SF 986

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:17am

A bill for an act
relating to health and human services; relieving counties of certain mandates;
allowing counties to place children for treatment in bordering states; modifying
county payment of funeral expenses; modifying provisions related to children's
therapeutic services and supports; modifying certain nursing facility rules;
providing an alternative licensing method for day training and habilitation
services; accepting certain independent audits; modifying renewal notice
requirements; modifying health care program information that school district
or charter school must provide; amending Minnesota Statutes 2008, sections
62Q.37, subdivision 3; 144A.04, subdivision 11, by adding a subdivision;
144A.45, subdivision 1; 157.22; 245.4871, subdivision 10; 245.4882, subdivision
1; 245.4885, subdivision 1a; 245A.09, subdivision 7; 256.935; 256.962,
subdivisions 6, 7; 256B.0915, subdivision 3h; 256B.0943, subdivisions 4, 6, 9;
256B.0945, subdivision 1; 256F.13, subdivision 1; 260C.212, subdivisions 4a,
11; 261.035; 471.61, subdivision 1.

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

ARTICLE 1

HUMAN SERVICES

Section 1.

Minnesota Statutes 2008, section 157.22, is amended to read:

157.22 EXEMPTIONS.

This chapter shall not be construed to apply to:

(1) interstate carriers under the supervision of the United States Department of
Health and Human Services;

(2) any building constructed and primarily used for religious worship;

(3) any building owned, operated, and used by a college or university in accordance
with health regulations promulgated by the college or university under chapter 14;

(4) any person, firm, or corporation whose principal mode of business is licensed
under sections 28A.04 and 28A.05, is exempt at that premises from licensure as a food
or beverage establishment; provided that the holding of any license pursuant to sections
28A.04 and 28A.05 shall not exempt any person, firm, or corporation from the applicable
provisions of this chapter or the rules of the state commissioner of health relating to
food and beverage service establishments;

(5) family day care homes and group family day care homes governed by sections
245A.01 to 245A.16;

(6) nonprofit senior citizen centers for the sale of home-baked goods;

(7) fraternal or patriotic organizations that are tax exempt under section 501(c)(3),
501(c)(4), 501(c)(6), 501(c)(7), 501(c)(10), or 501(c)(19) of the Internal Revenue Code of
1986, or organizations related to or affiliated with such fraternal or patriotic organizations.
Such organizations may organize events at which home-prepared food is donated by
organization members for sale at the events, provided:

(i) the event is not a circus, carnival, or fair;

(ii) the organization controls the admission of persons to the event, the event agenda,
or both; and

(iii) the organization's licensed kitchen is not used in any manner for the event;

(8) food not prepared at an establishment and brought in by individuals attending a
potluck event for consumption at the potluck event. An organization sponsoring a potluck
event under this clause may advertise the potluck event to the public through any means.
Individuals who are not members of an organization sponsoring a potluck event under this
clause may attend the potluck event and consume the food at the event. Licensed food
establishments other than schools cannot be sponsors of potluck events. A school may
sponsor and hold potluck events in areas of the school other than the school's kitchen,
provided that the school's kitchen is not used in any manner for the potluck event. For
purposes of this clause, "school" means a public school as defined in section 120A.05,
subdivisions 9, 11, 13, and 17, or a nonpublic school, church, or religious organization
at which a child is provided with instruction in compliance with sections 120A.22 and
120A.24. Potluck event food shall not be brought into a licensed food establishment
kitchen; deleted text begin and
deleted text end

(9) a home school in which a child is provided instruction at home new text begin ; and
new text end

new text begin (10) group residential facilities of ten or fewer beds licensed by the commissioner of
human services under Minnesota Rules, chapter 2960, provided the facility employs or
contracts with a certified food manager under Minnesota Rules, part 4626.2015 new text end .

Sec. 2.

Minnesota Statutes 2008, section 245.4871, subdivision 10, is amended to read:

Subd. 10.

Day treatment services.

"Day treatment," "day treatment services," or
"day treatment program" means a structured program of treatment and care provided to a
child in:

(1) an outpatient hospital accredited by the Joint Commission on Accreditation of
Health Organizations and licensed under sections 144.50 to 144.55;

(2) a community mental health center under section 245.62;

(3) an entity that is under contract with the county board to operate a program that
meets the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts
9505.0170 to 9505.0475; or

(4) an entity that operates a program that meets the requirements of section
245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is
under contract with an entity that is under contract with a county board.

Day treatment consists of group psychotherapy and other intensive therapeutic
services that are provided for a minimum deleted text begin three-hour deleted text end new text begin two-hour new text end time block by a
multidisciplinary staff under the clinical supervision of a mental health professional.
Day treatment may include education and consultation provided to families and
other individuals as an extension of the treatment process. The services are aimed at
stabilizing the child's mental health status, and developing and improving the child's daily
independent living and socialization skills. Day treatment services are distinguished from
day care by their structured therapeutic program of psychotherapy services. Day treatment
services are not a part of inpatient hospital or residential treatment services. deleted text begin Day treatment
services for a child are an integrated set of education, therapy, and family interventions.
deleted text end

A day treatment service must be available to a child deleted text begin at least five days a week deleted text end
throughout the year and must be coordinated with, integrated with, or part of an education
program offered by the child's school.

