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Capital IconMinnesota Legislature

HF 945

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 03/31/2017 10:13am

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

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 2.37 2.38 2.39 2.40 2.41 2.42 2.43 2.44 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 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
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 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 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 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22
8.23
8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18
9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 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 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 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 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 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 15.33 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8
16.9
16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 17.1 17.2 17.3 17.4 17.5 17.6
17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 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 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 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 21.36 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 23.35 24.1 24.2
24.3 24.4 24.5
24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 27.32 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21
28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 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 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 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 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 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 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 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 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 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 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31 41.32 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 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 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 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 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 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 48.34 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
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 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 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
53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 54.32 54.33 54.34 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 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 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 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 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 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 61.35 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 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 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 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
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 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 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 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 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16
72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 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 74.20 74.19 74.22 74.21 74.24 74.23 74.26 74.25 74.28 74.27 74.30 74.29 74.32 74.31 74.34 74.33 74.36 74.35 74.38 74.37 75.2 75.1 75.4 75.3 75.6 75.5 75.8 75.7 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 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15
76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25
76.26 76.27 76.28 76.29 76.30 76.31 76.32 77.1 77.2 77.3 77.4
77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15
77.16 77.17 77.18 77.19 77.20 77.21 77.22
77.23
77.24 77.25 77.26
77.27 77.28
77.29 77.30 77.31 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14
78.15
78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 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 80.1 80.2
80.3
80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 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 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 83.33 83.34 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 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
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 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 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 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13
89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31
90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27
90.28 90.29 90.30 90.31 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 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 92.32 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28
93.29 93.30 93.31 93.32 93.33 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 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 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 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 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 99.28 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9
100.10 100.11 100.12
100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 105.33 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30
106.31 106.32 107.1 107.2
107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22
108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24
110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32
112.1
112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26
113.27 113.28 113.29 113.30 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28
116.29
116.30 116.31 116.32 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8
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
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
118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 119.1 119.2 119.3
119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30
121.1 121.2 121.3 121.4 121.5 121.6
121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 121.33 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 122.33 123.1 123.2 123.3
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
124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16
124.17
124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 125.1 125.2
125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11
125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23
125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32
126.1 126.2 126.3 126.4
126.5 126.6 126.7 126.8 126.9
126.10 126.11 126.12 126.13 126.14
126.15 126.16 126.17 126.18
126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14
127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 127.33 128.1 128.2 128.3
128.4 128.5 128.6 128.7 128.8
128.9 128.10 128.11 128.12 128.13 128.14 128.15
128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27
128.28
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
129.31 129.32 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14
130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13
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
132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33 133.1 133.2 133.3 133.4 133.5 133.6 133.7
133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9
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
136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 137.1 137.2 137.3 137.4 137.5 137.6
137.7 137.8 137.9
137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11
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
140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17
140.18 140.19 140.20 140.21 140.22 140.23 140.24
140.25 140.26 140.27 140.28 140.29 140.30 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20
142.21
142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11
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
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
144.26 144.27 144.28 144.29 144.30 144.31 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31
147.1
147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 148.1 148.2 148.3 148.4 148.5 148.6 148.7
148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9
149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 151.1 151.2 151.3 151.4 151.5 151.6
151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20
153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13
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
156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 157.33 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 158.33 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21
160.22
160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16
161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26
161.27 161.28 161.29 161.30 161.31 161.32 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21
163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15
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
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
166.1 166.2 166.3 166.4 166.5 166.6 166.7
166.8 166.9 166.10 166.11
166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 167.1 167.2 167.3
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
168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12
168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12
169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24
169.25 169.26 169.27
169.28 169.29 169.30 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22
170.23 170.24 170.25 170.26 170.27
170.28 170.29 170.30 170.31
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
171.26 171.27 171.28 171.29 171.30 172.1 172.2 172.3 172.4
172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28
172.29 172.30 172.31
173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30
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
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
175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 179.33 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29
181.30 181.31 181.32 181.33 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30
182.31 182.32 182.33 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13
183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 184.34 184.35
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
185.25 185.26 185.27 185.28 185.29 185.30 185.31 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24
186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32
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
188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17
188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 188.32 188.33 189.1 189.2 189.3 189.4 189.5 189.6
189.7
189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14
191.15
191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9
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
194.1 194.2 194.3 194.4
194.5
194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 195.1 195.2
195.3
195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 195.33 196.1 196.2 196.3 196.4 196.5 196.6
196.7
196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12
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
197.29 197.30 197.31 198.1 198.2 198.3 198.4
198.5
198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31
198.32
199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 200.1 200.2 200.3 200.4
200.5 200.6
200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14
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
203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 204.1 204.2 204.3
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
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
205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 207.1 207.2 207.3 207.4 207.5 207.6
207.7
207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16
207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14
208.15 208.16 208.17
208.18 208.19 208.20 208.21 208.22 208.23
208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14
209.15
209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32
210.1 210.2 210.3 210.4 210.5 210.6
210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11
211.12
211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21
211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 213.1
213.2 213.3 213.4 213.5 213.6 213.7
213.8
213.9 213.10 213.11 213.12
213.13
213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24
213.25
213.26 213.27 213.28 213.29 214.1 214.2 214.3 214.4 214.5
214.6
214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11
215.12
215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23
215.24
215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 216.1 216.2 216.3 216.4 216.5 216.6
216.7
216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18
216.19
216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17
217.18
217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 218.1 218.2 218.3 218.4
218.5
218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16
219.17
219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8
220.9
220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24
220.25
220.26 220.27 220.28 220.29 220.30 220.31 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 221.33 221.34 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25
222.26
222.27 222.28 222.29 222.30 222.31 222.32 222.33 222.34 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17
223.18
223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 223.33 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 224.33 224.34 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13
225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28
226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10
226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19
226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 226.33 227.1 227.2 227.3 227.4 227.5 227.6
227.7
227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24
227.25
227.26 227.27 227.28 227.29 227.30 227.31 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25
228.26
228.27 228.28 228.29 228.30 228.31 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23
229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10
230.11
230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 230.33 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9
231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26
231.27 231.28 231.29 231.30 231.31 231.32 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20
232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11
233.12 233.13 233.14 233.15 233.16
233.17 233.18 233.19 233.20 233.21 233.22 233.23
233.24 233.25 233.26 233.27 233.28 233.29
234.1 234.2
234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19
234.20 234.21 234.22 234.23 234.24 234.25 234.26
234.27
234.28 234.29 234.30 234.31
235.1
235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31
235.32
236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15
236.16
236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31
236.32
237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8
237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32 238.33 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 240.1 240.2 240.3
240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27
240.28 240.29 240.30 240.31 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13
241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14
242.15 242.16 242.17 242.18
242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 243.1 243.2 243.3 243.4 243.5 243.6
243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 243.32 243.33 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9
245.10 245.11 245.12 245.13 245.14 245.15 245.16
245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25
245.26 245.27 245.28 245.29 245.30
246.1 246.2 246.3 246.4 246.5 246.6
246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25
246.26 246.27 246.28 246.29 246.30 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13
247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 248.32 248.33 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 249.32 249.33 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30
251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24
251.25 251.26 251.27 251.28 251.29 251.30 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 253.1 253.2 253.3
253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21
253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19
254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12
255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21
255.22 255.23
255.24 255.25 255.26
255.27
256.1 256.2 256.3 256.4
256.5
256.6 256.7
256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14
257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17
258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30
258.31 258.32 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 262.1 262.2 262.3 262.4 262.5 262.6
262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24
262.25 262.26 262.27 262.28 262.29 262.30 262.31 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9
263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21
263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 263.33 264.1 264.2
264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 264.33 265.1 265.2 265.3 265.4 265.5 265.6 265.7
265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32
266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 268.32 268.33 269.1 269.2 269.3
269.4 269.5 269.6 269.7 269.8 269.9
269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22
269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 270.33 270.34 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 271.33 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9
272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22
273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 274.32 275.1 275.2 275.3
275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18
276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 276.32 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17
278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27
278.28 278.29 278.30 278.31
279.1 279.2
279.3 279.4
279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20
279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 280.1 280.2 280.3
280.4
280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 280.32 280.33 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25
281.26 281.27 281.28 281.29 281.30 281.31 281.32 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28
282.29 282.30 282.31 282.32 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9
283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19
284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33 285.1 285.2
285.3 285.4
285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14
285.15
285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29
286.1 286.2 286.3 286.4
286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13
286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 286.32 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 287.33 287.34 287.35 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16
289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32
291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11
291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 291.34 292.1 292.2 292.3
292.4 292.5
292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19
293.20 293.21 293.22 293.23
293.24 293.25
293.26 293.27 293.28 293.29 293.30 294.1 294.2
294.3 294.4 294.5 294.6 294.7
294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 295.1 295.2 295.3 295.4 295.5 295.6
295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26
296.27 296.28 296.29 296.30 296.31 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 297.32 297.33 297.34 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 298.33 298.34
299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 300.32 300.33 300.34 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 301.34 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 302.33 302.34 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 303.33 303.34 303.35 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 304.32 304.33 304.34 304.35 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 305.33 305.34 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 306.32 306.33 306.34 307.1 307.2 307.3 307.4 307.5 307.6
307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 307.32 307.33 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 308.34 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28
309.29 309.30 309.31 309.32 309.33 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25
311.26 311.27 311.28 311.29 311.30 311.31 311.32 311.33 312.1 312.2 312.3 312.4
312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19
312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 312.32 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12
313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24
313.25 313.26 313.27 313.28 313.29 313.30 313.31 313.32 314.1 314.2
314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11
314.12 314.13 314.14 314.15 314.16 314.17 314.18
314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 315.1 315.2
315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 315.32 315.33 316.1 316.2
316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 316.32 316.33 316.34 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20
317.21 317.22 317.23 317.24 317.25 317.26
317.27 317.28 317.29 317.30 317.31 317.32 317.33 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27
319.28 319.29 319.30 319.31 319.32 319.33 320.1 320.2
320.3 320.4
320.5 320.6
320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17
320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14
321.15 321.16
321.17 321.18
321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 322.1
322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 322.33 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 323.32 323.33 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 324.33 324.34 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 325.32 325.33 325.34 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30 326.31 326.32 326.33 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 327.33 327.34 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 328.33 328.34 328.35 328.36 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 329.33 329.34 329.35 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 330.33 330.34 330.35 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 331.35 331.36 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 332.33 332.34 332.35 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 333.33 333.34 333.35 333.36 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 334.33 334.34 334.35 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 335.33 335.34 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 336.33 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 337.33 337.34 337.35 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 338.34 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 339.34 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 340.33 340.34 340.35 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 341.34 341.35 341.36 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 342.33 342.34 342.35 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 343.32 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 344.33 344.34 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 345.33 345.34 345.35 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32 346.33 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 347.33 347.34 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 348.33 348.34 348.35 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 349.33 349.34 349.35 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 350.34 350.35 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16
351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 351.33 351.34 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32 352.33 352.34 352.35 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 353.33 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 354.32 354.33 354.34 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 355.32 355.33 355.34 355.35 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 356.33 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 357.33
357.34 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 358.33 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 359.33 359.34 359.35 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13
361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 361.32 361.33 361.34 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16
362.17 362.18 362.19 362.20
362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28
362.29
362.30
363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21
363.22 363.23 363.24
363.25 363.26 363.27
363.28 363.29

A bill for an act
relating to state government; establishing the health and human services budget;
modifying provisions governing health care, continuing care, health department
and public health, children and families, health occupations, chemical and mental
health, and opiate abuse prevention; establishing prescribed pediatric extended
care center license; modifying certain definitions; establishing federally facilitated
marketplace; modifying sections related to telemedicine, nursing, psychology,
dentistry, and medical practice; requiring legislative approval for certain federal
waivers and approval; repealing MNsure; making technical changes; requiring
reports; establishing and modifying fees; making forecast adjustments; appropriating
money; amending Minnesota Statutes 2016, sections 3.972, by adding a subdivision;
62A.671, subdivision 6; 119B.011, by adding subdivisions; 119B.02, subdivision
5; 119B.03, subdivisions 4, 6; 119B.09, subdivision 9a; 119B.125, subdivisions
4, 6; 119B.13, subdivisions 1, 6; 119B.16, subdivisions 1, 1a, 1b, by adding
subdivisions; 144.0722, subdivision 1; 144.0724, subdivisions 1, 2, 6, 9; 144.1501,
subdivision 2; 144.1506; 144.551, subdivision 1; 144.562, subdivision 2; 144.99,
subdivision 1; 144A.071, subdivisions 3, 4a, 4c, 4d; 144A.073, subdivision 3c;
144A.10, subdivision 4; 144A.15, subdivision 2; 144A.154; 144A.161, subdivision
10; 144A.1888; 144A.474, subdivision 11; 144A.4799, subdivision 3; 144A.611,
subdivision 1; 144A.70, subdivision 6, by adding a subdivision; 144A.74; 145.4716,
subdivision 2; 148.171, subdivision 7b, by adding a subdivision; 148.211,
subdivisions 1a, 1c, 2; 148.881; 148.89; 148.90, subdivisions 1, 2; 148.905,
subdivision 1; 148.907, subdivisions 1, 2; 148.9105, subdivisions 1, 4, 5; 148.916,
subdivisions 1, 1a; 148.925; 148.96, subdivision 3; 148B.53, subdivision 1;
150A.06, subdivisions 3, 8; 150A.10, subdivision 4; 151.01, subdivision 5, by
adding subdivisions; 151.21; 152.11, by adding a subdivision; 245.462, subdivision
9; 245.4871, by adding a subdivision; 245.4876, subdivision 2; 245.4889,
subdivision 1; 245.814, subdivisions 2, 3; 245A.02, subdivisions 2b, 5a, by adding
subdivisions; 245A.03, subdivision 2; 245A.04, subdivision 4; 245A.06, subdivision
8, by adding a subdivision; 245A.191; 245D.03, subdivision 1; 245E.01, by adding
a subdivision; 245E.02, subdivisions 1, 3, 4; 245E.03, subdivisions 2, 4; 245E.04;
245E.05, subdivision 1; 245E.06, subdivisions 1, 2, 3; 245E.07, subdivision 1;
252.27, subdivision 2a; 252.41, subdivision 3; 254A.03, subdivision 3; 254A.08,
subdivision 2; 254B.01, by adding a subdivision; 254B.03, subdivision 2; 254B.05,
subdivisions 1, 5; 254B.12, by adding a subdivision; 256.9657, subdivision 1;
256.9686, subdivision 8; 256.969, subdivisions 1, 2b, 3a, 4b, 8, 8c, 9, 12, by adding
a subdivision; 256.98, subdivision 8; 256B.04, subdivision 12; 256B.0621,
subdivision 10; 256B.0625, subdivisions 3b, 6a, 13, 13e, 17, 17b, 18h, 20, 30, 45a,
60a, 64, by adding subdivisions; 256B.0644; 256B.0653, subdivisions 2, 3, 4, 5,
6, by adding a subdivision; 256B.072; 256B.0755; 256B.0915, subdivision 3e;
256B.0924, by adding a subdivision; 256B.0943, subdivision 13; 256B.0945,
subdivisions 2, 4; 256B.15, subdivisions 1, 1a, 2; 256B.196, subdivisions 2, 3, 4;
256B.35, subdivision 4; 256B.431, subdivision 30; 256B.434, subdivision 4;
256B.4913, subdivision 4a, by adding a subdivision; 256B.4914, subdivisions 2,
3, 5, 6, 7, 8, 9, 10; 256B.50, subdivisions 1, 1b; 256B.5012, by adding subdivisions;
256B.69, subdivision 5a, by adding a subdivision; 256B.75; 256B.763; 256B.766;
256C.23, subdivision 2, by adding subdivisions; 256C.233, subdivisions 1, 2;
256C.24, subdivisions 1, 2; 256C.261; 256I.04, subdivisions 1, 3; 256I.05, by
adding subdivisions; 256I.06, subdivision 8; 256J.45, subdivision 2; 256L.15,
subdivision 2; 256P.06, subdivision 2; 256R.02, subdivisions 4, 17, 18, 19, 22,
42, 52, by adding subdivisions; 256R.06, subdivision 5; 256R.07, subdivision 1,
by adding a subdivision; 256R.13, subdivision 4; 256R.37; 256R.40, subdivisions
1, 5; 256R.41; 256R.47; 256R.49; 256R.53, subdivision 2; 260C.451, subdivision
6; 609.5315, subdivision 5c; 626.556, subdivisions 2, 3, 3c, 10d; Laws 2015,
chapter 71, article 7, section 54; proposing coding for new law in Minnesota
Statutes, chapters 119B; 144; 147; 148; 152; 181; 245A; 256; 256B; 256N; 256R;
proposing coding for new law as Minnesota Statutes, chapter 144H; repealing
Minnesota Statutes 2016, sections 62V.01; 62V.02; 62V.03; 62V.04; 62V.05;
62V.051; 62V.055; 62V.06; 62V.07; 62V.08; 62V.09; 62V.10; 62V.11; 119B.16,
subdivision 2; 144.4961; 147.0375, subdivision 7; 148.211, subdivision 1b; 148.243,
subdivision 15; 148.906; 148.907, subdivision 5; 148.908; 148.909, subdivision
7; 148.96, subdivisions 4, 5; 179A.50; 179A.51; 179A.52; 179A.53; 245E.03,
subdivision 3; 245E.06, subdivisions 4, 5; 256B.4914, subdivision 16; 256B.7631;
256C.23, subdivision 3; 256C.233, subdivision 4; 256C.25, subdivisions 1, 2;
Minnesota Rules, part 3400.0185, subpart 5.

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

ARTICLE 1

HEALTH CARE

Section 1.

Minnesota Statutes 2016, section 3.972, is amended by adding a subdivision
to read:


Subd. 2a.

Audits of Department of Human Services.

(a) To ensure continuous
legislative oversight and accountability, the legislative auditor shall give high priority to
auditing the programs, services, and benefits administered by the Department of Human
Services. The audits shall determine whether the department offered programs and provided
services and benefits only to eligible persons and organizations, and complied with applicable
legal requirements.

(b) The legislative auditor shall, no less than three times each year, test a representative
sample of persons enrolled in medical assistance and MinnesotaCare to determine whether
they are eligible to receive benefits under those programs. The legislative auditor shall report
the results to the commissioner of human services and recommend corrective actions, which
the commissioner must implement within 20 business days. The legislative auditor shall
monitor the commissioner's implementation of corrective actions and periodically report
the results to the Legislative Audit Commission and the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance. The legislative auditor's reports to the commission and the chairs and ranking
minority members must include recommendations for any legislative actions needed to
ensure that medical assistance and MinnesotaCare benefits are provided only to eligible
persons.

Sec. 2.

Minnesota Statutes 2016, section 245.4889, subdivision 1, is amended to read:


Subdivision 1.

Establishment and authority.

(a) The commissioner is authorized to
make grants from available appropriations to assist:

(1) counties;

(2) Indian tribes;

(3) children's collaboratives under section 124D.23 or 245.493; or

(4) mental health service providers.

(b) The following services are eligible for grants under this section:

(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;

(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;

(3) respite care services for children with severe emotional disturbances who are at risk
of out-of-home placement;

(4) children's mental health crisis services;

(5) mental health services for people from cultural and ethnic minorities;

(6) children's mental health screening and follow-up diagnostic assessment and treatment;

(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;

(8) school-linked mental health services;

(9) building evidence-based mental health intervention capacity for children birth to age
five;

(10) suicide prevention and counseling services that use text messaging statewide;

(11) mental health first aid training;

(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
Web site to share information and strategies to promote resilience and prevent trauma;

(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;

(14) early childhood mental health consultation;

(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis; and

(16) psychiatric consultation for primary care practitioners.; and

(17) start-up funding to support providers in meeting program requirements and beginning
operations when establishing a new children's mental health program.

(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under paragraph (b) must be
designed to foster independent living in the community.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 3.

Minnesota Statutes 2016, section 256.9686, subdivision 8, is amended to read:


Subd. 8.

Rate year.

"Rate year" means a calendar year from January 1 to December 31.
Effective with the 2012 base year, rate year means a state fiscal year from July 1 to June
30.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 4.

Minnesota Statutes 2016, 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 Centers for Medicare and Medicaid Services Inpatient Hospital Market Basket. The
commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
the midpoint of the current rate year.

(b) Except as authorized under this section, 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.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 5.

Minnesota Statutes 2016, section 256.969, subdivision 2b, is amended to read:


Subd. 2b.

Hospital payment rates.

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

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

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

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

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

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

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

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

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

(1) pediatric services;

(2) behavioral health services;

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

(4) transplant services;

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

(6) outlier admissions;

(7) low-volume providers; and

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

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

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

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

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

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

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

(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year and the next base year. Changes in costs
between base years shall be measured using the lower of the hospital cost index defined in
subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim.
The commissioner shall establish the base year for each rebasing period considering
the most recent year for which filed Medicare cost reports are available. The estimated
change in the average payment per hospital discharge resulting from a scheduled rebasing
must be calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.

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

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

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

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

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

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

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

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

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

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

(6) geographic location.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 6.

Minnesota Statutes 2016, section 256.969, is amended by adding a subdivision to
read:


Subd. 2e.

Alternate inpatient payment rate.

(a) If the days, costs, and revenues
associated with patients who are eligible for medical assistance and also have private health
insurance are required to be included in the calculation of the hospital-specific
disproportionate share hospital payment limit for a rate year, then the commissioner, effective
retroactively to rate years beginning on or after January 1, 2015, shall compute an alternate
inpatient payment rate for a Minnesota hospital that is designated as a children's hospital
and enumerated as such by Medicare. The commissioner shall reimburse the hospital for a
rate year at the higher of the amount calculated under the alternate payment rate or the
amount calculated under subdivision 9.

(b) The alternate payment rate must meet the criteria in clauses (1) to (4):

(1) the alternate payment rate shall be structured to target a total aggregate reimbursement
amount equal to two percent less than each children's hospital's cost coverage percentage
in the applicable base year for providing fee-for-service inpatient services under this section
to patients enrolled in medical assistance;

(2) costs shall be determined using the most recently available medical assistance cost
report provided under subdivision 4b, paragraph (a), clause (3), for the applicable base year.
Costs shall be determined using standard Medicare cost finding and cost allocation methods
and applied in the same manner as the costs were in the rebasing for the applicable base
year. If the medical assistance cost report is not available, costs shall be determined in the
interim using the Medicare Cost Report;

(3) in any rate year in which payment to a hospital is made using the alternate payment
rate, no payments shall be made to the hospital under subdivision 9; and

(4) if the alternate payment amount increases payments at a rate that is higher than the
inflation factor applied over the rebasing period, the commissioner shall take this into
consideration when setting payment rates at the next rebasing.

Sec. 7.

Minnesota Statutes 2016, section 256.969, subdivision 3a, is amended to read:


Subd. 3a.

Payments.

(a) Acute care hospital billings under the medical assistance program
must not be submitted until the recipient is discharged. However, the commissioner shall
establish monthly interim payments for inpatient hospitals that have individual patient
lengths of stay over 30 days regardless of diagnostic category. Except as provided in section
256.9693, medical assistance reimbursement for treatment of mental illness shall be
reimbursed based on diagnostic classifications. Individual hospital payments established
under this section and sections 256.9685, 256.9686, and 256.9695, in addition to third-party
and recipient liability, for discharges occurring during the rate year shall not exceed, in
aggregate, the charges for the medical assistance covered inpatient services paid for the
same period of time to the hospital. 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 30 days prior to implementation. The rate setting data
must reflect the admissions data used to establish relative values. The commissioner may
adjust base year cost, relative value, and case mix index data to exclude the costs of services
that have been discontinued by the October 1 of the year preceding the rate year or that are
paid separately from inpatient services. Inpatient stays that encompass portions of two or
more rate years shall have payments established based on payment rates in effect at the time
of admission unless the date of admission preceded the rate year in effect by six months or
more. In this case, operating payment rates for services rendered during the rate year in
effect and established based on the date of admission shall be adjusted to the rate year in
effect by the hospital cost index.

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

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

(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after 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 or corresponding APR-DRGs, 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, 2006, to reflect this reduction.

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

(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 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 or corresponding APR-DRGs, 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.

(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 or
corresponding APR-DRGs, 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.

(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.

(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.

(j) Effective for discharges on and after November 1, 2014, from hospitals paid under
subdivision 2b, paragraph (a), clauses (1) and (4), the rate adjustments in this subdivision
must be incorporated into the rebased rates established under subdivision 2b, paragraph (c),
and must not be applied to each claim.

(k) Effective for discharges on and after July 1, 2015, from hospitals paid under
subdivision 2b, paragraph (a), clauses (2) and (3), the rate adjustments in this subdivision
must be incorporated into the rates and must not be applied to each claim.

(l) Effective for discharges on and after July 1, 2017, from hospitals paid under
subdivision 2b, paragraph (a), clause (2), the rate adjustments in this subdivision must be
incorporated into the rates and must not be applied to each claim.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 8.

Minnesota Statutes 2016, section 256.969, subdivision 4b, is amended to read:


Subd. 4b.

Medical assistance cost reports for services.

(a) A hospital that meets one
of the following criteria must annually submit to the commissioner medical assistance cost
reports within six months of the end of the hospital's fiscal year:

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

(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; or

(3) a Minnesota hospital that is designated as a children's hospital and enumerated as
such by Medicare
.

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

(b) The commissioner shall suspend payments to any hospital that fails to submit a report
required under this subdivision. Payments must remain suspended until the report has been
filed with and accepted by the commissioner.

EFFECTIVE DATE.

This section is effective retroactively from January 1, 2015.

Sec. 9.

Minnesota Statutes 2016, section 256.969, subdivision 8, is amended to read:


Subd. 8.

Unusual length of stay experience.

(a) The commissioner shall establish day
outlier thresholds for each diagnostic category established under subdivision 2 at two standard
deviations beyond the mean length of stay. Payment for the days beyond the outlier threshold
shall be in addition to the operating and property payment rates per admission established
under subdivisions 2 and 2b. Payment for outliers shall be at 70 percent of the allowable
operating cost, after adjustment by the case mix index, hospital cost index, relative values
and the disproportionate population adjustment. The outlier threshold for neonatal and burn
diagnostic categories shall be established at one standard deviation beyond the mean length
of stay, and payment shall be at 90 percent of allowable operating cost calculated in the
same manner as other outliers. A hospital may choose an alternative to the 70 percent outlier
payment that is at a minimum of 60 percent and a maximum of 80 percent if the
commissioner is notified in writing of the request by October 1 of the year preceding the
rate year. The chosen percentage applies to all diagnostic categories except burns and
neonates. The percentage of allowable cost that is unrecognized by the outlier payment shall
be added back to the base year operating payment rate per admission.

(b) Effective for admissions and transfers occurring on and after November 1, 2014, the
commissioner shall establish payment rates for outlier payments that are based on Medicare
methodologies.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 10.

Minnesota Statutes 2016, section 256.969, subdivision 8c, is amended to read:


Subd. 8c.

Hospital residents.

(a) For discharges occurring on or after November 1,
2014, payments for hospital residents shall be made as follows:

(1) payments for the first 180 days of inpatient care shall be the APR-DRG system plus
any outliers; and

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

(b) For discharges occurring on or after July 1, 2017, payment for hospital residents
shall be equal to the payments under subdivision 8, paragraph (b).

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 11.

Minnesota Statutes 2016, 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 July 1, 1993, 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. 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) 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.

(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.

(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:

(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;

(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;

(3) a hospital that has received payment from the fee-for-service program for at least 20
transplant services in the base year shall receive a factor of 0.0435;

(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;

(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than three standard
deviations above the mean shall receive a factor of 0.2300; and

(6) a hospital that has a medical assistance utilization rate in the base year that is at least
three standard deviations above the statewide mean utilization rate shall receive a factor of
0.3711.

(e) Any payments or portion of payments made to a hospital under this subdivision that
are subsequently returned to the commissioner because the payments are found to exceed
the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
number of fee-for-service discharges, to other DSH-eligible nonchildren's non-children's
hospitals that have a medical assistance utilization rate that is at least one standard deviation
above the mean.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 12.

Minnesota Statutes 2016, section 256.969, subdivision 12, is amended to read:


Subd. 12.

Rehabilitation hospitals and distinct parts.

(a) Units of hospitals that are
recognized as rehabilitation distinct parts by the Medicare program shall have separate
provider numbers under the medical assistance program for rate establishment and billing
purposes only. These units shall also have operating payment rates and the disproportionate
population adjustment, if allowed by federal law, established separately from other inpatient
hospital services.

(b) The commissioner shall establish separate relative values under subdivision 2 for
rehabilitation hospitals and distinct parts as defined by the Medicare program. Effective for
discharges occurring on and after November 1, 2014, the commissioner, to the extent
possible, shall replicate the existing payment rate methodology under the new diagnostic
classification system. The result must be budget neutral, ensuring that the total aggregate
payments under the new system are equal to the total aggregate payments made for the same
number and types of services in the base year, calendar year 2012.

