this section for an individual, the case manager shall offer
94.23to meet with the individual or the individual's guardian in order to discuss the prioritization
94.24of service needs within the coordinated service and support plan, comprehensive transitional
94.25service plan, or maintenance service plan. The reduction in the authorized services for an
94.26individual due to changes in funding for waivered services may not exceed the amount
94.27needed to ensure medically necessary services to meet the individual's health, safety, and
94.28welfare.
94.29(f) At the time of reassessment, local agency case managers shall assess each recipient
94.30of community access for disability inclusion or brain injury waivered services currently
94.31residing in a licensed adult foster home that is not the primary residence of the license
94.32holder, or in which the license holder is not the primary caregiver, to determine if that
94.33recipient could appropriately be served in a community-living setting. If appropriate for the
94.34recipient, the case manager shall offer the recipient, through a person-centered planning
95.1process, the option to receive alternative housing and service options. In the event that the
95.2recipient chooses to transfer from the adult foster home, the vacated bed shall not be filled
95.3with another recipient of waiver services and group residential housing and the licensed
95.4capacity shall be reduced accordingly, unless the savings required by the licensed bed closure
95.5reductions under Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40,
95.6paragraph (f), for foster care settings where the physical location is not the primary residence
95.7of the license holder are met through voluntary changes described in section 245A.03,
95.8subdivision 7
, paragraph (e), or as provided under paragraph (a), clauses (3) and (4). If the
95.9adult foster home becomes no longer viable due to these transfers, the county agency, with
95.10the assistance of the department, shall facilitate a consolidation of settings or closure. This
95.11reassessment process shall be completed by July 1, 2013.

95.12    Sec. 19. Minnesota Statutes 2016, section 256B.493, subdivision 1, is amended to read:
95.13    Subdivision 1. Commissioner's duties; report. The commissioner of human services
95.14shall solicit proposals for the conversion of services provided for persons with disabilities
95.15in settings licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, or community
95.16residential settings licensed under chapter 245D, to other types of community settings in
95.17conjunction with the closure of identified licensed adult foster care settings has the authority
95.18to manage statewide licensed corporate foster care or community residential settings capacity,
95.19including the reduction and realignment of licensed capacity of a current foster care or
95.20community residential settings to accomplish the consolidation or closure of settings. The
95.21commissioner shall implement a program for planned closure of licensed corporate adult
95.22foster care or community residential settings, necessary as a preferred method to: (1) respond
95.23to the informed decisions of those individuals who want to move out of these settings into
95.24other types of community settings; and (2) achieve necessary budgetary savings required
95.25in section 245A.03, subdivision 7, paragraphs (c) and (d).

95.26    Sec. 20. Minnesota Statutes 2016, section 256B.493, subdivision 2, is amended to read:
95.27    Subd. 2. Planned closure process needs determination. The commissioner shall
95.28announce and implement a program for planned closure of adult foster care homes. Planned
95.29closure shall be the preferred method for achieving necessary budgetary savings required
95.30by the licensed bed closure budget reduction in section 245A.03, subdivision 7, paragraph
95.31(c). If additional closures are required to achieve the necessary savings, the commissioner
95.32shall use the process and priorities in section 245A.03, subdivision 7, paragraph (c) A
95.33resource need determination process, managed at the state level, using available reports
96.1required by section 144A.351 and other data and information shall be used by the
96.2commissioner to align capacity where needed.

96.3    Sec. 21. Minnesota Statutes 2016, section 256B.493, is amended by adding a subdivision
96.4to read:
96.5    Subd. 2a. Closure process. (a) The commissioner shall work with stakeholders to
96.6establish a process for the application, review, approval, and implementation of setting
96.7closures. Voluntary proposals from license holders for consolidation and closure of adult
96.8foster care or community residential settings are encouraged. Whether voluntary or
96.9involuntary, all closure plans must include:
96.10(1) a description of the proposed closure plan, identifying the home or homes and
96.11occupied beds;
96.12(2) the proposed timetable for the proposed closure, including the proposed dates for
96.13notification to people living there and the affected lead agencies, commencement of closure,
96.14and completion of closure;
96.15(3) the proposed relocation plan jointly developed by the counties of financial
96.16responsibility, the people living there and their legal representatives, if any, who wish to
96.17continue to receive services from the provider, and the providers for current residents of
96.18any adult foster care home designated for closure; and
96.19(4) documentation from the provider in a format approved by the commissioner that all
96.20the adult foster care homes or community residential settings receiving a planned closure
96.21rate adjustment under the plan have accepted joint and severable for recovery of
96.22overpayments under section 256B.0641, subdivision 2, for the facilities designated for
96.23closure under this plan.
96.24(b) The commissioner shall give first priority to closure plans which:
96.25(1) target counties and geographic areas which have:
96.26(i) need for other types of services;
96.27(ii) need for specialized services;
96.28(iii) higher than average per capita use of licensed corporate foster care or community
96.29residential settings; or
96.30(iv) residents not living in the geographic area of their choice;
96.31(2) demonstrate savings of medical assistance expenditures; and
97.1(3) demonstrate that alternative services are based on the recipient's choice of provider
97.2and are consistent with federal law, state law, and federally approved waiver plans.
97.3The commissioner shall also consider any information provided by people using services,
97.4their legal representatives, family members, or the lead agency on the impact of the planned
97.5closure on people and the services they need.
97.6    (c) For each closure plan approved by the commissioner, a contract must be established
97.7between the commissioner, the counties of financial responsibility, and the participating
97.8license holder.

97.9    Sec. 22. Minnesota Statutes 2016, section 256D.44, subdivision 4, is amended to read:
97.10    Subd. 4. Temporary absence due to illness. For the purposes of this subdivision, "home"
97.11means a residence owned or rented by a recipient or the recipient's spouse. Home does not
97.12include a group residential housing facility. Assistance payments for recipients who are
97.13temporarily absent from their home due to hospitalization for illness must continue at the
97.14same level of payment during their absence if the following criteria are met:
97.15(1) a physician certifies that the absence is not expected to continue for more than three
97.16months;
97.17(2) a physician certifies that the recipient will be able to return to independent living;
97.18and
97.19(3) the recipient has expenses associated with maintaining a residence in the community.

97.20    Sec. 23. Minnesota Statutes 2016, section 256D.44, subdivision 5, is amended to read:
97.21    Subd. 5. Special needs. (a) In addition to the state standards of assistance established
97.22in subdivisions 1 to 4, payments are allowed for the following special needs of recipients
97.23of Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
97.24center, or a group residential setting authorized to receive housing facility support payments
97.25under chapter 256I.
97.26    (a) (b) The county agency shall pay a monthly allowance for medically prescribed diets
97.27if the cost of those additional dietary needs cannot be met through some other maintenance
97.28benefit. The need for special diets or dietary items must be prescribed by a licensed physician.
97.29Costs for special diets shall be determined as percentages of the allotment for a one-person
97.30household under the thrifty food plan as defined by the United States Department of
97.31Agriculture. The types of diets and the percentages of the thrifty food plan that are covered
97.32are as follows:
98.1    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
98.2    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent of
98.3thrifty food plan;
98.4    (3) controlled protein diet, less than 40 grams and requires special products, 125 percent
98.5of thrifty food plan;
98.6    (4) low cholesterol diet, 25 percent of thrifty food plan;
98.7    (5) high residue diet, 20 percent of thrifty food plan;
98.8    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;
98.9    (7) gluten-free diet, 25 percent of thrifty food plan;
98.10    (8) lactose-free diet, 25 percent of thrifty food plan;
98.11    (9) antidumping diet, 15 percent of thrifty food plan;
98.12    (10) hypoglycemic diet, 15 percent of thrifty food plan; or
98.13    (11) ketogenic diet, 25 percent of thrifty food plan.
98.14    (b) (c) Payment for nonrecurring special needs must be allowed for necessary home
98.15repairs or necessary repairs or replacement of household furniture and appliances using the
98.16payment standard of the AFDC program in effect on July 16, 1996, for these expenses, as
98.17long as other funding sources are not available.
98.18    (c) (d) A fee for guardian or conservator service is allowed at a reasonable rate negotiated
98.19by the county or approved by the court. This rate shall not exceed five percent of the
98.20assistance unit's gross monthly income up to a maximum of $100 per month. If the guardian
98.21or conservator is a member of the county agency staff, no fee is allowed.
98.22    (d) (e) The county agency shall continue to pay a monthly allowance of $68 for restaurant
98.23meals for a person who was receiving a restaurant meal allowance on June 1, 1990, and
98.24who eats two or more meals in a restaurant daily. The allowance must continue until the
98.25person has not received Minnesota supplemental aid for one full calendar month or until
98.26the person's living arrangement changes and the person no longer meets the criteria for the
98.27restaurant meal allowance, whichever occurs first.
98.28    (e) (f) A fee of ten percent of the recipient's gross income or $25, whichever is less, is
98.29allowed for representative payee services provided by an agency that meets the requirements
98.30under SSI regulations to charge a fee for representative payee services. This special need
99.1is available to all recipients of Minnesota supplemental aid regardless of their living
99.2arrangement.
99.3    (f) (g)(1) Notwithstanding the language in this subdivision, an amount equal to one-half
99.4of the maximum allotment authorized by the federal Food Stamp Program for a federal
99.5Supplemental Security Income payment amount for a single individual which is in effect
99.6on the first day of July of each year will be added to the standards of assistance established
99.7in subdivisions 1 to 4 for adults under the age of 65 who qualify as shelter needy in need
99.8of housing assistance and are:
99.9    (i) relocating from an institution, a setting authorized to receive housing support under
99.10chapter 256I, or an adult mental health residential treatment program under section
99.11256B.0622 ; or
99.12    (ii) eligible for personal care assistance under section 256B.0659; or
99.13    (iii) home and community-based waiver recipients living in their own home or rented
99.14or leased apartment which is not owned, operated, or controlled by a provider of service
99.15not related by blood or marriage, unless allowed under paragraph (g).
99.16    (2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the shelter
99.17needy benefit under this paragraph is considered a household of one. An eligible individual
99.18who receives this benefit prior to age 65 may continue to receive the benefit after the age
99.19of 65.
99.20    (3) "Shelter needy Housing assistance" means that the assistance unit incurs monthly
99.21shelter costs that exceed 40 percent of the assistance unit's gross income before the application
99.22of this special needs standard. "Gross income" for the purposes of this section is the
99.23applicant's or recipient's income as defined in section 256D.35, subdivision 10, or the
99.24standard specified in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient
99.25of a federal or state housing subsidy, that limits shelter costs to a percentage of gross income,
99.26shall not be considered shelter needy in need of housing assistance for purposes of this
99.27paragraph.
99.28(g) Notwithstanding this subdivision, to access housing and services as provided in
99.29paragraph (f), the recipient may choose housing that may be owned, operated, or controlled
99.30by the recipient's service provider. When housing is controlled by the service provider, the
99.31individual may choose the individual's own service provider as provided in section 256B.49,
99.32subdivision 23
, clause (3). When the housing is controlled by the service provider, the
99.33service provider shall implement a plan with the recipient to transition the lease to the
99.34recipient's name. Within two years of signing the initial lease, the service provider shall
100.1transfer the lease entered into under this subdivision to the recipient. In the event the landlord
100.2denies this transfer, the commissioner may approve an exception within sufficient time to
100.3ensure the continued occupancy by the recipient. This paragraph expires June 30, 2016.
100.4EFFECTIVE DATE.Paragraphs (a) to (f) are effective July 1, 2017. Paragraph (g),
100.5clause (1), is effective July 1, 2020, except paragraph (g), clause (1), items (ii) and (iii), are
100.6effective July 1, 2017.

100.7    Sec. 24. Minnesota Statutes 2016, section 256I.03, subdivision 8, is amended to read:
100.8    Subd. 8. Supplementary services. "Supplementary services" means housing support
100.9services provided to residents of group residential housing providers individuals in addition
100.10to room and board including, but not limited to, oversight and up to 24-hour supervision,
100.11medication reminders, assistance with transportation, arranging for meetings and
100.12appointments, and arranging for medical and social services.

100.13    Sec. 25. Minnesota Statutes 2016, section 256I.04, subdivision 1, is amended to read:
100.14    Subdivision 1. Individual eligibility requirements. An individual is eligible for and
100.15entitled to a group residential housing support payment to be made on the individual's behalf
100.16if the agency has approved the individual's residence in a group residential setting where
100.17the individual will receive housing setting support and the individual meets the requirements
100.18in paragraph (a) or, (b), or (c).
100.19(a) The individual is aged, blind, or is over 18 years of age and disabled as determined
100.20under the criteria used by the title II program of the Social Security Act, and meets the
100.21resource restrictions and standards of section 256P.02, and the individual's countable income
100.22after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
100.23assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
100.24income actually made available to a community spouse by an elderly waiver participant
100.25under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
100.26subdivision 2
, is less than the monthly rate specified in the agency's agreement with the
100.27provider of group residential housing support in which the individual resides.
100.28(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
100.29paragraph (a), clauses (1), (3), (5) to (9), and (14), and paragraph (b), if applicable, and the
100.30individual's resources are less than the standards specified by section 256P.02, and the
100.31individual's countable income as determined under section 256P.06, less the medical
100.32assistance personal needs allowance under section 256B.35 is less than the monthly rate
101.1specified in the agency's agreement with the provider of group residential housing support
101.2in which the individual resides.
101.3(c) The individual receives licensed residential crisis stabilization services under section
101.4256B.0624, subdivision 7, and is receiving medical assistance. The individual may receive
101.5concurrent housing support payments if receiving licensed residential crisis stabilization
101.6services under section 256B.0624, subdivision 7.
101.7EFFECTIVE DATE.Paragraph (c) is effective October 1, 2017.

101.8    Sec. 26. Minnesota Statutes 2016, section 256I.04, subdivision 2d, is amended to read:
101.9    Subd. 2d. Conditions of payment; commissioner's right to suspend or terminate
101.10agreement. (a) Group residential Housing or supplementary services support must be
101.11provided to the satisfaction of the commissioner, as determined at the sole discretion of the
101.12commissioner's authorized representative, and in accordance with all applicable federal,
101.13state, and local laws, ordinances, rules, and regulations, including business registration
101.14requirements of the Office of the Secretary of State. A provider shall not receive payment
101.15for room and board or supplementary services or housing found by the commissioner to be
101.16performed or provided in violation of federal, state, or local law, ordinance, rule, or
101.17regulation.
101.18(b) The commissioner has the right to suspend or terminate the agreement immediately
101.19when the commissioner determines the health or welfare of the housing or service recipients
101.20is endangered, or when the commissioner has reasonable cause to believe that the provider
101.21has breached a material term of the agreement under subdivision 2b.
101.22(c) Notwithstanding paragraph (b), if the commissioner learns of a curable material
101.23breach of the agreement by the provider, the commissioner shall provide the provider with
101.24a written notice of the breach and allow ten days to cure the breach. If the provider does
101.25not cure the breach within the time allowed, the provider shall be in default of the agreement
101.26and the commissioner may terminate the agreement immediately thereafter. If the provider
101.27has breached a material term of the agreement and cure is not possible, the commissioner
101.28may immediately terminate the agreement.

101.29    Sec. 27. Minnesota Statutes 2016, section 256I.04, subdivision 2g, is amended to read:
101.30    Subd. 2g. Crisis shelters. Secure crisis shelters for battered women and their children
101.31designated by the Minnesota Department of Corrections are not group residences eligible
101.32for housing support under this chapter.

102.1    Sec. 28. Minnesota Statutes 2016, section 256I.04, subdivision 3, is amended to read:
102.2    Subd. 3. Moratorium on development of group residential housing support beds.
102.3    (a) Agencies shall not enter into agreements for new group residential housing support beds
102.4with total rates in excess of the MSA equivalent rate except:
102.5(1) for group residential housing establishments licensed under chapter 245D provided
102.6the facility is needed to meet the census reduction targets for persons with developmental
102.7disabilities at regional treatment centers;
102.8(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
102.9provide housing for chronic inebriates who are repetitive users of detoxification centers and
102.10are refused placement in emergency shelters because of their state of intoxication, and
102.11planning for the specialized facility must have been initiated before July 1, 1991, in
102.12anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
102.13subdivision 20a
, paragraph (b);
102.14(3) notwithstanding the provisions of subdivision 2a, for up to 190 226 supportive
102.15housing units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a
102.16mental illness, a history of substance abuse, or human immunodeficiency virus or acquired
102.17immunodeficiency syndrome. For purposes of this section, "homeless adult" means a person
102.18who is living on the street or in a shelter or discharged from a regional treatment center,
102.19community hospital, or residential treatment program and has no appropriate housing
102.20available and lacks the resources and support necessary to access appropriate housing. At
102.21least 70 percent of the supportive housing units must serve homeless adults with mental
102.22illness, substance abuse problems, or human immunodeficiency virus or acquired
102.23immunodeficiency syndrome who are about to be or, within the previous six months, has
102.24been discharged from a regional treatment center, or a state-contracted psychiatric bed in
102.25a community hospital, or a residential mental health or chemical dependency treatment
102.26program. If a person meets the requirements of subdivision 1, paragraph (a), and receives
102.27a federal or state housing subsidy, the group residential housing support rate for that person
102.28is limited to the supplementary rate under section 256I.05, subdivision 1a, and is determined
102.29by subtracting the amount of the person's countable income that exceeds the MSA equivalent
102.30rate from the group residential housing support supplementary service rate. A resident in a
102.31demonstration project site who no longer participates in the demonstration program shall
102.32retain eligibility for a group residential housing support payment in an amount determined
102.33under section 256I.06, subdivision 8, using the MSA equivalent rate. Service funding under
102.34section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching funds are
102.35available and the services can be provided through a managed care entity. If federal matching
103.1funds are not available, then service funding will continue under section 256I.05, subdivision
103.21a
;
103.3(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
103.4Hennepin County providing services for recovering and chemically dependent men that has
103.5had a group residential housing support contract with the county and has been licensed as
103.6a board and lodge facility with special services since 1980;
103.7(5) for a group residential housing support provider located in the city of St. Cloud, or
103.8a county contiguous to the city of St. Cloud, that operates a 40-bed facility, that received
103.9financing through the Minnesota Housing Finance Agency Ending Long-Term Homelessness
103.10Initiative and serves chemically dependent clientele, providing 24-hour-a-day supervision;
103.11(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
103.12persons, operated by a group residential housing support provider that currently operates a
103.13304-bed facility in Minneapolis, and a 44-bed facility in Duluth;
103.14(7) for a group residential housing support provider that operates two ten-bed facilities,
103.15one located in Hennepin County and one located in Ramsey County, that provide community
103.16support and 24-hour-a-day supervision to serve the mental health needs of individuals who
103.17have chronically lived unsheltered; and
103.18(8) for a group residential facility authorized for recipients of housing support in Hennepin
103.19County with a capacity of up to 48 beds that has been licensed since 1978 as a board and
103.20lodging facility and that until August 1, 2007, operated as a licensed chemical dependency
103.21treatment program.
103.22    (b) An agency may enter into a group residential housing support agreement for beds
103.23with rates in excess of the MSA equivalent rate in addition to those currently covered under
103.24a group residential housing support agreement if the additional beds are only a replacement
103.25of beds with rates in excess of the MSA equivalent rate which have been made available
103.26due to closure of a setting, a change of licensure or certification which removes the beds
103.27from group residential housing support payment, or as a result of the downsizing of a group
103.28residential housing setting authorized for recipients of housing support. The transfer of
103.29available beds from one agency to another can only occur by the agreement of both agencies.

103.30    Sec. 29. Minnesota Statutes 2016, section 256I.05, subdivision 1a, is amended to read:
103.31    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section 256I.04,
103.32subdivision 3
, the county agency may negotiate a payment not to exceed $426.37 for other
103.33services necessary to provide room and board provided by the group residence if the residence
104.1is licensed by or registered by the Department of Health, or licensed by the Department of
104.2Human Services to provide services in addition to room and board, and if the provider of
104.3services is not also concurrently receiving funding for services for a recipient under a home
104.4and community-based waiver under title XIX of the Social Security Act; or funding from
104.5the medical assistance program under section 256B.0659, for personal care services for
104.6residents in the setting; or residing in a setting which receives funding under section 245.73.
104.7If funding is available for other necessary services through a home and community-based
104.8waiver, or personal care services under section 256B.0659, then the GRH housing support
104.9rate is limited to the rate set in subdivision 1. Unless otherwise provided in law, in no case
104.10may the supplementary service rate exceed $426.37. The registration and licensure
104.11requirement does not apply to establishments which are exempt from state licensure because
104.12they are located on Indian reservations and for which the tribe has prescribed health and
104.13safety requirements. Service payments under this section may be prohibited under rules to
104.14prevent the supplanting of federal funds with state funds. The commissioner shall pursue
104.15the feasibility of obtaining the approval of the Secretary of Health and Human Services to
104.16provide home and community-based waiver services under title XIX of the Social Security
104.17Act for residents who are not eligible for an existing home and community-based waiver
104.18due to a primary diagnosis of mental illness or chemical dependency and shall apply for a
104.19waiver if it is determined to be cost-effective.
104.20(b) The commissioner is authorized to make cost-neutral transfers from the GRH housing
104.21support fund for beds under this section to other funding programs administered by the
104.22department after consultation with the county or counties in which the affected beds are
104.23located. The commissioner may also make cost-neutral transfers from the GRH housing
104.24support fund to county human service agencies for beds permanently removed from the
104.25GRH housing support census under a plan submitted by the county agency and approved
104.26by the commissioner. The commissioner shall report the amount of any transfers under this
104.27provision annually to the legislature.
104.28    (c) Counties must not negotiate supplementary service rates with providers of group
104.29residential housing support that are licensed as board and lodging with special services and
104.30that do not encourage a policy of sobriety on their premises and make referrals to available
104.31community services for volunteer and employment opportunities for residents.

105.1    Sec. 30. Minnesota Statutes 2016, section 256I.05, subdivision 1c, is amended to read:
105.2    Subd. 1c. Rate increases. An agency may not increase the rates negotiated for group
105.3residential housing support above those in effect on June 30, 1993, except as provided in
105.4paragraphs (a) to (f).
105.5(a) An agency may increase the rates for group residential housing settings room and
105.6board to the MSA equivalent rate for those settings whose current rate is below the MSA
105.7equivalent rate.
105.8(b) An agency may increase the rates for residents in adult foster care whose difficulty
105.9of care has increased. The total group residential housing support rate for these residents
105.10must not exceed the maximum rate specified in subdivisions 1 and 1a. Agencies must not
105.11include nor increase group residential housing difficulty of care rates for adults in foster
105.12care whose difficulty of care is eligible for funding by home and community-based waiver
105.13programs under title XIX of the Social Security Act.
105.14(c) The room and board rates will be increased each year when the MSA equivalent rate
105.15is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, less
105.16the amount of the increase in the medical assistance personal needs allowance under section
105.17256B.35 .
105.18(d) When a group residential housing rate is used to pay support pays for an individual's
105.19room and board, or other costs necessary to provide room and board, the rate payable to the
105.20residence must continue for up to 18 calendar days per incident that the person is temporarily
105.21absent from the residence, not to exceed 60 days in a calendar year, if the absence or absences
105.22have received the prior approval of the county agency's social service staff. Prior approval
105.23is not required for emergency absences due to crisis, illness, or injury.
105.24(e) For facilities meeting substantial change criteria within the prior year. Substantial
105.25change criteria exists if the group residential housing establishment experiences a 25 percent
105.26increase or decrease in the total number of its beds, if the net cost of capital additions or
105.27improvements is in excess of 15 percent of the current market value of the residence, or if
105.28the residence physically moves, or changes its licensure, and incurs a resulting increase in
105.29operation and property costs.
105.30(f) Until June 30, 1994, an agency may increase by up to five percent the total rate paid
105.31for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
105.32reside in residences that are licensed by the commissioner of health as a boarding care home,
105.33but are not certified for the purposes of the medical assistance program. However, an increase
105.34under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical
106.1assistance reimbursement rate for nursing home resident class A, in the geographic grouping
106.2in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to
106.39549.0058.

106.4    Sec. 31. Minnesota Statutes 2016, section 256I.05, subdivision 1e, is amended to read:
106.5    Subd. 1e. Supplementary rate for certain facilities. (a) Notwithstanding the provisions
106.6of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall negotiate a
106.7supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 per
106.8month, including any legislatively authorized inflationary adjustments, for a group residential
106.9housing support provider that:
106.10(1) is located in Hennepin County and has had a group residential housing support
106.11contract with the county since June 1996;
106.12(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a 26-bed
106.13facility; and
106.14(3) serves a chemically dependent clientele, providing 24 hours per day supervision and
106.15limiting a resident's maximum length of stay to 13 months out of a consecutive 24-month
106.16period.
106.17(b) Notwithstanding subdivisions 1a and 1c, a county agency shall negotiate a
106.18supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 per
106.19month, including any legislatively authorized inflationary adjustments, of a group residential
106.20housing support provider that:
106.21(1) is located in St. Louis County and has had a group residential housing support contract
106.22with the county since 2006;
106.23(2) operates a 62-bed facility; and
106.24(3) serves a chemically dependent adult male clientele, providing 24 hours per day
106.25supervision and limiting a resident's maximum length of stay to 13 months out of a
106.26consecutive 24-month period.
106.27(c) Notwithstanding subdivisions 1a and 1c, beginning July 1, 2013, a county agency
106.28shall negotiate a supplementary rate in addition to the rate specified in subdivision 1, not
106.29to exceed $700 per month, including any legislatively authorized inflationary adjustments,
106.30for the group residential provider described under paragraphs (a) and (b), not to exceed an
106.31additional 115 beds.

107.1    Sec. 32. Minnesota Statutes 2016, section 256I.05, subdivision 1j, is amended to read:
107.2    Subd. 1j. Supplementary rate for certain facilities; Crow Wing County.
107.3    Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 2007, a county
107.4agency shall negotiate a supplementary rate in addition to the rate specified in subdivision
107.51, not to exceed $700 per month, including any legislatively authorized inflationary
107.6adjustments, for a new 65-bed facility in Crow Wing County that will serve chemically
107.7dependent persons operated by a group residential housing support provider that currently
107.8operates a 304-bed facility in Minneapolis and a 44-bed facility in Duluth which opened in
107.9January of 2006.

107.10    Sec. 33. Minnesota Statutes 2016, section 256I.05, subdivision 1m, is amended to read:
107.11    Subd. 1m. Supplemental rate for certain facilities; Hennepin and Ramsey Counties.
107.12    (a) Notwithstanding the provisions of this section, beginning July 1, 2007, a county agency
107.13shall negotiate a supplemental service rate in addition to the rate specified in subdivision
107.141, not to exceed $700 per month or the existing monthly rate, whichever is higher, including
107.15any legislatively authorized inflationary adjustments, for a group residential housing support
107.16provider that operates two ten-bed facilities, one located in Hennepin County and one located
107.17in Ramsey County, which provide community support and serve the mental health needs
107.18of individuals who have chronically lived unsheltered, providing 24-hour-per-day supervision.
107.19    (b) An individual who has lived in one of the facilities under paragraph (a), who is being
107.20transitioned to independent living as part of the program plan continues to be eligible for
107.21group residential housing room and board and the supplemental service rate negotiated with
107.22the county under paragraph (a).

107.23    Sec. 34. Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
107.24to read:
107.25    Subd. 1p. Supplementary rate; St. Louis County. Notwithstanding the provisions of
107.26subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
107.27supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 per
107.28month, including any legislatively authorized inflationary adjustments, for a housing support
107.29provider that:
107.30(1) is located in St. Louis County and has had a housing support contract with the county
107.31since July 2016;
107.32(2) operates a 35-bed facility;
108.1(3) serves women who are chemically dependent, mentally ill, or both;
108.2(4) provides 24-hour per day supervision;
108.3(5) provides on-site support with skilled professionals, including a licensed practical
108.4nurse, registered nurses, peer specialists, and resident counselors; and
108.5(6) provides independent living skills training and assistance with family reunification.

108.6    Sec. 35. Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
108.7to read:
108.8    Subd. 1q. Supplemental rate; Olmsted County. Notwithstanding the provisions of
108.9subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
108.10supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per
108.11month, including any legislatively authorized inflationary adjustments, for a housing support
108.12provider located in Olmsted County that operates long-term residential facilities with a total
108.13of 104 beds that serve chemically dependent men and women and provide 24-hour-a-day
108.14supervision and other support services.

108.15    Sec. 36. Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
108.16to read:
108.17    Subd. 1r. Supplemental rate; Anoka County. Notwithstanding the provisions in this
108.18section, a county agency shall negotiate a supplemental rate for 42 beds in addition to the
108.19rate specified in subdivision 1, not to exceed the maximum rate allowed under subdivision
108.201a, including any legislatively authorized inflationary adjustments, for a housing support
108.21provider that is located in Anoka County and provides emergency housing on the former
108.22Anoka Regional Treatment Center campus.