Sec. 3.

Minnesota Statutes 2008, section 245.4882, subdivision 1, is amended to read:

Subdivision 1.

Availability of residential treatment services.

County boards must
provide or contract for enough residential treatment services to meet the needs of each
child with severe emotional disturbance residing in the county and needing this level of
care. Length of stay is based on the child's residential treatment need and shall be subject
to the six-month review process established in section 260C.212, subdivisions 7 and 9.
Services must be appropriate to the child's age and treatment needs and must be made
available as close to the county as possible new text begin that may include residential treatment services
provided in bordering states new text end . Residential treatment must be designed to:

(1) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet the child's needs;

(2) help the child improve family living and social interaction skills;

(3) help the child gain the necessary skills to return to the community;

(4) stabilize crisis admissions; and

(5) work with families throughout the placement to improve the ability of the
families to care for children with severe emotional disturbance in the home.

Sec. 4.

Minnesota Statutes 2008, section 245.4885, subdivision 1a, is amended to read:

Subd. 1a.

Emergency admission.

Effective July 1, 2006, if a child is admitted to
a treatment foster care setting, residential treatment facility, or acute care hospital for
emergency treatment or held for emergency care by a regional treatment center under
section 253B.05, subdivision 1, the level of care determination must occur within deleted text begin three deleted text end new text begin
five new text end working days of admission.

Sec. 5.

Minnesota Statutes 2008, section 256.935, is amended to read:

256.935 new text begin CREMATION AND new text end FUNERAL EXPENSES, PAYMENT BY
COUNTY AGENCY.

Subdivision 1.

Funeral expenses.

On the death of any person receiving public
assistance through MFIP, the county agency shall pay new text begin for cremation of the person's
remains. If it is determined that cremation is not in accordance with the religious and
moral beliefs of the decedent or the decedent's spouse or the decedent's next of kin, the
county agency shall pay new text end an amount for funeral expenses not exceeding the amount paid for
comparable services under section 261.035 plus actual cemetery charges. No new text begin cremation or
new text end funeral expenses shall be paid if the estate of the deceased is sufficient to pay such expenses
or if the spouse, who was legally responsible for the support of the deceased while living,
is able to pay such expenses deleted text begin ; provided, that the additional payment or donation of the cost
of cemetery lot, interment, religious service, or for the transportation of the body into or
out of the community in which the deceased resided, shall not limit payment by the county
agency as herein authorized. Freedom of choice in the selection of a funeral director shall
be granted to persons lawfully authorized to make arrangements for the burial of any such
deceased recipient deleted text end . In determining the sufficiency of such estate, due regard shall be had
for the nature and marketability of the assets of the estate. The county agency may grant
new text begin cremation or new text end funeral expenses where the sale would cause undue loss to the estate. Any
amount paid for new text begin cremation or new text end funeral expenses shall be a prior claim against the estate,
as provided in section 524.3-805, and any amount recovered shall be reimbursed to the
agency which paid the expenses. The commissioner shall specify requirements for reports,
including fiscal reports, according to section 256.01, subdivision 2, paragraph deleted text begin (17) deleted text end new text begin (q) new text end .
The state share shall pay the entire amount of county agency expenditures. Benefits shall
be issued to recipients by the state or county subject to provisions of section 256.017.

Sec. 6.

Minnesota Statutes 2008, section 256B.0943, subdivision 4, is amended to read:

Subd. 4.

Provider entity certification.

(a) Effective July 1, 2003, the commissioner
shall establish an initial provider entity application and certification process and
recertification process to determine whether a provider entity has an administrative
and clinical infrastructure that meets the requirements in subdivisions 5 and 6. The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity that no longer meets the
requirements in this section. The county, tribe, and the commissioner shall be mutually
responsible and accountable for the county's, tribe's, and state's part of the certification,
recertification, and decertification processes.

(b) For purposes of this section, a provider entity must be:

(1) an Indian health services facility or a facility owned and operated by a tribe or
tribal organization operating as a 638 facility under Public Law 93-638 certified by the
state;

(2) a county-operated entity certified by the state; or

(3) a noncounty entity deleted text begin recommended for certification by the provider's host county
and deleted text end certified by the state.

Sec. 7.

Minnesota Statutes 2008, section 256B.0943, subdivision 6, is amended to read:

Subd. 6.

Provider entity clinical infrastructure requirements.

(a) To be
an eligible provider entity under this section, a provider entity must have a clinical
infrastructure that utilizes diagnostic assessment, an individualized treatment plan,
service delivery, and individual treatment plan review that are culturally competent,
child-centered, and family-driven to achieve maximum benefit for the client. The provider
entity must review new text begin , new text end and update new text begin as necessary, new text end the clinical policies and procedures every
three years and must distribute the policies and procedures to staff initially and upon
each subsequent update.