(c) For individual hospitals that did not have separate medical assistance rehabilitation
provider numbers or rehabilitation distinct parts in the base year, hospitals shall provide the
information needed to separate rehabilitation distinct part cost and claims data from other
inpatient service data.

(d) Effective with discharges on or after July 1, 2017, payment to rehabilitation hospitals
shall be established under subdivision 2b, paragraph (a), clause (4).

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 13.

Minnesota Statutes 2016, section 256B.04, subdivision 12, is amended to read:


Subd. 12.

Limitation on services.

(a) Place limits on the types of services covered by
medical assistance, the frequency with which the same or similar services may be covered
by medical assistance for an individual recipient, and the amount paid for each covered
service. The state agency shall promulgate rules establishing maximum reimbursement rates
for emergency and nonemergency transportation.

The rules shall provide:

(1) an opportunity for all recognized transportation providers to be reimbursed for
nonemergency transportation consistent with the maximum rates established by the agency;
and

(2) reimbursement of public and private nonprofit providers serving the disabled
population generally at reasonable maximum rates that reflect the cost of providing the
service regardless of the fare that might be charged by the provider for similar services to
individuals other than those receiving medical assistance or medical care under this chapter;
and
.

(3) reimbursement for each additional passenger carried on a single trip at a substantially
lower rate than the first passenger carried on that trip.

(b) The commissioner shall encourage providers reimbursed under this chapter to
coordinate their operation with similar services that are operating in the same community.
To the extent practicable, the commissioner shall encourage eligible individuals to utilize
less expensive providers capable of serving their needs.

(c) For the purpose of this subdivision and section 256B.02, subdivision 8, and effective
on January 1, 1981, "recognized provider of transportation services" means an operator of
special transportation service as defined in section 174.29 that has been issued a current
certificate of compliance with operating standards of the commissioner of transportation
or, if those standards do not apply to the operator, that the agency finds is able to provide
the required transportation in a safe and reliable manner. Until January 1, 1981, "recognized
transportation provider" includes an operator of special transportation service that the agency
finds is able to provide the required transportation in a safe and reliable manner.

Sec. 14.

Minnesota Statutes 2016, section 256B.0625, subdivision 3b, is amended to read:


Subd. 3b.

Telemedicine services.

(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week. Telemedicine services
shall be paid at the full allowable rate.

(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:

(1) has identified the categories or types of services the health care provider will provide
via telemedicine;

(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;

(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;

(4) has established protocols addressing how and when to discontinue telemedicine
services; and

(5) has an established quality assurance process related to telemedicine services.

(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:

(1) the type of service provided by telemedicine;

(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;

(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;

(5) the location of the originating site and the distant site;

(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and

(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).

(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.

(e) For purposes of this section, "licensed health care provider" is defined means a
licensed health care provider
under section 62A.671, subdivision 6, and a mental health
practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision 26,
working under the general supervision of a mental health professional
; "health care provider"
is defined under section 62A.671, subdivision 3; and "originating site" is defined under
section 62A.671, subdivision 7.

Sec. 15.

Minnesota Statutes 2016, section 256B.0625, subdivision 13, is amended to read:


Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, physician assistant, or a nurse practitioner employed
by or under contract with a community health board as defined in section 145A.02,
subdivision 5
, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the formulary committee, as necessary, appropriate, and
cost-effective for the treatment of certain specified chronic diseases, conditions, or disorders,
and this determination shall not be subject to the requirements of chapter 14. A pharmacist
may prescribe over-the-counter medications as provided under this paragraph for purposes
of receiving reimbursement under Medicaid. When prescribing over-the-counter drugs under
this paragraph, licensed pharmacists must consult with the recipient to determine necessity,
provide drug counseling, review drug therapy for potential adverse interactions, and make
referrals as needed to other health care professionals. Over-the-counter medications must
be dispensed in a quantity that is the lowest of: (1) the number of dosage units contained in
the manufacturer's original package; (2) the number of dosage units required to complete
the patient's course of therapy; or (3) if applicable, the number of dosage units dispensed
from a system using retrospective billing, as provided under subdivision 13e, paragraph
(b).

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

Sec. 16.

Minnesota Statutes 2016, section 256B.0625, subdivision 13e, is amended to
read:


Subd. 13e.

Payment rates.

(a) Effective April 1, 2017, or upon federal approval,
whichever is later,
the basis for determining the amount of payment shall be the lower of
the actual acquisition costs ingredient cost of the drugs or the maximum allowable cost by
the commissioner
plus the fixed professional dispensing fee; or the usual and customary
price charged to the public. The usual and customary price is defined as the lowest price
charged by the provider to a patient who pays for the prescription by cash, check, or charge
account and includes those prices the pharmacy charges to customers enrolled in a
prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain.
The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The pharmacy professional dispensing fee
shall be $3.65 $11.35 for legend prescription drugs prescriptions filled with legend drugs
meeting the definition of "covered outpatient drugs" according to United States Code, title
42, section 1396r-8(k)(2)
, except that the dispensing fee for intravenous solutions which
must be compounded by the pharmacist shall be $8 $11.35 per bag, $14 per bag for cancer
chemotherapy products, and $30 per bag for total parenteral nutritional products dispensed
in one liter quantities, or $44 per bag for total parenteral nutritional products dispensed in
quantities greater than one liter
. The professional dispensing fee for prescriptions filled with
over-the-counter drugs meeting the definition of covered outpatient drugs shall be $11.35
for dispensed quantities equal to or greater than the number of units contained in the
manufacturer's original package. The professional dispensing fee shall be prorated based
on the percentage of the package dispensed when the pharmacy dispenses a quantity less
than the number of units contained in the manufacturer's original package.
The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs
shall be $3.65, except that the fee shall be $1.31 for retrospectively billing
pharmacies when billing for quantities less than the number of units contained in the
manufacturer's original package. Actual acquisition cost includes quantity and other special
discounts except time and cash discounts. The actual acquisition
for quantities equal to or
greater than the number of units contained in the manufacturer's original package and shall
be prorated based on the percentage of the package dispensed when the pharmacy dispenses
a quantity less than the number of units contained in the manufacturer's original package.
The National Average Drug Acquisition Cost (NADAC) shall be used to determine the
ingredient
cost of a drug shall be estimated by the commissioner at wholesale acquisition
cost plus four percent for independently owned pharmacies located in a designated rural
area within Minnesota, and at wholesale acquisition cost plus two percent for all other
pharmacies. A pharmacy is "independently owned" if it is one of four or fewer pharmacies
under the same ownership nationally. A "designated rural area" means an area defined as
a small rural area or isolated rural area according to the four-category classification of the
Rural Urban Commuting Area system developed for the United States Health Resources
and Services Administration. Effective January 1, 2014, the actual acquisition
. For drugs
for which a NADAC is not reported, the commissioner shall estimate the ingredient cost at
wholesale acquisition cost minus two percent. The commissioner shall establish the ingredient

cost of a drug acquired through the federal 340B Drug Pricing Program shall be estimated
by the commissioner at wholesale acquisition cost minus 40 percent
at a 340B Drug Pricing
Program maximum allowable cost. The 340B Drug Pricing Program maximum allowable
cost shall be comparable to, but no higher than, the 340B Drug Pricing Program ceiling
price established by the Health Resources and Services Administration
. Wholesale acquisition
cost is defined as the manufacturer's list price for a drug or biological to wholesalers or
direct purchasers in the United States, not including prompt pay or other discounts, rebates,
or reductions in price, for the most recent month for which information is available, as
reported in wholesale price guides or other publications of drug or biological pricing data.
The maximum allowable cost of a multisource drug may be set by the commissioner and it
shall be comparable to, but the actual acquisition cost of the drug product and no higher
than, the maximum amount paid by other third-party payors in this state who have maximum
allowable cost programs and no higher than the NADAC of the generic product.
Establishment of the amount of payment for drugs shall not be subject to the requirements
of the Administrative Procedure Act.

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

(c) An additional dispensing fee of $.30 may be added to the dispensing fee paid to
pharmacists for legend drug prescriptions dispensed to residents of long-term care facilities
when a unit dose blister card system, approved by the department, is used. Under this type
of dispensing system, the pharmacist must dispense a 30-day supply of drug. The National
Drug Code (NDC) from the drug container used to fill the blister card must be identified
on the claim to the department. The unit dose blister card containing the drug must meet
the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return
of unused drugs to the pharmacy for reuse.
A pharmacy provider using packaging that meets
the standards set forth in Minnesota Rules, part 6800.2700, is required to credit the
department for the actual acquisition cost of all unused drugs that are eligible for reuse,
unless the pharmacy is using retrospective billing. The commissioner may permit the drug
clozapine to be dispensed in a quantity that is less than a 30-day supply.

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

(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
Effective January 1, 2014, the commissioner shall discount the payment rate for drugs
obtained through the federal 340B Drug Pricing Program by 20 percent. The payment for
drugs administered in an outpatient setting shall be made to the administering facility or
practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
outpatient setting is not eligible for direct reimbursement.

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

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

(h) Effective for prescriptions filled on or after April 1, 2017, or upon federal approval,
whichever is later, the commissioner shall increase the ingredient cost reimbursement
calculated in paragraphs (a) and (f) by two percent for prescription and nonprescription
drugs subject to the wholesale drug distributor tax under section 295.52.

EFFECTIVE DATE.

This section is effective retroactively from April 1, 2017, or from
the effective date of federal approval, whichever is later. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.

Sec. 17.

Minnesota Statutes 2016, section 256B.0625, subdivision 17, is amended to read:


Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
common carrier nonemergency medical transportation company, or other recognized
providers of transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transit, as defined in section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers.

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and in consultation with the Minnesota Department of
Transportation. All nonemergency medical transportation providers shall bill for
nonemergency medical transportation services in accordance with Minnesota health care
programs criteria. Publicly operated transit systems, volunteers, and not-for-hire vehicles
are exempt from the requirements outlined in this paragraph.

(d) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(e) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner in consultation with the
Nonemergency Medical Transportation Advisory Committee;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a Web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.

(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).

(g) The commissioner may use an order by the recipient's attending physician or a medical
or mental health professional to certify that the recipient requires nonemergency medical
transportation services. Nonemergency medical transportation providers shall perform
driver-assisted services for eligible individuals, when appropriate. Driver-assisted service
includes passenger pickup at and return to the individual's residence or place of business,
assistance with admittance of the individual to the medical facility, and assistance in
passenger securement or in securing of wheelchairs, child seats, or stretchers in the vehicle.

Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.

Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

(h) The administrative agency shall use the level of service process established by the
commissioner in consultation with the Nonemergency Medical Transportation Advisory
Committee to determine the client's most appropriate mode of transportation. If public transit
or a certified transportation provider is not available to provide the appropriate service mode
for the client, the client may receive a onetime service upgrade.

(i) The covered modes of transportation, which may not be implemented without a new
rate structure,
are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the Web-based single
administrative structure, assessment tool, and level of need assessment under subdivision
18e. The local agency's financial obligation is limited to funds provided by the state or
federal government.

(k) The commissioner shall:

(1) in consultation with the Nonemergency Medical Transportation Advisory Committee,
verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.

(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:

(1) $0.22 per mile for client reimbursement;

(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;

(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 for the base rate and $1.30 per mile when provided by a nonemergency
medical transportation provider;

(4) $13 for the base rate and $1.30 per mile for assisted transport;

(5) $18 for the base rate and $1.55 per mile for lift-equipped/ramp transport;

(6) $75 for the base rate and $2.40 per mile for protected transport; and

(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.

(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:

(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and

(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).

(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.

(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.

(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).

Sec. 18.

Minnesota Statutes 2016, section 256B.0625, subdivision 17b, is amended to
read:


Subd. 17b.

Documentation required.

(a) As a condition for payment, nonemergency
medical transportation providers must document each occurrence of a service provided to
a recipient according to this subdivision. Providers must maintain odometer and other records
sufficient to distinguish individual trips with specific vehicles and drivers. The documentation
may be collected and maintained using electronic systems or software or in paper form but
must be made available and produced upon request. Program funds paid for transportation
that is not documented according to this subdivision shall be recovered by the department.

(b) A nonemergency medical transportation provider must compile transportation records
that meet the following requirements:

(1) the record must be in English and must be legible according to the standard of a
reasonable person;

(2) the recipient's name must be on each page of the record; and

(3) each entry in the record must document:

(i) the date on which the entry is made;

(ii) the date or dates the service is provided;

(iii) the printed last name, first name, and middle initial of the driver;

(iv) the signature of the driver attesting to the following: "I certify that I have accurately
reported in this record the trip miles I actually drove and the dates and times I actually drove
them. I understand that misreporting the miles driven and hours worked is fraud for which
I could face criminal prosecution or civil proceedings.";

(v) the signature of the recipient or authorized party attesting to the following: "I certify
that I received the reported transportation service.", or the signature of the provider of
medical services certifying that the recipient was delivered to the provider;

(vi) the address, or the description if the address is not available, of both the origin and
destination, and the mileage for the most direct route from the origin to the destination;

(vii) the mode of transportation in which the service is provided;

(viii) the license plate number of the vehicle used to transport the recipient;

(ix) whether the service was ambulatory or nonambulatory until the modes under
subdivision 17 are implemented
;

(x) the time of the pickup and the time of the drop-off with "a.m." and "p.m."
designations;

(xi) the name of the extra attendant when an extra attendant is used to provide special
transportation service; and

(xii) the electronic source documentation used to calculate driving directions and mileage.

Sec. 19.

Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
to read:


Subd. 17c.

Nursing facility transports.

A Minnesota health care program enrollee
residing in, or being discharged from, a licensed nursing facility is exempt from a level of
need determination and is eligible for nonemergency medical transportation services until
the enrollee no longer resides in a licensed nursing facility, as provided in section 256B.04,
subdivision 14a.

Sec. 20.

Minnesota Statutes 2016, section 256B.0625, subdivision 18h, is amended to
read:


Subd. 18h.

Managed care.

(a) The following subdivisions do not apply to managed
care plans and county-based purchasing plans:

(1) subdivision 17, paragraphs (d) to (k) (a), (b), (i), and (n);

(2) subdivision 18e 18; and

(3) subdivision 18g 18a.

(b) A nonemergency medical transportation provider must comply with the operating
standards for special transportation service specified in sections 174.29 to 174.30 and
Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire
vehicles are exempt from the requirements in this paragraph.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 21.

Minnesota Statutes 2016, 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 (FQHC) 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 An FQHC 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
an FQHC 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 FQHCs 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 an FQHC 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 FQHCs 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
FQHCs
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 FQHCs or rural health clinics.

(d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally qualified
health center
an FQHC 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, through December 31, 2018, each federally qualified
health center
FQHC 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) Effective for services provided on or after January 1, 2019, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f), the alternative payment
methodology described in paragraph (f), or the alternative payment methodology described
in paragraph (l).

(g) (h) 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.

(h) (i) Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by federally qualified health centers FQHCs and rural health
clinics shall be paid by the commissioner. Effective for services provided on or after January
1, 2015, through July 1, 2017,
the commissioner shall determine the most feasible method
for paying claims from the following options:

(1) federally qualified health centers FQHCs and rural health clinics submit claims
directly to the commissioner for payment, and the commissioner provides claims information
for recipients enrolled in a managed care or county-based purchasing plan to the plan, on
a regular basis; or

(2) federally qualified health centers FQHCs and rural health clinics submit claims for
recipients enrolled in a managed care or county-based purchasing plan to the plan, and those
claims are submitted by the plan to the commissioner for payment to the clinic.

Effective for services provided on or after January 1, 2019, FQHCs and rural health clinics
shall submit claims directly to the commissioner for payment and the commissioner shall
provide claims information for recipients enrolled in a managed care plan or county-based
purchasing plan to the plan on a regular basis to be determined by the commissioner.

(i) (j) 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 plan or county-based purchasing plan claims for services provided 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.

(j) (k) The commissioner shall seek a federal waiver, authorized under section 1115 of
the Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center FQHC under paragraph (a)
that provides services to American Indian and Alaskan Native individuals eligible for
services under this subdivision.

(l) Effective for services provided on or after January 1, 2019, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner according to the current prospective payment system described in paragraph
(f), or an alternative payment methodology with the following requirements:

(1) each FQHC and rural health clinic must receive a single medical and a single dental
organization rate;

(2) the commissioner shall reimburse FQHCs and rural health clinics for allowable costs,
including direct patient care costs and patient-related support services, based upon Medicare
cost principles that apply at the time the alternative payment methodology is calculated;

(3) the 2019 payment rates for FQHCs and rural health clinics:

(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from 2015 and 2016. A provider must submit the required cost reports to the commissioner
within six months of the second base year calendar or fiscal year end. Cost reports must be
submitted six months before the quarter in which the base rate will take effect;

(ii) must be according to current Medicare cost principles applicable to FQHCs and rural
health clinics at the time of the alternative payment rate calculation without the application
of productivity screens and upper payment limits or the Medicare prospective payment
system FQHC aggregate mean upper payment limit; and

(iii) must provide for a 60-day appeals process;

(4) the commissioner shall inflate the base year payment rate for FQHCs and rural health
clinics to the effective date by using the Bureau of Economic Analysis's personal consumption
expenditures medical care inflator;

(5) the commissioner shall establish a statewide trend inflator using 2015-2020 costs
replacing the use of the personal consumption expenditures medical care inflator with the
2023 rate calculation forward;

(6) FQHC and rural health clinic payment rates shall be rebased by the commissioner
every two years using the methodology described in clause (3), using the provider's Medicare
cost reports from the previous third and fourth years. In nonrebasing years, the commissioner
shall adjust using the Medicare economic index until 2023 when the statewide trend inflator
is available;

(7) the commissioner shall increase payments by two percent according to Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 6. This is an add-on to
the rate and must not be included in the base rate calculation;

(8) for FQHCs and rural health clinics seeking a change of scope of services:

(i) the commissioner shall require FQHCs and rural health clinics to submit requests to
the commissioner, if the change of scope would result in the medical or dental payment rate
currently received by the FQHC or rural health clinic increasing or decreasing by at least
2-1/2 percent;

(ii) FQHCs and rural health clinics shall submit the request to the commissioner within
seven business days of submission of the scope change to the federal Health Resources
Services Administration;

(iii) the effective date of the payment change is the date the Health Resources Services
Administration approves the FQHC's or rural health clinic's change of scope request;

(iv) for change of scope requests that do not require Health Resources Services
Administration approval, FQHCs and rural health clinics shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner receives the request from the FQHC or rural health clinic; and

(v) the commissioner shall provide a response to the FQHC's or rural health clinic's
change of scope request within 45 days of submission and provide a final decision regarding
approval or disapproval within 120 days of submission. If more information is needed to
evaluate the request, this timeline may be waived by mutual agreement of the commissioner
and the FQHC or rural health clinic; and

(9) the commissioner shall establish a payment rate for new FQHC and rural health
clinic organizations, considering the following factors:

(i) a comparison of patient caseload of FQHCs and rural health clinics within a 60-mile
radius for organizations established outside the seven-county metropolitan area and within
a 30-mile radius for organizations within the seven-county metropolitan area; and

(ii) if a comparison is not feasible under item (i), the commissioner may use Medicare
cost reports or audited financial statements to establish the base rate.

Sec. 22.

Minnesota Statutes 2016, section 256B.0625, subdivision 45a, is amended to
read:


Subd. 45a.

Psychiatric residential treatment facility services for persons under 21
years of age.

(a) Medical assistance covers psychiatric residential treatment facility services,
according to section 256B.0941,
for persons under younger than 21 years of age. Individuals
who reach age 21 at the time they are receiving services are eligible to continue receiving
services until they no longer require services or until they reach age 22, whichever occurs
first.

(b) For purposes of this subdivision, "psychiatric residential treatment facility" means
a facility other than a hospital that provides psychiatric services, as described in Code of
Federal Regulations, title 42, sections 441.151 to 441.182, to individuals under age 21 in
an inpatient setting.

(c) The commissioner shall develop admissions and discharge procedures and establish
rates consistent with guidelines from the federal Centers for Medicare and Medicaid Services.

(d) The commissioner shall enroll up to 150 certified psychiatric residential treatment
facility services beds at up to six sites. The commissioner shall select psychiatric residential
treatment facility services providers through a request for proposals process. Providers of
state-operated services may respond to the request for proposals.

Sec. 23.

Minnesota Statutes 2016, section 256B.0625, subdivision 60a, is amended to
read:


Subd. 60a.

Community medical response emergency medical technician services.

(a) Medical assistance covers services provided by a community medical response emergency
medical technician (CEMT) who is certified under section 144E.275, subdivision 7, when
the services are provided in accordance with this subdivision.

(b) A CEMT may provide a posthospital discharge postdischarge visit, after discharge
from a hospital or skilled nursing facility,
when ordered by a treating physician. The
posthospital discharge postdischarge visit includes:

(1) verbal or visual reminders of discharge orders;

(2) recording and reporting of vital signs to the patient's primary care provider;

(3) medication access confirmation;

(4) food access confirmation; and

(5) identification of home hazards.

(c) An individual who has repeat ambulance calls due to falls, has been discharged from
a nursing home,
or has been identified by the individual's primary care provider as at risk
for nursing home placement, may receive a safety evaluation visit from a CEMT when
ordered by a primary care provider in accordance with the individual's care plan. A safety
evaluation visit includes:

(1) medication access confirmation;

(2) food access confirmation; and

(3) identification of home hazards.

(d) A CEMT shall be paid at $9.75 per 15-minute increment. A safety evaluation visit
may not be billed for the same day as a posthospital discharge postdischarge visit for the
same individual.

Sec. 24.

Minnesota Statutes 2016, section 256B.0625, subdivision 64, is amended to read:


Subd. 64.

Investigational drugs, biological products, and devices.

Medical assistance
and the early periodic screening, diagnosis, and treatment (EPSDT) program do not cover
costs incidental to, associated with, or resulting from the use of investigational drugs,
biological products, or devices as defined in section 151.375., except that stiripentol may
be covered by the EPSDT program, only if all of the following conditions are met:

(1) the use of stiripentol is determined to be medically necessary;

(2) stiripentol is covered only for eligible enrollees with a documented diagnosis of
Dravet syndrome, regardless of whether an SCN1A genetic mutation is found, or children
with Malignant Migrating Partial Epilepsy in Infancy due to an SCN2A genetic mutation;

(3) all other available covered prescription medications that are medically necessary for
the patient have been tried without successful outcomes; and

(4) the United States Food and Drug Administration has approved the treating physician's
individual patient investigational new drug application (IND) for the use of stiripentol for
treatment.

This provision related to coverage of stiripentol does not apply to MinnesotaCare
coverage under chapter 256L.

Sec. 25.

Minnesota Statutes 2016, section 256B.0644, is amended to read:


256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
PROGRAMS.

(a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a health
maintenance organization, as defined in chapter 62D, must participate as a provider or
contractor in the medical assistance program and MinnesotaCare as a condition of
participating as a provider in health insurance plans and programs or contractor for state
employees established under section 43A.18, the public employees insurance program under
section 43A.316, for health insurance plans offered to local statutory or home rule charter
city, county, and school district employees, the workers' compensation system under section
176.135, and insurance plans provided through the Minnesota Comprehensive Health
Association under sections 62E.01 to 62E.19. The limitations on insurance plans offered to
local government employees shall not be applicable in geographic areas where provider
participation is limited by managed care contracts with the Department of Human Services.
This section does not apply to dental service providers providing dental services outside
the seven-county metropolitan area.

(b) For providers other than health maintenance organizations, participation in the medical
assistance program means that:

(1) the provider accepts new medical assistance and MinnesotaCare patients;

(2) for providers other than dental service providers, at least 20 percent of the provider's
patients are covered by medical assistance and MinnesotaCare as their primary source of
coverage; or

(3) for dental service providers providing dental services in the seven-county metropolitan
area
, at least ten percent of the provider's patients are covered by medical assistance and
MinnesotaCare as their primary source of coverage, or the provider accepts new medical
assistance and MinnesotaCare patients who are children with special health care needs. For
purposes of this section, "children with special health care needs" means children up to age
18 who: (i) require health and related services beyond that required by children generally;
and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
neurological diseases; visual impairment or deafness; Down syndrome and other genetic
disorders; autism; fetal alcohol syndrome; and other conditions designated by the
commissioner after consultation with representatives of pediatric dental providers and
consumers.

(c) Patients seen on a volunteer basis by the provider at a location other than the provider's
usual place of practice may be considered in meeting the participation requirement in this
section. The commissioner shall establish participation requirements for health maintenance
organizations. The commissioner shall provide lists of participating medical assistance
providers on a quarterly basis to the commissioner of management and budget, the
commissioner of labor and industry, and the commissioner of commerce. Each of the
commissioners shall develop and implement procedures to exclude as participating providers
in the program or programs under their jurisdiction those providers who do not participate
in the medical assistance program. The commissioner of management and budget shall
implement this section through contracts with participating health and dental carriers.

(d) A volunteer dentist who has signed a volunteer agreement under section 256B.0625,
subdivision 9a
, shall not be considered to be participating in medical assistance or
MinnesotaCare for the purpose of this section.

EFFECTIVE DATE.

This section is effective upon receipt of any necessary federal
waiver or approval. The commissioner of human services shall notify the revisor of statutes
if a federal waiver or approval is sought and, if sought, when a federal waiver or approval
is obtained.

Sec. 26.

Minnesota Statutes 2016, section 256B.0755, is amended to read:


256B.0755 HEALTH CARE DELIVERY SYSTEMS INTEGRATED HEALTH
PARTNERSHIP
DEMONSTRATION PROJECT.

Subdivision 1.

Implementation.

(a) The commissioner shall develop and authorize a
demonstration project to test alternative and innovative health care delivery systems
integrated health partnerships
, including accountable care organizations that provide services
to a specified patient population for an agreed-upon total cost of care or risk/gain sharing
payment arrangement. The commissioner shall develop a request for proposals for
participation in the demonstration project in consultation with hospitals, primary care
providers, health plans, and other key stakeholders.

(b) In developing the request for proposals, the commissioner shall:

(1) establish uniform statewide methods of forecasting utilization and cost of care for
the appropriate Minnesota public program populations, to be used by the commissioner for
the health care delivery system integrated health partnership projects;

(2) identify key indicators of quality, access, patient satisfaction, and other performance
indicators that will be measured, in addition to indicators for measuring cost savings;

(3) allow maximum flexibility to encourage innovation and variation so that a variety
of provider collaborations are able to become health care delivery systems integrated health
partnerships and they can be customized for the special needs and barriers of patient
populations experiencing health disparities due to social, economic, racial, or ethnic factors
;

(4) encourage and authorize different levels and types of financial risk;

(5) encourage and authorize projects representing a wide variety of geographic locations,
patient populations, provider relationships, and care coordination models;

(6) encourage projects that involve close partnerships between the health care delivery
system
integrated health partnerships and counties and nonprofit agencies that provide
services to patients enrolled with the health care delivery system integrated health
partnerships
, including social services, public health, mental health, community-based
services, and continuing care;

(7) encourage projects established by community hospitals, clinics, and other providers
in rural communities;

(8) identify required covered services for a total cost of care model or services considered
in whole or partially in an analysis of utilization for a risk/gain sharing model;

(9) establish a mechanism to monitor enrollment;

(10) establish quality standards for the delivery system integrated health partnership
demonstrations that are appropriate for the particular patient population to be served; and

(11) encourage participation of privately insured population so as to create sufficient
alignment in demonstration systems integrated health partnerships.

(c) To be eligible to participate in the demonstration project, a health care delivery system
an integrated health partnership
must:

(1) provide required covered services and care coordination to recipients enrolled in the
health care delivery system integrated health partnership;

(2) establish a process to monitor enrollment and ensure the quality of care provided;

(3) in cooperation with counties and community social service agencies, coordinate the
delivery of health care services with existing social services programs;

(4) provide a system for advocacy and consumer protection; and

(5) adopt innovative and cost-effective methods of care delivery and coordination, which
may include the use of allied health professionals, telemedicine, patient educators, care
coordinators, and community health workers.

(d) A health care delivery system An integrated health partnership demonstration may
be formed by the following groups of providers of services and suppliers if they have
established a mechanism for shared governance:

(1) professionals in group practice arrangements;

(2) networks of individual practices of professionals;

(3) partnerships or joint venture arrangements between hospitals and health care
professionals;

(4) hospitals employing professionals; and

(5) other groups of providers of services and suppliers as the commissioner determines
appropriate.

A managed care plan or county-based purchasing plan may participate in this
demonstration in collaboration with one or more of the entities listed in clauses (1) to (5).