108.23    Sec. 37. Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
108.24to read:
108.25    Subd. 11. Transfer of emergency shelter funds. (a) The commissioner shall make a
108.26cost-neutral transfer of funding from the housing support fund to county human service
108.27agencies for emergency shelter beds removed from the housing support census under a
108.28biennial plan submitted by the county and approved by the commissioner. The plan must
108.29describe: (1) anticipated and actual outcomes for persons experiencing homelessness in
108.30emergency shelters; (2) improved efficiencies in administration; (3) requirements for
108.31individual eligibility; and (4) plans for quality assurance monitoring and quality assurance
109.1outcomes. The commissioner shall review the county plan to monitor implementation and
109.2outcomes at least biennially, and more frequently if the commissioner deems necessary.
109.3(b) The funding under paragraph (a) may be used for the provision of room and board
109.4or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
109.5meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
109.6annually, and the room and board portion of the allocation shall be adjusted according to
109.7the percentage change in the housing support room and board rate. The room and board
109.8portion of the allocation shall be determined at the time of transfer. The commissioner or
109.9county may return beds to the housing support fund with 180 days' notice, including financial
109.10reconciliation.
109.11EFFECTIVE DATE.This section is effective July 1, 2017.

109.12    Sec. 38. Minnesota Statutes 2016, section 256I.06, subdivision 2, is amended to read:
109.13    Subd. 2. Time of payment. A county agency may make payments to a group residence
109.14in advance for an individual whose stay in the group residence is expected to last beyond
109.15the calendar month for which the payment is made. Group residential Housing support
109.16payments made by a county agency on behalf of an individual who is not expected to remain
109.17in the group residence beyond the month for which payment is made must be made
109.18subsequent to the individual's departure from the group residence.
109.19EFFECTIVE DATE.This section is effective July 1, 2017.

109.20    Sec. 39. Minnesota Statutes 2016, section 256I.06, subdivision 8, is amended to read:
109.21    Subd. 8. Amount of group residential housing support payment. (a) The amount of
109.22a group residential housing room and board payment to be made on behalf of an eligible
109.23individual is determined by subtracting the individual's countable income under section
109.24256I.04, subdivision 1 , for a whole calendar month from the group residential housing
109.25charge room and board rate for that same month. The group residential housing charge
109.26support payment is determined by multiplying the group residential housing support rate
109.27times the period of time the individual was a resident or temporarily absent under section
109.28256I.05, subdivision 1c , paragraph (d).
109.29(b) For an individual with earned income under paragraph (a), prospective budgeting
109.30must be used to determine the amount of the individual's payment for the following six-month
109.31period. An increase in income shall not affect an individual's eligibility or payment amount
110.1until the month following the reporting month. A decrease in income shall be effective the
110.2first day of the month after the month in which the decrease is reported.
110.3(c) For an individual who receives licensed residential crisis stabilization services under
110.4section 256B.0624, subdivision 7, the amount of housing support payment is determined
110.5by multiplying the housing support rate times the period of time the individual was a resident.
110.6EFFECTIVE DATE.Paragraph (c) is effective October 1, 2017.

110.7    Sec. 40. [256I.09] COMMUNITY LIVING INFRASTRUCTURE.
110.8The commissioner shall awards grants to agencies through an annual competitive process.
110.9Grants awarded under this section may be used for: (1) outreach to locate and engage people
110.10who are homeless or residing in segregated settings to screen for basic needs and assist with
110.11referral to community living resources; (2) building capacity to provide technical assistance
110.12and consultation on housing and related support service resources for persons with both
110.13disabilities and low income; or (3) streamlining the administration and monitoring activities
110.14related to housing support funds. Agencies may collaborate and submit a joint application
110.15for funding under this section.

110.16    Sec. 41. DIRECTION TO COMMISSIONER; HOUSING SUPPORT STUDY.
110.17Within available appropriations, the commissioner of human services shall study the
110.18housing support supplementary service rates under Minnesota Statutes, section 256I.05,
110.19and make recommendations on the supplementary service rate structure to the chairs and
110.20ranking minority members of the legislative committees with jurisdiction over human
110.21services policy and finance by January 15, 2018.

110.22    Sec. 42. REVISOR'S INSTRUCTION.
110.23In each section of Minnesota Statutes referred to in column A, the revisor of statutes
110.24shall change the phrase in column B to the phrase in column C. The revisor may make
110.25technical and other necessary changes to sentence structure to preserve the meaning of the
110.26text. The revisor shall make other changes in chapter titles; section, subdivision, part, and
110.27subpart headnotes; and in other terminology necessary as a result of the enactment of this
110.28section.
110.29
Column A
Column B
Column C
110.30
110.31
144A.071, subdivision 4d
group residential housing
housing support under chapter
256I
110.32
110.33
201.061, subdivision 3
group residential housing
setting authorized to provide
housing support
111.1
111.2
111.3
244.052, subdivision 4c
group residential housing
facility
licensed setting authorized to
provide housing support
under section 256I.04
111.4
111.5
245.466, subdivision 7
under group residential
housing
by housing support under
chapter 256I
111.6
245.466, subdivision 7
from group residential housing
from housing support
111.7
111.8
245.4661, subdivision 6
group residential housing
housing support under chapter
256I
111.9
111.10
245C.10, subdivision 11
group residential housing or
supplementary services
housing support
111.11
111.12
256.01, subdivision 18
group residential housing
housing support under chapter
256I
111.13
256.017, subdivision 1
group residential housing
housing support
111.14
111.15
256.98, subdivision 8
group residential housing
housing support under chapter
256I
111.16
111.17
256B.49, subdivision 15
group residential housing
housing support under chapter
256I
111.18
111.19
256B.4914, subdivision 10
group residential housing rate
3 costs
housing support rate 3 costs
under chapter 256I
111.20
256B.501, subdivision 4b
group residential housing
housing support
111.21
111.22
111.23
256B.77, subdivision 12
residential services covered
under the group residential
housing program
housing support services
under chapter 256I
111.24
111.25
256D.44, subdivision 2
group residential housing
facility
setting authorized to provide
housing support
111.26
111.27
256G.01, subdivision 3
group residential housing
housing support under chapter
256I
111.28
256I.01
Group Residential Housing
Housing Support
111.29
256I.02
Group Residential Housing
Housing Support
111.30
256I.03, subdivision 2
"Group residential housing"
"Room and board"
111.31
256I.03, subdivision 2
Group residential housing
The room and board
111.32
256I.03, subdivision 3
"Group residential housing"
"Housing support"
111.33
256I.03, subdivision 6
group residential housing
room and board
111.34
256I.03, subdivisions 7 and 9
group residential housing
housing support
111.35
111.36
256I.04, subdivisions 1a, 1b,
1c, and 2
group residential housing
housing support
111.37
111.38
256I.04, subdivision 2a
provide group residential
housing
provide housing support
111.39
111.40
256I.04, subdivision 2a
of group residential housing
or supplementary services
of housing support
111.41
111.42
256I.04, subdivision 2a
complete group residential
housing
complete housing support
111.43
111.44
256I.04, subdivision 2b
group residential housing or
supplementary services
housing support
112.1
112.2
256I.04, subdivision 2b
provision of group residential
housing
provision of housing support
112.3
112.4
256I.04, subdivision 2c
group residential housing or
supplementary services
housing support
112.5
112.6
256I.04, subdivision 2e
group residential housing or
supplementary services
housing support
112.7
112.8
256I.04, subdivision 4
group residential housing
payment for room and board
room and board rate
112.9
112.10
256I.05, subdivision 1
living in group residential
housing
receiving housing support
112.11
112.12
256I.05, subdivisions 1h, 1k,
1l, 7b, and 7c
group residential housing
housing support
112.13
256I.05, subdivision 2
group residential housing
room and board
112.14
256I.05, subdivision 3
group residential housing
room and board
112.15
112.16
256I.05, subdivision 6
reside in group residential
housing
receive housing support
112.17
112.18
256I.06, subdivisions 1, 3, 4,
and 6
group residential housing
housing support
112.19
256I.06, subdivision 7
group residential housing
the housing support
112.20
256I.08
group residential housing
housing support
112.21
256P.03, subdivision 1
group residential housing
housing support
112.22
256P.05, subdivision 1
group residential housing
housing support
112.23
256P.07, subdivision 1
group residential housing
housing support
112.24
256P.08, subdivision 1
group residential housing
housing support
112.25
112.26
290A.03, subdivision 8
accepts group residential
housing
accepts housing support
112.27
112.28
290A.03, subdivision 8
the group residential housing
program
the housing support program

112.29ARTICLE 3
112.30CONTINUING CARE

112.31    Section 1. Minnesota Statutes 2016, section 144.0724, subdivision 4, is amended to read:
112.32    Subd. 4. Resident assessment schedule. (a) A facility must conduct and electronically
112.33submit to the commissioner of health MDS assessments that conform with the assessment
112.34schedule defined by Code of Federal Regulations, title 42, section 483.20, and published
112.35by the United States Department of Health and Human Services, Centers for Medicare and
112.36Medicaid Services, in the Long Term Care Assessment Instrument User's Manual, version
112.373.0, and subsequent updates when issued by the Centers for Medicare and Medicaid Services.
112.38The commissioner of health may substitute successor manuals or question and answer
112.39documents published by the United States Department of Health and Human Services,
113.1Centers for Medicare and Medicaid Services, to replace or supplement the current version
113.2of the manual or document.
113.3(b) The assessments used to determine a case mix classification for reimbursement
113.4include the following:
113.5(1) a new admission assessment;
113.6(2) an annual assessment which must have an assessment reference date (ARD) within
113.792 days of the previous assessment and the previous comprehensive assessment;
113.8(3) a significant change in status assessment must be completed within 14 days of the
113.9identification of a significant change, whether improvement or decline, and regardless of
113.10the amount of time since the last significant change in status assessment;
113.11(4) all quarterly assessments must have an assessment reference date (ARD) within 92
113.12days of the ARD of the previous assessment;
113.13(5) any significant correction to a prior comprehensive assessment, if the assessment
113.14being corrected is the current one being used for RUG classification; and
113.15(6) any significant correction to a prior quarterly assessment, if the assessment being
113.16corrected is the current one being used for RUG classification.
113.17(c) In addition to the assessments listed in paragraph (b), the assessments used to
113.18determine nursing facility level of care include the following:
113.19(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
113.20the Senior LinkAge Line or other organization under contract with the Minnesota Board on
113.21Aging; and
113.22(2) a nursing facility level of care determination as provided for under section 256B.0911,
113.23subdivision 4e
, as part of a face-to-face long-term care consultation assessment completed
113.24under section 256B.0911, by a county, tribe, or managed care organization under contract
113.25with the Department of Human Services.

113.26    Sec. 2. Minnesota Statutes 2016, section 144.0724, subdivision 6, is amended to read:
113.27    Subd. 6. Penalties for late or nonsubmission. (a) A facility that fails to complete or
113.28submit an assessment according to subdivisions 4 and 5 for a RUG-IV classification within
113.29seven days of the time requirements listed in the Long-Term Care Facility Resident
113.30Assessment Instrument User's Manual is subject to a reduced rate for that resident. The
113.31reduced rate shall be the lowest rate for that facility. The reduced rate is effective on the
113.32day of admission for new admission assessments, on the ARD for significant change in
114.1status assessments, or on the day that the assessment was due for all other assessments and
114.2continues in effect until the first day of the month following the date of submission and
114.3acceptance of the resident's assessment.
114.4    (b) If loss of revenue due to penalties incurred by a facility for any period of 92 days
114.5are equal to or greater than 1.0 0.1 percent of the total operating costs on the facility's most
114.6recent annual statistical and cost report, a facility may apply to the commissioner of human
114.7services for a reduction in the total penalty amount. The commissioner of human services,
114.8in consultation with the commissioner of health, may, at the sole discretion of the
114.9commissioner of human services, limit the penalty for residents covered by medical assistance
114.10to 15 ten days.
114.11EFFECTIVE DATE.This section is effective the day following final enactment.

114.12    Sec. 3. Minnesota Statutes 2016, section 144.562, subdivision 2, is amended to read:
114.13    Subd. 2. Eligibility for license condition. (a) A hospital is not eligible to receive a
114.14license condition for swing beds unless (1) it either has a licensed bed capacity of less than
114.1550 beds defined in the federal Medicare regulations, Code of Federal Regulations, title 42,
114.16section 482.66, or it has a licensed bed capacity of 50 beds or more and has swing beds that
114.17were approved for Medicare reimbursement before May 1, 1985, or it has a licensed bed
114.18capacity of less than 65 beds and the available nursing homes within 50 miles have had, in
114.19the aggregate, an average occupancy rate of 96 percent or higher in the most recent two
114.20years as documented on the statistical reports to the Department of Health; and (2) it is
114.21located in a rural area as defined in the federal Medicare regulations, Code of Federal
114.22Regulations, title 42, section 482.66.
114.23(b) Except for those critical access hospitals established under section 144.1483, clause
114.24(9), and section 1820 of the federal Social Security Act, United States Code, title 42, section
114.251395i-4, that have an attached nursing home or that owned a nursing home located in the
114.26same municipality as of May 1, 2005, eligible hospitals are allowed a total of 2,000 days
114.27of swing bed use per year. Critical access hospitals that have an attached nursing home or
114.28that owned a nursing home located in the same municipality as of May 1, 2005, are allowed
114.29swing bed use as provided in federal law.
114.30(c) Except for critical access hospitals that have an attached nursing home or that owned
114.31a nursing home located in the same municipality as of May 1, 2005, the commissioner of
114.32health may approve swing bed use beyond 2,000 days as long as there are no Medicare
114.33certified skilled nursing facility beds available within 25 miles of that hospital that are
114.34willing to admit the patient and the patient agrees to the referral being sent to the skilled
115.1nursing facility. Critical access hospitals exceeding 2,000 swing bed days must maintain
115.2documentation that they have contacted skilled nursing facilities within 25 miles to determine
115.3if any skilled nursing facility beds are available that are willing to admit the patient and the
115.4patient agrees to the referral being sent to the skilled nursing facility.
115.5(d) After reaching 2,000 days of swing bed use in a year, an eligible hospital to which
115.6this limit applies may admit six additional patients to swing beds each year without seeking
115.7approval from the commissioner or being in violation of this subdivision. These six swing
115.8bed admissions are exempt from the limit of 2,000 annual swing bed days for hospitals
115.9subject to this limit.
115.10(e) A health care system that is in full compliance with this subdivision may allocate its
115.11total limit of swing bed days among the hospitals within the system, provided that no hospital
115.12in the system without an attached nursing home may exceed 2,000 swing bed days per year.

115.13    Sec. 4. Minnesota Statutes 2016, section 144A.071, subdivision 4d, is amended to read:
115.14    Subd. 4d. Consolidation of nursing facilities. (a) The commissioner of health, in
115.15consultation with the commissioner of human services, may approve a request for
115.16consolidation of nursing facilities which includes the closure of one or more facilities and
115.17the upgrading of the physical plant of the remaining nursing facility or facilities, the costs
115.18of which exceed the threshold project limit under subdivision 2, clause (a). The
115.19commissioners shall consider the criteria in this section, section 144A.073, and section
115.20256B.437 256R.40, in approving or rejecting a consolidation proposal. In the event the
115.21commissioners approve the request, the commissioner of human services shall calculate an
115.22external fixed costs rate adjustment according to clauses (1) to (3):
115.23(1) the closure of beds shall not be eligible for a planned closure rate adjustment under
115.24section 256B.437, subdivision 6 256R.40, subdivision 5;
115.25(2) the construction project permitted in this clause shall not be eligible for a threshold
115.26project rate adjustment under section 256B.434, subdivision 4f, or a moratorium exception
115.27adjustment under section 144A.073; and
115.28(3) the payment rate for external fixed costs for a remaining facility or facilities shall
115.29be increased by an amount equal to 65 percent of the projected net cost savings to the state
115.30calculated in paragraph (b), divided by the state's medical assistance percentage of medical
115.31assistance dollars, and then divided by estimated medical assistance resident days, as
115.32determined in paragraph (c), of the remaining nursing facility or facilities in the request in
115.33this paragraph. The rate adjustment is effective on the later of the first day of the month
116.1following first day of the month of January or July, whichever date occurs first following
116.2both the completion of the construction upgrades in the consolidation plan or the first day
116.3of the month following and the complete closure of a facility closure of the facility or
116.4facilities designated for closure in the consolidation plan. If more than one facility is receiving
116.5upgrades in the consolidation plan, each facility's date of construction completion must be
116.6evaluated separately.
116.7(b) For purposes of calculating the net cost savings to the state, the commissioner shall
116.8consider clauses (1) to (7):
116.9(1) the annual savings from estimated medical assistance payments from the net number
116.10of beds closed taking into consideration only beds that are in active service on the date of
116.11the request and that have been in active service for at least three years;
116.12(2) the estimated annual cost of increased case load of individuals receiving services
116.13under the elderly waiver;
116.14(3) the estimated annual cost of elderly waiver recipients receiving support under group
116.15residential housing;
116.16(4) the estimated annual cost of increased case load of individuals receiving services
116.17under the alternative care program;
116.18(5) the annual loss of license surcharge payments on closed beds;
116.19(6) the savings from not paying planned closure rate adjustments that the facilities would
116.20otherwise be eligible for under section 256B.437 256R.40; and
116.21(7) the savings from not paying external fixed costs payment rate adjustments from
116.22submission of renovation costs that would otherwise be eligible as threshold projects under
116.23section 256B.434, subdivision 4f.
116.24(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
116.25assistance resident days of the remaining facility or facilities shall be computed assuming
116.2695 percent occupancy multiplied by the historical percentage of medical assistance resident
116.27days of the remaining facility or facilities, as reported on the facility's or facilities' most
116.28recent nursing facility statistical and cost report filed before the plan of closure is submitted,
116.29multiplied by 365.
116.30(d) For purposes of net cost of savings to the state in paragraph (b), the average occupancy
116.31percentages will be those reported on the facility's or facilities' most recent nursing facility
116.32statistical and cost report filed before the plan of closure is submitted, and the average
117.1payment rates shall be calculated based on the approved payment rates in effect at the time
117.2the consolidation request is submitted.
117.3(e) To qualify for the external fixed costs payment rate adjustment under this subdivision,
117.4the closing facilities shall:
117.5(1) submit an application for closure according to section 256B.437, subdivision 3
117.6256R.40, subdivision 2; and
117.7(2) follow the resident relocation provisions of section 144A.161.
117.8(f) The county or counties in which a facility or facilities are closed under this subdivision
117.9shall not be eligible for designation as a hardship area under subdivision 3 for five years
117.10from the date of the approval of the proposed consolidation. The applicant shall notify the
117.11county of this limitation and the county shall acknowledge this in a letter of support.
117.12EFFECTIVE DATE.This section is effective for consolidations occurring after July
117.131, 2017.

117.14    Sec. 5. Minnesota Statutes 2016, section 144A.74, is amended to read:
117.15144A.74 MAXIMUM CHARGES.
117.16A supplemental nursing services agency must not bill or receive payments from a nursing
117.17home licensed under this chapter at a rate higher than 150 percent of the sum of the weighted
117.18average wage rate, plus a factor determined by the commissioner to incorporate payroll
117.19taxes as defined in Minnesota Rules, part 9549.0020, subpart 33 section 256R.02, subdivision
117.2037, for the applicable employee classification for the geographic group to which the nursing
117.21home is assigned under Minnesota Rules, part 9549.0052 specified in section 256R.23,
117.22subdivision 4. The weighted average wage rates must be determined by the commissioner
117.23of human services and reported to the commissioner of health on an annual basis. Wages
117.24are defined as hourly rate of pay and shift differential, including weekend shift differential
117.25and overtime. Facilities shall provide information necessary to determine weighted average
117.26wage rates to the commissioner of human services in a format requested by the commissioner.
117.27The maximum rate must include all charges for administrative fees, contract fees, or other
117.28special charges in addition to the hourly rates for the temporary nursing pool personnel
117.29supplied to a nursing home. A nursing home that pays for the actual travel and housing costs
117.30for supplemental nursing services agency staff working at the facility and that pays these
117.31costs to the employee, the agency, or another vendor, is not violating the limitation on
117.32charges described in this section.
117.33EFFECTIVE DATE.This section is effective the day following final enactment.

118.1    Sec. 6. Minnesota Statutes 2016, section 256.975, subdivision 7, is amended to read:
118.2    Subd. 7. Consumer information and assistance and long-term care options
118.3counseling; Senior LinkAge Line. (a) The Minnesota Board on Aging shall operate a
118.4statewide service to aid older Minnesotans and their families in making informed choices
118.5about long-term care options and health care benefits. Language services to persons with
118.6limited English language skills may be made available. The service, known as Senior
118.7LinkAge Line, shall serve older adults as the designated Aging and Disability Resource
118.8Center under United States Code, title 42, section 3001, the Older Americans Act
118.9Amendments of 2006 in partnership with the Disability Linkage Line under section 256.01,
118.10subdivision 24
, and must be available during business hours through a statewide toll-free
118.11number and the Internet. The Minnesota Board on Aging shall consult with, and when
118.12appropriate work through, the area agencies on aging counties, and other entities that serve
118.13aging and disabled populations of all ages, to provide and maintain the telephone
118.14infrastructure and related support for the Aging and Disability Resource Center partners
118.15which agree by memorandum to access the infrastructure, including the designated providers
118.16of the Senior LinkAge Line and the Disability Linkage Line.
118.17    (b) The service must provide long-term care options counseling by assisting older adults,
118.18caregivers, and providers in accessing information and options counseling about choices in
118.19long-term care services that are purchased through private providers or available through
118.20public options. The service must:
118.21    (1) develop and provide for regular updating of a comprehensive database that includes
118.22detailed listings in both consumer- and provider-oriented formats that can provide search
118.23results down to the neighborhood level;
118.24    (2) make the database accessible on the Internet and through other telecommunication
118.25and media-related tools;
118.26    (3) link callers to interactive long-term care screening tools and make these tools available
118.27through the Internet by integrating the tools with the database;
118.28    (4) develop community education materials with a focus on planning for long-term care
118.29and evaluating independent living, housing, and service options;
118.30    (5) conduct an outreach campaign to assist older adults and their caregivers in finding
118.31information on the Internet and through other means of communication;
118.32    (6) implement a messaging system for overflow callers and respond to these callers by
118.33the next business day;
119.1    (7) link callers with county human services and other providers to receive more in-depth
119.2assistance and consultation related to long-term care options;
119.3    (8) link callers with quality profiles for nursing facilities and other home and
119.4community-based services providers developed by the commissioners of health and human
119.5services;
119.6(9) develop an outreach plan to seniors and their caregivers with a particular focus on
119.7establishing a clear presence in places that seniors recognize and:
119.8(i) place a significant emphasis on improved outreach and service to seniors and their
119.9caregivers by establishing annual plans by neighborhood, city, and county, as necessary, to
119.10address the unique needs of geographic areas in the state where there are dense populations
119.11of seniors;
119.12(ii) establish an efficient workforce management approach and assign community living
119.13specialist staff and volunteers to geographic areas as well as aging and disability resource
119.14center sites so that seniors and their caregivers and professionals recognize the Senior
119.15LinkAge Line as the place to call for aging services and information;
119.16(iii) recognize the size and complexity of the metropolitan area service system by working
119.17with metropolitan counties to establish a clear partnership with them, including seeking
119.18county advice on the establishment of local aging and disabilities resource center sites; and
119.19(iv) maintain dashboards with metrics that demonstrate how the service is expanding
119.20and extending or enhancing its outreach efforts in dispersed or hard to reach locations in
119.21varied population centers;
119.22    (10) incorporate information about the availability of housing options, as well as
119.23registered housing with services and consumer rights within the MinnesotaHelp.info network
119.24long-term care database to facilitate consumer comparison of services and costs among
119.25housing with services establishments and with other in-home services and to support financial
119.26self-sufficiency as long as possible. Housing with services establishments and their arranged
119.27home care providers shall provide information that will facilitate price comparisons, including
119.28delineation of charges for rent and for services available. The commissioners of health and
119.29human services shall align the data elements required by section 144G.06, the Uniform
119.30Consumer Information Guide, and this section to provide consumers standardized information
119.31and ease of comparison of long-term care options. The commissioner of human services
119.32shall provide the data to the Minnesota Board on Aging for inclusion in the
119.33MinnesotaHelp.info network long-term care database;
120.1(11) provide long-term care options counseling. Long-term care options counselors shall:
120.2(i) for individuals not eligible for case management under a public program or public
120.3funding source, provide interactive decision support under which consumers, family
120.4members, or other helpers are supported in their deliberations to determine appropriate
120.5long-term care choices in the context of the consumer's needs, preferences, values, and
120.6individual circumstances, including implementing a community support plan;
120.7(ii) provide Web-based educational information and collateral written materials to
120.8familiarize consumers, family members, or other helpers with the long-term care basics,
120.9issues to be considered, and the range of options available in the community;
120.10(iii) provide long-term care futures planning, which means providing assistance to
120.11individuals who anticipate having long-term care needs to develop a plan for the more
120.12distant future; and
120.13(iv) provide expertise in benefits and financing options for long-term care, including
120.14Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
120.15private pay options, and ways to access low or no-cost services or benefits through
120.16volunteer-based or charitable programs;
120.17(12) using risk management and support planning protocols, provide long-term care
120.18options counseling under clause (13) to current residents of nursing homes deemed
120.19appropriate for discharge by the commissioner, former residents of nursing homes who
120.20were discharged to community settings, and older adults who request service after
120.21consultation with the Senior LinkAge Line under clause (13). The Senior LinkAge Line
120.22shall also receive referrals from the residents or staff of nursing homes. who meet a profile
120.23that demonstrates that the consumer is either at risk of readmission to a nursing home or
120.24hospital, or would benefit from long-term care options counseling to age in place. The Senior
120.25LinkAge Line shall identify and contact residents or patients deemed appropriate for
120.26discharge by developing targeting criteria and creating a profile in consultation with the
120.27commissioner who. The commissioner shall provide designated Senior LinkAge Line contact
120.28centers with a list of current or former nursing home residents or people discharged from a
120.29hospital or for whom Medicare home care has ended, that meet the criteria as being
120.30appropriate for discharge planning long-term care options counseling through a referral via
120.31a secure Web portal. Senior LinkAge Line shall provide these residents, if they indicate a
120.32preference to receive long-term care options counseling, with initial assessment and, if
120.33appropriate, a referral to:
120.34(i) long-term care consultation services under section 256B.0911;
121.1(ii) designated care coordinators of contracted entities under section 256B.035 for persons
121.2who are enrolled in a managed care plan; or
121.3(iii) the long-term care consultation team for those who are eligible for relocation service
121.4coordination due to high-risk factors or psychological or physical disability; and
121.5(13) develop referral protocols and processes that will assist certified health care homes,
121.6Medicare home care, and hospitals to identify at-risk older adults and determine when to
121.7refer these individuals to the Senior LinkAge Line for long-term care options counseling
121.8under this section. The commissioner is directed to work with the commissioner of health
121.9to develop protocols that would comply with the health care home designation criteria and
121.10protocols available at the time of hospital discharge or the end of Medicare home care. The
121.11commissioner shall keep a record of the number of people who choose long-term care
121.12options counseling as a result of this section.
121.13(c) Nursing homes shall provide contact information to the Senior LinkAge Line for
121.14residents identified in paragraph (b), clause (12), to provide long-term care options counseling
121.15pursuant to paragraph (b), clause (11). The contact information for residents shall include
121.16all information reasonably necessary to contact residents, including first and last names,
121.17permanent and temporary addresses, telephone numbers, and e-mail addresses.
121.18(d) The Senior LinkAge Line shall determine when it is appropriate to refer a consumer
121.19who receives long-term care options counseling under paragraph (b), clause (12) or (13),
121.20and who uses an unpaid caregiver to the self-directed caregiver service under subdivision
121.2112.
121.22EFFECTIVE DATE.This section is effective July 1, 2017.

121.23    Sec. 7. Minnesota Statutes 2016, section 256.975, is amended by adding a subdivision to
121.24read:
121.25    Subd. 12. Self-directed caregiver grants. Beginning on July 1, 2019, the Minnesota
121.26Board on Aging shall administer self-directed caregiver grants to support at risk family
121.27caregivers of older adults or others eligible under the Older Americans Act of 1965, United
121.28States Code, title 42, chapter 35, sections 3001 to 3058ff, to sustain family caregivers in
121.29the caregivers' roles so older adults can remain at home longer. The board shall give priority
121.30to consumers referred under section 256.975, subdivision 7, paragraph (d).
121.31EFFECTIVE DATE.This section is effective July 1, 2017.

