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Capital IconMinnesota Legislature

HF 2150

1st Engrossment - 88th Legislature (2013 - 2014) Posted on 03/28/2014 12:28pm

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 02/24/2014
1st Engrossment Posted on 03/28/2014

Current Version - 1st Engrossment

Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 1.39 2.1 2.2 2.3 2.4 2.5
2.6 2.7
2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 3.36 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 4.35 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34
5.35
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 6.33 6.34 6.35 6.36 7.1 7.2 7.3 7.4 7.5 7.6 7.7
7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 7.33 7.34 7.35 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 8.33 8.34 8.35 8.36 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 9.34 9.35 9.36 9.37 9.38 9.39 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8
10.9 10.10
10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 10.34
11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 11.33 11.34 11.35 11.36 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 12.33 12.34 12.35 12.36 13.1 13.2 13.3 13.4 13.5
13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 13.33 13.34 13.35
14.1
14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32 14.33 14.34 14.35 15.1 15.2 15.3 15.4 15.5 15.6
15.7 15.8 15.9
15.10 15.11
15.12 15.13 15.14 15.15 15.16 15.17
15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28
15.29 15.30 15.31 15.32 16.1 16.2 16.3 16.4 16.5 16.6 16.7
16.8 16.9 16.10 16.11 16.12 16.13
16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30
16.31 16.32 16.33 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22
17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 17.34 17.35 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12
18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33
19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9
19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33 19.34 19.35 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 20.33 20.34 20.35 20.36 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22
21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 21.33 21.34 21.35 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 22.33 22.34 22.35
23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23
23.24 23.25
23.26 23.27 23.28 23.29 23.30 23.31 23.32 23.33 23.34 24.1 24.2 24.3 24.4 24.5 24.6
24.7 24.8 24.9
24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18
24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 25.33 25.34 25.35 25.36 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 26.33 26.34 26.35 26.36 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13
27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29
27.30 27.31 27.32 27.33 27.34 28.1 28.2 28.3 28.4 28.5 28.6
28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22
28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 29.1 29.2 29.3 29.4 29.5
29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19
29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28
29.29 29.30 29.31 29.32 29.33 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 30.34 30.35 30.36 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34
32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30
32.31 32.32 32.33 32.34 32.35 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 33.35 34.1 34.2
34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26
34.27 34.28 34.29 34.30 34.31 34.32 34.33 34.34 35.1 35.2 35.3 35.4 35.5 35.6 35.7
35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21
35.22 35.23 35.24
35.25 35.26
35.27 35.28 35.29 35.30 35.31 35.32 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13
36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 36.33 36.34 36.35 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12
37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 37.32 37.33 37.34 37.35 38.1 38.2 38.3 38.4 38.5 38.6
38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23
38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 38.34 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 39.34 39.35 39.36 40.1 40.2 40.3
40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25
40.26 40.27 40.28 40.29 40.30 40.31 40.32 40.33 40.34 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16
41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31 41.32 41.33 41.34 41.35 42.1 42.2 42.3 42.4 42.5 42.6
42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 42.33 42.34 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 43.33 43.34 43.35 43.36 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29
44.30 44.31 44.32 44.33 44.34 44.35 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24
45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 45.34 45.35 46.1 46.2 46.3 46.4 46.5 46.6
46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31
46.32 46.33 46.34 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17
47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 47.34 47.35 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 48.34 48.35 48.36 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 49.34 49.35 49.36 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 50.33 50.34 50.35 50.36 51.1 51.2 51.3
51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 51.35 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16
52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33 52.34 52.35 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9
53.10 53.11 53.12 53.13 53.14
53.15 53.16
53.17 53.18
53.19 53.20 53.21 53.22 53.23
53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 54.1 54.2 54.3 54.4 54.5
54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14
54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 54.32 54.33 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 55.33 55.34 55.35 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 56.33 56.34 56.35 56.36 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 57.33 57.34 57.35 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 58.33 58.34 58.35 58.36 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 59.34 59.35 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8
60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29
60.30 60.31 60.32 60.33 60.34 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19
61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 61.34 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 62.33 62.34 62.35 62.36 63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8
63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32 63.33 63.34 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29
64.30 64.31 64.32 64.33 64.34 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 65.32 65.33 65.34 65.35 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20
66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 66.34 66.35 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 67.33 67.34 67.35 67.36 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18
68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 68.33 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31
69.32 69.33 69.34 69.35 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28
70.29 70.30 70.31 70.32 70.33 70.34 70.35 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 71.32 71.33 71.34 71.35 71.36 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 72.32 72.33 72.34 73.1 73.2 73.3
73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 73.33 73.34 73.35 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 74.33 74.34 74.35 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 75.33 75.34 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13
76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 76.33 76.34 76.35 77.1 77.2 77.3 77.4 77.5 77.6 77.7
77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32 77.33 77.34 77.35 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21
78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 78.34 78.35 79.1 79.2 79.3 79.4 79.5
79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 79.33 79.34 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8
80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 80.34 81.1 81.2
81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12
81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 81.32 81.33 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16
82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25
82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13
83.14 83.15
83.16 83.17 83.18 83.19
83.20 83.21
83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 83.32 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 84.34 84.35 84.36 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33 85.34 85.35 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 86.33 86.34 86.35 86.36 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31
87.32 87.33 87.34 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 88.32 88.33 88.34 88.35 88.36 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 89.33 89.34 89.35 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 90.32 90.33 90.34 90.35 90.36 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 91.33 91.34 91.35 91.36 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 92.32 92.33 92.34 92.35 92.36 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 93.33 93.34 93.35 93.36 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 94.33 94.34 94.35 94.36 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 95.32 95.33 95.34 95.35 95.36 96.1 96.2 96.3 96.4
96.5
96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 96.32 96.33 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21
97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 97.33 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 98.34 98.35 98.36 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 99.33 99.34 99.35 99.36 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21
100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 100.34 100.35 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 101.34 101.35 101.36 102.1 102.2 102.3 102.4 102.5 102.6
102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 102.33 102.34 102.35 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20
103.21 103.22 103.23 103.24 103.25 103.26 103.27
103.28 103.29 103.30 103.31 103.32 103.33 104.1 104.2
104.3 104.4 104.5 104.6 104.7 104.8 104.9
104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 104.33 105.1 105.2 105.3 105.4 105.5 105.6
105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26
105.27 105.28 105.29 105.30 105.31 105.32 105.33 105.34
106.1 106.2 106.3 106.4 106.5 106.6
106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20
106.21 106.22 106.23 106.24
106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 107.33 107.34 107.35 107.36 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24
108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32
108.33 108.34 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31
109.32 109.33 109.34 109.35 110.1 110.2 110.3
110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 110.33 110.34 110.35 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33
111.34 111.35 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23
112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 112.33 112.34 112.35 113.1 113.2 113.3 113.4
113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28
113.29 113.30 113.31 113.32 113.33 113.34 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 114.33 114.34 114.35 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17
115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 115.33 115.34 116.1 116.2 116.3
116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20
116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 116.34 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23
117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 117.33 117.34 117.35 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 118.35 118.36 119.1 119.2 119.3
119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 120.1 120.2 120.3 120.4 120.5 120.6 120.7
120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 120.34 120.35 121.1 121.2 121.3
121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 121.33 121.34 122.1 122.2 122.3 122.4 122.5 122.6
122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 122.33 122.34 122.35 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12
123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 123.33 123.34 123.35 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21
124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 124.34 124.35 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 125.34 125.35 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23
126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 126.33 126.34 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18
127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 127.33 127.34 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11
128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 128.33 128.34 128.35 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17
129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 129.34 129.35 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8
130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 130.34 130.35 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 131.33 131.34 131.35 131.36
132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33 132.34 132.35 132.36 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8
133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 133.34 133.35
134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21
134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 134.33 134.34 134.35 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18
135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 135.33 135.34 135.35 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15
136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 136.33 136.34 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 137.34 137.35 138.1 138.2 138.3 138.4 138.5 138.6 138.7
138.8 138.9 138.10 138.11 138.12 138.13
138.14 138.15 138.16 138.17 138.18
138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 139.1 139.2 139.3
139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32
139.33
140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18
140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 140.34 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21
141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 141.33 141.34 141.35 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 142.33 142.34 142.35 143.1 143.2 143.3 143.4 143.5 143.6 143.7
143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27
143.28 143.29 143.30 143.31 143.32 143.33 143.34 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 144.33 144.34 144.35 144.36 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 145.34 145.35 145.36 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33 146.34 146.35 147.1 147.2
147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 147.33 147.34 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32
148.33 148.34
149.1 149.2 149.3
149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32 149.33 149.34 149.35 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 150.34 150.35 150.36 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 151.33 151.34 151.35 151.36 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17
152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 152.34 152.35 152.36 152.37 152.38 152.39 153.1 153.2 153.3 153.4 153.5 153.6
153.7 153.8
153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28
153.29 153.30 153.31 153.32 153.33 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14
154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32 154.33 154.34 154.35 155.1 155.2 155.3 155.4
155.5
155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17
155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 155.34 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29
156.30 156.31 156.32 156.33 156.34 157.1 157.2 157.3
157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29
157.30 157.31 157.32 157.33 157.34 158.1 158.2 158.3 158.4
158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31
158.32 158.33 159.1 159.2 159.3 159.4
159.5
159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31
159.32
159.33 160.1 160.2 160.3 160.4
160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17
160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30
160.31 160.32 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 161.33 161.34 161.35 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9
162.10 162.11 162.12 162.13 162.14
162.15 162.16
162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30
162.31 162.32 162.33 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21
165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 165.33 165.34 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 166.33 166.34 166.35 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 167.34 167.35 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33 168.34 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 169.34 169.35
170.1 170.2 170.3
170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 170.32 170.33 170.34 170.35 170.36
171.1
171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 172.34 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21
173.22
173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33 174.34 174.35 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 175.33 175.34 175.35 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 176.34 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 177.33 177.34 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 178.34 178.35 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 179.33 179.34 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 180.33 180.34 180.35 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 181.33 181.34 181.35 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 182.34 182.35 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25
183.26
183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 183.35 184.1 184.2 184.3 184.4 184.5
184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27
184.28 184.29 184.30 184.31 184.32 184.33 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 185.34 185.35 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 186.33 186.34 186.35 186.36 187.1 187.2
187.3
187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 187.33 187.34 187.35 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11
188.12
188.13 188.14 188.15
188.16 188.17
188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30
188.31 188.32 188.33 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27
189.28 189.29 189.30 189.31 189.32 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 190.33 190.34 190.35 190.36 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 191.33 191.34 191.35 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33 192.34 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 193.34 193.35 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18
194.19
194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 194.34 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 195.33 195.34 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 196.32 196.33 196.34 196.35 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 197.33 197.34 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13
198.14
198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 198.33 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 199.33 199.34 199.35 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32 200.33 200.34 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 201.33 201.34 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 202.33 202.34 202.35 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 203.33 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 205.33 205.34 205.35 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 206.33 206.34 206.35 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 207.34 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13
208.14
208.15 208.16

A bill for an act
relating to state government; making adjustments to health and human services
appropriations; making changes to provisions governing the Department of
Health, Department of Human Services, Northstar Care for Children program,
continuing care, community first services and supports, health care, public
assistance programs, and chemical dependency; modifying the hospital payment
system; modifying provisions governing background studies and home and
community-based services standards; modifying rulemaking authority; setting
fees; providing rate increases; establishing grant programs; modifying medical
assistance provisions; modifying the use of positive support strategies and
emergency manual restraint; requiring certain studies and reports; appropriating
money; amending Minnesota Statutes 2012, sections 13.46, subdivision 4;
144.0724, as amended; 144.551, subdivision 1; 245C.03, by adding a subdivision;
245C.04, by adding a subdivision; 245C.05, subdivision 5; 245C.10, by adding a
subdivision; 245C.33, subdivisions 1, 4; 252.451, subdivision 2; 254B.12; 256.01,
by adding a subdivision; 256.9685, subdivisions 1, 1a; 256.9686, subdivision 2;
256.969, subdivisions 1, 2, 2b, 2c, 3a, 3b, 3c, 6a, 9, 10, 14, 17, 30, by adding
subdivisions; 256.9752, subdivision 2; 256B.04, by adding a subdivision;
256B.0625, subdivision 30; 256B.0751, by adding a subdivision; 256B.199;
256B.35, subdivision 1; 256B.441, by adding a subdivision; 256B.5012, by
adding a subdivision; 256I.04, subdivision 2b; 256I.05, subdivision 2; 256J.49,
subdivision 13; 256J.53, subdivisions 1, 2, 5; 256J.531; 257.85, subdivision 11;
260C.212, subdivision 1; 260C.515, subdivision 4; 260C.611; Minnesota Statutes
2013 Supplement, sections 16A.724, subdivision 2; 145.4716, subdivision
2; 245.8251; 245A.03, subdivision 7; 245A.042, subdivision 3; 245A.16,
subdivision 1; 245C.08, subdivision 1; 245D.02, subdivisions 3, 4b, 8b, 11, 15b,
29, 34, 34a, by adding a subdivision; 245D.03, subdivisions 1, 2, 3, by adding a
subdivision; 245D.04, subdivision 3; 245D.05, subdivisions 1, 1a, 1b, 2, 4, 5;
245D.051; 245D.06, subdivisions 1, 2, 4, 6, 7, 8; 245D.071, subdivisions 3, 4, 5;
245D.081, subdivision 2; 245D.09, subdivisions 3, 4a; 245D.091, subdivisions 2,
3, 4; 245D.10, subdivisions 3, 4; 245D.11, subdivision 2; 256B.04, subdivision
21; 256B.056, subdivision 5c; 256B.0949, subdivision 4; 256B.439, subdivisions
1, 7; 256B.441, subdivision 53; 256B.4912, subdivision 1; 256B.492; 256B.69,
subdivision 34; 256B.85, subdivisions 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16,
17, 18, 23, 24, by adding subdivisions; 256N.22, subdivisions 1, 2, 4; 256N.23,
subdivision 4; 256N.25, subdivisions 2, 3; 256N.26, subdivision 1; 256N.27,
subdivision 4; Laws 2013, chapter 1, section 6, as amended; Laws 2013,
chapter 108, article 3, section 48; article 7, sections 14; 49; article 14, sections
2, subdivisions 1, 4, as amended, 5, 6, as amended, 6; 3, subdivisions 1, 4; 4,
subdivision 8; 12; proposing coding for new law in Minnesota Statutes, chapters
144; 144A; repealing Minnesota Statutes 2012, sections 256.969, subdivisions
8b, 9a, 9b, 11, 13, 20, 21, 22, 25, 26, 27, 28; 256.9695, subdivisions 3, 4;
Minnesota Statutes 2013 Supplement, section 256N.26, subdivision 7.

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

ARTICLE 1

HEALTH DEPARTMENT

Section 1.

Minnesota Statutes 2012, section 144.551, subdivision 1, is amended to read:


Subdivision 1.

Restricted construction or modification.

(a) The following
construction or modification may not be commenced:

(1) any erection, building, alteration, reconstruction, modernization, improvement,
extension, lease, or other acquisition by or on behalf of a hospital that increases the bed
capacity of a hospital, relocates hospital beds from one physical facility, complex, or site
to another, or otherwise results in an increase or redistribution of hospital beds within
the state; and

(2) the establishment of a new hospital.

(b) This section does not apply to:

(1) construction or relocation within a county by a hospital, clinic, or other health
care facility that is a national referral center engaged in substantial programs of patient
care, medical research, and medical education meeting state and national needs that
receives more than 40 percent of its patients from outside the state of Minnesota;

(2) a project for construction or modification for which a health care facility held
an approved certificate of need on May 1, 1984, regardless of the date of expiration of
the certificate;

(3) a project for which a certificate of need was denied before July 1, 1990, if a
timely appeal results in an order reversing the denial;

(4) a project exempted from certificate of need requirements by Laws 1981, chapter
200, section 2;

(5) a project involving consolidation of pediatric specialty hospital services within
the Minneapolis-St. Paul metropolitan area that would not result in a net increase in the
number of pediatric specialty hospital beds among the hospitals being consolidated;

(6) a project involving the temporary relocation of pediatric-orthopedic hospital beds
to an existing licensed hospital that will allow for the reconstruction of a new philanthropic,
pediatric-orthopedic hospital on an existing site and that will not result in a net increase in
the number of hospital beds. Upon completion of the reconstruction, the licenses of both
hospitals must be reinstated at the capacity that existed on each site before the relocation;

(7) the relocation or redistribution of hospital beds within a hospital building or
identifiable complex of buildings provided the relocation or redistribution does not result
in: (i) an increase in the overall bed capacity at that site; (ii) relocation of hospital beds
from one physical site or complex to another; or (iii) redistribution of hospital beds within
the state or a region of the state;

(8) relocation or redistribution of hospital beds within a hospital corporate system
that involves the transfer of beds from a closed facility site or complex to an existing site
or complex provided that: (i) no more than 50 percent of the capacity of the closed facility
is transferred; (ii) the capacity of the site or complex to which the beds are transferred
does not increase by more than 50 percent; (iii) the beds are not transferred outside of a
federal health systems agency boundary in place on July 1, 1983; and (iv) the relocation or
redistribution does not involve the construction of a new hospital building;

(9) a construction project involving up to 35 new beds in a psychiatric hospital in
Rice County that primarily serves adolescents and that receives more than 70 percent of its
patients from outside the state of Minnesota;

(10) a project to replace a hospital or hospitals with a combined licensed capacity
of 130 beds or less if: (i) the new hospital site is located within five miles of the current
site; and (ii) the total licensed capacity of the replacement hospital, either at the time of
construction of the initial building or as the result of future expansion, will not exceed 70
licensed hospital beds, or the combined licensed capacity of the hospitals, whichever is less;

(11) the relocation of licensed hospital beds from an existing state facility operated
by the commissioner of human services to a new or existing facility, building, or complex
operated by the commissioner of human services; from one regional treatment center
site to another; or from one building or site to a new or existing building or site on the
same campus;

(12) the construction or relocation of hospital beds operated by a hospital having a
statutory obligation to provide hospital and medical services for the indigent that does not
result in a net increase in the number of hospital beds, notwithstanding section 144.552, 27
beds, of which 12 serve mental health needs, may be transferred from Hennepin County
Medical Center to Regions Hospital under this clause;

(13) a construction project involving the addition of up to 31 new beds in an existing
nonfederal hospital in Beltrami County;

(14) a construction project involving the addition of up to eight new beds in an
existing nonfederal hospital in Otter Tail County with 100 licensed acute care beds;

(15) a construction project involving the addition of 20 new hospital beds
used for rehabilitation services in an existing hospital in Carver County serving the
southwest suburban metropolitan area. Beds constructed under this clause shall not be
eligible for reimbursement under medical assistance, general assistance medical care,
or MinnesotaCare;

(16) a project for the construction or relocation of up to 20 hospital beds for the
operation of up to two psychiatric facilities or units for children provided that the operation
of the facilities or units have received the approval of the commissioner of human services;

(17) a project involving the addition of 14 new hospital beds to be used for
rehabilitation services in an existing hospital in Itasca County;

(18) a project to add 20 licensed beds in existing space at a hospital in Hennepin
County that closed 20 rehabilitation beds in 2002, provided that the beds are used only
for rehabilitation in the hospital's current rehabilitation building. If the beds are used for
another purpose or moved to another location, the hospital's licensed capacity is reduced
by 20 beds;

(19) a critical access hospital established under section 144.1483, clause (9), and
section 1820 of the federal Social Security Act, United States Code, title 42, section
1395i-4, that delicensed beds since enactment of the Balanced Budget Act of 1997, Public
Law 105-33, to the extent that the critical access hospital does not seek to exceed the
maximum number of beds permitted such hospital under federal law;

(20) notwithstanding section 144.552, a project for the construction of a new hospital
in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:

(i) the project, including each hospital or health system that will own or control the
entity that will hold the new hospital license, is approved by a resolution of the Maple
Grove City Council as of March 1, 2006;

(ii) the entity that will hold the new hospital license will be owned or controlled by
one or more not-for-profit hospitals or health systems that have previously submitted a
plan or plans for a project in Maple Grove as required under section 144.552, and the
plan or plans have been found to be in the public interest by the commissioner of health
as of April 1, 2005;

(iii) the new hospital's initial inpatient services must include, but are not limited
to, medical and surgical services, obstetrical and gynecological services, intensive
care services, orthopedic services, pediatric services, noninvasive cardiac diagnostics,
behavioral health services, and emergency room services;

(iv) the new hospital:

(A) will have the ability to provide and staff sufficient new beds to meet the growing
needs of the Maple Grove service area and the surrounding communities currently being
served by the hospital or health system that will own or control the entity that will hold
the new hospital license;

(B) will provide uncompensated care;

(C) will provide mental health services, including inpatient beds;

(D) will be a site for workforce development for a broad spectrum of
health-care-related occupations and have a commitment to providing clinical training
programs for physicians and other health care providers;

(E) will demonstrate a commitment to quality care and patient safety;

(F) will have an electronic medical records system, including physician order entry;

(G) will provide a broad range of senior services;

(H) will provide emergency medical services that will coordinate care with regional
providers of trauma services and licensed emergency ambulance services in order to
enhance the continuity of care for emergency medical patients; and

(I) will be completed by December 31, 2009, unless delayed by circumstances
beyond the control of the entity holding the new hospital license; and

(v) as of 30 days following submission of a written plan, the commissioner of health
has not determined that the hospitals or health systems that will own or control the entity
that will hold the new hospital license are unable to meet the criteria of this clause;

(21) a project approved under section 144.553;

(22) a project for the construction of a hospital with up to 25 beds in Cass County
within a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's
license holder is approved by the Cass County Board;

(23) a project for an acute care hospital in Fergus Falls that will increase the bed
capacity from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16
and closing a separately licensed 13-bed skilled nursing facility; deleted text begin or
deleted text end

(24) notwithstanding section 144.552, a project for the construction and expansion
of a specialty psychiatric hospital in Hennepin County for up to 50 beds, exclusively for
patients who are under 21 years of age on the date of admission. The commissioner
conducted a public interest review of the mental health needs of Minnesota and the Twin
Cities metropolitan area in 2008. No further public interest review shall be conducted for
the construction or expansion project under this clausenew text begin ; or
new text end

new text begin (25) a project for a 16-bed psychiatric hospital in the city of Thief River Falls, if
the commissioner finds the project is in the public interest after the public interest review
conducted under section 144.552 is complete
new text end .

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

new text begin [144.9513] HEALTHY HOUSING GRANTS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of this section and sections 144.9501 to
144.9512, the following terms have the meanings given.
new text end

new text begin (a) "Housing" means a room or group of rooms located within a dwelling forming
a single habitable unit with facilities used or intended to be used for living, sleeping,
cooking, and eating.
new text end

new text begin (b) "Healthy housing" means housing that is sited, designed, built, renovated, and
maintained in ways that supports the health of residents.
new text end

new text begin (c) "Housing-based health threat" means a chemical, biologic, or physical agent in
the immediate housing environment which constitutes a potential or actual hazard to
human health at acute or chronic exposure levels.
new text end

new text begin (d) "Primary prevention" means preventing exposure to housing-based health threats
before seeing clinical symptoms or a diagnosis.
new text end

new text begin Subd. 2. new text end

new text begin Grants; administration. new text end

new text begin Grant applicants shall submit applications to
the commissioner as directed by a request for proposals. Grants must be competitively
awarded and recipients of a grant under this section must prepare and submit a quarterly
progress report to the commissioner beginning three months after receipt of the grant. The
commissioner shall provide technical assistance and program support as needed to ensure
that housing-based health threats are effectively identified, mitigated, and evaluated by
grantees.
new text end

new text begin Subd. 3. new text end

new text begin Education and training grant; eligible activities. new text end

new text begin (a) Within the limits of
available appropriations, the commissioner shall make grants to nonprofit organizations,
community health boards, and community action agencies under section 256E.31 with
expertise in providing outreach, education, and training on healthy homes subjects and in
providing comprehensive healthy homes assessments and interventions to provide healthy
housing education, training, and technical assistance services for persons engaged in
addressing housing-based health threats and other individuals impacted by housing-based
health threats.
new text end

new text begin (b) The grantee may conduct the following activities:
new text end

new text begin (1) implement and maintain primary prevention programs to reduce housing-based
health threats that include the following:
new text end

new text begin (i) providing education materials to the general public and to property owners,
contractors, code officials, health care providers, public health professionals, health
educators, nonprofit organizations, and other persons and organizations engaged in
housing and health issues;
new text end

new text begin (ii) promoting awareness of community, legal, and housing resources; and
new text end

new text begin (iii) promoting the use of hazard reduction measures in new housing construction
and housing rehabilitation programs;
new text end

new text begin (2) provide training on identifying and addressing housing-based health threats;
new text end

new text begin (3) provide technical assistance on the implementation of mitigation measures;
new text end

new text begin (4) promote adoption of evidence-based best practices for mitigation of
housing-based health threats; or
new text end

new text begin (5) develop work practices for addressing specific housing-based health threats.
new text end

Sec. 3.

new text begin [144A.484] INTEGRATED LICENSURE; HOME AND
COMMUNITY-BASED SERVICES DESIGNATION.
new text end

new text begin Subdivision 1. new text end

new text begin Integrated licensing established. new text end

new text begin (a) From January 1, 2014, to June
30, 2015, the commissioner of health shall enforce the home and community-based services
standards under chapter 245D for those providers who also have a home care license
pursuant to chapter 144A as required under Laws 2013, chapter 108, article 11, section 31,
and article 8, section 60. During this period, the commissioner shall provide technical
assistance on how to achieve and maintain compliance with applicable law or rules
governing the provision of home and community-based services, including complying with
the service recipient rights notice in subdivision 4, clause (4). If, during the survey, the
commissioner finds that the licensee has failed to achieve compliance with an applicable
law or rule under chapter 245D and this failure does not imminently endanger the health,
safety, or rights of the persons served by the program, the commissioner may issue a
licensing survey report with recommendations for achieving and maintaining compliance.
new text end

new text begin (b) Beginning July 1, 2015, a home care provider applicant or license holder may
apply to the commissioner of health for a home and community-based services designation
for the provision of basic home and community-based services identified under section
245D.03, subdivision 1, paragraph (b). The designation allows the license holder to
provide basic home and community-based services that would otherwise require licensure
under chapter 245D, under the license holder's home care license governed by sections
144A.43 to 144A.481.
new text end

new text begin Subd. 2. new text end

new text begin Application for home and community-based services designation. new text end

new text begin An
application for a home and community-based services designation must be made on the
forms and in the manner prescribed by the commissioner. The commissioner shall provide
the applicant with instruction for completing the application and provide information
about the requirements of other state agencies that affect the applicant. Application for
the home and community-based services designation is subject to the requirements under
section 144A.473.
new text end

new text begin Subd. 3. new text end

new text begin Home and community-based services designation fees. new text end

new text begin A home care
provider applicant or licensee applying for the home and community-based services
designation or renewal of a home and community-based services designation must submit
a fee in the amount specified in subdivision 8.
new text end

new text begin Subd. 4. new text end

new text begin Applicability of home and community-based services requirements. new text end

new text begin A
home care provider with a home and community-based services designation must comply
with the requirements for home care services governed by this chapter. For the provision
of basic home and community-based services, the home care provider must also comply
with the following home and community-based services licensing requirements:
new text end

new text begin (1) person-centered planning requirements in section 245D.07;
new text end

new text begin (2) protection standards in section 245D.06;
new text end

new text begin (3) emergency use of manual restraints in section 245D.061; and
new text end

new text begin (4) service recipient rights in section 245D.04, subdivision 3, paragraph (a), clauses
(5), (7), (8), (12), and (13), and paragraph (b).
new text end

new text begin A home care provider with the integrated license-HCBS designation may utilize a bill of
rights which incorporates the service recipient rights in section 245D.04, subdivision 3,
paragraph (a), clauses (5), (7), (8), (12), and (13), and paragraph (b) with the home care
bill of rights in section 144A.44.
new text end

new text begin Subd. 5. new text end

new text begin Monitoring and enforcement. new text end

new text begin (a) The commissioner shall monitor for
compliance with the home and community-based services requirements identified in
subdivision 5, in accordance with this section and any agreements by the commissioners
of health and human services.
new text end

new text begin (b) The commissioner shall enforce compliance with applicable home and
community-based services licensing requirements as follows:
new text end

new text begin (1) the commissioner may deny a home and community-based services designation
in accordance with section 144A.473 or 144A.475; and
new text end

new text begin (2) if the commissioner finds that the applicant or license holder has failed to comply
with the applicable home and community-based services designation requirements the
commissioner may issue:
new text end

new text begin (i) a correction order in accordance with section 144A.474;
new text end

new text begin (ii) an order of conditional license in accordance with section 144A.475;
new text end

new text begin (iii) a sanction in accordance with section 144A.475; or
new text end

new text begin (iv) any combination of clauses (i) to (iii).
new text end

new text begin Subd. 6. new text end

new text begin Appeals. new text end

new text begin A home care provider applicant that has been denied a temporary
license will also be denied their application for the home and community-based services
designation. The applicant may request reconsideration in accordance with section
144A.473, subdivision 3. A licensed home care provider whose application for a home
and community-based services designation has been denied or whose designation has been
suspended or revoked may appeal the denial, suspension, revocation, or refusal to renew a
home and community-based services designation in accordance with section 144A.475.
A license holder may request reconsideration of a correction order in accordance with
section 144A.474, subdivision 12.
new text end

new text begin Subd. 7. new text end

new text begin Agreements. new text end

new text begin The commissioners of health and human services shall enter
into any agreements necessary to implement this section.
new text end

new text begin Subd. 8. new text end

new text begin Fees; home and community-based services designation. new text end

new text begin (a) The initial
fee for a basic home and community-based services designation is $155. A home care
provider who is seeking to renew the provider's home and community-based services
designation must pay an annual nonrefundable fee with the annual home care license
fee according to the following schedule and based on revenues from the home and
community-based services:
new text end

new text begin Provider Annual Revenue from HCBS
new text end
new text begin HCBS
Designation
new text end
new text begin greater than $1,500,000
new text end
new text begin $320
new text end
new text begin greater than $1,275,000 and no more than $1,500,000
new text end
new text begin $300
new text end
new text begin greater than $1,100,000 and no more than $1,275,000
new text end
new text begin $280
new text end
new text begin greater than $950,000 and no more than $1,100,000
new text end
new text begin $260
new text end
new text begin greater than $850,000 and no more than $950,000
new text end
new text begin $240
new text end
new text begin greater than $750,000 and no more than $850,000
new text end
new text begin $220
new text end
new text begin greater than $650,000 and no more than $750,000
new text end
new text begin $200
new text end
new text begin greater than $550,000 and no more than $650,000
new text end
new text begin $180
new text end
new text begin greater than $450,000 and no more than $550,000
new text end
new text begin $160
new text end
new text begin greater than $350,000 and no more than $450,000
new text end
new text begin $140
new text end
new text begin greater than $250,000 and no more than $350,000
new text end
new text begin $120
new text end
new text begin greater than $100,000 and no more than $250,000
new text end
new text begin $100
new text end
new text begin greater than $50,000 and no more than $100,000
new text end
new text begin $80
new text end
new text begin greater than $25,000 and no more than $50,000
new text end
new text begin $60
new text end
new text begin no more than $25,000
new text end
new text begin $40
new text end

new text begin (b) Fees and penalties collected under this section shall be deposited in the state
treasury and credited to the state government special revenue fund.
new text end

new text begin Subd. 9. new text end

new text begin Study and report about client bill of rights. new text end

new text begin The commissioner shall
consult with Aging Services of Minnesota, Care Providers of Minnesota, Minnesota Home
Care Association, Department of Human Services, the Ombudsman for Long-Term Care,
and other stakeholders to review how to streamline the client bill of rights requirements
in sections 144A.44, 144A.441, and 245D.04 for providers whose practices fit into one
or several of these practice areas, while assuring and maintaining the health and safety
of clients. The evaluation shall consider the federal client bill of rights requirements for
Medicare-certified home care providers. The evaluation must determine whether there
are duplications or conflicts of client rights, evaluate how to reduce the complexity of the
client bill of rights requirements for providers and consumers, determine which of the
rights must be included in a client bill of rights document, and evaluate whether there are
other ways to ensure that consumers know their rights. The commissioner shall report to
the chairs of the health and human services committees of the legislature no later than
February 15, 2015, along with any recommendations for legislative changes.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Minnesota Statutes, section 144A.484, subdivisions 2 to 9,
are effective July 1, 2015.
new text end

Sec. 4.