A health care delivery system An integrated health partnership may contract with a
managed care plan or a county-based purchasing plan to provide administrative services,
including the administration of a payment system using the payment methods established
by the commissioner for health care delivery systems.

(e) The commissioner may require a health care delivery system an integrated health
partnership
to enter into additional third-party contractual relationships for the assessment
of risk and purchase of stop loss insurance or another form of insurance risk management
related to the delivery of care described in paragraph (c).

Subd. 2.

Enrollment.

(a) Individuals eligible for medical assistance or MinnesotaCare
shall be eligible for enrollment in a health care delivery system an integrated health
partnership
.

(b) Eligible applicants and recipients may enroll in a health care delivery system an
integrated health partnership
if a system an integrated health partnership serves the county
in which the applicant or recipient resides. If more than one health care delivery system
integrated health partnership
serves a county, the applicant or recipient shall be allowed to
choose among the delivery systems integrated health partnerships.

(c) The commissioner may assign an applicant or recipient to a health care delivery
system
an integrated health partnership if a health care delivery system an integrated health
partnership
is available and no choice has been made by the applicant or recipient.

Subd. 3.

Accountability.

(a) Health care delivery systems Integrated health partnerships
must accept responsibility for the quality of care based on standards established under
subdivision 1, paragraph (b), clause (10), and the cost of care or utilization of services
provided to its enrollees under subdivision 1, paragraph (b), clause (1). Accountability
standards must be appropriate to the particular population served.

(b) A health care delivery system An integrated health partnership may contract and
coordinate with providers and clinics for the delivery of services and shall contract with
community health clinics, federally qualified health centers, community mental health
centers or programs, county agencies, and rural clinics to the extent practicable.

(c) A health care delivery system An integrated health partnership must indicate how it
will coordinate with other services affecting its patients' health, quality of care, and cost of
care that are provided by other providers, county agencies, and other organizations in the
local service area. The health care delivery system integrated health partnership must indicate
how it will engage other providers, counties, and organizations, including county-based
purchasing plans, that provide services to patients of the health care delivery system
integrated health partnership
on issues related to local population health, including applicable
local needs, priorities, and public health goals. The health care delivery system integrated
health partnership
must describe how local providers, counties, organizations, including
county-based purchasing plans, and other relevant purchasers were consulted in developing
the application to participate in the demonstration project.

Subd. 4.

Payment system.

(a) In developing a payment system for health care delivery
systems
integrated health partnerships, the commissioner shall establish a total cost of care
benchmark or a risk/gain sharing payment model to be paid for services provided to the
recipients enrolled in a health care delivery system an integrated health partnership.

(b) The payment system may include incentive payments to health care delivery systems
integrated health partnerships
that meet or exceed annual quality and performance targets
realized through the coordination of care.

(c) An amount equal to the savings realized to the general fund as a result of the
demonstration project shall be transferred each fiscal year to the health care access fund.

(d) The payment system shall include a population-based payment that supports care
coordination services for all enrollees served by the integrated health partnerships, and is
risk-adjusted to reflect varying levels of care coordination intensiveness for enrollees with
chronic conditions or limited English skills, or who are homeless or experience health
disparities or other barriers to health care. The population-based payment shall be a
per-member per-month payment paid at least on a quarterly basis. Integrated health
partnerships receiving this payment must continue to meet cost and quality metrics under
the program to maintain eligibility for the population-based payment. An integrated health
partnership is eligible to receive a payment under this paragraph even if the partnership is
not participating in a risk-based or gain-sharing payment model and regardless of the size
of the patient population served by the integrated health partnership. Any integrated health
partnership participant certified as a health care home under section 256B.0751 that agrees
to a payment method that includes population-based payments for care coordination is not
eligible to receive health care home payment or care coordination fee authorized under
section 62U.23 or 256B.0753, subdivision 1, or in-reach care coordination under section
256B.0625, subdivision 56, for any medical assistance or MinnesotaCare recipients enrolled
or attributed to the integrated health partnership under this demonstration.

Subd. 5.

Outpatient prescription drug coverage.

Outpatient prescription drug coverage
may be provided through accountable care organizations only if the delivery method qualifies
for federal prescription drug rebates.

Subd. 6.

Federal approval.

The commissioner shall apply for any federal waivers or
other federal approval required to implement this section. The commissioner shall also apply
for any applicable grant or demonstration under the Patient Protection and Affordable Health
Care Act, Public Law 111-148, or the Health Care and Education Reconciliation Act of
2010, Public Law 111-152, that would further the purposes of or assist in the establishment
of accountable care organizations.

Subd. 7.

Expansion.

The commissioner shall expand the demonstration project to include
additional medical assistance and MinnesotaCare enrollees, and shall seek participation of
Medicare in demonstration projects. The commissioner shall seek to include participation
of privately insured persons and Medicare recipients in the health care delivery
demonstration. As part of the demonstration expansion, the commissioner may procure the
services of the health care delivery systems authorized under this section by geographic
area, to supplement or replace the services provided by managed care plans operating under
section 256B.69.

Sec. 27.

[256B.0759] HEALTH CARE DELIVERY SYSTEMS DEMONSTRATION
PROJECT.

Subdivision 1.

Implementation.

(a) The commissioner shall develop and implement a
demonstration project to test alternative and innovative health care delivery system payment
and care models that provide services to medical assistance and MinnesotaCare enrollees
for an agreed-upon, prospective per capita or total cost of care payment. The commissioner
shall implement this demonstration project in coordination with, and as an expansion of,
the demonstration project authorized under section 256B.0755.

(b) In developing the demonstration project, the commissioner shall:

(1) establish uniform statewide methods of forecasting utilization and cost of care for
the medical assistance and MinnesotaCare populations to be served under the health care
delivery system project;

(2) identify key indicators of quality, access, and patient satisfaction, and identify methods
to measure cost savings;

(3) allow maximum flexibility to encourage innovation and variation so that a variety
of provider collaborations are able to participate as health care delivery systems, and health
care delivery systems can be customized to address the special needs and barriers of patient
populations;

(4) authorize participation by health care delivery systems representing a variety of
geographic locations, patient populations, provider relationships, and care coordination
models;

(5) recognize the close partnerships between health care delivery systems and the counties
and nonprofit agencies that also provide services to patients enrolled in the health care
delivery system, including social services, public health, mental health, community-based
services, and continuing care;

(6) identify services to be included under a prospective per capita payment model, and
project utilization and cost of these services under a total cost of care risk/gain sharing
model;

(7) establish a mechanism to monitor enrollment and attribute enrollees to a specific
health care delivery system; and

(8) establish quality standards for delivery systems that are appropriate for the specific
patient populations served.

Subd. 2.

Requirements for health care delivery systems.

(a) To be eligible to participate
in the demonstration project, a health care delivery system must:

(1) provide required services and care coordination to individuals enrolled in the health
care delivery system;

(2) establish a process to monitor enrollment and ensure the quality of care provided;

(3) in cooperation with counties and community social service agencies, coordinate the
delivery of health care services with existing social services programs;

(4) provide a system for advocacy and consumer protection; and

(5) adopt innovative and cost-effective methods of care delivery and coordination, which
may include the use of allied health professionals, telemedicine and patient educators, care
coordinators, community paramedics, and community health workers.

(b) A health care delivery system may be formed by the following types of health care
providers, if they have established, as applicable, a mechanism for shared governance:

(1) health care providers in group practice arrangements;

(2) networks of health care providers in individual practice;

(3) partnerships or joint venture arrangements between hospitals and health care providers;

(4) hospitals employing or contracting with the necessary range of health care providers;
and

(5) other entities, as the commissioner determines appropriate.

(c) A health care delivery system must contract with a third-party administrator to provide
administrative services, including the administration of the payment system established
under the demonstration project. The third-party administrator must conduct an assessment
of risk, and must purchase stop-loss insurance or another form of insurance risk management
related to the delivery of care. The commissioner may waive the requirement for contracting
with a third-party administrator if the health care delivery system can demonstrate to the
commissioner that it can satisfactorily perform all of the duties assigned to the third-party
administrator.

Subd. 3.

Enrollment.

(a) Individuals eligible for medical assistance or MinnesotaCare
shall be eligible for enrollment in a health care delivery system. Individuals required to
enroll in the prepaid medical assistance program or prepaid MinnesotaCare may opt out of
receiving care from a managed care or county-based purchasing plan, and elect to receive
care through a health care delivery system established under this section.

(b) Eligible applicants and recipients may enroll in a health care delivery system if the
system serves the county in which the applicant or recipient resides. If more than one health
care delivery system serves a county, the applicant or recipient may choose among the
delivery systems.

(c) The commissioner shall assign an applicant or recipient to a health care delivery
system if:

(1) the applicant or recipient is currently or has recently been attributed to the health
care delivery system as part of an integrated health partnership under section 256B.0755;
or

(2) no choice has been made by the applicant or recipient. In this case, the commissioner
shall assign an applicant or recipient based on geographic criteria or based on the health
care providers from whom the applicant or recipient has received prior care.

Subd. 4.

Accountability.

(a) Health care delivery systems are responsible for the quality
of care based on standards established by the commissioner, and for enrollee cost of care
and utilization of services. The commissioner shall adjust accountability standards including
the quality, cost, and utilization of care to take into account the social, economic, racial, or
ethnic barriers experienced by the health care delivery system's patient population.

(b) A health care delivery system must contract with community health clinics, federally
qualified health centers, community mental health centers or programs, county agencies,
and rural health clinics to the extent practicable.

(c) A health care delivery system must indicate to the commissioner how it will coordinate
its services with those delivered by other providers, county agencies, and other organizations
in the local service area. The health care delivery system must indicate how it will engage
other providers, counties, and organizations that provide services to patients of the health
care delivery system on issues related to local population health, including applicable local
needs, priorities, and public health goals. The health care delivery system must describe
how local providers, counties, and organizations were consulted in developing the application
submitted to the commissioner requiring participation in the demonstration project.

Subd. 5.

Payment system.

The commissioner shall develop a payment system for the
health care delivery system project that includes prospective per capita payments, total cost
of care benchmarks, and risk/gain sharing payment options. The payment system may
include incentive payments to health care delivery systems that meet or exceed annual
quality and performance targets through the coordination of care.

Subd. 6.

Federal waiver or approval.

The commissioner shall seek all federal waivers
or approval necessary to implement the health care delivery system demonstration project.
The commissioner shall notify the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finance of any
federal action related to the request for waivers and approval.

EFFECTIVE DATE.

This section is effective January 1, 2018, or upon receipt of
federal waivers or approval, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.

Sec. 28.

[256B.0941] PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY
FOR PERSONS YOUNGER THAN 21 YEARS OF AGE.

Subdivision 1.

Eligibility.

(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:

(1) before admission, services are determined to be medically necessary by the state's
medical review agent according to Code of Federal Regulations, title 42, section 441.152;

(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;

(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;

(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;

(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;

(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and

(7) was referred for treatment in a psychiatric residential treatment facility by a qualified
mental health professional licensed as defined in section 245.4871, subdivision 27, clauses
(1) to (6).

(b) A mental health professional making a referral shall submit documentation to the
state's medical review agent containing all information necessary to determine medical
necessity, including a standard diagnostic assessment completed within 180 days of the
individual's admission. Documentation shall include evidence of family participation in the
individual's treatment planning and signed consent for services.

Subd. 2.

Services.

Psychiatric residential treatment facility service providers must offer
and have the capacity to provide the following services:

(1) development of the individual plan of care, review of the individual plan of care
every 30 days, and discharge planning by required members of the treatment team according
to Code of Federal Regulations, title 42, sections 441.155 to 441.156;

(2) any services provided by a psychiatrist or physician for development of an individual
plan of care, conducting a review of the individual plan of care every 30 days, and discharge
planning by required members of the treatment team according to Code of Federal
Regulations, title 42, sections 441.155 to 441.156;

(3) active treatment seven days per week that may include individual, family, or group
therapy as determined by the individual care plan;

(4) individual therapy, provided a minimum of twice per week;

(5) family engagement activities, provided a minimum of once per week;

(6) consultation with other professionals, including case managers, primary care
professionals, community-based mental health providers, school staff, or other support
planners;

(7) coordination of educational services between local and resident school districts and
the facility;

(8) 24-hour nursing; and

(9) direct care and supervision, supportive services for daily living and safety, and
positive behavior management.

Subd. 3.

Per diem rate.

(a) The commissioner shall establish a statewide per diem rate
for psychiatric residential treatment facility services for individuals 21 years of age or
younger. The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers. Payment must not be made to more than one entity for each
individual for services provided under this section on a given day. The commissioner shall
set rates prospectively for the annual rate period. The commissioner shall require providers
to submit annual cost reports on a uniform cost reporting form and shall use submitted cost
reports to inform the rate-setting process. The cost reporting shall be done according to
federal requirements for Medicare cost reports.

(b) The following are included in the rate:

(1) costs necessary for licensure and accreditation, meeting all staffing standards for
participation, meeting all service standards for participation, meeting all requirements for
active treatment, maintaining medical records, conducting utilization review, meeting
inspection of care, and discharge planning. The direct services costs must be determined
using the actual cost of salaries, benefits, payroll taxes, and training of direct services staff
and service-related transportation; and

(2) payment for room and board provided by facilities meeting all accreditation and
licensing requirements for participation.

(c) A facility may submit a claim for payment outside of the per diem for professional
services arranged by and provided at the facility by an appropriately licensed professional
who is enrolled as a provider with Minnesota health care programs. Arranged services must
be billed by the facility on a separate claim, and the facility shall be responsible for payment
to the provider. These services must be included in the individual plan of care and are subject
to prior authorization by the state's medical review agent.

(d) Medicaid shall reimburse for concurrent services as approved by the commissioner
to support continuity of care and successful discharge from the facility. "Concurrent services"
means services provided by another entity or provider while the individual is admitted to a
psychiatric residential treatment facility. Payment for concurrent services may be limited
and these services are subject to prior authorization by the state's medical review agent.
Concurrent services may include targeted case management, assertive community treatment,
clinical care consultation, team consultation, and treatment planning.

(e) Payment rates under this subdivision shall not include the costs of providing the
following services:

(1) educational services;

(2) acute medical care or specialty services for other medical conditions;

(3) dental services; and

(4) pharmacy drug costs.

(f) For purposes of this section, "actual cost" means costs that are allowable, allocable,
reasonable, and consistent with federal reimbursement requirements in Code of Federal
Regulations, title 48, chapter 1, part 31, relating to for-profit entities, and the Office of
Management and Budget Circular Number A-122, relating to nonprofit entities.

Subd. 4.

Leave days.

(a) Medical assistance covers therapeutic and hospital leave days,
provided the recipient was not discharged from the psychiatric residential treatment facility
and is expected to return to the psychiatric residential treatment facility. A reserved bed
must be held for a recipient on hospital leave or therapeutic leave.

(b) A therapeutic leave day to home shall be used to prepare for discharge and
reintegration and shall be included in the individual plan of care. The state shall reimburse
75 percent of the per diem rate for a reserve bed day while the recipient is on therapeutic
leave. A therapeutic leave visit may not exceed three days without prior authorization.

(c) A hospital leave day shall be a day for which a recipient has been admitted to a
hospital for medical or acute psychiatric care and is temporarily absent from the psychiatric
residential treatment facility. The state shall reimburse 50 percent of the per diem rate for
a reserve bed day while the recipient is receiving medical or psychiatric care in a hospital.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 29.

Minnesota Statutes 2016, section 256B.0943, subdivision 13, is amended to read:


Subd. 13.

Exception to excluded services.

Notwithstanding subdivision 12, up to 15
hours of children's therapeutic services and supports provided within a six-month period to
a child with severe emotional disturbance who is residing in a hospital; a group home as
defined in Minnesota Rules, parts 2960.0130 to 2960.0220;
a residential treatment facility
licensed under Minnesota Rules, parts 2960.0580 to 2960.0690; a psychiatric residential
treatment facility under section 256B.0625, subdivision 45a;
a regional treatment center;
or other institutional group setting or who is participating in a program of partial
hospitalization are eligible for medical assistance payment if part of the discharge plan.

Sec. 30.

Minnesota Statutes 2016, section 256B.0945, subdivision 2, is amended to read:


Subd. 2.

Covered services.

All services must be included in a child's individualized
treatment or multiagency plan of care as defined in chapter 245.

For facilities that are not institutions for mental diseases according to federal statute and
regulation, medical assistance covers mental health-related services that are required to be
provided by a residential facility under section 245.4882 and administrative rules promulgated
thereunder, except for room and board. For residential facilities determined by the federal
Centers for Medicare and Medicaid Services to be an institution for mental diseases, medical
assistance covers medically necessary mental health services provided by the facility
according to section 256B.055, subdivision 13, except for room and board.

Sec. 31.

Minnesota Statutes 2016, section 256B.0945, subdivision 4, is amended to read:


Subd. 4.

Payment rates.

(a) Notwithstanding sections 256B.19 and 256B.041, payments
to counties for residential services provided under this section by a residential facility shall:

(1) for services provided by a residential facility that is not an institution for mental
diseases,
only be made of federal earnings for services provided under this section, and the
nonfederal share of costs for services provided under this section shall be paid by the county
from sources other than federal funds or funds used to match other federal funds. Payment
to counties for services provided according to this section shall be a proportion of the per
day contract rate that relates to rehabilitative mental health services and shall not include
payment for costs or services that are billed to the IV-E program as room and board.; and

(2) for services provided by a residential facility that is determined to be an institution
for mental diseases, be equivalent to the federal share of the payment that would have been
made if the residential facility were not an institution for mental diseases. The portion of
the payment representing what would be the nonfederal shares shall be paid by the county.
Payment to counties for services provided according to this section shall be a proportion of
the per day contract rate that relates to rehabilitative mental health services and shall not
include payment for costs or services that are billed to the IV-E program as room and board.

(b) Per diem rates paid to providers under this section by prepaid plans shall be the
proportion of the per-day contract rate that relates to rehabilitative mental health services
and shall not include payment for group foster care costs or services that are billed to the
county of financial responsibility. Services provided in facilities located in bordering states
are eligible for reimbursement on a fee-for-service basis only as described in paragraph (a)
and are not covered under prepaid health plans.

(c) Payment for mental health rehabilitative services provided under this section by or
under contract with an American Indian tribe or tribal organization or by agencies operated
by or under contract with an American Indian tribe or tribal organization must be made
according to section 256B.0625, subdivision 34, or other relevant federally approved
rate-setting methodology.

(d) The commissioner shall set aside a portion not to exceed five percent of the federal
funds earned for county expenditures under this section to cover the state costs of
administering this section. Any unexpended funds from the set-aside shall be distributed to
the counties in proportion to their earnings under this section.

Sec. 32.

Minnesota Statutes 2016, section 256B.15, subdivision 1, is amended to read:


Subdivision 1.

Policy and applicability.

(a) It is the policy of this state that individuals
or couples, either or both of whom participate in the medical assistance program, use their
own assets to pay their share of the cost of their care during or after their enrollment in the
program according to applicable federal law and the laws of this state. The following
provisions apply:

(1) subdivisions 1c to 1k shall not apply to claims arising under this section which are
presented under section 525.313;

(2) the provisions of subdivisions 1c to 1k expanding the interests included in an estate
for purposes of recovery under this section give effect to the provisions of United States
Code, title 42, section 1396p, governing recoveries, but do not give rise to any express or
implied liens in favor of any other parties not named in these provisions;

(3) the continuation of a recipient's life estate or joint tenancy interest in real property
after the recipient's death for the purpose of recovering medical assistance under this section
modifies common law principles holding that these interests terminate on the death of the
holder;

(4) all laws, rules, and regulations governing or involved with a recovery of medical
assistance shall be liberally construed to accomplish their intended purposes;

(5) a deceased recipient's life estate and joint tenancy interests continued under this
section shall be owned by the remainderpersons or surviving joint tenants as their interests
may appear on the date of the recipient's death. They shall not be merged into the remainder
interest or the interests of the surviving joint tenants by reason of ownership. They shall be
subject to the provisions of this section. Any conveyance, transfer, sale, assignment, or
encumbrance by a remainderperson, a surviving joint tenant, or their heirs, successors, and
assigns shall be deemed to include all of their interest in the deceased recipient's life estate
or joint tenancy interest continued under this section; and

(6) the provisions of subdivisions 1c to 1k continuing a recipient's joint tenancy interests
in real property after the recipient's death do not apply to a homestead owned of record, on
the date the recipient dies, by the recipient and the recipient's spouse as joint tenants with
a right of survivorship. Homestead means the real property occupied by the surviving joint
tenant spouse as their sole residence on the date the recipient dies and classified and taxed
to the recipient and surviving joint tenant spouse as homestead property for property tax
purposes in the calendar year in which the recipient dies. For purposes of this exemption,
real property the recipient and their surviving joint tenant spouse purchase solely with the
proceeds from the sale of their prior homestead, own of record as joint tenants, and qualify
as homestead property under section 273.124 in the calendar year in which the recipient
dies and prior to the recipient's death shall be deemed to be real property classified and
taxed to the recipient and their surviving joint tenant spouse as homestead property in the
calendar year in which the recipient dies. The surviving spouse, or any person with personal
knowledge of the facts, may provide an affidavit describing the homestead property affected
by this clause and stating facts showing compliance with this clause. The affidavit shall be
prima facie evidence of the facts it states.

(b) For purposes of this section, "medical assistance" includes the medical assistance
program under this chapter, the general assistance medical care program formerly codified
under chapter 256D, and alternative care for nonmedical assistance recipients under section
256B.0913.

(c) For purposes of this section, beginning January 1, 2010, "medical assistance" does
not include Medicare cost-sharing benefits in accordance with United States Code, title 42,
section 1396p.

(d) All provisions in this subdivision, and subdivisions 1d, 1f, 1g, 1h, 1i, and 1j, related
to the continuation of a recipient's life estate or joint tenancy interests in real property after
the recipient's death for the purpose of recovering medical assistance, are effective only for
life estates and joint tenancy interests established on or after August 1, 2003. For purposes
of this paragraph, medical assistance does not include alternative care.

EFFECTIVE DATE.

This section is effective the day following final enactment and
applies retroactively to estate claims pending on or after July 1, 2016, and to the estates of
people who died on or after July 1, 2016.

Sec. 33.

Minnesota Statutes 2016, section 256B.15, subdivision 1a, is amended to read:


Subd. 1a.

Estates subject to claims.

(a) If a person receives medical assistance hereunder,
on the person's death, if single, or on the death of the survivor of a married couple, either
or both of whom received medical assistance, or as otherwise provided for in this section,
the amount paid for medical assistance as limited under subdivision 2 for the person and
spouse shall be filed as a claim against the estate of the person or the estate of the surviving
spouse in the court having jurisdiction to probate the estate or to issue a decree of descent
according to sections 525.31 to 525.313.

(b) For the purposes of this section, the person's estate must consist of:

(1) the person's probate estate;

(2) all of the person's interests or proceeds of those interests in real property the person
owned as a life tenant or as a joint tenant with a right of survivorship at the time of the
person's death;

(3) all of the person's interests or proceeds of those interests in securities the person
owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time
of the person's death, to the extent the interests or proceeds of those interests become part
of the probate estate under section 524.6-307;

(4) all of the person's interests in joint accounts, multiple-party accounts, and pay-on-death
accounts, brokerage accounts, investment accounts, or the proceeds of those accounts, as
provided under sections 524.6-201 to 524.6-214 at the time of the person's death to the
extent the interests become part of the probate estate under section 524.6-207; and

(5) assets conveyed to a survivor, heir, or assign of the person through survivorship,
living trust, or other arrangements.

(c) For the purpose of this section and recovery in a surviving spouse's estate for medical
assistance paid for a predeceased spouse, the estate must consist of all of the legal title and
interests the deceased individual's predeceased spouse had in jointly owned or marital
property at the time of the spouse's death, as defined in subdivision 2b, and the proceeds of
those interests, that passed to the deceased individual or another individual, a survivor, an
heir, or an assign of the predeceased spouse through a joint tenancy, tenancy in common,
survivorship, life estate, living trust, or other arrangement. A deceased recipient who, at
death, owned the property jointly with the surviving spouse shall have an interest in the
entire property.

(d) For the purpose of recovery in a single person's estate or the estate of a survivor of
a married couple, "other arrangement" includes any other means by which title to all or any
part of the jointly owned or marital property or interest passed from the predeceased spouse
to another including, but not limited to, transfers between spouses which are permitted,
prohibited, or penalized for purposes of medical assistance.

(e) A claim shall be filed if medical assistance was rendered for either or both persons
under one of the following circumstances:

(1) the person was over 55 years of age, and received services under this chapter prior
to January 1, 2014;

(2) (1) the person resided in a medical institution for six months or longer, received
services under this chapter, and, at the time of institutionalization or application for medical
assistance, whichever is later, the person could not have reasonably been expected to be
discharged and returned home, as certified in writing by the person's treating physician. For
purposes of this section only, a "medical institution" means a skilled nursing facility,
intermediate care facility, intermediate care facility for persons with developmental
disabilities, nursing facility, or inpatient hospital;

(3) (2) the person received general assistance medical care services under the program
formerly codified under chapter 256D; or

(4) (3) the person was 55 years of age or older and received medical assistance services
on or after January 1, 2014, that consisted of nursing facility services, home and
community-based services, or related hospital and prescription drug benefits.

(f) The claim shall be considered an expense of the last illness of the decedent for the
purpose of section 524.3-805. Notwithstanding any law or rule to the contrary, a state or
county agency with a claim under this section must be a creditor under section 524.6-307.
Any statute of limitations that purports to limit any county agency or the state agency, or
both, to recover for medical assistance granted hereunder shall not apply to any claim made
hereunder for reimbursement for any medical assistance granted hereunder. Notice of the
claim shall be given to all heirs and devisees of the decedent, and to other persons with an
ownership interest in the real property owned by the decedent at the time of the decedent's
death, whose identity can be ascertained with reasonable diligence. The notice must include
procedures and instructions for making an application for a hardship waiver under subdivision
5; time frames for submitting an application and determination; and information regarding
appeal rights and procedures. Counties are entitled to one-half of the nonfederal share of
medical assistance collections from estates that are directly attributable to county effort.
Counties are entitled to ten percent of the collections for alternative care directly attributable
to county effort.

EFFECTIVE DATE.

This section is effective the day following final enactment and
applies retroactively to estate claims pending on or after July 1, 2016, and to the estates of
people who died on or after July 1, 2016.

Sec. 34.

Minnesota Statutes 2016, section 256B.15, subdivision 2, is amended to read:


Subd. 2.

Limitations on claims.

(a) For services rendered prior to January 1, 2014, the
claim shall include only the total amount of medical assistance rendered after age 55 or
during a period of institutionalization described in subdivision 1a, paragraph (e), and the
total amount of general assistance medical care rendered under the program formerly codified
under chapter 256D, and shall not include interest.

(b) For services rendered on or after January 1, 2014, (a) The claim shall include only:

(1) the amount of medical assistance rendered to recipients 55 years of age or older and
that consisted of nursing facility services, home and community-based services, and related
hospital and prescription drug services; and

(2) the total amount of medical assistance rendered during a period of institutionalization
described in subdivision 1a, paragraph (e), clause (2). (1); and

(3) the total amount of general assistance medical care rendered under the program
formerly codified under chapter 256D.

The claim shall not include interest. For the purposes of this section, "home and
community-based services" has the same meaning it has when used in United States Code,
title 42, section 1396p(b)(1)(B)(i), and includes the alternative care program under section
256B.0913, even for periods when alternative care services receive only state funding.

(c) (b) Claims that have been allowed but not paid shall bear interest according to section
524.3-806, paragraph (d). A claim against the estate of a surviving spouse who did not
receive medical assistance, for medical assistance rendered for the predeceased spouse,
shall be payable from the full value of all of the predeceased spouse's assets and interests
which are part of the surviving spouse's estate under subdivisions 1a and 2b. Recovery of
medical assistance expenses in the nonrecipient surviving spouse's estate is limited to the
value of the assets of the estate that were marital property or jointly owned property at any
time during the marriage. The claim is not payable from the value of assets or proceeds of
assets in the estate attributable to a predeceased spouse whom the individual married after
the death of the predeceased recipient spouse for whom the claim is filed or from assets and
the proceeds of assets in the estate which the nonrecipient decedent spouse acquired with
assets which were not marital property or jointly owned property after the death of the
predeceased recipient spouse. Claims for alternative care shall be net of all premiums paid
under section 256B.0913, subdivision 12, on or after July 1, 2003, and shall be limited to
services provided on or after July 1, 2003. Claims against marital property shall be limited
to claims against recipients who died on or after July 1, 2009.

EFFECTIVE DATE.

This section is effective the day following final enactment and
applies retroactively to estate claims pending on or after July 1, 2016, and to the estates of
people who died on or after July 1, 2016.