122.1    Sec. 8. [256.9755] CAREGIVER SUPPORT PROGRAMS.
122.2    Subdivision 1. Program goals. It is the goal of all area agencies on aging and caregiver
122.3support programs to support family caregivers of persons with Alzheimer's disease or other
122.4related dementias who are living in the community by:
122.5(1) promoting caregiver support programs that serve Minnesotans in their homes and
122.6communities; and
122.7(2) providing, within the limits of available funds, the caregiver support services that
122.8will enable the family caregiver to access caregiver support programs in the most
122.9cost-effective and efficient manner.
122.10    Subd. 2. Authority. The Minnesota Board on Aging shall allocate to area agencies on
122.11aging the state and federal funds which are received for the caregiver support program in a
122.12manner consistent with federal requirements.
122.13    Subd. 3. Caregiver support services. Funds allocated to an area agency on aging for
122.14caregiver support services must be used in a manner consistent with the National Family
122.15Caregiver Support Program to reach family caregivers of persons with Alzheimer's disease
122.16or related dementias. The funds must be used to provide social, nonmedical,
122.17community-based services and activities that provide respite for caregivers and social
122.18interaction for participants.

122.19    Sec. 9. Minnesota Statutes 2016, section 256B.0911, subdivision 3a, is amended to read:
122.20    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment, services
122.21planning, or other assistance intended to support community-based living, including persons
122.22who need assessment in order to determine waiver or alternative care program eligibility,
122.23must be visited by a long-term care consultation team within 20 calendar days after the date
122.24on which an assessment was requested or recommended. Upon statewide implementation
122.25of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
122.26requesting personal care assistance services and home care nursing. The commissioner shall
122.27provide at least a 90-day notice to lead agencies prior to the effective date of this requirement.
122.28Face-to-face assessments must be conducted according to paragraphs (b) to (i).
122.29    (b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
122.30assessors to conduct the assessment. For a person with complex health care needs, a public
122.31health or registered nurse from the team must be consulted.
122.32    (c) The MnCHOICES assessment provided by the commissioner to lead agencies must
122.33be used to complete a comprehensive, person-centered assessment. The assessment must
123.1include the health, psychological, functional, environmental, and social needs of the
123.2individual necessary to develop a community support plan that meets the individual's needs
123.3and preferences.
123.4    (d) The assessment must be conducted in a face-to-face interview with the person being
123.5assessed and the person's legal representative. At the request of the person, other individuals
123.6may participate in the assessment to provide information on the needs, strengths, and
123.7preferences of the person necessary to develop a community support plan that ensures the
123.8person's health and safety. Except for legal representatives or family members invited by
123.9the person, persons participating in the assessment may not be a provider of service or have
123.10any financial interest in the provision of services. For persons who are to be assessed for
123.11elderly waiver customized living or adult day services under section 256B.0915, with the
123.12permission of the person being assessed or the person's designated or legal representative,
123.13the client's current or proposed provider of services may submit a copy of the provider's
123.14nursing assessment or written report outlining its recommendations regarding the client's
123.15care needs. The person conducting the assessment must notify the provider of the date by
123.16which this information is to be submitted. This information shall be provided to the person
123.17conducting the assessment prior to the assessment. For a person who is to be assessed for
123.18waiver services under section 256B.092 or 256B.49, with the permission of the person being
123.19assessed or the person's designated legal representative, the person's current provider of
123.20services may submit a written report outlining recommendations regarding the person's care
123.21needs prepared by a direct service employee with at least 20 hours of service to that client.
123.22The person conducting the assessment or reassessment must notify the provider of the date
123.23by which this information is to be submitted. This information shall be provided to the
123.24person conducting the assessment and the person or the person's legal representative, and
123.25must be considered prior to the finalization of the assessment or reassessment.
123.26    (e) The person or the person's legal representative must be provided with a written
123.27community support plan within 40 calendar days of the assessment visit, regardless of
123.28whether the individual is eligible for Minnesota health care programs.
123.29    (f) For a person being assessed for elderly waiver services under section 256B.0915, a
123.30provider who submitted information under paragraph (d) shall receive a copy of the
123.31assessment, the final written community support plan when available, the case mix level,
123.32and the Residential Services Workbook.
123.33    (g) The written community support plan must include:
123.34(1) a summary of assessed needs as defined in paragraphs (c) and (d);
124.1(2) the individual's options and choices to meet identified needs, including all available
124.2options for case management services and providers;
124.3(3) identification of health and safety risks and how those risks will be addressed,
124.4including personal risk management strategies;
124.5(4) referral information; and
124.6(5) informal caregiver supports, if applicable.
124.7For a person determined eligible for state plan home care under subdivision 1a, paragraph
124.8(b), clause (1), the person or person's representative must also receive a copy of the home
124.9care service plan developed by the certified assessor.
124.10(f) (h) A person may request assistance in identifying community supports without
124.11participating in a complete assessment. Upon a request for assistance identifying community
124.12support, the person must be transferred or referred to long-term care options counseling
124.13services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
124.14telephone assistance and follow up.
124.15    (g) (i) The person has the right to make the final decision between institutional placement
124.16and community placement after the recommendations have been provided, except as provided
124.17in section 256.975, subdivision 7a, paragraph (d).
124.18    (h) (j) The lead agency must give the person receiving assessment or support planning,
124.19or the person's legal representative, materials, and forms supplied by the commissioner
124.20containing the following information:
124.21    (1) written recommendations for community-based services and consumer-directed
124.22options;
124.23(2) documentation that the most cost-effective alternatives available were offered to the
124.24individual. For purposes of this clause, "cost-effective" means community services and
124.25living arrangements that cost the same as or less than institutional care. For an individual
124.26found to meet eligibility criteria for home and community-based service programs under
124.27section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
124.28approved waiver plan for each program;
124.29(3) the need for and purpose of preadmission screening conducted by long-term care
124.30options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
124.31nursing facility placement. If the individual selects nursing facility placement, the lead
124.32agency shall forward information needed to complete the level of care determinations and
125.1screening for developmental disability and mental illness collected during the assessment
125.2to the long-term care options counselor using forms provided by the commissioner;
125.3    (4) the role of long-term care consultation assessment and support planning in eligibility
125.4determination for waiver and alternative care programs, and state plan home care, case
125.5management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
125.6and (b);
125.7    (5) information about Minnesota health care programs;
125.8    (6) the person's freedom to accept or reject the recommendations of the team;
125.9    (7) the person's right to confidentiality under the Minnesota Government Data Practices
125.10Act, chapter 13;
125.11    (8) the certified assessor's decision regarding the person's need for institutional level of
125.12care as determined under criteria established in subdivision 4e and the certified assessor's
125.13decision regarding eligibility for all services and programs as defined in subdivision 1a,
125.14paragraphs (a), clause (6), and (b); and
125.15    (9) the person's right to appeal the certified assessor's decision regarding eligibility for
125.16all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
125.17(8), and (b), and incorporating the decision regarding the need for institutional level of care
125.18or the lead agency's final decisions regarding public programs eligibility according to section
125.19256.045, subdivision 3 .
125.20    (i) (k) Face-to-face assessment completed as part of eligibility determination for the
125.21alternative care, elderly waiver, community access for disability inclusion, community
125.22alternative care, and brain injury waiver programs under sections 256B.0913, 256B.0915,
125.23and 256B.49 is valid to establish service eligibility for no more than 60 calendar days after
125.24the date of assessment.
125.25(j) (l) The effective eligibility start date for programs in paragraph (i)(k) can never be
125.26prior to the date of assessment. If an assessment was completed more than 60 days before
125.27the effective waiver or alternative care program eligibility start date, assessment and support
125.28plan information must be updated and documented in the department's Medicaid Management
125.29Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
125.30state plan services, the effective date of eligibility for programs included in paragraph (i)
125.31(k) cannot be prior to the date the most recent updated assessment is completed.
125.32(m) If an eligibility update is completed within 90 days of the previous face-to-face
125.33assessment and documented in the department's Medicaid Management Information System
126.1(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
126.2of the previous face-to-face assessment when all other eligibility requirements are met.

126.3    Sec. 10. Minnesota Statutes 2016, section 256B.0915, subdivision 3a, is amended to read:
126.4    Subd. 3a. Elderly waiver cost limits. (a) Effective on the first day of the state fiscal
126.5year in which the resident assessment system as described in section 256B.438 256R.17 for
126.6nursing home rate determination is implemented and the first day of each subsequent state
126.7fiscal year, the monthly limit for the cost of waivered services to an individual elderly waiver
126.8client shall be the monthly limit of the case mix resident class to which the waiver client
126.9would be assigned under Minnesota Rules, parts 9549.0051 to 9549.0059, in effect on the
126.10last day of the previous state fiscal year, adjusted by any legislatively adopted home and
126.11community-based services percentage rate adjustment. If a legislatively authorized increase
126.12is service-specific, the monthly cost limit shall be adjusted based on the overall average
126.13increase to the elderly waiver program.
126.14    (b) The monthly limit for the cost of waivered services under paragraph (a) to an
126.15individual elderly waiver client assigned to a case mix classification A with:
126.16(1) no dependencies in activities of daily living; or
126.17(2) up to two dependencies in bathing, dressing, grooming, walking, and eating when
126.18the dependency score in eating is three or greater as determined by an assessment performed
126.19under section 256B.0911 shall be $1,750 per month effective on July 1, 2011, for all new
126.20participants enrolled in the program on or after July 1, 2011. This monthly limit shall be
126.21applied to all other participants who meet this criteria at reassessment. This monthly limit
126.22shall be increased annually as described in paragraphs (a) and (e).
126.23(c) If extended medical supplies and equipment or environmental modifications are or
126.24will be purchased for an elderly waiver client, the costs may be prorated for up to 12
126.25consecutive months beginning with the month of purchase. If the monthly cost of a recipient's
126.26waivered services exceeds the monthly limit established in paragraph (a), (b), (d), or (e),
126.27the annual cost of all waivered services shall be determined. In this event, the annual cost
126.28of all waivered services shall not exceed 12 times the monthly limit of waivered services
126.29as described in paragraph (a), (b), (d), or (e).
126.30(d) Effective July 1, 2013, the monthly cost limit of waiver services, including any
126.31necessary home care services described in section 256B.0651, subdivision 2, for individuals
126.32who meet the criteria as ventilator-dependent given in section 256B.0651, subdivision 1,
126.33paragraph (g), shall be the average of the monthly medical assistance amount established
127.1for home care services as described in section 256B.0652, subdivision 7, and the annual
127.2average contracted amount established by the commissioner for nursing facility services
127.3for ventilator-dependent individuals. This monthly limit shall be increased annually as
127.4described in paragraphs (a) and (e).
127.5(e) Effective July 1, 2016 January 1, 2018, and each July January 1 thereafter, the monthly
127.6cost limits for elderly waiver services in effect on the previous June 30 December 31 shall
127.7be increased by the difference between any legislatively adopted home and community-based
127.8provider rate increases effective on July January 1 or since the previous July January 1 and
127.9the average statewide percentage increase in nursing facility operating payment rates under
127.10sections 256B.431, 256B.434, and 256B.441 chapter 256R, effective the previous January
127.111. This paragraph shall only apply if the average statewide percentage increase in nursing
127.12facility operating payment rates is greater than any legislatively adopted home and
127.13community-based provider rate increases effective on July January 1, or occurring since
127.14the previous July January 1.

127.15    Sec. 11. Minnesota Statutes 2016, section 256B.0915, subdivision 3e, is amended to read:
127.16    Subd. 3e. Customized living service rate. (a) Payment for customized living services
127.17shall be a monthly rate authorized by the lead agency within the parameters established by
127.18the commissioner. The payment agreement must delineate the amount of each component
127.19service included in the recipient's customized living service plan. The lead agency, with
127.20input from the provider of customized living services, shall ensure that there is a documented
127.21need within the parameters established by the commissioner for all component customized
127.22living services authorized.
127.23(b) The payment rate must be based on the amount of component services to be provided
127.24utilizing component rates established by the commissioner. Counties and tribes shall use
127.25tools issued by the commissioner to develop and document customized living service plans
127.26and rates.
127.27(c) Component service rates must not exceed payment rates for comparable elderly
127.28waiver or medical assistance services and must reflect economies of scale. Customized
127.29living services must not include rent or raw food costs.
127.30    (d) With the exception of individuals described in subdivision 3a, paragraph (b), the
127.31individualized monthly authorized payment for the customized living service plan shall not
127.32exceed 50 percent of the greater of either the statewide or any of the geographic groups'
127.33weighted average monthly nursing facility rate of the case mix resident class to which the
127.34elderly waiver eligible client would be assigned under Minnesota Rules, parts 9549.0051
128.1to 9549.0059, less the maintenance needs allowance as described in subdivision 1d, paragraph
128.2(a). Effective On July 1 of the state fiscal each year in which the resident assessment system
128.3as described in section 256B.438 for nursing home rate determination is implemented and
128.4July 1 of each subsequent state fiscal year, the individualized monthly authorized payment
128.5for the services described in this clause shall not exceed the limit which was in effect on
128.6June 30 of the previous state fiscal year updated annually based on legislatively adopted
128.7changes to all service rate maximums for home and community-based service providers.
128.8(e) For rates effective on or after January 1, 2022, the elderly waiver payment for
128.9customized living services includes a cognitive and behavioral needs factor equal to an
128.10additional 15 percent applied to the component service rates for a client:
128.11(1) for whom the total monthly hours for customized living services divided by 30.4 is
128.12less than 3.62; and
128.13(2) who is determined, based on responses to questions 45 and 51 of the Minnesota
128.14long-term care consultation assessment form, to have either:
128.15(i) wandering or orientation issues; or
128.16(ii) anxiety, verbal aggression, physical aggression, repetitive behavior, agitation,
128.17self-injurious behavior, or behavior related to property destruction.
128.18(e) Effective July 1, 2011, (f) The individualized monthly payment for the customized
128.19living service plan for individuals described in subdivision 3a, paragraph (b), must be the
128.20monthly authorized payment limit for customized living for individuals classified as case
128.21mix A, reduced by 25 percent. This rate limit must be applied to all new participants enrolled
128.22in the program on or after July 1, 2011, who meet the criteria described in subdivision 3a,
128.23paragraph (b). This monthly limit also applies to all other participants who meet the criteria
128.24described in subdivision 3a, paragraph (b), at reassessment.
128.25    (f) (g) Customized living services are delivered by a provider licensed by the Department
128.26of Health as a class A or class F home care provider and provided in a building that is
128.27registered as a housing with services establishment under chapter 144D. Licensed home
128.28care providers are subject to section 256B.0651, subdivision 14.
128.29(g) (h) A provider may not bill or otherwise charge an elderly waiver participant or their
128.30family for additional units of any allowable component service beyond those available under
128.31the service rate limits described in paragraph (d) (e), nor for additional units of any allowable
128.32component service beyond those approved in the service plan by the lead agency.
129.1(h) (i) Effective July 1, 2016 January 1, 2018, and each July January 1 thereafter,
129.2individualized service rate limits for customized living services under this subdivision shall
129.3be increased by the difference between any legislatively adopted home and community-based
129.4provider rate increases effective on July January 1 or since the previous July January 1 and
129.5the average statewide percentage increase in nursing facility operating payment rates under
129.6sections 256B.431, 256B.434, and 256B.441 chapter 256R, effective the previous January
129.71. This paragraph shall only apply if the average statewide percentage increase in nursing
129.8facility operating payment rates is greater than any legislatively adopted home and
129.9community-based provider rate increases effective on July January 1, or occurring since
129.10the previous July January 1.
129.11EFFECTIVE DATE.This section prevails over any conflicting amendment regardless
129.12of the order of enactment.

129.13    Sec. 12. Minnesota Statutes 2016, section 256B.0915, subdivision 3h, is amended to read:
129.14    Subd. 3h. Service rate limits; 24-hour customized living services. (a) The payment
129.15rate for 24-hour customized living services is a monthly rate authorized by the lead agency
129.16within the parameters established by the commissioner of human services. The payment
129.17agreement must delineate the amount of each component service included in each recipient's
129.18customized living service plan. The lead agency, with input from the provider of customized
129.19living services, shall ensure that there is a documented need within the parameters established
129.20by the commissioner for all component customized living services authorized. The lead
129.21agency shall not authorize 24-hour customized living services unless there is a documented
129.22need for 24-hour supervision.
129.23(b) For purposes of this section, "24-hour supervision" means that the recipient requires
129.24assistance due to needs related to one or more of the following:
129.25    (1) intermittent assistance with toileting, positioning, or transferring;
129.26    (2) cognitive or behavioral issues;
129.27    (3) a medical condition that requires clinical monitoring; or
129.28    (4) for all new participants enrolled in the program on or after July 1, 2011, and all other
129.29participants at their first reassessment after July 1, 2011, dependency in at least three of the
129.30following activities of daily living as determined by assessment under section 256B.0911:
129.31bathing; dressing; grooming; walking; or eating when the dependency score in eating is
129.32three or greater; and needs medication management and at least 50 hours of service per
129.33month. The lead agency shall ensure that the frequency and mode of supervision of the
130.1recipient and the qualifications of staff providing supervision are described and meet the
130.2needs of the recipient.
130.3(c) The payment rate for 24-hour customized living services must be based on the amount
130.4of component services to be provided utilizing component rates established by the
130.5commissioner. Counties and tribes will use tools issued by the commissioner to develop
130.6and document customized living plans and authorize rates.
130.7(d) Component service rates must not exceed payment rates for comparable elderly
130.8waiver or medical assistance services and must reflect economies of scale.
130.9(e) The individually authorized 24-hour customized living payments, in combination
130.10with the payment for other elderly waiver services, including case management, must not
130.11exceed the recipient's community budget cap specified in subdivision 3a. Customized living
130.12services must not include rent or raw food costs.
130.13(f) The individually authorized 24-hour customized living payment rates shall not exceed
130.14the 95 percentile of statewide monthly authorizations for 24-hour customized living services
130.15in effect and in the Medicaid management information systems on March 31, 2009, for each
130.16case mix resident class under Minnesota Rules, parts 9549.0051 to 9549.0059, to which
130.17elderly waiver service clients are assigned. When there are fewer than 50 authorizations in
130.18effect in the case mix resident class, the commissioner shall multiply the calculated service
130.19payment rate maximum for the A classification by the standard weight for that classification
130.20under Minnesota Rules, parts 9549.0051 to 9549.0059, to determine the applicable payment
130.21rate maximum. Service payment rate maximums shall be updated annually based on
130.22legislatively adopted changes to all service rates for home and community-based service
130.23providers.
130.24    (g) Notwithstanding the requirements of paragraphs (d) and (f), the commissioner may
130.25establish alternative payment rate systems for 24-hour customized living services in housing
130.26with services establishments which are freestanding buildings with a capacity of 16 or fewer,
130.27by applying a single hourly rate for covered component services provided in either:
130.28    (1) licensed corporate adult foster homes; or
130.29    (2) specialized dementia care units which meet the requirements of section 144D.065
130.30and in which:
130.31    (i) each resident is offered the option of having their own apartment; or
131.1    (ii) the units are licensed as board and lodge establishments with maximum capacity of
131.2eight residents, and which meet the requirements of Minnesota Rules, part 9555.6205,
131.3subparts 1, 2, 3, and 4, item A.
131.4(h) Twenty-four-hour customized living services are delivered by a provider licensed
131.5by the Department of Health as a class A or class F home care provider and provided in a
131.6building that is registered as a housing with services establishment under chapter 144D.
131.7Licensed home care providers are subject to section 256B.0651, subdivision 14.
131.8(i) A provider may not bill or otherwise charge an elderly waiver participant or their
131.9family for additional units of any allowable component service beyond those available under
131.10the service rate limits described in paragraph (e), nor for additional units of any allowable
131.11component service beyond those approved in the service plan by the lead agency.
131.12(j) Effective July 1, 2016 January 1, 2018, and each July January 1 thereafter,
131.13individualized service rate limits for 24-hour customized living services under this
131.14subdivision shall be increased by the difference between any legislatively adopted home
131.15and community-based provider rate increases effective on July January 1 or since the previous
131.16July January 1 and the average statewide percentage increase in nursing facility operating
131.17payment rates under sections 256B.431, 256B.434, and 256B.441 chapter 256R, effective
131.18the previous January 1. This paragraph shall only apply if the average statewide percentage
131.19increase in nursing facility operating payment rates is greater than any legislatively adopted
131.20home and community-based provider rate increases effective on July January 1, or occurring
131.21since the previous July January 1.

131.22    Sec. 13. Minnesota Statutes 2016, section 256B.0915, subdivision 5, is amended to read:
131.23    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client shall
131.24receive an initial assessment of strengths, informal supports, and need for services in
131.25accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a client
131.26served under the elderly waiver must be conducted at least every 12 months and at other
131.27times when the case manager determines that there has been significant change in the client's
131.28functioning. This may include instances where the client is discharged from the hospital.
131.29There must be a determination that the client requires nursing facility level of care as defined
131.30in section 256B.0911, subdivision 4e, at initial and subsequent assessments to initiate and
131.31maintain participation in the waiver program.
131.32(b) Regardless of other assessments identified in section 144.0724, subdivision 4, as
131.33appropriate to determine nursing facility level of care for purposes of medical assistance
131.34payment for nursing facility services, only face-to-face assessments conducted according
132.1to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility level of care
132.2determination will be accepted for purposes of initial and ongoing access to waiver service
132.3payment.
132.4(c) The lead agency shall conduct a change-in-condition reassessment before the annual
132.5reassessment in cases where a client's condition changed due to a major health event, an
132.6emerging need or risk, worsening health condition, or cases where the current services do
132.7not meet the client's needs. A change-in-condition reassessment may be initiated by the lead
132.8agency, or it may be requested by the client or requested on the client's behalf by another
132.9party, such as a provider of services. The lead agency shall complete a change-in-condition
132.10reassessment no later than 20 calendar days from the request. The lead agency shall conduct
132.11these assessments in a timely manner and expedite urgent requests. The lead agency shall
132.12evaluate urgent requests based on the client's needs and risk to the client if a reassessment
132.13is not completed.

132.14    Sec. 14. Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
132.15to read:
132.16    Subd. 11. Payment rates; application. The payment methodologies in subdivisions 12
132.17to 16 apply to elderly waiver and elderly waiver customized living under this section,
132.18alternative care under section 256B.0913, essential community supports under section
132.19256B.0922, and community access for disability inclusion customized living, brain injury
132.20customized living, and elderly waiver foster care and residential care.

132.21    Sec. 15. Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
132.22to read:
132.23    Subd. 12. Payment rates; phase-in. (a) Effective January 1, 2019, through December
132.2431, 2020, all rates and rate components for services under subdivision 11 shall be the sum
132.25of 12 percent of the rates calculated under subdivisions 13 to 16 and 88 percent of the rates
132.26calculated using the rate methodology in effect as of June 30, 2017.
132.27(b) Effective January 1, 2021, all rates and rate components for services under subdivision
132.2811 shall be the sum of 20 percent of the rates calculated under subdivisions 13 to 16 and 80
132.29percent of the rates calculated using the rate methodology in effect as of June 30, 2017.

133.1    Sec. 16. Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
133.2to read:
133.3    Subd. 13. Payment rates; establishment. (a) The commissioner shall use standard
133.4occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
133.5the most recent edition of the Occupational Handbook and data from the most recent and
133.6available nursing facility cost report, to establish rates and component rates every January
133.71 using Minnesota-specific wages taken from job descriptions.
133.8(b) In creating the rates and component rates, the commissioner shall establish a base
133.9wage calculation for each component service and value, and add the following factors:
133.10(1) payroll taxes and benefits;
133.11(2) general and administrative;
133.12(3) program plan support;
133.13(4) registered nurse management and supervision; and
133.14(5) social worker supervision.

133.15    Sec. 17. Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
133.16to read:
133.17    Subd. 14. Payment rates; base wage index. (a) Base wages are calculated for customized
133.18living, foster care, and residential care component services as follows:
133.19(1) the home management and support services base wage equals 33.33 percent of the
133.20Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
133.21care aide (SOC code 39-9021); 33.33 percent of the Minneapolis-St. Paul-Bloomington,
133.22MN-WI MetroSA average wage for food preparation workers (SOC code 35-2021); and
133.2333.34 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage
133.24for maids and housekeeping cleaners (SOC code 37-2012);
133.25(2) the home care aide base wage equals 50 percent of the Minneapolis-St.
133.26Paul-Bloomington, MN-WI MetroSA average wage for home health aides (SOC code
133.2731-1011); and 50 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
133.28average wage for nursing assistants (SOC code 31-1014);
133.29(3) the home health aide base wage equals 20 percent of the Minneapolis-St.
133.30Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
133.31vocational nurses (SOC code 29-2061); and 80 percent of the Minneapolis-St.
134.1Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
134.231-1014); and
134.3(4) the medication setups by licensed practical nurse base wage equals ten percent of
134.4the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
134.5and licensed vocational nurses (SOC code 29-2061); and 90 percent of the Minneapolis-St.
134.6Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
134.729-1141).
134.8(b) Base wages are calculated for the following services as follows:
134.9(1) the chore services base wage equals 100 percent of the Minneapolis-St.
134.10Paul-Bloomington, MN-WI MetroSA average wage for landscaping and groundskeeping
134.11workers (SOC code 37-3011);
134.12(2) the companion services base wage equals 50 percent of the Minneapolis-St.
134.13Paul-Bloomington, MN-WI MetroSA average wage for personal and home care aides (SOC
134.14code 39-9021); and 50 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
134.15average wage for maids and housekeeping cleaners (SOC code 37-2012);
134.16(3) the homemaker services and assistance with personal care base wage equals 60
134.17percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
134.18personal and home care aide (SOC code 39-9021); 20 percent of the Minneapolis-St.
134.19Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
134.2031-1014); and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
134.21average wage for maids and housekeeping cleaners (SOC code 37-2012);
134.22(4) the homemaker services and cleaning base wage equals 60 percent of the
134.23Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
134.24care aide (SOC code 39-9021); 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
134.25MetroSA average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
134.26Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
134.27housekeeping cleaners (SOC code 37-2012);
134.28(5) the homemaker services and home management base wage equals 60 percent of the
134.29Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for personal and home
134.30care aide (SOC code 39-9021); 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
134.31MetroSA average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
134.32Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
134.33housekeeping cleaners (SOC code 37-2012);
135.1(6) the in-home respite care services base wage equals five percent of the Minneapolis-St.
135.2Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
135.329-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
135.4wage for nursing assistants (SOC code 31-1014); and 20 percent of the Minneapolis-St.
135.5Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
135.6vocational nurses (SOC code 29-2061);
135.7(7) the out-of-home respite care services base wage equals five percent of the
135.8Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for registered nurses
135.9(SOC code 29-1141); 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
135.10average wage for nursing assistants (SOC code 31-1014); and 20 percent of the
135.11Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
135.12and licensed vocational nurses (SOC code 29-2061); and
135.13(8) the individual community living support base wage equals 20 percent of the
135.14Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
135.15and licensed vocational nurses (SOC code 29-2061); and 80 percent of the Minneapolis-St.
135.16Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
135.1731-1014).
135.18(c) Base wages are calculated for the following values as follows:
135.19(1) the registered nurse base wage equals 100 percent of the Minneapolis-St.
135.20Paul-Bloomington, MN-WI MetroSA average wage for registered nurses (SOC code
135.2129-1141); and
135.22(2) the social worker base wage equals 100 percent of the Minneapolis-St.
135.23Paul-Bloomington, MN-WI MetroSA average wage for medical and public health social
135.24workers (SOC code 21-1022).
135.25(d) If any of the SOC codes and positions are no longer available, the commissioner
135.26shall, in consultation with stakeholders, select a new SOC code and position that is the
135.27closest match to the previously used SOC position.

135.28    Sec. 18. Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
135.29to read:
135.30    Subd. 15. Payment rates; factors. The commissioner shall use the following factors:
135.31(1) the payroll taxes and benefits factor is the sum of net payroll taxes and benefits
135.32divided by the sum of all salaries for all nursing facilities on the most recent and available
135.33cost report;
136.1(2) the general and administrative factor is the sum of net general and administrative
136.2expenses minus administrative salaries divided by total operating expenses for all nursing
136.3facilities on the most recent and available cost report;
136.4(3) the program plan support factor is defined as the direct service staff needed to provide
136.5support for the home and community-based service when not engaged in direct contact with
136.6clients. Based on the 2016 Non-Wage Provider Costs in Home and Community-Based
136.7Disability Waiver Services Report, this factor equals 12.8 percent;
136.8(4) the registered nurse management and supervision factor equals 15 percent of the
136.9product of the position's base wage and the sum of the factors in clauses (1) to (3); and
136.10(5) the social worker supervision factor equals 15 percent of the product of the position's
136.11base wage and the sum of the factors in clauses (1) to (3).