Minnesota Statutes 2013 Supplement, section 145.4716, subdivision 2, is
amended to read:


Subd. 2.

Duties of director.

The director of child sex trafficking prevention is
responsible for the following:

(1) developing and providing comprehensive training on sexual exploitation of
youth for social service professionals, medical professionals, public health workers, and
criminal justice professionals;

(2) collecting, organizing, maintaining, and disseminating information on sexual
exploitation and services across the state, including maintaining a list of resources on the
Department of Health Web site;

(3) monitoring and applying for federal funding for antitrafficking efforts that may
benefit victims in the state;

(4) managing grant programs established under sections 145.4716 to 145.4718;

(5) new text begin managing the request for proposals for grants for comprehensive services,
including trauma-informed, culturally specific services;
new text end

new text begin (6) new text end identifying best practices in serving sexually exploited youth, as defined in
section 260C.007, subdivision 31;

deleted text begin (6)deleted text end new text begin (7) new text end providing oversight of and technical support to regional navigators pursuant
to section 145.4717;

deleted text begin (7)deleted text end new text begin (8) new text end conducting a comprehensive evaluation of the statewide program for safe
harbor of sexually exploited youth; and

deleted text begin (8)deleted text end new text begin (9) new text end developing a policy consistent with the requirements of chapter 13 for sharing
data related to sexually exploited youth, as defined in section 260C.007, subdivision 31,
among regional navigators and community-based advocates.

Sec. 5.

Minnesota Statutes 2013 Supplement, section 256B.04, subdivision 21, is
amended to read:


Subd. 21.

Provider enrollment.

(a) If the commissioner or the Centers for
Medicare and Medicaid Services determines that a provider is designated "high-risk," the
commissioner may withhold payment from providers within that category upon initial
enrollment for a 90-day period. The withholding for each provider must begin on the date
of the first submission of a claim.

(b) An enrolled provider that is also licensed by the commissioner under chapter
245Anew text begin or that is licensed by the Department of Health under chapter 144A and has a
HCBS designation on the home care license
new text end must designate an individual as the entity's
compliance officer. The compliance officer must:

(1) develop policies and procedures to assure adherence to medical assistance laws
and regulations and to prevent inappropriate claims submissions;

(2) train the employees of the provider entity, and any agents or subcontractors of
the provider entity including billers, on the policies and procedures under clause (1);

(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;

(4) use evaluation techniques to monitor compliance with medical assistance laws
and regulations;

(5) promptly report to the commissioner any identified violations of medical
assistance laws or regulations; and

(6) within 60 days of discovery by the provider of a medical assistance
reimbursement overpayment, report the overpayment to the commissioner and make
arrangements with the commissioner for the commissioner's recovery of the overpayment.

The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.

(c) The commissioner may revoke the enrollment of an ordering or rendering
provider for a period of not more than one year, if the provider fails to maintain and, upon
request from the commissioner, provide access to documentation relating to written orders
or requests for payment for durable medical equipment, certifications for home health
services, or referrals for other items or services written or ordered by such provider, when
the commissioner has identified a pattern of a lack of documentation. A pattern means a
failure to maintain documentation or provide access to documentation on more than one
occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
provider under the provisions of section 256B.064.

(d) The commissioner shall terminate or deny the enrollment of any individual or
entity if the individual or entity has been terminated from participation in Medicare or
under the Medicaid program or Children's Health Insurance Program of any other state.

(e) As a condition of enrollment in medical assistance, the commissioner shall
require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
and Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.

(f) As a condition of enrollment in medical assistance, the commissioner shall
require that a high-risk provider, or a person with a direct or indirect ownership interest in
the provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is
designated high-risk for fraud, waste, or abuse.

(g)(1) Upon initial enrollment, reenrollment, and revalidation, all durable medical
equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers operating in
Minnesota and receiving Medicaid funds must purchase a surety bond that is annually
renewed and designates the Minnesota Department of Human Services as the obligee, and
must be submitted in a form approved by the commissioner.

(2) At the time of initial enrollment or reenrollment, the provider agency must
purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
in the previous calendar year is up to and including $300,000, the provider agency must
purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
in the previous calendar year is over $300,000, the provider agency must purchase a
performance bond of $100,000. The performance bond must allow for recovery of costs
and fees in pursuing a claim on the bond.

(h) The Department of Human Services may require a provider to purchase a
performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
department determines there is significant evidence of or potential for fraud and abuse by
the provider, or (3) the provider or category of providers is designated high-risk pursuant
to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450. The
performance bond must be in an amount of $100,000 or ten percent of the provider's
payments from Medicaid during the immediately preceding 12 months, whichever is
greater. The performance bond must name the Department of Human Services as an
obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.

Sec. 6. new text begin LEGISLATIVE HEALTH CARE WORKFORCE COMMISSION.
new text end

new text begin Subdivision 1. new text end

new text begin Legislative oversight. new text end

new text begin The Legislative Health Care Workforce
Commission is created to study and make recommendations to the legislature on how to
achieve the goal of strengthening the workforce in healthcare.
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin The Legislative Health Care Workforce Commission
consists of five members of the senate appointed by the Subcommittee on Committees
of the Committee on Rules and Administration and five members of the house of
representatives appointed by the speaker of the house. The Legislative Health Care
Workforce Commission must include three members of the majority party and two
members of the minority party in each house.
new text end

new text begin Subd. 3. new text end

new text begin Report to the legislature. new text end

new text begin The Legislative Health Care Workforce
Commission must provide a report making recommendations to the legislature by
December 31, 2014. The report must:
new text end

new text begin (1) identify current and anticipated health care workforce shortages, by both
provider type and geography;
new text end

new text begin (2) evaluate the effectiveness of incentives currently available to develop, attract,
and retain a highly skilled health care workforce;
new text end

new text begin (3) study alternative incentives to develop, attract, and retain a highly skilled and
diverse health care workforce; and
new text end

new text begin (4) identify current causes and potential solutions to barriers related to the primary
care workforce, including, but not limited to:
new text end

new text begin (i) training and residency shortages;
new text end

new text begin (ii) disparities in income between primary care and other providers; and
new text end

new text begin (iii) negative perceptions of primary care among students.
new text end

new text begin Subd. 4. new text end

new text begin Assistance to the commission. new text end

new text begin The commissioners of health, human
services, commerce, and other state agencies shall provide assistance and technical
support to the commission at the request of the commission. The commission may
convene subcommittees to provide additional assistance and advice to the commission.
new text end

new text begin Subd. 5. new text end

new text begin Expiration. new text end

new text begin The Legislative Health Care Workforce Commission expires
on January 1, 2015.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 7. new text begin GRANT PROGRAMS TO ADDRESS MINORITY HEALTH
DISPARITIES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Dementia" means a condition ascribed within the brain that leads to confusion,
lack of focus, and decreased memory.
new text end

new text begin (c) "Education activities" means providing materials related to health care topics
in ethnic-specific languages through materials including, but not limited to, Web sites,
brochures, flyers, and other similar vehicles.
new text end

new text begin (d) "Minority populations" means racial and ethnic groups including, but not limited
to, African-Americans, Native Americans, Hmong, Asians, and other similar groups.
new text end

new text begin (e) "Outreach" means the active pursuit of people within the minority groups
through specific and targeted activities to contact individuals who may not regularly
be contacted by health care professionals.
new text end

new text begin Subd. 2. new text end

new text begin Grants; distribution. new text end

new text begin The commissioner of health shall distribute grant
funds to grantees for the following purposes:
new text end

new text begin (1) dementia education and training to specific minority and under-represented
groups;
new text end

new text begin (2) a training conference related to immigrant and refugee mental health issues; and
new text end

new text begin (3) other programs, as prioritized by the commissioner, relating to health disparities
in minority populations, including, but not limited to, a Somali women-led prevention
health care agency located in Minnesota focused on minority women's health disparities.
new text end

new text begin Subd. 3. new text end

new text begin Grants; administration. new text end

new text begin Grant applicants shall submit applications
to the commissioner of health as directed by a request for proposals. Grants must be
competitively awarded and recipients of a grant under this section must prepare and
submit a quarterly progress report to the commissioner beginning three months after
receipt of the grant. The commissioner shall provide technical assistance and program
support as needed, including, but not limited to, assurance that minority individuals with
dementia are effectively identified, mitigated, and evaluated by grantees.
new text end

new text begin Subd. 4. new text end

new text begin Dementia education and training grant; eligible activities for dementia
outreach.
new text end

new text begin (a) Within the limits of available appropriations, the commissioner shall make
a grant to a nonprofit organization with expertise in providing outreach, education, and
training on dementia, Alzheimer's, and other related disabilities within specific minority
and under-represented groups.
new text end

new text begin (b) The grantee must conduct the following activities:
new text end

new text begin (1) providing and making available educational materials to the general public
as well as specific minority populations;
new text end

new text begin (2) promoting awareness of dementia-related resources and educational materials;
and
new text end

new text begin (3) promoting the use of materials within health care organizations.
new text end

Sec. 8. new text begin FULL-TIME EMPLOYEE RESTRICTION.
new text end

new text begin No more than one full-time employee may be hired by the Department of Health to
administer the grants under Minnesota Statutes, section 144.9513.
new text end

ARTICLE 2

HEALTH CARE

Section 1.

Minnesota Statutes 2012, section 256.01, is amended by adding a
subdivision to read:


new text begin Subd. 38. new text end

new text begin Contract to match recipient third-party liability information. new text end

new text begin The
commissioner may enter into a contract with a national organization to match recipient
third-party liability information and provide coverage and insurance primacy information
to the department at no charge to providers and the clearinghouses.
new text end

Sec. 2.

Minnesota Statutes 2012, section 256.9685, subdivision 1, is amended to read:


Subdivision 1.

Authority.

(a) The commissioner shall establish procedures for
determining medical assistance deleted text begin and general assistance medical caredeleted text end payment rates under
a prospective payment system for inpatient hospital services in hospitals that qualify as
vendors of medical assistance. The commissioner shall establish, by rule, procedures for
implementing this section and sections 256.9686, 256.969, and 256.9695. Services must
meet the requirements of section 256B.04, subdivision 15, deleted text begin or 256D.03, subdivision 7,
paragraph (b),
deleted text end to be eligible for payment.

(b) The commissioner may reduce the types of inpatient hospital admissions that
are required to be certified as medically necessary after notice in the State Register and a
30-day comment period.

Sec. 3.

Minnesota Statutes 2012, section 256.9685, subdivision 1a, is amended to read:


Subd. 1a.

Administrative reconsideration.

Notwithstanding deleted text begin sectionsdeleted text end new text begin section
new text end 256B.04, subdivision 15, deleted text begin and 256D.03, subdivision 7,deleted text end the commissioner shall establish
an administrative reconsideration process for appeals of inpatient hospital services
determined to be medically unnecessary. A physician or hospital may request a
reconsideration of the decision that inpatient hospital services are not medically necessary
by submitting a written request for review to the commissioner within 30 days after
receiving notice of the decision. The reconsideration process shall take place prior to the
procedures of subdivision 1b and shall be conducted by physicians that are independent
of the case under reconsideration. A majority decision by the physicians is necessary to
make a determination that the services were not medically necessary.

Sec. 4.

Minnesota Statutes 2012, section 256.9686, subdivision 2, is amended to read:


Subd. 2.

Base year.

"Base year" means a hospital's fiscal yearnew text begin or yearsnew text end that
is recognized by the Medicare program or a hospital's fiscal year specified by the
commissioner if a hospital is not required to file information by the Medicare program
from which cost and statistical data are used to establish medical assistance deleted text begin and general
assistance medical care
deleted text end payment rates.

Sec. 5.

Minnesota Statutes 2012, section 256.969, subdivision 1, is amended to read:


Subdivision 1.

Hospital cost index.

(a) The hospital cost index shall be the change
in the Consumer Price Index-All Items (United States city average) (CPI-U) forecasted
by Data Resources, Inc. The commissioner shall use the indices as forecasted in the
third quarter of the calendar year prior to the rate year. The hospital cost index may be
used to adjust the base year operating payment rate through the rate year on an annually
compounded basis.

(b) deleted text begin For fiscal years beginning on or after July 1, 1993, the commissioner of human
services shall not provide automatic annual inflation adjustments for hospital payment
rates under medical assistance, nor under general assistance medical care, except that
the inflation adjustments under paragraph (a) for medical assistance, excluding general
assistance medical care, shall apply through calendar year 2001. The index for calendar
year 2000 shall be reduced 2.5 percentage points to recover overprojections of the index
from 1994 to 1996.
deleted text end The commissioner of management and budget shall include as a
budget change request in each biennial detailed expenditure budget submitted to the
legislature under section 16A.11 annual adjustments in hospital payment rates under
medical assistance deleted text begin and general assistance medical care,deleted text end based upon the hospital cost index.

Sec. 6.

Minnesota Statutes 2012, section 256.969, subdivision 2, is amended to read:


Subd. 2.

Diagnostic categories.

The commissioner shall use to the extent possible
existing diagnostic classification systems, including the system deleted text begin used by the Medicare
program
deleted text end new text begin created by 3M for all patient refined diagnosis-related groups (APR-DRGs)new text end to
determine the relative values of inpatient services and case mix indices. The commissioner
may combine diagnostic classifications into diagnostic categories and may establish
separate categories and numbers of categories based on deleted text begin program eligibility ordeleted text end hospital
peer group. Relative values shall be recalculated when the base year is changed. Relative
value determinations shall include paid claims for admissions during each hospital's base
year. The commissioner may deleted text begin extend the time period forward to obtain sufficiently valid
information to establish relative values
deleted text end new text begin supplement the APR-DRG data with national
averages
new text end . Relative value determinations shall not include property cost data, Medicare
crossover data, and data on admissions that are paid a per day transfer rate under
subdivision 14. The computation of the base year cost per admission must include identified
outlier cases and their weighted costs up to the point that they become outlier cases, but
must exclude costs recognized in outlier payments beyond that point. The commissioner
may recategorize the diagnostic classifications and recalculate relative values and case mix
indices to reflect actual hospital practices, the specific character of specialty hospitals, or
to reduce variances within the diagnostic categories after notice in the State Register deleted text begin and a
30-day comment period. The commissioner shall recategorize the diagnostic classifications
and recalculate relative values and case mix indices based on the two-year schedule in
effect prior to January 1, 2013, reflected in subdivision 2b. The first recategorization shall
occur January 1, 2013, and shall occur every two years after. When rates are not rebased
under subdivision 2b, the commissioner may establish relative values and case mix indices
based on charge data and may update the base year to the most recent data available
deleted text end .

Sec. 7.

Minnesota Statutes 2012, section 256.969, subdivision 2b, is amended to read:


Subd. 2b.

Operating payment rates.

deleted text begin In determining operating payment rates for
admissions occurring on or after the rate year beginning January 1, 1991, and every two
years after, or more frequently as determined by the commissioner, the commissioner shall
obtain operating data from an updated base year and establish operating payment rates
per admission for each hospital based on the cost-finding methods and allowable costs of
the Medicare program in effect during the base year. Rates under the general assistance
medical care, medical assistance, and MinnesotaCare programs shall not be rebased to
more current data on January 1, 1997, January 1, 2005, for the first 24 months of the
rebased period beginning January 1, 2009.
deleted text end For the rebased period beginning January 1,
2011, rates shall not be rebased, except that a Minnesota long-term hospital shall be
rebased effective January 1, 2011, based on its most recent Medicare cost report ending on
or before September 1, 2008, with the provisions under subdivisions 9 and 23, based on
the rates in effect on December 31, 2010. For subsequent rate setting periods in which the
base years are updated, a Minnesota long-term hospital's base year shall remain within
the same period as other hospitals. deleted text begin Effective January 1, 2013, and after, rates shall not be
rebased.
deleted text end The base year operating payment rate per admission is standardized by the case
mix index and adjusted by the hospital cost index, relative values, and disproportionate
population adjustment. The cost and charge data used to establish operating rates shall
only reflect inpatient services covered by medical assistance deleted text begin and shall not include property
cost information and costs recognized in outlier payments
deleted text end .new text begin In determining operating
payment rates for admissions occurring on or after the rate year beginning January 1,
2011, through December 31, 2012, the operating payment rate per admission must be
based on the cost-finding methods and allowable costs of the Medicare program in effect
during the base year or years.
new text end

Sec. 8.

Minnesota Statutes 2012, section 256.969, subdivision 2c, is amended to read:


Subd. 2c.

Property payment rates.

deleted text begin For each hospital's first two consecutive
fiscal years beginning on or after July 1, 1988, the commissioner shall limit the annual
increase in property payment rates for depreciation, rents and leases, and interest expense
to the annual growth in the hospital cost index derived from the methodology in effect
on the day before July 1, 1989. When computing budgeted and settlement property
payment rates, the commissioner shall use the annual increase in the hospital cost index
forecasted by Data Resources, Inc., consistent with the quarter of the hospital's fiscal year
end. For admissions occurring on or after the rate year beginning January 1, 1991, the
commissioner shall obtain property data from an updated base year and establish property
payment rates per admission for each hospital.
deleted text end Property payment rates shall be derived
from data from the same base year that is used to establish operating payment rates. The
property information shall include cost categories not subject to the hospital cost index
and shall reflect the cost-finding methods and allowable costs of the Medicare program.
deleted text begin The base year property payment rates shall be adjusted for increases in the property cost
by increasing the base year property payment rate 85 percent of the percentage change
from the base year through the year for which a Medicare cost report has been submitted
to the Medicare program and filed with the department by the October 1 before the rate
year.
deleted text end The property rates shall only reflect inpatient services covered by medical assistance.
deleted text begin The commissioner shall adjust rates for the rate year beginning January 1, 1991, to ensure
that all hospitals are subject to the hospital cost index limitation for two complete years.
deleted text end

Sec. 9.

Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
to read:


new text begin Subd. 2d. new text end

new text begin Budget neutrality factor. new text end

new text begin For the rebased period effective September 1,
2014, when rebasing rates under subdivisions 2b and 2c, the commissioner must apply a
budget neutrality factor (BNF) to a hospital's conversion factor to ensure that total DRG
payments to hospitals do not exceed total DRG payments that would have been made to
hospitals if the relative rates and weights had not been recalibrated. For the purposes of
this section, BNF equals the percentage change from total aggregate payments calculated
under a new payment system to total aggregate payments calculated under the old system.
new text end

Sec. 10.

Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:


Subd. 3a.

Payments.

deleted text begin (a)deleted text end Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695, in addition to third-party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. deleted text begin This payment limitation
deleted text end deleted text begin shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991.
deleted text end Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and may
merge the payment rates while maintaining separate provider numbers. The operating and
property base rates per admission or per day shall be derived from the best Medicare and
claims data available when rates are established. The commissioner shall determine the
best Medicare and claims data, taking into consideration variables of recency of the data,
audit disposition, settlement status, and the ability to set rates in a timely manner. The
commissioner shall notify hospitals of payment rates deleted text begin by December 1 of the year preceding
the rate year
deleted text end new text begin 30 days prior to implementationnew text end . The rate setting data must reflect the
admissions data used to establish relative values. deleted text begin Base year changes from 1981 to the base
year established for the rate year beginning January 1, 1991, and for subsequent rate years,
shall not be limited to the limits ending June 30, 1987, on the maximum rate of increase
under subdivision 1.
deleted text end The commissioner may adjust base year cost, relative value, and case
mix index data to exclude the costs of services that have been discontinued by the October
1 of the year preceding the rate year or that are paid separately from inpatient services.
Inpatient stays that encompass portions of two or more rate years shall have payments
established based on payment rates in effect at the time of admission unless the date of
admission preceded the rate year in effect by six months or more. In this case, operating
payment rates for services rendered during the rate year in effect and established based on
the date of admission shall be adjusted to the rate year in effect by the hospital cost index.

deleted text begin (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.
deleted text end

deleted text begin (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, and
facilities defined under subdivision 16 are excluded from this paragraph.
deleted text end

deleted text begin (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent
from the current statutory rates. Mental health services within diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
assistance does not include general assistance medical care. Payments made to managed
care plans shall be reduced for services provided on or after January 1, 2006, to reflect
this reduction.
deleted text end

deleted text begin (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
deleted text end

deleted text begin (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
1.9 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
deleted text end

deleted text begin (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.79 percent
from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Payments made to managed care plans shall be reduced for services provided on or after
July 1, 2011, to reflect this reduction.
deleted text end

deleted text begin (h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
payment for fee-for-service admissions occurring on or after July 1, 2009, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
one percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.
deleted text end

deleted text begin (i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
payment for fee-for-service admissions occurring on or after July 1, 2011, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
1.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after January 1, 2011, to reflect this reduction.
deleted text end

Sec. 11.

Minnesota Statutes 2012, section 256.969, subdivision 3b, is amended to read:


Subd. 3b.

Nonpayment for hospital-acquired conditions and for certain
treatments.

(a) The commissioner must not make medical assistance payments to a
hospital for any costs of care that result from a condition listed in paragraph (c), if the
condition was hospital acquired.

(b) For purposes of this subdivision, a condition is hospital acquired if it is not
identified by the hospital as present on admission. For purposes of this subdivision,
medical assistance includes deleted text begin general assistance medical care anddeleted text end MinnesotaCare.

(c) The prohibition in paragraph (a) applies to payment for each hospital-acquired
condition listed in this paragraph that is represented by an deleted text begin ICD-9-CMdeleted text end new text begin ICD-10-CM
new text end diagnosis code deleted text begin and is designated as a complicating condition or a major complicating
condition:
deleted text end new text begin . The list of conditions is defined by the Centers for Medicare and Medicaid
Services on an annual basis with the hospital-acquired conditions (HAC) list:
new text end

(1) foreign object retained after surgery deleted text begin (ICD-9-CM codes 998.4 or 998.7)deleted text end ;

(2) air embolism deleted text begin (ICD-9-CM code 999.1)deleted text end ;

(3) blood incompatibility deleted text begin (ICD-9-CM code 999.6)deleted text end ;

(4) pressure ulcers stage III or IV deleted text begin (ICD-9-CM codes 707.23 or 707.24)deleted text end ;

(5) falls and trauma, including fracture, dislocation, intracranial injury, crushing
injury, burn, and electric shock deleted text begin (ICD-9-CM codes with these ranges on the complicating
condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929;
940-949; and 991-994)
deleted text end ;

(6) catheter-associated urinary tract infection deleted text begin (ICD-9-CM code 996.64)deleted text end ;

(7) vascular catheter-associated infection deleted text begin (ICD-9-CM code 999.31)deleted text end ;

(8) manifestations of poor glycemic control deleted text begin (ICD-9-CM codes 249.10; 249.11;
249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and
251.0)
deleted text end ;

(9) surgical site infection deleted text begin (ICD-9-CM codes 996.67 or 998.59)deleted text end following certain
orthopedic procedures deleted text begin (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07;
81.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and
81.85)
deleted text end ;

(10) surgical site infection deleted text begin (ICD-9-CM code 998.59)deleted text end following bariatric surgery
deleted text begin (procedure codes 44.38; 44.39; or 44.95)deleted text end for a principal diagnosis of morbid obesity
deleted text begin (ICD-9-CM code 278.01)deleted text end ;

(11) surgical site infection, mediastinitis deleted text begin (ICD-9-CM code 519.2)deleted text end following coronary
artery bypass graft deleted text begin (procedure codes 36.10 to 36.19)deleted text end ; and

(12) deep vein thrombosis deleted text begin (ICD-9-CM codes 453.40 to 453.42)deleted text end or pulmonary
embolism deleted text begin (ICD-9-CM codes 415.11 or 415.19)deleted text end following total knee replacement
deleted text begin (procedure code 81.54)deleted text end or hip replacement deleted text begin (procedure codes 00.85 to 00.87 or 81.51
to 81.52)
deleted text end .

(d) The prohibition in paragraph (a) applies to any additional payments that result
from a hospital-acquired condition listed in paragraph (c), including, but not limited to,
additional treatment or procedures, readmission to the facility after discharge, increased
length of stay, change to a higher diagnostic category, or transfer to another hospital. In
the event of a transfer to another hospital, the hospital where the condition listed under
paragraph (c) was acquired is responsible for any costs incurred at the hospital to which
the patient is transferred.

(e) A hospital shall not bill a recipient of services for any payment disallowed under
this subdivision.

Sec. 12.

Minnesota Statutes 2012, section 256.969, subdivision 3c, is amended to read:


Subd. 3c.

Rateable reduction and readmissions reduction.

(a) The total payment
for fee for service admissions occurring on or after September 1, 2011, through June 30,
2015, made to hospitals for inpatient services before third-party liability and spenddown,
is reduced ten percent from the current statutory rates. Facilities defined under subdivision
16, long-term hospitals as determined under the Medicare program, children's hospitals
whose inpatients are predominantly under 18 years of age, and payments under managed
care are excluded from this paragraph.

(b) Effective for admissions occurring during calendar year 2010 and each year
after, the commissioner shall calculate a regional readmission rate for admissions to all
hospitals occurring within 30 days of a previous discharge. The commissioner may
adjust the readmission rate taking into account factors such as the medical relationship,
complicating conditions, and sequencing of treatment between the initial admission and
subsequent readmissions.

(c) Effective for payments to all hospitals on or after July 1, 2013, through June 30,
2015, the reduction in paragraph (a) is reduced one percentage point for every percentage
point reduction in the overall readmissions rate between the two previous calendar years
to a maximum of five percent.

new text begin (d) A hospital with at least 1,700 licensed beds on January 1, 2012, located in
Hennepin County is excluded from the reduction in paragraph (a) for admissions occurring
on or after September 1, 2011, through August 30, 2013, but is subject to the reduction
in paragraph (a) for admissions occurring on or after September 1, 2013, through June
30, 2015.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effectively retroactively from September 1,
2011.
new text end

Sec. 13.

Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
to read:


new text begin Subd. 4b. new text end

new text begin Medical assistance cost reports for services. new text end

new text begin (a) A hospital that meets
one of the following criteria must annually file medical assistance cost reports within six
months of the end of the hospital's fiscal year:
new text end

new text begin (1) a hospital designated as a critical access hospital that receives medical assistance
payments; or
new text end

new text begin (2) a Minnesota hospital or out-of-state hospital located within a Minnesota local
trade area that receives a disproportionate population adjustment under subdivision 9.
new text end

new text begin For purposes of this subdivision, local trade area has the meaning given in
subdivision 17.
new text end

new text begin (b) The Department of Human Services must suspend payments to any hospital that
fails to file a report required under this subdivision. Payments must remain suspended
until the report has been filed with and accepted by the Department of Human Services
inpatient rates unit.
new text end

Sec. 14.

Minnesota Statutes 2012, section 256.969, subdivision 6a, is amended to read:


Subd. 6a.

Special considerations.

In determining the payment rates, the
commissioner shall consider whether the circumstances in subdivisions deleted text begin 7deleted text end new text begin 8new text end to 14 exist.

Sec. 15.

Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
to read:


new text begin Subd. 8c. new text end

new text begin Hospital residents. new text end

new text begin Payments for hospital residents shall be made
as follows:
new text end

new text begin (1) payments for the first 180 days of inpatient care shall be the APR-DRG payment
plus any appropriate outliers; and
new text end

new text begin (2) payment for all medically necessary patient care subsequent to 180 days shall
be reimbursed at a rate computed by multiplying the statewide average cost-to-charge
ratio by the usual and customary charges.
new text end

Sec. 16.

Minnesota Statutes 2012, section 256.969, subdivision 9, is amended to read:


Subd. 9.

Disproportionate numbers of low-income patients served.

(a) For
admissions occurring on or after October 1, 1992, through December 31, 1992, the
medical assistance disproportionate population adjustment shall comply with federal law
and shall be paid to a hospital, excluding regional treatment centers and facilities of the
federal Indian Health Service, with a medical assistance inpatient utilization rate in excess
of the arithmetic mean. The adjustment must be determined as follows:

(1) for a hospital with a medical assistance inpatient utilization rate above the
arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
federal Indian Health Service but less than or equal to one standard deviation above the
mean, the adjustment must be determined by multiplying the total of the operating and
property payment rates by the difference between the hospital's actual medical assistance
inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
treatment centers and facilities of the federal Indian Health Service; and

(2) for a hospital with a medical assistance inpatient utilization rate above one
standard deviation above the mean, the adjustment must be determined by multiplying
the adjustment that would be determined under clause (1) for that hospital by 1.1. If
federal matching funds are not available for all adjustments under this subdivision, the
commissioner shall reduce payments on a pro rata basis so that all adjustments qualify for
federal match. deleted text begin The commissioner may establish a separate disproportionate population
operating payment rate adjustment under the general assistance medical care program.
For purposes of this subdivision medical assistance does not include general assistance
medical care.
deleted text end The commissioner shall report annually on the number of hospitals likely to
receive the adjustment authorized by this paragraph. The commissioner shall specifically
report on the adjustments received by public hospitals and public hospital corporations
located in cities of the first class.