Sec. 35.

Minnesota Statutes 2016, section 256B.196, subdivision 2, is amended to read:


Subd. 2.

Commissioner's duties.

(a) For the purposes of this subdivision and subdivision
3, the commissioner shall determine the fee-for-service outpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall then determine
the amount of a supplemental payment to Hennepin County Medical Center and Regions
Hospital for these services that would increase medical assistance spending in this category
to the aggregate upper payment limit for all nonstate government hospitals in Minnesota.
In making this determination, the commissioner shall allot the available increases between
Hennepin County Medical Center and Regions Hospital based on the ratio of medical
assistance fee-for-service outpatient hospital payments to the two facilities. The commissioner
shall adjust this allotment as necessary based on federal approvals, the amount of
intergovernmental transfers received from Hennepin and Ramsey Counties, and other factors,
in order to maximize the additional total payments. The commissioner shall inform Hennepin
County and Ramsey County of the periodic intergovernmental transfers necessary to match
federal Medicaid payments available under this subdivision in order to make supplementary
medical assistance payments to Hennepin County Medical Center and Regions Hospital
equal to an amount that when combined with existing medical assistance payments to
nonstate governmental hospitals would increase total payments to hospitals in this category
for outpatient services to the aggregate upper payment limit for all hospitals in this category
in Minnesota. Upon receipt of these periodic transfers, the commissioner shall make
supplementary payments to Hennepin County Medical Center and Regions Hospital.

(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians and other billing professionals affiliated
with Hennepin County Medical Center and with Regions Hospital. The upper payment limit
shall be based on the average commercial rate or be determined using another method
acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
necessary to match the federal Medicaid payments available under this subdivision in order
to make supplementary payments to physicians and other billing professionals affiliated
with Hennepin County Medical Center and to make supplementary payments to physicians
and other billing professionals affiliated with Regions Hospital through HealthPartners
Medical Group equal to the difference between the established medical assistance payment
for physician and other billing professional services and the upper payment limit. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to physicians and other billing professionals affiliated with Hennepin County Medical Center
and shall make supplementary payments to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group.

(c) Beginning January 1, 2010, Hennepin County and Ramsey County may make monthly
voluntary intergovernmental transfers to the commissioner in amounts not to exceed
$12,000,000 per year from Hennepin County and $6,000,000 per year from Ramsey County.
The commissioner shall increase the medical assistance capitation payments to any licensed
health plan under contract with the medical assistance program that agrees to make enhanced
payments to Hennepin County Medical Center or Regions Hospital. The increase shall be
in an amount equal to the annual value of the monthly transfers plus federal financial
participation, with each health plan receiving its pro rata share of the increase based on the
pro rata share of medical assistance admissions to Hennepin County Medical Center and
Regions Hospital by those plans. Upon the request of the commissioner, health plans shall
submit individual-level cost data for verification purposes. The commissioner may ratably
reduce these payments on a pro rata basis in order to satisfy federal requirements for actuarial
soundness. If payments are reduced, transfers shall be reduced accordingly. Any licensed
health plan that receives increased medical assistance capitation payments under the
intergovernmental transfer described in this paragraph shall increase its medical assistance
payments to Hennepin County Medical Center and Regions Hospital by the same amount
as the increased payments received in the capitation payment described in this paragraph.

(d) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for ambulance services affiliated with Hennepin County
Medical Center and the city of St. Paul, and ambulance services owned and operated by
another governmental entity that chooses to participate by requesting the commissioner to
determine an upper payment limit
. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County and,
the city of St. Paul, and other participating governmental entities of the periodic
intergovernmental transfers necessary to match the federal Medicaid payments available
under this subdivision in order to make supplementary payments to Hennepin County
Medical Center and, the city of St. Paul, and other participating governmental entities equal
to the difference between the established medical assistance payment for ambulance services
and the upper payment limit. Upon receipt of these periodic transfers, the commissioner
shall make supplementary payments to Hennepin County Medical Center and, the city of
St. Paul., and other participating governmental entities. A tribal government that owns and
operates an ambulance service is not eligible to participate under this subdivision.

(e) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians, dentists, and other billing professionals
affiliated with the University of Minnesota and University of Minnesota Physicians. The
upper payment limit shall be based on the average commercial rate or be determined using
another method acceptable to the Centers for Medicare and Medicaid Services. The
commissioner shall inform the University of Minnesota Medical School and University of
Minnesota School of Dentistry of the periodic intergovernmental transfers necessary to
match the federal Medicaid payments available under this subdivision in order to make
supplementary payments to physicians, dentists, and other billing professionals affiliated
with the University of Minnesota and the University of Minnesota Physicians equal to the
difference between the established medical assistance payment for physician, dentist, and
other billing professional services and the upper payment limit. Upon receipt of these periodic
transfers, the commissioner shall make supplementary payments to physicians, dentists,
and other billing professionals affiliated with the University of Minnesota and the University
of Minnesota Physicians.

(f) Beginning January 1, 2018, the University of Minnesota Medical School and the
University of Minnesota School of Dentistry may make monthly voluntary intergovernmental
transfers to the commissioner in amounts not to exceed $20,000,000 per year from the
University of Minnesota Medical School and $6,000,000 per year from the University of
Minnesota School of Dentistry. The commissioner shall increase the medical assistance
capitation payments to any licensed health plan under contract with the medical assistance
program that agrees to make enhanced payments to the University of Minnesota and the
University of Minnesota Physicians. The increase shall be in an amount equal to the annual
value of the monthly transfers plus federal financial participation, with each health plan
receiving its pro rata share of the increase based on the pro rata share of medical assistance
services by physicians, dentists, and other billing professionals affiliated with the University
of Minnesota and the University of Minnesota Physicians. Upon the request of the
commissioner, health plans shall submit individual-level cost data for verification purposes.
The commissioner may ratably reduce these payments on a pro rata basis in order to satisfy
federal requirements for actuarial soundness. If payments are reduced, transfers shall be
reduced accordingly. Any licensed health plan that receives increased medical assistance
capitation payments under the intergovernmental transfer described in this paragraph shall
increase its medical assistance payments to the University of Minnesota and the University
of Minnesota Physicians by the same amount as the increased payments received in the
capitation payment described in this paragraph.

(g) The commissioner shall inform the transferring governmental entities on an ongoing
basis of the need for any changes needed in the intergovernmental transfers in order to
continue the payments under paragraphs (a) to (d) (f), at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.

(f) (h) The payments in paragraphs (a) to (d) (f) shall be implemented independently of
each other, subject to federal approval and to the receipt of transfers under subdivision 3.

(i) All of the data and funding transactions related to the payments in paragraphs (a) to
(f) shall be between the commissioner and the governmental entities.

EFFECTIVE DATE.

Paragraph (d) is effective July 1, 2017, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is received.

Sec. 36.

Minnesota Statutes 2016, section 256B.196, subdivision 3, is amended to read:


Subd. 3.

Intergovernmental transfers.

Based on the determination by the commissioner
under subdivision 2, Hennepin County and Ramsey County shall make periodic
intergovernmental transfers to the commissioner for the purposes of subdivision 2, paragraphs
(a) and (b). All of the intergovernmental transfers made by Hennepin County shall be used
to match federal payments to Hennepin County Medical Center under subdivision 2,
paragraph (a), and to physicians and other billing professionals affiliated with Hennepin
County Medical Center under subdivision 2, paragraph (b). All of the intergovernmental
transfers made by Ramsey County shall be used to match federal payments to Regions
Hospital under subdivision 2, paragraph (a), and to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group under subdivision
2, paragraph (b). All of the intergovernmental transfer payments made by the University of
Minnesota Medical School and the University of Minnesota School of Dentistry shall be
used to match federal payments to the University of Minnesota and the University of
Minnesota Physicians under subdivision 2, paragraphs (e) and (f).

Sec. 37.

Minnesota Statutes 2016, section 256B.196, subdivision 4, is amended to read:


Subd. 4.

Adjustments permitted.

(a) The commissioner may adjust the
intergovernmental transfers under subdivision 3 and the payments under subdivision 2,
based on the commissioner's determination of Medicare upper payment limits,
hospital-specific charge limits, hospital-specific limitations on disproportionate share
payments, medical inflation, actuarial certification, average commercial rates for physician
and other professional services,
and cost-effectiveness for purposes of federal waivers. Any
adjustments must be made on a proportional basis. The commissioner may make adjustments
under this subdivision only after consultation with the affected counties, university schools,
and hospitals. All payments under subdivision 2 and all intergovernmental transfers under
subdivision 3 are limited to amounts available after all other base rates, adjustments, and
supplemental payments in chapter 256B are calculated.

(b) The ratio of medical assistance payments specified in subdivision 2 to the voluntary
intergovernmental transfers specified in subdivision 3 shall not be reduced except as provided
under paragraph (a).

Sec. 38.

Minnesota Statutes 2016, section 256B.69, subdivision 5a, is amended to read:


Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.

(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.

(d) The commissioner shall require that managed care plans use the assessment and
authorization processes, forms, timelines, standards, documentation, and data reporting
requirements, protocols, billing processes, and policies consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements consistent with
medical assistance fee-for-service or the Department of Human Services contract
requirements for all personal care assistance services under section 256B.0659.

(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.

The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.

(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.

The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.

(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.

The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.

(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.

(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.

(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.

(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.

(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).

(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.

(n) Effective for services provided on or after January 1, 2018, through December 31,
2018, the commissioner shall withhold two percent of the capitation payment provided to
managed care plans under this section, and county-based purchasing plans under section
256B.692, for each medical assistance enrollee. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year, for capitation payments
for enrollees for whom the plan has submitted to the commissioner a verification of coverage
form completed and signed by the enrollee. The verification of coverage form must be
developed by the commissioner and made available to managed care and county-based
purchasing plans. The form must require the enrollee to provide the enrollee's name, street
address, and the name of the managed care or county-based purchasing plan selected by or
assigned to the enrollee, and must include a signature block that allows the enrollee to attest
that the information provided is accurate. A plan shall request that all enrollees complete
the verification of coverage form, and shall submit all completed forms to the commissioner
by February 28, 2018. If a completed form for an enrollee is not received by the commissioner
by that date:

(1) the commissioner shall not return to the plan funds withheld for that enrollee;

(2) the commissioner shall cease making capitation payments to the plan for that enrollee,
effective with the April 2018 coverage month; and

(3) the commissioner shall disenroll the enrollee from medical assistance, subject to any
enrollee appeal.

Sec. 39.

Minnesota Statutes 2016, section 256B.69, is amended by adding a subdivision
to read:


Subd. 36.

Competitive bidding and procurement.

(a) For managed care organization
contracts effective on or after January 1, 2019, the commissioner shall utilize a competitive
price and technical bidding program on a regional basis for nonelderly adults and children
who are not eligible on the basis of a disability and are enrolled in medical assistance and
MinnesotaCare. If the commissioner utilizes a competitive price bidding program, the
commissioner shall establish geographic regions for the purposes of competitive price
bidding. The commissioner shall not implement a competitive price bidding program for
more than 40 percent of the regions during each procurement. The commissioner shall
ensure that there is an adequate choice of managed care organizations based on the potential
enrollment, in a manner that is consistent with the requirements of section 256B.694. The
commissioner shall operate the competitive bidding program by region, but shall award
contracts by county and shall allow managed care organizations with a service area consisting
of only a portion of a region to bid on those counties within their service area only. For
purposes of this subdivision, "managed care organization" means a demonstration provider
as defined in subdivision 2, paragraph (b).

(b) The commissioner shall provide the scoring weight of selection criteria to be assigned
in the procurement process and include the scoring weight in the request for proposals.
Substantial weight shall be given to county board resolutions and priority areas identified
by counties.

(c) If a best and final offer is requested, each responding managed care organization
must be offered the opportunity to submit a best and final offer.

(d) The commissioner, when evaluating proposals, shall consider network adequacy for
dental and other services.

(e) Notwithstanding sections 13.591 and 13.599, after the managed care organizations
are notified about the award determination, but before contracts are signed, the commissioner
shall provide each managed care organization with its own scoring sheet and supporting
information. The scoring sheet shall not be made available to other managed care
organizations until final contracts are signed.

(f) A managed care organization that is aggrieved by the commissioner's decision related
to the selection of managed care organizations to deliver services in a county or counties
may appeal the commissioner's decision using the process outlined in section 256B.69,
subdivision 3a, paragraph (d), except that the recommendation of the three-person mediation
panel shall be binding on the commissioner.

(g) The commissioner shall contract for an independent evaluation of the competitive
price bidding process. The contractor must solicit recommendations from all parties
participating in the competitive price bidding process for service delivery in calendar year
2019 on how the competitive price bidding process may be improved for service delivery
in calendar year 2020 and annually thereafter. The commissioner shall make evaluation
results available to the public on the department's Web site.

Sec. 40.

Minnesota Statutes 2016, section 256B.75, is amended to read:


256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.

(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.

(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2016, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.

(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.

(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.

(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.

(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 41.

[256B.7635] REIMBURSEMENT FOR EVIDENCE-BASED PUBLIC
HEALTH NURSE HOME VISITS.

Effective for services provided on or after January 1, 2018, prenatal and postpartum
follow-up home visits provided by public health nurses or registered nurses supervised by
a public health nurse using evidence-based models shall be paid a minimum of $140 per
visit. Evidence-based postpartum follow-up home visits must be administered by home
visiting programs that meet the United States Department of Health and Human Services
criteria for evidence-based models and are identified by the commissioner of health as
eligible to be implemented under the Maternal, Infant, and Early Childhood Home Visiting
program. Home visits must target mothers and their children beginning with prenatal visits
through age three for the child.

Sec. 42.

Minnesota Statutes 2016, section 256B.766, is amended to read:


256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

(a) Effective for services provided on or after July 1, 2009, total payments for basic care
services, shall be reduced by three percent, except that for the period July 1, 2009, through
June 30, 2011, total payments shall be reduced by 4.5 percent for the medical assistance
and general assistance medical care programs, prior to third-party liability and spenddown
calculation. Effective July 1, 2010, the commissioner shall classify physical therapy services,
occupational therapy services, and speech-language pathology and related services as basic
care services. The reduction in this paragraph shall apply to physical therapy services,
occupational therapy services, and speech-language pathology and related services provided
on or after July 1, 2010.

(b) Payments made to managed care plans and county-based purchasing plans shall be
reduced for services provided on or after October 1, 2009, to reflect the reduction effective
July 1, 2009, and payments made to the plans shall be reduced effective October 1, 2010,
to reflect the reduction effective July 1, 2010.

(c) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for outpatient hospital facility fees shall be reduced by five percent from the
rates in effect on August 31, 2011.

(d) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for ambulatory surgery centers facility fees, medical supplies and durable
medical equipment not subject to a volume purchase contract, prosthetics and orthotics,
renal dialysis services, laboratory services, public health nursing services, physical therapy
services, occupational therapy services, speech therapy services, eyeglasses not subject to
a volume purchase contract, hearing aids not subject to a volume purchase contract, and
anesthesia services shall be reduced by three percent from the rates in effect on August 31,
2011.

(e) Effective for services provided on or after September 1, 2014, payments for
ambulatory surgery centers facility fees, hospice services, renal dialysis services, laboratory
services, public health nursing services, eyeglasses not subject to a volume purchase contract,
and hearing aids not subject to a volume purchase contract shall be increased by three percent
and payments for outpatient hospital facility fees shall be increased by three percent.
Payments made to managed care plans and county-based purchasing plans shall not be
adjusted to reflect payments under this paragraph.

(f) Payments for medical supplies and durable medical equipment not subject to a volume
purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014, through
June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies and durable
medical equipment not subject to a volume purchase contract, and prosthetics and orthotics,
provided on or after July 1, 2015, shall be increased by three percent from the rates as
determined under paragraphs (i) and (j).

(g) Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics and orthotics, and laboratory services to a hospital
meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4),
shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments made
to managed care plans and county-based purchasing plans shall not be adjusted to reflect
payments under this paragraph.

(h) This section does not apply to physician and professional services, inpatient hospital
services, family planning services, mental health services, dental services, prescription
drugs, medical transportation, federally qualified health centers, rural health centers, Indian
health services, and Medicare cost-sharing.

(i) Effective for services provided on or after July 1, 2015, the following categories of
medical supplies and
durable medical equipment shall be individually priced items: enteral
nutrition and supplies, customized and other specialized tracheostomy tubes and supplies,
electric patient lifts, and durable medical equipment repair and service. This paragraph does
not apply to medical supplies and durable medical equipment subject to a volume purchase
contract, products subject to the preferred diabetic testing supply program, and items provided
to dually eligible recipients when Medicare is the primary payer for the item. The
commissioner shall not apply any medical assistance rate reductions to durable medical
equipment as a result of Medicare competitive bidding.

(j) Effective for services provided on or after July 1, 2015, medical assistance payment
rates for durable medical equipment, prosthetics, orthotics, or supplies shall be increased
as follows:

(1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
were subject to the Medicare competitive bid that took effect in January of 2009 shall be
increased by 9.5 percent; and

(2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
being applied after calculation of any increased payment rate under clause (1).

This paragraph does not apply to medical supplies and durable medical equipment subject
to a volume purchase contract, products subject to the preferred diabetic testing supply
program, items provided to dually eligible recipients when Medicare is the primary payer
for the item, and individually priced items identified in paragraph (i). Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect the
rate increases in this paragraph.

(k) Effective for nonpressure support ventilators provided on or after January 1, 2016,
the rate shall be the lower of the submitted charge or the Medicare fee schedule rate. Effective
for pressure support ventilators provided on or after January 1, 2016, the rate shall be the
lower of the submitted charge or 47 percent above the Medicare fee schedule rate.

EFFECTIVE DATE.

This section is effective retroactively from January 1, 2016.

Sec. 43.

[256B.90] DEFINITIONS.

Subdivision 1.

Generally.

For the purposes of sections 256B.90 to 256B.92, the following
terms have the meanings given.

Subd. 2.

Commissioner.

"Commissioner" means the commissioner of human services.

Subd. 3.

Department.

"Department" means the Department of Human Services.

Subd. 4.

Hospital.

"Hospital" means a public or private institution licensed as a hospital
under section 144.50 that participates in medical assistance.

Subd. 5.

Medical assistance.

"Medical assistance" means the state's Medicaid program
under title XIX of the Social Security Act and administered according to this chapter.

Subd. 6.

Potentially avoidable complication.

"Potentially avoidable complication"
means a harmful event or negative outcome with respect to an individual, including an
infection or surgical complication, that: (1) occurs after the individual's admission to a
hospital or long-term care facility; and (2) may have resulted from the care, lack of care, or
treatment provided during the hospital or long-term care facility stay rather than from a
natural progression of an underlying disease.

Subd. 7.

Potentially avoidable event.

"Potentially avoidable event" means a potentially
avoidable complication, potentially avoidable readmission, or a combination of those events.

Subd. 8.

Potentially avoidable readmission.

"Potentially avoidable readmission" means
a return hospitalization of an individual within a period specified by the commissioner that
may have resulted from deficiencies in the care or treatment provided to the individual
during a previous hospital stay or from deficiencies in posthospital discharge follow-up.
Potentially avoidable readmission does not include a hospital readmission necessitated by
the occurrence of unrelated events after the discharge. Potentially avoidable readmission
includes the readmission of an individual to a hospital for: (1) the same condition or
procedure for which the individual was previously admitted; (2) an infection or other
complication resulting from care previously provided; or (3) a condition or procedure that
indicates that a surgical intervention performed during a previous admission was unsuccessful
in achieving the anticipated outcome.

Sec. 44.

[256B.91] MEDICAL ASSISTANCE OUTCOMES-BASED PAYMENT
PROGRAM.

Subdivision 1.

Generally.

The commissioner must establish and implement a medical
assistance outcomes-based payment program as a hospital outcomes program under section
256B.92 to provide hospitals with information and incentives to reduce potentially avoidable
events.

Subd. 2.

Potentially avoidable event methodology.

(a) The commissioner shall issue
a request for proposals to select a methodology for identifying potentially avoidable events
and for the costs associated with these events, and for measuring hospital performance with
respect to these events.

(b) The commissioner shall develop definitions for each potentially avoidable event
according to the selected methodology.

(c) To the extent possible, the methodology shall be one that has been used by other title
XIX programs under the Social Security Act or by commercial payers in health care outcomes
performance measurement and in outcome-based payment programs. The methodology
shall be open, transparent, and available for review by the public.

Subd. 3.

Medical assistance system waste.

(a) The commissioner must conduct a
comprehensive analysis of relevant state databases to identify waste in the medical assistance
system.

(b) The analysis must identify instances of potentially avoidable events in medical
assistance, and the costs associated with these events. The overall estimate of waste must
be broken down into actionable categories including but not limited to regions, hospitals,
MCOs, physicians, service lines, diagnosis-related groups, medical conditions and procedures,
patient characteristics, provider characteristics, and medical assistance program type.

(c) Information collected from this analysis must be utilized in hospital outcomes
programs described in this section.

Sec. 45.

[256B.92] HOSPITAL OUTCOMES PROGRAM.

Subdivision 1.

Generally.

The hospital outcomes program shall:

(1) target reduction of potentially avoidable readmissions and complications;

(2) apply to all state acute care hospitals participating in medical assistance. Program
adjustments may be made for certain types of hospitals; and

(3) be implemented in two phases: performance reporting and outcomes-based financial
incentives.

Subd. 2.

Phase 1; performance reporting.

(a) The commissioner shall develop and
maintain a reporting system to provide each hospital in Minnesota with regular confidential
reports regarding the hospital's performance for potentially avoidable readmissions and
potentially avoidable complications.

(b) The commissioner shall:

(1) conduct ongoing analyses of relevant state claims databases to identify instances of
potentially avoidable readmissions and potentially avoidable complications, and the
expenditures associated with these events;

(2) create or locate state readmission and complications norms;

(3) measure actual-to-expected hospital performance compared to state norms;

(4) compare hospitals with peers using risk adjustment procedures that account for the
severity of illness of each hospital's patients;

(5) distribute reports to hospitals to provide actionable information to create policies,
contracts, or programs designed to improve target outcomes; and

(6) foster collaboration among hospitals to share best practices.

(c) A hospital may share the information contained in the outcome performance reports
with physicians and other health care providers providing services at the hospital to foster
coordination and cooperation in the hospital's outcome improvement and waste reduction
initiatives.

Subd. 3.

Phase 2; outcomes-based financial incentives.

Twelve months after
implementation of performance reporting under subdivision 2, the commissioner must
establish financial incentives for a hospital to reduce potentially avoidable readmissions
and potentially avoidable complications.

Subd. 4.

Rate adjustment methodology.

(a) The commissioner must adjust the
reimbursement that a hospital receives under the All Patients Refined Diagnosis-Related
Group inpatient prospective payment system based on the hospital's performance exceeding,
or failing to achieve, outcome results based on the rates of potentially avoidable readmissions
and potentially avoidable complications.

(b) The rate adjustment methodology must:

(1) apply to each hospital discharge;

(2) determine a hospital-specific potentially avoidable outcome adjustment factor based
on the hospital's actual versus expected risk-adjusted performance compared to the state
norm;

(3) be based on a retrospective analysis of performance prospectively applied;

(4) include both rewards and penalties; and

(5) be communicated to a hospital in a clear and transparent manner.

Subd. 5.

Amendment of contracts.

The commissioner must amend contracts with
participating hospitals as necessary to incorporate the financial incentives established under
this section.

Subd. 6.

Budget neutrality.

The hospital outcomes program shall be implemented in a
budget-neutral manner with respect to aggregate Medicaid hospital expenditures.

Sec. 46.

Minnesota Statutes 2016, section 256L.15, subdivision 2, is amended to read:


Subd. 2.

Sliding fee scale; monthly individual or family income.

(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.

(b) Beginning January 1, 2014 October 1, 2017, MinnesotaCare enrollees shall pay
premiums according to the premium scale specified in paragraph (d).

(c) Paragraph (b) does not apply to:

(1) children 20 years of age or younger; and

(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.

(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:

Federal Poverty Guideline
Greater than or Equal to
Less than
Individual Premium
Amount
35%
55%
$4
$5
55%
80%
$6
$7
80%
90%
$8
$11
90%
100%
$10
$12
100%
110%
$12
$13
110%
120%
$14
$15
120%
130%
$15
$16
130%
140%
$16
$18
140%
150%
$25
$32
150%
160%
$29
$40
160%
170%
$33
$48
170%
180%
$38
$56
180%
190%
$43
$65
190%
$50
$75
200%
$85

Sec. 47. CAPITATION PAYMENT DELAY.

(a) The commissioner of human services shall delay $135,000,000 of the medical
assistance and MinnesotaCare capitation payment to managed care plans and county-based
purchasing plans due in May 2019 and the payment due in April 2019 for special needs
basic care until July 1, 2019. The payment shall be made no earlier than July 1, 2019, and
no later than July 31, 2019.

(b) The commissioner of human services shall delay $135,000,000 of the medical
assistance and MinnesotaCare capitation payment to managed care plans and county-based
purchasing plans due in the second quarter of calendar year 2021 and the April 2021 payment
for special needs basic care until July 1, 2021. The payment shall be made no earlier than
July 1, 2021, and no later than July 31, 2021.

Sec. 48. CHILDREN'S MENTAL HEALTH REPORT AND RECOMMENDATIONS.

The commissioner of human services shall conduct a comprehensive analysis of
Minnesota's continuum of intensive mental health services and shall develop
recommendations for a sustainable and community-driven continuum of care for children
with serious mental health needs, including children currently being served in residential
treatment. The commissioner's analysis shall include, but not be limited to:

(1) data related to access, utilization, efficacy, and outcomes for Minnesota's current
system of residential mental health treatment for a child with a severe emotional disturbance;

(2) potential expansion of the state's psychiatric residential treatment facility (PRTF)
capacity, including increasing the number of PRTF beds and conversion of existing children's
mental health residential treatment programs into PRTFs;

(3) the capacity need for PRTF and other group settings within the state if adequate
community-based alternatives are accessible, equitable, and effective statewide;

(4) recommendations for expanding alternative community-based service models to
meet the needs of a child with a serious mental health disorder who would otherwise require
residential treatment and potential service models that could be utilized, including data
related to access, utilization, efficacy, and outcomes;

(5) models of care used in other states; and

(6) analysis and specific recommendations for the design and implementation of new
service models, including analysis to inform rate setting as necessary.

The analysis shall be supported and informed by extensive stakeholder engagement.
Stakeholders include individuals who receive services, family members of individuals who
receive services, providers, counties, health plans, advocates, and others. Stakeholder
engagement shall include interviews with key stakeholders, intentional outreach to individuals
who receive services and the individual's family members, and regional listening sessions.

The commissioner shall provide a report with specific recommendations and timelines
for implementation to the legislative committees with jurisdiction over children's mental
health policy and finance by November 15, 2018.

Sec. 49. ENCOUNTER REPORTING OF 340B ELIGIBLE DRUGS.

(a) The commissioner of human services, in consultation with federally qualified health
centers, managed care organizations, and contract pharmacies shall develop a report on the
feasibility of a process to identify and report at point of sale the 340B drugs that are dispensed
to enrollees of managed care organizations who are patients of a federally qualified health
center to exclude these claims from the Medicaid drug rebate program and ensure that
duplicate discounts for drugs do not occur.

(b) By January 1, 2018, the commissioner shall present the report to the chairs and
ranking minority members of the house of representatives and senate committees with
jurisdiction over medical assistance.

Sec. 50. RATE-SETTING ANALYSIS REPORT.

The commissioner of human services shall conduct a comprehensive analysis report of
the current rate-setting methodology for outpatient, professional, and physician services
that do not have a cost-based, federally mandated, or contracted rate. The report shall include
recommendations for changes to the existing fee schedule that utilizes the Resource-Based
Relative Value System (RBRVS), and alternate payment methodologies for services that
do not have relative values, to simplify the fee for service medical assistance rate structure
and to improve consistency and transparency. In developing the report, the commissioner
shall consult with outside experts in Medicaid financing. The commissioner shall provide
a report on the analysis to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services finance by November 1, 2019.

Sec. 51. STUDY OF PAYMENT RATES FOR DURABLE MEDICAL EQUIPMENT
AND SUPPLIES.

The commissioner of human services shall study the impact of basing medical assistance
payment for durable medical equipment and medical supplies on Medicare payment rates,
as limited by the payment provisions in the 21st Century Cures Act, Public Law 114-255,
on access by medical assistance enrollees to these items. The study must include
recommendations for ensuring and improving access by medical assistance enrollees to
durable medical equipment and medical supplies. The commissioner shall report study
results and recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finance by February
1, 2018.

Sec. 52. FEDERAL APPROVAL.