136.12    Sec. 19. Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
136.13to read:
136.14    Subd. 16. Payment rates; component rates. (a) For the purposes of this subdivision,
136.15the "adjusted base wage" for a position equals the position's base wage plus:
136.16(1) the position's base wage multiplied by the payroll taxes and benefits factor;
136.17(2) the position's base wage multiplied by the general and administrative factor; and
136.18(3) the position's base wage multiplied by the program plan support factor.
136.19(b) For medication setups by licensed nurse, registered nurse, and social worker services,
136.20the component rate for each service equals the respective position's adjusted base wage.
136.21(c) For home management and support services, home care aide, and home health aide
136.22services, the component rate for each service equals the respective position's adjusted base
136.23wage plus the registered nurse management and supervision factor.
136.24(d) The home management and support services component rate shall be used for payment
136.25for socialization and transportation component rates under elderly waiver customized living.
136.26(e) The 15-minute unit rates for chore services and companion services are calculated
136.27as follows:
136.28(1) sum the adjusted base wage for the respective position and the social worker factor;
136.29and
136.30(2) divide the result of clause (1) by four.
137.1(f) The 15-minute unit rates for homemaker services and assistance with personal care,
137.2homemaker services and cleaning, and homemaker services and home management are
137.3calculated as follows:
137.4(1) sum the adjusted base wage for the respective position and the registered nurse
137.5management and supervision factor; and
137.6(2) divide the result of clause (1) by four.
137.7(g) The 15-minute unit rate for in-home respite care services is calculated as follows:
137.8(1) sum the adjusted base wage for in-home respite care services and the registered nurse
137.9management and supervision factor; and
137.10(2) divide the result of clause (1) by four.
137.11(h) The in-home respite care services daily rate equals the in-home respite care services
137.1215-minute unit rate multiplied by 18.
137.13(i) The 15-minute unit rate for out-of-home respite care is calculated as follows:
137.14(1) sum the out-of-home respite care services adjusted base wage and the registered
137.15nurse management and supervision factor; and
137.16(2) divide the result of clause (1) by four.
137.17(j) The out-of-home respite care services daily rate equals the out-of-home respite care
137.18services 15-minute unit rate multiplied by 18.
137.19(k) The individual community living support rate is calculated as follows:
137.20(1) sum the adjusted base wage for the home care aide rate in subdivision 14, paragraph
137.21(a), clause (2), and the social worker factor; and
137.22(2) divide the result of clause (1) by four.
137.23(l) The home delivered meals rate equals $9.30. Beginning July 1, 2018, the commissioner
137.24shall increase the home delivered meals rate every July 1 by the percent increase in the
137.25nursing facility dietary per diem using the two most recent nursing facility cost reports.
137.26(m) The adult day services rate is based on the home care aide rate in subdivision 14,
137.27paragraph (a), clause (2), plus the additional factors from subdivision 15, except that the
137.28general and administrative factor used shall be 20 percent. The nonregistered nurse portion
137.29of the rate shall be multiplied by 0.25, to reflect an assumed-ratio staffing of one caregiver
137.30to four clients, and divided by four to determine the 15-minute unit rate. The registered
138.1nurse portion is divided by four to determine the 15-minute unit rate and $0.63 per 15-minute
138.2unit is added to cover the cost of meals.
138.3(n) The adult day services bath 15-minute unit rate is the same as the calculation of the
138.4adult day services 15-minute unit rate without the adjustment for staffing ratio.
138.5(o) If a bath is authorized for an adult day services client, at least two 15-minute units
138.6must be authorized to allow for adequate time to meet client needs. Adult day services may
138.7be authorized for up to 48 units, or 12 hours, per day based on client and family caregiver
138.8needs.

138.9    Sec. 20. Minnesota Statutes 2016, section 256B.0915, is amended by adding a subdivision
138.10to read:
138.11    Subd. 17. Evaluation of rate methodology. The commissioner, in consultation with
138.12stakeholders, shall conduct a study to evaluate the following:
138.13(1) base wages in subdivision 14, to determine if the standard occupational classification
138.14codes for each rate and component rate are an appropriate representation of staff who deliver
138.15the services; and
138.16(2) factors in subdivision 15, and adjusted base wage calculation in subdivision 16, to
138.17determine if the factors and calculations appropriately address nonwage provider costs.
138.18By January 1, 2019, the commissioner shall submit a report to the legislature on the
138.19changes to the rate methodology in this statute, based on the results of the evaluation. Where
138.20feasible, the report shall address the impact of the new rates on the workforce situation and
138.21client access to services. The report should include any changes to the rate calculations
138.22methods that the commissioner recommends.

138.23    Sec. 21. Minnesota Statutes 2016, section 256B.0922, subdivision 1, is amended to read:
138.24    Subdivision 1. Essential community supports. (a) The purpose of the essential
138.25community supports program is to provide targeted services to persons age 65 and older
138.26who need essential community support, but whose needs do not meet the level of care
138.27required for nursing facility placement under section 144.0724, subdivision 11.
138.28(b) Essential community supports are available not to exceed $400 $600 per person per
138.29month. Essential community supports may be used as authorized within an authorization
138.30period not to exceed 12 months. Services must be available to a person who:
138.31(1) is age 65 or older;
139.1(2) is not eligible for medical assistance;
139.2(3) has received a community assessment under section 256B.0911, subdivision 3a or
139.33b, and does not require the level of care provided in a nursing facility;
139.4(4) meets the financial eligibility criteria for the alternative care program under section
139.5256B.0913, subdivision 4 ;
139.6(5) has a community support plan; and
139.7(6) has been determined by a community assessment under section 256B.0911,
139.8subdivision 3a or 3b, to be a person who would require provision of at least one of the
139.9following services, as defined in the approved elderly waiver plan, in order to maintain their
139.10community residence:
139.11(i) adult day services;
139.12(ii) family caregiver support services;
139.13(iii) respite care;
139.14(iii) (iv) homemaker support;
139.15(v) companion services;
139.16(iv) (vi) chores;
139.17(v) (vii) a personal emergency response device or system;
139.18(vi) (viii) home-delivered meals; or
139.19(vii) (ix) community living assistance as defined by the commissioner.
139.20(c) The person receiving any of the essential community supports in this subdivision
139.21must also receive service coordination, not to exceed $600 in a 12-month authorization
139.22period, as part of their community support plan.
139.23(d) A person who has been determined to be eligible for essential community supports
139.24must be reassessed at least annually and continue to meet the criteria in paragraph (b) to
139.25remain eligible for essential community supports.
139.26(e) The commissioner is authorized to use federal matching funds for essential community
139.27supports as necessary and to meet demand for essential community supports as outlined in
139.28subdivision 2, and that amount of federal funds is appropriated to the commissioner for this
139.29purpose.

140.1    Sec. 22. Minnesota Statutes 2016, section 256B.431, subdivision 10, is amended to read:
140.2    Subd. 10. Property rate adjustments and construction projects. A nursing facility
140.3completing a construction project that is eligible for a rate adjustment under section
140.4256B.434, subdivision 4f , and that was not approved through the moratorium exception
140.5process in section 144A.073 must request from the commissioner a property-related payment
140.6rate adjustment. If the request is made within 60 days after the construction project's
140.7completion date, The effective date of the rate adjustment is the first of the month of January
140.8or July, whichever occurs first following both the construction project's completion date
140.9and submission of the provider's rate adjustment request. If the request is made more than
140.1060 days after the completion date, the rate adjustment is effective on the first of the month
140.11following the request. The commissioner shall provide a rate notice reflecting the allowable
140.12costs within 60 days after receiving all the necessary information to compute the rate
140.13adjustment. No sooner than the effective date of the rate adjustment for the construction
140.14project, a nursing facility may adjust its rates by the amount anticipated to be allowed. Any
140.15amounts collected from private pay residents in excess of the allowable rate must be repaid
140.16to private pay residents with interest at the rate used by the commissioner of revenue for
140.17the late payment of taxes and in effect on the date the rate increase is effective. Construction
140.18projects with completion dates within one year of the completion date associated with the
140.19property rate adjustment request and phased projects with project completion dates within
140.20three years of the last phase of the phased project must be aggregated for purposes of the
140.21minimum thresholds in subdivisions 16 and 17, and the maximum threshold in section
140.22144A.071, subdivision 2 . "Construction project" and "project construction costs" have the
140.23meanings given them in Minnesota Statutes, section 144A.071, subdivision 1a.
140.24EFFECTIVE DATE.This section is effective for projects completed after January 1,
140.252018.

140.26    Sec. 23. Minnesota Statutes 2016, section 256B.431, subdivision 16, is amended to read:
140.27    Subd. 16. Major additions and replacements; equity incentive. For rate years beginning
140.28after June 30, 1993, if a nursing facility acquires capital assets in connection with a project
140.29approved under the moratorium exception process in section 144A.073 or in connection
140.30with an addition to or replacement of buildings, attached fixtures, or land improvements
140.31for which the total historical cost of those capital asset additions exceeds the lesser of
140.32$150,000 or ten percent of the most recent appraised value, the nursing facility shall be
140.33eligible for an equity incentive payment rate as in paragraphs (a) to (d). This computation
141.1is separate from the determination of the nursing facility's rental rate. An equity incentive
141.2payment rate as computed under this subdivision is limited to one in a 12-month period.
141.3(a) An eligible nursing facility shall receive an equity incentive payment rate equal to
141.4the allowable historical cost of the capital asset acquired, minus the allowable debt directly
141.5identified to that capital asset, multiplied by the equity incentive factor as described in
141.6paragraphs (b) and (c), and divided by the nursing facility's occupancy factor under
141.7subdivision 3f, paragraph (c). This amount shall be added to the nursing facility's total
141.8payment rate and shall be effective the same day as the incremental increase in paragraph
141.9(d) or subdivision 17. The allowable historical cost of the capital assets and the allowable
141.10debt shall be determined as provided in Minnesota Rules, parts 9549.0010 to 9549.0080,
141.11and this section.
141.12(b) The equity incentive factor shall be determined under clauses (1) to (4):
141.13(1) divide the initial allowable debt in paragraph (a) by the initial historical cost of the
141.14capital asset additions referred to in paragraph (a), then cube the quotient,
141.15(2) subtract the amount calculated in clause (1) from the number one,
141.16(3) determine the difference between the rental factor and the lesser of two percentage
141.17points above the posted yield for standard conventional fixed rate mortgages of the Federal
141.18Home Loan Mortgage Corporation as published in the Wall Street Journal and in effect on
141.19the first day of the month the debt or cost is incurred, or 16 percent,
141.20(4) multiply the amount calculated in clause (2) by the amount calculated in clause (3).
141.21(c) The equity incentive payment rate shall be limited to the term of the allowable debt
141.22in paragraph (a), not greater than 20 years nor less than ten years. If no debt is incurred in
141.23acquiring the capital asset, the equity incentive payment rate shall be paid for ten years. The
141.24sale of a nursing facility under subdivision 14 shall terminate application of the equity
141.25incentive payment rate effective on the date provided in subdivision 14, paragraph (f), for
141.26the sale.
141.27(d) A nursing facility with an addition to or a renovation of its buildings, attached fixtures,
141.28or land improvements meeting the criteria in this subdivision and not receiving the
141.29property-related payment rate adjustment in subdivision 17, shall receive the incremental
141.30increase in the nursing facility's rental rate as determined under Minnesota Rules, parts
141.319549.0010 to 9549.0080, and this section. The incremental increase shall be added to the
141.32nursing facility's property-related payment rate. The effective date of this incremental
142.1increase shall be the first day of the month of January or July, whichever occurs first
142.2following the month in date on which the addition or replacement is completed.
142.3EFFECTIVE DATE.This section is effective for additions or replacements completed
142.4after January 1, 2018.

142.5    Sec. 24. Minnesota Statutes 2016, section 256B.431, subdivision 30, is amended to read:
142.6    Subd. 30. Bed layaway and delicensure. (a) For rate years beginning on or after July
142.71, 2000, a nursing facility reimbursed under this section which has placed beds on layaway
142.8shall, for purposes of application of the downsizing incentive in subdivision 3a, paragraph
142.9(c), and calculation of the rental per diem, have those beds given the same effect as if the
142.10beds had been delicensed so long as the beds remain on layaway. At the time of a layaway,
142.11a facility may change its single bed election for use in calculating capacity days under
142.12Minnesota Rules, part 9549.0060, subpart 11. The property payment rate increase shall be
142.13effective the first day of the month of January or July, whichever occurs first following the
142.14month in date on which the layaway of the beds becomes effective under section 144A.071,
142.15subdivision 4b
.
142.16(b) For rate years beginning on or after July 1, 2000, notwithstanding any provision to
142.17the contrary under section 256B.434, a nursing facility reimbursed under that section which
142.18that has placed beds on layaway shall, for so long as the beds remain on layaway, be allowed
142.19to:
142.20(1) aggregate the applicable investment per bed limits based on the number of beds
142.21licensed immediately prior to entering the alternative payment system;
142.22(2) retain or change the facility's single bed election for use in calculating capacity days
142.23under Minnesota Rules, part 9549.0060, subpart 11; and
142.24(3) establish capacity days based on the number of beds immediately prior to the layaway
142.25and the number of beds after the layaway.
142.26    The commissioner shall increase the facility's property payment rate by the incremental
142.27increase in the rental per diem resulting from the recalculation of the facility's rental per
142.28diem applying only the changes resulting from the layaway of beds and clauses (1), (2), and
142.29(3). If a facility reimbursed under section 256B.434 completes a moratorium exception
142.30project after its base year, the base year property rate shall be the moratorium project property
142.31rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
142.32paragraph (c). The property payment rate increase shall be effective the first day of the
143.1month of January or July, whichever occurs first following the month in date on which the
143.2layaway of the beds becomes effective.
143.3(c) If a nursing facility removes a bed from layaway status in accordance with section
143.4144A.071, subdivision 4b , the commissioner shall establish capacity days based on the
143.5number of licensed and certified beds in the facility not on layaway and shall reduce the
143.6nursing facility's property payment rate in accordance with paragraph (b).
143.7(d) For the rate years beginning on or after July 1, 2000, notwithstanding any provision
143.8to the contrary under section 256B.434, a nursing facility reimbursed under that section,
143.9which that has delicensed beds after July 1, 2000, by giving notice of the delicensure to the
143.10commissioner of health according to the notice requirements in section 144A.071, subdivision
143.114b
, shall be allowed to:
143.12(1) aggregate the applicable investment per bed limits based on the number of beds
143.13licensed immediately prior to entering the alternative payment system;
143.14(2) retain or change the facility's single bed election for use in calculating capacity days
143.15under Minnesota Rules, part 9549.0060, subpart 11; and
143.16(3) establish capacity days based on the number of beds immediately prior to the
143.17delicensure and the number of beds after the delicensure.
143.18    The commissioner shall increase the facility's property payment rate by the incremental
143.19increase in the rental per diem resulting from the recalculation of the facility's rental per
143.20diem applying only the changes resulting from the delicensure of beds and clauses (1), (2),
143.21and (3). If a facility reimbursed under section 256B.434 completes a moratorium exception
143.22project after its base year, the base year property rate shall be the moratorium project property
143.23rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
143.24paragraph (c). The property payment rate increase shall be effective the first day of the
143.25month of January or July, whichever occurs first following the month in date on which the
143.26delicensure of the beds becomes effective.
143.27(e) For nursing facilities reimbursed under this section or section 256B.434, any beds
143.28placed on layaway shall not be included in calculating facility occupancy as it pertains to
143.29leave days defined in Minnesota Rules, part 9505.0415.
143.30(f) For nursing facilities reimbursed under this section or section 256B.434, the rental
143.31rate calculated after placing beds on layaway may not be less than the rental rate prior to
143.32placing beds on layaway.
144.1(g) A nursing facility receiving a rate adjustment as a result of this section shall comply
144.2with section 256B.47, subdivision 2 256R.06, subdivision 5.
144.3(h) A facility that does not utilize the space made available as a result of bed layaway
144.4or delicensure under this subdivision to reduce the number of beds per room or provide
144.5more common space for nursing facility uses or perform other activities related to the
144.6operation of the nursing facility shall have its property rate increase calculated under this
144.7subdivision reduced by the ratio of the square footage made available that is not used for
144.8these purposes to the total square footage made available as a result of bed layaway or
144.9delicensure.
144.10EFFECTIVE DATE.This section is effective for layaways occurring after July 1, 2017.

144.11    Sec. 25. Minnesota Statutes 2016, section 256B.434, subdivision 4, is amended to read:
144.12    Subd. 4. Alternate rates for nursing facilities. Effective for the rate years beginning
144.13on and after January 1, 2019, a nursing facility's case mix property payment rates rate for
144.14the second and subsequent years of a facility's contract under this section are the previous
144.15rate year's contract property payment rates rate plus an inflation adjustment and, for facilities
144.16reimbursed under this section or section 256B.431, an adjustment to include the cost of any
144.17increase in Health Department licensing fees for the facility taking effect on or after July
144.181, 2001. The index for the inflation adjustment must be based on the change in the Consumer
144.19Price Index-All Items (United States City average) (CPI-U) forecasted by the commissioner
144.20of management and budget's national economic consultant Reports and Forecasts Division
144.21of the Department of Human Services, as forecasted in the fourth quarter of the calendar
144.22year preceding the rate year. The inflation adjustment must be based on the 12-month period
144.23from the midpoint of the previous rate year to the midpoint of the rate year for which the
144.24rate is being determined. For the rate years beginning on July 1, 1999, July 1, 2000, July 1,
144.252001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007, July
144.261, 2008, October 1, 2009, and October 1, 2010, this paragraph shall apply only to the
144.27property-related payment rate. For the rate years beginning on October 1, 2011, October 1,
144.282012, October 1, 2013, October 1, 2014, October 1, 2015, January 1, 2016, and January 1,
144.292017, the rate adjustment under this paragraph shall be suspended. Beginning in 2005,
144.30adjustment to the property payment rate under this section and section 256B.431 shall be
144.31effective on October 1. In determining the amount of the property-related payment rate
144.32adjustment under this paragraph, the commissioner shall determine the proportion of the
144.33facility's rates that are property-related based on the facility's most recent cost report.
144.34EFFECTIVE DATE.This section is effective the day following final enactment.

145.1    Sec. 26. Minnesota Statutes 2016, section 256B.434, subdivision 4f, is amended to read:
145.2    Subd. 4f. Construction project rate adjustments effective October 1, 2006. (a)
145.3Effective October 1, 2006, facilities reimbursed under this section may receive a property
145.4rate adjustment for construction projects exceeding the threshold in section 256B.431,
145.5subdivision 16, and below the threshold in section 144A.071, subdivision 2, clause (a). For
145.6these projects, capital assets purchased shall be counted as construction project costs for a
145.7rate adjustment request made by a facility if they are: (1) purchased within 24 months of
145.8the completion of the construction project; (2) purchased after the completion date of any
145.9prior construction project; and (3) are not purchased prior to July 14, 2005. Except as
145.10otherwise provided in this subdivision, the definitions, rate calculation methods, and
145.11principles in sections 144A.071 and 256B.431 and Minnesota Rules, parts 9549.0010 to
145.129549.0080, shall be used to calculate rate adjustments for allowable construction projects
145.13under this subdivision and section 144A.073. Facilities completing construction projects
145.14between October 1, 2005, and October 1, 2006, are eligible to have a property rate adjustment
145.15effective October 1, 2006. Facilities completing projects after October 1, 2006, are eligible
145.16for a property rate adjustment effective on the first day of the month following the completion
145.17date. Facilities completing projects after January 1, 2018, are eligible for a property rate
145.18adjustment effective on the first day of the month of January or July, whichever occurs
145.19immediately following the completion date.
145.20(b) Notwithstanding subdivision 18, as of July 14, 2005, facilities with rates set under
145.21section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, that commenced a
145.22construction project on or after October 1, 2004, and do not have a contract under subdivision
145.233 by September 30, 2006, are eligible to request a rate adjustment under section 256B.431,
145.24subdivision 10, through September 30, 2006. If the request results in the commissioner
145.25determining a rate adjustment is allowable, the rate adjustment is effective on the first of
145.26the month following project completion. These facilities shall be allowed to accumulate
145.27construction project costs for the period October 1, 2004, to September 30, 2006.
145.28(c) Facilities shall be allowed construction project rate adjustments no sooner than 12
145.29months after completing a previous construction project. Facilities must request the rate
145.30adjustment according to section 256B.431, subdivision 10.
145.31(d) Capacity days shall be computed according to Minnesota Rules, part 9549.0060,
145.32subpart 11. For rate calculations under this section, the number of licensed beds in the
145.33nursing facility shall be the number existing after the construction project is completed and
145.34the number of days in the nursing facility's reporting period shall be 365.
146.1(e) The value of assets to be recognized for a total replacement project as defined in
146.2section 256B.431, subdivision 17d, shall be computed as described in clause (1). The value
146.3of assets to be recognized for all other projects shall be computed as described in clause
146.4(2).
146.5(1) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
146.6number of beds allowed under subdivision 3a, paragraph (c), shall be used to compute the
146.7maximum amount of assets allowable in a facility's property rate calculation. If a facility's
146.8current request for a rate adjustment results from the completion of a construction project
146.9that was previously approved under section 144A.073, the assets to be used in the rate
146.10calculation cannot exceed the lesser of the amount determined under sections 144A.071,
146.11subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction
146.12project. A current request that is not the result of a project under section 144A.073 cannot
146.13exceed the limit under section 144A.071, subdivision 2, paragraph (a). Applicable credits
146.14must be deducted from the cost of the construction project.
146.15(2)(i) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
146.16number of beds allowed under section 256B.431, subdivision 3a, paragraph (c), shall be
146.17used to compute the maximum amount of assets allowable in a facility's property rate
146.18calculation.
146.19(ii) The value of a facility's assets to be compared to the amount in item (i) begins with
146.20the total appraised value from the last rate notice a facility received when its rates were set
146.21under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080. This value
146.22shall be indexed by the factor in section 256B.431, subdivision 3f, paragraph (a), for each
146.23rate year the facility received an inflation factor on its property-related rate when its rates
146.24were set under this section. The value of assets listed as previous capital additions, capital
146.25additions, and special projects on the facility's base year rate notice and the value of assets
146.26related to a construction project for which the facility received a rate adjustment when its
146.27rates were determined under this section shall be added to the indexed appraised value.
146.28(iii) The maximum amount of assets to be recognized in computing a facility's rate
146.29adjustment after a project is completed is the lesser of the aggregate replacement-cost-new
146.30limit computed in (i) minus the assets recognized in (ii) or the actual allowable costs of the
146.31construction project.
146.32(iv) If a facility's current request for a rate adjustment results from the completion of a
146.33construction project that was previously approved under section 144A.073, the assets to be
146.34added to the rate calculation cannot exceed the lesser of the amount determined under
147.1sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable
147.2costs of the construction project. A current request that is not the result of a project under
147.3section 144A.073 cannot exceed the limit stated in section 144A.071, subdivision 2,
147.4paragraph (a). Assets disposed of as a result of a construction project and applicable credits
147.5must be deducted from the cost of the construction project.
147.6(f) For construction projects approved under section 144A.073, allowable debt may
147.7never exceed the lesser of the cost of the assets purchased, the threshold limit in section
147.8144A.071 , subdivision 2, or the replacement-cost-new limit less previously existing capital
147.9debt.
147.10(g) For construction projects that were not approved under section 144A.073, allowable
147.11debt is limited to the lesser of the threshold in section 144A.071, subdivision 2, for such
147.12construction projects or the applicable limit in paragraph (e), clause (1) or (2), less previously
147.13existing capital debt. Amounts of debt taken out that exceed the costs of a construction
147.14project shall not be allowed regardless of the use of the funds.
147.15For all construction projects being recognized, interest expense and average debt shall
147.16be computed based on the first 12 months following project completion. "Previously existing
147.17capital debt" means capital debt recognized on the last rate determined under section
147.18256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, and the amount of debt
147.19recognized for a construction project for which the facility received a rate adjustment when
147.20its rates were determined under this section.
147.21For a total replacement project as defined in section 256B.431, subdivision 17d, the
147.22value of previously existing capital debt shall be zero.
147.23(h) In addition to the interest expense allowed from the application of paragraph (f), the
147.24amounts allowed under section 256B.431, subdivision 17a, paragraph (a), clauses (2) and
147.25(3), will be added to interest expense.
147.26(i) The equity portion of the construction project shall be computed as the allowable
147.27assets in paragraph (e), less the average debt in paragraph (f). The equity portion must be
147.28multiplied by 5.66 percent and the allowable interest expense in paragraph (f) must be added.
147.29This sum must be divided by 95 percent of capacity days to compute the construction project
147.30rate adjustment.
147.31(j) For projects that are not a total replacement of a nursing facility, the amount in
147.32paragraph (i) is adjusted for nonreimbursable areas and then added to the current property
147.33payment rate of the facility.
148.1(k) For projects that are a total replacement of a nursing facility, the amount in paragraph
148.2(i) becomes the new property payment rate after being adjusted for nonreimbursable areas.
148.3Any amounts existing in a facility's rate before the effective date of the construction project
148.4for equity incentives under section 256B.431, subdivision 16; capital repairs and replacements
148.5under section 256B.431, subdivision 15; or refinancing incentives under section 256B.431,
148.6subdivision 19, shall be removed from the facility's rates.
148.7(l) No additional equipment allowance is allowed under Minnesota Rules, part 9549.0060,
148.8subpart 10, as the result of construction projects under this section. Allowable equipment
148.9shall be included in the construction project costs.
148.10(m) Capital assets purchased after the completion date of a construction project shall be
148.11counted as construction project costs for any future rate adjustment request made by a facility
148.12under section 144A.071, subdivision 2, clause (a), if they are purchased within 24 months
148.13of the completion of the future construction project.
148.14(n) In subsequent rate years, the property payment rate for a facility that results from
148.15the application of this subdivision shall be the amount inflated in subdivision 4.
148.16(o) Construction projects are eligible for an equity incentive under section 256B.431,
148.17subdivision 16. When computing the equity incentive for a construction project under this
148.18subdivision, only the allowable costs and allowable debt related to the construction project
148.19shall be used. The equity incentive shall not be a part of the property payment rate and not
148.20inflated under subdivision 4. Effective October 1, 2006, all equity incentives for nursing
148.21facilities reimbursed under this section shall be allowed for a duration determined under
148.22section 256B.431, subdivision 16, paragraph (c).
148.23EFFECTIVE DATE.This section is effective January 1, 2018.

148.24    Sec. 27. Minnesota Statutes 2016, section 256B.50, subdivision 1b, is amended to read:
148.25    Subd. 1b. Filing an appeal. To appeal, the provider shall file with the commissioner a
148.26written notice of appeal; the appeal must be postmarked or received by the commissioner
148.27within 60 days of the publication date the determination of the payment rate was mailed or
148.28personally received by a provider, whichever is earlier printed on the rate notice. The notice
148.29of appeal must specify each disputed item; the reason for the dispute; the total dollar amount
148.30in dispute for each separate disallowance, allocation, or adjustment of each cost item or part
148.31of a cost item; the computation that the provider believes is correct; the authority in statute
148.32or rule upon which the provider relies for each disputed item; the name and address of the
149.1person or firm with whom contacts may be made regarding the appeal; and other information
149.2required by the commissioner.
149.3EFFECTIVE DATE.This section is effective the day following final enactment.

149.4    Sec. 28. Minnesota Statutes 2016, section 256B.5012, is amended by adding a subdivision
149.5to read:
149.6    Subd. 3a. Therapeutic leave days. Notwithstanding Minnesota Rules, part 9505.0415,
149.7subpart 7, a vacant bed in an intermediate care facility for persons with developmental
149.8disabilities shall be counted as a reserved bed when determining occupancy rates and
149.9eligibility for payment of a therapeutic leave day.

149.10    Sec. 29. Minnesota Statutes 2016, section 256B.5012, is amended by adding a subdivision
149.11to read:
149.12    Subd. 17. ICF/DD rate increase effective July 1, 2017; Murray County. Effective
149.13July 1, 2017, the daily rate for an intermediate care facility for persons with developmental
149.14disabilities located in Murray County that is classified as a class B facility and licensed for
149.1514 beds is $400. This increase is in addition to any other increase that is effective on July
149.161, 2017.

149.17    Sec. 30. Minnesota Statutes 2016, section 256R.02, subdivision 4, is amended to read:
149.18    Subd. 4. Administrative costs. "Administrative costs" means the identifiable costs for
149.19administering the overall activities of the nursing home. These costs include salaries and
149.20wages of the administrator, assistant administrator, business office employees, security
149.21guards, and associated fringe benefits and payroll taxes, fees, contracts, or purchases related
149.22to business office functions, licenses, and permits except as provided in the external fixed
149.23costs category, employee recognition, travel including meals and lodging, all training except
149.24as specified in subdivision 17, voice and data communication or transmission, office supplies,
149.25property and liability insurance and other forms of insurance not designated to other areas
149.26except insurance that is a fringe benefit under subdivision 22, personnel recruitment, legal
149.27services, accounting services, management or business consultants, data processing,
149.28information technology, Web site, central or home office costs, business meetings and
149.29seminars, postage, fees for professional organizations, subscriptions, security services,
149.30advertising, board of directors fees, working capital interest expense, and bad debts, and
149.31bad debt collection fees, and costs incurred for travel and housing for persons employed by
149.32a supplemental nursing services agency as defined in section 144A.70, subdivision 6.
150.1EFFECTIVE DATE.This section is effective October 1, 2017.