(b) The clinical infrastructure written policies and procedures must include policies
and procedures for:

(1) providing or obtaining a client's diagnostic assessment that identifies acute and
chronic clinical disorders, co-occurring medical conditions, sources of psychological
and environmental problems, deleted text begin and deleted text end new text begin including new text end a functional assessment. The functional
assessment new text begin component new text end must clearly summarize the client's individual strengths and needs;

(2) developing an individual treatment plan that is:

(i) based on the information in the client's diagnostic assessment;

(ii) developed no later than the end of the first psychotherapy session after the
completion of the client's diagnostic assessment by the mental health professional who
provides the client's psychotherapy;

(iii) developed through a child-centered, family-driven planning process that
identifies service needs and individualized, planned, and culturally appropriate
interventions that contain specific treatment goals and objectives for the client and the
client's family or foster family;

(iv) reviewed at least once every 90 days and revised, if necessary; and

(v) signed by the client or, if appropriate, by the client's parent or other person
authorized by statute to consent to mental health services for the client;

(3) developing an individual behavior plan that documents services to be provided
by the mental health behavioral aide. The individual behavior plan must include:

(i) detailed instructions on the service to be provided;

(ii) time allocated to each service;

(iii) methods of documenting the child's behavior;

(iv) methods of monitoring the child's progress in reaching objectives; and

(v) goals to increase or decrease targeted behavior as identified in the individual
treatment plan;

(4) clinical supervision of the mental health practitioner and mental health behavioral
aide. A mental health professional must document the clinical supervision the professional
provides by cosigning individual treatment plans and making entries in the client's record
on supervisory activities. Clinical supervision does not include the authority to make or
terminate court-ordered placements of the child. A clinical supervisor must be available
for urgent consultation as required by the individual client's needs or the situation. Clinical
supervision may occur individually or in a small group to discuss treatment and review
progress toward goals. The focus of clinical supervision must be the client's treatment
needs and progress and the mental health practitioner's or behavioral aide's ability to
provide services;

(4a) CTSS certified provider entities providing day treatment programs must meet
the conditions in items (i) to (iii):

(i) the supervisor must be present and available on the premises more than 50
percent of the time in a five-working-day period during which the supervisee is providing
a mental health service;

(ii) the diagnosis and the client's individual treatment plan or a change in the
diagnosis or individual treatment plan must be made by or reviewed, approved, and signed
by the supervisor; and

(iii) every 30 days, the supervisor must review and sign the record deleted text begin of deleted text end new text begin indicating the
supervisor has reviewed new text end the client's care for all activities in the preceding 30-day period;

(4b) for all other services provided under CTSS, clinical supervision standards
provided in items (i) to (iii) must be used:

(i) medical assistance shall reimburse a mental health practitioner who maintains a
consulting relationship with a mental health professional who accepts full professional
responsibility deleted text begin and is present on site for at least one observation during the first 12 hours
in which the mental health practitioner provides the individual, family, or group skills
training to the child or the child's family deleted text end ;

(ii) deleted text begin thereafter, deleted text end the mental health professional is required to be present on site for
observation as clinically appropriate when the mental health practitioner is providing
individual, family, or group skills training to the child or the child's family; and

(iii) new text begin when conducted, new text end the observation must be a minimum of one clinical unit. The
on-site presence of the mental health professional must be documented in the child's record
and signed by the mental health professional who accepts full professional responsibility;

(5) providing direction to a mental health behavioral aide. For entities that employ
mental health behavioral aides, the clinical supervisor must be employed by the provider
entity or other certified children's therapeutic supports and services provider entity to
ensure necessary and appropriate oversight for the client's treatment and continuity
of care. The mental health professional or mental health practitioner giving direction
must begin with the goals on the individualized treatment plan, and instruct the mental
health behavioral aide on how to construct therapeutic activities and interventions that
will lead to goal attainment. The professional or practitioner giving direction must also
instruct the mental health behavioral aide about the client's diagnosis, functional status,
and other characteristics that are likely to affect service delivery. Direction must also
include determining that the mental health behavioral aide has the skills to interact with
the client and the client's family in ways that convey personal and cultural respect and
that the aide actively solicits information relevant to treatment from the family. The aide
must be able to clearly explain the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision
and requires the professional or practitioner providing it to continuously evaluate the
mental health behavioral aide's ability to carry out the activities of the individualized
treatment plan and the individualized behavior plan. When providing direction, the
professional or practitioner must:

(i) review progress notes prepared by the mental health behavioral aide for accuracy
and consistency with diagnostic assessment, treatment plan, and behavior goals and the
professional or practitioner must approve and sign the progress notes;

(ii) identify changes in treatment strategies, revise the individual behavior plan,
and communicate treatment instructions and methodologies as appropriate to ensure
that treatment is implemented correctly;

(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;

(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; and

(v) record the results of any evaluation and corrective actions taken to modify the
work of the mental health behavioral aide;

(6) providing service delivery that implements the individual treatment plan and
meets the requirements under subdivision 9; and

(7) individual treatment plan review. The review must determine the extent to which
the services have met the goals and objectives in the previous treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the client, if appropriate, and by the client's parent or other person authorized by
statute to give consent to the mental health services for the child.

Sec. 8.

Minnesota Statutes 2008, section 256B.0943, subdivision 9, is amended to read:

Subd. 9.

Service delivery criteria.