(b) For admissions occurring on or after July 1, 1993, the medical assistance
disproportionate population adjustment shall comply with federal law and shall be paid to
a hospital, excluding regional treatment centersnew text begin , critical access hospitals,new text end and facilities of
the federal Indian Health Service, with a medical assistance inpatient utilization rate in
excess of the arithmetic mean. The adjustment must be determined as follows:

(1) for a hospital with a medical assistance inpatient utilization rate above the
arithmetic mean for all hospitals excluding regional treatment centersnew text begin , critical access
hospitals,
new text end and facilities of the federal Indian Health Service but less than or equal to one
standard deviation above the mean, the adjustment must be determined by multiplying the
total of the operating and property payment rates by the difference between the hospital's
actual medical assistance inpatient utilization rate and the arithmetic mean for all hospitals
excluding regional treatment centers and facilities of the federal Indian Health Service;new text begin and
new text end

(2) for a hospital with a medical assistance inpatient utilization rate above one
standard deviation above the mean, the adjustment must be determined by multiplying
the adjustment that would be determined under clause (1) for that hospital by 1.1. deleted text begin The
deleted text end deleted text begin commissioner may establish a separate disproportionate population operating payment
rate adjustment under the general assistance medical care program. For purposes of this
subdivision, medical assistance does not include general assistance medical care.
deleted text end The
commissioner shall report annually on the number of hospitals likely to receive the
adjustment authorized by this paragraph. The commissioner shall specifically report on
the adjustments received by public hospitals and public hospital corporations located in
cities of the first classdeleted text begin ;deleted text end new text begin .
new text end

deleted text begin (3) for a hospital that had medical assistance fee-for-service payment volume during
calendar year 1991 in excess of 13 percent of total medical assistance fee-for-service
payment volume, a medical assistance disproportionate population adjustment shall be
paid in addition to any other disproportionate payment due under this subdivision as
follows: $1,515,000 due on the 15th of each month after noon, beginning July 15, 1995.
For a hospital that had medical assistance fee-for-service payment volume during calendar
year 1991 in excess of eight percent of total medical assistance fee-for-service payment
volume and was the primary hospital affiliated with the University of Minnesota, a
medical assistance disproportionate population adjustment shall be paid in addition to any
other disproportionate payment due under this subdivision as follows: $505,000 due on
the 15th of each month after noon, beginning July 15, 1995; and
deleted text end

deleted text begin (4) effective August 1, 2005, the payments in paragraph (b), clause (3), shall be
reduced to zero.
deleted text end

deleted text begin (c) The commissioner shall adjust rates paid to a health maintenance organization
under contract with the commissioner to reflect rate increases provided in paragraph (b),
clauses (1) and (2), on a nondiscounted hospital-specific basis but shall not adjust those
rates to reflect payments provided in clause (3).
deleted text end

deleted text begin (d) If federal matching funds are not available for all adjustments under paragraph
(b), the commissioner shall reduce payments under paragraph (b), clauses (1) and (2), on a
pro rata basis so that all adjustments under paragraph (b) qualify for federal match.
deleted text end

deleted text begin (e) For purposes of this subdivision, medical assistance does not include general
assistance medical care.
deleted text end

deleted text begin (f) For hospital services occurring on or after July 1, 2005, to June 30, 2007:
deleted text end

deleted text begin (1) general assistance medical care expenditures for fee-for-service inpatient and
outpatient hospital payments made by the department shall be considered Medicaid
disproportionate share hospital payments, except as limited below:
deleted text end

deleted text begin (i) only the portion of Minnesota's disproportionate share hospital allotment under
section 1923(f) of the Social Security Act that is not spent on the disproportionate
population adjustments in paragraph (b), clauses (1) and (2), may be used for general
assistance medical care expenditures;
deleted text end

deleted text begin (ii) only those general assistance medical care expenditures made to hospitals that
qualify for disproportionate share payments under section 1923 of the Social Security Act
and the Medicaid state plan may be considered disproportionate share hospital payments;
deleted text end

deleted text begin (iii) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and
deleted text end

deleted text begin (iv) general assistance medical care expenditures may be considered only to the
extent of Minnesota's aggregate allotment under section 1923 of the Social Security Act.
deleted text end

deleted text begin All hospitals and prepaid health plans participating in general assistance medical care
must provide any necessary expenditure, cost, and revenue information required by the
commissioner as necessary for purposes of obtaining federal Medicaid matching funds for
general assistance medical care expenditures; and
deleted text end

deleted text begin (2)deleted text end new text begin (c)new text end Certified public expenditures made by Hennepin County Medical Center shall
be considered Medicaid disproportionate share hospital payments. Hennepin County
and Hennepin County Medical Center shall report by June 15, 2007, on payments made
beginning July 1, 2005, or another date specified by the commissioner, that may qualify
for reimbursement under federal law. Based on these reports, the commissioner shall
apply for federal matching funds.

deleted text begin (g)deleted text end new text begin (d)new text end Upon federal approval of the related state plan amendment, paragraph deleted text begin (f)deleted text end new text begin (c)
new text end is effective retroactively from July 1, 2005, or the earliest effective date approved by the
Centers for Medicare and Medicaid Services.

Sec. 17.

Minnesota Statutes 2012, section 256.969, subdivision 10, is amended to read:


Subd. 10.

Separate billing by certified registered nurse anesthetists.

Hospitals
deleted text begin maydeleted text end new text begin mustnew text end exclude certified registered nurse anesthetist costs from the operating payment
rate deleted text begin as allowed by section 256B.0625, subdivision 11. To be eligible, a hospital must
notify the commissioner in writing by October 1 of even-numbered years to exclude
certified registered nurse anesthetist costs. The hospital must agree that all hospital
claims for the cost and charges of certified registered nurse anesthetist services will not
be included as part of the rates for inpatient services provided during the rate year. In
this case, the operating payment rate shall be adjusted to exclude the cost of certified
registered nurse anesthetist services
deleted text end .

deleted text begin For admissions occurring on or after July 1, 1991, and until the expiration date of
section 256.9695, subdivision 3, services of certified registered nurse anesthetists provided
on an inpatient basis may be paid as allowed by section 256B.0625, subdivision 11, when
the hospital's base year did not include the cost of these services. To be eligible, a hospital
must notify the commissioner in writing by July 1, 1991, of the request and must comply
with all other requirements of this subdivision.
deleted text end

Sec. 18.

Minnesota Statutes 2012, section 256.969, subdivision 14, is amended to read:


Subd. 14.

Transfers.

deleted text begin Except as provided in subdivisions 11 and 13,deleted text end Operating
and property payment rates for admissions that result in transfers and transfers shall be
established on a per day payment system. The per day payment rate shall be the sum of
the adjusted operating and property payment rates determined under this subdivision and
subdivisions 2, 2b, 2c, 3a, 4a, 5a, and deleted text begin 7deleted text end new text begin 8new text end to 12, divided by the arithmetic mean length
of stay for the diagnostic category. Each admission that results in a transfer and each
transfer is considered a separate admission to each hospital, and the total of the admission
and transfer payments to each hospital must not exceed the total per admission payment
that would otherwise be made to each hospital under this subdivision and subdivisions
2, 2b, 2c, 3a, 4a, 5a, and deleted text begin 7 to 13deleted text end new text begin 8 to 12new text end .

Sec. 19.

Minnesota Statutes 2012, section 256.969, subdivision 17, is amended to read:


Subd. 17.

Out-of-state hospitals in local trade areas.

Out-of-state hospitals that
are located within a Minnesota local trade area and that have more than 20 admissions in
the base year new text begin or years new text end shall have rates established using the same procedures and methods
that apply to Minnesota hospitals. For this subdivision and subdivision 18, local trade area
means a county contiguous to Minnesota and located in a metropolitan statistical area as
determined by Medicare for October 1 prior to the most current rebased rate year. Hospitals
that are not required by law to file information in a format necessary to establish rates shall
have rates established based on the commissioner's estimates of the information. Relative
values of the diagnostic categories shall not be redetermined under this subdivision until
required by deleted text begin ruledeleted text end new text begin statutenew text end . Hospitals affected by this subdivision shall then be included in
determining relative values. However, hospitals that have rates established based upon
the commissioner's estimates of information shall not be included in determining relative
values. This subdivision is effective for hospital fiscal years beginning on or after July
1, 1988. A hospital shall provide the information necessary to establish rates under this
subdivision at least 90 days before the start of the hospital's fiscal year.

Sec. 20.

Minnesota Statutes 2012, section 256.969, subdivision 30, is amended to read:


Subd. 30.

Payment rates for births.

(a) For admissions occurring on or after
deleted text begin October 1, 2009deleted text end new text begin September 1, 2014new text end , the total operating and property payment rate,
excluding disproportionate population adjustment, for the following diagnosis-related
groups, as they fall within the deleted text begin diagnosticdeleted text end new text begin APR-DRGnew text end categories: (1) deleted text begin 371 cesarean section
without complicating diagnosis
deleted text end new text begin 5601, 5602, 5603, 5604 vaginal deliverynew text end ;new text begin andnew text end (2) deleted text begin 372
vaginal delivery with complicating diagnosis; and (3) 373 vaginal delivery without
complicating diagnosis
deleted text end new text begin 5401, 5402, 5403, 5404 cesarean sectionnew text end , shall be no greater
than $3,528.

(b) The rates described in this subdivision do not include newborn care.

(c) Payments to managed care and county-based purchasing plans under section
256B.69, 256B.692, or 256L.12 shall be reduced for services provided on or after October
1, 2009, to reflect the adjustments in paragraph (a).

(d) Prior authorization shall not be required before reimbursement is paid for a
cesarean section delivery.

Sec. 21.

Minnesota Statutes 2012, section 256B.04, is amended by adding a
subdivision to read:


new text begin Subd. 24. new text end

new text begin Medicaid waiver requests and state plan amendments. new text end

new text begin Prior to
submitting any Medicaid waiver request or Medicaid state plan amendment to the federal
government for approval, the commissioner shall publish the text of the waiver request or
state plan amendment, and a summary of and explanation of the need for the request, on
the agency's Web site and provide a 30-day public comment period. The commissioner
shall notify the public of the availability of this information through the agency's electronic
subscription service. The commissioner shall consider public comments when preparing
the final waiver request or state plan amendment that is to be submitted to the federal
government for approval. The commissioner shall also publish on the agency's Web site
notice of any federal decision related to the state request for approval, within 30 days of
the decision. This notice must describe any modifications to the state request that have
been agreed to by the commissioner as a condition of receiving federal approval.
new text end

Sec. 22.

Minnesota Statutes 2013 Supplement, section 256B.056, subdivision 5c,
is amended to read:


Subd. 5c.

Excess income standard.

(a) The excess income standard for parents
and caretaker relatives, pregnant women, infants, and children ages two through 20 is the
standard specified in subdivision 4, paragraph (b).

(b) The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years shall equal 75 percent of the federal poverty
guidelines.new text begin The excess income standard under this paragraph shall equal 80 percent of
the federal poverty guidelines, effective January 1, 2017.
new text end

Sec. 23.

Minnesota Statutes 2012, section 256B.0625, subdivision 30, is amended to
read:


Subd. 30.

Other clinic services.

(a) Medical assistance covers rural health clinic
services, federally qualified health center services, nonprofit community health clinic
services, and public health clinic services. Rural health clinic services and federally
qualified health center services mean services defined in United States Code, title 42,
section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified
health center services shall be made according to applicable federal law and regulation.

(b) A federally qualified health center that is beginning initial operation shall submit
an estimate of budgeted costs and visits for the initial reporting period in the form and
detail required by the commissioner. A federally qualified health center that is already in
operation shall submit an initial report using actual costs and visits for the initial reporting
period. Within 90 days of the end of its reporting period, a federally qualified health
center shall submit, in the form and detail required by the commissioner, a report of
its operations, including allowable costs actually incurred for the period and the actual
number of visits for services furnished during the period, and other information required
by the commissioner. Federally qualified health centers that file Medicare cost reports
shall provide the commissioner with a copy of the most recent Medicare cost report filed
with the Medicare program intermediary for the reporting year which support the costs
claimed on their cost report to the state.

(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), a federally qualified health center or rural health clinic
must apply for designation as an essential community provider within six months of final
adoption of rules by the Department of Health according to section 62Q.19, subdivision
7
. For those federally qualified health centers and rural health clinics that have applied
for essential community provider status within the six-month time prescribed, medical
assistance payments will continue to be made according to paragraphs (a) and (b) for the
first three years after application. For federally qualified health centers and rural health
clinics that either do not apply within the time specified above or who have had essential
community provider status for three years, medical assistance payments for health services
provided by these entities shall be according to the same rates and conditions applicable
to the same service provided by health care providers that are not federally qualified
health centers or rural health clinics.

(d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally
qualified health center or a rural health clinic to make application for an essential
community provider designation in order to have cost-based payments made according
to paragraphs (a) and (b) no longer apply.

(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b)
shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.

(f) Effective January 1, 2001, each federally qualified health center and rural health
clinic may elect to be paid either under the prospective payment system established
in United States Code, title 42, section 1396a(aa), or under an alternative payment
methodology consistent with the requirements of United States Code, title 42, section
1396a(aa), and approved by the Centers for Medicare and Medicaid Services. The
alternative payment methodology shall be 100 percent of cost as determined according to
Medicare cost principles.

(g) For purposes of this section, "nonprofit community clinic" is a clinic that:

(1) has nonprofit status as specified in chapter 317A;

(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);

(3) is established to provide health services to low-income population groups,
uninsured, high-risk and special needs populations, underserved and other special needs
populations;

(4) employs professional staff at least one-half of which are familiar with the
cultural background of their clients;

(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and

(6) does not restrict access or services because of a client's financial limitations or
public assistance status and provides no-cost care as needed.

new text begin (h) Effective for dates of service on and after January 1, 2015, all claims for payment
of clinic services provided by federally qualified health centers and rural health clinics
shall be submitted directly to the commissioner and paid by the commissioner. The
commissioner shall provide claims information received by the commissioner under
this paragraph for recipients enrolled in managed care to managed care organizations
on a regular basis.
new text end

new text begin (i) For clinic services provided prior to January 1, 2015, the commissioner shall
calculate and pay monthly the proposed managed care supplemental payments to clinics
and clinics shall conduct a timely review of the payment calculation data in order to
finalize all supplemental payments in accordance with federal law. Any issues arising
from a clinic's review must be reported to the commissioner by January 1, 2017. Upon
final agreement between the commissioner and a clinic on issues identified under this
subdivision, and in accordance with United States Code, title 42, section 1396a(bb), no
supplemental payments for managed care claims for dates of service prior to January 1,
2015, shall be made after June 30, 2017. If the commissioner and clinics are unable to
resolve issues under this subdivision, the parties shall submit the dispute to the arbitration
process under section 14.57.
new text end

Sec. 24.

Minnesota Statutes 2012, section 256B.0751, is amended by adding a
subdivision to read:


new text begin Subd. 10. new text end

new text begin Health care homes advisory committee. new text end

new text begin (a) The commissioners of
health and human services shall establish a health care homes advisory committee to
advise the commissioners on the ongoing statewide implementation of the health care
homes program authorized in this section.
new text end

new text begin (b) The commissioners shall establish an advisory committee that includes
representatives of the health care professions such as primary care providers; mental
health providers; nursing and care coordinators; certified health care home clinics with
statewide representation; health plan companies; state agencies; employers; academic
researchers; consumers; and organizations that work to improve health care quality in
Minnesota. At least 25 percent of the committee members must be consumers or patients
in health care homes. The commissioners, in making appointments to the committee, shall
ensure geographic representation of all regions of the state.
new text end

new text begin (c) The advisory committee shall advise the commissioners on ongoing
implementation of the health care homes program, including, but not limited to, the
following activities:
new text end

new text begin (1) implementation of certified health care homes across the state on performance
management and implementation of benchmarking;
new text end

new text begin (2) implementation of modifications to the health care homes program based on
results of the legislatively mandated health care home evaluation;
new text end

new text begin (3) statewide solutions for engagement of employers and commercial payers;
new text end

new text begin (4) potential modifications of the health care home rules or statutes;
new text end

new text begin (5) consumer engagement, including patient and family-centered care, patient
activation in health care, and shared decision making;
new text end

new text begin (6) oversight for health care home subject matter task forces or workgroups; and
new text end

new text begin (7) other related issues as requested by the commissioners.
new text end

new text begin (d) The advisory committee shall have the ability to establish subcommittees on
specific topics. The advisory committee is governed by section 15.059. Notwithstanding
section 15.059, the advisory committee does not expire.
new text end

Sec. 25.

Minnesota Statutes 2012, section 256B.199, is amended to read:


256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.

(a) deleted text begin Effective July 1, 2007,deleted text end The commissioner shall apply for federal matching
funds for the expenditures in paragraphs (b) and (c). deleted text begin Effective September 1, 2011, the
commissioner shall apply for matching funds for expenditures in paragraph (e).
deleted text end

(b) The commissioner shall apply for federal matching funds for certified public
expenditures as followsdeleted text begin :deleted text end new text begin .
new text end

deleted text begin (1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions
Hospital, the University of Minnesota, and Fairview-University Medical Center shall
report quarterly to the commissioner beginning June 1, 2007, payments made during the
second previous quarter that may qualify for reimbursement under federal law;
deleted text end

deleted text begin (2) based on these reports, the commissioner shall apply for federal matching
funds. These funds are appropriated to the commissioner for the payments under section
256.969, subdivision 27; and
deleted text end

deleted text begin (3)deleted text end By May 1 of each year, beginning May 1, 2007, the commissioner shall inform
the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
hospital payment money expected to be available in the current federal fiscal year.

deleted text begin (c) The commissioner shall apply for federal matching funds for general assistance
medical care expenditures as follows:
deleted text end

deleted text begin (1) for hospital services occurring on or after July 1, 2007, general assistance medical
care expenditures for fee-for-service inpatient and outpatient hospital payments made by
the department shall be used to apply for federal matching funds, except as limited below:
deleted text end

deleted text begin (i) only those general assistance medical care expenditures made to an individual
hospital that would not cause the hospital to exceed its individual hospital limits under
section 1923 of the Social Security Act may be considered; and
deleted text end

deleted text begin (ii) general assistance medical care expenditures may be considered only to the extent
of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
deleted text end

deleted text begin (2) all hospitals must provide any necessary expenditure, cost, and revenue
information required by the commissioner as necessary for purposes of obtaining federal
Medicaid matching funds for general assistance medical care expenditures.
deleted text end

deleted text begin (d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the American Recovery and Reinvestment Act of 2009. These funds shall
be made available as the state share of payments under section 256.969, subdivision 28.
The entities required to report certified public expenditures under paragraph (b), clause
(1), shall report additional certified public expenditures as necessary under this paragraph.
deleted text end

deleted text begin (e)deleted text end new text begin (c)new text end For services provided on or after September 1, 2011, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the MinnesotaCare program deleted text begin according to the requirements and conditions
of paragraph (c)
deleted text end . A hospital may elect on an annual basis to not be a disproportionate
share hospital for purposes of this paragraph, if the hospital does not qualify for a payment
under section 256.969, subdivision 9, paragraph (b).

Sec. 26.

Minnesota Statutes 2012, section 256B.35, subdivision 1, is amended to read:


Subdivision 1.

Personal needs allowance.

(a) Notwithstanding any law to the
contrary, welfare allowances for clothing and personal needs for individuals receiving
medical assistance while residing in any skilled nursing home, intermediate care facility,
or medical institution including recipients of Supplemental Security Income, in this state
shall not be less than $45 per month from all sources. When benefit amounts for Social
Security or Supplemental Security Income recipients are increased pursuant to United
States Code, title 42, sections 415(i) and 1382f, the commissioner shall, effective in the
month in which the increase takes effect, increase by the same percentage to the nearest
whole dollar the clothing and personal needs allowance for individuals receiving medical
assistance while residing in any skilled nursing home, medical institution, or intermediate
care facility. The commissioner shall provide timely notice to local agencies, providers,
and recipients of increases under this provision.

(b) The personal needs allowance may be paid as part of the Minnesota supplemental
aid program, and payments to recipients of Minnesota supplemental aid may be made once
each three months covering liabilities that accrued during the preceding three months.

(c) The personal needs allowance shall be increased to include income garnished
for child support under a court order, up to a maximum of $250 per month but only to
the extent that the amount garnished is not deducted as a monthly allowance for children
under section 256B.0575, paragraph (a), clause (5).

new text begin (d) Solely for the purpose of section 256B.0575, subdivision 1, paragraph (a), clause
(1), the personal needs allowance shall be increased to include income garnished for
spousal maintenance under a judgment and decree for dissolution of marriage, and any
administrative fees garnished for collection efforts.
new text end

Sec. 27.

Minnesota Statutes 2013 Supplement, section 256B.69, subdivision 34,
is amended to read:


Subd. 34.

Supplemental recovery program.

The commissioner shall conduct a
supplemental recovery program for third-party liabilitiesnew text begin , identified through coordination
of benefits,
new text end not recovered by managed care plans and county-based purchasing plans for
state public health programs. Any third-party liability identified new text begin through coordination
of benefits,
new text end and recovered by the commissioner more than deleted text begin sixdeleted text end new text begin eight new text end months after the
date a managed care plan or county-based purchasing plan deleted text begin receivesdeleted text end new text begin adjudicatesnew text end a health
care claimnew text begin , based on accurate and timely coordination of benefits information from the
commissioner,
new text end shall be retained by the commissioner and deposited in the general fund.
The commissioner shall establish a mechanismnew text begin , including a reconciliation process, new text end for
managed care plans and county-based purchasing plans to coordinate third-party liability
collections efforts new text begin resulting from coordination of benefits under this subdivision new text end with the
commissioner to ensure there is no duplication of efforts. The coordination mechanism
must be consistent with the reporting requirements in subdivision 9c.

Sec. 28. new text begin MEDICAL ASSISTANCE SPENDDOWN REQUIREMENTS.
new text end

new text begin The commissioner of human services, in consultation with interested stakeholders,
shall review medical assistance spenddown requirements and processes, including those
used in other states, for individuals with disabilities and seniors age 65 years of age or
older. Based on this review, the commissioner shall recommend alternative medical
assistance spenddown payment requirements and processes that:
new text end

new text begin (1) are practical for current and potential medical assistance recipients, providers,
and the Department of Human Services;
new text end

new text begin (2) improve the medical assistance payment process for providers; and
new text end

new text begin (3) allow current and potential medical assistance recipients to obtain consistent
and affordable medical coverage.
new text end

new text begin The commissioner shall report these recommendations, along with the projected cost,
to the chairs and ranking minority members of the legislative committees and divisions
with jurisdiction over health and human services policy and finance by November 15, 2015.
new text end

Sec. 29. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2012, sections 256.969, subdivisions 8b, 9a, 9b, 11, 13, 20, 21,
22, 25, 26, 27, and 28; and 256.9695, subdivisions 3 and 4,
new text end new text begin are repealed.
new text end

ARTICLE 3

NORTHSTAR CARE FOR CHILDREN

Section 1.

Minnesota Statutes 2012, section 245C.05, subdivision 5, is amended to read:


Subd. 5.

Fingerprints.

(a) Except as provided in paragraph (c), for any background
study completed under this chapter, when the commissioner has reasonable cause to
believe that further pertinent information may exist on the subject of the background
study, the subject shall provide the commissioner with a set of classifiable fingerprints
obtained from an authorized agency.

(b) For purposes of requiring fingerprints, the commissioner has reasonable cause
when, but not limited to, the:

(1) information from the Bureau of Criminal Apprehension indicates that the subject
is a multistate offender;

(2) information from the Bureau of Criminal Apprehension indicates that multistate
offender status is undetermined; or

(3) commissioner has received a report from the subject or a third party indicating
that the subject has a criminal history in a jurisdiction other than Minnesota.

(c) Except as specified under section 245C.04, subdivision 1, paragraph (d), for
background studies conducted by the commissioner for child foster care deleted text begin ordeleted text end new text begin ,new text end adoptions,new text begin or a
transfer of permanent legal and physical custody of a child,
new text end the subject of the background
study, who is 18 years of age or older, shall provide the commissioner with a set of
classifiable fingerprints obtained from an authorized agency.

Sec. 2.

Minnesota Statutes 2013 Supplement, section 245C.08, subdivision 1, is
amended to read:


Subdivision 1.

Background studies conducted by Department of Human
Services.

(a) For a background study conducted by the Department of Human Services,
the commissioner shall review:

(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);

(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;

(3) information from juvenile courts as required in subdivision 4 for individuals
listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;

(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;

(5) except as provided in clause (6), information from the national crime information
system when the commissioner has reasonable cause as defined under section 245C.05,
subdivision 5; and

(6) for a background study related to a child foster care application for licensurenew text begin , a
transfer of permanent legal and physical custody of a child under sections 260C.503 to
260C.515,
new text end or adoptions, the commissioner shall also review:

(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years; and

(ii) information from national crime information databases, when the background
study subject is 18 years of age or older.

(b) Notwithstanding expungement by a court, the commissioner may consider
information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
received notice of the petition for expungement and the court order for expungement is
directed specifically to the commissioner.

(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that
relates to individuals who have already been studied under this chapter and who remain
affiliated with the agency that initiated the background study.

Sec. 3.

Minnesota Statutes 2012, section 245C.33, subdivision 1, is amended to read:


Subdivision 1.

Background studies conducted by commissioner.

new text begin (a) new text end Before
placement of a child for purposes of adoption, the commissioner shall conduct a
background study on individuals listed in deleted text begin sectiondeleted text end new text begin sectionsnew text end 259.41, subdivision 3,new text begin and
260C.611,
new text end for county agencies and private agencies licensed to place children for adoption.
new text begin When a prospective adoptive parent is seeking to adopt a child who is currently placed in
the prospective adoptive parent's home and is under the guardianship of the commissioner
according to section 260C.325, subdivision 1, paragraph (b), and the prospective adoptive
parent holds a child foster care license, a new background study is not required when:
new text end

new text begin (1) a background study was completed on persons required to be studied under section
245C.03 in connection with the application for child foster care licensure after July 1, 2007;
new text end

new text begin (2) the background study included a review of the information in section 245C.08,
subdivisions 1, 3, and 4; and
new text end

new text begin (3) as a result of the background study, the individual was either not disqualified
or, if disqualified, the disqualification was set aside under section 245C.22, or a variance
was issued under section 245C.30.
new text end

new text begin (b) Before the kinship placement agreement is signed for the purpose of transferring
permanent legal and physical custody to a relative under sections 260C.503 to 260C.515,
the commissioner shall conduct a background study on each person age 13 or older living
in the home. When a prospective relative custodian has a child foster care license, a new
background study is not required when:
new text end

new text begin (1) a background study was completed on persons required to be studied under section
245C.03 in connection with the application for child foster care licensure after July 1, 2007;
new text end

new text begin (2) the background study included a review of the information in section 245C.08,
subdivisions 1, 3, and 4; and
new text end

new text begin (3) as a result of the background study, the individual was either not disqualified or,
if disqualified, the disqualification was set aside under section 245C.22, or a variance was
issued under section 245C.30. The commissioner and the county agency shall expedite any
request for a set aside or variance for a background study required under chapter 256N.
new text end

Sec. 4.

Minnesota Statutes 2012, section 245C.33, subdivision 4, is amended to read:


Subd. 4.

Information commissioner reviews.

(a) The commissioner shall review
the following information regarding the background study subject:

(1) the information under section 245C.08, subdivisions 1, 3, and 4;

(2) information from the child abuse and neglect registry for any state in which the
subject has resided for the past five years; and

(3) information from national crime information databases, when required under
section 245C.08.

(b) The commissioner shall provide any information collected under this subdivision
to the county or private agency that initiated the background study. The commissioner
shall also provide the agency:

(1) notice whether the information collected shows that the subject of the background
study has a conviction listed in United States Code, title 42, section 671(a)(20)(A); and

(2)new text begin for background studies conducted under subdivision 1, paragraph (a),new text end the date of
all adoption-related background studies completed on the subject by the commissioner
after June 30, 2007, and the name of the county or private agency that initiated the
adoption-related background study.

Sec. 5.

Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 1, is
amended to read:


Subdivision 1.

General eligibility requirements.

(a) To be eligible for guardianship
assistance under this section, there must be a judicial determination under section
260C.515, subdivision 4, that a transfer of permanent legal and physical custody to a
relative is in the child's best interest. For a child under jurisdiction of a tribal court, a
judicial determination under a similar provision in tribal code indicating that a relative
will assume the duty and authority to provide care, control, and protection of a child who
is residing in foster care, and to make decisions regarding the child's education, health
care, and general welfare until adulthood, and that this is in the child's best interest is
considered equivalent. Additionally, a child must:

(1) have been removed from the child's home pursuant to a voluntary placement
agreement or court order;

(2)(i) have resided deleted text begin indeleted text end new text begin with the prospective relative custodian who has been a
licensed child
new text end foster deleted text begin caredeleted text end new text begin parentnew text end for at least six consecutive months deleted text begin in the home of the
prospective relative custodian
deleted text end ; or

(ii) have received new text begin from the commissioner new text end an exemption from the requirement in item
(i) deleted text begin from the courtdeleted text end new text begin that the prospective relative custodian has been a licensed child foster
parent for at least six consecutive months
new text end new text begin ,new text end based on a determination that:

(A) an expedited move to permanency is in the child's best interest;

(B) expedited permanency cannot be completed without provision of guardianship
assistance; deleted text begin and
deleted text end

(C) the prospective relative custodian is uniquely qualified to meet the child's needsnew text begin ,
as defined in section 260C.212, subdivision 2,
new text end on a permanent basis;

new text begin (D) the child and prospective relative custodian meet the eligibility requirements
of this section; and
new text end

new text begin (E) efforts were made by the legally responsible agency to place the child with the
prospective relative custodian as a licensed child foster parent for six consecutive months
before permanency, or an explanation why these efforts were not in the child's best interests;
new text end

(3) meet the agency determinations regarding permanency requirements in
subdivision 2;

(4) meet the applicable citizenship and immigration requirements in subdivision 3;

(5) have been consulted regarding the proposed transfer of permanent legal and
physical custody to a relative, if the child is at least 14 years of age or is expected to attain
14 years of age prior to the transfer of permanent legal and physical custody; and

(6) have a written, binding agreement under section 256N.25 among the caregiver or
caregivers, the financially responsible agency, and the commissioner established prior to
transfer of permanent legal and physical custody.

(b) In addition to the requirements in paragraph (a), the child's prospective relative
custodian or custodians must meet the applicable background study requirements in
subdivision 4.

(c) To be eligible for title IV-E guardianship assistance, a child must also meet any
additional criteria in section 473(d) of the Social Security Act. The sibling of a child
who meets the criteria for title IV-E guardianship assistance in section 473(d) of the
Social Security Act is eligible for title IV-E guardianship assistance if the child and
sibling are placed with the same prospective relative custodian or custodians, and the
legally responsible agency, relatives, and commissioner agree on the appropriateness of
the arrangement for the sibling. A child who meets all eligibility criteria except those
specific to title IV-E guardianship assistance is entitled to guardianship assistance paid
through funds other than title IV-E.

Sec. 6.

Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 2, is
amended to read:


Subd. 2.

Agency determinations regarding permanency.

(a) To be eligible for
guardianship assistance, the legally responsible agency must complete the following
determinations regarding permanency for the child prior to the transfer of permanent
legal and physical custody:

(1) a determination that reunification and adoption are not appropriate permanency
options for the child; and

(2) a determination that the child demonstrates a strong attachment to the prospective
relative custodian and the prospective relative custodian has a strong commitment to
caring permanently for the child.

(b) The legally responsible agency shall document the determinations in paragraph
(a) and deleted text begin thedeleted text end new text begin eligibility requirements in this section that comply with United States Code,
title 42, sections 673(d) and 675(1)(F). These determinations must be documented in a
kinship placement agreement, which must be in the format prescribed by the commissioner
and must be signed by the prospective relative custodian and the legally responsible
agency. In the case of a Minnesota tribe, the determinations and eligibility requirements
in this section may be provided in an alternative format approved by the commissioner.
new text end Supporting information for completing each determination new text begin must be documented new text end in the
new text begin legally responsible agency's new text end case file and deleted text begin make themdeleted text end available for review as requested
by the financially responsible agency and the commissioner during the guardianship
assistance eligibility determination process.

Sec. 7.

Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 4, is
amended to read:


Subd. 4.

Background study.

(a) A background study deleted text begin under section 245C.33deleted text end must be
completed on each prospective relative custodian and any other adult residing in the home
of the prospective relative custodian.new text begin The background study must meet the requirements of
United States Code, title 42, section 671(a)(20). A study completed under section 245C.33
meets this requirement.
new text end A background study on the prospective relative custodian or adult
residing in the household previously completed under deleted text begin section 245C.04deleted text end new text begin chapter 245Cnew text end for the
purposes of new text begin child new text end foster care licensure deleted text begin maydeleted text end new text begin under chapter 245A or licensure by a Minnesota
tribe, shall
new text end be used for the purposes of this section, provided that the background study deleted text begin is
current
deleted text end new text begin meets the requirements of this subdivision and the prospective relative custodian is
a licensed child foster parent
new text end at the time of the application for guardianship assistance.