150.2    Sec. 31. Minnesota Statutes 2016, section 256R.02, subdivision 17, is amended to read:
150.3    Subd. 17. Direct care costs. "Direct care costs" means costs for the wages of nursing
150.4administration, direct care registered nurses, licensed practical nurses, certified nursing
150.5assistants, trained medication aides, employees conducting training in resident care topics
150.6and associated fringe benefits and payroll taxes; services from a supplemental nursing
150.7services agency; supplies that are stocked at nursing stations or on the floor and distributed
150.8or used individually, including, but not limited to: alcohol, applicators, cotton balls,
150.9incontinence pads, disposable ice bags, dressings, bandages, water pitchers, tongue
150.10depressors, disposable gloves, enemas, enema equipment, soap, medication cups, diapers,
150.11plastic waste bags, sanitary products, thermometers, hypodermic needles and syringes,
150.12clinical reagents or similar diagnostic agents, drugs that are not paid on a separate fee
150.13schedule by the medical assistance program or any other payer, and technology related to
150.14the provision of nursing care to residents, such as electronic charting systems; costs of
150.15materials used for resident care training, and training courses outside of the facility attended
150.16by direct care staff on resident care topics; and costs for nurse consultants, pharmacy
150.17consultants, and medical directors. Salaries and payroll taxes for nurse consultants who
150.18work out of a central office must be allocated proportionately by total resident days or by
150.19direct identification to the nursing facilities served by those consultants.

150.20    Sec. 32. Minnesota Statutes 2016, section 256R.02, subdivision 18, is amended to read:
150.21    Subd. 18. Employer health insurance costs. "Employer health insurance costs" means
150.22premium expenses for group coverage and reinsurance,; actual expenses incurred for
150.23self-insured plans, including reinsurance; and employer contributions to employee health
150.24reimbursement and health savings accounts. Premium and expense costs and contributions
150.25are allowable for (1) all employees and (2) the spouse and dependents of those employees
150.26who meet the definition of full-time employees under the federal Affordable Care Act,
150.27Public Law 111-148 are employed on average at least 30 hours per week.
150.28EFFECTIVE DATE.This section is effective the day following final enactment.

150.29    Sec. 33. Minnesota Statutes 2016, section 256R.02, subdivision 19, is amended to read:
150.30    Subd. 19. External fixed costs. "External fixed costs" means costs related to the nursing
150.31home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
150.32family advisory council fee under section 144A.33; scholarships under section 256R.37;
151.1planned closure rate adjustments under section 256R.40; consolidation rate adjustments
151.2under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
151.3single-bed room incentives under section 256R.41; property taxes, assessments, and payments
151.4in lieu of taxes; employer health insurance costs; quality improvement incentive payment
151.5rate adjustments under section 256R.39; performance-based incentive payments under
151.6section 256R.38; special dietary needs under section 256R.51; rate adjustments for
151.7compensation-related costs for minimum wage changes under section 256R.49 provided
151.8on or after January 1, 2018; and Public Employees Retirement Association employer costs.

151.9    Sec. 34. Minnesota Statutes 2016, section 256R.02, subdivision 22, is amended to read:
151.10    Subd. 22. Fringe benefit costs. "Fringe benefit costs" means the costs for group life,
151.11dental, workers' compensation, and other employee insurances and short- and long-term
151.12disability, long-term care insurance, accident insurance, supplemental insurance, legal
151.13assistance insurance, profit sharing, health insurance costs not covered under subdivision
151.1418, including costs associated with part-time employee family members or retirees, and
151.15pension and retirement plan contributions, except for the Public Employees Retirement
151.16Association and employer health insurance costs; profit sharing; and retirement plans for
151.17which the employer pays all or a portion of the costs.

151.18    Sec. 35. Minnesota Statutes 2016, section 256R.02, subdivision 42, is amended to read:
151.19    Subd. 42. Raw food costs. "Raw food costs" means the cost of food provided to nursing
151.20facility residents and the allocation of dietary credits. Also included are special dietary
151.21supplements used for tube feeding or oral feeding, such as elemental high nitrogen diet.

151.22    Sec. 36. Minnesota Statutes 2016, section 256R.02, is amended by adding a subdivision
151.23to read:
151.24    Subd. 42a. Real estate taxes. "Real estate taxes" means the real estate tax liability shown
151.25on the annual property tax statement of the nursing facility for the reporting period. The
151.26term does not include personnel costs or fees for late payment.

151.27    Sec. 37. Minnesota Statutes 2016, section 256R.02, is amended by adding a subdivision
151.28to read:
151.29    Subd. 48a. Special assessments. "Special assessments" means the actual special
151.30assessments and related interest paid during the reporting period. The term does not include
151.31personnel costs or fees for late payment.

152.1    Sec. 38. Minnesota Statutes 2016, section 256R.02, subdivision 52, is amended to read:
152.2    Subd. 52. Therapy costs. "Therapy costs" means any costs related to medical assistance
152.3therapy services provided to residents that are not billed separately billable from the daily
152.4operating rate.

152.5    Sec. 39. Minnesota Statutes 2016, section 256R.06, subdivision 5, is amended to read:
152.6    Subd. 5. Notice to residents. (a) No increase in nursing facility rates for private paying
152.7residents shall be effective unless the nursing facility notifies the resident or person
152.8responsible for payment of the increase in writing 30 days before the increase takes effect.
152.9The notice must include the amount of the rate increase, the new payment rate, and the date
152.10the rate increase takes effect.
152.11A nursing facility may adjust its rates without giving the notice required by this
152.12subdivision when the purpose of the rate adjustment is to reflect a change in the case mix
152.13classification of the resident. The nursing facility shall notify private pay residents of any
152.14rate increase related to a change in case mix classifications in a timely manner after
152.15confirmation of the case mix classification change is received from the Department of
152.16Health.
152.17If the state fails to set rates as required by section 256R.09, subdivision 1, the time
152.18required for giving notice is decreased by the number of days by which the state was late
152.19in setting the rates.
152.20(b) If the state does not set rates by the date required in section 256R.09, subdivision 1,
152.21or otherwise provides nursing facilities with retroactive notification of the amount of a rate
152.22increase, nursing facilities shall meet the requirement for advance notice by informing the
152.23resident or person responsible for payments, on or before the effective date of the increase,
152.24that a rate increase will be effective on that date. The requirements of paragraph (a) do not
152.25apply to situations described in this paragraph.
152.26If the exact amount has not yet been determined, the nursing facility may raise the rates
152.27by the amount anticipated to be allowed. Any amounts collected from private pay residents
152.28in excess of the allowable rate must be repaid to private pay residents with interest at the
152.29rate used by the commissioner of revenue for the late payment of taxes and in effect on the
152.30date the rate increase is effective.

153.1    Sec. 40. Minnesota Statutes 2016, section 256R.07, is amended by adding a subdivision
153.2to read:
153.3    Subd. 6. Electronic signature. For documentation requiring a signature under this
153.4chapter or section 256B.431 or 256B.434, use of an electronic signature as defined under
153.5section 325L.02, paragraph (h), is allowed.

153.6    Sec. 41. Minnesota Statutes 2016, section 256R.10, is amended by adding a subdivision
153.7to read:
153.8    Subd. 7. Not specified allowed costs. When the cost category for allowed cost items or
153.9services is not specified in this chapter or the provider reimbursement manual, the
153.10commissioner, in consultation with stakeholders, shall determine the cost category for the
153.11allowed cost item or service.
153.12EFFECTIVE DATE.This section is effective the day following final enactment.

153.13    Sec. 42. [256R.18] REPORT BY COMMISSIONER OF HUMAN SERVICES.
153.14Beginning January 1, 2019, the commissioner shall provide to the house of representatives
153.15and senate committees with jurisdiction over nursing facility payment rates a biennial report
153.16on the effectiveness of the reimbursement system in improving quality, restraining costs,
153.17and any other features of the system as determined by the commissioner.
153.18EFFECTIVE DATE.This section is effective the day following final enactment.

153.19    Sec. 43. Minnesota Statutes 2016, section 256R.37, is amended to read:
153.20256R.37 SCHOLARSHIPS.
153.21(a) For the 27-month period beginning October 1, 2015, through December 31, 2017,
153.22the commissioner shall allow a scholarship per diem of up to 25 cents for each nursing
153.23facility with no scholarship per diem that is requesting a scholarship per diem to be added
153.24to the external fixed payment rate to be used:
153.25(1) for employee scholarships that satisfy the following requirements:
153.26(i) scholarships are available to all employees who work an average of at least ten hours
153.27per week at the facility except the administrator, and to reimburse student loan expenses
153.28for newly hired and recently graduated registered nurses and licensed practical nurses, and
153.29training expenses for nursing assistants as specified in section 144A.611, subdivisions 2
153.30and 4, who are newly hired and have graduated within the last 12 months; and
154.1(ii) the course of study is expected to lead to career advancement with the facility or in
154.2long-term care, including medical care interpreter services and social work; and
154.3(2) to provide job-related training in English as a second language.
154.4(b) All facilities may annually request a rate adjustment under this section by submitting
154.5information to the commissioner on a schedule and in a form supplied by the commissioner.
154.6The commissioner shall allow a scholarship payment rate equal to the reported and allowable
154.7costs divided by resident days.
154.8(c) In calculating the per diem under paragraph (b), the commissioner shall allow costs
154.9related to tuition, direct educational expenses, and reasonable costs as defined by the
154.10commissioner for child care costs and transportation expenses related to direct educational
154.11expenses.
154.12(d) The rate increase under this section is an optional rate add-on that the facility must
154.13request from the commissioner in a manner prescribed by the commissioner. The rate
154.14increase must be used for scholarships as specified in this section.
154.15(e) For instances in which a rate adjustment will be 15 cents or greater, nursing facilities
154.16that close beds during a rate year may request to have their scholarship adjustment under
154.17paragraph (b) recalculated by the commissioner for the remainder of the rate year to reflect
154.18the reduction in resident days compared to the cost report year.

154.19    Sec. 44. Minnesota Statutes 2016, section 256R.40, subdivision 1, is amended to read:
154.20    Subdivision 1. Definitions. (a) The definitions in this subdivision apply to this section.
154.21(b) "Closure" means the cessation of operations of a nursing facility and delicensure and
154.22decertification of all beds within the facility.
154.23(c) "Closure plan" means a plan to close a nursing facility and reallocate a portion of
154.24the resulting savings to provide planned closure rate adjustments at other facilities.
154.25(d) "Commencement of closure" means the date on which residents and designated
154.26representatives are notified of a planned closure as provided in section 144A.161, subdivision
154.275a, as part of an approved closure plan.
154.28(e) "Completion of closure" means the date on which the final resident of the nursing
154.29facility designated for closure in an approved closure plan is discharged from the facility
154.30or the date that beds from a partial closure are delicensed and decertified.
154.31(f) "Partial closure" means the delicensure and decertification of a portion of the beds
154.32within the facility.
155.1(g) "Planned closure rate adjustment" means an increase in a nursing facility's operating
155.2rates resulting from a planned closure or a planned partial closure of another facility.

155.3    Sec. 45. Minnesota Statutes 2016, section 256R.40, subdivision 5, is amended to read:
155.4    Subd. 5. Planned closure rate adjustment. (a) The commissioner shall calculate the
155.5amount of the planned closure rate adjustment available under subdivision 6 according to
155.6clauses (1) to (4):
155.7(1) the amount available is the net reduction of nursing facility beds multiplied by $2,080;
155.8(2) the total number of beds in the nursing facility or facilities receiving the planned
155.9closure rate adjustment must be identified;
155.10(3) capacity days are determined by multiplying the number determined under clause
155.11(2) by 365; and
155.12(4) the planned closure rate adjustment is the amount available in clause (1), divided by
155.13capacity days determined under clause (3).
155.14(b) A planned closure rate adjustment under this section is effective on the first day of
155.15the month of January or July, whichever occurs immediately following completion of closure
155.16of the facility designated for closure in the application and becomes part of the nursing
155.17facility's external fixed payment rate.
155.18(c) Upon the request of a closing facility, the commissioner must allow the facility a
155.19closure rate adjustment as provided under section 144A.161, subdivision 10.
155.20(d) A facility that has received a planned closure rate adjustment may reassign it to
155.21another facility that is under the same ownership at any time within three years of its effective
155.22date. The amount of the adjustment is computed according to paragraph (a).
155.23(e) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, the
155.24commissioner shall recalculate planned closure rate adjustments for facilities that delicense
155.25beds under this section on or after July 1, 2001, to reflect the increase in the per bed dollar
155.26amount. The recalculated planned closure rate adjustment is effective from the date the per
155.27bed dollar amount is increased.
155.28EFFECTIVE DATE.This section is effective for closures occurring after July 1, 2017.

155.29    Sec. 46. Minnesota Statutes 2016, section 256R.41, is amended to read:
155.30256R.41 SINGLE-BED ROOM INCENTIVE.
156.1(a) Beginning July 1, 2005, the operating payment rate for nursing facilities reimbursed
156.2under this chapter shall be increased by 20 percent multiplied by the ratio of the number of
156.3new single-bed rooms created divided by the number of active beds on July 1, 2005, for
156.4each bed closure that results in the creation of a single-bed room after July 1, 2005. The
156.5commissioner may implement rate adjustments for up to 3,000 new single-bed rooms each
156.6year. For eligible bed closures for which the commissioner receives a notice from a facility
156.7during a calendar quarter that a bed has been delicensed and a new single-bed room has
156.8been established, the rate adjustment in this paragraph shall be effective on either the first
156.9day of the second month of January or July, whichever occurs first following that calendar
156.10quarter the date of the bed delicensure.
156.11(b) A nursing facility is prohibited from discharging residents for purposes of establishing
156.12single-bed rooms. A nursing facility must submit documentation to the commissioner in a
156.13form prescribed by the commissioner, certifying the occupancy status of beds closed to
156.14create single-bed rooms. In the event that the commissioner determines that a facility has
156.15discharged a resident for purposes of establishing a single-bed room, the commissioner shall
156.16not provide a rate adjustment under paragraph (a).
156.17EFFECTIVE DATE.This section is effective for closures occurring after July 1, 2017.

156.18    Sec. 47. Minnesota Statutes 2016, section 256R.47, is amended to read:
156.19256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING
156.20FACILITIES.
156.21(a) The commissioner, in consultation with the commissioner of health, may designate
156.22certain nursing facilities as critical access nursing facilities. The designation shall be granted
156.23on a competitive basis, within the limits of funds appropriated for this purpose.
156.24(b) The commissioner shall request proposals from nursing facilities every two years.
156.25Proposals must be submitted in the form and according to the timelines established by the
156.26commissioner. In selecting applicants to designate, the commissioner, in consultation with
156.27the commissioner of health, and with input from stakeholders, shall develop criteria designed
156.28to preserve access to nursing facility services in isolated areas, rebalance long-term care,
156.29and improve quality. To the extent practicable, the commissioner shall ensure an even
156.30distribution of designations across the state.
156.31(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing facilities
156.32designated as critical access nursing facilities:
157.1(1) partial rebasing, with the commissioner allowing a designated facility operating
157.2payment rates being the sum of up to 60 percent of the operating payment rate determined
157.3in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of
157.4the two portions being equal to 100 percent, of the operating payment rate that would have
157.5been allowed had the facility not been designated. The commissioner may adjust these
157.6percentages by up to 20 percent and may approve a request for less than the amount allowed;
157.7(2) enhanced payments for leave days. Notwithstanding section 256R.43, upon
157.8designation as a critical access nursing facility, the commissioner shall limit payment for
157.9leave days to 60 percent of that nursing facility's total payment rate for the involved resident,
157.10and shall allow this payment only when the occupancy of the nursing facility, inclusive of
157.11bed hold days, is equal to or greater than 90 percent;
157.12(3) two designated critical access nursing facilities, with up to 100 beds in active service,
157.13may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part
157.144658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner
157.15of health shall consider each waiver request independently based on the criteria under
157.16Minnesota Rules, part 4658.0040;
157.17(4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall
157.18be 40 percent of the amount that would otherwise apply; and
157.19(5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to
157.20designated critical access nursing facilities.
157.21(d) Designation of a critical access nursing facility is for a period of two years, after
157.22which the benefits allowed under paragraph (c) shall be removed. Designated facilities may
157.23apply for continued designation.
157.24(e) This section is suspended and no state or federal funding shall be appropriated or
157.25allocated for the purposes of this section from January 1, 2016, to December 31, 2017 2019.
157.26EFFECTIVE DATE.This section is effective the day following final enactment.

157.27    Sec. 48. Minnesota Statutes 2016, section 256R.49, subdivision 1, is amended to read:
157.28    Subdivision 1. Rate adjustments for compensation-related costs. (a) Operating payment
157.29rates of all nursing facilities that are reimbursed under this chapter shall be increased effective
157.30for rate years beginning on and after October 1, 2014, to address changes in compensation
157.31costs for nursing facility employees paid less than $14 per hour in accordance with this
157.32section. Rate increases provided under this section before October 1, 2016, expire effective
158.1January 1, 2018, and rate increases provided on or after October 1, 2016, expire effective
158.2January 1, 2019.
158.3(b) Nursing facilities that receive approval of the applications in subdivision 2 must
158.4receive rate adjustments according to subdivision 4. The rate adjustments must be used to
158.5pay compensation costs for nursing facility employees paid less than $14 per hour.
158.6EFFECTIVE DATE.This section is effective the day following final enactment.

158.7    Sec. 49. Minnesota Statutes 2016, section 256R.53, subdivision 2, is amended to read:
158.8    Subd. 2. Nursing facility facilities in Breckenridge border cities. The operating
158.9payment rate of a nonprofit nursing facility that exists on January 1, 2015, is located within
158.10the boundaries of the city cities of Breckenridge or Moorhead, and is reimbursed under this
158.11chapter, is equal to the greater of:
158.12(1) the operating payment rate determined under section 256R.21, subdivision 3; or
158.13(2) the median case mix adjusted rates, including comparable rate components as
158.14determined by the median case mix adjusted rates, including comparable rate components
158.15as determined by the commissioner, for the equivalent case mix indices of the nonprofit
158.16nursing facility or facilities located in an adjacent city in another state and in cities contiguous
158.17to the adjacent city. The commissioner shall make the comparison required in this subdivision
158.18on November 1 of each year and shall apply it to the rates to be effective on the following
158.19January 1. The Minnesota facility's operating payment rate with a case mix index of 1.0 is
158.20computed by dividing the adjacent city's nursing facility or facilities' median operating
158.21payment rate with an index of 1.02 by 1.02. If the adjustments under this subdivision result
158.22in a rate that exceeds the limits in section 256R.23, subdivision 5, and whose costs exceed
158.23the rate in section 256R.24, subdivision 3, in a given rate year, the facility's rate shall not
158.24be subject to the limits in section 256R.23, subdivision 5, and shall not be limited to the
158.25rate established in section 256R.24, subdivision 3, for that rate year.
158.26EFFECTIVE DATE.The rate increases for a facility located in Moorhead are effective
158.27for the rate year beginning January 1, 2020, and annually thereafter.

158.28    Sec. 50. DIRECTION TO COMMISSIONER; ADULT DAY SERVICES STAFFING
158.29RATIOS.
158.30The commissioner of human services shall study the staffing ratio for adult day services
158.31clients and shall provide the chairs and ranking minority members of the house of
159.1representatives and senate committees with jurisdiction over adult day services with
159.2recommendations to adjust staffing ratios based on client needs by January 1, 2018.

159.3    Sec. 51. ALZHEIMER'S DISEASE WORKING GROUP.
159.4    Subdivision 1. Members. (a) The Minnesota Board on Aging must appoint 16 members
159.5to an Alzheimer's disease working group, as follows:
159.6(1) a caregiver of a person who has been diagnosed with Alzheimer's disease;
159.7(2) a person who has been diagnosed with Alzheimer's disease;
159.8(3) two representatives from the nursing facility or senior housing profession;
159.9(4) a representative of the home care or adult day services profession;
159.10(5) two geriatricians, one of whom serves a diverse or underserved community;
159.11(6) a psychologist who specializes in dementia care;
159.12(7) an Alzheimer's researcher;
159.13(8) a representative of the Alzheimer's Association;
159.14(9) two members from community-based organizations serving one or more diverse or
159.15underserved communities;
159.16(10) the commissioner of human services or a designee;
159.17(11) the commissioner of health or a designee;
159.18(12) the ombudsman for long-term care or a designee; and
159.19(13) one member of the Minnesota Board on Aging, selected by the board.
159.20(b) The executive director of the Minnesota Board on Aging serves on the working group
159.21as a nonvoting member.
159.22(c) The appointing authorities under this subdivision must complete their appointments
159.23no later than December 15, 2017.
159.24(d) To the extent practicable, the membership of the working group must reflect the
159.25diversity in Minnesota, and must include representatives from rural and metropolitan areas
159.26and representatives of different ethnicities, races, genders, ages, cultural groups, and abilities.
159.27    Subd. 2. Duties; recommendations. The Alzheimer's disease working group must
159.28review and revise the 2011 report, Preparing Minnesota for Alzheimer's: the Budgetary,
160.1Social and Personal Impacts. The working group shall consider and make recommendations
160.2and findings on the following issues as related to Alzheimer's disease or other dementias:
160.3(1) analysis and assessment of public health and health care data to accurately determine
160.4trends and disparities in cognitive decline;
160.5(2) public awareness, knowledge, and attitudes, including knowledge gaps, stigma,
160.6availability of information, and supportive community environments;
160.7(3) risk reduction, including health education and health promotion on risk factors,
160.8safety, and potentially avoidable hospitalizations;
160.9(4) diagnosis and treatment, including early detection, access to diagnosis, quality of
160.10dementia care, and cost of treatment;
160.11(5) professional education and training, including geriatric education for licensed health
160.12care professionals and dementia-specific training for direct care workers, first responders,
160.13and other professionals in communities;
160.14(6) residential services, including cost to families as well as regulation and licensing
160.15gaps; and
160.16(7) cultural competence and responsiveness to reduce health disparities and improve
160.17access to high-quality dementia care.
160.18    Subd. 3. Meetings. The Board on Aging must convene the first meeting of the working
160.19group no later than January 15, 2018. Before the first meeting, the Board on Aging must
160.20designate one member to serve as chair. Meetings of the working group must be open to
160.21the public, and to the extent practicable, technological means, such as Web casts, shall be
160.22used to reach the greatest number of people throughout the state. The working group may
160.23not meet more than five times.
160.24    Subd. 4. Compensation. Members of the working group serve without compensation,
160.25but may be reimbursed for allowed actual and necessary expenses incurred in the performance
160.26of the member's duties for the working group in the same manner and amount as authorized
160.27by the commissioner's plan adopted under Minnesota Statutes, section 43A.18, subdivision
160.282.
160.29    Subd. 5. Administrative support. The Minnesota Board on Aging shall provide
160.30administrative support and arrange meeting space for the working group.
160.31    Subd. 6. Report. The Board on Aging must submit a report providing the findings and
160.32recommendations of the working group, including any draft legislation necessary to
161.1implement the recommendations, to the governor and chairs and ranking minority members
161.2of the legislative committees with jurisdiction over health care by January 15, 2019.
161.3    Subd. 7. Expiration. The working group expires June 30, 2019, or the day after the
161.4working group submits the report required in subdivision 6, whichever is earlier.

161.5    Sec. 52. ELECTRONIC SERVICE DELIVERY DOCUMENTATION SYSTEM.
161.6    Subdivision 1. Documentation; establishment. The commissioner of human services
161.7shall establish implementation requirements and standards for an electronic service delivery
161.8documentation system to comply with the 21st Century Cures Act, Public Law 114-255.
161.9    Subd. 2. Definitions. (a) For purposes of this section, the terms in this subdivision have
161.10the meanings given them.
161.11(b) "Electronic service delivery documentation" means the electronic documentation of
161.12the:
161.13(1) type of service performed;
161.14(2) individual receiving the service;
161.15(3) date of the service;
161.16(4) location of the service delivery;
161.17(5) individual providing the service; and
161.18(6) time the service begins and ends.
161.19(c) "Electronic service delivery documentation system" means a system that provides
161.20electronic service delivery documentation that complies with the 21st Century Cures Act,
161.21Public Law 114-255, and the requirements of subdivision 3.
161.22(d) "Service" means one of the following:
161.23(1) personal care assistance services as defined in Minnesota Statutes, section 256B.0625,
161.24subdivision 19a, and provided according to Minnesota Statutes, section 256B.0659; or
161.25(2) community first services and supports under Minnesota Statutes, section 256B.85.
161.26    Subd. 3. Requirements. (a) In developing implementation requirements for an electronic
161.27service delivery documentation system, the commissioner shall consider electronic visit
161.28verification systems and other electronic service delivery documentation methods. The
161.29commissioner shall convene stakeholders that will be impacted by an electronic service
161.30delivery system, including service providers and their representatives, service recipients
162.1and their representatives, and, as appropriate, those with expertise in the development and
162.2operation of an electronic service delivery documentation system, to ensure that the
162.3requirements:
162.4(1) are minimally administratively and financially burdensome to a provider;
162.5(2) are minimally burdensome to the service recipient and the least disruptive to the
162.6service recipient in receiving and maintaining allowed services;
162.7(3) consider existing best practices and use of electronic service delivery documentation;
162.8(4) are conducted according to all state and federal laws;
162.9(5) are effective methods for preventing fraud when balanced against the requirements
162.10of clauses (1) and (2); and
162.11(6) are consistent with the Department of Human Services' policies related to covered
162.12services, flexibility of service use, and quality assurance.
162.13(b) The commissioner shall make training available to providers on the electronic service
162.14delivery documentation system requirements.
162.15(c) The commissioner shall establish baseline measurements related to preventing fraud
162.16and establish measures to determine the effect of electronic service delivery documentation
162.17requirements on program integrity.
162.18    Subd. 4. Legislative report. (a) The commissioner shall submit a report by January 15,
162.192018, to the chairs and ranking minority members of the legislative committees with
162.20jurisdiction over human services with recommendations, based on the requirements of
162.21subdivision 3, to establish electronic service delivery documentation system requirements
162.22and standards. The report shall identify:
162.23(1) the essential elements necessary to operationalize a base-level electronic service
162.24delivery documentation system to be implemented by January 1, 2019; and
162.25(2) enhancements to the base-level electronic service delivery documentation system to
162.26be implemented by January 1, 2019, or after, with projected operational costs and the costs
162.27and benefits for system enhancements.
162.28(b) The report must also identify current regulations on service providers that are either
162.29inefficient, minimally effective, or will be unnecessary with the implementation of an
162.30electronic service delivery documentation system.
162.31EFFECTIVE DATE.This section is effective the day following final enactment.

163.1    Sec. 53. DIRECTION TO COMMISSIONER; ICF/DD PAYMENT RATE STUDY.
163.2Within available appropriations, the commissioner of human services shall study the
163.3intermediate care facility for persons with developmental disabilities payment rates under
163.4Minnesota Statutes, sections 256B.5011 to 256B.5013, and make recommendations on the
163.5rate structure to the chairs and ranking minority members of the legislative committees with
163.6jurisdiction over human services policy and finance by January 15, 2018.

163.7    Sec. 54. REVISOR'S INSTRUCTION.
163.8The revisor of statutes, in consultation with the House Research Department, Office of
163.9Senate Counsel, Research, and Fiscal Analysis, and Department of Human Services shall
163.10prepare legislation for the 2018 legislative session to recodify laws governing the elderly
163.11waiver program in Minnesota Statutes, chapter 256B.
163.12EFFECTIVE DATE.This section is effective the day following final enactment.

163.13ARTICLE 4
163.14HEALTH CARE

163.15    Section 1. Minnesota Statutes 2016, section 3.972, is amended by adding a subdivision
163.16to read:
163.17    Subd. 2a. Audits of Department of Human Services. (a) To ensure continuous
163.18legislative oversight and accountability, the legislative auditor shall give high priority to
163.19auditing the programs, services, and benefits administered by the Department of Human
163.20Services. The audits shall determine whether the department offered programs and provided
163.21services and benefits only to eligible persons and organizations, and complied with applicable
163.22legal requirements.
163.23(b) The legislative auditor shall, based on an assessment of risk and using professional
163.24standards to provide a statistically significant sample, no less than three times each year,
163.25test a representative sample of persons enrolled in a medical assistance program or
163.26MinnesotaCare to determine whether they are eligible to receive benefits under those
163.27programs. The legislative auditor shall report the results to the commissioner of human
163.28services and recommend corrective actions. The commissioner shall provide a response to
163.29the legislative auditor within 20 business days, including corrective actions to be taken to
163.30address any problems identified by the legislative auditor and anticipated completion dates.
163.31The legislative auditor shall monitor the commissioner's implementation of corrective actions
163.32and periodically report the results to the Legislative Audit Commission and the chairs and
164.1ranking minority members of the legislative committees with jurisdiction over health and
164.2human services policy and finance. The legislative auditor's reports to the commission and
164.3the chairs and ranking minority members must include recommendations for any legislative
164.4actions needed to ensure that medical assistance and MinnesotaCare benefits are provided
164.5only to eligible persons.