The commissioner of human services shall request any federal waivers and approvals
necessary to allow the state to retain federal funds accruing in the state's basic health program
trust fund, and expend those funds for purposes other than those specified in Code of Federal
Regulations, title 42, part 600.705. The commissioner shall report any federal action regarding
this request to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 53. FEDERAL WAIVER OR APPROVAL.

The commissioner of human services shall seek any federal waiver or approval necessary
to implement Minnesota Statutes, section 256B.0644.

ARTICLE 2

CONTINUING CARE

Section 1.

Minnesota Statutes 2016, section 144.0724, subdivision 6, is amended to read:


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 0.1 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 ten days.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 2.

Minnesota Statutes 2016, section 144.562, subdivision 2, is amended to read:


Subd. 2.

Eligibility for license condition.

(a) A hospital is not eligible to receive a
license condition for swing beds unless (1) it either has a licensed bed capacity of less than
50 beds defined in the federal Medicare regulations, Code of Federal Regulations, title 42,
section 482.66, or it has a licensed bed capacity of 50 beds or more and has swing beds that
were approved for Medicare reimbursement before May 1, 1985, or it has a licensed bed
capacity of less than 65 beds and the available nursing homes within 50 miles have had, in
the aggregate, an average occupancy rate of 96 percent or higher in the most recent two
years as documented on the statistical reports to the Department of Health; and (2) it is
located in a rural area as defined in the federal Medicare regulations, Code of Federal
Regulations, title 42, section 482.66.

(b) Except for those critical access hospitals 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 have an attached nursing home or that owned a nursing home located in the
same municipality as of May 1, 2005, eligible hospitals are allowed a total of 2,000 days
of swing bed use per year. Critical access hospitals that have an attached nursing home or
that owned a nursing home located in the same municipality as of May 1, 2005, are allowed
swing bed use as provided in federal law.

(c) Except for critical access hospitals that have an attached nursing home or that owned
a nursing home located in the same municipality as of May 1, 2005, the commissioner of
health may approve swing bed use beyond 2,000 days as long as there are no Medicare
certified skilled nursing facility beds available within 25 miles of that hospital that are
willing to admit the patient and the patient agrees to the referral being sent to the skilled
nursing facility
. Critical access hospitals exceeding 2,000 swing bed days must maintain
documentation that they have contacted skilled nursing facilities within 25 miles to determine
if any skilled nursing facility beds are available that are willing to admit the patient and the
patient agrees to the referral being sent to the skilled nursing facility
.

(d) After reaching 2,000 days of swing bed use in a year, an eligible hospital to which
this limit applies may admit six additional patients to swing beds each year without seeking
approval from the commissioner or being in violation of this subdivision. These six swing
bed admissions are exempt from the limit of 2,000 annual swing bed days for hospitals
subject to this limit.

(e) A health care system that is in full compliance with this subdivision may allocate its
total limit of swing bed days among the hospitals within the system, provided that no hospital
in the system without an attached nursing home may exceed 2,000 swing bed days per year.

Sec. 3.

Minnesota Statutes 2016, section 144A.74, is amended to read:


144A.74 MAXIMUM CHARGES.

A supplemental nursing services agency must not bill or receive payments from a nursing
home licensed under this chapter at a rate higher than 150 percent of the sum of the weighted
average wage rate, plus a factor determined by the commissioner to incorporate payroll
taxes as defined in Minnesota Rules, part 9549.0020, subpart 33 section 256R.02, subdivision
37
, for the applicable employee classification for the geographic group to which the nursing
home is assigned under Minnesota Rules, part 9549.0052. The weighted average wage rates
must be determined by the commissioner of human services and reported to the commissioner
of health on an annual basis. Wages are defined as hourly rate of pay and shift differential,
including weekend shift differential and overtime. Facilities shall provide information
necessary to determine weighted average wage rates to the commissioner of human services
in a format requested by the commissioner. The maximum rate must include all charges for
administrative fees, contract fees, or other special charges in addition to the hourly rates for
the temporary nursing pool personnel supplied to a nursing home. A nursing home that pays
for the actual travel and housing costs for supplemental nursing services agency staff working
at the facility and that pays these costs to the employee, the agency, or another vendor, is
not violating the limitation on charges described in this section.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 4.

Minnesota Statutes 2016, 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 welfare 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 access
for disability inclusion, developmental disability, and elderly waiver plans, 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;

(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult 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 access for disability inclusion 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 access for disability inclusion,
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 welfare 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 access
for disability inclusion 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
access for disability inclusion 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 access for disability inclusion 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 to more than four persons with developmental
disabilities in a supervised living facility, including ICFs/DD;

(4) day services, including:

(i) structured day services as defined under the brain injury waiver plan;

(ii) day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disability waiver plan; and

(iii) prevocational services as defined under the brain injury and community access for
disability inclusion waiver plans; and

(5) supported employment as defined under the brain injury, developmental disability,
and community access for disability inclusion waiver plans.
employment exploration services
as defined under the brain injury, community alternative care, community access for disability
inclusion, and developmental disability waiver plans;

(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans; and

(7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plans.

EFFECTIVE DATE.

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

Sec. 5.

Minnesota Statutes 2016, section 252.27, subdivision 2a, is amended to read:


Subd. 2a.

Contribution amount.

(a) The natural or adoptive parents of a minor child,
including a child determined eligible for medical assistance without consideration of parental
income, must contribute to the cost of services used by making monthly payments on a
sliding scale based on income, unless the child is married or has been married, parental
rights have been terminated, or the child's adoption is subsidized according to chapter 259A
or through title IV-E of the Social Security Act. The parental contribution is a partial or full
payment for medical services provided for diagnostic, therapeutic, curing, treating, mitigating,
rehabilitation, maintenance, and personal care services as defined in United States Code,
title 26, section 213, needed by the child with a chronic illness or disability.

(b) For households with adjusted gross income equal to or greater than 275 percent of
federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:

(1) if the adjusted gross income is equal to or greater than 275 percent of federal poverty
guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 2.23 1.6725 percent of adjusted gross income at 275
percent of federal poverty guidelines and increases to 6.08 4.56 percent of adjusted gross
income for those with adjusted gross income up to 545 percent of federal poverty guidelines;

(2) if the adjusted gross income is greater than 545 percent of federal poverty guidelines
and less than 675 percent of federal poverty guidelines, the parental contribution shall be
6.08 4.56 percent of adjusted gross income;

(3) if the adjusted gross income is equal to or greater than 675 percent of federal poverty
guidelines and less than 975 percent of federal poverty guidelines, the parental contribution
shall be determined using a sliding fee scale established by the commissioner of human
services which begins at 6.08 4.56 percent of adjusted gross income at 675 percent of federal
poverty guidelines and increases to 8.1 6.075 percent of adjusted gross income for those
with adjusted gross income up to 975 percent of federal poverty guidelines; and

(4) if the adjusted gross income is equal to or greater than 975 percent of federal poverty
guidelines, the parental contribution shall be 10.13 7.5975 percent of adjusted gross income.

If the child lives with the parent, the annual adjusted gross income is reduced by $2,400
prior to calculating the parental contribution. If the child resides in an institution specified
in section 256B.35, the parent is responsible for the personal needs allowance specified
under that section in addition to the parental contribution determined under this section.
The parental contribution is reduced by any amount required to be paid directly to the child
pursuant to a court order, but only if actually paid.

(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes in
the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.

(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.

(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis effective
with the first month in which the child receives services. Annually upon redetermination
or at termination of eligibility, if the contribution exceeded the cost of services provided,
the local agency or the state shall reimburse that excess amount to the parents, either by
direct reimbursement if the parent is no longer required to pay a contribution, or by a
reduction in or waiver of parental fees until the excess amount is exhausted. All
reimbursements must include a notice that the amount reimbursed may be taxable income
if the parent paid for the parent's fees through an employer's health care flexible spending
account under the Internal Revenue Code, section 125, and that the parent is responsible
for paying the taxes owed on the amount reimbursed.

(f) The monthly contribution amount must be reviewed at least every 12 months; when
there is a change in household size; and when there is a loss of or gain in income from one
month to another in excess of ten percent. The local agency shall mail a written notice 30
days in advance of the effective date of a change in the contribution amount. A decrease in
the contribution amount is effective in the month that the parent verifies a reduction in
income or change in household size.

(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be deducted
from the adjusted gross income of the parent making the payment prior to calculating the
parental contribution under paragraph (b).

(h) The contribution under paragraph (b) shall be increased by an additional five percent
if the local agency determines that insurance coverage is available but not obtained for the
child. For purposes of this section, "available" means the insurance is a benefit of employment
for a family member at an annual cost of no more than five percent of the family's annual
income. For purposes of this section, "insurance" means health and accident insurance
coverage, enrollment in a nonprofit health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.

Parents who have more than one child receiving services shall not be required to pay
more than the amount for the child with the highest expenditures. There shall be no resource
contribution from the parents. The parent shall not be required to pay a contribution in
excess of the cost of the services provided to the child, not counting payments made to
school districts for education-related services. Notice of an increase in fee payment must
be given at least 30 days before the increased fee is due.

(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in
the 12 months prior to July 1:

(1) the parent applied for insurance for the child;

(2) the insurer denied insurance;

(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a
complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and

(4) as a result of the dispute, the insurer reversed its decision and granted insurance.

For purposes of this section, "insurance" has the meaning given in paragraph (h).

A parent who has requested a reduction in the contribution amount under this paragraph
shall submit proof in the form and manner prescribed by the commissioner or county agency,
including, but not limited to, the insurer's denial of insurance, the written letter or complaint
of the parents, court documents, and the written response of the insurer approving insurance.
The determinations of the commissioner or county agency under this paragraph are not rules
subject to chapter 14.

Sec. 6.

Minnesota Statutes 2016, section 252.41, subdivision 3, is amended to read:


Subd. 3.

Day training and habilitation services for adults with developmental
disabilities.

(a) "Day training and habilitation services for adults with developmental
disabilities" means services that:

(1) include supervision, training, assistance, and supported employment, center-based
work-related activities, or other community-integrated activities designed and implemented
in accordance with the individual service and individual habilitation plans required under
Minnesota Rules, parts 9525.0004 to 9525.0036, to help an adult reach and maintain the
highest possible level of independence, productivity, and integration into the community;
and

(2) are provided by a vendor licensed under sections 245A.01 to 245A.16 and 252.28,
subdivision 2
, to provide day training and habilitation services.

(b) Day training and habilitation services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.

(c) Day training and habilitation services do not include employment exploration,
employment development, or employment supports services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.

EFFECTIVE DATE.

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

Sec. 7.

[256.9755] CAREGIVER SUPPORT PROGRAMS.

Subdivision 1.

Program goals.

It is the goal of all area agencies on aging and caregiver
support programs to support family caregivers of persons with Alzheimer's disease or other
related dementias who are living in the community by:

(1) promoting caregiver support programs that serve Minnesotans in their homes and
communities; and

(2) providing, within the limits of available funds, the caregiver support services that
will enable the family caregiver to access caregiver support programs in the most
cost-effective and efficient manner.

Subd. 2.

Authority.

The Minnesota Board on Aging shall allocate to area agencies on
aging the state and federal funds which are received for the caregiver support program in a
manner consistent with federal requirements.

Subd. 3.

Caregiver support services.

Funds allocated to an area agency on aging for
caregiver support services must be used in a manner consistent with the National Family
Caregiver Support Program to reach family caregivers of persons with Alzheimer's disease
or related dementias. The funds must be used to provide social, nonmedical,
community-based services and activities that provide respite for caregivers and social
interaction for participants.

Sec. 8.

Minnesota Statutes 2016, section 256B.0625, subdivision 6a, is amended to read:


Subd. 6a.

Home health services.

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

Sec. 9.

Minnesota Statutes 2016, section 256B.0653, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

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

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

(c) "Home health agency services" means services delivered in the recipient's home
residence, except as specified in section 256B.0625,
by a home health agency to a recipient
with medical needs due to illness, disability, or physical conditions in settings permitted
under section 256B.0625, subdivision 6a
.

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

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

(f) "Occupational therapy services" mean the services defined in Minnesota Rules, part
9505.0390.

(g) "Physical therapy services" mean the services defined in Minnesota Rules, part
9505.0390.

(h) "Respiratory therapy services" mean the services defined in chapter 147C.

(i) "Speech-language pathology services" mean the services defined in Minnesota Rules,
part 9505.0390.

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

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

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

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

Sec. 10.

Minnesota Statutes 2016, section 256B.0653, subdivision 3, is amended to read:


Subd. 3.

Home health aide visits.

(a) Home health aide visits must be provided by a
certified home health aide using a written plan of care that is updated in compliance with
Medicare regulations. A home health aide shall provide hands-on personal care, perform
simple procedures as an extension of therapy or nursing services, and assist in instrumental
activities of daily living as defined in section 256B.0659, including assuring that the person
gets to medical appointments if identified in the written plan of care. Home health aide
visits must may be provided in the recipient's home or in the community where normal life
activities take the recipient
.

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

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

Sec. 11.

Minnesota Statutes 2016, section 256B.0653, subdivision 4, is amended to read:


Subd. 4.

Skilled nurse visit services.

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

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

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

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

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

Sec. 12.

Minnesota Statutes 2016, section 256B.0653, subdivision 5, is amended to read:


Subd. 5.

Home care therapies.

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

(b) Home care therapies must be:

(1) provided in the recipient's residence or in the community where normal life activities
take the recipient
after it has been determined the recipient is unable to access outpatient
therapy;

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

(3) assessed by an appropriate therapist; and

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

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

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

Sec. 13.

Minnesota Statutes 2016, section 256B.0653, subdivision 6, is amended to read:


Subd. 6.

Noncovered home health agency services.

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

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

(2) the following skilled nurse visits:

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

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

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

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

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

(vi) Medicare evaluation or administrative nursing visits required by Medicare;

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

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

(5) home health agency services without qualifying documentation of a face-to-face
encounter as specified in subdivision 7
.

Sec. 14.

Minnesota Statutes 2016, section 256B.0653, is amended by adding a subdivision
to read:


Subd. 7.

Face-to-face encounter.

(a) A face-to-face encounter by a qualifying provider
must be completed for all home health services regardless of the need for prior authorization,
except when providing a onetime perinatal visit by skilled nursing. The face-to-face encounter
may occur through telemedicine as defined in section 256B.0625, subdivision 3b. The
encounter must be related to the primary reason the recipient requires home health services
and must occur within the 90 days before or the 30 days after the start of services. The
face-to-face encounter may be conducted by one of the following practitioners, licensed in
Minnesota:

(1) a physician;

(2) a nurse practitioner or clinical nurse specialist;

(3) a certified nurse midwife; or

(4) a physician assistant.

(b) The allowed nonphysician practitioner, as described in this subdivision, performing
the face-to-face encounter must communicate the clinical findings of that face-to-face
encounter to the ordering physician. Those clinical findings must be incorporated into a
written or electronic document included in the recipient's medical record. To assure clinical
correlation between the face-to-face encounter and the associated home health services, the
physician responsible for ordering the services must:

(1) document that the face-to-face encounter, which is related to the primary reason the
recipient requires home health services, occurred within the required time period; and

(2) indicate the practitioner who conducted the encounter and the date of the encounter.

(c) For home health services requiring authorization, including prior authorization, home
health agencies must retain the qualifying documentation of a face-to-face encounter as part
of the recipient health service record, and submit the qualifying documentation to the
commissioner or the commissioner's designee upon request.

Sec. 15.

Minnesota Statutes 2016, section 256B.431, subdivision 30, is amended to read:


Subd. 30.

Bed layaway and delicensure.

(a) For rate years beginning on or after July
1, 2000, a nursing facility reimbursed under this section which has placed beds on layaway
shall, for purposes of application of the downsizing incentive in subdivision 3a, paragraph
(c), and calculation of the rental per diem, have those beds given the same effect as if the
beds had been delicensed so long as the beds remain on layaway. At the time of a layaway,
a facility may change its single bed election for use in calculating capacity days under
Minnesota Rules, part 9549.0060, subpart 11. The property payment rate increase shall be
effective the first day of the month of January or July, whichever occurs first following the
month date in which the layaway of the beds becomes effective under section 144A.071,
subdivision 4b
.

(b) For rate years beginning on or after July 1, 2000, notwithstanding any provision to
the contrary under section 256B.434, a nursing facility reimbursed under that section which
has placed beds on layaway shall, for so long as the beds remain on layaway, be allowed
to:

(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the layaway
and the number of beds after the layaway.

The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the layaway of beds and clauses (1), (2), and
(3). If a facility reimbursed under section 256B.434 completes a moratorium exception
project after its base year, the base year property rate shall be the moratorium project property
rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
paragraph (c). The property payment rate increase shall be effective the first day of the
month of January or July, whichever occurs first following the month date in which the
layaway of the beds becomes effective.

(c) If a nursing facility removes a bed from layaway status in accordance with section
144A.071, subdivision 4b, the commissioner shall establish capacity days based on the
number of licensed and certified beds in the facility not on layaway and shall reduce the
nursing facility's property payment rate in accordance with paragraph (b).

(d) For the rate years beginning on or after July 1, 2000, notwithstanding any provision
to the contrary under section 256B.434, a nursing facility reimbursed under that section,
which has delicensed beds after July 1, 2000, by giving notice of the delicensure to the
commissioner of health according to the notice requirements in section 144A.071, subdivision
4b
, shall be allowed to:

(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the
delicensure and the number of beds after the delicensure.

The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the delicensure of beds and clauses (1), (2),
and (3). If a facility reimbursed under section 256B.434 completes a moratorium exception
project after its base year, the base year property rate shall be the moratorium project property
rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
paragraph (c). The property payment rate increase shall be effective the first day of the
month of January or July, whichever occurs first following the month date in which the
delicensure of the beds becomes effective.

(e) For nursing facilities reimbursed under this section or section 256B.434, any beds
placed on layaway shall not be included in calculating facility occupancy as it pertains to
leave days defined in Minnesota Rules, part 9505.0415.

(f) For nursing facilities reimbursed under this section or section 256B.434, the rental
rate calculated after placing beds on layaway may not be less than the rental rate prior to
placing beds on layaway.

(g) A nursing facility receiving a rate adjustment as a result of this section shall comply
with section 256B.47 256R.06, subdivision 2 5.

(h) A facility that does not utilize the space made available as a result of bed layaway
or delicensure under this subdivision to reduce the number of beds per room or provide
more common space for nursing facility uses or perform other activities related to the
operation of the nursing facility shall have its property rate increase calculated under this
subdivision reduced by the ratio of the square footage made available that is not used for
these purposes to the total square footage made available as a result of bed layaway or
delicensure.

Sec. 16.

Minnesota Statutes 2016, section 256B.434, subdivision 4, is amended to read:


Subd. 4.

Alternate rates for nursing facilities.

Effective for the rate years beginning
on and after January 1, 2018,
a nursing facility's case mix property payment rates rate for
the second and subsequent years of a facility's contract under this section are the previous
rate year's contract property payment rates rate plus an inflation adjustment and, for facilities
reimbursed under this section or section 256B.431, an adjustment to include the cost of any
increase in Health Department licensing fees for the facility taking effect on or after July
1, 2001
. The index for the inflation adjustment must be based on the change in the Consumer
Price Index-All Items (United States City average) (CPI-U) forecasted by the commissioner
of management and budget's national economic consultant
Reports and Forecasts Division
of the Department of Human Services
, as forecasted in the fourth quarter of the calendar
year preceding the rate year. The inflation adjustment must be based on the 12-month period
from the midpoint of the previous rate year to the midpoint of the rate year for which the
rate is being determined. For the rate years beginning on July 1, 1999, July 1, 2000, July 1,
2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007, July
1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall apply only to the
property-related payment rate. For the rate years beginning on October 1, 2011, October 1,
2012, October 1, 2013, October 1, 2014, October 1, 2015, January 1, 2016, and January 1,
2017, the rate adjustment under this paragraph shall be suspended. Beginning in 2005,
adjustment to the property payment rate under this section and section 256B.431 shall be
effective on October 1. In determining the amount of the property-related payment rate
adjustment under this paragraph, the commissioner shall determine the proportion of the
facility's rates that are property-related based on the facility's most recent cost report.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 17.

Minnesota Statutes 2016, section 256B.4913, subdivision 4a, is amended to read:


Subd. 4a.

Rate stabilization adjustment.

(a) For purposes of this subdivision,
"implementation period" means the period beginning January 1, 2014, and ending on the
last day of the month in which the rate management system is populated with the data
necessary to calculate rates for substantially all individuals receiving home and
community-based waiver services under sections 256B.092 and 256B.49. "Banding period"
means the time period beginning on January 1, 2014, and ending upon the expiration of the
12-month period defined in paragraph (c), clause (5).

(b) For purposes of this subdivision, the historical rate for all service recipients means
the individual reimbursement rate for a recipient in effect on December 1, 2013, except
that:

(1) for a day service recipient who was not authorized to receive these waiver services
prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
changed providers on or after January 1, 2014, the historical rate must be the weighted
average
authorized rate for the provider number in the county of service, effective December
1, 2013; or

(2) for a unit-based service with programming or a unit-based service without
programming recipient who was not authorized to receive these waiver services prior to
January 1, 2014; added a new service or services on or after January 1, 2014; or changed
providers on or after January 1, 2014, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or

(3) for residential service recipients who change providers on or after January 1, 2014,
the historical rate must be set by each lead agency within their county aggregate budget
using their respective methodology for residential services effective December 1, 2013, for
determining the provider rate for a similarly situated recipient being served by that provider.

(c) The commissioner shall adjust individual reimbursement rates determined under this
section so that the unit rate is no higher or lower than:

(1) 0.5 percent from the historical rate for the implementation period;

(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately
following the time period of clause (1);

(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately
following the time period of clause (2);

(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately
following the time period of clause (3);

(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately
following the time period of clause (4); and

(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
following the time period of clause (5). During this banding rate period, the commissioner
shall not enforce any rate decrease or increase that would otherwise result from the end of
the banding period. The commissioner shall, upon enactment, seek federal approval for the
addition of this banding period.

(d) The commissioner shall review all changes to rates that were in effect on December
1, 2013, to verify that the rates in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013.

(e) By December 31, 2014, the commissioner shall complete the review in paragraph
(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.

(f) During the banding period, the Medicaid Management Information System (MMIS)
service agreement rate must be adjusted to account for change in an individual's need. The
commissioner shall adjust the Medicaid Management Information System (MMIS) service
agreement rate by:

(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the level of service in effect on December 1, 2013;

(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the updated level of service at the time of application;
and

(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
service agreement rate, the difference between the values in clauses (1) and (2).

(g) This subdivision must not apply to rates for recipients served by providers new to a
given county after January 1, 2014. Providers of personal supports services who also acted
as fiscal support entities must be treated as new providers as of January 1, 2014.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 18.

Minnesota Statutes 2016, section 256B.4913, is amended by adding a subdivision
to read:


Subd. 7.

New services.

(a) A service added to section 256B.4914 after January 1, 2014,
is not subject to rate stabilization adjustment in this section.

(b) Employment support services authorized after January 1, 2018, under the new
employment support services definition according to the home and community-based services
waivers for people with disabilities under sections 256B.092 and 256B.49 are not subject
to rate stabilization adjustment in this section.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 19.

Minnesota Statutes 2016, section 256B.4914, subdivision 2, is amended to read:


Subd. 2.

Definitions.

(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.

(b) "Commissioner" means the commissioner of human services.

(c) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.

(d) "Customized living tool" means a methodology for setting service rates that delineates
and documents the amount of each component service included in a recipient's customized
living service plan.

(e) "Disability waiver rates system" means a statewide system that establishes rates that
are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.

(f) "Individual staffing" means the time spent as a one-to-one interaction specific to an
individual recipient by staff to provide direct support and assistance with activities of daily
living, instrumental activities of daily living, and training to participants, and is based on
the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.

(g) "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.

(h) "Median" means the amount that divides distribution into two equal groups, one-half
above the median and one-half below the median.

(i) "Payment or rate" means reimbursement to an eligible provider for services provided
to a qualified individual based on an approved service authorization.

(j) "Rates management system" means a Web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.

(k) "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.

(l) "Shared staffing" means time spent by employees, not defined under paragraph (f),
providing or available to provide more than one individual with direct support and assistance
with activities of daily living as defined under section 256B.0659, subdivision 1, paragraph
(b); instrumental activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (i); ancillary activities needed to support individual services; and training to
participants, and is based on the requirements in each individual's coordinated service and
support plan under section 245D.02, subdivision 4b; any coordinated service and support
plan addendum under section 245D.02, subdivision 4c; an assessment tool; and provider
observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.

(m) "Staffing ratio" means the number of recipients a service provider employee supports
during a unit of service based on a uniform assessment tool, provider observation, case
history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.

(n) "Unit of service" means the following:

(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;

(2) for day services under subdivision 7:

(i) for day training and habilitation services, a unit of service is either:

(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or

(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and

(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;

(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;

(iii) for prevocational services, a unit of service is a day or an hour. A day unit of service
is six or more hours of time spent providing direct service;

(3) for unit-based services with programming under subdivision 8:

(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; and

(ii) for all other services, a unit of service is 15 minutes; and

(4) for unit-based services without programming under subdivision 9:

(i) for respite services, a unit of service is a day or 15 minutes. When a day rate is
authorized, any portion of a calendar day when an individual receives services is billable
as a day; and

(ii) for all other services, a unit of service is 15 minutes.

EFFECTIVE DATE.

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

Sec. 20.

Minnesota Statutes 2016, section 256B.4914, subdivision 3, is amended to read:


Subd. 3.

Applicable services.

Applicable services are those authorized under the state's
home and community-based services waivers under sections 256B.092 and 256B.49,
including the following, as defined in the federally approved home and community-based
services plan:

(1) 24-hour customized living;

(2) adult day care;

(3) adult day care bath;

(4) behavioral programming;

(5) companion services;

(6) customized living;

(7) day training and habilitation;

(8) housing access coordination;

(9) independent living skills;

(10) in-home family support;

(11) night supervision;

(12) personal support;

(13) prevocational services;

(14) residential care services;

(15) residential support services;

(16) respite services;

(17) structured day services;

(18) supported employment services;

(19) (18) supported living services;

(20) (19) transportation services; and

(20) independent living skills specialist services;

(21) employment exploration services;

(22) employment development services;

(23) employment support services; and

(21) (24) other services as approved by the federal government in the state home and
community-based services plan.

EFFECTIVE DATE.

This section is effective upon federal approval, except clause
(20) is effective January 1, 2020. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.

Sec. 21.

Minnesota Statutes 2016, section 256B.4914, subdivision 5, is amended to read:


Subd. 5.

Base wage index and standard component values.

(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:

(1) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing aide assistant
(SOC code 31-1012 31-1014); and 20 percent of the median wage for social and human
services aide (SOC code 21-1093); and

(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing aide assistant (SOC code
31-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 20 percent of the median wage for social and human services aide (SOC code
21-1093);

(2) for day services, 20 percent of the median wage for nursing aide assistant (SOC code
31-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);

(3) for residential asleep-overnight staff, the wage will be $7.66 per hour is the minimum
wage in Minnesota for large employers
, except in a family foster care setting, the wage is
$2.80 per hour 36 percent of the minimum wage in Minnesota for large employers;

(4) for behavior program analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);

(5) for behavior program professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);

(6) for behavior program specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);

(7) for supportive living services staff, 20 percent of the median wage for nursing aide
assistant
(SOC code 31-1012 31-1014); 20 percent of the median wage for psychiatric
technician (SOC code 29-2053); and 60 percent of the median wage for social and human
services aide (SOC code 21-1093);

(8) for housing access coordination staff, 50 100 percent of the median wage for
community and social services specialist (SOC code 21-1099); and 50 percent of the median
wage for social and human services aide (SOC code 21-1093);

(9) for in-home family support staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 30 percent of the median wage for community social service specialist
(SOC code 21-1099); 40 percent of the median wage for social and human services aide
(SOC code 21-1093); and ten percent of the median wage for psychiatric technician (SOC
code 29-2053);

(10) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);

(11) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);

(11) (12) for supported employment supports services staff, 20 50 percent of the median
wage for nursing aide rehabilitation counselor (SOC code 31-1012 21-1015); 20 percent of
the median wage for psychiatric technician (SOC code 29-2053);
and 60 50 percent of the
median wage for community and social and human services aide specialist (SOC code
21-1093 21-1099);

(13) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(14) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);

(12) (15) for adult companion staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants
assistant (SOC code 31-1012 31-1014);

(13) (16) for night supervision staff, 20 percent of the median wage for home health
aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
aide (SOC code 39-9021); 20 percent of the median wage for nursing aide assistant (SOC
code 31-1012 31-1014); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093);

(14) (17) for respite staff, 50 percent of the median wage for personal and home care
aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies,
and attendants
assistant (SOC code 31-1012 31-1014);

(15) (18) for personal support staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants
assistant (SOC code 31-1012 31-1014);

(16) (19) for supervisory staff, the basic wage is $17.43 per hour with exception of the
supervisor of behavior analyst and behavior specialists, which must be $30.75 per hour;

(17) (20) for registered nurse, the basic wage is $30.82 per hour; and

(18) (21) for licensed practical nurse staff, the basic wage is $18.64 per hour 100 percent
of the median wage for licensed practical nurses (SOC code 29-2061)
.