(b) If the background study reveals:

(1) a felony conviction at any time for:

(i) child abuse or neglect;

(ii) spousal abuse;

(iii) a crime against a child, including child pornography; or

(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
including other physical assault or battery; or

(2) a felony conviction within the past five years for:

(i) physical assault;

(ii) battery; or

(iii) a drug-related offense;

the prospective relative custodian is prohibited from receiving guardianship assistance
on behalf of an otherwise eligible child.

Sec. 8.

Minnesota Statutes 2013 Supplement, section 256N.23, subdivision 4, is
amended to read:


Subd. 4.

Background study.

new text begin (a) new text end A background study deleted text begin under section 259.41deleted text end must be
completed on each prospective adoptive parentdeleted text begin .deleted text end new text begin and all other adults residing in the home.
A background study must meet the requirements of United States Code, title 42, section
671(a)(20). A study completed under section 245C.33 meets this requirement. If the
prospective adoptive parent is a licensed child foster parent licensed under chapter 245A
or by a Minnesota tribe, the background study previously completed for the purposes of
child foster care licensure shall be used for the purpose of this section, provided that the
background study meets all other requirements of this subdivision and the prospective
adoptive parent is a licensed child foster parent at the time of the application for adoption
assistance.
new text end

new text begin (b)new text end If the background study reveals:

(1) a felony conviction at any time for:

(i) child abuse or neglect;

(ii) spousal abuse;

(iii) a crime against a child, including child pornography; or

(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
including other physical assault or battery; or

(2) a felony conviction within the past five years for:

(i) physical assault;

(ii) battery; or

(iii) a drug-related offense;

the adoptive parent is prohibited from receiving adoption assistance on behalf of an
otherwise eligible child.

Sec. 9.

Minnesota Statutes 2013 Supplement, section 256N.25, subdivision 2, is
amended to read:


Subd. 2.

Negotiation of agreement.

(a) When a child is determined to be eligible
for guardianship assistance or adoption assistance, the financially responsible agency, or,
if there is no financially responsible agency, the agency designated by the commissioner,
must negotiate with the caregiver to develop an agreement under subdivision 1. If and when
the caregiver and agency reach concurrence as to the terms of the agreement, both parties
shall sign the agreement. The agency must submit the agreement, along with the eligibility
determination outlined in sections 256N.22, subdivision 7, and 256N.23, subdivision 7, to
the commissioner for final review, approval, and signature according to subdivision 1.

(b) A monthly payment is provided as part of the adoption assistance or guardianship
assistance agreement to support the care of children unless the child is new text begin eligible for adoption
assistance and
new text end determined to be an at-risk child, in which case deleted text begin the special at-risk monthly
payment under section 256N.26, subdivision 7, must
deleted text end new text begin no payment willnew text end be made new text begin unless and
new text end until the caregiver obtains written documentation from a qualified expert that the potential
disability upon which eligibility for the agreement was based has manifested itself.

(1) The amount of the payment made on behalf of a child eligible for guardianship
assistance or adoption assistance is determined through agreement between the prospective
relative custodian or the adoptive parent and the financially responsible agency, or, if there
is no financially responsible agency, the agency designated by the commissioner, using
the assessment tool established by the commissioner in section 256N.24, subdivision 2,
and the associated benefit and payments outlined in section 256N.26. Except as provided
under section 256N.24, subdivision 1, paragraph (c), the assessment tool establishes
the monthly benefit level for a child under foster care. The monthly payment under a
guardianship assistance agreement or adoption assistance agreement may be negotiated up
to the monthly benefit level under foster care. In no case may the amount of the payment
under a guardianship assistance agreement or adoption assistance agreement exceed the
foster care maintenance payment which would have been paid during the month if the
child with respect to whom the guardianship assistance or adoption assistance payment is
made had been in a foster family home in the state.

(2) The rate schedule for the agreement is determined based on the age of the
child on the date that the prospective adoptive parent or parents or relative custodian or
custodians sign the agreement.

(3) The income of the relative custodian or custodians or adoptive parent or parents
must not be taken into consideration when determining eligibility for guardianship
assistance or adoption assistance or the amount of the payments under section 256N.26.

(4) With the concurrence of the relative custodian or adoptive parent, the amount of
the payment may be adjusted periodically using the assessment tool established by the
commissioner in section 256N.24, subdivision 2, and the agreement renegotiated under
subdivision 3 when there is a change in the child's needs or the family's circumstances.

(5) deleted text begin The guardianship assistance or adoption assistance agreement of a child who is
identified as at-risk receives the special at-risk monthly payment under section 256N.26,
subdivision 7, unless and until the potential disability manifests itself, as documented by
an appropriate professional, and the commissioner authorizes commencement of payment
by modifying the agreement accordingly. A relative custodian or
deleted text end new text begin Annew text end adoptive parent
of an at-risk child with deleted text begin a guardianship assistance ordeleted text end new text begin annew text end adoption assistance agreement
may request a reassessment of the child under section 256N.24, subdivision deleted text begin 9deleted text end new text begin 10new text end , and
renegotiation of the deleted text begin guardianship assistance ordeleted text end adoption assistance agreement under
subdivision 3 to include a monthly payment, if the caregiver has written documentation
from a qualified expert that the potential disability upon which eligibility for the agreement
was based has manifested itself. Documentation of the disability must be limited to
evidence deemed appropriate by the commissioner.

(c) For guardianship assistance agreements:

(1) the initial amount of the monthly guardianship assistance payment must be
equivalent to the foster care rate in effect at the time that the agreement is signed less any
offsets under section 256N.26, subdivision 11, or a lesser negotiated amount if agreed to
by the prospective relative custodian and specified in that agreement, unless deleted text begin the child is
deleted text end deleted text begin identified as at-risk ordeleted text end the guardianship assistance agreement is entered into when a child
is under the age of six;new text begin and
new text end

deleted text begin (2) an at-risk child must be assigned level A as outlined in section 256N.26 and
receive the special at-risk monthly payment under section 256N.26, subdivision 7, unless
and until the potential disability manifests itself, as documented by a qualified expert, and
the commissioner authorizes commencement of payment by modifying the agreement
accordingly; and
deleted text end

deleted text begin (3)deleted text end new text begin (2)new text end the amount of the monthly payment for a guardianship assistance agreement
for a childdeleted text begin , other than an at-risk child,deleted text end who is under the age of six must be as specified in
section 256N.26, subdivision 5.

(d) For adoption assistance agreements:

(1) for a child in foster care with the prospective adoptive parent immediately prior
to adoptive placement, the initial amount of the monthly adoption assistance payment
must be equivalent to the foster care rate in effect at the time that the agreement is signed
less any offsets in section 256N.26, subdivision 11, or a lesser negotiated amount if agreed
to by the prospective adoptive parents and specified in that agreement, unless the child is
identified as at-risk or the adoption assistance agreement is entered into when a child is
under the age of six;

(2) new text begin for new text end an at-risk child new text begin who new text end must be assigned level A as outlined in section
256N.26 deleted text begin and receive the special at-risk monthly payment under section 256N.26,
subdivision 7
deleted text end ,new text begin no payment will be made new text end unless and until the potential disability manifests
itself, as documented by an appropriate professional, and the commissioner authorizes
commencement of payment by modifying the agreement accordingly;

(3) the amount of the monthly payment for an adoption assistance agreement for
a child under the age of six, other than an at-risk child, must be as specified in section
256N.26, subdivision 5;

(4) for a child who is in the guardianship assistance program immediately prior
to adoptive placement, the initial amount of the adoption assistance payment must be
equivalent to the guardianship assistance payment in effect at the time that the adoption
assistance agreement is signed or a lesser amount if agreed to by the prospective adoptive
parent and specified in that agreementnew text begin , unless the child is identified as an at-risk childnew text end ; and

(5) for a child who is not in foster care placement or the guardianship assistance
program immediately prior to adoptive placement or negotiation of the adoption assistance
agreement, the initial amount of the adoption assistance agreement must be determined
using the assessment tool and process in this section and the corresponding payment
amount outlined in section 256N.26.

Sec. 10.

Minnesota Statutes 2013 Supplement, section 256N.25, subdivision 3, is
amended to read:


Subd. 3.

Renegotiation of agreement.

(a) A relative custodian or adoptive
parent of a child with a guardianship assistance or adoption assistance agreement may
request renegotiation of the agreement when there is a change in the needs of the child
or in the family's circumstances. When a relative custodian or adoptive parent requests
renegotiation of the agreement, a reassessment of the child must be completed consistent
with section 256N.24, subdivisions 9 and 10. If the reassessment indicates that the
child's level has changed, the financially responsible agency or, if there is no financially
responsible agency, the agency designated by the commissioner or the commissioner's
designee, and the caregiver must renegotiate the agreement to include a payment with
the level determined through the reassessment process. The agreement must not be
renegotiated unless the commissioner, the financially responsible agency, and the caregiver
mutually agree to the changes. The effective date of any renegotiated agreement must be
determined by the commissioner.

(b) deleted text begin A relative custodian ordeleted text end new text begin Annew text end adoptive parent of an at-risk child with deleted text begin a guardianship
assistance or
deleted text end new text begin annew text end adoption assistance agreement may request renegotiation of the agreement
to include a monthly payment deleted text begin higher than the special at-risk monthly paymentdeleted text end under
section 256N.26deleted text begin , subdivision 7,deleted text end if the caregiver has written documentation from a
qualified expert that the potential disability upon which eligibility for the agreement
was based has manifested itself. Documentation of the disability must be limited to
evidence deemed appropriate by the commissioner. Prior to renegotiating the agreement, a
reassessment of the child must be conducted as outlined in section 256N.24, subdivision
9
. The reassessment must be used to renegotiate the agreement to include an appropriate
monthly payment. The agreement must not be renegotiated unless the commissioner, the
financially responsible agency, and the caregiver mutually agree to the changes. The
effective date of any renegotiated agreement must be determined by the commissioner.

(c) Renegotiation of a guardianship assistance or adoption assistance agreement is
required when one of the circumstances outlined in section 256N.26, subdivision 13,
occurs.

Sec. 11.

Minnesota Statutes 2013 Supplement, section 256N.26, subdivision 1, is
amended to read:


Subdivision 1.

Benefits.

(a) There are three benefits under Northstar Care for
Children: medical assistance, basic payment, and supplemental difficulty of care payment.

(b) A child is eligible for medical assistance under subdivision 2.

(c) A child is eligible for the basic payment under subdivision 3, except for a child
assigned level A under section 256N.24, subdivision 1, because the child is determined to
be an at-risk child receiving deleted text begin guardianship assistance ordeleted text end adoption assistance.

(d) A child, including a foster child age 18 to 21, is eligible for an additional
supplemental difficulty of care payment under subdivision 4, as determined by the
assessment under section 256N.24.

(e) An eligible child entering guardianship assistance or adoption assistance under
the age of six receives a basic payment and supplemental difficulty of care payment as
specified in subdivision 5.

(f) A child transitioning in from a pre-Northstar Care for Children program under
section 256N.28, subdivision 7, shall receive basic and difficulty of care supplemental
payments according to those provisions.

Sec. 12.

Minnesota Statutes 2013 Supplement, section 256N.27, subdivision 4, is
amended to read:


Subd. 4.

Nonfederal share.

(a) The commissioner shall establish a percentage share
of the maintenance payments, reduced by federal reimbursements under title IV-E of the
Social Security Act, to be paid by the state and to be paid by the financially responsible
agency.

(b) These state and local shares must initially be calculated based on the ratio of the
average appropriate expenditures made by the state and all financially responsible agencies
during calendar years 2011, 2012, 2013, and 2014. For purposes of this calculation,
appropriate expenditures for the financially responsible agencies must include basic and
difficulty of care payments for foster care reduced by federal reimbursements, but not
including any initial clothing allowance, administrative payments to child care agencies
specified in section 317A.907, child care, or other support or ancillary expenditures. For
purposes of this calculation, appropriate expenditures for the state shall include adoption
assistance and relative custody assistance, reduced by federal reimbursements.

(c) For each of the periods January 1, 2015, to June 30, 2016, and fiscal years 2017,
2018, and 2019, the commissioner shall adjust this initial percentage of state and local
shares to reflect the relative expenditure trends during calendar years 2011, 2012, 2013, and
2014, taking into account appropriations for Northstar Care for Children and the turnover
rates of the components. In making these adjustments, the commissioner's goal shall be to
make these state and local expenditures other than the appropriations for Northstar Care
for Children to be the same as they would have been had Northstar Care for Children not
been implemented, or if that is not possible, proportionally higher or lower, as appropriate.
new text begin Except for adjustments so that the costs of the phase-in are borne by the state, new text end the state and
local share percentages for fiscal year 2019 must be used for all subsequent years.

Sec. 13.

Minnesota Statutes 2012, section 257.85, subdivision 11, is amended to read:


Subd. 11.

Financial considerations.

(a) Payment of relative custody assistance
under a relative custody assistance agreement is subject to the availability of state funds
and payments may be reduced or suspended on order of the commissioner if insufficient
funds are available.

(b) deleted text begin Upon receipt from a local agency of a claim for reimbursement, the commissioner
shall reimburse the local agency in an amount equal to 100 percent of the relative custody
assistance payments provided to relative custodians. The
deleted text end new text begin Anew text end local agency may not seek and
the commissioner shall not provide reimbursement for the administrative costs associated
with performing the duties described in subdivision 4.

(c) For the purposes of determining eligibility or payment amounts under MFIP,
relative custody assistance payments shall be excluded in determining the family's
available income.

new text begin (d) For expenditures made on or before December 31, 2014, upon receipt from a
local agency of a claim for reimbursement, the commissioner shall reimburse the local
agency in an amount equal to 100 percent of the relative custody assistance payments
provided to relative custodians.
new text end

new text begin (e) For expenditures made on or after January 1, 2015, upon receipt from a local
agency of a claim for reimbursement, the commissioner shall reimburse the local agency as
part of the Northstar Care for Children fiscal reconciliation process under section 256N.27.
new text end

Sec. 14.

Minnesota Statutes 2012, section 260C.212, subdivision 1, is amended to read:


Subdivision 1.

Out-of-home placement; plan.

(a) An out-of-home placement plan
shall be prepared within 30 days after any child is placed in foster care by court order or a
voluntary placement agreement between the responsible social services agency and the
child's parent pursuant to section 260C.227 or chapter 260D.

(b) An out-of-home placement plan means a written document which is prepared
by the responsible social services agency jointly with the parent or parents or guardian
of the child and in consultation with the child's guardian ad litem, the child's tribe, if the
child is an Indian child, the child's foster parent or representative of the foster care facility,
and, where appropriate, the child. For a child in voluntary foster care for treatment under
chapter 260D, preparation of the out-of-home placement plan shall additionally include
the child's mental health treatment provider. As appropriate, the plan shall be:

(1) submitted to the court for approval under section 260C.178, subdivision 7;

(2) ordered by the court, either as presented or modified after hearing, under section
260C.178, subdivision 7, or 260C.201, subdivision 6; and

(3) signed by the parent or parents or guardian of the child, the child's guardian ad
litem, a representative of the child's tribe, the responsible social services agency, and, if
possible, the child.

(c) The out-of-home placement plan shall be explained to all persons involved in its
implementation, including the child who has signed the plan, and shall set forth:

(1) a description of the foster care home or facility selected, including how the
out-of-home placement plan is designed to achieve a safe placement for the child in the
least restrictive, most family-like, setting available which is in close proximity to the home
of the parent or parents or guardian of the child when the case plan goal is reunification,
and how the placement is consistent with the best interests and special needs of the child
according to the factors under subdivision 2, paragraph (b);

(2) the specific reasons for the placement of the child in foster care, and when
reunification is the plan, a description of the problems or conditions in the home of the
parent or parents which necessitated removal of the child from home and the changes the
parent or parents must make in order for the child to safely return home;

(3) a description of the services offered and provided to prevent removal of the child
from the home and to reunify the family including:

(i) the specific actions to be taken by the parent or parents of the child to eliminate
or correct the problems or conditions identified in clause (2), and the time period during
which the actions are to be taken; and

(ii) the reasonable efforts, or in the case of an Indian child, active efforts to be made
to achieve a safe and stable home for the child including social and other supportive
services to be provided or offered to the parent or parents or guardian of the child, the
child, and the residential facility during the period the child is in the residential facility;

(4) a description of any services or resources that were requested by the child or the
child's parent, guardian, foster parent, or custodian since the date of the child's placement
in the residential facility, and whether those services or resources were provided and if
not, the basis for the denial of the services or resources;

(5) the visitation plan for the parent or parents or guardian, other relatives as defined
in section 260C.007, subdivision 27, and siblings of the child if the siblings are not placed
together in foster care, and whether visitation is consistent with the best interest of the
child, during the period the child is in foster care;

(6) new text begin when a child cannot return to or be in the care of either parent, new text end documentation of
steps to finalize the new text begin permanency plan for the child, including:
new text end

new text begin (i) reasonable efforts to place the child for new text end adoption deleted text begin or legal guardianship of the child
if the court has issued an order terminating the rights of both parents of the child or of the
only known, living parent of the child
deleted text end . At a minimum, the documentation must include
new text begin consideration of whether adoption is in the best interests of the child, new text end child-specific
recruitment efforts such as relative search and the use of state, regional, and national
adoption exchanges to facilitate orderly and timely placements in and outside of the state.
A copy of this documentation shall be provided to the court in the review required under
section 260C.317, subdivision 3, paragraph (b);new text begin and
new text end

new text begin (ii) documentation necessary to support the requirements of the kinship placement
agreement under section 256N.22 when adoption is determined not to be in the child's
best interest;
new text end

(7) efforts to ensure the child's educational stability while in foster care, including:

(i) efforts to ensure that the child remains in the same school in which the child was
enrolled prior to placement or upon the child's move from one placement to another,
including efforts to work with the local education authorities to ensure the child's
educational stability; or

(ii) if it is not in the child's best interest to remain in the same school that the child
was enrolled in prior to placement or move from one placement to another, efforts to
ensure immediate and appropriate enrollment for the child in a new school;

(8) the educational records of the child including the most recent information
available regarding:

(i) the names and addresses of the child's educational providers;

(ii) the child's grade level performance;

(iii) the child's school record;

(iv) a statement about how the child's placement in foster care takes into account
proximity to the school in which the child is enrolled at the time of placement; and

(v) any other relevant educational information;

(9) the efforts by the local agency to ensure the oversight and continuity of health
care services for the foster child, including:

(i) the plan to schedule the child's initial health screens;

(ii) how the child's known medical problems and identified needs from the screens,
including any known communicable diseases, as defined in section 144.4172, subdivision
2, will be monitored and treated while the child is in foster care;

(iii) how the child's medical information will be updated and shared, including
the child's immunizations;

(iv) who is responsible to coordinate and respond to the child's health care needs,
including the role of the parent, the agency, and the foster parent;

(v) who is responsible for oversight of the child's prescription medications;

(vi) how physicians or other appropriate medical and nonmedical professionals
will be consulted and involved in assessing the health and well-being of the child and
determine the appropriate medical treatment for the child; and

(vii) the responsibility to ensure that the child has access to medical care through
either medical insurance or medical assistance;

(10) the health records of the child including information available regarding:

(i) the names and addresses of the child's health care and dental care providers;

(ii) a record of the child's immunizations;

(iii) the child's known medical problems, including any known communicable
diseases as defined in section 144.4172, subdivision 2;

(iv) the child's medications; and

(v) any other relevant health care information such as the child's eligibility for
medical insurance or medical assistance;

(11) an independent living plan for a child age 16 or older. The plan should include,
but not be limited to, the following objectives:

(i) educational, vocational, or employment planning;

(ii) health care planning and medical coverage;

(iii) transportation including, where appropriate, assisting the child in obtaining a
driver's license;

(iv) money management, including the responsibility of the agency to ensure that
the youth annually receives, at no cost to the youth, a consumer report as defined under
section 13C.001 and assistance in interpreting and resolving any inaccuracies in the report;

(v) planning for housing;

(vi) social and recreational skills; and

(vii) establishing and maintaining connections with the child's family and
community; and

(12) for a child in voluntary foster care for treatment under chapter 260D, diagnostic
and assessment information, specific services relating to meeting the mental health care
needs of the child, and treatment outcomes.

(d) The parent or parents or guardian and the child each shall have the right to legal
counsel in the preparation of the case plan and shall be informed of the right at the time
of placement of the child. The child shall also have the right to a guardian ad litem.
If unable to employ counsel from their own resources, the court shall appoint counsel
upon the request of the parent or parents or the child or the child's legal guardian. The
parent or parents may also receive assistance from any person or social services agency
in preparation of the case plan.

After the plan has been agreed upon by the parties involved or approved or ordered
by the court, the foster parents shall be fully informed of the provisions of the case plan
and shall be provided a copy of the plan.

Upon discharge from foster care, the parent, adoptive parent, or permanent legal and
physical custodian, as appropriate, and the child, if appropriate, must be provided with
a current copy of the child's health and education record.

Sec. 15.

Minnesota Statutes 2012, section 260C.515, subdivision 4, is amended to read:


Subd. 4.

Custody to relative.

The court may order permanent legal and physical
custody to a new text begin fit and willing new text end relative in the best interests of the child according to the
following deleted text begin conditionsdeleted text end new text begin requirementsnew text end :

(1) an order for transfer of permanent legal and physical custody to a relative shall
only be made after the court has reviewed the suitability of the prospective legal and
physical custodian;

(2) in transferring permanent legal and physical custody to a relative, the juvenile
court shall follow the standards applicable under this chapter and chapter 260, and the
procedures in the Minnesota Rules of Juvenile Protection Procedure;

(3) a transfer of legal and physical custody includes responsibility for the protection,
education, care, and control of the child and decision making on behalf of the child;

(4) a permanent legal and physical custodian may not return a child to the permanent
care of a parent from whom the court removed custody without the court's approval and
without notice to the responsible social services agency;

(5) the social services agency may file a petition naming a fit and willing relative as
a proposed permanent legal and physical custodiannew text begin . A petition for transfer of permanent
legal and physical custody to a relative who is not a parent shall be accompanied by a
kinship placement agreement under section 256N.22, subdivision 2, between the agency
and proposed permanent legal and physical custodian
new text end ;

(6) another party to the permanency proceeding regarding the child may file a
petition to transfer permanent legal and physical custody to a relativedeleted text begin , but thedeleted text end new text begin . Thenew text end petition
new text begin must include facts upon which the court can make the determination required under clause
(7) and
new text end must be filed not later than the date for the required admit-deny hearing under
section 260C.507; or if the agency's petition is filed under section 260C.503, subdivision
2
, the petition must be filed not later than 30 days prior to the trial required under section
260C.509; deleted text begin and
deleted text end

new text begin (7) where a petition is for transfer of permanent legal and physical custody to a
relative who is not a parent, the court must find that:
new text end

new text begin (i) transfer of permanent legal and physical custody and receipt of Northstar kinship
assistance under chapter 256N, when requested and the child is eligible, is in the child's
best interests;
new text end

new text begin (ii) adoption is not in the child's best interests based on the determinations in the
kinship placement agreement required under section 256N.22, subdivision 2;
new text end

new text begin (iii) the agency made efforts to discuss adoption with the child's parent or parents,
or the agency did not make efforts to discuss adoption and the reasons why efforts were
not made; and
new text end

new text begin (iv) there are reasons to separate siblings during placement, if applicable;
new text end

new text begin (8) the court may defer finalization of an order transferring permanent legal and
physical custody to a relative when deferring finalization is necessary to determine
eligibility for Northstar kinship assistance under chapter 256N;
new text end

new text begin (9) the court may finalize a permanent transfer of physical and legal custody to a
relative regardless of eligibility for Northstar kinship assistance under chapter 256N; and
new text end

deleted text begin (7)deleted text end new text begin (10)new text end the juvenile court may maintain jurisdiction over the responsible social
services agency, the parents or guardian of the child, the child, and the permanent legal
and physical custodian for purposes of ensuring appropriate services are delivered to the
child and permanent legal custodian for the purpose of ensuring conditions ordered by the
court related to the care and custody of the child are met.

Sec. 16.

Minnesota Statutes 2012, section 260C.611, is amended to read:


260C.611 ADOPTION STUDY REQUIRED.

new text begin (a) new text end An adoption study under section 259.41 approving placement of the child in the
home of the prospective adoptive parent shall be completed before placing any child under
the guardianship of the commissioner in a home for adoption. If a prospective adoptive
parent hasnew text begin a current child foster care license under chapter 245A and is seeking to adopt
a foster child who is placed in the prospective adoptive parent's home and is under the
guardianship of the commissioner according to section 260C.325, subdivision 1, the child
foster care home study meets the requirements of this section for an approved adoption
home study if:
new text end

new text begin (1) the written home study on which the foster care license was based is completed
in the commissioner's designated format, consistent with the requirements in sections
260C.215, subdivision 4, clause (5); and 259.41, subdivision 2; and Minnesota Rules,
part 2960.3060, subpart 4;
new text end

new text begin (2) the background studies on each prospective adoptive parent and all required
household members were completed according to section 245C.33;
new text end

new text begin (3) the commissioner has not issued, within the last three years, a sanction on the
license under section 245A.07 or an order of a conditional license under section 245A.06;
and
new text end

new text begin (4) the legally responsible agency determines that the individual needs of the child
are being met by the prospective adoptive parent through an assessment under section
256N.24, subdivision 2, or a documented placement decision consistent with section
260C.212, subdivision 2.
new text end

new text begin (b) If a prospective adoptive parent hasnew text end previously held a foster care license or
adoptive home study, any update necessary to the foster care license, or updated or new
adoptive home study, if not completed by the licensing authority responsible for the
previous license or home study, shall include collateral information from the previous
licensing or approving agency, if available.

Sec. 17. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall change the term "guardianship assistance" to "Northstar
kinship assistance" wherever it appears in Minnesota Statutes and Minnesota Rules to
refer to the program components related to Northstar Care for Children under Minnesota
Statutes, chapter 256N.
new text end

Sec. 18. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2013 Supplement, section 256N.26, subdivision 7, new text end new text begin is repealed.
new text end

ARTICLE 4

COMMUNITY FIRST SERVICES AND SUPPORTS

Section 1.

Minnesota Statutes 2012, section 245C.03, is amended by adding a
subdivision to read:


new text begin Subd. 8. new text end

new text begin Community first services and supports organizations. new text end

new text begin The
commissioner shall conduct background studies on any individual required under section
256B.85 to have a background study completed under this chapter.
new text end

Sec. 2.

Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision
to read:


new text begin Subd. 7. new text end

new text begin Community first services and supports organizations. new text end

new text begin (a) The
commissioner shall conduct a background study of an individual required to be studied
under section 245C.03, subdivision 8, at least upon application for initial enrollment
under section 256B.85.
new text end

new text begin (b) Before an individual described in section 245C.03, subdivision 8, begins a
position allowing direct contact with a person served by an organization required to initiate
a background study under section 256B.85, the organization must receive a notice from
the commissioner that the support worker is:
new text end

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

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

Sec. 3.

Minnesota Statutes 2012, section 245C.10, is amended by adding a subdivision
to read:


new text begin Subd. 10. new text end

new text begin Community first services and supports organizations. new text end

new text begin The
commissioner shall recover the cost of background studies initiated by an agency-provider
delivering services under section 256B.85, subdivision 11, or a financial management
services contractor providing service functions under section 256B.85, subdivision 13,
through a fee of no more than $20 per study, charged to the organization responsible for
submitting the background study form. The fees collected under this subdivision are
appropriated to the commissioner for the purpose of conducting background studies.
new text end

Sec. 4.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 2, is
amended to read:


Subd. 2.

Definitions.

(a) For the purposes of this section, the terms defined in
this subdivision have the meanings given.

(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
dressing, bathing, mobility, positioning, and transferring.

(c) "Agency-provider model" means a method of CFSS under which a qualified
agency provides services and supports through the agency's own employees and policies.
The agency must allow the participant to have a significant role in the selection and
dismissal of support workers of their choice for the delivery of their specific services
and supports.