164.6    Sec. 2. Minnesota Statutes 2016, section 3.972, is amended by adding a subdivision to
164.7read:
164.8    Subd. 2b. Audits of managed care organizations. (a) The legislative auditor shall audit
164.9each managed care organization that contracts with the commissioner of human services to
164.10provide health care services under sections 256B.69, 256B.692, and 256L.12. The legislative
164.11auditor shall design the audits to determine if a managed care organization used the public
164.12money in compliance with federal and state laws, rules, and in accordance with provisions
164.13in the managed care organization's contract with the commissioner of human services. The
164.14legislative auditor shall determine the schedule and scope of the audit work and may contract
164.15with vendors to assist with the audits. The managed care organization must cooperate with
164.16the legislative auditor and must provide the legislative auditor with all data, documents, and
164.17other information, regardless of classification, that the legislative auditor requests to conduct
164.18an audit. The legislative auditor shall periodically report audit results and recommendations
164.19to the Legislative Audit Commission and the chairs and ranking minority members of the
164.20legislative committees with jurisdiction over health and human services policy and finance.
164.21(b) For purposes of this subdivision, a "managed care organization" means a
164.22demonstration provider as defined under section 256B.69, subdivision 2.

164.23    Sec. 3. Minnesota Statutes 2016, section 13.69, subdivision 1, is amended to read:
164.24    Subdivision 1. Classifications. (a) The following government data of the Department
164.25of Public Safety are private data:
164.26    (1) medical data on driving instructors, licensed drivers, and applicants for parking
164.27certificates and special license plates issued to physically disabled persons;
164.28    (2) other data on holders of a disability certificate under section 169.345, except that (i)
164.29data that are not medical data may be released to law enforcement agencies, and (ii) data
164.30necessary for enforcement of sections 169.345 and 169.346 may be released to parking
164.31enforcement employees or parking enforcement agents of statutory or home rule charter
164.32cities and towns;
165.1    (3) Social Security numbers in driver's license and motor vehicle registration records,
165.2except that Social Security numbers must be provided to the Department of Revenue for
165.3purposes of tax administration, the Department of Labor and Industry for purposes of
165.4workers' compensation administration and enforcement, and the Department of Natural
165.5Resources for purposes of license application administration, and except that the last four
165.6digits of the Social Security number must be provided to the Department of Human Services
165.7for purposes of recovery of Minnesota health care program benefits paid; and
165.8    (4) data on persons listed as standby or temporary custodians under section 171.07,
165.9subdivision 11
, except that the data must be released to:
165.10    (i) law enforcement agencies for the purpose of verifying that an individual is a designated
165.11caregiver; or
165.12    (ii) law enforcement agencies who state that the license holder is unable to communicate
165.13at that time and that the information is necessary for notifying the designated caregiver of
165.14the need to care for a child of the license holder.
165.15    The department may release the Social Security number only as provided in clause (3)
165.16and must not sell or otherwise provide individual Social Security numbers or lists of Social
165.17Security numbers for any other purpose.
165.18    (b) The following government data of the Department of Public Safety are confidential
165.19data: data concerning an individual's driving ability when that data is received from a member
165.20of the individual's family.
165.21EFFECTIVE DATE.This section is effective July 1, 2017.

165.22    Sec. 4. [62J.815] HEALTH CARE PROVIDERS PRICE DISCLOSURES.
165.23(a) Each health care provider, as defined by section 62J.03, subdivision 8, except hospitals
165.24and outpatient surgical centers subject to the requirements of section 62J.82, shall maintain
165.25a list of the services or procedures that correspond with the 35 most frequent current
165.26procedural terminology (CPT) codes, and a list of the ten most frequent CPT codes for
165.27preventive services used by the provider for reimbursement purposes and the provider's
165.28charge for each of these services or procedures that the provider would charge to patients
165.29who are not covered by private or public health care coverage.
165.30(b) This list must be updated annually and be readily available on site at no cost to the
165.31public. The provider must also post this information on the provider's Web site or the health
165.32care clinic's Web site where the provider practices.

166.1    Sec. 5. Minnesota Statutes 2016, section 256.9686, subdivision 8, is amended to read:
166.2    Subd. 8. Rate year. "Rate year" means a calendar year from January 1 to December 31.
166.3Effective with the 2012 base year, rate year means a state fiscal year from July 1 to June
166.430.
166.5EFFECTIVE DATE.This section is effective the day following final enactment.

166.6    Sec. 6. Minnesota Statutes 2016, section 256.969, subdivision 1, is amended to read:
166.7    Subdivision 1. Hospital cost index. (a) The hospital cost index shall be the change in
166.8the Centers for Medicare and Medicaid Services Inpatient Hospital Market Basket. The
166.9commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
166.10the midpoint of the current rate year.
166.11(b) Except as authorized under this section, for fiscal years beginning on or after July
166.121, 1993, the commissioner of human services shall not provide automatic annual inflation
166.13adjustments for hospital payment rates under medical assistance.
166.14EFFECTIVE DATE.This section is effective July 1, 2017.

166.15    Sec. 7. Minnesota Statutes 2016, section 256.969, subdivision 2b, is amended to read:
166.16    Subd. 2b. Hospital payment rates. (a) For discharges occurring on or after November
166.171, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
166.18to the following:
166.19(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
166.20methodology;
166.21(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
166.22under subdivision 25;
166.23(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
166.24distinct parts as defined by Medicare shall be paid according to the methodology under
166.25subdivision 12; and
166.26(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
166.27    (b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
166.28be rebased, except that a Minnesota long-term hospital shall be rebased effective January
166.291, 2011, based on its most recent Medicare cost report ending on or before September 1,
166.302008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
166.31December 31, 2010. For rate setting periods after November 1, 2014, in which the base
167.1years are updated, a Minnesota long-term hospital's base year shall remain within the same
167.2period as other hospitals.
167.3(c) Effective for discharges occurring on and after November 1, 2014, payment rates
167.4for hospital inpatient services provided by hospitals located in Minnesota or the local trade
167.5area, except for the hospitals paid under the methodologies described in paragraph (a),
167.6clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
167.7manner similar to Medicare. The base year for the rates effective November 1, 2014, shall
167.8be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring
167.9that the total aggregate payments under the rebased system are equal to the total aggregate
167.10payments that were made for the same number and types of services in the base year. Separate
167.11budget neutrality calculations shall be determined for payments made to critical access
167.12hospitals and payments made to hospitals paid under the DRG system. Only the rate increases
167.13or decreases under subdivision 3a or 3c that applied to the hospitals being rebased during
167.14the entire base period shall be incorporated into the budget neutrality calculation.
167.15(d) For discharges occurring on or after November 1, 2014, through the next rebasing
167.16that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
167.17(a), clause (4), shall include adjustments to the projected rates that result in no greater than
167.18a five percent increase or decrease from the base year payments for any hospital. Any
167.19adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
167.20shall maintain budget neutrality as described in paragraph (c).
167.21(e) For discharges occurring on or after November 1, 2014, through the next two rebasing
167.22that occurs periods the commissioner may make additional adjustments to the rebased rates,
167.23and when evaluating whether additional adjustments should be made, the commissioner
167.24shall consider the impact of the rates on the following:
167.25(1) pediatric services;
167.26(2) behavioral health services;
167.27(3) trauma services as defined by the National Uniform Billing Committee;
167.28(4) transplant services;
167.29(5) obstetric services, newborn services, and behavioral health services provided by
167.30hospitals outside the seven-county metropolitan area;
167.31(6) outlier admissions;
167.32(7) low-volume providers; and
168.1(8) services provided by small rural hospitals that are not critical access hospitals.
168.2(f) Hospital payment rates established under paragraph (c) must incorporate the following:
168.3    (1) for hospitals paid under the DRG methodology, the base year payment rate per
168.4admission is standardized by the applicable Medicare wage index and adjusted by the
168.5hospital's disproportionate population adjustment;
168.6    (2) for critical access hospitals, payment rates for discharges between November 1, 2014,
168.7and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
168.8October 31, 2014;
168.9    (3) the cost and charge data used to establish hospital payment rates must only reflect
168.10inpatient services covered by medical assistance; and
168.11    (4) in determining hospital payment rates for discharges occurring on or after the rate
168.12year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
168.13discharge shall be based on the cost-finding methods and allowable costs of the Medicare
168.14program in effect during the base year or years. In determining hospital payment rates for
168.15discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
168.16methods and allowable costs of the Medicare program in effect during the base year or
168.17years.
168.18(g) The commissioner shall validate the rates effective November 1, 2014, by applying
168.19the rates established under paragraph (c), and any adjustments made to the rates under
168.20paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
168.21total aggregate payments for the same number and types of services under the rebased rates
168.22are equal to the total aggregate payments made during calendar year 2013.
168.23(h) Effective for discharges occurring on or after July 1, 2017, and every two years
168.24thereafter, payment rates under this section shall be rebased to reflect only those changes
168.25in hospital costs between the existing base year and the next base year. Changes in costs
168.26between base years shall be measured using the lower of the hospital cost index defined in
168.27subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
168.28claim. The commissioner shall establish the base year for each rebasing period considering
168.29the most recent year for which filed Medicare cost reports are available. The estimated
168.30change in the average payment per hospital discharge resulting from a scheduled rebasing
168.31must be calculated and made available to the legislature by January 15 of each year in which
168.32rebasing is scheduled to occur, and must include by hospital the differential in payment
168.33rates compared to the individual hospital's costs.
169.1(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
169.2for critical access hospitals located in Minnesota or the local trade area shall be determined
169.3using a new cost-based methodology. The commissioner shall establish within the
169.4methodology tiers of payment designed to promote efficiency and cost-effectiveness.
169.5Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
169.6the total cost for critical access hospitals as reflected in base year cost reports. Until the
169.7next rebasing that occurs, the new methodology shall result in no greater than a five percent
169.8decrease from the base year payments for any hospital, except a hospital that had payments
169.9that were greater than 100 percent of the hospital's costs in the base year shall have their
169.10rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
169.11after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
169.12in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
169.13be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
169.14following criteria:
169.15(1) hospitals that had payments at or below 80 percent of their costs in the base year
169.16shall have a rate set that equals 85 percent of their base year costs;
169.17(2) hospitals that had payments that were above 80 percent, up to and including 90
169.18percent of their costs in the base year shall have a rate set that equals 95 percent of their
169.19base year costs; and
169.20(3) hospitals that had payments that were above 90 percent of their costs in the base year
169.21shall have a rate set that equals 100 percent of their base year costs.
169.22(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
169.23to coincide with the next rebasing under paragraph (h). The factors used to develop the new
169.24methodology may include, but are not limited to:
169.25(1) the ratio between the hospital's costs for treating medical assistance patients and the
169.26hospital's charges to the medical assistance program;
169.27(2) the ratio between the hospital's costs for treating medical assistance patients and the
169.28hospital's payments received from the medical assistance program for the care of medical
169.29assistance patients;
169.30(3) the ratio between the hospital's charges to the medical assistance program and the
169.31hospital's payments received from the medical assistance program for the care of medical
169.32assistance patients;
169.33(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
170.1(5) the proportion of that hospital's costs that are administrative and trends in
170.2administrative costs; and
170.3(6) geographic location.
170.4EFFECTIVE DATE.This section is effective July 1, 2017.

170.5    Sec. 8. Minnesota Statutes 2016, section 256.969, subdivision 3a, is amended to read:
170.6    Subd. 3a. Payments. (a) Acute care hospital billings under the medical assistance program
170.7must not be submitted until the recipient is discharged. However, the commissioner shall
170.8establish monthly interim payments for inpatient hospitals that have individual patient
170.9lengths of stay over 30 days regardless of diagnostic category. Except as provided in section
170.10256.9693 , medical assistance reimbursement for treatment of mental illness shall be
170.11reimbursed based on diagnostic classifications. Individual hospital payments established
170.12under this section and sections 256.9685, 256.9686, and 256.9695, in addition to third-party
170.13and recipient liability, for discharges occurring during the rate year shall not exceed, in
170.14aggregate, the charges for the medical assistance covered inpatient services paid for the
170.15same period of time to the hospital. Services that have rates established under subdivision
170.1611 or 12, must be limited separately from other services. After consulting with the affected
170.17hospitals, the commissioner may consider related hospitals one entity and may merge the
170.18payment rates while maintaining separate provider numbers. The operating and property
170.19base rates per admission or per day shall be derived from the best Medicare and claims data
170.20available when rates are established. The commissioner shall determine the best Medicare
170.21and claims data, taking into consideration variables of recency of the data, audit disposition,
170.22settlement status, and the ability to set rates in a timely manner. The commissioner shall
170.23notify hospitals of payment rates 30 days prior to implementation. The rate setting data
170.24must reflect the admissions data used to establish relative values. The commissioner may
170.25adjust base year cost, relative value, and case mix index data to exclude the costs of services
170.26that have been discontinued by the October 1 of the year preceding the rate year or that are
170.27paid separately from inpatient services. Inpatient stays that encompass portions of two or
170.28more rate years shall have payments established based on payment rates in effect at the time
170.29of admission unless the date of admission preceded the rate year in effect by six months or
170.30more. In this case, operating payment rates for services rendered during the rate year in
170.31effect and established based on the date of admission shall be adjusted to the rate year in
170.32effect by the hospital cost index.
171.1    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total payment,
171.2before third-party liability and spenddown, made to hospitals for inpatient services is reduced
171.3by .5 percent from the current statutory rates.
171.4    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
171.5admissions occurring on or after July 1, 2003, made to hospitals for inpatient services before
171.6third-party liability and spenddown, is reduced five percent from the current statutory rates.
171.7Mental health services within diagnosis related groups 424 to 432 or corresponding
171.8APR-DRGs, and facilities defined under subdivision 16 are excluded from this paragraph.
171.9    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
171.10fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
171.11inpatient services before third-party liability and spenddown, is reduced 6.0 percent from
171.12the current statutory rates. Mental health services within diagnosis related groups 424 to
171.13432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded
171.14from this paragraph. Payments made to managed care plans shall be reduced for services
171.15provided on or after January 1, 2006, to reflect this reduction.
171.16    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
171.17fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
171.18to hospitals for inpatient services before third-party liability and spenddown, is reduced
171.193.46 percent from the current statutory rates. Mental health services with diagnosis related
171.20groups 424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision
171.2116 are excluded from this paragraph. Payments made to managed care plans shall be reduced
171.22for services provided on or after January 1, 2009, through June 30, 2009, to reflect this
171.23reduction.
171.24    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
171.25fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
171.26to hospitals for inpatient services before third-party liability and spenddown, is reduced 1.9
171.27percent from the current statutory rates. Mental health services with diagnosis related groups
171.28424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are
171.29excluded from this paragraph. Payments made to managed care plans shall be reduced for
171.30services provided on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
171.31    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
171.32fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for inpatient
171.33services before third-party liability and spenddown, is reduced 1.79 percent from the current
171.34statutory rates. Mental health services with diagnosis related groups 424 to 432 or
172.1corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded from
172.2this paragraph. Payments made to managed care plans shall be reduced for services provided
172.3on or after July 1, 2011, to reflect this reduction.
172.4(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total payment
172.5for fee-for-service admissions occurring on or after July 1, 2009, made to hospitals for
172.6inpatient services before third-party liability and spenddown, is reduced one percent from
172.7the current statutory rates. Facilities defined under subdivision 16 are excluded from this
172.8paragraph. Payments made to managed care plans shall be reduced for services provided
172.9on or after October 1, 2009, to reflect this reduction.
172.10(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total payment
172.11for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
172.12inpatient services before third-party liability and spenddown, is reduced 1.96 percent from
172.13the current statutory rates. Facilities defined under subdivision 16 are excluded from this
172.14paragraph. Payments made to managed care plans shall be reduced for services provided
172.15on or after January 1, 2011, to reflect this reduction.
172.16(j) Effective for discharges on and after November 1, 2014, from hospitals paid under
172.17subdivision 2b, paragraph (a), clauses (1) and (4), the rate adjustments in this subdivision
172.18must be incorporated into the rebased rates established under subdivision 2b, paragraph (c),
172.19and must not be applied to each claim.
172.20(k) Effective for discharges on and after July 1, 2015, from hospitals paid under
172.21subdivision 2b, paragraph (a), clauses (2) and (3), the rate adjustments in this subdivision
172.22must be incorporated into the rates and must not be applied to each claim.
172.23(l) Effective for discharges on and after July 1, 2017, from hospitals paid under
172.24subdivision 2b, paragraph (a), clause (2), the rate adjustments in this subdivision must be
172.25incorporated into the rates and must not be applied to each claim.
172.26EFFECTIVE DATE.This section is effective July 1, 2017.

172.27    Sec. 9. Minnesota Statutes 2016, section 256.969, subdivision 8, is amended to read:
172.28    Subd. 8. Unusual length of stay experience. (a) The commissioner shall establish day
172.29outlier thresholds for each diagnostic category established under subdivision 2 at two standard
172.30deviations beyond the mean length of stay. Payment for the days beyond the outlier threshold
172.31shall be in addition to the operating and property payment rates per admission established
172.32under subdivisions 2 and 2b. Payment for outliers shall be at 70 percent of the allowable
172.33operating cost, after adjustment by the case mix index, hospital cost index, relative values
173.1and the disproportionate population adjustment. The outlier threshold for neonatal and burn
173.2diagnostic categories shall be established at one standard deviation beyond the mean length
173.3of stay, and payment shall be at 90 percent of allowable operating cost calculated in the
173.4same manner as other outliers. A hospital may choose an alternative to the 70 percent outlier
173.5payment that is at a minimum of 60 percent and a maximum of 80 percent if the
173.6commissioner is notified in writing of the request by October 1 of the year preceding the
173.7rate year. The chosen percentage applies to all diagnostic categories except burns and
173.8neonates. The percentage of allowable cost that is unrecognized by the outlier payment shall
173.9be added back to the base year operating payment rate per admission.
173.10(b) Effective for admissions and transfers occurring on and after November 1, 2014, the
173.11commissioner shall establish payment rates for outlier payments that are based on Medicare
173.12methodologies.
173.13EFFECTIVE DATE.This section is effective July 1, 2017.

173.14    Sec. 10. Minnesota Statutes 2016, section 256.969, subdivision 8c, is amended to read:
173.15    Subd. 8c. Hospital residents. (a) For discharges occurring on or after November 1,
173.162014, payments for hospital residents shall be made as follows:
173.17(1) payments for the first 180 days of inpatient care shall be the APR-DRG system plus
173.18any outliers; and
173.19(2) payment for all medically necessary patient care subsequent to the first 180 days
173.20shall be reimbursed at a rate computed by multiplying the statewide average cost-to-charge
173.21ratio by the usual and customary charges.
173.22(b) For discharges occurring on or after July 1, 2017, payment for hospital residents
173.23shall be equal to the payments under subdivision 8, paragraph (b).
173.24EFFECTIVE DATE.This section is effective July 1, 2017.

173.25    Sec. 11. Minnesota Statutes 2016, section 256.969, subdivision 9, is amended to read:
173.26    Subd. 9. Disproportionate numbers of low-income patients served. (a) For admissions
173.27occurring on or after July 1, 1993, the medical assistance disproportionate population
173.28adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
173.29treatment centers and facilities of the federal Indian Health Service, with a medical assistance
173.30inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
173.31as follows:
174.1    (1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
174.2mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
174.3Health Service but less than or equal to one standard deviation above the mean, the
174.4adjustment must be determined by multiplying the total of the operating and property
174.5payment rates by the difference between the hospital's actual medical assistance inpatient
174.6utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
174.7and facilities of the federal Indian Health Service; and
174.8    (2) for a hospital with a medical assistance inpatient utilization rate above one standard
174.9deviation above the mean, the adjustment must be determined by multiplying the adjustment
174.10that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
174.11report annually on the number of hospitals likely to receive the adjustment authorized by
174.12this paragraph. The commissioner shall specifically report on the adjustments received by
174.13public hospitals and public hospital corporations located in cities of the first class.
174.14    (b) Certified public expenditures made by Hennepin County Medical Center shall be
174.15considered Medicaid disproportionate share hospital payments. Hennepin County and
174.16Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
174.17July 1, 2005, or another date specified by the commissioner, that may qualify for
174.18reimbursement under federal law. Based on these reports, the commissioner shall apply for
174.19federal matching funds.
174.20    (c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
174.21retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
174.22Medicare and Medicaid Services.
174.23    (d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
174.24in accordance with a new methodology using 2012 as the base year. Annual payments made
174.25under this paragraph shall equal the total amount of payments made for 2012. A licensed
174.26children's hospital shall receive only a single DSH factor for children's hospitals. Other
174.27DSH factors may be combined to arrive at a single factor for each hospital that is eligible
174.28for DSH payments. The new methodology shall make payments only to hospitals located
174.29in Minnesota and include the following factors:
174.30    (1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
174.31base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
174.32fee-for-service discharges in the base year shall receive a factor of 0.7880;
175.1    (2) a hospital that has in effect for the initial rate year a contract with the commissioner
175.2to provide extended psychiatric inpatient services under section 256.9693 shall receive a
175.3factor of 0.0160;
175.4    (3) a hospital that has received payment from the fee-for-service program for at least 20
175.5transplant services in the base year shall receive a factor of 0.0435;
175.6    (4) a hospital that has a medical assistance utilization rate in the base year between 20
175.7percent up to one standard deviation above the statewide mean utilization rate shall receive
175.8a factor of 0.0468;
175.9    (5) a hospital that has a medical assistance utilization rate in the base year that is at least
175.10one standard deviation above the statewide mean utilization rate but is less than three standard
175.11deviations above the mean shall receive a factor of 0.2300; and
175.12(6) a hospital that has a medical assistance utilization rate in the base year that is at least
175.13three standard deviations above the statewide mean utilization rate shall receive a factor of
175.140.3711.
175.15    (e) Any payments or portion of payments made to a hospital under this subdivision that
175.16are subsequently returned to the commissioner because the payments are found to exceed
175.17the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
175.18number of fee-for-service discharges, to other DSH-eligible nonchildren's non-children's
175.19hospitals that have a medical assistance utilization rate that is at least one standard deviation
175.20above the mean.
175.21EFFECTIVE DATE.This section is effective July 1, 2017.

175.22    Sec. 12. Minnesota Statutes 2016, section 256.969, subdivision 12, is amended to read:
175.23    Subd. 12. Rehabilitation hospitals and distinct parts. (a) Units of hospitals that are
175.24recognized as rehabilitation distinct parts by the Medicare program shall have separate
175.25provider numbers under the medical assistance program for rate establishment and billing
175.26purposes only. These units shall also have operating payment rates and the disproportionate
175.27population adjustment, if allowed by federal law, established separately from other inpatient
175.28hospital services.
175.29(b) The commissioner shall establish separate relative values under subdivision 2 for
175.30rehabilitation hospitals and distinct parts as defined by the Medicare program. Effective for
175.31discharges occurring on and after November 1, 2014, the commissioner, to the extent
175.32possible, shall replicate the existing payment rate methodology under the new diagnostic
175.33classification system. The result must be budget neutral, ensuring that the total aggregate
176.1payments under the new system are equal to the total aggregate payments made for the same
176.2number and types of services in the base year, calendar year 2012.
176.3(c) For individual hospitals that did not have separate medical assistance rehabilitation
176.4provider numbers or rehabilitation distinct parts in the base year, hospitals shall provide the
176.5information needed to separate rehabilitation distinct part cost and claims data from other
176.6inpatient service data.
176.7(d) Effective with discharges on or after July 1, 2017, payment to rehabilitation hospitals
176.8shall be established under subdivision 2b, paragraph (a), clause (4).
176.9EFFECTIVE DATE.This section is effective July 1, 2017.

176.10    Sec. 13. Minnesota Statutes 2016, section 256B.04, subdivision 12, is amended to read:
176.11    Subd. 12. Limitation on services. (a) Place limits on the types of services covered by
176.12medical assistance, the frequency with which the same or similar services may be covered
176.13by medical assistance for an individual recipient, and the amount paid for each covered
176.14service. The state agency shall promulgate rules establishing maximum reimbursement rates
176.15for emergency and nonemergency transportation.
176.16The rules shall provide:
176.17(1) an opportunity for all recognized transportation providers to be reimbursed for
176.18nonemergency transportation consistent with the maximum rates established by the agency;
176.19and
176.20(2) reimbursement of public and private nonprofit providers serving the disabled
176.21population generally at reasonable maximum rates that reflect the cost of providing the
176.22service regardless of the fare that might be charged by the provider for similar services to
176.23individuals other than those receiving medical assistance or medical care under this chapter;
176.24and.
176.25(3) reimbursement for each additional passenger carried on a single trip at a substantially
176.26lower rate than the first passenger carried on that trip.
176.27(b) The commissioner shall encourage providers reimbursed under this chapter to
176.28coordinate their operation with similar services that are operating in the same community.
176.29To the extent practicable, the commissioner shall encourage eligible individuals to utilize
176.30less expensive providers capable of serving their needs.
176.31(c) For the purpose of this subdivision and section 256B.02, subdivision 8, and effective
176.32on January 1, 1981, "recognized provider of transportation services" means an operator of
177.1special transportation service as defined in section 174.29 that has been issued a current
177.2certificate of compliance with operating standards of the commissioner of transportation
177.3or, if those standards do not apply to the operator, that the agency finds is able to provide
177.4the required transportation in a safe and reliable manner. Until January 1, 1981, "recognized
177.5transportation provider" includes an operator of special transportation service that the agency
177.6finds is able to provide the required transportation in a safe and reliable manner.

177.7    Sec. 14. Minnesota Statutes 2016, section 256B.056, subdivision 5c, is amended to read:
177.8    Subd. 5c. Excess income standard. (a) The excess income standard for parents and
177.9caretaker relatives, pregnant women, infants, and children ages two through 20 is the standard
177.10specified in subdivision 4, paragraph (b).
177.11    (b) The excess income standard for a person whose eligibility is based on blindness,
177.12disability, or age of 65 or more years shall equal 80 81 percent of the federal poverty
177.13guidelines.
177.14EFFECTIVE DATE.This section is effective June 1, 2019.

177.15    Sec. 15. Minnesota Statutes 2016, section 256B.0621, subdivision 10, is amended to read:
177.16    Subd. 10. Payment rates. The commissioner shall set payment rates for targeted case
177.17management under this subdivision. Case managers may bill according to the following
177.18criteria:
177.19    (1) for relocation targeted case management, case managers may bill for direct case
177.20management activities, including face-to-face and contact, telephone contacts contact, and
177.21interactive video contact according to section 256B.0924, subdivision 4a, in the lesser of:
177.22    (i) 180 days preceding an eligible recipient's discharge from an institution; or
177.23    (ii) the limits and conditions which apply to federal Medicaid funding for this service;
177.24    (2) for home care targeted case management, case managers may bill for direct case
177.25management activities, including face-to-face and telephone contacts; and
177.26    (3) billings for targeted case management services under this subdivision shall not
177.27duplicate payments made under other program authorities for the same purpose.
177.28EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
177.29of human services shall notify the revisor of statutes when federal approval is obtained.

178.1    Sec. 16. Minnesota Statutes 2016, section 256B.0625, subdivision 3b, is amended to read:
178.2    Subd. 3b. Telemedicine services. (a) Medical assistance covers medically necessary
178.3services and consultations delivered by a licensed health care provider via telemedicine in
178.4the same manner as if the service or consultation was delivered in person. Coverage is
178.5limited to three telemedicine services per enrollee per calendar week. Telemedicine services
178.6shall be paid at the full allowable rate.
178.7(b) The commissioner shall establish criteria that a health care provider must attest to
178.8in order to demonstrate the safety or efficacy of delivering a particular service via
178.9telemedicine. The attestation may include that the health care provider:
178.10(1) has identified the categories or types of services the health care provider will provide
178.11via telemedicine;
178.12(2) has written policies and procedures specific to telemedicine services that are regularly
178.13reviewed and updated;
178.14(3) has policies and procedures that adequately address patient safety before, during,
178.15and after the telemedicine service is rendered;
178.16(4) has established protocols addressing how and when to discontinue telemedicine
178.17services; and
178.18(5) has an established quality assurance process related to telemedicine services.
178.19(c) As a condition of payment, a licensed health care provider must document each
178.20occurrence of a health service provided by telemedicine to a medical assistance enrollee.
178.21Health care service records for services provided by telemedicine must meet the requirements
178.22set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:
178.23(1) the type of service provided by telemedicine;
178.24(2) the time the service began and the time the service ended, including an a.m. and p.m.
178.25designation;
178.26(3) the licensed health care provider's basis for determining that telemedicine is an
178.27appropriate and effective means for delivering the service to the enrollee;
178.28(4) the mode of transmission of the telemedicine service and records evidencing that a
178.29particular mode of transmission was utilized;
178.30(5) the location of the originating site and the distant site;
179.1(6) if the claim for payment is based on a physician's telemedicine consultation with
179.2another physician, the written opinion from the consulting physician providing the
179.3telemedicine consultation; and
179.4(7) compliance with the criteria attested to by the health care provider in accordance
179.5with paragraph (b).
179.6(d) For purposes of this subdivision, unless otherwise covered under this chapter,
179.7"telemedicine" is defined as the delivery of health care services or consultations while the
179.8patient is at an originating site and the licensed health care provider is at a distant site. A
179.9communication between licensed health care providers, or a licensed health care provider
179.10and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
179.11does not constitute telemedicine consultations or services. Telemedicine may be provided
179.12by means of real-time two-way, interactive audio and visual communications, including the
179.13application of secure video conferencing or store-and-forward technology to provide or
179.14support health care delivery, which facilitate the assessment, diagnosis, consultation,
179.15treatment, education, and care management of a patient's health care.
179.16(e) For purposes of this section, "licensed health care provider" is defined means a
179.17licensed health care provider under section 62A.671, subdivision 6, and a mental health
179.18practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision 26,
179.19working under the general supervision of a mental health professional
; "health care provider"
179.20is defined under section 62A.671, subdivision 3; and "originating site" is defined under
179.21section 62A.671, subdivision 7.
179.22EFFECTIVE DATE.This section is effective the day following final enactment.