(b) Component values for residential support services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(c) Component values for family foster care are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 3.3 percent;

(5) program-related expense ratio: 1.3 percent; and

(6) absence factor: 1.7 percent.

(d) Component values for day services for all services are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 5.6 percent;

(5) client programming and support ratio: ten percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 1.8 percent; and

(8) absence and utilization factor ratio: 3.9 5.9 percent.

(e) Component values for unit-based services with programming are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan supports ratio: 3.1 15.5 percent;

(5) client programming and supports ratio: 8.6 4.7 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(f) Component values for unit-based services without programming except respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) program plan support ratio: 3.1 7.0 percent;

(5) client programming and support ratio: 8.6 2.3 percent;

(6) general administrative support ratio: 13.25 percent;

(7) program-related expense ratio: 6.1 2.9 percent; and

(8) absence and utilization factor ratio: 3.9 percent.

(g) Component values for unit-based services without programming for respite are:

(1) supervisory span of control ratio: 11 percent;

(2) employee vacation, sick, and training allowance ratio: 8.71 percent;

(3) employee-related cost ratio: 23.6 percent;

(4) general administrative support ratio: 13.25 percent;

(5) program-related expense ratio: 6.1 2.9 percent; and

(6) absence and utilization factor ratio: 3.9 percent.

(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system. This adjustment occurs every five
years. For adjustments in 2021 and beyond, the commissioner shall use the data available
on December 31 of the calendar year five years prior.
On January 1, 2022, and every two
years thereafter, the commissioner shall update the base wage index in paragraph (a) based
on the most recently available wage data by standard occupational code (SOC) from the
Bureau of Labor Statistics. The commissioner shall publish these updated values and load
them into the rate management system.

(i) On July 1, 2017, the commissioner shall update the framework components in
paragraphs (b) to (g) paragraph (d), clause (5); paragraph (e), clause (5); and paragraph (f),
clause (5)
; subdivision 6, clauses (8) and (9); and subdivision 7, clauses (10), (16), and (17),
for changes in the Consumer Price Index. The commissioner will adjust these values higher
or lower by the percentage change in the Consumer Price Index-All Items, United States
city average (CPI-U) from January 1, 2014, to January 1, 2017. The commissioner shall
publish these updated values and load them into the rate management system. This adjustment
occurs every five years. For adjustments in 2021 and beyond, the commissioner shall use
the data available on January 1 of the calendar year four years prior and January 1 of the
current calendar year.
On January 1, 2022, and every two years thereafter, the commissioner
shall update the framework components in paragraph (d), clause (5); paragraph (e), clause
(5); and paragraph (f), clause (5); subdivision 6, clauses (8) and (9); and subdivision 7,
clauses (10), (16), and (17), for changes in the Consumer Price Index. The commissioner
shall adjust these values higher or lower by the percentage change in the Consumer Price
Index-All Items, United States city average (CPI-U) from the date of the previous update
to the date of the data most recently available prior to the scheduled update. The
commissioner shall publish these updated values and load them into the rate management
system.

(j) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.

(k) The commissioner must ensure that wage values and component values in subdivisions
5 to 9 reflect the cost to provide the service. As determined by the commissioner, in
consultation with stakeholders identified in section 256B.4913, subdivision 5, a provider
enrolled to provide services with rates determined under this section must submit business
cost data to the commissioner to support research on the cost of providing services that have
rates determined by the disability waiver rates system. Required business cost data includes,
but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

(5) vacation, sick, and training time paid;

(6) taxes, workers' compensation, and unemployment insurance costs paid;

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

(11) other data relating to costs required to provide services requested by the
commissioner.

(l) A provider must submit cost component data at least once in any five-year period,
on a schedule determined by the commissioner, in consultation with stakeholders identified
in section 256B.4913, subdivision 5. If a provider fails to submit required reporting data,
the commissioner shall provide notice to providers that have not provided required data 30
days after the required submission date, and a second notice for providers who have not
provided required data 60 days after the required submission date. The commissioner shall
temporarily suspend payments to the provider if cost component data is not received 90
days after the required submission date. Withheld payments shall be made once data is
received by the commissioner.

(m) The commissioner shall conduct a random audit of data submitted under paragraph
(k) to ensure data accuracy. The commissioner shall analyze cost documentation in paragraph
(k) and provide recommendations for adjustments to cost components.

(n) The commissioner shall analyze cost documentation in paragraph (k) and, in
consultation with stakeholders identified in section 256B.4913, subdivision 5, may submit
recommendations on component values and inflationary factor adjustments to the chairs
and ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, 2020. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph (e). The commissioner shall release business cost data in an
aggregate form, and business cost data from individual providers shall not be released except
as provided for in current law.

(o) The commissioner, in consultation with stakeholders identified in section 256B.4913,
subdivision 5, shall develop and implement a process for providing training and technical
assistance necessary to support provider submission of cost documentation required under
paragraph (k).

EFFECTIVE DATE.

(a) The amendments to paragraphs (a) to (g) are effective January
1, 2018, except paragraph (d), clause (8), is effective January 1, 2019.

(b) The amendments to paragraphs (h) to (o) are effective the day following final
enactment.

Sec. 22.

Minnesota Statutes 2016, section 256B.4914, subdivision 6, is amended to read:


Subd. 6.

Payments for residential support services.

(a) Payments for residential support
services, as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
must be calculated as follows:

(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5. This is defined as the direct-care rate;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages in
subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (19);

(6) combine the results of clauses (4) and (5), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (2). This is defined as the direct staffing cost;

(7) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (3);

(8) for client programming and supports, the commissioner shall add $2,179; and

(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.

(b) The total rate must be calculated using the following steps:

(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (7);

(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;

(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and

(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.

(c) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.

(d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
meet or exceed the days of service used to convert service agreements in effect on December
1, 2013, and must not result in a reduction in spending or service utilization due to conversion
during the implementation period under section 256B.4913, subdivision 4a. If during the
implementation period, an individual's historical rate, including adjustments required under
section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.

(e) The number of days authorized for all individuals enrolling after January 1, 2014,
in residential services must include every day that services start and end.

Sec. 23.

Minnesota Statutes 2016, section 256B.4914, subdivision 7, is amended to read:


Subd. 7.

Payments for day programs.

Payments for services with day programs
including adult day care, day treatment and habilitation, prevocational services, and structured
day services must be calculated as follows:

(1) determine the number of units of service and staffing ratio to meet a recipient's needs:

(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and

(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage in subdivision 5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (19);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (5);

(10) for program facility costs, add $19.30 per week with consideration of staffing ratios
to meet individual needs;

(11) for adult day bath services, add $7.01 per 15 minute unit;

(12) this is the subtotal rate;

(13) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(14) divide the result of clause (12) by one minus the result of clause (13). This is the
total payment amount;

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;

(16) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:

(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;

(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;

(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or

(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;

(17) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:

(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;

(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;

(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or

(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.

Sec. 24.

Minnesota Statutes 2016, section 256B.4914, subdivision 8, is amended to read:


Subd. 8.

Payments for unit-based services with programming.

Payments for unit-based
services with programming, including behavior programming, housing access coordination,
in-home family support, independent living skills training, independent living skills specialist
services,
hourly supported living services, employment exploration services, employment
development services,
and supported employment support services provided to an individual
outside of any day or residential service plan must be calculated as follows, unless the
services are authorized separately under subdivision 6 or 7:

(1) determine the number of units of service to meet a recipient's needs;

(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a), or the customized direct-care rate;

(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (19);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan supports ratio in subdivision 5, paragraph (e), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;

(13) for supported employment support services provided in a shared manner, divide
the total payment amount in clause (12) by the number of service recipients, not to exceed
three six. For independent living skills training provided in a shared manner, divide the total
payment amount in clause (12) by the number of service recipients, not to exceed two; and

(14) adjust the result of clause (13) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 25.

Minnesota Statutes 2016, section 256B.4914, subdivision 9, is amended to read:


Subd. 9.

Payments for unit-based services without programming.

Payments for
unit-based services without programming, including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivision 6 or 7:

(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;

(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;

(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5 or the customized direct care rate;

(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (19);

(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (f), clause
(2). This is defined as the direct staffing rate;

(7) for program plan support, multiply the result of clause (6) by one plus the program
plan support ratio in subdivision 5, paragraph (f), clause (4);

(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (3);

(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (f), clause (5);

(10) this is the subtotal rate;

(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;

(13) for respite services, determine the number of day units of service to meet an
individual's needs;

(14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;

(15) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (14). This
is defined as the customized direct care rate;

(16) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a);

(17) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16) (19);

(18) combine the results of clauses (16) and (17), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
clause (2). This is defined as the direct staffing rate;

(19) for employee-related expenses, multiply the result of clause (18) by one plus the
employee-related cost ratio in subdivision 5, paragraph (g), clause (3);

(20) this is the subtotal rate;

(21) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;

(22) divide the result of clause (20) by one minus the result of clause (21). This is the
total payment amount; and

(23) adjust the result of clauses (12) and (22) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.

Sec. 26.

Minnesota Statutes 2016, section 256B.4914, subdivision 10, is amended to read:


Subd. 10.

Updating payment values and additional information.

(a) From January
1, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
procedures to refine terms and adjust values used to calculate payment rates in this section.

(b) No later than July 1, 2014, the commissioner shall, within available resources, begin
to conduct research and gather data and information from existing state systems or other
outside sources on the following items:

(1) differences in the underlying cost to provide services and care across the state; and

(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and

(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.

(c) Beginning January 1, 2014, through December 31, 2018, using a statistically valid
set of rates management system data, the commissioner, in consultation with stakeholders,
shall analyze for each service the average difference in the rate on December 31, 2013, and
the framework rate at the individual, provider, lead agency, and state levels. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a
. The commissioner shall issue the first report by October 1, 2014, and the final report
shall be issued by December 31, 2018
.

(d) No later than July 1, 2014, the commissioner, in consultation with stakeholders, shall
begin the review and evaluation of the following values already in subdivisions 6 to 9, or
issues that impact all services, including, but not limited to:

(1) values for transportation rates for day services;

(2) values for transportation rates in residential services;

(3) (2) values for services where monitoring technology replaces staff time;

(4) (3) values for indirect services;

(5) (4) values for nursing;

(6) component values for independent living skills;

(7) component values for family foster care that reflect licensing requirements;

(8) adjustments to other components to replace the budget neutrality factor;

(9) remote monitoring technology for nonresidential services;

(10) values for basic and intensive services in residential services;

(11) (5) values for the facility use rate in day services, and the weightings used in the
day service ratios and adjustments to those weightings;

(12) (6) values for workers' compensation as part of employee-related expenses;

(13) (7) values for unemployment insurance as part of employee-related expenses;

(14) a component value to reflect costs for individuals with rates previously adjusted
for the inclusion of group residential housing rate 3 costs, only for any individual enrolled
as of December 31, 2013; and

(15) (8) any changes in state or federal law with an a direct impact on the underlying
cost of providing home and community-based services.; and

(9) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section.

(e) The commissioner shall report to the chairs and the ranking minority members of
the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs (b) to (d) on
the following dates:

(1) January 15, 2015, with preliminary results and data;

(2) January 15, 2016, with a status implementation update, and additional data and
summary information;

(3) January 15, 2017, with the full report; and

(4) January 15, 2019 2020, with another full report, and a full report once every four
years thereafter.

(f) Based on the commissioner's evaluation of the information and data collected in
paragraphs (b) to (d), the commissioner shall make recommendations to the legislature by
January 15, 2015, to address any issues identified during the first year of implementation.
After January 15, 2015, the commissioner may make recommendations to the legislature
to address potential issues.

(g) (f) The commissioner shall implement a regional adjustment factor to all rate
calculations in subdivisions 6 to 9, effective no later than January 1, 2015. Beginning July
1, 2017, the commissioner shall renew analysis and implement changes to the regional
adjustment factors when adjustments required under subdivision 5, paragraph (h), occur.
Prior to implementation, the commissioner shall consult with stakeholders on the
methodology to calculate the adjustment.

(h) (g) The commissioner shall provide a public notice via LISTSERV in October of
each year beginning October 1, 2014, containing information detailing legislatively approved
changes in:

(1) calculation values including derived wage rates and related employee and
administrative factors;

(2) service utilization;

(3) county and tribal allocation changes; and

(4) information on adjustments made to calculation values and the timing of those
adjustments.

The information in this notice must be effective January 1 of the following year.

(i) No later than July 1, 2016, the commissioner shall develop and implement, in
consultation with stakeholders, a methodology sufficient to determine the shared staffing
levels necessary to meet, at a minimum, health and welfare needs of individuals who will
be living together in shared residential settings, and the required shared staffing activities
described in subdivision 2, paragraph (l). This determination methodology must ensure
staffing levels are adaptable to meet the needs and desired outcomes for current and
prospective residents in shared residential settings.

(j) (h) When the available shared staffing hours in a residential setting are insufficient
to meet the needs of an individual who enrolled in residential services after January 1, 2014,
or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f), then individual staffing hours
shall be used.

(i) The commissioner shall study the underlying cost of absence and utilization for day
services. Based on the commissioner's evaluation of the data collected under this paragraph,
the commissioner shall make recommendations to the legislature by January 15, 2018, for
changes, if any, to the absence and utilization factor ratio component value for day services.

(j) Beginning July 1, 2017, the commissioner shall collect transportation and trip
information for all day services through the rates management system.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 27.

Minnesota Statutes 2016, section 256B.50, subdivision 1b, is amended to read:


Subd. 1b.

Filing an appeal.

To appeal, the provider shall file with the commissioner a
written notice of appeal; the appeal must be postmarked or received by the commissioner
within 60 days of the publication date the determination of the payment rate was mailed or
personally received by a provider, whichever is earlier
printed on the rate notice. The notice
of appeal must specify each disputed item; the reason for the dispute; the total dollar amount
in dispute for each separate disallowance, allocation, or adjustment of each cost item or part
of a cost item; the computation that the provider believes is correct; the authority in statute
or rule upon which the provider relies for each disputed item; the name and address of the
person or firm with whom contacts may be made regarding the appeal; and other information
required by the commissioner.

Sec. 28.

Minnesota Statutes 2016, section 256B.5012, is amended by adding a subdivision
to read:


Subd. 3a.

Therapeutic leave days.

Notwithstanding Minnesota Rules, part 9505.0415,
subpart 7, a vacant bed in an intermediate care facility for persons with developmental
disabilities shall be counted as a reserved bed when determining occupancy rates and
eligibility for payment of a therapeutic leave day.

Sec. 29.

Minnesota Statutes 2016, section 256B.5012, is amended by adding a subdivision
to read:


Subd. 17.

ICF/DD rate increase effective July 1, 2017; Murray County.

Effective
July 1, 2017, the daily rate for an intermediate care facility for persons with developmental
disabilities located in Murray County that is classified as a class B facility and licensed for
14 beds is $400. This increase is in addition to any other increase that is effective on July
1, 2017.

Sec. 30.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:


Subd. 1a.

Culturally affirmative.

"Culturally affirmative" describes services that are
designed and delivered within the context of the culture, language, and life experiences of
a person who is deaf, a person who is deafblind, and a person who is hard-of-hearing.

Sec. 31.

Minnesota Statutes 2016, section 256C.23, subdivision 2, is amended to read:


Subd. 2.

Deaf.

"Deaf" means a hearing loss of such severity that the individual must
depend primarily on visual communication such as American Sign Language or other signed
language, visual and manual means of communication such as signing systems in English
or Cued Speech,
writing, lip speech reading, manual communication, and gestures.

Sec. 32.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:


Subd. 2c.

Interpreting services.

"Interpreting services" means services that include:

(1) interpreting between a spoken language, such as English, and a visual language, such
as American Sign Language;

(2) interpreting between a spoken language and a visual representation of a spoken
language, such as Cued Speech and signing systems in English;

(3) interpreting within one language where the interpreter uses natural gestures and
silently repeats the spoken message, replacing some words or phrases to give higher visibility
on the lips;

(4) interpreting using low vision or tactile methods for persons who have a combined
hearing and vision loss or are deafblind; and

(5) interpreting from one communication mode or language into another communication
mode or language that is linguistically and culturally appropriate for the participants in the
communication exchange.

Sec. 33.

Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:


Subd. 6.

Real-time captioning.

"Real-time captioning" means a method of captioning
in which a caption is simultaneously prepared and displayed or transmitted at the time of
origination by specially trained real-time captioners.

Sec. 34.

Minnesota Statutes 2016, section 256C.233, subdivision 1, is amended to read:


Subdivision 1.

Deaf and Hard-of-Hearing Services Division.

The commissioners of
human services, education, employment and economic development, and health shall create
a distinct and separate organizational unit to be known as
advise the commissioner of human
services on the activities of
the Deaf and Hard-of-Hearing Services Division to address.
This division addresses
the developmental, social, educational, and occupational and
social-emotional
needs of persons who are deaf, persons who are deafblind, and persons
who are
hard-of-hearing persons through a statewide network of collaborative services and
by coordinating the promulgation of public policies, regulations, legislation, and programs
affecting
advocates on behalf of and provides information and training about how to best
serve persons who are
deaf, persons who are deafblind, and persons who are hard-of-hearing
persons. An interdepartmental management team shall advise the activities of the Deaf and
Hard-of-Hearing Services Division.
The commissioner of human services shall coordinate
the work of the interagency management team advisers and receive legislative appropriations
for the division.

Sec. 35.

Minnesota Statutes 2016, section 256C.233, subdivision 2, is amended to read:


Subd. 2.

Responsibilities.

The Deaf and Hard-of-Hearing Services Division shall:

(1) establish and maintain a statewide network of regional service centers culturally
affirmative services
for Minnesotans who are deaf, Minnesotans who are deafblind, and
Minnesotans who are
hard-of-hearing Minnesotans;

(2) assist work across divisions within the Departments Department of Human Services,
Education, and Employment and Economic Development to coordinate the promulgation
and implementation of public policies, regulations, legislation, programs, and services
affecting
as well as with other agencies and counties, to ensure that there is an understanding
of:

(i) the communication challenges faced by persons who are deaf, persons who are
deafblind, and persons who are hard-of-hearing persons;

(ii) the best practices for accommodating and mitigating communication challenges;
and

(iii) the legal requirements for providing access to and effective communication with
persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing
; and

(3) provide a coordinated system of assess the supply and demand statewide interpreting
or
for interpreter referral services. and real-time captioning services, implement strategies
to provide greater access to these services in areas without sufficient supply, and build the
base of service providers across the state;

(4) maintain a statewide information resource that includes contact information and
professional certification credentials of interpreting service providers and real-time captioning
service providers;

(5) provide culturally affirmative mental health services to persons who are deaf, persons
who are deafblind, and persons who are hard-of-hearing who:

(i) use a visual language such as American Sign Language or a tactile form of a language;
or

(ii) otherwise need culturally affirmative therapeutic services;

(6) research and develop best practices and recommendations for emerging issues;

(7) provide as much information as practicable on the division's stand-alone Web site
in American Sign Language; and

(8) report to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services biennially, beginning on January 1, 2019, on the following:

(i) the number of regional service center staff, the location of the office of each staff
person, other service providers with which they are colocated, the number of people served
by each staff person and a breakdown of whether each person was served on-site or off-site,
and for those served off-site, a list of locations where services were delivered and the number
who were served in-person and the number who were served via technology;

(ii) the amount and percentage of the division budget spent on reasonable
accommodations for staff;

(iii) the number of people who use demonstration equipment and consumer evaluations
of the experience;

(iv) the number of training sessions provided by division staff, the topics covered, the
number of participants, and consumer evaluations, including a breakdown by delivery
method such as in-person or via technology;

(v) the number of training sessions hosted at a division location provided by another
service provider, the topics covered, the number of participants, and consumer evaluations,
including a breakdown by delivery method such as in-person or via technology;

(vi) for each grant awarded, the amount awarded to the grantee and a summary of the
grantee's results, including consumer evaluations of the services or products provided;

(vii) the number of people on waiting lists for any services provided by division staff
or for services or equipment funded through grants awarded by the division;

(viii) the amount of time staff spent driving to appointments to deliver direct one-to-one
client services in locations outside of the regional service centers;

(ix) the amount spent on mileage reimbursement and the number of clients who received
mileage reimbursement for traveling to the regional service centers for services; and

(x) the regional needs and feedback on addressing service gaps identified by the advisory
committees.

Sec. 36.

Minnesota Statutes 2016, section 256C.24, subdivision 1, is amended to read:


Subdivision 1.

Location.

The Deaf and Hard-of-Hearing Services Division shall establish
up to eight at least six regional service centers for persons who are deaf and persons who
are
hard-of-hearing persons. The centers shall be distributed regionally to provide access
for persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing
persons in all parts of the state.

Sec. 37.

Minnesota Statutes 2016, section 256C.24, subdivision 2, is amended to read:


Subd. 2.

Responsibilities.

(a) Each regional service center shall:

(1) serve as a central entry point for establish connections and collaborations and explore
co-locating with other public and private entities providing services to persons who are

deaf, persons who are deafblind, and persons who are hard-of-hearing persons in need of
services and make referrals to the services needed
in the region;

(2) for those in need of services, assist in coordinating services between service providers
and persons who are deaf, persons who are deafblind, and persons who are hard-of-hearing,
and the persons' families, and make referrals to the services needed;

(2) (3) employ staff trained to work with persons who are deaf, persons who are deafblind,
and persons who are hard-of-hearing persons;

(3) (4) if adequate services are not available from another public or private service
provider in the region,
provide to all individual assistance to persons who are deaf, persons
who are
deafblind, and persons who are hard-of-hearing persons access to interpreter services
which are necessary to help them obtain services
, and the persons' families. Individually
culturally affirmative assistance may be provided using technology only in areas of the state
where a person has access to sufficient quality telecommunications or broadband services
to allow effective communication. When a person who is deaf, a person who is deafblind,
or a person who is hard-of-hearing does not have access to sufficient telecommunications
or broadband service, individual assistance shall be available in person
;

(5) identify regional training needs, work with deaf and hard-of-hearing services training
staff, and collaborate with others to deliver training for persons who are deaf, persons who
are deafblind, and persons who are hard-of-hearing, and the persons' families, and other
service providers about subjects including the persons' rights under the law, American Sign
Language, and the impact of hearing loss and options for accommodating it;

(4) implement a plan to provide loaned equipment and resource materials to deaf,
deafblind, and hard-of-hearing
(6) have a mobile or permanent lab where persons who are
deaf, persons who are deafblind, and persons who are hard-of-hearing can try a selection
of modern assistive technology and equipment to determine what would best meet the
persons' needs
;

(5) cooperate with responsible departments and administrative authorities to provide
access for deaf, deafblind, and hard-of-hearing persons to services provided by state, county,
and regional agencies;

(6) (7) collaborate with the Resource Center for the Deaf and Hard-of-Hearing Persons,
other divisions of the Department of Education, and local school districts to develop and
deliver programs and services for families with children who are deaf, children who are
deafblind, or children who are hard-of-hearing children and to support school personnel
serving these children;

(7) when possible, (8) provide training to the social service or income maintenance staff
employed by counties or by organizations with whom counties contract for services to
ensure that communication barriers which prevent persons who are deaf, persons who are
deafblind, and persons who are hard-of-hearing persons from using services are removed;

(8) when possible, (9) provide training to state and regional human service agencies in
the region
regarding program access for persons who are deaf, persons who are deafblind,
and persons who are hard-of-hearing persons; and

(9) (10) assess the ongoing need and supply of services for persons who are deaf, persons
who are
deafblind, and persons who are hard-of-hearing persons in all parts of the state,
annually consult with the division's advisory committees to identify regional needs and
solicit feedback on addressing service gaps,
and cooperate with public and private service
providers to develop these services.;

(11) provide culturally affirmative mental health services to persons who are deaf,
persons who are deafblind, and persons who are hard-of-hearing who:

(i) use a visual language such as American Sign Language or a tactile form of a language;
or

(ii) otherwise need culturally affirmative therapeutic services; and

(12) establish partnerships with state and regional entities statewide that have the
technological capacity to provide Minnesotans with virtual access to the division's services
and division-sponsored training via technology.

(b) Persons who are deaf, persons who are deafblind, and persons who are
hard-of-hearing, and the persons' family members who travel more than 50 miles round-trip
from the persons' home or work location to receive services at the regional service center
may be reimbursed for mileage at the reimbursement rate established by the Internal Revenue
Service.

Sec. 38.

Minnesota Statutes 2016, section 256C.261, is amended to read:


256C.261 SERVICES FOR PERSONS WHO ARE DEAFBLIND PERSONS.

(a) The commissioner of human services shall combine the existing biennial base level
funding for deafblind services into a single grant program. At least 35 percent of the total
funding is awarded for services and other supports to deafblind children and their families
and at least 25 percent is awarded for services and other supports to deafblind adults.
use
at least 35 percent of the deafblind services biennial base level grant funding for services
and other supports for a child who is deafblind and the child's family. The commissioner
shall use at least 25 percent of the deafblind services biennial base level grant funding for
services and other supports for an adult who is deafblind.

The commissioner shall award grants for the purposes of:

(1) providing services and supports to individuals persons who are deafblind; and

(2) developing and providing training to counties and the network of senior citizen
service providers. The purpose of the training grants is to teach counties how to use existing
programs that capture federal financial participation to meet the needs of eligible persons
who are
deafblind persons and to build capacity of senior service programs to meet the
needs of seniors with a dual sensory hearing and vision loss.

(b) The commissioner may make grants:

(1) for services and training provided by organizations; and

(2) to develop and administer consumer-directed services.

(c) Consumer-directed services shall be provided in whole by grant-funded providers.
The deaf and hard-of-hearing regional service centers shall not provide any aspect of a
grant-funded consumer-directed services program.

(c) (d) Any entity that is able to satisfy the grant criteria is eligible to receive a grant
under paragraph (a).

(d) (e) Deafblind service providers may, but are not required to, provide intervenor
services as part of the service package provided with grant funds under this section.

Sec. 39.

Minnesota Statutes 2016, section 256R.02, subdivision 4, is amended to read:


Subd. 4.

Administrative costs.

"Administrative costs" means the identifiable costs for
administering the overall activities of the nursing home. These costs include salaries and
wages of the administrator, assistant administrator, business office employees, security
guards, and associated fringe benefits and payroll taxes, fees, contracts, or purchases related
to business office functions, licenses, and permits except as provided in the external fixed
costs category, employee recognition, travel including meals and lodging, all training except
as specified in subdivision 17, voice and data communication or transmission, office supplies,
property and liability insurance and other forms of insurance not designated to other areas
including insurance that is an employee benefit
, personnel recruitment, legal services,
accounting services, management or business consultants, data processing, information
technology, Web site, central or home office costs, business meetings and seminars, postage,
fees for professional organizations, subscriptions, security services, advertising, board of
directors fees, working capital interest expense, and bad debts and bad debt collection fees,
and costs incurred for travel and housing for persons employed by a supplemental nursing
services agency as defined in section 144A.70, subdivision 6
.

EFFECTIVE DATE.

This section is effective October 1, 2017.

Sec. 40.

Minnesota Statutes 2016, section 256R.02, subdivision 17, is amended to read:


Subd. 17.

Direct care costs.

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

Sec. 41.

Minnesota Statutes 2016, section 256R.02, subdivision 18, is amended to read:


Subd. 18.

Employer health insurance costs.

"Employer health insurance costs" means
premium expenses for group coverage and reinsurance, actual expenses incurred for
self-insured plans including reinsurance and administrative costs, and employer contributions
to employee health reimbursement and health savings accounts. Premium and expense costs
and contributions are allowable for (1) all employees and (2) the spouse and dependents of
those employees who meet the definition of full-time employees under the federal Affordable
Care Act, Public Law 111-148
are employed on average at least 30 hours of service per
week, or 130 hours of service per month
.

Sec. 42.

Minnesota Statutes 2016, section 256R.02, subdivision 19, is amended to read:


Subd. 19.

External fixed costs.

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

Sec. 43.

Minnesota Statutes 2016, section 256R.02, subdivision 22, is amended to read:


Subd. 22.

Fringe benefit costs.