(d) "Behavior" means a description of a need for services and supports used to
determine the home care rating and additional service units. The presence of Level I
behavior is used to determine the home care rating. "Level I behavior" means physical
aggression towards self or others or destruction of property that requires the immediate
response of another person. If qualified for a home care rating as described in subdivision
8, additional service units can be added as described in subdivision 8, paragraph (f), for
the following behaviors:

(1) Level I behavior;

(2) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or

(3) increased need for assistance for deleted text begin recipientsdeleted text end new text begin participantsnew text end who are verbally
aggressive or resistive to care so that time needed to perform activities of daily living is
increased.

new text begin (e) "Budget model" means a service delivery method of CFSS that allows the
use of a service budget and assistance from a vendor fiscal/employer agent financial
management services (FMS) contractor for a participant to directly employ support
workers and purchase supports and goods.
new text end

deleted text begin (e)deleted text end new text begin (f)new text end "Complex health-related needs" means an intervention listed in clauses (1)
to (8) that has been ordered by a physician, and is specified in a community support
plan, including:

(1) tube feedings requiring:

(i) a gastrojejunostomy tube; or

(ii) continuous tube feeding lasting longer than 12 hours per day;

(2) wounds described as:

(i) stage III or stage IV;

(ii) multiple wounds;

(iii) requiring sterile or clean dressing changes or a wound vac; or

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

(3) parenteral therapy described as:

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

(ii) total parenteral nutrition (TPN) daily;

(4) respiratory interventions, including:

(i) oxygen required more than eight hours per day;

(ii) respiratory vest more than one time per day;

(iii) bronchial drainage treatments more than two times per day;

(iv) sterile or clean suctioning more than six times per day;

(v) dependence on another to apply respiratory ventilation augmentation devices
such as BiPAP and CPAP; and

(vi) ventilator dependence under section 256B.0652;

(5) insertion and maintenance of catheter, including:

(i) sterile catheter changes more than one time per month;

(ii) clean intermittent catheterization, and including self-catheterization more than
six times per day; or

(iii) bladder irrigations;

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

(7) neurological intervention, including:

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

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

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

deleted text begin (f)deleted text end new text begin (g)new text end "Community first services and supports" or "CFSS" means the assistance and
supports program under this section needed for accomplishing activities of daily living,
instrumental activities of daily living, and health-related tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task, or the
purchase of goods as defined in subdivision 7, deleted text begin paragraph (a),deleted text end clause (3), that replace
the need for human assistance.

deleted text begin (g)deleted text end new text begin (h)new text end "Community first services and supports service delivery plan" or "service
delivery plan" means a written deleted text begin summary ofdeleted text end new text begin document detailingnew text end the services and supports
new text begin chosen by the participant to meet assessed needs new text end that deleted text begin isdeleted text end new text begin are within the approved CFSS
service authorization amount. Services and supports are
new text end based on the community support
plan identified in section 256B.0911 and coordinated services and support plan and budget
identified in section 256B.0915, subdivision 6, if applicable, that is determined by the
participant to meet the assessed needs, using a person-centered planning process.

new text begin (i) "Consultation services" means a Minnesota health care program enrolled provider
organization that is under contract with the department and has the knowledge, skills,
and ability to assist CFSS participants in using either the agency-provider model under
subdivision 11 or the budget model under subdivision 13.
new text end

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

deleted text begin (i)deleted text end new text begin (k)new text end "Dependency" in activities of daily living means a person requires hands-on
assistance or constant supervision and cueing to accomplish one or more of the activities
of daily living every day or on the days during the week that the activity is performed;
however, a child may not be found to be dependent in an activity of daily living if,
because of the child's age, an adult would either perform the activity for the child or assist
the child with the activity and the assistance needed is the assistance appropriate for
a typical child of the same age.

deleted text begin (j)deleted text end new text begin (l)new text end "Extended CFSS" means CFSS services and supports deleted text begin under the
agency-provider model
deleted text end included in a service plan through one of the home and
community-based services waivers new text begin and as approved and new text end authorized under sections
256B.0915; 256B.092, subdivision 5; and 256B.49, which exceed the amount, duration,
and frequency of the state plan CFSS services for participants.

deleted text begin (k)deleted text end new text begin (m)new text end "Financial management services contractor or vendor"new text begin or "FMS contractor"
new text end means a qualified organization deleted text begin havingdeleted text end new text begin necessary to use the budget model under subdivision
13 that has
new text end a written contract with the department to provide new text begin vendor fiscal/employer agent
financial management
new text end services deleted text begin necessary to use the budget model under subdivision 13
that
deleted text end new text begin (FMS). Servicesnew text end include but are not limited to: deleted text begin participant education and technical
assistance; CFSS service delivery planning and budgeting;
deleted text end new text begin filing and payment of federal
and state payroll taxes on behalf of the participant; initiating criminal background
checks;
new text end billingdeleted text begin , making payments, anddeleted text end new text begin for approved CFSS services with authorized
funds;
new text end monitoring deleted text begin of spendingdeleted text end new text begin expendituresnew text end ; new text begin accounting for and disbursing CFSS funds;
providing assistance in obtaining and filing for liability, workers' compensation, and
unemployment coverage;
new text end and deleted text begin assistingdeleted text end new text begin participant instruction and technical assistance to
new text end the participant in fulfilling employer-related requirements in accordance with Section
3504 of the Internal Revenue Code and deleted text begin the Internal Revenue Service Revenue Procedure
70-6
deleted text end new text begin related regulations and interpretations, including Code of Federal Regulations, title
26, section 31.3504-1
new text end .

deleted text begin (l) "Budget model" means a service delivery method of CFSS that allows the use of
an individualized CFSS service delivery plan and service budget and provides assistance
from the financial management services contractor to facilitate participant employment of
support workers and the acquisition of supports and goods.
deleted text end

deleted text begin (m)deleted text end new text begin (n)new text end "Health-related procedures and tasks" means procedures and tasks related
to the specific needs of an individual that can be deleted text begin delegateddeleted text end new text begin taughtnew text end or assigned by a
state-licensed healthcare or mental health professional and performed by a support worker.

deleted text begin (n)deleted text end new text begin (o)new text end "Instrumental activities of daily living" means activities related to
living independently in the community, including but not limited to: meal planning,
preparation, and cooking; shopping for food, clothing, or other essential items; laundry;
housecleaning; assistance with medications; managing finances; communicating needs
and preferences during activities; arranging supports; and assistance with traveling around
and participating in the community.

deleted text begin (o)deleted text end new text begin (p)new text end "Legal representative" means parent of a minor, a court-appointed guardian,
or another representative with legal authority to make decisions about services and
supports for the participant. Other representatives with legal authority to make decisions
include but are not limited to a health care agent or an attorney-in-fact authorized through
a health care directive or power of attorney.

deleted text begin (p)deleted text end new text begin (q)new text end "Medication assistance" means providing verbal or visual reminders to take
regularly scheduled medication, and includes any of the following supports listed in clauses
(1) to (3) and other types of assistance, except that a support worker may not determine
medication dose or time for medication or inject medications into veins, muscles, or skin:

(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;

(2) organizing medications as directed by the participant or the participant's
representative; and

(3) providing verbal or visual reminders to perform regularly scheduled medications.

deleted text begin (q)deleted text end new text begin (r)new text end "Participant's representative" means a parent, family member, advocate,
or other adult authorized by the participant to serve as a representative in connection
with the provision of CFSS. This authorization must be in writing or by another method
that clearly indicates the participant's free choice. The participant's representative must
have no financial interest in the provision of any services included in the participant's
service delivery plan and must be capable of providing the support necessary to assist
the participant in the use of CFSS. If through the assessment process described in
subdivision 5 a participant is determined to be in need of a participant's representative, one
must be selected. If the participant is unable to assist in the selection of a participant's
representative, the legal representative shall appoint one. Two persons may be designated
as a participant's representative for reasons such as divided households and court-ordered
custodies. Duties of a participant's representatives may include:

(1) being available while deleted text begin care isdeleted text end new text begin services arenew text end provided in a method agreed upon by
the participant or the participant's legal representative and documented in the participant's
CFSS service delivery plan;

(2) monitoring CFSS services to ensure the participant's CFSS service delivery
plan is being followed; and

(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.

deleted text begin (r)deleted text end new text begin (s)new text end "Person-centered planning process" means a process that is directed by the
participant to plan for services and supports. The person-centered planning process must:

(1) include people chosen by the participant;

(2) provide necessary information and support to ensure that the participant directs
the process to the maximum extent possible, and is enabled to make informed choices
and decisions;

(3) be timely and occur at time and locations of convenience to the participant;

(4) reflect cultural considerations of the participant;

(5) include strategies for solving conflict or disagreement within the process,
including clear conflict-of-interest guidelines for all planning;

(6) provide the participant choices of the services and supports they receive and the
staff providing those services and supports;

(7) include a method for the participant to request updates to the plan; and

(8) record the alternative home and community-based settings that were considered
by the participant.

deleted text begin (s)deleted text end new text begin (t)new text end "Shared services" means the provision of CFSS services by the same CFSS
support worker to two or three participants who voluntarily enter into an agreement to
receive services at the same time and in the same setting by the same deleted text begin providerdeleted text end new text begin employernew text end .

deleted text begin (t) "Support specialist" means a professional with the skills and ability to assist the
participant using either the agency-provider model under subdivision 11 or the flexible
spending model under subdivision 13, in services including but not limited to assistance
regarding:
deleted text end

deleted text begin (1) the development, implementation, and evaluation of the CFSS service delivery
plan under subdivision 6;
deleted text end

deleted text begin (2) recruitment, training, or supervision, including supervision of health-related tasks
or behavioral supports appropriately delegated or assigned by a health care professional,
and evaluation of support workers; and
deleted text end

deleted text begin (3) facilitating the use of informal and community supports, goods, or resources.
deleted text end

(u) "Support worker" means deleted text begin andeleted text end new text begin a qualified and trainednew text end employee of the deleted text begin agency
provider
deleted text end new text begin agency-providernew text end or of the participant new text begin employer under the budget model new text end who
has direct contact with the participant and provides services as specified within the
participant's service delivery plan.

(v) "Wages and benefits" means the hourly wages and salaries, the employer's
share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
compensation, mileage reimbursement, health and dental insurance, life insurance,
disability insurance, long-term care insurance, uniform allowance, contributions to
employee retirement accounts, or other forms of employee compensation and benefits.

new text begin (w) "Worker training and development" means services for developing workers'
skills as required by the participant's individual CFSS delivery plan that are arranged for
or provided by the agency-provider or purchased by the participant employer. These
services include training, education, direct observation and supervision, and evaluation
and coaching of job skills and tasks, including supervision of health-related tasks or
behavioral supports.
new text end

Sec. 5.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 3, is
amended to read:


Subd. 3.

Eligibility.

(a) CFSS is available to a person who meets one of the
following:

(1) is deleted text begin a recipientdeleted text end new text begin an enrolleenew text end of medical assistance as determined under section
256B.055, 256B.056, or 256B.057, subdivisions 5 and 9;

(2) is a deleted text begin recipient ofdeleted text end new text begin participant innew text end the alternative care program under section
256B.0913;

(3) is a waiver deleted text begin recipientdeleted text end new text begin participantnew text end as defined under section 256B.0915, 256B.092,
256B.093, or 256B.49; or

(4) has medical services identified in a participant's individualized education
program and is eligible for services as determined in section 256B.0625, subdivision 26.

(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:

(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911;new text begin and
new text end

(2) is not a deleted text begin recipient ofdeleted text end new text begin participant undernew text end a family support grant under section 252.32deleted text begin ;deleted text end new text begin .
new text end

deleted text begin (3) lives in the person's own apartment or home including a family foster care setting
licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
noncertified boarding care home or a boarding and lodging establishment under chapter
157.
deleted text end

Sec. 6.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 5, is
amended to read:


Subd. 5.

Assessment requirements.

(a) The assessment of functional need must:

(1) be conducted by a certified assessor according to the criteria established in
section 256B.0911, subdivision 3a;

(2) be conducted face-to-face, initially and at least annually thereafter, or when there
is a significant change in the participant's condition or a change in the need for services
and supportsnew text begin , or at the request of the participant when there is a change in condition or a
change in the need for services or supports
new text end ; and

(3) be completed using the format established by the commissioner.

deleted text begin (b) A participant who is residing in a facility may be assessed and choose CFSS for
the purpose of using CFSS to return to the community as described in subdivisions 3
and 7, paragraph (a), clause (5).
deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end The results of the assessment and any recommendations and authorizations
for CFSS must be determined and communicated in writing by the lead agency's certified
assessor as defined in section 256B.0911 to the participant and the agency-provider or
deleted text begin financial management services providerdeleted text end new text begin FMS contractornew text end chosen by the participant within
40 calendar days and must include the participant's right to appeal under section 256.045,
subdivision 3
.

deleted text begin (d)deleted text end new text begin (c)new text end The lead agency assessor may deleted text begin requestdeleted text end new text begin authorizenew text end a temporary authorization
for CFSS servicesnew text begin to be provided under the agency-provider modelnew text end . Authorization for
a temporary level of CFSS services new text begin under the agency-provider model new text end is limited to the
time specified by the commissioner, but shall not exceed 45 days. The level of services
authorized under this deleted text begin provisiondeleted text end new text begin paragraphnew text end shall have no bearing on a future authorization.

Sec. 7.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 6, is
amended to read:


Subd. 6.

Community first services and support service delivery plan.

(a) The
CFSS service delivery plan must be developeddeleted text begin , implemented,deleted text end and evaluated through a
person-centered planning process by the participant, or the participant's representative
or legal representative who may be assisted by a deleted text begin support specialistdeleted text end new text begin consultation services
provider
new text end . The CFSS service delivery plan must reflect the services and supports that
are important to the participant and for the participant to meet the needs assessed
by the certified assessor and identified in the community support plan under section
256B.0911, subdivision 3, or the coordinated services and support plan identified in
section 256B.0915, subdivision 6, if applicable. The CFSS service delivery plan must be
reviewed by the participantnew text begin , the consultation services provider,new text end and the agency-provider
or deleted text begin financial management servicesdeleted text end new text begin FMSnew text end contractor new text begin prior to starting services and new text end at least
annually upon reassessment, or when there is a significant change in the participant's
condition, or a change in the need for services and supports.

(b) The commissioner shall establish the format and criteria for the CFSS service
delivery plan.

(c) The CFSS service delivery plan must be person-centered and:

(1) specify the new text begin consultation services provider, new text end agency-providernew text begin ,new text end or deleted text begin financial
management services
deleted text end new text begin FMSnew text end contractor selected by the participant;

(2) reflect the setting in which the participant resides that is chosen by the participant;

(3) reflect the participant's strengths and preferences;

(4) include the means to address the clinical and support needs as identified through
an assessment of functional needs;

(5) include individually identified goals and desired outcomes;

(6) reflect the services and supports, paid and unpaid, that will assist the participant
to achieve identified goals, new text begin including the costs of the services and supports, new text end and the
providers of those services and supports, including natural supports;

(7) identify the amount and frequency of face-to-face supports and amount and
frequency of remote supports and technology that will be used;

(8) identify risk factors and measures in place to minimize them, including
individualized backup plans;

(9) be understandable to the participant and the individuals providing support;

(10) identify the individual or entity responsible for monitoring the plan;

(11) be finalized and agreed to in writing by the participant and signed by all
individuals and providers responsible for its implementation;

(12) be distributed to the participant and other people involved in the plan; deleted text begin and
deleted text end

(13) prevent the provision of unnecessary or inappropriate caredeleted text begin .deleted text end new text begin ;
new text end

new text begin (14) include a detailed budget for expenditures for budget model participants or
participants under the agency-provider model if purchasing goods; and
new text end

new text begin (15) include a plan for worker training and development detailing what service
components will be used, when the service components will be used, how they will be
provided, and how these service components relate to the participant's individual needs
and CFSS support worker services.
new text end

(d) The total units of agency-provider services or the new text begin service new text end budget deleted text begin allocation
deleted text end amount for the budget model include both annual totals and a monthly average amount
that cover the number of months of the service authorization. The amount used each
month may vary, but additional funds must not be provided above the annual service
authorization amount unless a change in condition is assessed and authorized by the
certified assessor and documented in the community support plan, coordinated services
and supports plan, and new text begin CFSS new text end service delivery plan.

new text begin (e) In assisting with the development or modification of the plan during the
authorization time period, the consultation services provider shall:
new text end

new text begin (1) consult with the FMS contractor on the spending budget when applicable; and
new text end

new text begin (2) consult with the participant or participant's representative, agency-provider, and
case manager/care coordinator.
new text end

new text begin (f) The service plan must be approved by the consultation services provider for
participants without a case manager/care coordinator. A case manager/care coordinator
must approve the plan for a waiver or alternative care program participant.
new text end

Sec. 8.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 7, is
amended to read:


Subd. 7.

Community first services and supports; covered services.

Within the
service unit authorization or new text begin service new text end budget deleted text begin allocationdeleted text end new text begin amountnew text end , services and supports
covered under CFSS include:

(1) assistance to accomplish activities of daily living (ADLs), instrumental activities
of daily living (IADLs), and health-related procedures and tasks through hands-on
assistance to accomplish the task or constant supervision and cueing to accomplish the task;

(2) assistance to acquire, maintain, or enhance the skills necessary for the participant
to accomplish activities of daily living, instrumental activities of daily living, or
health-related tasks;

(3) expenditures for items, services, supports, environmental modifications, or
goods, including assistive technology. These expenditures must:

(i) relate to a need identified in a participant's CFSS service delivery plan;

(ii) increase independence or substitute for human assistance to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;

(4) observation and redirection for behavior or symptoms where there is a need for
assistance. An assessment of behaviors must meet the criteria in this clause. A deleted text begin recipient
deleted text end new text begin participantnew text end qualifies as having a need for assistance due to behaviors if the deleted text begin recipient's
deleted text end new text begin participant'snew text end behavior requires assistance at least four times per week and shows one or
more of the following behaviors:

(i) physical aggression towards self or others, or destruction of property that requires
the immediate response of another person;

(ii) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or

(iii) increased need for assistance for deleted text begin recipientsdeleted text end new text begin participantsnew text end who are verbally
aggressive or resistive to care so that time needed to perform activities of daily living is
increased;

(5) back-up systems or mechanisms, such as the use of pagers or other electronic
devices, to ensure continuity of the participant's services and supports;

deleted text begin (6) transition costs, including:
deleted text end

deleted text begin (i) deposits for rent and utilities;
deleted text end

deleted text begin (ii) first month's rent and utilities;
deleted text end

deleted text begin (iii) bedding;
deleted text end

deleted text begin (iv) basic kitchen supplies;
deleted text end

deleted text begin (v) other necessities, to the extent that these necessities are not otherwise covered
under any other funding that the participant is eligible to receive; and
deleted text end

deleted text begin (vi) other required necessities for an individual to make the transition from a nursing
facility, institution for mental diseases, or intermediate care facility for persons with
developmental disabilities to a community-based home setting where the participant
resides; and
deleted text end

deleted text begin (7)deleted text end new text begin (6)new text end services new text begin provided new text end by a deleted text begin support specialistdeleted text end new text begin consultation services provider under
contract with the department and enrolled as a Minnesota health care program provider as
new text end defined under subdivision deleted text begin 2 that are chosen by the participant.deleted text end new text begin 17;
new text end

new text begin (7) services provided by an FMS contractor under contract with the department
as defined under subdivision 13;
new text end

new text begin (8) CFSS services provided by a qualified support worker who is a parent, stepparent,
or legal guardian of a participant under age 18, or who is the participant's spouse. These
support workers shall not provide any medical assistance home and community-based
services in excess of 40 hours per seven-day period regardless of the number of parents,
combination of parents and spouses, or number of children who receive medical assistance
services; and
new text end

new text begin (9) worker training and development services as defined in subdivision 2, paragraph
(w), and described in subdivision 18a.
new text end

Sec. 9.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 8, is
amended to read:


Subd. 8.

Determination of CFSS service methodology.

(a) All community first
services and supports must be authorized by the commissioner or the commissioner's
designee before services begin, except for the assessments established in section
256B.0911. The authorization for CFSS must be completed as soon as possible following
an assessment but no later than 40 calendar days from the date of the assessment.

(b) The amount of CFSS authorized must be based on the deleted text begin recipient'sdeleted text end new text begin participant's
new text end home care rating described in paragraphs (d) and (e) and any additional service units for
which the deleted text begin persondeleted text end new text begin participantnew text end qualifies as described in paragraph (f).

(c) The home care rating shall be determined by the commissioner or the
commissioner's designee based on information submitted to the commissioner identifying
the following for a deleted text begin recipientdeleted text end new text begin participantnew text end :

(1) the total number of dependencies of activities of daily living as defined in
subdivision 2, paragraph (b);

(2) the presence of complex health-related needs as defined in subdivision 2,
paragraph (e); and

(3) the presence of Level I behavior as defined in subdivision 2, paragraph (d)deleted text begin ,
clause (1)
deleted text end .

(d) The methodology to determine the total service units for CFSS for each home
care rating is based on the median paid units per day for each home care rating from
fiscal year 2007 data for the PCA program.

(e) Each home care rating is designated by the letters P through Z and EN and has
the following base number of service units assigned:

(1) P home care rating requires Level I behavior or one to three dependencies in
ADLs and qualifies one for five service units;

(2) Q home care rating requires Level I behavior and one to three dependencies in
ADLs and qualifies one for six service units;

(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies one for seven service units;

(4) S home care rating requires four to six dependencies in ADLs and qualifies
one for ten service units;

(5) T home care rating requires four to six dependencies in ADLs and Level I
behavior and qualifies one for 11 service units;

(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies one for 14 service units;

(7) V home care rating requires seven to eight dependencies in ADLs and qualifies
one for 17 service units;

(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies one for 20 service units;

(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies one for 30 service units; and

(10) EN home care rating includes ventilator dependency as defined in section
256B.0651, subdivision 1, paragraph (g). deleted text begin Recipientsdeleted text end new text begin Participantsnew text end who meet the definition
of ventilator-dependent and the EN home care rating and utilize a combination of
CFSS and other home care services are limited to a total of 96 service units per day for
those services in combination. Additional units may be authorized when a deleted text begin recipient's
deleted text end new text begin participant'snew text end assessment indicates a need for two staff to perform activities. Additional
time is limited to 16 service units per day.

(f) Additional service units are provided through the assessment and identification of
the following:

(1) 30 additional minutes per day for a dependency in each critical activity of daily
living as defined in subdivision 2, paragraph deleted text begin (h)deleted text end new text begin (j)new text end ;

(2) 30 additional minutes per day for each complex health-related function as
defined in subdivision 2, paragraph deleted text begin (e)deleted text end new text begin (f)new text end ; and

(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2,
paragraph (d).

new text begin (g) The service budget for budget model participants shall be based on:
new text end

new text begin (1) assessed units as determined by the home care rating; and
new text end

new text begin (2) an adjustment needed for administrative expenses.
new text end

Sec. 10.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 9, is
amended to read:


Subd. 9.

Noncovered services.

(a) Services or supports that are not eligible for
payment under this section include those that:

(1) are not authorized by the certified assessor or included in the written service
delivery plan;

(2) are provided prior to the authorization of services and the approval of the written
CFSS service delivery plan;

(3) are duplicative of other paid services in the written service delivery plan;

(4) supplant natural unpaid supports that appropriately meet a need in the service
plan, are provided voluntarily to the participant, and are selected by the participant in lieu
of other services and supports;

(5) are not effective means to meet the participant's needs; and

(6) are available through other funding sources, including, but not limited to, funding
through title IV-E of the Social Security Act.

(b) Additional services, goods, or supports that are not covered include:

(1) those that are not for the direct benefit of the participant, except that services for
caregivers such as training to improve the ability to provide CFSS are considered to directly
benefit the participant if chosen by the participant and approved in the support plan;

(2) any fees incurred by the participant, such as Minnesota health care programs fees
and co-pays, legal fees, or costs related to advocate agencies;

(3) insurance, except for insurance costs related to employee coverage;

(4) room and board costs for the participant deleted text begin with the exception of allowable
transition costs in subdivision 7, clause (6)
deleted text end ;

(5) services, supports, or goods that are not related to the assessed needs;

(6) special education and related services provided under the Individuals with
Disabilities Education Act and vocational rehabilitation services provided under the
Rehabilitation Act of 1973;

(7) assistive technology devices and assistive technology services other than those
for back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;

(8) medical supplies and equipmentnew text begin covered under medical assistancenew text end ;

(9) environmental modifications, except as specified in subdivision 7;

(10) expenses for travel, lodging, or meals related to training the participantdeleted text begin ,deleted text end new text begin ornew text end the
participant's representativedeleted text begin ,deleted text end new text begin or new text end legal representativedeleted text begin , or paid or unpaid caregivers that
exceed $500 in a 12-month period
deleted text end ;

(11) experimental treatments;

(12) any service or good covered by other medical assistance state plan services,
including prescription and over-the-counter medications, compounds, and solutions and
related fees, including premiums and co-payments;

(13) membership dues or costs, except when the service is necessary and appropriate
to treat a deleted text begin physicaldeleted text end new text begin healthnew text end condition or to improve or maintain the participant's deleted text begin physical
deleted text end new text begin healthnew text end condition. The condition must be identified in the participant's CFSS plan and
monitored by a deleted text begin physician enrolled in adeleted text end Minnesota health care programnew text begin enrolled physiciannew text end ;

(14) vacation expenses other than the cost of direct services;

(15) vehicle maintenance or modifications not related to the disability, health
condition, or physical need; deleted text begin and
deleted text end

(16) tickets and related costs to attend sporting or other recreational or entertainment
eventsdeleted text begin .deleted text end new text begin ;
new text end

new text begin (17) services provided and billed by a provider who is not an enrolled CFSS provider;
new text end

new text begin (18) CFSS provided by a participant's representative or paid legal guardian;
new text end

new text begin (19) services that are used solely as a child care or babysitting service;
new text end

new text begin (20) services that are the responsibility or in the daily rate of a residential or program
license holder under the terms of a service agreement and administrative rules;
new text end

new text begin (21) sterile procedures;
new text end

new text begin (22) giving of injections into veins, muscles, or skin;
new text end

new text begin (23) homemaker services that are not an integral part of the assessed CFSS service;
new text end

new text begin (24) home maintenance or chore services;
new text end

new text begin (25) home care services, including hospice services if elected by the participant,
covered by Medicare or any other insurance held by the participant;
new text end

new text begin (26) services to other members of the participant's household;
new text end

new text begin (27) services not specified as covered under medical assistance as CFSS;
new text end

new text begin (28) application of restraints or implementation of deprivation procedures;
new text end

new text begin (29) assessments by CFSS provider organizations or by independently enrolled
registered nurses;
new text end

new text begin (30) services provided in lieu of legally required staffing in a residential or child
care setting; and
new text end

new text begin (31) services provided by the residential or program license holder in a residence for
more than four persons.
new text end

Sec. 11.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 10,
is amended to read:


Subd. 10.

deleted text begin Providerdeleted text end new text begin Agency-provider and FMS contractornew text end qualifications deleted text begin anddeleted text end new text begin ,
new text end general requirementsnew text begin , and dutiesnew text end .

new text begin (a) new text end Agency-providers delivering services under the
agency-provider model under subdivision 11 or deleted text begin financial management service (FMS)
deleted text end new text begin FMSnew text end contractors under subdivision 13 shall:

(1) enroll as a medical assistance Minnesota health care programs provider and meet
all applicable provider standardsnew text begin and requirementsnew text end ;

deleted text begin (2) comply with medical assistance provider enrollment requirements;
deleted text end

deleted text begin (3)deleted text end new text begin (2)new text end demonstrate compliance with deleted text begin lawdeleted text end new text begin federal and state lawsnew text end and policies deleted text begin ofdeleted text end new text begin for
new text end CFSS as determined by the commissioner;

deleted text begin (4)deleted text end new text begin (3)new text end comply with background study requirements under chapter 245Cnew text begin and
maintain documentation of background study requests and results
new text end ;

deleted text begin (5)deleted text end new text begin (4)new text end verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers deleted text begin and support specialistsdeleted text end ;

deleted text begin (6)deleted text end new text begin (5)new text end not engage in any agency-initiated direct contact or marketing in person, by
telephone, or other electronic means to potential participants, guardians, family members,
or participants' representatives;

new text begin (6) directly provide services and not use a subcontractor or reporting agent;
new text end

new text begin (7) meet the financial requirements established by the commissioner for financial
solvency;
new text end

new text begin (8) have never had a lead agency contract or provider agreement discontinued due to
fraud, or have never had an owner, board member, or manager fail a state or FBI-based
criminal background check while enrolled or seeking enrollment as a Minnesota health
care programs provider;
new text end

new text begin (9) have established business practices that include written policies and procedures,
internal controls, and a system that demonstrates the organization's ability to deliver
quality CFSS; and
new text end

new text begin (10) have an office located in Minnesota.
new text end

new text begin (b) In conducting general duties, agency-providers and FMS contractors shall:
new text end

deleted text begin (7)deleted text end new text begin (1)new text end pay support workers deleted text begin and support specialistsdeleted text end based upon actual hours of
services provided;

new text begin (2) pay for worker training and development services based upon actual hours of
services provided or the unit cost of the training session purchased;
new text end

deleted text begin (8)deleted text end new text begin (3)new text end withhold and pay all applicable federal and state payroll taxes;

deleted text begin (9)deleted text end new text begin (4)new text end make arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

deleted text begin (10)deleted text end new text begin (5)new text end enter into a written agreement with the participant, participant's
representative, or legal representative that assigns roles and responsibilities to be
performed before services, supports, or goods are provided using a format established by
the commissioner;

deleted text begin (11)deleted text end new text begin (6)new text end report maltreatment as required under sections 626.556 and 626.557; deleted text begin and
deleted text end

deleted text begin (12)deleted text end new text begin (7)new text end provide the participant with a copy of the service-related rights under
subdivision 20 at the start of services and supportsdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (8) comply with any data requests from the department consistent with the
Minnesota Government Data Practices Act under chapter 13.
new text end

Sec. 12.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 11,
is amended to read:


Subd. 11.

Agency-provider model.

(a) The agency-provider model deleted text begin is limited to
the
deleted text end new text begin includesnew text end services provided by support workers and deleted text begin support specialistsdeleted text end new text begin staff providing
worker training and development services
new text end who are employed by an agency-provider
that is licensed according to chapter 245A or meets other criteria established by the
commissioner, including required training.

(b) The agency-provider shall allow the participant to have a significant role in the
selection and dismissal of the support workers for the delivery of the services and supports
specified in the participant's service delivery plan.

(c) A participant may use authorized units of CFSS services as needed within a
service authorization that is not greater than 12 months. Using authorized units in a
flexible manner in either the agency-provider model or the budget model does not increase
the total amount of services and supports authorized for a participant or included in the
participant's service delivery plan.

(d) A participant may share CFSS services. Two or three CFSS participants may
share services at the same time provided by the same support worker.

(e) The agency-provider must use a minimum of 72.5 percent of the revenue
generated by the medical assistance payment for CFSS for support worker wages and
benefits. The agency-provider must document how this requirement is being met. The
revenue generated by the deleted text begin support specialistdeleted text end new text begin worker training and development services
new text end and the reasonable costs associated with the deleted text begin support specialistdeleted text end new text begin worker training and
development services
new text end must not be used in making this calculation.

(f) The agency-provider model must be used by individuals who have been restricted
by the Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160
to 9505.2245.

new text begin (g) Participants purchasing goods under this model, along with support worker
services, must:
new text end

new text begin (1) specify the goods in the service delivery plan and detailed budget for
expenditures that must be approved by the consultation services provider or the case
manager/care coordinator; and
new text end

new text begin (2) use the FMS contractor for the billing and payment of such goods.
new text end

Sec. 13.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 12,
is amended to read:


Subd. 12.

Requirements for enrollment of CFSS deleted text begin providerdeleted text end new text begin agency-provider
new text end agencies.

(a) All CFSS deleted text begin provider agenciesdeleted text end new text begin agency-providersnew text end must provide, at the time of
enrollment, reenrollment, and revalidation as a CFSS deleted text begin provider agencydeleted text end new text begin agency-providernew text end in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:

(1) the CFSS deleted text begin provider agency'sdeleted text end new text begin agency-provider'snew text end current contact information
including address, telephone number, and e-mail address;

(2) proof of surety bond coverage. Upon new enrollment, or if the deleted text begin provider agency's
deleted text end new text begin agency-provider'snew text end Medicaid revenue in the previous calendar year is less than or equal
to $300,000, the deleted text begin provider agencydeleted text end new text begin agency-providernew text end must purchase a performance bond of
$50,000. If the deleted text begin provider agency'sdeleted text end new text begin agency-provider'snew text end Medicaid revenue in the previous
calendar year is greater than $300,000, the deleted text begin provider agencydeleted text end new text begin agency-providernew text end must
purchase a performance bond of $100,000. The performance bond must be in a form
approved by the commissioner, must be renewed annually, and must allow for recovery of
costs and fees in pursuing a claim on the bond;

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

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

(6) a description of the CFSS deleted text begin provider agency'sdeleted text end new text begin agency-provider'snew text end organization
identifying the names of all owners, managing employees, staff, board of directors, and
the affiliations of the directorsdeleted text begin ,deleted text end new text begin andnew text end ownersdeleted text begin , or staffdeleted text end to other service providers;

(7) a copy of the CFSS deleted text begin provider agency'sdeleted text end new text begin agency-provider'snew text end written policies and
procedures including: hiring of employees; training requirements; service delivery;
and employee and consumer safety including process for notification and resolution
of consumer grievances, identification and prevention of communicable diseases, and
employee misconduct;

(8) copies of all other forms the CFSS deleted text begin provider agencydeleted text end new text begin agency-providernew text end uses in the
course of daily business including, but not limited to:

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

(ii) deleted text begin thedeleted text end new text begin a copy of the participant's individualnew text end CFSS deleted text begin provider agency's template for the
CFSS care
deleted text end new text begin service deliverynew text end plan;

(9) a list of all training and classes that the CFSS deleted text begin provider agencydeleted text end new text begin agency-provider
new text end requires of its staff providing CFSS services;

(10) documentation that the CFSS deleted text begin provider agencydeleted text end new text begin agency-providernew text end and staff have
successfully completed all the training required by this section;

(11) documentation of the deleted text begin agency'sdeleted text end new text begin agency-provider'snew text end marketing practices;

(12) disclosure of ownership, leasing, or management of all residential properties
that are used or could be used for providing home care services;

(13) documentation that the deleted text begin agencydeleted text end new text begin agency-providernew text end will use at least the following
percentages of revenue generated from the medical assistance rate paid for CFSS services
for deleted text begin employee personal care assistantdeleted text end new text begin CFSS support workernew text end wages and benefits: 72.5
percent of revenue from CFSS providers. The revenue generated by the deleted text begin support specialist
deleted text end new text begin worker training and development servicesnew text end and the reasonable costs associated with the
deleted text begin support specialistdeleted text end new text begin worker training and development servicesnew text end shall not be used in making
this calculation; and

(14) documentation that the deleted text begin agencydeleted text end new text begin agency-providernew text end does not burden deleted text begin recipients'
deleted text end new text begin participants'new text end free exercise of their right to choose service providers by requiring deleted text begin personal
care assistants
deleted text end new text begin CFSS support workersnew text end to sign an agreement not to work with any particular
CFSS deleted text begin recipientdeleted text end new text begin participantnew text end or for another CFSS deleted text begin provider agencydeleted text end new text begin agency-providernew text end after
leaving the agency and that the agency is not taking action on any such agreements or
requirements regardless of the date signed.