179.23    Sec. 17. Minnesota Statutes 2016, section 256B.0625, subdivision 7, is amended to read:
179.24    Subd. 7. Home care nursing. Medical assistance covers home care nursing services in
179.25a recipient's home. Recipients who are authorized to receive home care nursing services in
179.26their home may use approved hours outside of the home during hours when normal life
179.27activities take them outside of their home. To use home care nursing services at school, the
179.28recipient or responsible party must provide written authorization in the care plan identifying
179.29the chosen provider and the daily amount of services to be used at school. Medical assistance
179.30does not cover home care nursing services for residents of a hospital, nursing facility,
179.31intermediate care facility, or a health care facility licensed by the commissioner of health,
179.32except as authorized in section 256B.64 for ventilator-dependent recipients in hospitals or
179.33unless a resident who is otherwise eligible is on leave from the facility and the facility either
179.34pays for the home care nursing services or forgoes the facility per diem for the leave days
180.1that home care nursing services are used. Total hours of service and payment allowed for
180.2services outside the home cannot exceed that which is otherwise allowed in an in-home
180.3setting according to sections 256B.0651 and 256B.0654 . All home care nursing services
180.4must be provided according to the limits established under sections 256B.0651, 256B.0653,
180.5and 256B.0654. Home care nursing services may not be reimbursed if the nurse is the family
180.6foster care provider of a recipient who is under age 18, unless allowed under section
180.7256B.0654, subdivision 4 .

180.8    Sec. 18. Minnesota Statutes 2016, section 256B.0625, subdivision 13, is amended to read:
180.9    Subd. 13. Drugs. (a) Medical assistance covers drugs, except for fertility drugs when
180.10specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
180.11by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
180.12dispensing physician, or by a physician, physician assistant, or a nurse practitioner employed
180.13by or under contract with a community health board as defined in section 145A.02,
180.14subdivision 5
, for the purposes of communicable disease control.
180.15(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
180.16unless authorized by the commissioner.
180.17(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
180.18ingredient" is defined as a substance that is represented for use in a drug and when used in
180.19the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
180.20drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
180.21for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
180.22excipients which are included in the medical assistance formulary. Medical assistance covers
180.23selected active pharmaceutical ingredients and excipients used in compounded prescriptions
180.24when the compounded combination is specifically approved by the commissioner or when
180.25a commercially available product:
180.26(1) is not a therapeutic option for the patient;
180.27(2) does not exist in the same combination of active ingredients in the same strengths
180.28as the compounded prescription; and
180.29(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
180.30prescription.
180.31(d) Medical assistance covers the following over-the-counter drugs when prescribed by
180.32a licensed practitioner or by a licensed pharmacist who meets standards established by the
180.33commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
181.1planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
181.2with documented vitamin deficiencies, vitamins for children under the age of seven and
181.3pregnant or nursing women, and any other over-the-counter drug identified by the
181.4commissioner, in consultation with the formulary committee, as necessary, appropriate, and
181.5cost-effective for the treatment of certain specified chronic diseases, conditions, or disorders,
181.6and this determination shall not be subject to the requirements of chapter 14. A pharmacist
181.7may prescribe over-the-counter medications as provided under this paragraph for purposes
181.8of receiving reimbursement under Medicaid. When prescribing over-the-counter drugs under
181.9this paragraph, licensed pharmacists must consult with the recipient to determine necessity,
181.10provide drug counseling, review drug therapy for potential adverse interactions, and make
181.11referrals as needed to other health care professionals. Over-the-counter medications must
181.12be dispensed in a quantity that is the lowest of: (1) the number of dosage units contained in
181.13the manufacturer's original package; (2) the number of dosage units required to complete
181.14the patient's course of therapy; or (3) if applicable, the number of dosage units dispensed
181.15from a system using retrospective billing, as provided under subdivision 13e, paragraph
181.16(b).
181.17(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
181.18under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
181.19Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
181.20for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
181.21Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
181.22individuals, medical assistance may cover drugs from the drug classes listed in United States
181.23Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
181.2413g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
181.25not be covered.
181.26(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
181.27Program and dispensed by 340B covered entities and ambulatory pharmacies under common
181.28ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
181.29through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

181.30    Sec. 19. Minnesota Statutes 2016, section 256B.0625, subdivision 13e, is amended to
181.31read:
181.32    Subd. 13e. Payment rates. (a) Effective April 1, 2017, or upon federal approval,
181.33whichever is later, the basis for determining the amount of payment shall be the lower of
181.34the actual acquisition costs ingredient cost of the drugs or the maximum allowable cost by
182.1the commissioner plus the fixed professional dispensing fee; or the usual and customary
182.2price charged to the public. The usual and customary price is defined as the lowest price
182.3charged by the provider to a patient who pays for the prescription by cash, check, or charge
182.4account and includes those prices the pharmacy charges to customers enrolled in a
182.5prescription savings club or prescription discount club administered by the pharmacy or
182.6pharmacy chain. The amount of payment basis must be reduced to reflect all discount
182.7amounts applied to the charge by any third-party provider/insurer agreement or contract for
182.8submitted charges to medical assistance programs. The net submitted charge may not be
182.9greater than the patient liability for the service. The pharmacy professional dispensing fee
182.10shall be $3.65 $11.35 for legend prescription drugs prescriptions filled with legend drugs
182.11meeting the definition of "covered outpatient drugs" according to United States Code, title
182.1242, section 1396r-8(k)(2), except that the dispensing fee for intravenous solutions which
182.13must be compounded by the pharmacist shall be $8 $11.35 per bag, $14 per bag for cancer
182.14chemotherapy products, and $30 per bag for total parenteral nutritional products dispensed
182.15in one liter quantities, or $44 per bag for total parenteral nutritional products dispensed in
182.16quantities greater than one liter. The professional dispensing fee for prescriptions filled with
182.17over-the-counter drugs meeting the definition of covered outpatient drugs shall be $11.35
182.18for dispensed quantities equal to or greater than the number of units contained in the
182.19manufacturer's original package. The professional dispensing fee shall be prorated based
182.20on the percentage of the package dispensed when the pharmacy dispenses a quantity less
182.21than the number of units contained in the manufacturer's original package. The pharmacy
182.22dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
182.23outpatient drugs shall be $3.65, except that the fee shall be $1.31 for retrospectively billing
182.24pharmacies when billing for quantities less than the number of units contained in the
182.25manufacturer's original package. Actual acquisition cost includes quantity and other special
182.26discounts except time and cash discounts. The actual acquisition for quantities equal to or
182.27greater than the number of units contained in the manufacturer's original package and shall
182.28be prorated based on the percentage of the package dispensed when the pharmacy dispenses
182.29a quantity less than the number of units contained in the manufacturer's original package.
182.30The National Average Drug Acquisition Cost (NADAC) shall be used to determine the
182.31ingredient cost of a drug shall be estimated by the commissioner at wholesale acquisition
182.32cost plus four percent for independently owned pharmacies located in a designated rural
182.33area within Minnesota, and at wholesale acquisition cost plus two percent for all other
182.34pharmacies. A pharmacy is "independently owned" if it is one of four or fewer pharmacies
182.35under the same ownership nationally. A "designated rural area" means an area defined as
182.36a small rural area or isolated rural area according to the four-category classification of the
183.1Rural Urban Commuting Area system developed for the United States Health Resources
183.2and Services Administration. Effective January 1, 2014, the actual acquisition. For drugs
183.3for which a NADAC is not reported, the commissioner shall estimate the ingredient cost at
183.4wholesale acquisition cost minus two percent. The commissioner shall establish the ingredient
183.5cost of a drug acquired through the federal 340B Drug Pricing Program shall be estimated
183.6by the commissioner at wholesale acquisition cost minus 40 percent at a 340B Drug Pricing
183.7Program maximum allowable cost. The 340B Drug Pricing Program maximum allowable
183.8cost shall be comparable to, but no higher than, the 340B Drug Pricing Program ceiling
183.9price established by the Health Resources and Services Administration. Wholesale acquisition
183.10cost is defined as the manufacturer's list price for a drug or biological to wholesalers or
183.11direct purchasers in the United States, not including prompt pay or other discounts, rebates,
183.12or reductions in price, for the most recent month for which information is available, as
183.13reported in wholesale price guides or other publications of drug or biological pricing data.
183.14The maximum allowable cost of a multisource drug may be set by the commissioner and it
183.15shall be comparable to, but the actual acquisition cost of the drug product and no higher
183.16than, the maximum amount paid by other third-party payors in this state who have maximum
183.17allowable cost programs and no higher than the NADAC of the generic product.
183.18Establishment of the amount of payment for drugs shall not be subject to the requirements
183.19of the Administrative Procedure Act.
183.20    (b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
183.21an automated drug distribution system meeting the requirements of section 151.58, or a
183.22packaging system meeting the packaging standards set forth in Minnesota Rules, part
183.236800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
183.24retrospective billing for prescription drugs dispensed to long-term care facility residents. A
183.25retrospectively billing pharmacy must submit a claim only for the quantity of medication
183.26used by the enrolled recipient during the defined billing period. A retrospectively billing
183.27pharmacy must use a billing period not less than one calendar month or 30 days.
183.28    (c) An additional dispensing fee of $.30 may be added to the dispensing fee paid to
183.29pharmacists for legend drug prescriptions dispensed to residents of long-term care facilities
183.30when a unit dose blister card system, approved by the department, is used. Under this type
183.31of dispensing system, the pharmacist must dispense a 30-day supply of drug. The National
183.32Drug Code (NDC) from the drug container used to fill the blister card must be identified
183.33on the claim to the department. The unit dose blister card containing the drug must meet
183.34the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return
183.35of unused drugs to the pharmacy for reuse. A pharmacy provider using packaging that meets
184.1the standards set forth in Minnesota Rules, part 6800.2700, is required to credit the
184.2department for the actual acquisition cost of all unused drugs that are eligible for reuse,
184.3unless the pharmacy is using retrospective billing. The commissioner may permit the drug
184.4clozapine to be dispensed in a quantity that is less than a 30-day supply.
184.5    (d) Whenever a maximum allowable cost has been set for If a pharmacy dispenses a
184.6multisource drug, payment shall be the lower of the usual and customary price charged to
184.7the public or the ingredient cost shall be the NADAC of the generic product or the maximum
184.8allowable cost established by the commissioner unless prior authorization for the brand
184.9name product has been granted according to the criteria established by the Drug Formulary
184.10Committee as required by subdivision 13f, paragraph (a), and the prescriber has indicated
184.11"dispense as written" on the prescription in a manner consistent with section 151.21,
184.12subdivision 2
.
184.13    (e) The basis for determining the amount of payment for drugs administered in an
184.14outpatient setting shall be the lower of the usual and customary cost submitted by the
184.15provider, 106 percent of the average sales price as determined by the United States
184.16Department of Health and Human Services pursuant to title XVIII, section 1847a of the
184.17federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
184.18set by the commissioner. If average sales price is unavailable, the amount of payment must
184.19be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
184.20cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
184.21Effective January 1, 2014, the commissioner shall discount the payment rate for drugs
184.22obtained through the federal 340B Drug Pricing Program by 20 percent. The payment for
184.23drugs administered in an outpatient setting shall be made to the administering facility or
184.24practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
184.25outpatient setting is not eligible for direct reimbursement.
184.26    (f) The commissioner may negotiate lower reimbursement rates establish maximum
184.27allowable cost rates for specialty pharmacy products than the rates that are lower than the
184.28ingredient cost formulas specified in paragraph (a). The commissioner may require
184.29individuals enrolled in the health care programs administered by the department to obtain
184.30specialty pharmacy products from providers with whom the commissioner has negotiated
184.31lower reimbursement rates able to provide enhanced clinical services and willing to accept
184.32the specialty pharmacy reimbursement. Specialty pharmacy products are defined as those
184.33used by a small number of recipients or recipients with complex and chronic diseases that
184.34require expensive and challenging drug regimens. Examples of these conditions include,
184.35but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C, growth
185.1hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of cancer.
185.2Specialty pharmaceutical products include injectable and infusion therapies, biotechnology
185.3drugs, antihemophilic factor products, high-cost therapies, and therapies that require complex
185.4care. The commissioner shall consult with the formulary committee to develop a list of
185.5specialty pharmacy products subject to this paragraph maximum allowable cost
185.6reimbursement. In consulting with the formulary committee in developing this list, the
185.7commissioner shall take into consideration the population served by specialty pharmacy
185.8products, the current delivery system and standard of care in the state, and access to care
185.9issues. The commissioner shall have the discretion to adjust the reimbursement rate maximum
185.10allowable cost to prevent access to care issues.
185.11(g) Home infusion therapy services provided by home infusion therapy pharmacies must
185.12be paid at rates according to subdivision 8d.
185.13(h) Effective for prescriptions filled on or after April 1, 2017, or upon federal approval,
185.14whichever is later, the commissioner shall increase the ingredient cost reimbursement
185.15calculated in paragraphs (a) and (f) by two percent for prescription and nonprescription
185.16drugs subject to the wholesale drug distributor tax under section 295.52.
185.17EFFECTIVE DATE.This section is effective retroactively from April 1, 2017, or from
185.18the effective date of federal approval, whichever is later. The commissioner of human
185.19services shall notify the revisor of statutes when federal approval is obtained.

185.20    Sec. 20. Minnesota Statutes 2016, section 256B.0625, subdivision 17, is amended to read:
185.21    Subd. 17. Transportation costs. (a) "Nonemergency medical transportation service"
185.22means motor vehicle transportation provided by a public or private person that serves
185.23Minnesota health care program beneficiaries who do not require emergency ambulance
185.24service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.
185.25(b) Medical assistance covers medical transportation costs incurred solely for obtaining
185.26emergency medical care or transportation costs incurred by eligible persons in obtaining
185.27emergency or nonemergency medical care when paid directly to an ambulance company,
185.28common carrier nonemergency medical transportation company, or other recognized
185.29providers of transportation services. Medical transportation must be provided by:
185.30(1) nonemergency medical transportation providers who meet the requirements of this
185.31subdivision;
185.32(2) ambulances, as defined in section 144E.001, subdivision 2;
185.33(3) taxicabs that meet the requirements of this subdivision;
186.1(4) public transit, as defined in section 174.22, subdivision 7; or
186.2(5) not-for-hire vehicles, including volunteer drivers.
186.3(c) Medical assistance covers nonemergency medical transportation provided by
186.4nonemergency medical transportation providers enrolled in the Minnesota health care
186.5programs. All nonemergency medical transportation providers must comply with the
186.6operating standards for special transportation service as defined in sections 174.29 to 174.30
186.7and Minnesota Rules, chapter 8840, and in consultation with the Minnesota Department of
186.8Transportation. All nonemergency medical transportation providers shall bill for
186.9nonemergency medical transportation services in accordance with Minnesota health care
186.10programs criteria. Publicly operated transit systems, volunteers, and not-for-hire vehicles
186.11are exempt from the requirements outlined in this paragraph.
186.12(d) An organization may be terminated, denied, or suspended from enrollment if:
186.13(1) the provider has not initiated background studies on the individuals specified in
186.14section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or
186.15(2) the provider has initiated background studies on the individuals specified in section
186.16174.30, subdivision 10 , paragraph (a), clauses (1) to (3), and:
186.17(i) the commissioner has sent the provider a notice that the individual has been
186.18disqualified under section 245C.14; and
186.19(ii) the individual has not received a disqualification set-aside specific to the special
186.20transportation services provider under sections 245C.22 and 245C.23.
186.21(e) The administrative agency of nonemergency medical transportation must:
186.22(1) adhere to the policies defined by the commissioner in consultation with the
186.23Nonemergency Medical Transportation Advisory Committee;
186.24(2) pay nonemergency medical transportation providers for services provided to
186.25Minnesota health care programs beneficiaries to obtain covered medical services;
186.26(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
186.27trips, and number of trips by mode; and
186.28(4) by July 1, 2016, in accordance with subdivision 18e, utilize a Web-based single
186.29administrative structure assessment tool that meets the technical requirements established
186.30by the commissioner, reconciles trip information with claims being submitted by providers,
186.31and ensures prompt payment for nonemergency medical transportation services.
187.1    (f) Until the commissioner implements the single administrative structure and delivery
187.2system under subdivision 18e, clients shall obtain their level-of-service certificate from the
187.3commissioner or an entity approved by the commissioner that does not dispatch rides for
187.4clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).
187.5    (g) The commissioner may use an order by the recipient's attending physician or a medical
187.6or mental health professional to certify that the recipient requires nonemergency medical
187.7transportation services. Nonemergency medical transportation providers shall perform
187.8driver-assisted services for eligible individuals, when appropriate. Driver-assisted service
187.9includes passenger pickup at and return to the individual's residence or place of business,
187.10assistance with admittance of the individual to the medical facility, and assistance in
187.11passenger securement or in securing of wheelchairs, child seats, or stretchers in the vehicle.
187.12Nonemergency medical transportation providers must take clients to the health care
187.13provider using the most direct route, and must not exceed 30 miles for a trip to a primary
187.14care provider or 60 miles for a trip to a specialty care provider, unless the client receives
187.15authorization from the local agency.
187.16Nonemergency medical transportation providers may not bill for separate base rates for
187.17the continuation of a trip beyond the original destination. Nonemergency medical
187.18transportation providers must maintain trip logs, which include pickup and drop-off times,
187.19signed by the medical provider or client, whichever is deemed most appropriate, attesting
187.20to mileage traveled to obtain covered medical services. Clients requesting client mileage
187.21reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
187.22services.
187.23(h) The administrative agency shall use the level of service process established by the
187.24commissioner in consultation with the Nonemergency Medical Transportation Advisory
187.25Committee to determine the client's most appropriate mode of transportation. If public transit
187.26or a certified transportation provider is not available to provide the appropriate service mode
187.27for the client, the client may receive a onetime service upgrade.
187.28(i) The covered modes of transportation, which may not be implemented without a new
187.29rate structure, are:
187.30(1) client reimbursement, which includes client mileage reimbursement provided to
187.31clients who have their own transportation, or to family or an acquaintance who provides
187.32transportation to the client;
187.33(2) volunteer transport, which includes transportation by volunteers using their own
187.34vehicle;
188.1(3) unassisted transport, which includes transportation provided to a client by a taxicab
188.2or public transit. If a taxicab or public transit is not available, the client can receive
188.3transportation from another nonemergency medical transportation provider;
188.4(4) assisted transport, which includes transport provided to clients who require assistance
188.5by a nonemergency medical transportation provider;
188.6(5) lift-equipped/ramp transport, which includes transport provided to a client who is
188.7dependent on a device and requires a nonemergency medical transportation provider with
188.8a vehicle containing a lift or ramp;
188.9(6) protected transport, which includes transport provided to a client who has received
188.10a prescreening that has deemed other forms of transportation inappropriate and who requires
188.11a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
188.12locks, a video recorder, and a transparent thermoplastic partition between the passenger and
188.13the vehicle driver; and (ii) who is certified as a protected transport provider; and
188.14(7) stretcher transport, which includes transport for a client in a prone or supine position
188.15and requires a nonemergency medical transportation provider with a vehicle that can transport
188.16a client in a prone or supine position.
188.17(j) The local agency shall be the single administrative agency and shall administer and
188.18reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
188.19commissioner has developed, made available, and funded the Web-based single
188.20administrative structure, assessment tool, and level of need assessment under subdivision
188.2118e. The local agency's financial obligation is limited to funds provided by the state or
188.22federal government.
188.23(k) The commissioner shall:
188.24(1) in consultation with the Nonemergency Medical Transportation Advisory Committee,
188.25verify that the mode and use of nonemergency medical transportation is appropriate;
188.26(2) verify that the client is going to an approved medical appointment; and
188.27(3) investigate all complaints and appeals.
188.28(l) The administrative agency shall pay for the services provided in this subdivision and
188.29seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
188.30local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
188.31recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.
189.1(m) Payments for nonemergency medical transportation must be paid based on the client's
189.2assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
189.3medical assistance reimbursement rates for nonemergency medical transportation services
189.4that are payable by or on behalf of the commissioner for nonemergency medical
189.5transportation services are:
189.6(1) $0.22 per mile for client reimbursement;
189.7(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
189.8transport;
189.9(3) equivalent to the standard fare for unassisted transport when provided by public
189.10transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
189.11medical transportation provider;
189.12(4) $13 for the base rate and $1.30 per mile for assisted transport;
189.13(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;
189.14(6) $75 for the base rate and $2.40 per mile for protected transport; and
189.15(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
189.16an additional attendant if deemed medically necessary.
189.17(n) The base rate for nonemergency medical transportation services in areas defined
189.18under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
189.19paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
189.20services in areas defined under RUCA to be rural or super rural areas is:
189.21(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
189.22rate in paragraph (m), clauses (1) to (7); and
189.23(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
189.24rate in paragraph (m), clauses (1) to (7).
189.25(o) For purposes of reimbursement rates for nonemergency medical transportation
189.26services under paragraphs (m) and (n), the zip code of the recipient's place of residence
189.27shall determine whether the urban, rural, or super rural reimbursement rate applies.
189.28(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
189.29a census-tract based classification system under which a geographical area is determined
189.30to be urban, rural, or super rural.
190.1(q) The commissioner, when determining reimbursement rates for nonemergency medical
190.2transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
190.3under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).

190.4    Sec. 21. Minnesota Statutes 2016, section 256B.0625, subdivision 17b, is amended to
190.5read:
190.6    Subd. 17b. Documentation required. (a) As a condition for payment, nonemergency
190.7medical transportation providers must document each occurrence of a service provided to
190.8a recipient according to this subdivision. Providers must maintain odometer and other records
190.9sufficient to distinguish individual trips with specific vehicles and drivers. The documentation
190.10may be collected and maintained using electronic systems or software or in paper form but
190.11must be made available and produced upon request. Program funds paid for transportation
190.12that is not documented according to this subdivision shall be recovered by the department.
190.13(b) A nonemergency medical transportation provider must compile transportation records
190.14that meet the following requirements:
190.15(1) the record must be in English and must be legible according to the standard of a
190.16reasonable person;
190.17(2) the recipient's name must be on each page of the record; and
190.18(3) each entry in the record must document:
190.19(i) the date on which the entry is made;
190.20(ii) the date or dates the service is provided;
190.21(iii) the printed last name, first name, and middle initial of the driver;
190.22(iv) the signature of the driver attesting to the following: "I certify that I have accurately
190.23reported in this record the trip miles I actually drove and the dates and times I actually drove
190.24them. I understand that misreporting the miles driven and hours worked is fraud for which
190.25I could face criminal prosecution or civil proceedings.";
190.26(v) the signature of the recipient or authorized party attesting to the following: "I certify
190.27that I received the reported transportation service.", or the signature of the provider of
190.28medical services certifying that the recipient was delivered to the provider;
190.29(vi) the address, or the description if the address is not available, of both the origin and
190.30destination, and the mileage for the most direct route from the origin to the destination;
190.31(vii) the mode of transportation in which the service is provided;
191.1(viii) the license plate number of the vehicle used to transport the recipient;
191.2(ix) whether the service was ambulatory or nonambulatory until the modes under
191.3subdivision 17 are implemented;
191.4(x) the time of the pickup and the time of the drop-off with "a.m." and "p.m."
191.5designations;
191.6(xi) the name of the extra attendant when an extra attendant is used to provide special
191.7transportation service; and
191.8(xii) the electronic source documentation used to calculate driving directions and mileage.

191.9    Sec. 22. Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
191.10to read:
191.11    Subd. 17c. Nursing facility transports. A Minnesota health care program enrollee
191.12residing in, or being discharged from, a licensed nursing facility is exempt from a level of
191.13need determination and is eligible for nonemergency medical transportation services until
191.14the enrollee no longer resides in a licensed nursing facility, as provided in section 256B.04,
191.15subdivision 14a.

191.16    Sec. 23. Minnesota Statutes 2016, section 256B.0625, subdivision 18h, is amended to
191.17read:
191.18    Subd. 18h. Managed care. (a) The following subdivisions do not apply to managed
191.19care plans and county-based purchasing plans:
191.20    (1) subdivision 17, paragraphs (d) to (k) (a), (b), (i), and (n);
191.21    (2) subdivision 18e 18; and
191.22    (3) subdivision 18g 18a.
191.23(b) A nonemergency medical transportation provider must comply with the operating
191.24standards for special transportation service specified in sections 174.29 to 174.30 and
191.25Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire
191.26vehicles are exempt from the requirements in this paragraph.

191.27    Sec. 24. Minnesota Statutes 2016, section 256B.0625, subdivision 20, is amended to read:
191.28    Subd. 20. Mental health case management. (a) To the extent authorized by rule of the
191.29state agency, medical assistance covers case management services to persons with serious
191.30and persistent mental illness and children with severe emotional disturbance. Services
192.1provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
192.2the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
192.39520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.
192.4    (b) Entities meeting program standards set out in rules governing family community
192.5support services as defined in section 245.4871, subdivision 17, are eligible for medical
192.6assistance reimbursement for case management services for children with severe emotional
192.7disturbance when these services meet the program standards in Minnesota Rules, parts
192.89520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
192.9    (c) Medical assistance and MinnesotaCare payment for mental health case management
192.10shall be made on a monthly basis. In order to receive payment for an eligible child, the
192.11provider must document at least a face-to-face contact with the child, the child's parents, or
192.12the child's legal representative. To receive payment for an eligible adult, the provider must
192.13document:
192.14    (1) at least a face-to-face contact with the adult or the adult's legal representative or a
192.15contact by interactive video that meets the requirements of subdivision 20b; or
192.16    (2) at least a telephone contact with the adult or the adult's legal representative and
192.17document a face-to-face contact or a contact by interactive video that meets the requirements
192.18of subdivision 20b with the adult or the adult's legal representative within the preceding
192.19two months.
192.20    (d) Payment for mental health case management provided by county or state staff shall
192.21be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
192.22(b), with separate rates calculated for child welfare and mental health, and within mental
192.23health, separate rates for children and adults.
192.24    (e) Payment for mental health case management provided by Indian health services or
192.25by agencies operated by Indian tribes may be made according to this section or other relevant
192.26federally approved rate setting methodology.
192.27    (f) Payment for mental health case management provided by vendors who contract with
192.28a county or Indian tribe shall be based on a monthly rate negotiated by the host county or
192.29tribe. The negotiated rate must not exceed the rate charged by the vendor for the same
192.30service to other payers. If the service is provided by a team of contracted vendors, the county
192.31or tribe may negotiate a team rate with a vendor who is a member of the team. The team
192.32shall determine how to distribute the rate among its members. No reimbursement received
192.33by contracted vendors shall be returned to the county or tribe, except to reimburse the county
192.34or tribe for advance funding provided by the county or tribe to the vendor.
193.1    (g) If the service is provided by a team which includes contracted vendors, tribal staff,
193.2and county or state staff, the costs for county or state staff participation in the team shall be
193.3included in the rate for county-provided services. In this case, the contracted vendor, the
193.4tribal agency, and the county may each receive separate payment for services provided by
193.5each entity in the same month. In order to prevent duplication of services, each entity must
193.6document, in the recipient's file, the need for team case management and a description of
193.7the roles of the team members.
193.8    (h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
193.9mental health case management shall be provided by the recipient's county of responsibility,
193.10as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
193.11used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
193.12share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
193.13without a federal share through fee-for-service, 50 percent of the cost shall be provided by
193.14the recipient's county of responsibility.
193.15    (i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
193.16and MinnesotaCare include mental health case management. When the service is provided
193.17through prepaid capitation, the nonfederal share is paid by the state and the county pays no
193.18share.
193.19    (j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
193.20that does not meet the reporting or other requirements of this section. The county of
193.21responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
193.22is responsible for any federal disallowances. The county or tribe may share this responsibility
193.23with its contracted vendors.
193.24    (k) The commissioner shall set aside a portion of the federal funds earned for county
193.25expenditures under this section to repay the special revenue maximization account under
193.26section 256.01, subdivision 2, paragraph (o). The repayment is limited to:
193.27    (1) the costs of developing and implementing this section; and
193.28    (2) programming the information systems.
193.29    (l) Payments to counties and tribal agencies for case management expenditures under
193.30this section shall only be made from federal earnings from services provided under this
193.31section. When this service is paid by the state without a federal share through fee-for-service,
193.3250 percent of the cost shall be provided by the state. Payments to county-contracted vendors
193.33shall include the federal earnings, the state share, and the county share.
194.1    (m) Case management services under this subdivision do not include therapy, treatment,
194.2legal, or outreach services.
194.3    (n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
194.4and the recipient's institutional care is paid by medical assistance, payment for case
194.5management services under this subdivision is limited to the lesser of:
194.6    (1) the last 180 days of the recipient's residency in that facility and may not exceed more
194.7than six months in a calendar year; or
194.8    (2) the limits and conditions which apply to federal Medicaid funding for this service.
194.9    (o) Payment for case management services under this subdivision shall not duplicate
194.10payments made under other program authorities for the same purpose.
194.11(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
194.12licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
194.13mental health targeted case management services must actively support identification of
194.14community alternatives for the recipient and discharge planning.
194.15EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
194.16of human services shall notify the revisor of statutes when federal approval is obtained.