(a) In delivering services under this section, a
certified provider entity must ensure that:

(1) each individual provider's caseload size permits the provider to deliver services
to both clients with severe, complex needs and clients with less intensive needs. The
provider's caseload size should reasonably enable the provider to play an active role in
service planning, monitoring, and delivering services to meet the client's and client's
family's needs, as specified in each client's individual treatment plan;

(2) site-based programs, including day treatment and preschool programs, provide
staffing and facilities to ensure the client's health, safety, and protection of rights, and that
the programs are able to implement each client's individual treatment plan;

(3) a day treatment program is provided to a group of clients by a multidisciplinary
team under the clinical supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections
144.50 to 144.55; (ii) a community mental health center under section 245.62; and (iii)
an entity that is under contract with the county board to operate a program that meets
the requirements of sections 245.4712, subdivision 2, and 245.4884, subdivision 2,
and Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must
stabilize the client's mental health status while developing and improving the client's
independent living and socialization skills. The goal of the day treatment program must
be to reduce or relieve the effects of mental illness and provide training to enable the
client to live in the community. The program must be available at least one day a week
for a deleted text begin three-hour deleted text end new text begin two-hour new text end time block. The deleted text begin three-hour deleted text end new text begin two-hour new text end time block must include
at least one hour deleted text begin , but no more than two hours, deleted text end of individual or group psychotherapy.
deleted text begin The remainder of the three-hour time block may include recreation therapy, socialization
therapy, or independent living skills therapy, but only if the therapies are included in the
client's individual treatment plan deleted text end new text begin The structured treatment program may include individual
or group psychotherapy and recreation therapy, socialization therapy, or independent
living skills therapy, if included in the client's individual treatment plan new text end . Day treatment
programs are not part of inpatient or residential treatment services; and

(4) a preschool program is a structured treatment program offered to a child who
is at least 33 months old, but who has not yet reached the first day of kindergarten, by a
preschool multidisciplinary team in a day program licensed under Minnesota Rules, parts
9503.0005 to 9503.0175. The program must be available at least one day a week for a
minimum two-hour time block. The structured treatment program may include individual
or group psychotherapy and recreation therapy, socialization therapy, or independent
living skills therapy, if included in the client's individual treatment plan.

(b) A provider entity must deliver the service components of children's therapeutic
services and supports in compliance with the following requirements:

(1) individual, family, and group psychotherapy must be delivered as specified in
Minnesota Rules, part 9505.0323;

(2) individual, family, or group skills training must be provided by a mental health
professional or a mental health practitioner who has a consulting relationship with a
mental health professional who accepts full professional responsibility for the training;

(3) crisis assistance must be time-limited and designed to resolve or stabilize crisis
through arrangements for direct intervention and support services to the child and the
child's family. Crisis assistance must utilize resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family as evidenced by
a sudden change in behavior with negative consequences for well being, a loss of usual
coping mechanisms, or the presentation of danger to self or others;

(4) medically necessary services that are provided by a mental health behavioral
aide must be designed to improve the functioning of the child and support the family in
activities of daily and community living. A mental health behavioral aide must document
the delivery of services in written progress notes. The mental health behavioral aide
must implement goals in the treatment plan for the child's emotional disturbance that
allow the child to acquire developmentally and therapeutically appropriate daily living
skills, social skills, and leisure and recreational skills through targeted activities. These
activities may include:

(i) assisting a child as needed with skills development in dressing, eating, and
toileting;

(ii) assisting, monitoring, and guiding the child to complete tasks, including
facilitating the child's participation in medical appointments;

(iii) observing the child and intervening to redirect the child's inappropriate behavior;

(iv) assisting the child in using age-appropriate self-management skills as related
to the child's emotional disorder or mental illness, including problem solving, decision
making, communication, conflict resolution, anger management, social skills, and
recreational skills;

(v) implementing deescalation techniques as recommended by the mental health
professional;

(vi) implementing any other mental health service that the mental health professional
has approved as being within the scope of the behavioral aide's duties; or

(vii) assisting the parents to develop and use parenting skills that help the child
achieve the goals outlined in the child's individual treatment plan or individual behavioral
plan. Parenting skills must be directed exclusively to the child's treatment; and

(5) direction of a mental health behavioral aide must include the following:

(i) a total of one hour of on-site observation by a mental health professional during
the first 12 hours of service provided to a child;

(ii) ongoing on-site observation by a mental health professional or mental health
practitioner for at least a total of one hour during every 40 hours of service provided
to a child; and

(iii) immediate accessibility of the mental health professional or mental health
practitioner to the mental health behavioral aide during service provision.

Sec. 9.

Minnesota Statutes 2008, section 256B.0945, subdivision 1, is amended to read:

Subdivision 1.

Residential services; provider qualifications.

Counties must
arrange to provide residential services for children with severe emotional disturbance
according to sections 245.4882, 245.4885, and this section. Services must be provided
by a facility that is licensed according to section 245.4882 and administrative rules
promulgated thereunder, and under contract with the county. new text begin Eligible services may be
provided in a facility that is located in a state that borders Minnesota if:
new text end

new text begin (1) the facility is the closest facility to the child's home that provides the appropriate
level of care; and
new text end

new text begin (2) the county has inspected and certified that the facility meets the applicable
Minnesota licensing and provider standards.
new text end

Sec. 10.

Minnesota Statutes 2008, section 256F.13, subdivision 1, is amended to read:

Subdivision 1.

Federal revenue enhancement.