"Fringe benefit costs" means the costs for group life,
dental, workers' compensation, and other employee insurances and short- and long-term
disability, long-term care insurance, accident insurance, supplemental insurance, legal
assistance insurance, profit sharing, health insurance costs not covered under subdivision
18, including costs associated with part-time employee family members or retirees, and

pension and retirement plan contributions, except for the Public Employees Retirement
Association and employer health insurance costs; profit sharing; and retirement plans for
which the employer pays all or a portion of the
costs.

Sec. 44.

Minnesota Statutes 2016, section 256R.02, subdivision 42, is amended to read:


Subd. 42.

Raw food costs.

"Raw food costs" means the cost of food provided to nursing
facility residents and the allocation of dietary credits. Also included are special dietary
supplements used for tube feeding or oral feeding, such as elemental high nitrogen diet.

Sec. 45.

Minnesota Statutes 2016, section 256R.02, is amended by adding a subdivision
to read:


Subd. 42a.

Real estate taxes.

"Real estate taxes" means the real estate tax liability shown
on the annual property tax statement of the nursing facility for the reporting period. The
term does not include personnel costs or fees for late payment.

Sec. 46.

Minnesota Statutes 2016, section 256R.02, is amended by adding a subdivision
to read:


Subd. 48a.

Special assessments.

"Special assessments" means the actual special
assessments and related interest paid during the reporting period. The term does not include
personnel costs or fees for late payment.

Sec. 47.

Minnesota Statutes 2016, section 256R.02, subdivision 52, is amended to read:


Subd. 52.

Therapy costs.

"Therapy costs" means any costs related to medical assistance
therapy services provided to residents that are not billed separately billable from the daily
operating rate.

Sec. 48.

Minnesota Statutes 2016, section 256R.06, subdivision 5, is amended to read:


Subd. 5.

Notice to residents.

(a) No increase in nursing facility rates for private paying
residents shall be effective unless the nursing facility notifies the resident or person
responsible for payment of the increase in writing 30 days before the increase takes effect.
The notice must include the amount of the rate increase, the new payment rate, and the date
the rate increase takes effect.

A nursing facility may adjust its rates without giving the notice required by this
subdivision when the purpose of the rate adjustment is to reflect a change in the case mix
classification of the resident. The nursing facility shall notify private pay residents of any
rate increase related to a change in case mix classifications in a timely manner after
confirmation of the case mix classification change is received from the Department of
Health.

If the state fails to set rates as required by section 256R.09, subdivision 1, the time
required for giving notice is decreased by the number of days by which the state was late
in setting the rates.

(b) If the state does not set rates by the date required in section 256R.09, subdivision 1,
or otherwise provides nursing facilities with retroactive notification of the amount of a rate
increase,
nursing facilities shall meet the requirement for advance notice by informing the
resident or person responsible for payments, on or before the effective date of the increase,
that a rate increase will be effective on that date. The requirements of paragraph (a) do not
apply to situations described in this paragraph.

If the exact amount has not yet been determined, the nursing facility may raise the rates
by the amount anticipated to be allowed. Any amounts collected from private pay residents
in excess of the allowable rate must be repaid to private pay residents with interest at the
rate used by the commissioner of revenue for the late payment of taxes and in effect on the
date the rate increase is effective.

Sec. 49.

Minnesota Statutes 2016, section 256R.07, subdivision 1, is amended to read:


Subdivision 1.

Criteria.

A nursing facility shall keep adequate documentation. In order
to be adequate, documentation must:

(1) be maintained in orderly, well-organized files;

(2) not include documentation of more than one nursing facility in one set of files unless
transactions may be traced by the commissioner to the nursing facility's annual cost report;

(3) include a paid invoice or copy of a paid invoice with date of purchase, vendor name
and address, purchaser name and delivery destination address, listing of items or services
purchased, cost of items purchased, account number to which the cost is posted, and a
breakdown of any allocation of costs between accounts or nursing facilities. If any of the
information is not available, the nursing facility shall document its good faith attempt to
obtain the information;

(4) include contracts, agreements, amortization schedules, mortgages, other debt
instruments, and all other documents necessary to explain the nursing facility's costs or
revenues; and

(5) be retained by the nursing facility to support the five most recent annual cost reports.
The commissioner may extend the period of retention if the field audit was postponed
because of inadequate record keeping or accounting practices as in section 256R.13,
subdivisions 2
and 4, the records are necessary to resolve a pending appeal, or the records
are required for the enforcement of sections 256R.04; 256R.05, subdivision 2; 256R.06,
subdivisions 2
, and 6, and 7; 256R.08, subdivisions 1 to 3; and 256R.09, subdivisions 3 and
4.

Sec. 50.

Minnesota Statutes 2016, section 256R.07, is amended by adding a subdivision
to read:


Subd. 6.

Electronic signature.

For documentation requiring a signature under this
chapter or section 256B.431 or 256B.434, use of an electronic signature as defined under
section 325L.02, paragraph (h), is allowed.

Sec. 51.

Minnesota Statutes 2016, section 256R.13, subdivision 4, is amended to read:


Subd. 4.

Extended record retention requirements.

The commissioner shall extend the
period for retention of records under section 256R.09, subdivision 3, for purposes of
performing field audits as necessary to enforce sections 256R.04; 256R.05, subdivision 2;
256R.06, subdivisions 2, and 6, and 7; 256R.08, subdivisions 1 to 3; and 256R.09,
subdivisions 3 and 4, with written notice to the facility postmarked no later than 90 days
prior to the expiration of the record retention requirement.

Sec. 52.

[256R.18] BIENNIAL REPORT.

The commissioner shall provide to the legislative committees with jurisdiction over
nursing facility payment rates a biennial report including:

(1) the impact of using cost report data to set rates without updating the cost report data
by the change in the Consumer Price Index for all urban consumers from the mid-point of
the cost report to the mid-point of the rate year;

(2) the impact of the quality adjusted care limits;

(3) the ability of nursing facilities to retain employees, including whether rate increases
are passed through to employees;

(4) the efficacy of the critical access nursing facility program under section 256R.47;
and

(5) the impact of payment rate limit reduction under section 256R.23, subdivision 6.

EFFECTIVE DATE.

This section is effective January 1, 2019.

Sec. 53.

Minnesota Statutes 2016, section 256R.37, is amended to read:


256R.37 SCHOLARSHIPS.

(a) For the 27-month period beginning October 1, 2015, through December 31, 2017,
the commissioner shall allow a scholarship per diem of up to 25 cents for each nursing
facility with no scholarship per diem that is requesting a scholarship per diem to be added
to the external fixed payment rate to be used:

(1) for employee scholarships that satisfy the following requirements:

(i) scholarships are available to all employees who work an average of at least ten hours
per week at the facility except the administrator, and to reimburse student loan expenses
for newly hired and recently graduated registered nurses and licensed practical nurses, and
training expenses for nursing assistants as specified in section 144A.611, subdivisions 2
and 4, who are newly hired and have graduated within the last 12 months; and

(ii) the course of study is expected to lead to career advancement with the facility or in
long-term care, including medical care interpreter services and social work; and

(2) to provide job-related training in English as a second language.

(b) All facilities may annually request a rate adjustment under this section by submitting
information to the commissioner on a schedule and in a form supplied by the commissioner.
The commissioner shall allow a scholarship payment rate equal to the reported and allowable
costs divided by resident days.

(c) In calculating the per diem under paragraph (b), the commissioner shall allow costs
related to tuition, direct educational expenses, and reasonable costs as defined by the
commissioner for child care costs and transportation expenses related to direct educational
expenses.

(d) The rate increase under this section is an optional rate add-on that the facility must
request from the commissioner in a manner prescribed by the commissioner. The rate
increase must be used for scholarships as specified in this section.

(e) For instances in which a rate adjustment will be 15 cents or greater, nursing facilities
that close beds during a rate year may request to have their scholarship adjustment under
paragraph (b) recalculated by the commissioner for the remainder of the rate year to reflect
the reduction in resident days compared to the cost report year.

Sec. 54.

Minnesota Statutes 2016, section 256R.40, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this section.

(b) "Closure" means the cessation of operations of a nursing facility and delicensure and
decertification of all beds within the facility.

(c) "Closure plan" means a plan to close a nursing facility and reallocate a portion of
the resulting savings to provide planned closure rate adjustments at other facilities.

(d) "Commencement of closure" means the date on which residents and designated
representatives are notified of a planned closure as provided in section 144A.161, subdivision
5a, as part of an approved closure plan.

(e) "Completion of closure" means the date on which the final resident of the nursing
facility designated for closure in an approved closure plan is discharged from the facility
or the date that beds from a partial closure are delicensed and decertified
.

(f) "Partial closure" means the delicensure and decertification of a portion of the beds
within the facility.

(g) "Planned closure rate adjustment" means an increase in a nursing facility's operating
rates resulting from a planned closure or a planned partial closure of another facility.

Sec. 55.

Minnesota Statutes 2016, section 256R.40, subdivision 5, is amended to read:


Subd. 5.

Planned closure rate adjustment.

(a) The commissioner shall calculate the
amount of the planned closure rate adjustment available under subdivision 6 according to
clauses (1) to (4):

(1) the amount available is the net reduction of nursing facility beds multiplied by $2,080;

(2) the total number of beds in the nursing facility or facilities receiving the planned
closure rate adjustment must be identified;

(3) capacity days are determined by multiplying the number determined under clause
(2) by 365; and

(4) the planned closure rate adjustment is the amount available in clause (1), divided by
capacity days determined under clause (3).

(b) A planned closure rate adjustment under this section is effective on the first day of
the month of January or July, whichever occurs first following completion of closure of the
facility designated for closure in the application and becomes part of the nursing facility's
external fixed payment rate.

(c) Upon the request of a closing facility, the commissioner must allow the facility a
closure rate adjustment as provided under section 144A.161, subdivision 10.

(d) A facility that has received a planned closure rate adjustment may reassign it to
another facility that is under the same ownership at any time within three years of its effective
date. The amount of the adjustment is computed according to paragraph (a).

(e) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, the
commissioner shall recalculate planned closure rate adjustments for facilities that delicense
beds under this section on or after July 1, 2001, to reflect the increase in the per bed dollar
amount. The recalculated planned closure rate adjustment is effective from the date the per
bed dollar amount is increased.

(f) For a nursing facility that is ceasing operations through delicensure and decertification
of all beds within the facility, the planned closure rate adjustment under this section is
effective on the first day of the month following completion of closure of the facility
designated for closure in the application and becomes part of any assigned nursing facility's
external fixed payment rate.

Sec. 56.

Minnesota Statutes 2016, section 256R.41, is amended to read:


256R.41 SINGLE-BED ROOM INCENTIVE.

(a) Beginning July 1, 2005, the operating payment rate for nursing facilities reimbursed
under this chapter shall be increased by 20 percent multiplied by the ratio of the number of
new single-bed rooms created divided by the number of active beds on July 1, 2005, for
each bed closure that results in the creation of a single-bed room after July 1, 2005. The
commissioner may implement rate adjustments for up to 3,000 new single-bed rooms each
year. For eligible bed closures for which the commissioner receives a notice from a facility
during a calendar quarter that a bed has been delicensed and a new single-bed room has
been established, the rate adjustment in this paragraph shall be effective on either the first
day of the second month of January or July, whichever occurs first following that calendar
quarter
the date of the bed delicensure.

(b) A nursing facility is prohibited from discharging residents for purposes of establishing
single-bed rooms. A nursing facility must submit documentation to the commissioner in a
form prescribed by the commissioner, certifying the occupancy status of beds closed to
create single-bed rooms. In the event that the commissioner determines that a facility has
discharged a resident for purposes of establishing a single-bed room, the commissioner shall
not provide a rate adjustment under paragraph (a).

Sec. 57.

Minnesota Statutes 2016, section 256R.47, is amended to read:


256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING
FACILITIES.

(a) The commissioner, in consultation with the commissioner of health, may designate
certain nursing facilities as critical access nursing facilities. The designation shall be granted
on a competitive basis, within the limits of funds appropriated for this purpose.

(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by the
commissioner. In selecting applicants to designate, the commissioner, in consultation with
the commissioner of health, and with input from stakeholders, shall develop criteria designed
to preserve access to nursing facility services in isolated areas, rebalance long-term care,
and improve quality. To the extent practicable, the commissioner shall ensure an even
distribution of designations across the state.

(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing facilities
designated as critical access nursing facilities:

(1) partial rebasing, with the commissioner allowing a designated facility operating
payment rates being the sum of up to 60 percent of the operating payment rate determined
in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of
the two portions being equal to 100 percent, of the operating payment rate that would have
been allowed had the facility not been designated. The commissioner may adjust these
percentages by up to 20 percent and may approve a request for less than the amount allowed;

(2) enhanced payments for leave days. Notwithstanding section 256R.43, upon
designation as a critical access nursing facility, the commissioner shall limit payment for
leave days to 60 percent of that nursing facility's total payment rate for the involved resident,
and shall allow this payment only when the occupancy of the nursing facility, inclusive of
bed hold days, is equal to or greater than 90 percent;

(3) two designated critical access nursing facilities, with up to 100 beds in active service,
may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part
4658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner
of health shall consider each waiver request independently based on the criteria under
Minnesota Rules, part 4658.0040;

(4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall
be 40 percent of the amount that would otherwise apply; and

(5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to
designated critical access nursing facilities.

(d) Designation of a critical access nursing facility is for a period of two years, after
which the benefits allowed under paragraph (c) shall be removed. Designated facilities may
apply for continued designation.

(e) This section is suspended and no state or federal funding shall be appropriated or
allocated for the purposes of this section from January 1, 2016, to December 31, 2017 2019.

Sec. 58.

Minnesota Statutes 2016, section 256R.49, is amended to read:


256R.49 RATE ADJUSTMENTS FOR COMPENSATION-RELATED COSTS
FOR MINIMUM WAGE CHANGES.

Subdivision 1.

Rate adjustments for compensation-related costs.

(a) Operating
Payment rates of all nursing facilities that are reimbursed under this chapter shall be increased
effective for rate years beginning on and after October 1, 2014, to address changes in
compensation costs for nursing facility employees paid less than $14 per hour in accordance
with this section. Rate increases provided under this section before October 1, 2016, expire
effective January 1, 2018. Rate increases provided on or after October 1, 2016, expire two
years after the effective date of the rate increases.

(b) Nursing facilities that receive approval of the applications in subdivision 2 must
receive rate adjustments according to subdivision 4. The rate adjustments must be used to
pay compensation costs for nursing facility employees paid less than $14 per hour.

Subd. 2.

Application process.

To receive a rate adjustment, nursing facilities must
submit applications to the commissioner in a form and manner determined by the
commissioner. The applications for the rate adjustments shall include specified data, and
spending plans that describe how the funds from the rate adjustments will be allocated for
compensation to employees paid less than $14 per hour. The applications must be submitted
within three months of the effective date of any operating payment rate adjustment under
this section. The commissioner may request any additional information needed to determine
the rate adjustment within three weeks of receiving a complete application. The nursing
facility must provide any additional information requested by the commissioner within six
months of the effective date of any operating payment rate adjustment under this section.
The commissioner may waive the deadlines in this section under extraordinary circumstances.

Subd. 3.

Additional application requirements for facilities with employees
represented by an exclusive bargaining representative.

For nursing facilities in which
employees are represented by an exclusive bargaining representative, the commissioner
shall approve the applications submitted under subdivision 2 only upon receipt of a letter
or letters of acceptance of the spending plans in regard to members of the bargaining unit,
signed by the exclusive bargaining agent and dated after May 31, 2014. Upon receipt of the
letter or letters of acceptance, the commissioner shall deem all requirements of this section
as having been met in regard to the members of the bargaining unit.

Subd. 4.

Determination of the rate adjustments for compensation-related costs.

Based on the application in subdivision 2, the commissioner shall calculate the allowable
annualized compensation costs by adding the totals of clauses (1), and (2), and (3). The
result must be divided by the standardized or sum of the facility's resident days from the
most recently available cost report to determine per day amounts, which must be included
in the operating portion external fixed costs payment rate of the total payment rate and
allocated to direct care or other operating as determined by the commissioner
:

(1) the sum of the difference between $9.50 and any hourly wage rate less than $9.50
for October 1, 2016; and between the indexed value of the minimum wage, as defined in
section 177.24, subdivision 1, paragraph (f), or any other minimum wage implemented in
statute or by any local ordinance,
and any hourly wage less than that indexed value for rate
years beginning on and after October 1, 2017 January 1, 2018; multiplied by the number
of compensated hours at that wage rate; and

(2) using wages and hours in effect during the first three months of calendar year 2014,
beginning with the first pay period beginning on or after January 1, 2014; 22.2 percent of
the sum of items (i) to (viii) for October 1, 2016;

(i) for all compensated hours from $8 to $8.49 per hour, the number of compensated
hours is multiplied by $0.13;

(ii) for all compensated hours from $8.50 to $8.99 per hour, the number of compensated
hours is multiplied by $0.25;

(iii) for all compensated hours from $9 to $9.49 per hour, the number of compensated
hours is multiplied by $0.38;

(iv) for all compensated hours from $9.50 to $10.49 per hour, the number of compensated
hours is multiplied by $0.50;

(v) for all compensated hours from $10.50 to $10.99 per hour, the number of compensated
hours is multiplied by $0.40;

(vi) for all compensated hours from $11 to $11.49 per hour, the number of compensated
hours is multiplied by $0.30;

(vii) for all compensated hours from $11.50 to $11.99 per hour, the number of
compensated hours is multiplied by $0.20; and

(viii) for all compensated hours from $12 to $13 per hour, the number of compensated
hours is multiplied by $0.10; and

(3) (2) the sum of the employer's share of FICA taxes, Medicare taxes, state and federal
unemployment taxes, workers' compensation, pensions, and contributions to employee
retirement accounts attributable to the amounts in clauses clause (1) and (2).

Sec. 59.

Minnesota Statutes 2016, section 256R.53, subdivision 2, is amended to read:


Subd. 2.

Nursing facility facilities in Breckenridge border cities.

The operating
payment rate of a nonprofit nursing facility that exists on January 1, 2015, is located within
the boundaries of the city cities of Breckenridge or Moorhead, and is reimbursed under this
chapter, is equal to the greater of:

(1) the operating payment rate determined under section 256R.21, subdivision 3; or

(2) the median case mix adjusted rates, including comparable rate components as
determined by the median case mix adjusted rates, including comparable rate components
as determined by the commissioner, for the equivalent case mix indices of the nonprofit
nursing facility or facilities located in an adjacent city in another state and in cities contiguous
to the adjacent city. The commissioner shall make the comparison required in this subdivision
on November 1 of each year and shall apply it to the rates to be effective on the following
January 1.
The Minnesota facility's operating payment rate with a case mix index of 1.0 is
computed by dividing the adjacent city's nursing facility or facilities' median operating
payment rate with an index of 1.02 by 1.02. If the adjustments under this subdivision result
in a rate that exceeds the limits in section 256R.23, subdivision 5, and whose costs exceed
the rate in section 256R.24, subdivision 3, in a given rate year, the facility's rate shall not
be subject to the limits in section 256R.23, subdivision 5, and shall not be limited to the
rate established in section 256R.24, subdivision 3, for that rate year.

EFFECTIVE DATE.

The rate increases for a facility located in Moorhead are effective
for the rate year beginning January 1, 2020, and annually thereafter.

Sec. 60.

Laws 2015, chapter 71, article 7, section 54, is amended to read:


Sec. 54. EXPANSION OF CONSUMER-DIRECTED COMMUNITY SUPPORTS
BUDGET METHODOLOGY EXCEPTION.

(a) No later than September 30, 2015 2017, if necessary, the commissioner of human
services shall submit an amendment to the Centers for Medicare and Medicaid Services for
the home and community-based services waivers authorized under Minnesota Statutes,
sections 256B.092 and 256B.49, to establish an expand the 2015 exception to the
consumer-directed community supports budget methodology to provide up to 20 30 percent
more funds for both:

(1) consumer-directed community supports participants who have graduated from high
school and
have a coordinated service and support plan which identifies the need for more
services under consumer-directed community supports, either prior to graduation or in order
to increase the amount of time a person works or to improve their employment opportunities,

an increased amount of services or supports under consumer-directed community supports

than the amount they are eligible to receive currently receiving under the current
consumer-directed community supports budget methodology; and:

(i) to increase the amount of time a person works or otherwise improves employment
opportunities;

(ii) to plan a transition to, move to, or live in a setting as described in Minnesota Statutes,
section 256D.44, subdivision 5, paragraph (f), clause (1), item (ii), or (g); or

(iii) to develop and implement a positive behavior support plan;

(2) home and community-based waiver participants who are currently using licensed
services providers for employment supports or services during the day or residential services,
either of
which cost more annually than the person would spend under a consumer-directed
community supports plan for individualized employment supports or services during the
day
any or all of the supports needed to meet the goals identified in paragraph (a), clause
(1)
.

(b) The exception under paragraph (a) is limited to those persons who can demonstrate
either that they will have to leave discontinue using consumer-directed community supports
and use accept other non-self-directed waiver services because their need for day or
employment
supports needed for the goals described in paragraph (a), clause (1), cannot be
met within the consumer-directed community supports budget limits or they will move to
consumer-directed community supports and their services will cost less than services
currently being used
.

(c) The exception under paragraph (a), clause (2), is limited to those persons who can
demonstrate that, upon choosing to become a consumer-directed community support
participant, the total cost of services, including the exception, will be less than the cost of
current waiver services.

EFFECTIVE DATE.

The exception under this section is effective October 1, 2017, or
upon federal approval, whichever is later. The commissioner of human services shall notify
the revisor of statutes when federal approval is obtained.

Sec. 61.

ALZHEIMER'S DISEASE WORKING GROUP.

Subdivision 1.

Members.

(a) The Minnesota Board on Aging must appoint 16 members
to an Alzheimer's disease working group, as follows:

(1) a caregiver of a person who has been diagnosed with Alzheimer's disease;

(2) a person who has been diagnosed with Alzheimer's disease;

(3) two representatives from the nursing facility or senior housing profession;

(4) a representative of the home care or adult day services profession;

(5) two geriatricians, one of whom serves a diverse or underserved community;

(6) a psychologist who specializes in dementia care;

(7) an Alzheimer's researcher;

(8) a representative of the Alzheimer's Association;

(9) two members from community-based organizations serving one or more diverse or
underserved communities;

(10) the commissioner of human services or a designee;

(11) the commissioner of health or a designee;

(12) the ombudsman for long-term care or a designee; and

(13) one member of the Minnesota Board on Aging, selected by the board.

(b) The executive director of the Minnesota Board on Aging serves on the working group
as a nonvoting member.

(c) The appointing authorities under this subdivision must complete their appointments
no later than December 15, 2017.

(d) To the extent practicable, the membership of the working group must reflect the
diversity in Minnesota, and must include representatives from rural and metropolitan areas
and representatives of different ethnicities, races, genders, ages, cultural groups, and abilities.

Subd. 2.

Duties; recommendations.

The Alzheimer's disease working group must
review and revise the 2011 report, Preparing Minnesota for Alzheimer's: the Budgetary,
Social and Personal Impacts. The working group shall consider and make recommendations
and findings on the following issues as related to Alzheimer's disease or other dementias:

(1) analysis and assessment of public health and health care data to accurately determine
trends and disparities in cognitive decline;

(2) public awareness, knowledge, and attitudes, including knowledge gaps, stigma,
availability of information, and supportive community environments;

(3) risk reduction, including health education and health promotion on risk factors,
safety, and potentially avoidable hospitalizations;

(4) diagnosis and treatment, including early detection, access to diagnosis, quality of
dementia care, and cost of treatment;

(5) professional education and training, including geriatric education for licensed health
care professionals and dementia-specific training for direct care workers, first responders,
and other professionals in communities;

(6) residential services, including cost to families as well as regulation and licensing
gaps; and

(7) cultural competence and responsiveness to reduce health disparities and improve
access to high-quality dementia care.

Subd. 3.

Meetings.

The Board on Aging must convene the first meeting of the working
group no later than January 15, 2018. Before the first meeting, the Board on Aging must
designate one member to serve as chair. Meetings of the working group must be open to
the public, and to the extent practicable, technological means, such as Web casts, shall be
used to reach the greatest number of people throughout the state. The working group may
not meet more than five times.

Subd. 4.

Compensation.

Members of the working group serve without compensation,
but may be reimbursed for allowed actual and necessary expenses incurred in the performance
of the member's duties for the working group in the same manner and amount as authorized
by the commissioner's plan adopted under Minnesota Statutes, section 43A.18, subdivision
2.

Subd. 5.

Administrative support.

The Minnesota Board on Aging shall provide
administrative support and arrange meeting space for the working group.

Subd. 6.

Report.

The Board on Aging must submit a report providing the findings and
recommendations of the working group, including any draft legislation necessary to
implement the recommendations, to the governor and chairs and ranking minority members
of the legislative committees with jurisdiction over health care by January 15, 2019.

Subd. 7.

Expiration.

The working group expires June 30, 2019, or the day after the
working group submits the report required in subdivision 6, whichever is earlier.

Sec. 62. CONSUMER-DIRECTED COMMUNITY SUPPORTS REVISED BUDGET
METHODOLOGY REPORT.

(a) The commissioner of human services, in consultation with stakeholders and others
including representatives of lead agencies, home and community-based services waiver
participants using consumer-directed community supports, advocacy groups, state agencies,
the Institute on Community Integration at the University of Minnesota, and service and
financial management providers, shall develop a revised consumer-directed community
supports budget methodology. The new methodology shall be based on (1) the costs of
providing services as reflected by the wage and other relevant components incorporated in
the disability waiver rate formulas under chapter 256B, and (2) state-to-county
waiver-funding methodologies. The new methodology should develop individual
consumer-directed community supports budgets comparable to those provided for similar
needs individuals if paying for non-consumer-directed community supports waiver services.

(b) By December 15, 2018, the commissioner shall report a revised consumer-directed
community supports budget methodology, including proposed legislation and funding
necessary to implement the new methodology, to the chairs and ranking minority members
of the house of representatives and senate committees with jurisdiction over health and
human services.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 63. DIRECTION TO COMMISSIONER; TELECOMMUNICATION
EQUIPMENT PROGRAM.

The commissioner of human services shall work in consultation with the Commission
of Deaf, Deafblind, and Hard-of-Hearing Minnesotans to provide recommendations by
January 15, 2018, to the chairs and ranking minority members of the house of representatives
and senate committees with jurisdiction over human services to modernize the
telecommunication equipment program. The recommendations must address:

(1) types of equipment and supports the program should provide to ensure people with
communication difficulties have equitable access to telecommunications services;

(2) additional services the program should provide, such as education about technology
options that can improve a person's access to telecommunications services; and

(3) how the current program's service delivery structure might be improved to better
meet the needs of people with communication disabilities.

The commissioner shall also provide draft legislative language to accomplish the
recommendations. Final recommendations, the final report, and draft legislative language
must be approved by both the commissioner and the chair of the Commission of Deaf,
Deafblind, and Hard-of-Hearing Minnesotans.

Sec. 64. DIRECTION TO COMMISSIONER; BILLING FOR MENTAL HEALTH
SERVICES.

By January 1, 2018, the commissioner of human services shall report to the chairs and
ranking minority members of the house of representatives and senate committees with
jurisdiction over deaf and hard-of-hearing services on the potential costs and benefits of the
Deaf and Hard-of-Hearing Services Division billing for the cost of providing mental health
services.

Sec. 65. ELECTRONIC SERVICE DELIVERY DOCUMENTATION SYSTEM.

Subdivision 1.

Documentation; establishment.

The commissioner of human services
shall establish implementation requirements and standards for an electronic service delivery
documentation system to comply with the 21st Century Cures Act, Public Law 114-255.

Subd. 2.

Definitions.

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

(b) "Electronic service delivery documentation" means the electronic documentation of
the:

(1) type of service performed;

(2) individual receiving the service;

(3) date of the service;

(4) location of the service delivery;

(5) individual providing the service; and

(6) time the service begins and ends.

(c) "Electronic service delivery documentation system" means a system that provides
electronic service delivery documentation that complies with the 21st Century Cures Act,
Public Law 114-255, and the requirements of subdivision 3.

(d) "Service" means one of the following:

(1) personal care assistance services as defined in Minnesota Statutes, section 256B.0625,
subdivision 19a, and provided according to Minnesota Statutes, section 256B.0659; or

(2) community first services and supports under Minnesota Statutes, section 256B.85.

Subd. 3.

Requirements.