194.17    Sec. 25. Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
194.18to read:
194.19    Subd. 20b. Mental health targeted case management through interactive video. (a)
194.20Subject to federal approval, contact made for targeted case management by interactive video
194.21shall be eligible for payment if:
194.22    (1) the person receiving targeted case management services is residing in:
194.23    (i) a hospital;
194.24    (ii) a nursing facility; or
194.25    (iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
194.26establishment or lodging establishment that provides supportive services or health supervision
194.27services according to section 157.17 that is staffed 24 hours a day, seven days a week;
194.28    (2) interactive video is in the best interests of the person and is deemed appropriate by
194.29the person receiving targeted case management or the person's legal guardian, the case
194.30management provider, and the provider operating the setting where the person is residing;
195.1    (3) the use of interactive video is approved as part of the person's written personal service
195.2or case plan, taking into consideration the person's vulnerability and active personal
195.3relationships; and
195.4    (4) interactive video is used for up to, but not more than, 50 percent of the minimum
195.5required face-to-face contact.
195.6    (b) The person receiving targeted case management or the person's legal guardian has
195.7the right to choose and consent to the use of interactive video under this subdivision and
195.8has the right to refuse the use of interactive video at any time.
195.9    (c) The commissioner shall establish criteria that a targeted case management provider
195.10must attest to in order to demonstrate the safety or efficacy of delivering the service via
195.11interactive video. The attestation may include that the case management provider has:
195.12    (1) written policies and procedures specific to interactive video services that are regularly
195.13reviewed and updated;
195.14    (2) policies and procedures that adequately address client safety before, during, and after
195.15the interactive video services are rendered;
195.16    (3) established protocols addressing how and when to discontinue interactive video
195.17services; and
195.18    (4) established a quality assurance process related to interactive video services.
195.19    (d) As a condition of payment, the targeted case management provider must document
195.20the following for each occurrence of targeted case management provided by interactive
195.21video:
195.22    (1) the time the service began and the time the service ended, including an a.m. and p.m.
195.23designation;
195.24    (2) the basis for determining that interactive video is an appropriate and effective means
195.25for delivering the service to the person receiving case management services;
195.26    (3) the mode of transmission of the interactive video services and records evidencing
195.27that a particular mode of transmission was utilized;
195.28    (4) the location of the originating site and the distant site; and
195.29    (5) compliance with the criteria attested to by the targeted case management provider
195.30as provided in paragraph (c).
196.1EFFECTIVE DATE.This section is effective upon federal approval. The commissioner
196.2of human services shall notify the revisor of statutes when federal approval is obtained.

196.3    Sec. 26. Minnesota Statutes 2016, section 256B.0625, subdivision 30, is amended to read:
196.4    Subd. 30. Other clinic services. (a) Medical assistance covers rural health clinic services,
196.5federally qualified health center services, nonprofit community health clinic services, and
196.6public health clinic services. Rural health clinic services and federally qualified health center
196.7services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
196.8(C). Payment for rural health clinic and federally qualified health center services shall be
196.9made according to applicable federal law and regulation.
196.10    (b) A federally qualified health center (FQHC) that is beginning initial operation shall
196.11submit an estimate of budgeted costs and visits for the initial reporting period in the form
196.12and detail required by the commissioner. A federally qualified health center An FQHC that
196.13is already in operation shall submit an initial report using actual costs and visits for the
196.14initial reporting period. Within 90 days of the end of its reporting period, a federally qualified
196.15health center an FQHC shall submit, in the form and detail required by the commissioner,
196.16a report of its operations, including allowable costs actually incurred for the period and the
196.17actual number of visits for services furnished during the period, and other information
196.18required by the commissioner. Federally qualified health centers FQHCs that file Medicare
196.19cost reports shall provide the commissioner with a copy of the most recent Medicare cost
196.20report filed with the Medicare program intermediary for the reporting year which support
196.21the costs claimed on their cost report to the state.
196.22    (c) In order to continue cost-based payment under the medical assistance program
196.23according to paragraphs (a) and (b), a federally qualified health center an FQHC or rural
196.24health clinic must apply for designation as an essential community provider within six
196.25months of final adoption of rules by the Department of Health according to section 62Q.19,
196.26subdivision 7
. For those federally qualified health centers FQHCs and rural health clinics
196.27that have applied for essential community provider status within the six-month time
196.28prescribed, medical assistance payments will continue to be made according to paragraphs
196.29(a) and (b) for the first three years after application. For federally qualified health centers
196.30FQHCs and rural health clinics that either do not apply within the time specified above or
196.31who have had essential community provider status for three years, medical assistance
196.32payments for health services provided by these entities shall be according to the same rates
196.33and conditions applicable to the same service provided by health care providers that are not
196.34federally qualified health centers FQHCs or rural health clinics.
197.1    (d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally qualified
197.2health center an FQHC or a rural health clinic to make application for an essential community
197.3provider designation in order to have cost-based payments made according to paragraphs
197.4(a) and (b) no longer apply.
197.5    (e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
197.6be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
197.7    (f) Effective January 1, 2001, through December 31, 2018, each federally qualified
197.8health center FQHC and rural health clinic may elect to be paid either under the prospective
197.9payment system established in United States Code, title 42, section 1396a(aa), or under an
197.10alternative payment methodology consistent with the requirements of United States Code,
197.11title 42, section 1396a(aa), and approved by the Centers for Medicare and Medicaid Services.
197.12The alternative payment methodology shall be 100 percent of cost as determined according
197.13to Medicare cost principles.
197.14    (g) Effective for services provided on or after January 1, 2019, all claims for payment
197.15of clinic services provided by FQHCs and rural health clinics shall be paid by the
197.16commissioner, according to an annual election by the FQHC or rural health clinic, under
197.17the current prospective payment system described in paragraph (f), the alternative payment
197.18methodology described in paragraph (f), or the alternative payment methodology described
197.19in paragraph (l).
197.20    (g) (h) For purposes of this section, "nonprofit community clinic" is a clinic that:
197.21    (1) has nonprofit status as specified in chapter 317A;
197.22    (2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
197.23    (3) is established to provide health services to low-income population groups, uninsured,
197.24high-risk and special needs populations, underserved and other special needs populations;
197.25    (4) employs professional staff at least one-half of which are familiar with the cultural
197.26background of their clients;
197.27    (5) charges for services on a sliding fee scale designed to provide assistance to
197.28low-income clients based on current poverty income guidelines and family size; and
197.29    (6) does not restrict access or services because of a client's financial limitations or public
197.30assistance status and provides no-cost care as needed.
197.31    (h) (i) Effective for services provided on or after January 1, 2015, all claims for payment
197.32of clinic services provided by federally qualified health centers FQHCs and rural health
198.1clinics shall be paid by the commissioner. Effective for services provided on or after January
198.21, 2015, through July 1, 2017, the commissioner shall determine the most feasible method
198.3for paying claims from the following options:
198.4    (1) federally qualified health centers FQHCs and rural health clinics submit claims
198.5directly to the commissioner for payment, and the commissioner provides claims information
198.6for recipients enrolled in a managed care or county-based purchasing plan to the plan, on
198.7a regular basis; or
198.8    (2) federally qualified health centers FQHCs and rural health clinics submit claims for
198.9recipients enrolled in a managed care or county-based purchasing plan to the plan, and those
198.10claims are submitted by the plan to the commissioner for payment to the clinic.
198.11Effective for services provided on or after January 1, 2019, FQHCs and rural health clinics
198.12shall submit claims directly to the commissioner for payment and the commissioner shall
198.13provide claims information for recipients enrolled in a managed care plan or county-based
198.14purchasing plan to the plan on a regular basis to be determined by the commissioner.
198.15    (i) (j) For clinic services provided prior to January 1, 2015, the commissioner shall
198.16calculate and pay monthly the proposed managed care supplemental payments to clinics,
198.17and clinics shall conduct a timely review of the payment calculation data in order to finalize
198.18all supplemental payments in accordance with federal law. Any issues arising from a clinic's
198.19review must be reported to the commissioner by January 1, 2017. Upon final agreement
198.20between the commissioner and a clinic on issues identified under this subdivision, and in
198.21accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
198.22for managed care plan or county-based purchasing plan claims for services provided prior
198.23to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
198.24unable to resolve issues under this subdivision, the parties shall submit the dispute to the
198.25arbitration process under section 14.57.
198.26    (j) (k) The commissioner shall seek a federal waiver, authorized under section 1115 of
198.27the Social Security Act, to obtain federal financial participation at the 100 percent federal
198.28matching percentage available to facilities of the Indian Health Service or tribal organization
198.29in accordance with section 1905(b) of the Social Security Act for expenditures made to
198.30organizations dually certified under Title V of the Indian Health Care Improvement Act,
198.31Public Law 94-437, and as a federally qualified health center FQHC under paragraph (a)
198.32that provides services to American Indian and Alaskan Native individuals eligible for
198.33services under this subdivision.
199.1    (l) Effective for services provided on or after January 1, 2019, all claims for payment
199.2of clinic services provided by FQHCs and rural health clinics shall be paid by the
199.3commissioner according to the current prospective payment system described in paragraph
199.4(f), or an alternative payment methodology with the following requirements:
199.5    (1) each FQHC and rural health clinic must receive a single medical and a single dental
199.6organization rate;
199.7    (2) the commissioner shall reimburse FQHCs and rural health clinics for allowable costs,
199.8including direct patient care costs and patient-related support services, based upon Medicare
199.9cost principles that apply at the time the alternative payment methodology is calculated;
199.10    (3) the 2019 payment rates for FQHCs and rural health clinics:
199.11    (i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
199.12from 2015 and 2016. A provider must submit the required cost reports to the commissioner
199.13within six months of the second base year calendar or fiscal year end. Cost reports must be
199.14submitted six months before the quarter in which the base rate will take effect;
199.15    (ii) must be according to current Medicare cost principles applicable to FQHCs and rural
199.16health clinics at the time of the alternative payment rate calculation without the application
199.17of productivity screens and upper payment limits or the Medicare prospective payment
199.18system FQHC aggregate mean upper payment limit; and
199.19    (iii) must provide for a 60-day appeals process;
199.20    (4) the commissioner shall inflate the base year payment rate for FQHCs and rural health
199.21clinics to the effective date by using the Bureau of Economic Analysis's personal consumption
199.22expenditures medical care inflator;
199.23    (5) the commissioner shall establish a statewide trend inflator using 2015-2020 costs
199.24replacing the use of the personal consumption expenditures medical care inflator with the
199.252023 rate calculation forward;
199.26    (6) FQHC and rural health clinic payment rates shall be rebased by the commissioner
199.27every two years using the methodology described in clause (3), using the provider's Medicare
199.28cost reports from the previous third and fourth years. In nonrebasing years, the commissioner
199.29shall adjust using the Medicare economic index until 2023 when the statewide trend inflator
199.30is available;
199.31    (7) the commissioner shall increase payments by two percent according to Laws 2003,
199.32First Special Session chapter 14, article 13C, section 2, subdivision 6. This is an add-on to
199.33the rate and must not be included in the base rate calculation;
200.1    (8) for FQHCs and rural health clinics seeking a change of scope of services:
200.2    (i) the commissioner shall require FQHCs and rural health clinics to submit requests to
200.3the commissioner, if the change of scope would result in the medical or dental payment rate
200.4currently received by the FQHC or rural health clinic increasing or decreasing by at least
200.52-1/2 percent;
200.6    (ii) FQHCs and rural health clinics shall submit the request to the commissioner within
200.7seven business days of submission of the scope change to the federal Health Resources
200.8Services Administration;
200.9    (iii) the effective date of the payment change is the date the Health Resources Services
200.10Administration approves the FQHC's or rural health clinic's change of scope request;
200.11    (iv) for change of scope requests that do not require Health Resources Services
200.12Administration approval, FQHCs and rural health clinics shall submit the request to the
200.13commissioner before implementing the change, and the effective date of the change is the
200.14date the commissioner receives the request from the FQHC or rural health clinic; and
200.15    (v) the commissioner shall provide a response to the FQHC's or rural health clinic's
200.16change of scope request within 45 days of submission and provide a final decision regarding
200.17approval or disapproval within 120 days of submission. If more information is needed to
200.18evaluate the request, this timeline may be waived by mutual agreement of the commissioner
200.19and the FQHC or rural health clinic; and
200.20    (9) the commissioner shall establish a payment rate for new FQHC and rural health
200.21clinic organizations, considering the following factors:
200.22    (i) a comparison of patient caseload of FQHCs and rural health clinics within a 60-mile
200.23radius for organizations established outside the seven-county metropolitan area and within
200.24a 30-mile radius for organizations within the seven-county metropolitan area; and
200.25    (ii) if a comparison is not feasible under item (i), the commissioner may use Medicare
200.26cost reports or audited financial statements to establish the base rate.

200.27    Sec. 27. Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
200.28to read:
200.29    Subd. 56a. Post-arrest community-based service coordination. (a) Medical assistance
200.30covers post-arrest community-based service coordination for an individual who:
200.31(1) has been identified as having a mental illness or substance use disorder using a
200.32screening tool approved by the commissioner;
201.1(2) does not require the security of a public detention facility and is not considered an
201.2inmate of a public institution as defined in Code of Federal Regulations, title 42, section
201.3435.1010;
201.4(3) meets the eligibility requirements in section 256B.056; and
201.5(4) has agreed to participate in post-arrest community-based service coordination through
201.6a diversion contract in lieu of incarceration.
201.7(b) Post-arrest community-based service coordination means navigating services to
201.8address a client's mental health, chemical health, social, economic, and housing needs, or
201.9any other activity targeted at reducing the incidence of jail utilization and connecting
201.10individuals with existing covered services available to them, including, but not limited to,
201.11targeted case management, waiver case management, or care coordination.
201.12(c) Post-arrest community-based service coordination must be provided by individuals
201.13who are qualified under one of the following criteria:
201.14(1) a licensed mental health professional as defined in section 245.462, subdivision 18,
201.15clauses (1) to (6);
201.16(2) a mental health practitioner as defined in section 245.462, subdivision 17, working
201.17under the clinical supervision of a mental health professional; or
201.18(3) a certified peer specialist under section 256B.0615, working under the clinical
201.19supervision of a mental health professional.
201.20(d) Reimbursement must be made in 15-minute increments and allowed for up to 60
201.21days following the initial determination of eligibility.
201.22(e) Providers of post-arrest community-based service coordination shall annually report
201.23to the commissioner on the number of individuals served, and number of the
201.24community-based services that were accessed by recipients. The commissioner shall ensure
201.25that services and payments provided under post-arrest community-based service coordination
201.26do not duplicate services or payments provided under section 256B.0625, subdivision 20,
201.27256B.0753, 256B.0755, or 256B.0757.
201.28(f) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of cost for
201.29post-arrest community-based service coordination services shall be provided by the recipient's
201.30county of residence, from sources other than federal funds or funds used to match other
201.31federal funds.
202.1EFFECTIVE DATE.This section is effective upon federal approval for services
202.2provided on or after July 1, 2017. The commissioner of human services shall notify the
202.3revisor of statutes when federal approval is obtained.

202.4    Sec. 28. Minnesota Statutes 2016, section 256B.0625, subdivision 64, is amended to read:
202.5    Subd. 64. Investigational drugs, biological products, and devices. (a) Medical
202.6assistance and the early periodic screening, diagnosis, and treatment (EPSDT) program do
202.7not cover costs incidental to, associated with, or resulting from the use of investigational
202.8drugs, biological products, or devices as defined in section 151.375.
202.9(b) Notwithstanding paragraph (a), stiripentol may be covered by the EPSDT program
202.10if all the following conditions are met:
202.11(1) the use of stiripentol is determined to be medically necessary;
202.12(2) the enrollee has a documented diagnosis of Dravet syndrome, regardless of whether
202.13an SCN1A genetic mutation is found, or the enrollee is a child with malignant migrating
202.14partial epilepsy in infancy due to an SCN2A genetic mutation;
202.15(3) all other available covered prescription medications that are medically necessary for
202.16the enrollee have been tried without successful outcomes; and
202.17(4) the United States Food and Drug Administration has approved the treating physician's
202.18individual patient investigational new drug application (IND) for the use of stiripentol for
202.19treatment.
202.20This paragraph does not apply to MinnesotaCare coverage under chapter 256L.

202.21    Sec. 29. Minnesota Statutes 2016, section 256B.072, is amended to read:
202.22256B.072 PERFORMANCE REPORTING AND QUALITY IMPROVEMENT
202.23SYSTEM.
202.24    Subdivision 1. Performance measures. (a) The commissioner of human services shall
202.25establish a performance reporting system for health care providers who provide health care
202.26services to public program recipients covered under chapters 256B, 256D, and 256L,
202.27reporting separately for managed care and fee-for-service recipients.
202.28(b) The measures used for the performance reporting system for medical groups shall
202.29include measures of care for asthma, diabetes, hypertension, and coronary artery disease
202.30and measures of preventive care services. The measures used for the performance reporting
202.31system for inpatient hospitals shall include measures of care for acute myocardial infarction,
203.1heart failure, and pneumonia, and measures of care and prevention of surgical infections.
203.2In the case of a medical group, the measures used shall be consistent with measures published
203.3by nonprofit Minnesota or national organizations that produce and disseminate health care
203.4quality measures or evidence-based health care guidelines. In the case of inpatient hospital
203.5measures, the commissioner shall appoint the Minnesota Hospital Association and Stratis
203.6Health to advise on the development of the performance measures to be used for hospital
203.7reporting. To enable a consistent measurement process across the community, the
203.8commissioner may use measures of care provided for patients in addition to those identified
203.9in paragraph (a). The commissioner shall ensure collaboration with other health care reporting
203.10organizations so that the measures described in this section are consistent with those reported
203.11by those organizations and used by other purchasers in Minnesota.
203.12(c) The commissioner may require providers to submit information in a required format
203.13to a health care reporting organization or to cooperate with the information collection
203.14procedures of that organization. The commissioner may collaborate with a reporting
203.15organization to collect information reported and to prevent duplication of reporting.
203.16(d) By October 1, 2007, and annually thereafter, the commissioner shall report through
203.17a public Web site the results by medical groups and hospitals, where possible, of the measures
203.18under this section, and shall compare the results by medical groups and hospitals for patients
203.19enrolled in public programs to patients enrolled in private health plans. To achieve this
203.20reporting, the commissioner may collaborate with a health care reporting organization that
203.21operates a Web site suitable for this purpose.
203.22(e) Performance measures must be stratified as provided under section 62U.02,
203.23subdivision 1, paragraph (b), and risk-adjusted as specified in section 62U.02, subdivision
203.243, paragraph (b).
203.25(f) Assessment of patient satisfaction with chronic pain management for the purpose of
203.26determining compensation or quality incentive payments is prohibited. The commissioner
203.27shall require managed care plans, county-based purchasing plans, and integrated health
203.28partnerships to comply with this requirement as a condition of contract. This prohibition
203.29does not apply to:
203.30(1) assessing patient satisfaction with chronic pain management for the purpose of quality
203.31improvement; and
203.32(2) pain management as a part of a palliative care treatment plan to treat patients with
203.33cancer or patients receiving hospice care.
204.1    Subd. 2. Adjustment of quality metrics for special populations. Notwithstanding
204.2subdivision 1, paragraph (b), by January 1, 2019, the commissioner shall consider and
204.3appropriately adjust quality metrics and benchmarks for providers who primarily serve
204.4socio-economically complex patient populations and request to be scored on additional
204.5measures in this subdivision. This requirement applies to all medical assistance and
204.6MinnesotaCare programs and enrollees, including persons enrolled in managed care and
204.7county-based purchasing plans or other managed care organizations, persons receiving care
204.8under fee-for-service, and persons receiving care under value-based purchasing arrangements,
204.9including but not limited to initiatives operating under sections 256B.0751, 256B.0753,
204.10256B.0755, 256B.0756, and 256B.0757.

204.11    Sec. 30. Minnesota Statutes 2016, section 256B.0755, subdivision 1, is amended to read:
204.12    Subdivision 1. Implementation. (a) The commissioner shall develop and authorize
204.13continue a demonstration project established under this section to test alternative and
204.14innovative integrated health care delivery systems partnerships, including accountable care
204.15organizations that provide services to a specified patient population for an agreed-upon total
204.16cost of care or risk/gain sharing payment arrangement. The commissioner shall develop a
204.17request for proposals for participation in the demonstration project in consultation with
204.18hospitals, primary care providers, health plans, and other key stakeholders.
204.19(b) In developing the request for proposals, the commissioner shall:
204.20(1) establish uniform statewide methods of forecasting utilization and cost of care for
204.21the appropriate Minnesota public program populations, to be used by the commissioner for
204.22the health care delivery system integrated health partnership projects;
204.23(2) identify key indicators of quality, access, patient satisfaction, and other performance
204.24indicators that will be measured, in addition to indicators for measuring cost savings;
204.25(3) allow maximum flexibility to encourage innovation and variation so that a variety
204.26of provider collaborations are able to become health care delivery systems integrated health
204.27partnerships, and may be customized for the special needs and barriers of patient populations
204.28experiencing health disparities due to social, economic, racial, or ethnic factors,;
204.29(4) encourage and authorize different levels and types of financial risk;
204.30(5) encourage and authorize projects representing a wide variety of geographic locations,
204.31patient populations, provider relationships, and care coordination models;
204.32(6) encourage projects that involve close partnerships between the health care delivery
204.33system integrated health partnership and counties and nonprofit agencies that provide services
205.1to patients enrolled with the health care delivery system integrated health partnership,
205.2including social services, public health, mental health, community-based services, and
205.3continuing care;
205.4(7) encourage projects established by community hospitals, clinics, and other providers
205.5in rural communities;
205.6(8) identify required covered services for a total cost of care model or services considered
205.7in whole or partially in an analysis of utilization for a risk/gain sharing model;
205.8(9) establish a mechanism to monitor enrollment;
205.9(10) establish quality standards for the delivery system integrated health partnership
205.10demonstrations that are appropriate for the particular patient population to be served; and
205.11(11) encourage participation of privately insured population so as to create sufficient
205.12alignment in demonstration systems.
205.13(c) To be eligible to participate in the demonstration project an integrated health
205.14partnership, a health care delivery system must:
205.15(1) provide required covered services and care coordination to recipients enrolled in the
205.16health care delivery system integrated health partnership;
205.17(2) establish a process to monitor enrollment and ensure the quality of care provided;
205.18(3) in cooperation with counties and community social service agencies, coordinate the
205.19delivery of health care services with existing social services programs;
205.20(4) provide a system for advocacy and consumer protection; and
205.21(5) adopt innovative and cost-effective methods of care delivery and coordination, which
205.22may include the use of allied health professionals, telemedicine, patient educators, care
205.23coordinators, and community health workers.
205.24(d) A health care delivery system An integrated health partnership demonstration may
205.25be formed by the following groups of providers of services and suppliers if they have
205.26established a mechanism for shared governance:
205.27(1) professionals in group practice arrangements;
205.28(2) networks of individual practices of professionals;
205.29(3) partnerships or joint venture arrangements between hospitals and health care
205.30professionals;
205.31(4) hospitals employing professionals; and
206.1(5) other groups of providers of services and suppliers as the commissioner determines
206.2appropriate.
206.3A managed care plan or county-based purchasing plan may participate in this
206.4demonstration in collaboration with one or more of the entities listed in clauses (1) to (5).
206.5A health care delivery system An integrated health partnership may contract with a
206.6managed care plan or a county-based purchasing plan to provide administrative services,
206.7including the administration of a payment system using the payment methods established
206.8by the commissioner for health care delivery systems integrated health partnerships.
206.9(e) The commissioner may require a health care delivery system an integrated health
206.10partnership to enter into additional third-party contractual relationships for the assessment
206.11of risk and purchase of stop loss insurance or another form of insurance risk management
206.12related to the delivery of care described in paragraph (c).
206.13EFFECTIVE DATE.This section is effective January 1, 2018.

206.14    Sec. 31. Minnesota Statutes 2016, section 256B.0755, subdivision 3, is amended to read:
206.15    Subd. 3. Accountability. (a) Health care delivery systems Integrated health partnerships
206.16must accept responsibility for the quality of care based on standards established under
206.17subdivision 1, paragraph (b), clause (10), and the cost of care or utilization of services
206.18provided to its enrollees under subdivision 1, paragraph (b), clause (1). Accountability
206.19standards must be appropriate to the particular population served.
206.20(b) A health care delivery system An integrated health partnership may contract and
206.21coordinate with providers and clinics for the delivery of services and shall contract with
206.22community health clinics, federally qualified health centers, community mental health
206.23centers or programs, county agencies, and rural clinics to the extent practicable.
206.24(c) A health care delivery system An integrated health partnership must indicate how it
206.25will coordinate with other services affecting its patients' health, quality of care, and cost of
206.26care that are provided by other providers, county agencies, and other organizations in the
206.27local service area. The health care delivery system integrated health partnership must indicate
206.28how it will engage other providers, counties, and organizations, including county-based
206.29purchasing plans, that provide services to patients of the health care delivery system
206.30integrated health partnership on issues related to local population health, including applicable
206.31local needs, priorities, and public health goals. The health care delivery system integrated
206.32health partnership must describe how local providers, counties, organizations, including
207.1county-based purchasing plans, and other relevant purchasers were consulted in developing
207.2the application to participate in the demonstration project.

207.3    Sec. 32. Minnesota Statutes 2016, section 256B.0755, subdivision 4, is amended to read:
207.4    Subd. 4. Payment system. (a) In developing a payment system for health care delivery
207.5systems integrated health partnerships, the commissioner shall establish a total cost of care
207.6benchmark or a risk/gain sharing payment model to be paid for services provided to the
207.7recipients enrolled in a health care delivery system an integrated health partnership.
207.8(b) The payment system may include incentive payments to health care delivery systems
207.9integrated health partnerships that meet or exceed annual quality and performance targets
207.10realized through the coordination of care.
207.11(c) An amount equal to the savings realized to the general fund as a result of the
207.12demonstration project shall be transferred each fiscal year to the health care access fund.
207.13(d) The payment system shall include a population-based payment that supports care
207.14coordination services for all enrollees served by the integrated health partnerships, and is
207.15risk-adjusted to reflect varying levels of care coordination intensiveness for enrollees with
207.16chronic conditions, limited English skills, cultural differences, are homeless, or experience
207.17health disparities or other barriers to health care. The population-based payment shall be a
207.18per member, per month payment paid at least on a quarterly basis. Integrated health
207.19partnerships receiving this payment must continue to meet cost and quality metrics under
207.20the program to maintain eligibility for the population-based payment. An integrated health
207.21partnership is eligible to receive a payment under this paragraph even if the partnership is
207.22not participating in a risk-based or gain-sharing payment model and regardless of the size
207.23of the patient population served by the integrated health partnership. Any integrated health
207.24partnership participant certified as a health care home under section 256B.0751 that agrees
207.25to a payment method that includes population-based payments for care coordination is not
207.26eligible to receive health care home payment or care coordination fee authorized under
207.27section 62U.03 or 256B.0753, subdivision 1, or in-reach care coordination under section
207.28256B.0625, subdivision 56, for any medical assistance or MinnesotaCare recipients enrolled
207.29or attributed to the integrated health partnership under this demonstration.
207.30EFFECTIVE DATE.This section is effective January 1, 2018.

208.1    Sec. 33. Minnesota Statutes 2016, section 256B.0755, is amended by adding a subdivision
208.2to read:
208.3    Subd. 9. Patient incentives. The commissioner may authorize an integrated health
208.4partnership to provide incentives for patients to:
208.5(1) see a primary care provider for an initial health assessment;
208.6(2) maintain a continuous relationship with the primary care provider; and
208.7(3) participate in ongoing health