(a) The commissioner of human
services may enter into an agreement with one or more family services collaboratives
to enhance federal reimbursement under title IV-E of the Social Security Act and
federal administrative reimbursement under title XIX of the Social Security Act. The
commissioner may contract with the Department of Education for purposes of transferring
the federal reimbursement to the commissioner of education to be distributed to the
collaboratives according to clause (2). The commissioner shall have the following
authority and responsibilities regarding family services collaboratives:

(1) the commissioner shall submit amendments to state plans and seek waivers as
necessary to implement the provisions of this section;

(2) the commissioner shall pay the federal reimbursement earned under this
subdivision to each collaborative based on their earnings. Payments to collaboratives for
expenditures under this subdivision will only be made of federal earnings from services
provided by the collaborative;

(3) the commissioner shall review expenditures of family services collaboratives
using reports specified in the agreement with the collaborative to ensure that the base level
of expenditures is continued and new federal reimbursement is used to expand education,
social, health, or health-related services to young children and their families;

(4) the commissioner may reduce, suspend, or eliminate a family services
collaborative's obligations to continue the base level of expenditures or expansion of
services if the commissioner determines that one or more of the following conditions
apply:

(i) imposition of levy limits that significantly reduce available funds for social,
health, or health-related services to families and children;

(ii) reduction in the net tax capacity of the taxable property eligible to be taxed by
the lead county or subcontractor that significantly reduces available funds for education,
social, health, or health-related services to families and children;

(iii) reduction in the number of children under age 19 in the county, collaborative
service delivery area, subcontractor's district, or catchment area when compared to the
number in the base year using the most recent data provided by the State Demographer's
Office; or

(iv) termination of the federal revenue earned under the family services collaborative
agreement;

(5) the commissioner shall not use the federal reimbursement earned under this
subdivision in determining the allocation or distribution of other funds to counties or
collaboratives;

(6) the commissioner may suspend, reduce, or terminate the federal reimbursement
to a provider that does not meet the reporting or other requirements of this subdivision;

(7) the commissioner shall recover from the family services collaborative any federal
fiscal disallowances or sanctions for audit exceptions directly attributable to the family
services collaborative's actions in the integrated fund, or the proportional share if federal
fiscal disallowances or sanctions are based on a statewide random sample; and

(8) the commissioner shall establish criteria for the family services collaborative
for the accounting and financial management system that will support claims for federal
reimbursement.

(b) The family services collaborative shall have the following authority and
responsibilities regarding federal revenue enhancement:

(1) the family services collaborative shall be the party with which the commissioner
contracts. A lead county shall be designated as the fiscal agency for reporting, claiming,
and receiving payments;

(2) the family services collaboratives may enter into subcontracts with other
counties, school districts, special education cooperatives, municipalities, and other public
and nonprofit entities for purposes of identifying and claiming eligible expenditures to
enhance federal reimbursement, or to expand education, social, health, or health-related
services to families and children;

(3) deleted text begin the family services collaborative must continue the base level of expenditures for
education, social, health, or health-related services to families and children from any state,
county, federal, or other public or private funding source which, in the absence of the new
federal reimbursement earned under this subdivision, would have been available for those
services, except as provided in paragraph (a), clause (4). The base year for purposes of this
subdivision shall be the four-quarter calendar year ending at least two calendar quarters
before the first calendar quarter in which the new federal reimbursement is earned;
deleted text end

deleted text begin (4) deleted text end the family services collaborative must use all new federal reimbursement
resulting from federal revenue enhancement to expand expenditures for education, social,
health, or health-related services to families and children beyond the base level, except
as provided in paragraph (a), clause (4);

deleted text begin (5) deleted text end new text begin (4) new text end the family services collaborative must ensure that expenditures submitted
for federal reimbursement are not made from federal funds or funds used to match other
federal funds. Notwithstanding section 256B.19, subdivision 1, for the purposes of family
services collaborative expenditures under agreement with the department, the nonfederal
share of costs shall be provided by the family services collaborative from sources other
than federal funds or funds used to match other federal funds;

deleted text begin (6) deleted text end new text begin (5) new text end the family services collaborative must develop and maintain an accounting
and financial management system adequate to support all claims for federal reimbursement,
including a clear audit trail and any provisions specified in the agreement; and

deleted text begin (7) deleted text end new text begin (6) new text end the family services collaborative shall submit an annual report to the
commissioner as specified in the agreement.

Sec. 11.

Minnesota Statutes 2008, section 260C.212, subdivision 4a, is amended to
read:

Subd. 4a.

Monthly caseworker visits.

(a) Every child in foster care or on a trial
home visit shall be visited by the child's caseworker on a monthly basis, with the majority
of visits occurring in the child's residence. For the purposes of this section, the following
definitions apply:

(1) "visit" is defined as a face-to-face contact between a child and the child's
caseworker;

(2) "visited on a monthly basis" is defined as at least one visit per calendar month;

(3) "the child's caseworker" is defined as the person who has responsibility for
managing the child's foster care placement case new text begin or another person who has responsibility
for visitation of the child, new text end as assigned by the responsible social service agency; and

(4) "the child's residence" is defined as the home where the child is residing, and
can include the foster home, child care institution, or the home from which the child was
removed if the child is on a trial home visit.

(b) Caseworker visits shall be of sufficient substance and duration to address issues
pertinent to case planning and service delivery to ensure the safety, permanency, and
well-being of the child.