(b) CFSS deleted text begin provider agenciesdeleted text end new text begin agency-providersnew text end shall provide to the commissioner
the information specified in paragraph (a).

(c) All CFSS deleted text begin provider agenciesdeleted text end new text begin agency-providersnew text end shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner. Employees in management and supervisory positions
and owners who are active in the day-to-day operations of an agency who have completed
the required training as an employee with a CFSS deleted text begin provider agencydeleted text end new text begin agency-providernew text end do
not need to repeat the required training if they are hired by another agency, if they have
completed the training within the past three years. CFSS deleted text begin provider agencydeleted text end new text begin agency-provider
new text end billing staff shall complete training about CFSS program financial management. Any new
owners or employees in management and supervisory positions involved in the day-to-day
operations are required to complete mandatory training as a requisite of working for the
agency. deleted text begin CFSS provider agencies certified for participation in Medicare as home health
agencies are exempt from the training required in this subdivision.
deleted text end

new text begin (d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:
new text end

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

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

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

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

Sec. 14.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 13,
is amended to read:


Subd. 13.

Budget model.

(a) Under the budget model participants deleted text begin candeleted text end new text begin maynew text end exercise
deleted text begin moredeleted text end responsibility and control over the services and supports described and budgeted
within the CFSS service delivery plan. new text begin Participants must use services provided by an FMS
contractor as defined in subdivision 2, paragraph (m).
new text end Under this model, participants may
use their new text begin approved service new text end budget allocation to:

(1) directly employ support workersnew text begin , and pay wages, federal and state payroll taxes,
and premiums for workers' compensation, liability, and health insurance coverage
new text end ;new text begin and
new text end

(2) obtain supports and goods as defined in subdivision 7deleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (3) choose a range of support assistance services from the financial management
services (FMS) contractor related to:
deleted text end

deleted text begin (i) assistance in managing the budget to meet the service delivery plan needs,
consistent with federal and state laws and regulations;
deleted text end

deleted text begin (ii) the employment, training, supervision, and evaluation of workers by the
participant;
deleted text end

deleted text begin (iii) acquisition and payment for supports and goods; and
deleted text end

deleted text begin (iv) evaluation of individual service outcomes as needed for the scope of the
participant's degree of control and responsibility.
deleted text end

(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
may authorize a legal representative or participant's representative to do so on their behalf.

new text begin (c) The commissioner shall disenroll or exclude participants from the budget model
and transfer them to the agency-provider model under the following circumstances that
include but are not limited to:
new text end

new text begin (1) when a participant has been restricted by the Minnesota restricted recipient
program, in which case the participant may be excluded for a specified time period under
Minnesota Rules, parts 9505.2160 to 9505.2245;
new text end

new text begin (2) when a participant exits the budget model during the participant's service plan
year. Upon transfer, the participant shall not access the budget model for the remainder of
that service plan year; or
new text end

new text begin (3) when the department determines that the participant or participant's representative
or legal representative cannot manage participant responsibilities under the budget model.
The commissioner must develop policies for determining if a participant is unable to
manage responsibilities under the budget model.
new text end

new text begin (d) A participant may appeal in writing to the department under section 256.045,
subdivision 3, to contest the department's decision under paragraph (c), clause (3), to
disenroll or exclude the participant from the budget model.
new text end

deleted text begin (c)deleted text end new text begin (e)new text end The FMS contractor shall not provide CFSS services and supports under the
agency-provider service model.

new text begin (f) new text end The FMS contractor shall provide service functions as determined by the
commissioner new text begin for budget model participants new text end that include but are not limited to:

deleted text begin (1) information and consultation about CFSS;
deleted text end

deleted text begin (2)deleted text end new text begin (1)new text end assistance with the development of the new text begin detailed budget for expenditures
portion of the
new text end service delivery plan deleted text begin and budget modeldeleted text end as requested by the new text begin consultation
services provider or
new text end participant;

deleted text begin (3)deleted text end new text begin (2)new text end billing and making payments for budget model expenditures;

deleted text begin (4)deleted text end new text begin (3)new text end assisting participants in fulfilling employer-related requirements according to
deleted text begin Internal Revenue Service Revenue Procedure 70-6, section 3504, Agency Employer Tax
Liability, regulation 137036-08
deleted text end new text begin section 3504 of the Internal Revenue Code and related
regulations and interpretations, including Code of Federal Regulations, title 26, section
31.3504-1
new text end , which includes assistance with filing and paying payroll taxes, and obtaining
worker compensation coverage;

deleted text begin (5)deleted text end new text begin (4)new text end data recording and reporting of participant spending; deleted text begin and
deleted text end

deleted text begin (6)deleted text end new text begin (5)new text end other duties established in the contract with the department, including with
respect to providing assistance to the participant, participant's representative, or legal
representative in performing their employer responsibilities regarding support workers.
The support worker shall not be considered the employee of the deleted text begin financial management
services
deleted text end new text begin FMSnew text end contractordeleted text begin .deleted text end new text begin ; and
new text end

new text begin (6) billing, payment, and accounting of approved expenditures for goods for
agency-provider participants.
new text end

deleted text begin (d) A participant who requests to purchase goods and supports along with support
worker services under the agency-provider model must use the budget model with
a service delivery plan that specifies the amount of services to be authorized to the
agency-provider and the expenditures to be paid by the FMS contractor.
deleted text end

deleted text begin (e)deleted text end new text begin (g)new text end The FMS contractor shall:

(1) not limit or restrict the participant's choice of service or support providers or
service delivery models consistent with any applicable state and federal requirements;

(2) provide the participantnew text begin , consultation services provider,new text end and the deleted text begin targeteddeleted text end case
manager, if applicable, with a monthly written summary of the spending for services and
supports that were billed against the spending budget;

(3) be knowledgeable of state and federal employment regulations, including those
under the Fair Labor Standards Act of 1938, and comply with the requirements under deleted text begin the
Internal Revenue Service Revenue Procedure 70-6, Section 3504,
deleted text end new text begin section 3504 of the
Internal Revenue Code and related regulations and interpretations, including Code of
Federal Regulations, title 26, section 31.3504-1, regarding
new text end agency employer tax liability
for vendor or fiscal employer agent, and any requirements necessary to process employer
and employee deductions, provide appropriate and timely submission of employer tax
liabilities, and maintain documentation to support medical assistance claims;

(4) have current and adequate liability insurance and bonding and sufficient cash
flow as determined by the commissioner and have on staff or under contract a certified
public accountant or an individual with a baccalaureate degree in accounting;

(5) assume fiscal accountability for state funds designated for the programnew text begin and be
held liable for any overpayments or violations of applicable statutes or rules, including
but not limited to the Minnesota False Claims Act
new text end ; and

(6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support
workers. The documentation and time records must be maintained for a minimum of
five years from the claim date and be available for audit or review upon request by the
commissioner. Claims submitted by the FMS contractor to the commissioner for payment
must correspond with services, amounts, and time periods as authorized in the participant's
deleted text begin spendingdeleted text end new text begin servicenew text end budget and service plannew text begin and must contain specific identifying information
as determined by the commissioner
new text end .

deleted text begin (f)deleted text end new text begin (h)new text end The commissioner of human services shall:

(1) establish rates and payment methodology for the FMS contractor;

(2) identify a process to ensure quality and performance standards for the FMS
contractor and ensure statewide access to FMS contractors; and

(3) establish a uniform protocol for delivering and administering CFSS services
to be used by eligible FMS contractors.

deleted text begin (g) The commissioner of human services shall disenroll or exclude participants from
the budget model and transfer them to the agency-provider model under the following
circumstances that include but are not limited to:
deleted text end

deleted text begin (1) when a participant has been restricted by the Minnesota restricted recipient
program, the participant may be excluded for a specified time period under Minnesota
Rules, parts 9505.2160 to 9505.2245;
deleted text end

deleted text begin (2) when a participant exits the budget model during the participant's service plan
year. Upon transfer, the participant shall not access the budget model for the remainder of
that service plan year; or
deleted text end

deleted text begin (3) when the department determines that the participant or participant's representative
or legal representative cannot manage participant responsibilities under the budget model.
The commissioner must develop policies for determining if a participant is unable to
manage responsibilities under a budget model.
deleted text end

deleted text begin (h) A participant may appeal under section 256.045, subdivision 3, in writing to the
department to contest the department's decision under paragraph (c), clause (3), to remove
or exclude the participant from the budget model.
deleted text end

Sec. 15.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 15,
is amended to read:


Subd. 15.

Documentation of support services provided.

(a) Support services
provided to a participant by a support worker employed by either an agency-provider
or the participant acting as the employer must be documented daily by each support
worker, on a time sheet form approved by the commissioner. All documentation may be
Web-based, electronic, or paper documentation. The completed form must be submitted
on a deleted text begin monthlydeleted text end new text begin regularnew text end basis to the provider or the participant and the FMS contractor
selected by the participant to provide assistance with meeting the participant's employer
obligations and kept in the deleted text begin recipient's healthdeleted text end new text begin participant'snew text end record.

(b) The activity documentation must correspond to the written service delivery plan
and be reviewed by the agency-provider or the participant and the FMS contractor when
the participant is deleted text begin acting asdeleted text end the employer of the support worker.

(c) The time sheet must be on a form approved by the commissioner documenting
time the support worker provides services deleted text begin in the homedeleted text end new text begin to the participantnew text end . The following
criteria must be included in the time sheet:

(1) full name of the support worker and individual provider number;

(2) deleted text begin providerdeleted text end new text begin agency-providernew text end name and telephone numbers, if deleted text begin an agency-provider is
deleted text end responsible for delivery services under the written service plan;

(3) full name of the participant;

(4) consecutive dates, including month, day, and year, and arrival and departure
times with a.m. or p.m. notations;

(5) signatures of the participant or the participant's representative;

(6) personal signature of the support worker;

(7) any shared care provided, if applicable;

(8) a statement that it is a federal crime to provide false information on CFSS
billings for medical assistance payments; and

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

Sec. 16.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 16,
is amended to read:


Subd. 16.

Support workers requirements.

(a) Support workers shall:

(1) enroll with the department as a support worker after a background study under
chapter 245C has been completed and the support worker has received a notice from the
commissioner that:

(i) the support worker is not disqualified under section 245C.14; or

(ii) is disqualified, but the support worker has received a set-aside of the
disqualification under section 245C.22;

(2) have the ability to effectively communicate with the participant or the
participant's representative;

(3) have the skills and ability to provide the services and supports according to
the deleted text begin person'sdeleted text end new text begin participant'snew text end CFSS service delivery plan and respond appropriately to the
participant's needs;

(4) not be a participant of CFSS, unless the support services provided by the support
worker differ from those provided to the support worker;

(5) complete the basic standardized training as determined by the commissioner
before completing enrollment. The training must be available in languages other than
English and to those who need accommodations due to disabilities. Support worker
training must include successful completion of the following training components: basic
first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
and responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance
to participants;

(6) complete training and orientation on the participant's individual needs; and

(7) maintain the privacy and confidentiality of the participant, and not independently
determine the medication dose or time for medications for the participant.

(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:

(1) lacks the skills, knowledge, or ability to adequately or safely perform the
required work;

(2) fails to provide the authorized services required by the participant employer;

(3) has been intoxicated by alcohol or drugs while providing authorized services to
the participant or while in the participant's home;

(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or

(5) has been excluded as a provider by the commissioner of human services, or the
United States Department of Health and Human Services, Office of Inspector General,
from participation in Medicaid, Medicare, or any other federal health care program.

(c) A support worker may appeal in writing to the commissioner to contest the
decision to terminate the support worker's provider enrollment and provider number.

new text begin (d) A support worker must not provide or be paid for more than 275 hours of
CFSS per month, regardless of the number of participants the support worker serves or
the number of agency-providers or participant employers by which the support worker
is employed. The department shall not disallow the number of hours per day a support
worker works unless it violates other law.
new text end

Sec. 17.

Minnesota Statutes 2013 Supplement, section 256B.85, is amended by adding
a subdivision to read:


new text begin Subd. 16a. new text end

new text begin Exception to support worker requirements for continuity of services.
new text end

new text begin The support worker for a participant may be allowed to enroll with a different CFSS
agency-provider or FMS contractor upon initiation, rather than completion, of a new
background study according to chapter 245C, if the following conditions are met:
new text end

new text begin (1) the commissioner determines that the support worker's change in enrollment or
affiliation is needed to ensure continuity of services and protect the health and safety
of the participant;
new text end

new text begin (2) the chosen agency-provider or FMS contractor has been continuously enrolled as
a CFSS agency-provider or FMS contractor for at least two years or since the inception of
the CFSS program, whichever is shorter;
new text end

new text begin (3) the participant served by the support worker chooses to transfer to the CFSS
agency-provider or the FMS contractor to which the support worker is transferring;
new text end

new text begin (4) the support worker has been continuously enrolled with the former CFSS
agency-provider or FMS contractor since the support worker's last background study
was completed; and
new text end

new text begin (5) the support worker continues to meet requirements of subdivision 16, excluding
paragraph (a), clause (1).
new text end

Sec. 18.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 17,
is amended to read:


Subd. 17.

deleted text begin Support specialist requirements and paymentsdeleted text end new text begin Consultation services
description and duties
new text end .

deleted text begin The commissioner shall develop qualifications, scope of
functions, and payment rates and service limits for a support specialist that may provide
additional or specialized assistance necessary to plan, implement, arrange, augment, or
evaluate services and supports.
deleted text end

new text begin (a) Consultation services means providing assistance to the participant in making
informed choices regarding CFSS services in general and self-directed tasks in particular
and in developing a person-centered service delivery plan to achieve quality service
outcomes.
new text end

new text begin (b) Consultation services is a required service that may include but is not limited to:
new text end

new text begin (1) an initial and annual orientation to CFSS information and policies, including
selecting a service model;
new text end

new text begin (2) assistance with the development, implementation, management, and evaluation
of the person-centered service delivery plan;
new text end

new text begin (3) consultation on recruiting, selecting, training, managing, directing, evaluating,
and supervising support workers;
new text end

new text begin (4) reviewing the use of and access to informal and community supports, goods, or
resources;
new text end

new text begin (5) assistance with fulfilling responsibilities and requirements of CFSS including
modifying service delivery plans and changing service models; and
new text end

new text begin (6) assistance with accessing FMS contractors or agency-providers.
new text end

new text begin (c) Duties of a consultation services provider shall include but are not limited to:
new text end

new text begin (1) review and finalization of the CFSS service delivery plan by the consultation
services provider organization;
new text end

new text begin (2) distribution of copies of the final service delivery plan to the participant and
to the agency-provider or FMS contractor, case manager/care coordinator, and other
designated parties;
new text end

new text begin (3) an evaluation of services upon receiving information from an FMS contractor
indicating spending or participant employer concerns;
new text end

new text begin (4) a semiannual review of services if the participant does not have a case
manager/care coordinator and when the support worker is a paid parent of a minor
participant or the participant's spouse;
new text end

new text begin (5) collection and reporting of data as required by the department; and
new text end

new text begin (6) providing the participant with a copy of the service-related rights under
subdivision 20 at the start of consultation services.
new text end

Sec. 19.

Minnesota Statutes 2013 Supplement, section 256B.85, is amended by adding
a subdivision to read:


new text begin Subd. 17a. new text end

new text begin Consultation service provider qualifications and requirements.
new text end

new text begin The commissioner shall develop the qualifications and requirements for providers of
consultation services under subdivision 17. These providers must satisfy at least the
following qualifications and requirements:
new text end

new text begin (1) are under contract with the department;
new text end

new text begin (2) are not the FMS contractor as defined in subdivision 2, paragraph (m), the CFSS
or HCBS waiver agency-provider or vendor to the participant, or a lead agency;
new text end

new text begin (3) meet the service standards as established by the commissioner;
new text end

new text begin (4) employ lead professional staff with a minimum of three years of experience
in providing support planning, support broker, or consultation services and consumer
education to participants using a self-directed program using FMS under medical
assistance;
new text end

new text begin (5) are knowledgeable about CFSS roles and responsibilities including those of the
certified assessor, FMS contractor, agency-provider, and case manager/care coordinator;
new text end

new text begin (6) comply with medical assistance provider requirements;
new text end

new text begin (7) understand the CFSS program and its policies;
new text end

new text begin (8) are knowledgeable about self-directed principles and the application of the
person-centered planning process;
new text end

new text begin (9) have general knowledge of the FMS contractor duties and participant
employment model, including all applicable federal, state, and local laws and regulations
regarding tax, labor, employment, and liability and workers' compensation coverage for
household workers; and
new text end

new text begin (10) have all employees, including lead professional staff, staff in management
and supervisory positions, and owners of the agency who are active in the day-to-day
management and operations of the agency, complete training as specified in the contract
with the department.
new text end

Sec. 20.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 18,
is amended to read:


Subd. 18.

Service unit and budget allocation requirements and limits.

(a) For the
agency-provider model, services will be authorized in units of service. The total service
unit amount must be established based upon the assessed need for CFSS services, and must
not exceed the maximum number of units available as determined under subdivision 8.

(b) For the budget model, the new text begin service new text end budget allocation allowed for services and
supports is deleted text begin established by multiplying the number of units authorized under subdivision 8
by the payment rate established by the commissioner
deleted text end new text begin defined in subdivision 8, paragraph
(g)
new text end .

Sec. 21.

Minnesota Statutes 2013 Supplement, section 256B.85, is amended by adding
a subdivision to read:


new text begin Subd. 18a. new text end

new text begin Worker training and development services. new text end

new text begin (a) The commissioner
shall develop the scope of tasks and functions, service standards, and service limits for
worker training and development services.
new text end

new text begin (b) Worker training and development services are in addition to the participant's
assessed service units or service budget. Services provided according to this subdivision
must:
new text end

new text begin (1) help support workers obtain and expand the skills and knowledge necessary to
ensure competency in providing quality services as needed and defined in the participant's
service delivery plan;
new text end

new text begin (2) be provided or arranged for by the agency-provider under subdivision 11 or
purchased by the participant employer under the budget model under subdivision 13; and
new text end

new text begin (3) be described in the participant's CFSS service delivery plan and documented in
the participant's file.
new text end

new text begin (c) Services covered under worker training and development shall include:
new text end

new text begin (1) support worker training on the participant's individual assessed needs, condition,
or both, provided individually or in a group setting by a skilled and knowledgeable trainer
beyond any training the participant or participant's representative provides;
new text end

new text begin (2) tuition for professional classes and workshops for the participant's support
workers that relate to the participant's assessed needs, condition, or both;
new text end

new text begin (3) direct observation, monitoring, coaching, and documentation of support worker
job skills and tasks, beyond any training the participant or participant's representative
provides, including supervision of health-related tasks or behavioral supports that is
conducted by an appropriate professional based on the participant's assessed needs. These
services must be provided within 14 days of the start of services or the start of a new
support worker and must be specified in the participant's service delivery plan; and
new text end

new text begin (4) reporting service and support concerns to the appropriate provider.
new text end

new text begin (d) Worker training and development services shall not include:
new text end

new text begin (1) general agency training, worker orientation, or training on CFSS self-directed
models;
new text end

new text begin (2) payment for preparation or development time for the trainer or presenter;
new text end

new text begin (3) payment of the support worker's salary or compensation during the training;
new text end

new text begin (4) training or supervision provided by the participant, the participant's support
worker, or the participant's informal supports, including the participant's representative; or
new text end

new text begin (5) services in excess of 96 units per annual service authorization, unless approved
by the department.
new text end

Sec. 22.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 23,
is amended to read:


Subd. 23.

Commissioner's access.

When the commissioner is investigating a
possible overpayment of Medicaid funds, the commissioner must be given immediate
access without prior notice to the deleted text begin agency providerdeleted text end new text begin agency-providernew text end or FMS contractor's
office during regular business hours and to documentation and records related to services
provided and submission of claims for services provided. Denying the commissioner
access to records is cause for immediate suspension of payment and terminating the agency
provider's enrollment according to section 256B.064 or terminating the FMS contract.

Sec. 23.

Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 24,
is amended to read:


Subd. 24.

CFSS agency-providers; background studies.

CFSS agency-providers
enrolled to provide deleted text begin personal care assistancedeleted text end new text begin CFSSnew text end services under the medical assistance
program shall comply with the following:

(1) owners who have a five percent interest or more and all managing employees
are subject to a background study as provided in chapter 245C. This applies to currently
enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
agency-provider. "Managing employee" has the same meaning as Code of Federal
Regulations, title 42, section 455. An organization is barred from enrollment if:

(i) the organization has not initiated background studies on owners managing
employees; or

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

(2) a background study must be initiated and completed for all deleted text begin support specialists
deleted text end new text begin staff who will have direct contact with the participant to provide worker training and
development
new text end ; and

(3) a background study must be initiated and completed for all support workers.

Sec. 24.

Laws 2013, chapter 108, article 7, section 49, the effective date, is amended to
read:


EFFECTIVE DATE.

This section is effective upon federal approval but no earlier
than April 1, 2014. The service will begin 90 days after federal approval deleted text begin or April 1,
2014, whichever is later
deleted text end . The commissioner of human services shall notify the revisor of
statutes when this occurs.

ARTICLE 5

CONTINUING CARE

Section 1.

Minnesota Statutes 2012, section 13.46, subdivision 4, is amended to read:


Subd. 4.

Licensing data.

(a) As used in this subdivision:

(1) "licensing data" are all data collected, maintained, used, or disseminated by the
welfare system pertaining to persons licensed or registered or who apply for licensure
or registration or who formerly were licensed or registered under the authority of the
commissioner of human services;

(2) "client" means a person who is receiving services from a licensee or from an
applicant for licensure; and

(3) "personal and personal financial data" are Social Security numbers, identity
of and letters of reference, insurance information, reports from the Bureau of Criminal
Apprehension, health examination reports, and social/home studies.

(b)(1)(i) Except as provided in paragraph (c), the following data on applicants,
license holders, and former licensees are public: name, address, telephone number of
licensees, date of receipt of a completed application, dates of licensure, licensed capacity,
type of client preferred, variances granted, record of training and education in child care
and child development, type of dwelling, name and relationship of other family members,
previous license history, class of license, the existence and status of complaints, and the
number of serious injuries to or deaths of individuals in the licensed program as reported
to the commissioner of human services, the local social services agency, or any other
county welfare agency. For purposes of this clause, a serious injury is one that is treated
by a physician.

(ii) When a correction order, an order to forfeit a fine, an order of license suspension,
an order of temporary immediate suspension, an order of license revocation, an order
of license denial, or an order of conditional license has been issued, or a complaint is
resolved, the following data on current and former licensees and applicants are public: the
substance and investigative findings of the licensing or maltreatment complaint, licensing
violation, or substantiated maltreatment; the record of informal resolution of a licensing
violation; orders of hearing; findings of fact; conclusions of law; specifications of the final
correction order, fine, suspension, temporary immediate suspension, revocation, denial, or
conditional license contained in the record of licensing action; whether a fine has been
paid; and the status of any appeal of these actions.

(iii) When a license denial under section 245A.05 or a sanction under section
245A.07 is based on a determination that the license holder or applicant is responsible for
maltreatment under section 626.556 or 626.557, the identity of the applicant or license
holder as the individual responsible for maltreatment is public data at the time of the
issuance of the license denial or sanction.

(iv) When a license denial under section 245A.05 or a sanction under section
245A.07 is based on a determination that the license holder or applicant is disqualified
under chapter 245C, the identity of the license holder or applicant as the disqualified
individual and the reason for the disqualification are public data at the time of the
issuance of the licensing sanction or denial. If the applicant or license holder requests
reconsideration of the disqualification and the disqualification is affirmed, the reason for
the disqualification and the reason to not set aside the disqualification are public data.

(2) Notwithstanding sections 626.556, subdivision 11, and 626.557, subdivision 12b,
when any person subject to disqualification under section 245C.14 in connection with a
license to provide family day care for children, child care center services, foster care for
children in the provider's home, or foster care or day care services for adults in the provider's
home is a substantiated perpetrator of maltreatment, and the substantiated maltreatment is
a reason for a licensing action, the identity of the substantiated perpetrator of maltreatment
is public data. For purposes of this clause, a person is a substantiated perpetrator if the
maltreatment determination has been upheld under section 256.045; 626.556, subdivision
10i
; 626.557, subdivision 9d; or chapter 14, or if an individual or facility has not timely
exercised appeal rights under these sections, except as provided under clause (1).

(3) For applicants who withdraw their application prior to licensure or denial of a
license, the following data are public: the name of the applicant, the city and county in
which the applicant was seeking licensure, the dates of the commissioner's receipt of the
initial application and completed application, the type of license sought, and the date
of withdrawal of the application.

(4) For applicants who are denied a license, the following data are public: the name
and address of the applicant, the city and county in which the applicant was seeking
licensure, the dates of the commissioner's receipt of the initial application and completed
application, the type of license sought, the date of denial of the application, the nature of
the basis for the denial, the record of informal resolution of a denial, orders of hearings,
findings of fact, conclusions of law, specifications of the final order of denial, and the
status of any appeal of the denial.

(5) The following data on persons subject to disqualification under section 245C.14 in
connection with a license to provide family day care for children, child care center services,
foster care for children in the provider's home, or foster care or day care services for adults
in the provider's home, are public: the nature of any disqualification set aside under section
245C.22, subdivisions 2 and 4, and the reasons for setting aside the disqualification; the
nature of any disqualification for which a variance was granted under sections 245A.04,
subdivision 9
; and 245C.30, and the reasons for granting any variance under section
245A.04, subdivision 9; and, if applicable, the disclosure that any person subject to
a background study under section 245C.03, subdivision 1, has successfully passed a
background study. If a licensing sanction under section 245A.07, or a license denial under
section 245A.05, is based on a determination that an individual subject to disqualification
under chapter 245C is disqualified, the disqualification as a basis for the licensing sanction
or denial is public data. As specified in clause (1), item (iv), if the disqualified individual
is the license holder or applicant, the identity of the license holder or applicant and the
reason for the disqualification are public data; and, if the license holder or applicant
requested reconsideration of the disqualification and the disqualification is affirmed, the
reason for the disqualification and the reason to not set aside the disqualification are
public data. If the disqualified individual is an individual other than the license holder or
applicant, the identity of the disqualified individual shall remain private data.

(6) When maltreatment is substantiated under section 626.556 or 626.557 and the
victim and the substantiated perpetrator are affiliated with a program licensed under
chapter 245A, the commissioner of human services, local social services agency, or
county welfare agency may inform the license holder where the maltreatment occurred of
the identity of the substantiated perpetrator and the victim.

(7) Notwithstanding clause (1), for child foster care, only the name of the license
holder and the status of the license are public if the county attorney has requested that data
otherwise classified as public data under clause (1) be considered private data based on the
best interests of a child in placement in a licensed program.

(c) The following are private data on individuals under section 13.02, subdivision
12
, or nonpublic data under section 13.02, subdivision 9: personal and personal financial
data on family day care program and family foster care program applicants and licensees
and their family members who provide services under the license.

(d) The following are private data on individuals: the identity of persons who have
made reports concerning licensees or applicants that appear in inactive investigative data,
and the records of clients or employees of the licensee or applicant for licensure whose
records are received by the licensing agency for purposes of review or in anticipation of a
contested matter. The names of reporters of complaints or alleged violations of licensing
standards under chapters 245A, 245B, 245C, new text begin and 245D, new text end and applicable rules and alleged
maltreatment under sections 626.556 and 626.557, are confidential data and may be
disclosed only as provided in section 626.556, subdivision 11, or 626.557, subdivision 12b.

(e) Data classified as private, confidential, nonpublic, or protected nonpublic under
this subdivision become public data if submitted to a court or administrative law judge as
part of a disciplinary proceeding in which there is a public hearing concerning a license
which has been suspended, immediately suspended, revoked, or denied.

(f) Data generated in the course of licensing investigations that relate to an alleged
violation of law are investigative data under subdivision 3.

(g) Data that are not public data collected, maintained, used, or disseminated under
this subdivision that relate to or are derived from a report as defined in section 626.556,
subdivision 2
, or 626.5572, subdivision 18, are subject to the destruction provisions of
sections 626.556, subdivision 11c, and 626.557, subdivision 12b.

(h) Upon request, not public data collected, maintained, used, or disseminated under
this subdivision that relate to or are derived from a report of substantiated maltreatment as
defined in section 626.556 or 626.557 may be exchanged with the Department of Health
for purposes of completing background studies pursuant to section 144.057 and with
the Department of Corrections for purposes of completing background studies pursuant
to section 241.021.

(i) Data on individuals collected according to licensing activities under chapters
245A and 245C, data on individuals collected by the commissioner of human services
according to investigations under chapters 245A, 245B, deleted text begin anddeleted text end 245C, new text begin and 245D, new text end and
sections 626.556 and 626.557 may be shared with the Department of Human Rights, the
Department of Health, the Department of Corrections, the ombudsman for mental health
and developmental disabilities, and the individual's professional regulatory board when
there is reason to believe that laws or standards under the jurisdiction of those agencies may
have been violated or the information may otherwise be relevant to the board's regulatory
jurisdiction. Background study data on an individual who is the subject of a background
study under chapter 245C for a licensed service for which the commissioner of human
services is the license holder may be shared with the commissioner and the commissioner's
delegate by the licensing division. Unless otherwise specified in this chapter, the identity
of a reporter of alleged maltreatment or licensing violations may not be disclosed.

(j) In addition to the notice of determinations required under section 626.556,
subdivision 10f
, if the commissioner or the local social services agency has determined
that an individual is a substantiated perpetrator of maltreatment of a child based on sexual
abuse, as defined in section 626.556, subdivision 2, and the commissioner or local social
services agency knows that the individual is a person responsible for a child's care in
another facility, the commissioner or local social services agency shall notify the head
of that facility of this determination. The notification must include an explanation of the
individual's available appeal rights and the status of any appeal. If a notice is given under
this paragraph, the government entity making the notification shall provide a copy of the
notice to the individual who is the subject of the notice.

(k) All not public data collected, maintained, used, or disseminated under this
subdivision and subdivision 3 may be exchanged between the Department of Human
Services, Licensing Division, and the Department of Corrections for purposes of
regulating services for which the Department of Human Services and the Department
of Corrections have regulatory authority.

Sec. 2.

Minnesota Statutes 2012, section 144.0724, as amended by Laws 2014, chapter
147, section 1, is amended to read:


144.0724 RESIDENT REIMBURSEMENT CLASSIFICATION.

Subdivision 1.

Resident reimbursement case mix classifications.

The
commissioner of health shall establish resident reimbursement classifications based upon
the assessments of residents of nursing homes and boarding care homes conducted under
this section and according to section 256B.438.

Subd. 2.

Definitions.

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

(a) "Assessment reference date" or "ARD" means the specific end point for
look-back periods in the MDS assessment process. This look-back period is also called
the observation or assessment period.

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

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

(d) "Minimum data set" or "MDS" means a core set of screening, clinical assessment,
and functional status elements, that include common definitions and coding categories
specified by the Centers for Medicare and Medicaid Services and designated by the
Minnesota Department of Health.

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

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

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

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

(1) nursing facility services under section 256B.434 or 256B.441;

(2) elderly waiver services under section 256B.0915;

(3) CADI and BI waiver services under section 256B.49; and

(4) state payment of alternative care services under section 256B.0913.

Subd. 3a.

Resident reimbursement classifications beginning January 1, 2012.