Sec. 12.

Minnesota Statutes 2008, section 260C.212, subdivision 11, is amended to
read:

Subd. 11.

Rules; family and group foster care.

deleted text begin The commissioner shall revise
Minnesota Rules, parts 9545.0010 to 9545.0260, the rules setting standards for family and
group family foster care. deleted text end The commissioner shall:

(1) require that, as a condition of licensure, foster care providers attend training on
understanding and validating the cultural heritage of all children in their care, and on the
importance of the Indian Child Welfare Act, United States Code, title 25, sections 1901 to
1923, and the Minnesota Indian Family Preservation Act, sections 260.751 to 260.835; deleted text begin and
deleted text end

(2) review and, where necessary, revise foster care rules to reflect sensitivity to
cultural diversity and differing lifestyles. Specifically, the commissioner shall examine
whether space and other requirements discriminate against single-parent, minority, or
low-income families who may be able to provide quality foster care reflecting the values
of their own respective cultures new text begin ; and
new text end

new text begin (3) relieve relative foster care providers of the requirements promulgated as a result
of clauses (1) and (2) when the safety of the child is not jeopardized and as allowed
under federal law new text end .

Sec. 13.

Minnesota Statutes 2008, section 261.035, is amended to read:

261.035 new text begin CREMATION AND new text end FUNERALS AT EXPENSE OF COUNTY.

When a person dies in any county without apparent means to provide for that
person's funeral or final disposition, the county board shall first investigate to determine
whether that person had contracted for any prepaid funeral arrangements. If new text begin prepaid
new text end arrangements have been made, the county shall authorize arrangements to be implemented
in accord with the instructions of the deceased. If it is determined that the person did not
leave sufficient means to defray the necessary expenses of a funeral and final disposition,
nor any spouse of sufficient ability to procure the burial, the county board shall provide for
deleted text begin a funeral and final disposition deleted text end new text begin cremation new text end of the person's remains deleted text begin to be made deleted text end at the expense
of the county. new text begin If it is determined that cremation is not in accordance with the religious
and moral beliefs of the decedent or the decedent's spouse or the decedent's next of kin,
the county board shall provide for a funeral. new text end Any funeral and final disposition provided
at the expense of the county shall be in accordance with religious and moral beliefs of
the decedent or the decedent's spouse or the decedent's next of kin. If the wishes of the
decedent are not known and the county has no information about the existence of or
location of any next of kin, the county deleted text begin may determine the method of final disposition deleted text end new text begin shall
provide for cremation of the person's remains new text end .

ARTICLE 2

HEALTH CARE

Section 1.

Minnesota Statutes 2008, section 62Q.37, subdivision 3, is amended to read:

Subd. 3.

Audits.

(a) The commissioner may conduct routine audits and
investigations as prescribed under the commissioner's respective state authorizing statutes.
If a nationally recognized independent organization has conducted an audit of the health
plan company using audit procedures that are comparable to or more stringent than the
commissioner's audit procedures:

(1) the commissioner deleted text begin may deleted text end new text begin shall new text end accept the independent audit and require no further
audit if the results of the independent audit show that the performance standard being
audited meets or exceeds state standards;

(2) the commissioner may accept the independent audit and limit further auditing
if the results of the independent audit show that the performance standard being audited
partially meets state standards;

(3) the health plan company must demonstrate to the commissioner that the
nationally recognized independent organization that conducted the audit is qualified and
that the results of the audit demonstrate that the particular performance standard partially
or fully meets state standards; and

(4) if the commissioner has partially or fully accepted an independent audit of the
performance standard, the commissioner may use the finding of a deficiency with regard
to statutes or rules by an independent audit as the basis for a targeted audit or enforcement
action.

(b) If a health plan company has formally delegated activities that are required
under either state law or contract to another organization that has undergone an audit by
a nationally recognized independent organization, that health plan company may use
the nationally recognized accrediting body's determination on its own behalf under this
section.

Sec. 2.

Minnesota Statutes 2008, section 144A.04, subdivision 11, is amended to read:

Subd. 11.

Incontinent residents.

Notwithstanding Minnesota Rules, part
4658.0520, an incontinent resident must be deleted text begin checked according to a specific time interval
written in the resident's deleted text end new text begin treated according to the comprehensive assessment and new text end care plan.
deleted text begin The resident's attending physician must authorize in writing any interval longer than
two hours unless the resident, if competent, or a family member or legally appointed
conservator, guardian, or health care agent of a resident who is not competent, agrees in
writing to waive physician involvement in determining this interval, and this waiver
is documented in the resident's care plan.
deleted text end

Sec. 3.

Minnesota Statutes 2008, section 144A.04, is amended by adding a subdivision
to read:

new text begin Subd. 12. new text end

new text begin Resident positioning. new text end

new text begin Notwithstanding Minnesota Rules, part 4658.0525,
subpart 4, the position of residents unable to change their own position must be changed
based on the comprehensive assessment and care plan.
new text end

Sec. 4.

Minnesota Statutes 2008, section 144A.45, subdivision 1, is amended to read:

Subdivision 1.

Rules.

The commissioner shall adopt rules for the regulation of
home care providers pursuant to sections 144A.43 to 144A.47. The rules shall include
the following:

(1) provisions to assure, to the extent possible, the health, safety and well-being, and
appropriate treatment of persons who receive home care services;

(2) requirements that home care providers furnish the commissioner with specified
information necessary to implement sections 144A.43 to 144A.47;

(3) standards of training of home care provider personnel, which may vary according
to the nature of the services provided or the health status of the consumer;

(4) standards for medication management which may vary according to the nature of
the services provided, the setting in which the services are provided, or the status of the
consumer. Medication management includes the central storage, handling, distribution,
and administration of medications;

(5) standards for supervision of home care services requiring supervision by a
registered nurse or other appropriate health care professional which must occur on site
at least every 62 days, or more frequently if indicated by a clinical assessment, and in
accordance with sections 148.171 to 148.285 and rules adopted thereunder, except that deleted text begin ,
notwithstanding the provisions of Minnesota Rules, part 4668.0110, subpart 5, item B,
supervision of deleted text end a person performing home care aide tasks for a class B licensee providing
paraprofessional services deleted text begin must occur only every 180 days, or more frequently if indicated
by a clinical assessment deleted text end new text begin does not require nursing supervision new text end ;

(6) standards for client evaluation or assessment which may vary according to the
nature of the services provided or the status of the consumer;

(7) requirements for the involvement of a consumer's physician, the documentation
of physicians' orders, if required, and the consumer's treatment plan, and the maintenance
of accurate, current clinical records;

(8) the establishment of different classes of licenses for different types of providers
and different standards and requirements for different kinds of home care services; and

(9) operating procedures required to implement the home care bill of rights.

Sec. 5.

Minnesota Statutes 2008, section 245A.09, subdivision 7, is amended to read:

Subd. 7.

Regulatory methods.

(a) Where appropriate and feasible the commissioner
shall identify and implement alternative methods of regulation and enforcement to the
extent authorized in this subdivision. These methods shall include:

(1) expansion of the types and categories of licenses that may be granted;

(2) when the standards of another state or federal governmental agency or an
independent accreditation body have been shown to require the same standards, methods,
or alternative methods to achieve substantially the same intended outcomes as the
licensing standards, the commissioner shall consider compliance with the governmental
or accreditation standards to be equivalent to partial compliance with the licensing
standards; deleted text begin and
deleted text end

(3) use of an abbreviated inspection that employs key standards that have been
shown to predict full compliance with the rules new text begin ; and
new text end

new text begin (4) for day training and habilitation service providers, the commissioner shall deem
three-year accreditation by the Commission on Rehabilitation Facilities as equivalent to
compliance with the licensing standards new text end .

(b) If the commissioner accepts accreditation as documentation of compliance with a
licensing standard under paragraph (a), the commissioner shall continue to investigate
complaints related to noncompliance with all licensing standards. The commissioner
may take a licensing action for noncompliance under this chapter and shall recognize all
existing appeal rights regarding any licensing actions taken under this chapter.

(c) The commissioner shall work with the commissioners of health, public
safety, administration, and education in consolidating duplicative licensing and
certification rules and standards if the commissioner determines that consolidation is
administratively feasible, would significantly reduce the cost of licensing, and would
not reduce the protection given to persons receiving services in licensed programs.
Where administratively feasible and appropriate, the commissioner shall work with the
commissioners of health, public safety, administration, and education in conducting joint
agency inspections of programs.

(d) The commissioner shall work with the commissioners of health, public safety,
administration, and education in establishing a single point of application for applicants
who are required to obtain concurrent licensure from more than one of the commissioners
listed in this clause.

(e) Unless otherwise specified in statute, the commissioner may conduct routine
inspections biennially.

Sec. 6.

Minnesota Statutes 2008, section 256.962, subdivision 6, is amended to read:

Subd. 6.

School districts new text begin and charter schools new text end .

(a) At the beginning of each school
year, a school district new text begin or charter school new text end shall provide information to each student on the
availability of health care coverage through the Minnesota health care programs.

(b) deleted text begin For each child who is determined to be eligible for the free and reduced-price
school lunch program, the district shall provide the child's family with information on how
to obtain an application for the Minnesota health care programs and application assistance.
deleted text end

deleted text begin (c) deleted text end A new text begin school new text end district new text begin or charter school new text end shall also ensure that applications and
information on application assistance are available at early childhood education sites and
public schools located within the district's jurisdiction.

deleted text begin (d) Each district shall designate an enrollment specialist to provide application
assistance and follow-up services with families who have indicated an interest in receiving
information or an application for the Minnesota health care program. A district is eligible
for the application assistance bonus described in subdivision 5.
deleted text end

deleted text begin (e) Each deleted text end new text begin (c) If a school district or charter school maintains a district Web site, the new text end
school district new text begin or charter school new text end shall provide on deleted text begin their deleted text end new text begin its new text end Web site a link to information on
how to obtain an application and application assistance.

Sec. 7.

Minnesota Statutes 2008, section 256.962, subdivision 7, is amended to read:

Subd. 7.

Renewal notice.

(a) deleted text begin Beginning December 1, 2007, deleted text end The commissioner shall
mail a renewal notice to enrollees notifying the enrollees that the enrollees eligibility must
be renewed. A notice shall be sent at least deleted text begin 90 days prior to the renewal date and at least deleted text end
60 days prior to the renewal date.