(a) Beginning January 1, 2012, resident reimbursement classifications shall be based
on the minimum data set, version 3.0 assessment instrument, or its successor version
mandated by the Centers for Medicare and Medicaid Services that nursing facilities are
required to complete for all residents. The commissioner of health shall establish resident
classifications according to the RUG-IV, 48 group, resource utilization groups. Resident
classification must be established based on the individual items on the minimum data set,
which must be completed according to the Long Term Care Facility Resident Assessment
Instrument User's Manual Version 3.0 or its successor issued by the Centers for Medicare
and Medicaid Services.

(b) Each resident must be classified based on the information from the minimum
data set according to general categories as defined in the Case Mix Classification Manual
for Nursing Facilities issued by the Minnesota Department of Health.

Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and
electronically submit to the commissioner of health MDS assessments that conform with
the assessment schedule defined by Code of Federal Regulations, title 42, section 483.20,
and published by the United States Department of Health and Human Services, Centers for
Medicare and Medicaid Services, in the Long Term Care Assessment Instrument User's
Manual, version 3.0, and subsequent updates when issued by the Centers for Medicare
and Medicaid Services. The commissioner of health may substitute successor manuals or
question and answer documents published by the United States Department of Health and
Human Services, Centers for Medicare and Medicaid Services, to replace or supplement
the current version of the manual or document.

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

(1) a new admission assessment;

(2) an annual assessment which must have an assessment reference date (ARD)
within 92 days of the previous assessment and within 366 days of the ARD of the previous
comprehensive assessment;

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

(4) all quarterly assessments must have an assessment reference date (ARD) within
92 days of the ARD of the previous assessment;

(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; and

(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classification.

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

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

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

Subd. 5.

Short stays.

(a) A facility must submit to the commissioner of health an
admission assessment for all residents who stay in the facility 14 days or less.

(b) Notwithstanding the admission assessment requirements of paragraph (a), a
facility may elect to accept a short stay rate with a case mix index of 1.0 for all facility
residents who stay 14 days or less in lieu of submitting an admission assessment. Facilities
shall make this election annually.

(c) Nursing facilities must elect one of the options described in paragraphs (a) and
(b) by reporting to the commissioner of health, as prescribed by the commissioner. The
election is effective on July 1 each year.

Subd. 6.

Penalties for late or nonsubmission.

(a) A facility that fails to complete
or submit an assessment according to subdivisions 4 and 5 for a RUG-IV classification
within seven days of the time requirements listed in the Long-Term Care Facility Resident
Assessment Instrument User's Manual is subject to a reduced rate for that resident. The
reduced rate shall be the lowest rate for that facility. The reduced rate is effective on the
day of admission for new admission assessments, on the ARD for significant change in
status assessments, or on the day that the assessment was due for all other assessments and
continues in effect until the first day of the month following the date of submission and
acceptance of the resident's assessment.

(b) If loss of revenue due to penalties incurred by a facility for any period of 92 days
are equal to or greater than 1.0 percent of the total operating costs on the facility's most
recent annual statistical and cost report, a facility may apply to the commissioner of
human services for a reduction in the total penalty amount. The commissioner of human
services, in consultation with the commissioner of health, may, at the sole discretion of
the commissioner of human services, limit the penalty for residents covered by medical
assistance to 15 days.

Subd. 7.

Notice of resident reimbursement classification.

(a) The commissioner
of health shall provide to a nursing facility a notice for each resident of the reimbursement
classification established under subdivision 1. The notice must inform the resident of the
classification that was assigned, the opportunity to review the documentation supporting
the classification, the opportunity to obtain clarification from the commissioner, and the
opportunity to request a reconsideration of the classification and the address and telephone
number of the Office of Ombudsman for Long-Term Care. The commissioner must
transmit the notice of resident classification by electronic means to the nursing facility.
A nursing facility is responsible for the distribution of the notice to each resident, to the
person responsible for the payment of the resident's nursing home expenses, or to another
person designated by the resident. This notice must be distributed within three working
days after the facility's receipt of the electronic file of notice of case mix classifications
from the commissioner of health.

(b) If a facility submits a modification to the most recent assessment used to establish
a case mix classification conducted under subdivision 3 that results in a change in case
mix classification, the facility shall give written notice to the resident or the resident's
representative about the item that was modified and the reason for the modification. The
notice of modified assessment may be provided at the same time that the resident or
resident's representative is provided the resident's modified notice of classification.

Subd. 8.

Request for reconsideration of resident classifications.

(a) The resident,
or resident's representative, or the nursing facility or boarding care home may request that
the commissioner of health reconsider the assigned reimbursement classification. The
request for reconsideration must be submitted in writing to the commissioner within
30 days of the day the resident or the resident's representative receives the resident
classification notice. The request for reconsideration must include the name of the
resident, the name and address of the facility in which the resident resides, the reasons
for the reconsideration, and documentation supporting the request. The documentation
accompanying the reconsideration request is limited to a copy of the MDS that determined
the classification and other documents that would support or change the MDS findings.

(b) Upon request, the nursing facility must give the resident or the resident's
representative a copy of the assessment form and the other documentation that was given
to the commissioner of health to support the assessment findings. The nursing facility
shall also provide access to and a copy of other information from the resident's record that
has been requested by or on behalf of the resident to support a resident's reconsideration
request. A copy of any requested material must be provided within three working days of
receipt of a written request for the information. Notwithstanding any law to the contrary,
the facility may not charge a fee for providing copies of the requested documentation.
If a facility fails to provide the material within this time, it is subject to the issuance
of a correction order and penalty assessment under sections 144.653 and 144A.10.
Notwithstanding those sections, any correction order issued under this subdivision must
require that the nursing facility immediately comply with the request for information and
that as of the date of the issuance of the correction order, the facility shall forfeit to the
state a $100 fine for the first day of noncompliance, and an increase in the $100 fine by
$50 increments for each day the noncompliance continues.

(c) In addition to the information required under paragraphs (a) and (b), a
reconsideration request from a nursing facility must contain the following information: (i)
the date the reimbursement classification notices were received by the facility; (ii) the date
the classification notices were distributed to the resident or the resident's representative;
and (iii) a copy of a notice sent to the resident or to the resident's representative. This
notice must inform the resident or the resident's representative that a reconsideration
of the resident's classification is being requested, the reason for the request, that the
resident's rate will change if the request is approved by the commissioner, the extent of the
change, that copies of the facility's request and supporting documentation are available
for review, and that the resident also has the right to request a reconsideration. If the
facility fails to provide the required information listed in item (iii) with the reconsideration
request, the commissioner may request that the facility provide the information within 14
calendar days. The reconsideration request must be denied if the information is then not
provided, and the facility may not make further reconsideration requests on that specific
reimbursement classification.

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

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

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

Subd. 9.

Audit authority.

(a) The commissioner shall audit the accuracy of resident
assessments performed under section 256B.438 through any of the following: desk
audits; on-site review of residents and their records; and interviews with staff, residents,
or residents' families. The commissioner shall reclassify a resident if the commissioner
determines that the resident was incorrectly classified.

(b) The commissioner is authorized to conduct on-site audits on an unannounced
basis.

(c) A facility must grant the commissioner access to examine the medical records
relating to the resident assessments selected for audit under this subdivision. The
commissioner may also observe and speak to facility staff and residents.

(d) The commissioner shall consider documentation under the time frames for
coding items on the minimum data set as set out in the Long-Term Care Facility Resident
Assessment Instrument User's Manual published by the Centers for Medicare and
Medicaid Services.

(e) The commissioner shall develop an audit selection procedure that includes the
following factors:

(1) Each facility shall be audited annually. If a facility has two successive audits in
which the percentage of change is five percent or less and the facility has not been the
subject of a special audit in the past 36 months, the facility may be audited biannually.
A stratified sample of 15 percent, with a minimum of ten assessments, of the most
current assessments shall be selected for audit. If more than 20 percent of the RUG-IV
classifications are changed as a result of the audit, the audit shall be expanded to a second
15 percent sample, with a minimum of ten assessments. If the total change between
the first and second samples is 35 percent or greater, the commissioner may expand the
audit to all of the remaining assessments.

(2) If a facility qualifies for an expanded audit, the commissioner may audit the
facility again within six months. If a facility has two expanded audits within a 24-month
period, that facility will be audited at least every six months for the next 18 months.

(3) The commissioner may conduct special audits if the commissioner determines
that circumstances exist that could alter or affect the validity of case mix classifications of
residents. These circumstances include, but are not limited to, the following:

(i) frequent changes in the administration or management of the facility;

(ii) an unusually high percentage of residents in a specific case mix classification;

(iii) a high frequency in the number of reconsideration requests received from
a facility;

(iv) frequent adjustments of case mix classifications as the result of reconsiderations
or audits;

(v) a criminal indictment alleging provider fraud;

(vi) other similar factors that relate to a facility's ability to conduct accurate
assessments;

(vii) an atypical pattern of scoring minimum data set items;

(viii) nonsubmission of assessments;

(ix) late submission of assessments; or

(x) a previous history of audit changes of 35 percent or greater.

(f) Within 15 working days of completing the audit process, the commissioner shall
make available electronically the results of the audit to the facility. If the results of the
audit reflect a change in the resident's case mix classification, a case mix classification
notice will be made available electronically to the facility, using the procedure in
subdivision 7, paragraph (a). The notice must contain the resident's classification and a
statement informing the resident, the resident's authorized representative, and the facility
of their right to review the commissioner's documents supporting the classification and to
request a reconsideration of the classification. This notice must also include the address
and telephone number of the Office of Ombudsman for Long-Term Care.

Subd. 10.

Transition.

After implementation of this section, reconsiderations
requested for classifications made under section 144.0722, subdivision 1, shall be
determined under section 144.0722, subdivision 3.

Subd. 11.

Nursing facility level of care.

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

(1) the person requires formal clinical monitoring at least once per day;

(2) the person needs the assistance of another person or constant supervision to begin
and complete at least four of the following activities of living: bathing, bed mobility,
dressing, eating, grooming, toileting, transferring, and walking;

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

(4) the person has significant difficulty with memory, using information, daily
decision making, or behavioral needs that require intervention;

(5) the person has had a qualifying nursing facility stay of at least 90 days;

(6) the person meets the nursing facility level of care criteria determined 90 days
after admission or on the first quarterly assessment after admission, whichever is later; or

(7) the person is determined to be at risk for nursing facility admission or
readmission through a face-to-face long-term care consultation assessment as specified
in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
organization under contract with the Department of Human Services. The person is
considered at risk under this clause if the person currently lives alone or will live alone
deleted text begin upon dischargedeleted text end new text begin or be homeless without the person's current housing typenew text end and also meets
one of the following criteria:

(i) the person has experienced a fall resulting in a fracture;

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

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

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

(c) The assessment used to establish medical assistance payment for long-term care
services provided under sections 256B.0915 and 256B.49 and alternative care payment
for services provided under section 256B.0913 must be the most recent face-to-face
assessment performed under section 256B.0911, subdivision 3a, 3b, or 4d, that occurred
no more than 60 calendar days before the effective date of medical assistance eligibility
for payment of long-term care services.

Subd. 12.

Appeal of nursing facility level of care determination.

A resident or
prospective resident whose level of care determination results in a denial of long-term care
services can appeal the determination as outlined in section 256B.0911, subdivision 3a,
paragraph (h), clause (9).new text begin The commissioner of human services shall ensure that notice of
changes in eligibility due to a nursing facility level of care determination is provided to
each affected recipient or the recipient's guardian at least 30 days before the effective date
of the change. The notice shall include the following information:
new text end

new text begin (1) how to obtain further information on the changes;
new text end

new text begin (2) how to receive assistance in obtaining other services;
new text end

new text begin (3) a list of community resources; and
new text end

new text begin (4) appeal rights.
new text end

new text begin A recipient who meets the criteria in section 256B.0922, subdivision 2, paragraph (a),
clauses (1) and (2), may request continued services pending appeal within the time period
allowed to request an appeal under section 256.045, subdivision 3, paragraph (h).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015.
new text end

Sec. 3.

Minnesota Statutes 2013 Supplement, section 245.8251, is amended to read:


245.8251 POSITIVE SUPPORT STRATEGIES AND EMERGENCY
MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.

Subdivision 1.

Rulesnew text begin governing the use of positive support strategies and
restricting or prohibiting restrictive interventions
new text end .

The commissioner of human
services shall, deleted text begin within 24 months of May 23, 2013deleted text end new text begin by August 31, 2015new text end , adopt rules
governing the use of positive support strategies, deleted text begin safety interventions, anddeleted text end emergency use
of manual restraintnew text begin , and restricting or prohibiting the use of restrictive interventions, new text end in
new text begin all new text end facilities and services licensed under chapter 245Ddeleted text begin .deleted text end new text begin , and in all licensed facilities and
licensed services serving persons with a developmental disability or related condition.
For the purposes of this section, "developmental disability or related condition" has the
meaning given in Minnesota Rules, part 9525.0016, subpart 2, items A to E.
new text end

Subd. 2.

Data collection.

(a) The commissioner shall, with stakeholder input,
deleted text begin developdeleted text end new text begin identifynew text end data deleted text begin collectiondeleted text end elements specific to incidents of emergency use of
manual restraint and positive support transition plans for persons receiving services from
deleted text begin providers governeddeleted text end new text begin licensed facilities and licensed services new text end under chapter 245D new text begin and in
licensed facilities and licensed services serving persons with a developmental disability
or related condition as defined in Minnesota Rules, part 9525.0016, subpart 2,
new text end effective
January 1, 2014. deleted text begin Providersdeleted text end new text begin Licensed facilities and licensed servicesnew text end shall report the data in
a format and at a frequency determined by the commissioner of human servicesdeleted text begin . Providers
shall submit the data
deleted text end to the commissioner and the Office of the Ombudsman for Mental
Health and Developmental Disabilities.

(b) Beginning July 1, 2013, deleted text begin providersdeleted text end new text begin licensed facilities and licensed services
new text end regulated under Minnesota Rules, parts 9525.2700 to 9525.2810, shall submit data
regarding the use of all controlled procedures identified in Minnesota Rules, part
9525.2740, in a format and at a frequency determined by the commissionerdeleted text begin . Providers
shall submit the data
deleted text end to the commissioner and the Office of the Ombudsman for Mental
Health and Developmental Disabilities.

new text begin Subd. 3. new text end

new text begin External program review committee. new text end

new text begin Rules adopted according to this
section shall establish requirements for an external program review committee appointed
by the commissioner to monitor implementation of the rules and make recommendations
to the commissioner about any needed policy changes after adoption of the rules.
new text end

new text begin Subd. 4. new text end

new text begin Interim review panel. new text end

new text begin (a) The commissioner shall establish an interim
review panel by August 15, 2014, for the purpose of reviewing requests for emergency
use of procedures that have been part of an approved positive support transition plan
when necessary to protect a person from imminent risk of serious injury as defined in
section 245.91, subdivision 6, due to self-injurious behavior. The panel must make
recommendations to the commissioner to approve or deny these requests based on criteria
to be established by the interim review panel. The interim review panel shall operate until
the external program review committee is established as required under subdivision 3.
new text end

new text begin (b) Members of the interim review panel shall be selected based on their expertise
and knowledge related to the use of positive support strategies as alternatives to the use
of restrictive interventions. The commissioner shall seek input and recommendations in
establishing the interim review panel. Members of the interim review panel shall include
the following representatives:
new text end

new text begin (1) an expert in positive supports;
new text end

new text begin (2) a mental health professional, as defined in section 245.462;
new text end

new text begin (3) a licensed health professional as defined in section 245D.02, subdivision 14; and
new text end

new text begin (4) a representative of the Department of Health.
new text end

Sec. 4.

Minnesota Statutes 2013 Supplement, section 245A.03, subdivision 7, is
amended to read:


Subd. 7.

Licensing moratorium.

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

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

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph (b);

(3) new foster care licenses or community residential setting licenses determined to
be needed by the commissioner under paragraph (b) for the closure of a nursing facility,
ICF/DD, or regional treatment center; restructuring of state-operated services that limits
the capacity of state-operated facilities; or allowing movement to the community for
people who no longer require the level of care provided in state-operated facilities as
provided under section 256B.092, subdivision 13, or 256B.49, subdivision 24;

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

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

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

(c) When an adult resident served by the program moves out of a foster home
that is not the primary residence of the license holder according to section 256B.49,
subdivision 15
, paragraph (f), or the adult community residential setting, the county
shall immediately inform the Department of Human Services Licensing Division. The
department shall decrease the statewide licensed capacity for adult foster care settings
where the physical location is not the primary residence of the license holder, or for adult
community residential settings, if the voluntary changes described in paragraph (e) are
not sufficient to meet the savings required by reductions in licensed bed capacity under
Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f),
and maintain statewide long-term care residential services capacity within budgetary
limits. Implementation of the statewide licensed capacity reduction shall begin on July
1, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the
needs determination process. new text begin Prior to any involuntary reduction of licensed capacity, the
commissioner shall consult with lead agencies and license holders to determine which
adult foster care settings where the physical location is not the primary residence of the
license holder, or community residential settings, are licensed for up to five beds but have
operated at less than full capacity for 12 or more months as of March 1, 2014. The settings
that meet these criteria shall be the first to be considered for any involuntary decrease
in statewide licensed capacity, up to a maximum of 35 beds. If more than 35 beds are
identified that meet these criteria, the commissioner shall prioritize the selection of those
beds to be closed based on the length of time the beds have been vacant. The longer a bed
has been vacant, the higher priority it must be given for closure.
new text end Under this paragraph,
the commissioner has the authority to reduce unused licensed capacity of a current foster
care program, or the community residential settings, to accomplish the consolidation or
closure of settings. Under this paragraph, the commissioner has the authority to manage
statewide capacity, including adjusting the capacity available to each county and adjusting
statewide available capacity, to meet the statewide needs identified through the process in
paragraph (e). A decreased licensed capacity according to this paragraph is not subject to
appeal under this chapter.

(d) Residential settings that would otherwise be subject to the decreased license
capacity established in paragraph (c) shall be exempt under the following circumstances:

(1) until August 1, 2013, the license holder's beds occupied by residents whose
primary diagnosis is mental illness and the license holder is:

(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
health services (ARMHS) as defined in section 256B.0623;

(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
9520.0870;

(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
9520.0870; or

(iv) a provider of intensive residential treatment services (IRTS) licensed under
Minnesota Rules, parts 9520.0500 to 9520.0670; or

(2) the license holder's beds occupied by residents whose primary diagnosis is
mental illness and the license holder is certified under the requirements in subdivision 6a
or section 245D.33.

(e) A resource need determination process, managed at the state level, using the
available reports required by section 144A.351, and other data and information shall
be used to determine where the reduced capacity required under paragraph (c) will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet
long-term care service needs within budgetary limits, including seeking proposals from
service providers or lead agencies to change service type, capacity, or location to improve
services, increase the independence of residents, and better meet needs identified by the
long-term care services reports and statewide data and information. By February 1, 2013,
and August 1, 2014, and each following year, the commissioner shall provide information
and data on the overall capacity of licensed long-term care services, actions taken under
this subdivision to manage statewide long-term care services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over
health and human services budget.

(f) At the time of application and reapplication for licensure, the applicant and the
license holder that are subject to the moratorium or an exclusion established in paragraph
(a) are required to inform the commissioner whether the physical location where the foster
care will be provided is or will be the primary residence of the license holder for the entire
period of licensure. If the primary residence of the applicant or license holder changes, the
applicant or license holder must notify the commissioner immediately. The commissioner
shall print on the foster care license certificate whether or not the physical location is the
primary residence of the license holder.

(g) License holders of foster care homes identified under paragraph (f) that are not
the primary residence of the license holder and that also provide services in the foster care
home that are covered by a federally approved home and community-based services
waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must inform the
human services licensing division that the license holder provides or intends to provide
these waiver-funded services.

Sec. 5.

Minnesota Statutes 2013 Supplement, section 245A.042, subdivision 3, is
amended to read:


Subd. 3.

Implementation.

(a) The commissioner shall implement the
responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
only within the limits of available appropriations or other administrative cost recovery
methodology.

(b) The licensure of home and community-based services according to this section
shall be implemented January 1, 2014. License applications shall be received and
processed on a phased-in schedule as determined by the commissioner beginning July
1, 2013. Licenses will be issued thereafter upon the commissioner's determination that
the application is complete according to section 245A.04.

(c) Within the limits of available appropriations or other administrative cost recovery
methodology, implementation of compliance monitoring must be phased in after January
1, 2014.

(1) Applicants who do not currently hold a license issued under chapter 245B must
receive an initial compliance monitoring visit after 12 months of the effective date of the
initial license for the purpose of providing technical assistance on how to achieve and
maintain compliance with the applicable law or rules governing the provision of home and
community-based services under chapter 245D. If during the review the commissioner
finds that the license holder has failed to achieve compliance with an applicable law or
rule and this failure does not imminently endanger the health, safety, or rights of the
persons served by the program, the commissioner may issue a licensing review report with
recommendations for achieving and maintaining compliance.

(2) Applicants who do currently hold a license issued under this chapter must receive
a compliance monitoring visit after 24 months of the effective date of the initial license.

(d) Nothing in this subdivision shall be construed to limit the commissioner's
authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
or issue correction orders and make a license conditional for failure to comply with
applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
of the violation of law or rule and the effect of the violation on the health, safety, or
rights of persons served by the program.

new text begin (e) License holders governed under chapter 245D must ensure compliance with the
following requirements within the stated timelines:
new text end

new text begin (1) service initiation and service planning requirements must be met at the next
annual meeting of the person's support team or by January 1, 2015, whichever is later,
for the following:
new text end

new text begin (i) provision of a written notice that identifies the service recipient rights and an
explanation of those rights as required under section 245D.04, subdivision 1;
new text end

new text begin (ii) service planning for basic support services as required under section 245D.07,
subdivision 2; and
new text end

new text begin (iii) service planning for intensive support services under section 245D.071,
subdivisions 3 and 4;
new text end

new text begin (2) staff orientation to program requirements as required under section 245D.09,
subdivision 4, for staff hired before January 1, 2014, must be met by January 1, 2015.
The license holder may otherwise provide documentation verifying these requirements
were met before January 1, 2014;
new text end

new text begin (3) development of policy and procedures as required under section 245D.11, must
be completed no later than August 31, 2014;
new text end

new text begin (4) written or electronic notice and copies of policies and procedures must be
provided to all persons or their legal representatives and case managers as required under
section 245D.10, subdivision 4, paragraphs (b) and (c), by September 15, 2014, or within
30 days of development of the required policies and procedures, whichever is earlier; and
new text end

new text begin (5) all employees must be informed of the revisions and training must be provided on
implementation of the revised policies and procedures as required under section 245D.10,
subdivision 4, paragraph (d), by September 15, 2014, or within 30 days of development of
the required policies and procedures, whichever is earlier.
new text end

Sec. 6.

Minnesota Statutes 2013 Supplement, section 245A.16, subdivision 1, is
amended to read:


Subdivision 1.

Delegation of authority to agencies.

(a) County agencies and
private agencies that have been designated or licensed by the commissioner to perform
licensing functions and activities under section 245A.04 and background studies for family
child care under chapter 245C; to recommend denial of applicants under section 245A.05;
to issue correction orders, to issue variances, and recommend a conditional license under
section 245A.06, or to recommend suspending or revoking a license or issuing a fine under
section 245A.07, shall comply with rules and directives of the commissioner governing
those functions and with this section. The following variances are excluded from the
delegation of variance authority and may be issued only by the commissioner:

(1) dual licensure of family child care and child foster care, dual licensure of child
and adult foster care, and adult foster care and family child care;

(2) adult foster care maximum capacity;

(3) adult foster care minimum age requirement;

(4) child foster care maximum age requirement;

(5) variances regarding disqualified individuals except that county agencies may
issue variances under section 245C.30 regarding disqualified individuals when the county
is responsible for conducting a consolidated reconsideration according to sections 245C.25
and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
and a disqualification based on serious or recurring maltreatment;

(6) the required presence of a caregiver in the adult foster care residence during
normal sleeping hours; and

(7) variances for community residential setting licenses under chapter 245D.

Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency
must not grant a license holder a variance to exceed the maximum allowable family child
care license capacity of 14 children.

(b) County agencies must report information about disqualification reconsiderations
under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
prescribed by the commissioner.

(c) For family day care programs, the commissioner may authorize licensing reviews
every two years after a licensee has had at least one annual review.

(d) For family adult day services programs, the commissioner may authorize
licensing reviews every two years after a licensee has had at least one annual review.

(e) A license issued under this section may be issued for up to two years.

(f) During implementation of chapter 245D, the commissioner shall consider:

(1) the role of counties in quality assurance;

(2) the duties of county licensing staff; and

(3) the possible use of joint powers agreements, according to section 471.59, with
counties through which some licensing duties under chapter 245D may be delegated by
the commissioner to the counties.

Any consideration related to this paragraph must meet all of the requirements of the
corrective action plan ordered by the federal Centers for Medicare and Medicaid Services.

new text begin (g) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child
foster care programs providing out-of-home respite, as identified in section 245D.03,
subdivision 1, paragraph (b), clause (1), is excluded from the delegation of authority
to county and private agencies.
new text end

Sec. 7.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 3, is
amended to read:


Subd. 3.

Case manager.

"Case manager" means the individual designated
to provide waiver case management services, care coordination, or long-term care
consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
or successor provisions.new text begin For purposes of this chapter, "case manager" includes case
management services as defined in Minnesota Rules, part 9520.0902, subpart 3.
new text end

Sec. 8.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 4b, is
amended to read:


Subd. 4b.

Coordinated service and support plan.

"Coordinated service and
support plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915,
subdivision
6; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor
provisions.new text begin For purposes of this chapter, "coordinated service and support plan" includes
the individual program plan or individual treatment plan as defined in Minnesota Rules,
part 9520.0510, subpart 12.
new text end

Sec. 9.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 8b, is
amended to read:


Subd. 8b.

Expanded support team.

"Expanded support team" means the members
of the support team defined in subdivision deleted text begin 46deleted text end new text begin 34new text end and a licensed health or mental health
professional or other licensed, certified, or qualified professionals or consultants working
with the person and included in the team at the request of the person or the person's legal
representative.

Sec. 10.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 11,
is amended to read:


Subd. 11.

Incident.

"Incident" means an occurrence which involves a person and
requires the program to make a response that is not a part of the program's ordinary
provision of services to that person, and includes:

(1) serious injury of a person as determined by section 245.91, subdivision 6;

(2) a person's death;

(3) any medical emergency, unexpected serious illness, or significant unexpected
change in an illness or medical condition of a person that requires the program to call
911, physician treatment, or hospitalization;

(4) any mental health crisis that requires the program to call 911 deleted text begin ordeleted text end new text begin ,new text end a mental
health crisis intervention teamnew text begin , or a similar mental health response team or service when
available and appropriate
new text end ;

(5) an act or situation involving a person that requires the program to call 911,
law enforcement, or the fire department;

(6) a person's unauthorized or unexplained absence from a program;

(7) conduct by a person receiving services against another person receiving services
that:

(i) is so severe, pervasive, or objectively offensive that it substantially interferes with
a person's opportunities to participate in or receive service or support;

(ii) places the person in actual and reasonable fear of harm;

(iii) places the person in actual and reasonable fear of damage to property of the
person; or

(iv) substantially disrupts the orderly operation of the program;

(8) any sexual activity between persons receiving services involving force or
coercion as defined under section 609.341, subdivisions 3 and 14;

(9) any emergency use of manual restraint as identified in section 245D.061new text begin or
successor provisions
new text end ; or

(10) a report of alleged or suspected child or vulnerable adult maltreatment under
section 626.556 or 626.557.

Sec. 11.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 15b,
is amended to read:


Subd. 15b.

Mechanical restraint.

new text begin (a) new text end deleted text begin Except for devices worn by the person that
trigger electronic alarms to warn staff that a person is leaving a room or area, which
do not, in and of themselves, restrict freedom of movement, or the use of adaptive aids
or equipment or orthotic devices ordered by a health care professional used to treat or
manage a medical condition,
deleted text end "Mechanical restraint" means the use of devices, materials,
or equipment attached or adjacent to the person's body, or the use of practices that are
intended to restrict freedom of movement or normal access to one's body or body parts,
or limits a person's voluntary movement or holds a person immobile as an intervention
precipitated by a person's behavior. The term applies to the use of mechanical restraint
used to prevent injury with persons who engage in self-injurious behaviors, such as
head-banging, gouging, or other actions resulting in tissue damage that have caused or
could cause medical problems resulting from the self-injury.

new text begin (b) Mechanical restraint does not include the following:
new text end

new text begin (1) devices worn by the person that trigger electronic alarms to warn staff that a
person is leaving a room or area, which do not, in and of themselves, restrict freedom of
movement; or
new text end

new text begin (2) the use of adaptive aids or equipment or orthotic devices ordered by a health care
professional used to treat or manage a medical condition.
new text end

Sec. 12.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 29,
is amended to read:


Subd. 29.

Seclusion.

"Seclusion" means deleted text begin the placement of a person alone indeleted text end new text begin : (1)
removing a person involuntarily to
new text end a room from which exit is prohibited by a staff person
or a mechanism such as a lock, a device, or an object positioned to hold the door closed
or otherwise prevent the person from leaving the roomdeleted text begin .deleted text end new text begin ; or (2) otherwise involuntarily
removing or separating a person from an area, activity, situation, or social contact with
others and blocking or preventing the person's return.
new text end

Sec. 13.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 34,
is amended to read:


Subd. 34.

Support team.

"Support team" means the service planning team
identified in section 256B.49, subdivision 15deleted text begin , ordeleted text end new text begin ;new text end the interdisciplinary team identified in
Minnesota Rules, part 9525.0004, subpart 14new text begin ; or the case management team as defined in
Minnesota Rules, part 9520.0902, subpart 6
new text end .

Sec. 14.

Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 34a,
is amended to read:


Subd. 34a.

Time out.

"Time out" means deleted text begin removing a person involuntarily from an
ongoing activity to a room, either locked or unlocked, or otherwise separating a person
from others in a way that prevents social contact and prevents the person from leaving the
situation if the person chooses
deleted text end new text begin the involuntary removal of a person for a period of time to
a designated area from which the person is not prevented from leaving
new text end . For the purpose of
this chapter, "time out" does not mean voluntary removal or self-removal for the purpose
of calming, prevention of escalation, or de-escalation of behavior deleted text begin for a period of up to 15
minutes. "Time out" does not include a person voluntarily moving from an ongoing activity
to an unlocked room or otherwise separating from a situation or social contact with others
if the person chooses. For the purposes of this definition, "voluntarily" means without
being forced, compelled, or coerced.
deleted text end new text begin ; nor does it mean taking a brief "break" or "rest" from
an activity for the purpose of providing the person an opportunity to regain self-control.
new text end

Sec. 15.

Minnesota Statutes 2013 Supplement, section 245D.02, is amended by adding
a subdivision to read:


new text begin Subd. 35b. new text end

new text begin Unlicensed staff. new text end

new text begin "Unlicensed staff" means individuals not otherwise
licensed or certified by a governmental health board or agency.
new text end

Sec. 16.

Minnesota Statutes 2013 Supplement, section 245D.03, subdivision 1, is
amended to read:


Subdivision 1.

Applicability.

(a) The commissioner shall regulate the provision of
home and community-based services to persons with disabilities and persons age 65 and
older pursuant to this chapter. The licensing standards in this chapter govern the provision
of basic support services and intensive support services.