(b) deleted text begin For enrollees who are receiving services through managed care plans, the
managed care plan must provide a follow-up renewal call at least 60 days prior to the
enrollees' renewal dates.
deleted text end

deleted text begin (c) deleted text end The commissioner shall include the end of coverage dates on the monthly rosters
of enrollees provided to managed care organizations.

Sec. 8.

Minnesota Statutes 2008, section 256B.0915, subdivision 3h, is amended to
read:

Subd. 3h.

Service rate limits; 24-hour customized living services.

new text begin (a) new text end The
payment rates for 24-hour customized living services is a monthly rate negotiated and
authorized by the lead agency within the parameters established by the commissioner
of human services. The payment agreement must delineate the services that have been
customized for each recipient and specify the amount of each service to be provided. The
lead agency shall ensure that there is a documented need for all services authorized.
The lead agency shall not authorize 24-hour customized living services unless there is
a documented need for 24-hour supervision. For purposes of this section, "24-hour
supervision" means that the recipient requires assistance due to needs related to one or
more of the following:

(1) intermittent assistance with toileting or transferring;

(2) cognitive or behavioral issues;

(3) a medical condition that requires clinical monitoring; or

(4) other conditions or needs as defined by the commissioner of human services.
The lead agency shall ensure that the frequency and mode of supervision of the recipient
and the qualifications of staff providing supervision are described and meet the needs
of the recipient. Customized living services must not include rent or raw food costs.
The negotiated payment rate for 24-hour customized living services must be based on
services to be provided. Negotiated rates must not exceed payment rates for comparable
elderly waiver or medical assistance services and must reflect economies of scale. The
individually negotiated 24-hour customized living payments, in combination with the
payment for other elderly waiver services, including case management, must not exceed
the recipient's community budget cap specified in subdivision 3a.

new text begin (b) Twenty-four hour customized living services are delivered by a provider licensed
by the commissioner of health as a class A or class F home care provider and provided in a
building that is registered as a housing with services establishment under chapter 144D.
Those home care providers with a capacity to serve 12 or fewer clients may provide
nighttime supervision to clients using personnel who have other duties and are located in
an adjoining building if:
new text end

new text begin (1) the personnel providing supervision have been trained and determined to be
competent in accordance with all applicable home care licensing requirements;
new text end

new text begin (2) the provider has assessed the clients needing 24-hour supervision and determined
that their needs can be safely met;
new text end

new text begin (3) the provider has a communication system that permits staff providing supervision
to be summoned by the clients; and
new text end

new text begin (4) staff providing supervision to clients are able to respond within a time frame that
meets the clients' needs and in no event exceeds ten minutes.
new text end

Sec. 9.

Minnesota Statutes 2008, section 471.61, subdivision 1, is amended to read:

Subdivision 1.

Officers, employees.

A county, municipal corporation, town, school
district, county extension committee, other political subdivision or other body corporate
and politic of this state, other than the state or any department of the state, through its
governing body, and any two or more subdivisions acting jointly through their governing
bodies, may insure or protect its or their officers and employees, and their dependents, or
any class or classes of officers, employees, or dependents, under a policy or policies or
contract or contracts of group insurance or benefits covering life, health, and accident, in
the case of employees, and medical and surgical benefits and hospitalization insurance
or benefits for both employees and dependents or dependents of an employee whose
death was due to causes arising out of and in the course of employment, or any one or
more of those forms of insurance or protection. A governmental unit, including county
extension committees and those paying their employees, may pay all or any part of
the premiums or charges on the insurance or protection. A payment is deemed to be
additional compensation paid to the officers or employees, but for purposes of determining
contributions or benefits under a public pension or retirement system it is not deemed
to be additional compensation. One or more governmental units may determine that
a person is an officer or employee if the person receives income from the governmental
subdivisions without regard to the manner of election or appointment, including but not
limited to employees of county historical societies that receive funding from the county
and employees of the Minnesota Inter-county Association. The appropriate officer of
the governmental unit, or those disbursing county extension funds, shall deduct from
the salary or wages of each officer and employee who elects to become insured or so
protected, on the officer's or employee's written order, all or part of the officer's or
employee's share of premiums or charges and remit the share or portion to the insurer or
company issuing the policy or contract.

A governmental unit, other than a school district, that pays all or part of the premiums
or charges is authorized to levy and collect a tax, if necessary, in the next annual tax levy
for the purpose of providing the necessary money for the payment of the premiums or
charges, and the sums levied and appropriated are not, in the event the sum exceeds the
maximum sum allowed by the charter of a municipal corporation, considered part of
the cost of government of the governmental unit as defined in any levy or expenditure
limitation; provided at least 50 percent of the cost of benefits on dependents must be
contributed by the employee or be paid by levies within existing charter tax limitations.

The word "dependents" as used in this subdivision means spouse and minor
unmarried children under the age of 18 years actually dependent upon the employee.

new text begin Notwithstanding any other law to the contrary, a political subdivision described in
this subdivision may provide health benefits to its employees, dependents, and other
eligible persons through negotiated contributions to self-funded multiemployer health
and welfare funds.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment;
applies to contributions made before, on, or after that date; and is intended as a clarification
of existing law.
new text end