(b) Basic support services provide the level of assistance, supervision, and care that
is necessary to ensure the health and safety of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of
the person. Basic support services include:

(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community
alternatives for disabled individuals, developmental disability, and elderly waiver plansnew text begin ,
excluding out-of-home respite care provided to children in a family child foster care home
licensed under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care
license holder complies with the requirements under section 245D.06, subdivisions 5, 6,
7, and 8, or successor provisions; and section 245D.061 or successor provisions, which
must be stipulated in the statement of intended use required under Minnesota Rules,
part 2960.3000, subpart 4
new text end ;

(2) new text begin adult new text end companion services as defined under the brain injury, community
alternatives for disabled individuals, and elderly waiver plans, excluding new text begin adult new text end companion
services provided under the Corporation for National and Community Services Senior
Companion Program established under the Domestic Volunteer Service Act of 1973,
Public Law 98-288;

(3) personal support as defined under the developmental disability waiver plan;

(4) 24-hour emergency assistance, personal emergency response as defined under the
community alternatives for disabled individuals and developmental disability waiver plans;

(5) night supervision services as defined under the brain injury waiver plan; and

(6) homemaker services as defined under the community alternatives for disabled
individuals, brain injury, community alternative care, developmental disability, and elderly
waiver plans, excluding providers licensed by the Department of Health under chapter
144A and those providers providing cleaning services only.

(c) Intensive support services provide assistance, supervision, and care that is
necessary to ensure the health and safety of the person and services specifically directed
toward the training, habilitation, or rehabilitation of the person. Intensive support services
include:

(1) intervention services, including:

(i) behavioral support services as defined under the brain injury and community
alternatives for disabled individuals waiver plans;

(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and

(iii) specialist services as defined under the current developmental disability waiver
plan;

(2) in-home support services, including:

(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;

(ii) independent living services training as defined under the brain injury and
community alternatives for disabled individuals waiver plans; and

(iii) semi-independent living services;

(3) residential supports and services, including:

(i) supported living services as defined under the developmental disability waiver
plan provided in a family or corporate child foster care residence, a family adult foster
care residence, a community residential setting, or a supervised living facility;

(ii) foster care services as defined in the brain injury, community alternative care,
and community alternatives for disabled individuals waiver plans provided in a family or
corporate child foster care residence, a family adult foster care residence, or a community
residential setting; and

(iii) residential services provided new text begin to more than four persons with developmental
disabilities
new text end in a supervised living facility deleted text begin that is certified by the Department of Health as
an ICF/DD
deleted text end new text begin , including ICFs/DDnew text end ;

(4) day services, including:

(i) structured day services as defined under the brain injury waiver plan;

(ii) day training and habilitation services under sections 252.40 to 252.46, and as
defined under the developmental disability waiver plan; and

(iii) prevocational services as defined under the brain injury and community
alternatives for disabled individuals waiver plans; and

(5) supported employment as defined under the brain injury, developmental
disability, and community alternatives for disabled individuals waiver plans.

Sec. 17.

Minnesota Statutes 2013 Supplement, section 245D.03, is amended by adding
a subdivision to read:


new text begin Subd. 1a. new text end

new text begin Effect. new text end

new text begin The home and community-based services standards establish
health, safety, welfare, and rights protections for persons receiving services governed by
this chapter. The standards recognize the diversity of persons receiving these services and
require that these services are provided in a manner that meets each person's individual
needs and ensures continuity in service planning, care, and coordination between the
license holder and members of each person's support team or expanded support team.
new text end

Sec. 18.

Minnesota Statutes 2013 Supplement, section 245D.03, subdivision 2, is
amended to read:


Subd. 2.

Relationship to other standards governing home and community-based
services.

(a) A license holder governed by this chapter is also subject to the licensure
requirements under chapter 245A.

(b) deleted text begin A corporate or family child foster care site controlled by a license holder and
providing services governed by this chapter is exempt from compliance with section
245D.04. This exemption applies to foster care homes where at least one resident is
receiving residential supports and services licensed according to this chapter.
deleted text end This chapter
does not apply to corporate or family child foster care homes that do not provide services
licensed under this chapter.

(c) A family adult foster care site controlled by a license holder deleted text begin anddeleted text end providing
services governed by this chapter is exempt from compliance with Minnesota Rules,
parts 9555.6185; 9555.6225new text begin , subpart 8new text end ; 9555.6245; 9555.6255; and 9555.6265. These
exemptions apply to family adult foster care homes where at least one resident is receiving
residential supports and services licensed according to this chapter. This chapter does
not apply to family adult foster care homes that do not provide services licensed under
this chapter.

(d) A license holder providing services licensed according to this chapter in a
supervised living facility is exempt from compliance with deleted text begin sectionsdeleted text end new text begin section new text end 245D.04deleted text begin ;
245D.05, subdivision 2; and 245D.06, subdivision 2, clauses (1), (4), and (5)
deleted text end .

(e) A license holder providing residential services to persons in an ICF/DD is exempt
from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision
2
, clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09,
subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.

(f) A license holder providing homemaker services licensed according to this chapter
and registered according to chapter 144A is exempt from compliance with section 245D.04.

(g) Nothing in this chapter prohibits a license holder from concurrently serving
persons without disabilities or people who are or are not age 65 and older, provided this
chapter's standards are met as well as other relevant standards.

(h) The documentation required under sections 245D.07 and 245D.071 must meet
the individual program plan requirements identified in section 256B.092 or successor
provisions.

Sec. 19.

Minnesota Statutes 2013 Supplement, section 245D.03, subdivision 3, is
amended to read:


Subd. 3.

Variance.

If the conditions in section 245A.04, subdivision 9, are met,
the commissioner may grant a variance to any of the requirements in this chapter, except
sections 245D.04; 245D.06, subdivision 4, paragraph (b)new text begin , and subdivision 6, or successor
provisions
new text end ; and deleted text begin 245D.061, subdivision 3, ordeleted text end provisions governing data practices and
information rights of persons.

Sec. 20.

Minnesota Statutes 2013 Supplement, section 245D.04, subdivision 3, is
amended to read:


Subd. 3.

Protection-related rights.

(a) A person's protection-related rights include
the right to:

(1) have personal, financial, service, health, and medical information kept private,
and be advised of disclosure of this information by the license holder;

(2) access records and recorded information about the person in accordance with
applicable state and federal law, regulation, or rule;

(3) be free from maltreatment;

(4) be free from restraint, time out, deleted text begin ordeleted text end seclusionnew text begin , restrictive intervention, or other
prohibited procedure identified in section 245D.06, subdivision 5, or successor provisions,
new text end except fornew text begin : (i)new text end emergency use of manual restraint to protect the person from imminent
danger to self or others according to the requirements in section deleted text begin 245D.06;deleted text end new text begin 245D.061 or
successor provisions; or (ii) the use of safety interventions as part of a positive support
transition plan under section 245D.06, subdivision 8, or successor provisions;
new text end

(5) receive services in a clean and safe environment when the license holder is the
owner, lessor, or tenant of the service site;

(6) be treated with courtesy and respect and receive respectful treatment of the
person's property;

(7) reasonable observance of cultural and ethnic practice and religion;

(8) be free from bias and harassment regarding race, gender, age, disability,
spirituality, and sexual orientation;

(9) be informed of and use the license holder's grievance policy and procedures,
including knowing how to contact persons responsible for addressing problems and to
appeal under section 256.045;

(10) know the name, telephone number, and the Web site, e-mail, and street
addresses of protection and advocacy services, including the appropriate state-appointed
ombudsman, and a brief description of how to file a complaint with these offices;

(11) assert these rights personally, or have them asserted by the person's family,
authorized representative, or legal representative, without retaliation;

(12) give or withhold written informed consent to participate in any research or
experimental treatment;

(13) associate with other persons of the person's choice;

(14) personal privacy; and

(15) engage in chosen activities.

(b) For a person residing in a residential site licensed according to chapter 245A,
or where the license holder is the owner, lessor, or tenant of the residential service site,
protection-related rights also include the right to:

(1) have daily, private access to and use of a non-coin-operated telephone for local
calls and long-distance calls made collect or paid for by the person;

(2) receive and send, without interference, uncensored, unopened mail or electronic
correspondence or communication;

(3) have use of and free access to common areas in the residence; and

(4) privacy for visits with the person's spouse, next of kin, legal counsel, religious
advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
privacy in the person's bedroom.

(c) Restriction of a person's rights under deleted text begin subdivision 2, clause (10), ordeleted text end paragraph (a),
clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure
the health, safety, and well-being of the person. Any restriction of those rights must be
documented in the person's coordinated service and support plan or coordinated service
and support plan addendum. The restriction must be implemented in the least restrictive
alternative manner necessary to protect the person and provide support to reduce or
eliminate the need for the restriction in the most integrated setting and inclusive manner.
The documentation must include the following information:

(1) the justification for the restriction based on an assessment of the person's
vulnerability related to exercising the right without restriction;

(2) the objective measures set as conditions for ending the restriction;

(3) a schedule for reviewing the need for the restriction based on the conditions
for ending the restriction to occur semiannually from the date of initial approval, at a
minimum, or more frequently if requested by the person, the person's legal representative,
if any, and case manager; and

(4) signed and dated approval for the restriction from the person, or the person's
legal representative, if any. A restriction may be implemented only when the required
approval has been obtained. Approval may be withdrawn at any time. If approval is
withdrawn, the right must be immediately and fully restored.

Sec. 21.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1, is
amended to read:


Subdivision 1.

Health needs.

(a) The license holder is responsible for meeting
health service needs assigned in the coordinated service and support plan or the
coordinated service and support plan addendum, consistent with the person's health needs.
The license holder is responsible for promptly notifying the person's legal representative,
if any, and the case manager of changes in a person's physical and mental health needs
affecting health service needs assigned to the license holder in the coordinated service and
support plan or the coordinated service and support plan addendum, when discovered by
the license holder, unless the license holder has reason to know the change has already
been reported. The license holder must document when the notice is provided.

(b) If responsibility for meeting the person's health service needs has been assigned
to the license holder in the coordinated service and support plan or the coordinated service
and support plan addendum, the license holder must maintain documentation on how the
person's health needs will be met, including a description of the procedures the license
holder will follow in order to:

(1) provide medication new text begin setup, new text end assistancenew text begin ,new text end or deleted text begin medicationdeleted text end administration according
to this chapternew text begin . Unlicensed staff responsible for medication setup or medication
administration under this section must complete training according to section 245D.09,
subdivision 4a, paragraph (d)
new text end ;

(2) monitor health conditions according to written instructions from a licensed
health professional;

(3) assist with or coordinate medical, dental, and other health service appointments; or

(4) use medical equipment, devices, or adaptive aides or technology safely and
correctly according to written instructions from a licensed health professional.

Sec. 22.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1a,
is amended to read:


Subd. 1a.

Medication setup.

new text begin (a) new text end For the purposes of this subdivision, "medication
setup" means the arranging of medications according to instructions from the pharmacy,
the prescriber, or a licensed nurse, for later administration when the license holder
is assigned responsibility deleted text begin for medication assistance or medication administrationdeleted text end in
the coordinated service and support plan or the coordinated service and support plan
addendum. A prescription label or the prescriber's written or electronically recorded order
for the prescription is sufficient to constitute written instructions from the prescriber.

new text begin (b) If responsibility for medication setup is assigned to the license holder in
the coordinated service and support plan or the coordinated service and support plan
addendum, or if the license holder provides it as part of medication assistance or
medication administration,
new text end the license holder must document in the person's medication
administration record: dates of setup, name of medication, quantity of dose, times to be
administered, and route of administration at time of setup; and, when the person will be
away from home, to whom the medications were given.

Sec. 23.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1b,
is amended to read:


Subd. 1b.

Medication assistance.

new text begin (a) For purposes of this subdivision, "medication
assistance" means any of the following:
new text end

new text begin (1) bringing to the person and opening a container of previously set up medications,
emptying the container into the person's hand, or opening and giving the medications in
the original container to the person under the direction of the person;
new text end

new text begin (2) bringing to the person liquids or food to accompany the medication; or
new text end

new text begin (3) providing reminders to take regularly scheduled medication or perform regularly
scheduled treatments and exercises.
new text end

new text begin (b) new text end If responsibility for medication assistance is assigned to the license holder
in the coordinated service and support plan or the coordinated service and support
plan addendum, the license holder must ensure that deleted text begin the requirements of subdivision 2,
paragraph (b), have been met when staff provides
deleted text end medication assistance deleted text begin to enabledeleted text end new text begin is
provided in a manner that enables
new text end a person to self-administer medication or treatment
when the person is capable of directing the person's own care, or when the person's legal
representative is present and able to direct care for the person. deleted text begin For the purposes of this
subdivision, "medication assistance" means any of the following:
deleted text end

deleted text begin (1) bringing to the person and opening a container of previously set up medications,
emptying the container into the person's hand, or opening and giving the medications in
the original container to the person;
deleted text end

deleted text begin (2) bringing to the person liquids or food to accompany the medication; or
deleted text end

deleted text begin (3) providing reminders to take regularly scheduled medication or perform regularly
scheduled treatments and exercises.
deleted text end

Sec. 24.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 2, is
amended to read:


Subd. 2.

Medication administration.

(a) deleted text begin If responsibility for medication
administration is assigned to the license holder in the coordinated service and support
plan or the coordinated service and support plan addendum, the license holder must
implement the following medication administration procedures to ensure a person takes
medications and treatments as prescribed
deleted text end new text begin For purposes of this subdivision, "medication
administration" means
new text end :

(1) checking the person's medication record;

(2) preparing the medication as necessary;

(3) administering the medication or treatment to the person;

(4) documenting the administration of the medication or treatment or the reason for
not administering the medication or treatment; and

(5) reporting to the prescriber or a nurse any concerns about the medication or
treatment, including side effects, effectiveness, or a pattern of the person refusing to
take the medication or treatment as prescribed. Adverse reactions must be immediately
reported to the prescriber or a nurse.

(b)(1) new text begin If responsibility for medication administration is assigned to the license holder
in the coordinated service and support plan or the coordinated service and support plan
addendum, the license holder must implement medication administration procedures
to ensure a person takes medications and treatments as prescribed.
new text end The license holder
must ensure that the requirements in clauses (2) deleted text begin to (4)deleted text end new text begin and (3)new text end have been met before
administering medication or treatment.

(2) The license holder must obtain written authorization from the person or the
person's legal representative to administer medication or treatment and must obtain
reauthorization annually as needed. new text begin This authorization shall remain in effect unless it is
withdrawn in writing and may be withdrawn at any time.
new text end If the person or the person's
legal representative refuses to authorize the license holder to administer medication, the
medication must not be administered. The refusal to authorize medication administration
must be reported to the prescriber as expediently as possible.

deleted text begin (3) The staff person responsible for administering the medication or treatment must
complete medication administration training according to section 245D.09, subdivision
4a, paragraphs (a) and (c), and, as applicable to the person, paragraph (d).
deleted text end

deleted text begin (4)deleted text end new text begin (3)new text end For a license holder providing intensive support services, the medication or
treatment must be administered according to the license holder's medication administration
policy and procedures as required under section 245D.11, subdivision 2, clause (3).

(c) The license holder must ensure the following information is documented in the
person's medication administration record:

(1) the information on the current prescription label or the prescriber's current
written or electronically recorded order or prescription that includes the person's name,
description of the medication or treatment to be provided, and the frequency and other
information needed to safely and correctly administer the medication or treatment to
ensure effectiveness;

(2) information on any risks or other side effects that are reasonable to expect, and
any contraindications to its use. This information must be readily available to all staff
administering the medication;

(3) the possible consequences if the medication or treatment is not taken or
administered as directed;

(4) instruction on when and to whom to report the following:

(i) if a dose of medication is not administered or treatment is not performed as
prescribed, whether by error by the staff or the person or by refusal by the person; and

(ii) the occurrence of possible adverse reactions to the medication or treatment;

(5) notation of any occurrence of a dose of medication not being administered or
treatment not performed as prescribed, whether by error by the staff or the person or by
refusal by the person, or of adverse reactions, and when and to whom the report was
made; and

(6) notation of when a medication or treatment is started, administered, changed, or
discontinued.

Sec. 25.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 4, is
amended to read:


Subd. 4.

Reviewing and reporting medication and treatment issues.

(a) When
assigned responsibility for medication administration, the license holder must ensure
that the information maintained in the medication administration record is current and
is regularly reviewed to identify medication administration errors. At a minimum, the
review must be conducted every three months, or more frequently as directed in the
coordinated service and support plan or coordinated service and support plan addendum
or as requested by the person or the person's legal representative. Based on the review,
the license holder must develop and implement a plan to correct patterns of medication
administration errors when identified.

(b) If assigned responsibility for medication assistance or medication administration,
the license holder must report the following to the person's legal representative and case
manager as they occur or as otherwise directed in the coordinated service and support plan
or the coordinated service and support plan addendum:

(1) any reports deleted text begin made to the person's physician or prescriberdeleted text end required under
subdivision 2, paragraph (c), clause (4);

(2) a person's refusal or failure to take or receive medication or treatment as
prescribed; or

(3) concerns about a person's self-administration of medication or treatment.

Sec. 26.

Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 5, is
amended to read:


Subd. 5.

Injectable medications.

Injectable medications may be administered
according to a prescriber's order and written instructions when one of the following
conditions has been met:

(1) a registered nurse or licensed practical nurse will administer the deleted text begin subcutaneous or
intramuscular
deleted text end injection;

(2) a supervising registered nurse with a physician's order has delegated the
administration of deleted text begin subcutaneousdeleted text end injectable medication to an unlicensed staff member
and has provided the necessary training; or

(3) there is an agreement signed by the license holder, the prescriber, and the
person or the person's legal representative specifying what deleted text begin subcutaneousdeleted text end injections may
be given, when, how, and that the prescriber must retain responsibility for the license
holder's giving the injections. A copy of the agreement must be placed in the person's
service recipient record.

Only licensed health professionals are allowed to administer psychotropic
medications by injection.

Sec. 27.

Minnesota Statutes 2013 Supplement, section 245D.051, is amended to read:


245D.051 PSYCHOTROPIC MEDICATION USE AND MONITORING.

Subdivision 1.

Conditions for psychotropic medication administration.

(a)
When a person is prescribed a psychotropic medication and the license holder is assigned
responsibility for administration of the medication in the person's coordinated service
and support plan or the coordinated service and support plan addendum, the license
holder must ensure that the requirements in deleted text begin paragraphs (b) to (d) anddeleted text end section 245D.05,
subdivision 2, are met.

deleted text begin (b) Use of the medication must be included in the person's coordinated service and
support plan or in the coordinated service and support plan addendum and based on a
prescriber's current written or electronically recorded prescription.
deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end The license holder must develop, implement, and maintain the following
documentation in the person's coordinated service and support plan addendum according
to the requirements in sections 245D.07 and 245D.071:

(1) a description of the target symptoms that the psychotropic medication is to
alleviate; and

(2) documentation methods the license holder will use to monitor and measure
changes in the target symptoms that are to be alleviated by the psychotropic medication if
required by the prescriber. The license holder must collect and report on medication and
symptom-related data as instructed by the prescriber. The license holder must provide
the monitoring data to the expanded support team for review every three months, or as
otherwise requested by the person or the person's legal representative.

For the purposes of this section, "target symptom" refers to any perceptible
diagnostic criteria for a person's diagnosed mental disorder, as defined by the Diagnostic
and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
successive editions, that has been identified for alleviation.

Subd. 2.

Refusal to authorize psychotropic medication.

If the person or the
person's legal representative refuses to authorize the administration of a psychotropic
medication as ordered by the prescriber, the license holder must deleted text begin follow the requirement in
section 245D.05, subdivision 2, paragraph (b), clause (2).
deleted text end new text begin not administer the medication.
The refusal to authorize medication administration must be reported to the prescriber as
expediently as possible.
new text end After reporting the refusal to the prescriber, the license holder
must follow any directives or orders given by the prescriber. deleted text begin A court order must be
obtained to override the refusal.
deleted text end new text begin A refusal may not be overridden without a court order.
new text end Refusal to authorize administration of a specific psychotropic medication is not grounds
for service termination and does not constitute an emergency. A decision to terminate
services must be reached in compliance with section 245D.10, subdivision 3.

Sec. 28.

Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 1, is
amended to read:


Subdivision 1.

Incident response and reporting.

(a) The license holder must
respond to incidents under section 245D.02, subdivision 11, that occur while providing
services to protect the health and safety of and minimize risk of harm to the person.

(b) The license holder must maintain information about and report incidents to the
person's legal representative or designated emergency contact and case manager within
24 hours of an incident occurring while services are being provided, within 24 hours of
discovery or receipt of information that an incident occurred, unless the license holder
has reason to know that the incident has already been reported, or as otherwise directed
in a person's coordinated service and support plan or coordinated service and support
plan addendum. An incident of suspected or alleged maltreatment must be reported as
required under paragraph (d), and an incident of serious injury or death must be reported
as required under paragraph (e).

(c) When the incident involves more than one person, the license holder must not
disclose personally identifiable information about any other person when making the report
to each person and case manager unless the license holder has the consent of the person.

(d) Within 24 hours of reporting maltreatment as required under section 626.556
or 626.557, the license holder must inform the case manager of the report unless there is
reason to believe that the case manager is involved in the suspected maltreatment. The
license holder must disclose the nature of the activity or occurrence reported and the
agency that received the report.

(e) The license holder must report the death or serious injury of the person as
required in paragraph (b) and to the Department of Human Services Licensing Division,
and the Office of Ombudsman for Mental Health and Developmental Disabilities as
required under section 245.94, subdivision 2a, within 24 hours of the death, or receipt of
information that the death occurred, unless the license holder has reason to know that the
death has already been reported.

(f) When a death or serious injury occurs in a facility certified as an intermediate
care facility for persons with developmental disabilities, the death or serious injury must
be reported to the Department of Health, Office of Health Facility Complaints, and the
Office of Ombudsman for Mental Health and Developmental Disabilities, as required
under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
know that the death has already been reported.

(g) The license holder must conduct an internal review of incident reports of deaths
and serious injuries that occurred while services were being provided and that were not
reported by the program as alleged or suspected maltreatment, for identification of incident
patterns, and implementation of corrective action as necessary to reduce occurrences.
The review must include an evaluation of whether related policies and procedures were
followed, whether the policies and procedures were adequate, whether there is a need for
additional staff training, whether the reported event is similar to past events with the
persons or the services involved, and whether there is a need for corrective action by the
license holder to protect the health and safety of persons receiving services. Based on
the results of this review, the license holder must develop, document, and implement a
corrective action plan designed to correct current lapses and prevent future lapses in
performance by staff or the license holder, if any.

(h) The license holder must verbally report the emergency use of manual restraint
of a person as required in paragraph (b) within 24 hours of the occurrence. The license
holder must ensure the written report and internal review of all incident reports of the
emergency use of manual restraints are completed according to the requirements in section
245D.061new text begin or successor provisionsnew text end .

Sec. 29.

Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 2, is
amended to read:


Subd. 2.

Environment and safety.

The license holder must:

(1) ensure the following when the license holder is the owner, lessor, or tenant
of the service site:

(i) the service site is a safe and hazard-free environment;

(ii) that toxic substances or dangerous items are inaccessible to persons served by
the program only to protect the safety of a person receiving services new text begin when a known safety
threat exists
new text end and not as a substitute for staff supervision or interactions with a person who
is receiving services. If toxic substances or dangerous items are made inaccessible, the
license holder must document an assessment of the physical plant, its environment, and its
population identifying the risk factors which require toxic substances or dangerous items
to be inaccessible and a statement of specific measures to be taken to minimize the safety
risk to persons receiving servicesnew text begin and to restore accessibility to all persons receiving
services at the service site
new text end ;

(iii) doors are locked from the inside to prevent a person from exiting only when
necessary to protect the safety of a person receiving services and not as a substitute for
staff supervision or interactions with the person. If doors are locked from the inside, the
license holder must document an assessment of the physical plant, the environment and
the population served, identifying the risk factors which require the use of locked doors,
and a statement of specific measures to be taken to minimize the safety risk to persons
receiving services at the service site; and

(iv) a staff person is available at the service site who is trained in basic first aid and,
when required in a person's coordinated service and support plan or coordinated service
and support plan addendum, cardiopulmonary resuscitation (CPR) whenever persons are
present and staff are required to be at the site to provide direct new text begin support new text end service. The CPR
training must include in-person instruction, hands-on practice, and an observed skills
assessment under the direct supervision of a CPR instructor;

(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
license holder in good condition when used to provide services;

(3) follow procedures to ensure safe transportation, handling, and transfers of the
person and any equipment used by the person, when the license holder is responsible for
transportation of a person or a person's equipment;

(4) be prepared for emergencies and follow emergency response procedures to
ensure the person's safety in an emergency; and

(5) follow universal precautions and sanitary practices, including hand washing, for
infection prevention and control, and to prevent communicable diseases.

Sec. 30.

Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 4, is
amended to read:


Subd. 4.

Funds and propertynew text begin ; legal representative restrictionsnew text end .

(a) Whenever the
license holder assists a person with the safekeeping of funds or other property according
to section 245A.04, subdivision 13, the license holder must obtain written authorization
to do so from the person or the person's legal representative and the case manager.
Authorization must be obtained within five working days of service initiation and renewed
annually thereafter. At the time initial authorization is obtained, the license holder must
survey, document, and implement the preferences of the person or the person's legal
representative and the case manager for frequency of receiving a statement that itemizes
receipts and disbursements of funds or other property. The license holder must document
changes to these preferences when they are requested.

(b) A license holder or staff person may not accept powers-of-attorney from a person
receiving services from the license holder for any purpose. This does not apply to license
holders that are Minnesota counties or other units of government or to staff persons
employed by license holders who were acting as attorney-in-fact for specific individuals
prior to implementation of this chapter. The license holder must maintain documentation
of the power-of-attorney in the service recipient record.

new text begin (c) A license holder or staff person is restricted from accepting an appointment
as a guardian as follows:
new text end

new text begin (1) under section 524.5-309 of the Uniform Probate Code, any individual or agency
that provides residence, custodial care, medical care, employment training, or other care
or services for which the individual or agency receives a fee may not be appointed as
guardian unless related to the respondent by blood, marriage, or adoption; and
new text end

new text begin (2) under section 245A.03, subdivision 2, paragraph (a), clause (1), a related
individual as defined under section 245A.02, subdivision 13, is excluded from licensure.
Services provided by a license holder to a person under the license holder's guardianship
are not licensed services.
new text end

deleted text begin (c)deleted text end new text begin (d)new text end Upon the transfer or death of a person, any funds or other property of the
person must be surrendered to the person or the person's legal representative, or given to
the executor or administrator of the estate in exchange for an itemized receipt.

Sec. 31.

Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 6, is
amended to read:


Subd. 6.

Restricted procedures.

new text begin (a) new text end The following procedures are allowed when
the procedures are implemented in compliance with the standards governing their use as
identified in clauses (1) to (3). Allowed but restricted procedures include:

(1) permitted actions and procedures subject to the requirements in subdivision 7;

(2) procedures identified in a positive support transition plan subject to the
requirements in subdivision 8; or

(3) emergency use of manual restraint subject to the requirements in section
245D.061.

For purposes of this chapter, this section supersedes the requirements identified in
Minnesota Rules, part 9525.2740.

new text begin (b) A restricted procedure identified in paragraph (a) must not:
new text end

new text begin (1) be implemented with a child in a manner that constitutes sexual abuse, neglect,
physical abuse, or mental injury, as defined in section 626.556, subdivision 2;
new text end

new text begin (2) be implemented with an adult in a manner that constitutes abuse or neglect as
defined in section 626.5572, subdivision 2 or 17;
new text end

new text begin (3) be implemented in a manner that violates a person's rights identified in section
245D.04;
new text end

new text begin (4) restrict a person's normal access to a nutritious diet, drinking water, adequate
ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping
conditions, necessary clothing, or any protection required by state licensing standards or
federal regulations governing the program;
new text end

new text begin (5) deny the person visitation or ordinary contact with legal counsel, a legal
representative, or next of kin;
new text end

new text begin (6) be used for the convenience of staff, as punishment, as a substitute for adequate
staffing, or as a consequence if the person refuses to participate in the treatment or services
provided by the program;
new text end

new text begin (7) use prone restraint. For purposes of this section, "prone restraint" means use
of manual restraint that places a person in a face-down position. Prone restraint does
not include brief physical holding of a person who, during an emergency use of manual
restraint, rolls into a prone position, if the person is restored to a standing, sitting, or
side-lying position as quickly as possible;
new text end

new text begin (8) apply back or chest pressure while a person is in a prone position as identified in
clause (7), supine position, or side-lying position; or
new text end

new text begin (9) be implemented in a manner that is contraindicated for any of the person's known
medical or psychological limitations.
new text end

Sec. 32.

Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 7, is
amended to read:


Subd. 7.

Permitted actions and procedures.

(a) Use of the instructional techniques
and intervention procedures as identified in paragraphs (b) and (c) is permitted when used
on an intermittent or continuous basis. When used on a continuous basis, it must be
addressed in a person's coordinated service and support plan addendum as identified in
sections 245D.07 and 245D.071. For purposes of this chapter, the requirements of this
subdivision supersede the requirements identified in Minnesota Rules, part 9525.2720.

(b) Physical contact or instructional techniques must use the least restrictive
alternative possible to meet the needs of the person and may be used:

(1) to calm or comfort a person by holding that person with no resistance from
that person;

(2) to protect a person known to be at risk deleted text begin ordeleted text end new text begin of new text end injury due to frequent falls as a result
of a medical condition;

(3) to facilitate the person's completion of a task or response when the person does
not resist or the person's resistance is minimal in intensity and duration; deleted text begin or
deleted text end

(4) to deleted text begin brieflydeleted text end block or redirect a person's limbs or body without holding the person or
limiting the person's movement to interrupt the person's behavior that may result in injury
to self or othersdeleted text begin .deleted text end new text begin with less than 60 seconds of physical contact by staff; or
new text end

new text begin (5) to redirect a person's behavior when the behavior does not pose a serious threat
to the person or others and the behavior is effectively redirected with less than 60 seconds
of physical contact by staff.
new text end

(c) Restraint may be used as an intervention procedure to:

(1) allow a licensed health care professional to safely conduct a medical examination
or to provide medical treatment ordered by a licensed health care professional to a person
necessary to promote healing or recovery from an acute, meaning short-term, medical
condition;

(2) assist in the safe evacuation or redirection of a person in the event of an
emergency and the person is at imminent risk of harmdeleted text begin .deleted text end new text begin ; or
new text end

deleted text begin Any use of manual restraint as allowed in this paragraph must comply with the restrictions
identified in section deleted text begin 245D.061, deleted text end subdivision deleted text begin 3deleted text end ; or
deleted text end

(3) position a person with physical disabilities in a manner specified in the person's
coordinated service and support plan addendum.

new text begin Any use of manual restraint as allowed in this paragraph must comply with the restrictions
identified in subdivision 6, paragraph (b).
new text end

(d) Use of adaptive aids or equipment, orthotic devices, or other medical equipment
ordered by a licensed health professional to treat a diagnosed medical condition do not in
and of themselves constitute the use of mechanical restraint.

new text begin (e) Use of an auxiliary device to ensure a person does not unfasten a seat belt when
being transported in a vehicle in accordance with seat belt use requirements in section
169.686 does not constitute the use of mechanical restraint.
new text end

Sec. 33.

Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 8, is
amended to read:


Subd. 8.

Positive support transition plan.

new text begin (a) new text end License holders must develop
a positive support transition plan on the forms and in the manner prescribed by the
commissioner for a person who requires intervention in order to maintain safety when
it is known that the person's behavior poses an immediate risk of physical harm to self
or others. The po