(a) In developing implementation requirements for an electronic
service delivery documentation system, the commissioner shall consider electronic visit
verification systems and other electronic service delivery documentation methods. The
commissioner shall convene stakeholders that will be impacted by an electronic service
delivery system, including service providers and their representatives, service recipients
and their representatives, and, as appropriate, those with expertise in the development and
operation of an electronic service delivery documentation system, to ensure that the
requirements:

(1) are minimally administratively and financially burdensome to a provider;

(2) are minimally burdensome to the service recipient and the least disruptive to the
service recipient in receiving and maintaining allowed services;

(3) consider existing best practices and use of electronic service delivery documentation;

(4) are conducted according to all state and federal laws;

(5) are effective methods for preventing fraud when balanced against the requirements
of clauses (1) and (2); and

(6) are consistent with the Department of Human Services' policies related to covered
services, flexibility of service use, and quality assurance.

(b) The commissioner shall make training available to providers on the electronic service
delivery documentation system requirements.

(c) The commissioner shall establish baseline measurements related to preventing fraud
and establish measures to determine the effect of electronic service delivery documentation
requirements on program integrity.

Subd. 4.

Legislative report.

(a) The commissioner shall submit a report by January 15,
2018, to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services with recommendations, based on the requirements of
subdivision 3, to establish electronic service delivery documentation system requirements
and standards. The report shall identify:

(1) the essential elements necessary to operationalize a base-level electronic service
delivery documentation system to be implemented by January 1, 2019; and

(2) enhancements to the base-level electronic service delivery documentation system to
be implemented by January 1, 2019, or after, with projected operational costs and the costs
and benefits for system enhancements.

(b) The report must also identify current regulations on service providers that are either
inefficient, minimally effective, or will be unnecessary with the implementation of an
electronic service delivery documentation system.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 66. TRANSPORTATION STUDY.

The commissioner of human services, with cooperation from lead agencies and in
consultation with stakeholders, shall conduct a study to identify opportunities to increase
access to transportation services for an individual who receives home and community-based
services. The commissioner shall submit a report with recommendations to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services by January 15, 2019. The report shall:

(1) study all aspects of the current transportation service network, including the fleet
available, the different rate-setting methods currently used, methods that an individual uses
to access transportation, and the diversity of available provider agencies;

(2) identify current barriers for an individual accessing transportation and for a provider
providing waiver services transportation in the marketplace;

(3) identify efficiencies and collaboration opportunities to increase available
transportation, including transportation funded by medical assistance, and available regional
transportation and transit options;

(4) study transportation solutions in other states for delivering home and community-based
services;

(5) study provider costs required to administer transportation services;

(6) make recommendations for coordinating and increasing transportation accessibility
across the state; and

(7) make recommendations for the rate setting of waivered transportation.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 67. DIRECTION TO COMMISSIONER; ICF/DD PAYMENT RATE STUDY.

Within available appropriations, the commissioner of human services shall study the
intermediate care facility for persons with developmental disabilities payment rates under
Minnesota Statutes, sections 256B.5011 to 256B.5013, and make recommendations on the
rate structure to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services policy and finance by January 15, 2018.

Sec. 68. FEDERAL WAIVER AMENDMENTS.

The commissioner of human services shall submit necessary waiver amendments to the
Centers for Medicare and Medicaid Services to add employment exploration services,
employment development services, and employment support services to the home and
community-based services waivers authorized under Minnesota Statutes, sections 256B.092
and 256B.49. The commissioner shall also submit necessary waiver amendments to remove
community-based employment services from day training and habilitation and prevocational
services. The commissioner shall submit all necessary waiver amendments by October 1,
2017.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 69.

EXCEPTION TO THE BUDGET METHODOLOGY FOR PERSONS
LEAVING INSTITUTIONS AND CRISIS RESIDENTIAL SETTINGS.

(a) By September 30, 2017, the commissioner shall establish an institutional and crisis
bed consumer-directed community supports budget exception process as described in the
home and community-based services waivers under sections 256B.092 and 256B.49. This
budget exception process shall be available for any individual who:

(1) is not offered available and appropriate services within 60 days since approval for
discharge from the individual's current institutional setting; or

(2) requires services that are more expensive than appropriate less-restrictive services
using the consumer-directed community supports option.

(b) Institutional settings for purposes of this exception include intermediate care facilities
for persons with developmental disabilities, nursing facilities, acute care hospitals, Anoka
Metro Regional Treatment Center, Minnesota Security Hospital, and crisis beds. The budget
exception shall be limited to no more than the amount of appropriate less-restrictive available
services determined by the lead agency managing the individual's home and community-based
services waiver. The lead agency shall notify the Department of Human Services of the
budget exception.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 70. REPEALER.

(a) Minnesota Statutes 2016, sections 256C.23, subdivision 3; 256C.233, subdivision
4; and 256C.25, subdivisions 1 and 2,
are repealed.

(b) Minnesota Statutes 2016, section 256B.4914, subdivision 16, is repealed effective
January 1, 2018.

ARTICLE 3

HEALTH DEPARTMENT AND PUBLIC HEALTH

Section 1.

[144.059] PALLIATIVE CARE ADVISORY COUNCIL.

Subdivision 1.

Establishment.

The Palliative Care Advisory Council is established to
advise and assist the commissioner of health regarding improving the quality and delivery
of patient-centered and family-focused palliative care.

Subd. 2.

Membership.

(a) The council shall consist of 18 public members and four
members of the legislature.

(b) The commissioner shall appoint 18 public members, including at least the following:

(1) two physicians, of which one is certified by the American Board of Hospice and
Palliative Medicine;

(2) two registered nurses or advanced practice registered nurses, of which one is certified
by the National Board for Certification of Hospice and Palliative Nurses;

(3) one care coordinator experienced in working with people with serious or chronic
illness and their families;

(4) one spiritual counselor experienced in working with people with serious or chronic
illness and their families;

(5) three licensed health professionals, such as complementary and alternative health
care practitioners, dietitians or nutritionists, pharmacists, or physical therapists, who are
neither physicians nor nurses, but who have experience as members of a palliative care
interdisciplinary team working with people with serious or chronic illness and their families;

(6) one licensed social worker experienced in working with people with serious or chronic
illness and their families;

(7) four patients or personal caregivers experienced with serious or chronic illness;

(8) one representative of a health plan company; and

(9) one physician assistant that is a member of the American Academy of Hospice and
Palliative Medicine.

(c) The Subcommittee on Committees of the Committee on Rules and Administration
shall appoint one member of the senate, the minority leader in the senate shall appoint one
member of the senate, the speaker of the house shall appoint one member of the house of
representatives, and the minority leader in the house of representatives shall appoint one
member of the house of representatives.

(d) Council membership must include, where possible, representation that is racially,
culturally, linguistically, geographically, and economically diverse.

(e) The council must include at least six members who reside outside Anoka, Carver,
Chisago, Dakota, Hennepin, Isanti, Mille Lacs, Ramsey, Scott, Sherburne, Sibley, Stearns,
Washington, or Wright Counties.

(f) Council membership must include health professionals who have palliative care work
experience or expertise in palliative care delivery models in a variety of inpatient, outpatient,
and community settings, including acute care, long-term care, or hospice, with a variety of
populations, including pediatric, youth, and adult patients.

(g) To the extent possible, council membership must include persons who have experience
in palliative care research, palliative care instruction in a medical or nursing school setting,
palliative care services for veterans as a provider or recipient, or pediatric care.

Subd. 3.

Term.

Members of the council shall serve for a term of three years and may
be reappointed. Members shall serve until their successors have been appointed.

Subd. 4.

Administration.

The commissioner or the commissioner's designee shall
provide meeting space and administrative services for the council.

Subd. 5.

Initial appointments and first meeting.

The appointing authorities shall
appoint the first members of the council by July 1, 2017. The commissioner shall convene
the first meeting by September 15, 2017, and the commissioner or the commissioner's
designee shall act as chair until the council elects a chair at its first meeting.

Subd. 6.

Chairs.

At the council's first meeting, and biannually thereafter, the members
shall elect a chair and a vice-chair whose duties shall be established by the council.

Subd. 7.

Meeting.

The council chair shall fix a time and place for regular meetings of
the council, which shall meet at least twice yearly.

Subd. 8.

No compensation.

Public members of the council serve without compensation,
except for reimbursement from the commissioner for allowed actual and necessary expenses
incurred in the performance of the public member's council duties.

Subd. 9.

Duties.

(a) The council shall consult with and advise the commissioner on
matters related to the establishment, maintenance, operation, and outcomes evaluation of
palliative care initiatives in the state.

(b) By February 15 of each year, the council shall prepare and submit to the chairs and
ranking minority members of the committees of the senate and the house of representatives
with primary jurisdiction over health care a report containing a description of:

(1) the advisory committee's assessment of the availability of palliative care in the state;

(2) the advisory committee's analysis of barriers to greater access to palliative care; and

(3) recommendations for legislative action.

(c) The Department of Health shall publish the report each year on the department's Web
site.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 2.

[144.1215] AUTHORIZATION TO USE HANDHELD DENTAL X-RAY
EQUIPMENT.

Subdivision 1.

Definition; handheld dental x-ray equipment.

For purposes of this
section, "handheld dental x-ray equipment" means x-ray equipment that is used to take
dental radiographs, is designed to be handheld during operation, and is operated by an
individual authorized to take dental radiographs under chapter 150A.

Subd. 2.

Use authorized.

(a) Handheld dental x-ray equipment may be used if the
equipment:

(1) has been approved for human use by the United States Food and Drug Administration
and is being used in a manner consistent with that approval; and

(2) utilizes a backscatter shield that:

(i) is composed of a leaded polymer or a substance with a substantially equivalent
protective capacity;

(ii) has at least 0.25 millimeters of lead or lead-shielding equivalent; and

(iii) is permanently affixed to the handheld dental x-ray equipment.

(b) The use of handheld dental x-ray equipment is prohibited if the equipment's
backscatter shield is broken or not permanently affixed to the system.

(c) The use of handheld dental x-ray equipment shall not be limited to situations in which
it is impractical to transfer the patient to a stationary x-ray system.

(d) Handheld dental x-ray equipment must be stored when not in use, by being secured
in a restricted, locked area of the facility.

(e) Handheld dental x-ray equipment must be calibrated initially and at intervals that
must not exceed 24 months. Calibration must include the test specified in Minnesota Rules,
part 4732.1100, subpart 11.

(f) Notwithstanding Minnesota Rules, part 4732.0880, subpart 2, item C, the tube housing
and the position-indicating device of handheld dental x-ray equipment may be handheld
during an exposure.

Subd. 3.

Exemptions from certain shielding requirements.

Handheld dental x-ray
equipment used according to this section and according to manufacturer instructions is
exempt from the following requirements for the equipment:

(1) shielding requirements in Minnesota Rules, part 4732.0365, item B; and

(2) requirements for the location of the x-ray control console or utilization of a protective
barrier in Minnesota Rules, part 4732.0800, subpart 2, item B, subitems (2) and (3), provided
the equipment utilizes a backscatter shield that satisfies the requirements in subdivision 2,
paragraph (a), clause (2).

Subd. 4.

Compliance with rules.

A registrant using handheld dental x-ray equipment
shall otherwise comply with Minnesota Rules, chapter 4732.

Sec. 3.

Minnesota Statutes 2016, section 144.1501, subdivision 2, is amended to read:


Subd. 2.

Creation of account.

(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:

(1) for medical residents and mental health professionals agreeing to practice in designated
rural areas or underserved urban communities or specializing in the area of pediatric
psychiatry;

(2) for midlevel practitioners agreeing to practice in designated rural areas or to teach
at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program
at the undergraduate level or the equivalent at the graduate level;

(3) for nurses who agree to practice in a Minnesota nursing home; an intermediate care
facility for persons with developmental disability; or a hospital if the hospital owns and
operates a Minnesota nursing home and a minimum of 50 percent of the hours worked by
the nurse is in the nursing home; a housing with services establishment as defined in section
144D.01, subdivision 4; or a home care provider as defined in section 144A.43, subdivision
4;
or agree to teach at least 12 credit hours, or 720 hours per year in the nursing field in a
postsecondary program at the undergraduate level or the equivalent at the graduate level;

(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;

(5) for pharmacists, advanced dental therapists, dental therapists, and public health nurses
who agree to practice in designated rural areas; and

(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section 51, chapter 303.

(b) Appropriations made to the account do not cancel and are available until expended,
except that at the end of each biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing commitments shall cancel to the
fund.

Sec. 4.

[144.1504] SENIOR CARE WORKFORCE INNOVATION GRANT
PROGRAM.

Subdivision 1.

Establishment.

The senior care workforce innovation grant program is
established to assist eligible applicants to fund pilot programs or expand existing programs
that increase the pool of caregivers working in the field of senior care services.

Subd. 2.

Competitive grants.

The commissioner shall make competitive grants available
to eligible applicants to expand the workforce for senior care services.

Subd. 3.

Eligibility.

(a) Eligible applicants must recruit and train individuals to work
with individuals who are primarily 65 years of age or older and receiving services through:

(1) a home and community-based setting, including housing with services establishments
as defined in section 144D.01, subdivision 4;

(2) adult day care as defined in section 245A.02, subdivision 2a;

(3) home care services as defined in section 144A.43, subdivision 3; or

(4) a nursing home as defined in section 144A.01, subdivision 5.

(b) Applicants must apply for a senior care workforce innovation grant as specified in
subdivision 4.

Subd. 4.

Application.

(a) Eligible applicants must apply for a grant on the forms and
according to the timelines established by the commissioner.

(b) Each applicant must propose a project or initiative to expand the number of workers
in the field of senior care services. At a minimum, a proposal must include:

(1) a description of the senior care workforce innovation project or initiative being
proposed, including the process by which the applicant will expand the senior care workforce;

(2) whether the applicant is proposing to target the proposed project or initiative to any
of the groups described in paragraph (c);

(3) information describing the applicant's current senior care workforce project or
initiative, if applicable;

(4) the amount of funding the applicant is seeking through the grant program;

(5) any other sources of funding the applicant has for the project or initiative;

(6) a proposed budget detailing how the grant funds will be spent; and

(7) outcomes established by the applicant to measure the success of the project or
initiative.

Subd. 5.

Commissioner's duties; requests for proposals; grantee selections.

(a) By
September 1, 2017, and annually thereafter, the commissioner shall publish a request for
proposals in the State Register specifying applicant eligibility requirements, qualifying
senior care workforce innovation program criteria, applicant selection criteria, documentation
required for program participation, maximum award amount, and methods of evaluation.

(b) Priority must be given to proposals that target employment of individuals who have
multiple barriers to employment, individuals who have been unemployed long-term, and
veterans.

(c) The commissioner shall determine the maximum award for grants and make grant
selections based on the information provided in the grant application, including the targeted
employment population, the applicant's proposed budget, the proposed measurable outcomes,
and other criteria as determined by the commissioner.

Subd. 6.

Grant funding.

Notwithstanding any law or rule to the contrary, funds awarded
to grantees in a grant agreement under this section do not lapse until the grant agreement
expires.

Subd. 7.

Reporting requirements.

(a) Grant recipients shall report to the commissioner
on the forms and according to the timelines established by the commissioner.

(b) The commissioner shall report to the chairs and ranking minority members of the
house of representatives and senate committees with jurisdiction over health by January 15,
2019, and annually thereafter, on the grant program. The report must include:

(1) information on each grant recipient;

(2) a summary of all projects or initiatives undertaken with each grant;

(3) the measurable outcomes established by each grantee, an explanation of the evaluation
process used to determine whether the outcomes were met, and the results of the evaluation;
and

(4) an accounting of how the grant funds were spent.

(c) During the grant period, the commissioner may require and collect from grant
recipients additional information necessary to evaluate the grant program.

Sec. 5.

[144.1505] PRIMARY CARE AND MENTAL HEALTH PROFESSIONS
CLINICAL TRAINING EXPANSION GRANT PROGRAM.

Subdivision 1.

Definitions.

For purposes of this section, the following definitions apply:

(1) "eligible advanced practice registered nurse program" means a program that is located
in Minnesota and is currently accredited as a master's, doctoral, or postgraduate level
advanced practice registered nurse program by the Commission on Collegiate Nursing
Education or by the Accreditation Commission for Education in Nursing, or is a candidate
for accreditation;

(2) "eligible dental therapy program" means a dental therapy education program or
advanced dental therapy education program that is located in Minnesota and is either:

(i) approved by the Board of Dentistry; or

(ii) currently accredited by the Commission on Dental Accreditation;

(3) "eligible mental health professional program" means a program that is located in
Minnesota and is listed as a mental health professional training program by the appropriate
accrediting body for clinical social work, psychology, marriage and family therapy, or
licensed professional clinical counseling, or is a candidate for accreditation;

(4) "eligible physician assistant program" means a program that is located in Minnesota
and is currently accredited as a physician assistant program by the Accreditation Review
Commission on Education for the Physician Assistant, or is a candidate for accreditation;

(5) "eligible pharmacy program" means a program that is located in Minnesota and is
currently accredited as a doctor of pharmacy program by the Accreditation Council on
Pharmacy Education;

(6) "mental health professional" means an individual providing clinical services in the
treatment of mental illness who meets one of the definitions in section 245.462, subdivision
18; and

(7) "project" means a project to establish or expand clinical training for physician
assistants, advanced practice registered nurses, pharmacists, dental therapists, advanced
dental therapists, or mental health professionals in Minnesota.

Subd. 2.

Program.

(a) The commissioner of health shall award health professional
training site grants to eligible physician assistant, advanced practice registered nurse,
pharmacy, dental therapy, and mental health professional programs to plan and implement
expanded clinical training. A planning grant shall not exceed $75,000, and a training grant
shall not exceed $150,000 for the first year, $100,000 for the second year, and $50,000 for
the third year per program.

(b) Funds may be used for:

(1) establishing or expanding clinical training for physician assistants, advanced practice
registered nurses, pharmacists, dental therapists, advanced dental therapists, and mental
health professionals in Minnesota;

(2) recruitment, training, and retention of students and faculty;

(3) connecting students with appropriate clinical training sites, internships, practicums,
or externship activities;

(4) travel and lodging for students;

(5) faculty, student, and preceptor salaries, incentives, or other financial support;

(6) development and implementation of cultural competency training;

(7) evaluations;

(8) training site improvements, fees, equipment, and supplies required to establish,
maintain, or expand a physician assistant, advanced practice registered nurse, pharmacy,
dental therapy, or mental health professional training program; and

(9) supporting clinical education in which trainees are part of a primary care team model.

Subd. 3.

Applications.

Eligible physician assistant, advanced practice registered nurse,
pharmacy, dental therapy, and mental health professional programs seeking a grant shall
apply to the commissioner. Applications must include a description of the number of
additional students who will be trained using grant funds; attestation that funding will be
used to support an increase in the number of clinical training slots; a description of the
problem that the proposed project will address; a description of the project, including all
costs associated with the project, sources of funds for the project, detailed uses of all funds
for the project, and the results expected; and a plan to maintain or operate any component
included in the project after the grant period. The applicant must describe achievable
objectives, a timetable, and roles and capabilities of responsible individuals in the
organization.

Subd. 4.

Consideration of applications.

The commissioner shall review each application
to determine whether or not the application is complete and whether the program and the
project are eligible for a grant. In evaluating applications, the commissioner shall score each
application based on factors including, but not limited to, the applicant's clarity and
thoroughness in describing the project and the problems to be addressed, the extent to which
the applicant has demonstrated that the applicant has made adequate provisions to ensure
proper and efficient operation of the training program once the grant project is completed,
the extent to which the proposed project is consistent with the goal of increasing access to
primary care and mental health services for rural and underserved urban communities, the
extent to which the proposed project incorporates team-based primary care, and project
costs and use of funds.

Subd. 5.

Program oversight.

The commissioner shall determine the amount of a grant
to be given to an eligible program based on the relative score of each eligible program's
application, other relevant factors discussed during the review, and the funds available to
the commissioner. Appropriations made to the program do not cancel and are available until
expended. During the grant period, the commissioner may require and collect from programs
receiving grants any information necessary to evaluate the program.

Sec. 6.

Minnesota Statutes 2016, section 144.1506, is amended to read:


144.1506 PRIMARY CARE PHYSICIAN RESIDENCY EXPANSION GRANT
PROGRAM.

Subdivision 1.

Definitions.

For purposes of this section, the following definitions apply:

(1) "eligible primary care physician residency program" means a program that meets
the following criteria:

(i) is located in Minnesota;

(ii) trains medical residents in the specialties of family medicine, general internal
medicine, general pediatrics, psychiatry, geriatrics, or general surgery, obstetrics and
gynecology, or other physician specialties with training programs that incorporate rural
training components
; and

(iii) is accredited by the Accreditation Council for Graduate Medical Education or
presents a credible plan to obtain accreditation;

(2) "eligible project" means a project to establish a new eligible primary care physician
residency program or create at least one new residency slot in an existing eligible primary
care
physician residency program; and

(3) "new residency slot" means the creation of a new residency position and the execution
of a contract with a new resident in a residency program.

Subd. 2.

Expansion grant program.

(a) The commissioner of health shall award primary
care
physician residency expansion grants to eligible primary care physician residency
programs to plan and implement new residency slots. A planning grant shall not exceed
$75,000, and a training grant shall not exceed $150,000 per new residency slot for the first
year, $100,000 for the second year, and $50,000 for the third year of the new residency slot.

(b) Funds may be spent to cover the costs of:

(1) planning related to establishing an accredited primary care physician residency
program;

(2) obtaining accreditation by the Accreditation Council for Graduate Medical Education
or another national body that accredits residency programs;

(3) establishing new residency programs or new resident training slots;

(4) recruitment, training, and retention of new residents and faculty;

(5) travel and lodging for new residents;

(6) faculty, new resident, and preceptor salaries related to new residency slots;

(7) training site improvements, fees, equipment, and supplies required for new primary
care
physician resident training slots; and

(8) supporting clinical education in which trainees are part of a primary care team model.

Subd. 3.

Applications for expansion grants.

Eligible primary care physician residency
programs seeking a grant shall apply to the commissioner. Applications must include the
number of new primary care physician residency slots planned or under contract; attestation
that funding will be used to support an increase in the number of available residency slots;
a description of the training to be received by the new residents, including the location of
training; a description of the project, including all costs associated with the project; all
sources of funds for the project; detailed uses of all funds for the project; the results expected;
and a plan to maintain the new residency slot after the grant period. The applicant must
describe achievable objectives, a timetable, and roles and capabilities of responsible
individuals in the organization.

Subd. 4.

Consideration of expansion grant applications.

The commissioner shall
review each application to determine whether or not the residency program application is
complete and whether the proposed new residency program and any new residency slots
are eligible for a grant. The commissioner shall award grants to support up to six family
medicine, general internal medicine, or general pediatrics residents; four psychiatry residents;
two geriatrics residents; and two four general surgery residents; two obstetrics and
gynecology residents; and four specialty physician residents participating in training programs
that incorporate rural training components
. If insufficient applications are received from
any eligible specialty, funds may be redistributed to applications from other eligible
specialties.

Subd. 5.

Program oversight.

During the grant period, the commissioner may require
and collect from grantees any information necessary to evaluate the program. Appropriations
made to the program do not cancel and are available until expended.

Sec. 7.

[144.397] STATEWIDE TOBACCO QUITLINE SERVICES.

(a) The commissioner of health shall administer, or contract for the administration of,
a statewide tobacco quitline service to assist Minnesotans who are seeking advice or services
to help them quit using tobacco products. The commissioner shall establish statewide public
awareness activities to inform the public of the availability of the service and encourage
the public to utilize the services because of the dangers and harm of tobacco use and
dependence.

(b) Services to be provided include, but are not limited to:

(1) telephone-based coaching and counseling;

(2) referrals;

(3) written materials mailed upon request;

(4) Web-based texting or e-mail services; and

(5) free Food and Drug Administration-approved tobacco cessation medications.

(c) Services provided must be consistent with evidence-based best practices in tobacco
cessation services. Services provided must be coordinated with employer, health plan
company, and private sector tobacco prevention and cessation services that may be available
to individuals depending on their employment or health coverage.

Sec. 8.

Minnesota Statutes 2016, 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 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;

(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 clause;

(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; or

(26)(i) a project for a 20-bed psychiatric hospital, within an existing facility in the city
of Maple Grove, exclusively for patients who are under 21 years of age on the date of
admission, if the commissioner finds the project is in the public interest after the public
interest review conducted under section 144.552 is complete;

(ii) this project shall serve patients in the continuing care benefit program under section
256.9693. The project may also serve patients not in the continuing care benefit program;
and

(iii) if the project ceases to participate in the continuing care benefit program, the
commissioner must complete a subsequent public interest review under section 144.552. If
the project is found not to be in the public interest, the license must be terminated six months
from the date of that finding. If the commissioner of human services terminates the contract
without cause or reduces per diem payment rates for patients under the continuing care
benefit program below the rates in effect for services provided on December 31, 2015, the
project may cease to participate in the continuing care benefit program and continue to
operate without a subsequent public interest review; or

(27) a project involving the addition of 21 new beds in an existing psychiatric hospital
in Hennepin County that is exclusively for patients who are under 21 years of age on the
date of admission
.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 9.

[144.88] MINNESOTA BIOMEDICINE AND BIOETHICS INNOVATION
GRANTS.

Subdivision 1.

Grants.

(a) The commissioner of health, in consultation with interested
parties with relevant knowledge and expertise as specified in subdivision 2, shall award
grants to entities that apply for a grant under this subdivision to fund innovations and research
in biomedicine and bioethics. Grant funds must be used to fund biomedical and bioethical
research, and related clinical translation and commercialization activities in this state. Entities
applying for a grant must do so in a form and manner specified by the commissioner. The
commissioner and interested parties shall use the following criteria to award grants under
this subdivision:

(1) the likelihood that the research will lead to a new discovery;

(2) the prospects for commercialization of the research;

(3) the likelihood that the research will strengthen Minnesota's economy through the
creation of new businesses, increased public or private funding for research in Minnesota,
or attracting additional clinicians and researchers to Minnesota; and

(4) whether the proposed research includes a bioethics research plan to ensure the research
is conducted using ethical research practices.

(b) Projects that include the acquisition or use of human fetal tissue are not eligible for
grants under this subdivision. For purposes of this paragraph, "human fetal tissue" has the
meaning given in United States Code, title 42, section 289g-1(f).

Subd. 2.

Consultation.

In awarding grants under subdivision 1, the commissioner must
consult with interested parties who are able to provide the commissioner with technical
information, advice, and recommendations on grant projects and awards. Interested parties
with whom the commissioner must consult include but are not limited to representatives of
the University of Minnesota, Mayo Clinic, and private industries who have expertise in
biomedical research, bioethical research, clinical translation, commercialization, and medical
venture financing.

Sec. 10.

Minnesota Statutes 2016, section 144.99, subdivision 1, is amended to read:


Subdivision 1.

Remedies available.

The provisions of chapters 103I and 157 and sections
115.71 to 115.77; 144.12, subdivision 1, paragraphs (1), (2), (5), (6), (10), (12), (13), (14),
and (15)
; 144.1201 to 144.1204; 144.121; 144.1215; 144.1222; 144.35; 144.381 to 144.385;
144.411 to 144.417; 144.495; 144.71 to 144.74; 144.9501 to 144.9512; 144.97 to 144.98;
144.992; 326.70 to 326.785; 327.10 to 327.131; and 327.14 to 327.28 and all rules, orders,
stipulation agreements, settlements, compliance agreements, licenses, registrations,
certificates, and permits adopted or issued by the department or under any other law now
in force or later enacted for the preservation of public health may, in addition to provisions
in other statutes, be enforced under this section.

Sec. 11.

Minnesota Statutes 2016, section 144A.474, subdivision 11, is amended to read:


Subd. 11.

Fines.

(a) Fines and enforcement actions under this subdivision may be assessed
based on the level and scope of the violations described in paragraph (c) as follows:

(1) Level 1, no fines or enforcement;

(2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
mechanisms authorized in section 144A.475 for widespread violations;

(3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
mechanisms authorized in section 144A.475; and

(4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the enforcement
mechanisms authorized in section 144A.475.

(b) Correction orders for violations are categorized by both level and scope and fines
shall be assessed as follows:

(1) level of violation:

(i) Level 1 is a violation that has no potential to cause more than a minimal impact on
the client and does not affect health or safety;

(ii) Level 2 is a violation that did not harm a client's health or safety but had the potential
to have harmed a client's health or safety, but was not likely to cause serious injury,
impairment, or death;

(iii) Level 3 is a violation that harmed a client's health or safety, not including serious
injury, impairment, or death, or a violation that has the potential to lead to serious injury,
impairment, or death; and

(iv) Level 4 is a violation that results in serious injury, impairment, or death.

(2) scope of violation:

(i) isolated, when one or a limited number of clients are affected or one or a limited
number of staff are involved or the situation has occurred only occasionally;

(ii) pattern, when more than a limited number of clients are affected, more than a limited
number of staff are involved, or the situation has occurred repeatedly but is not found to be
pervasive; and

(iii) widespread, when problems are pervasive or represent a systemic failure that has
affected or has the potential to affect a large portion or all of the clients.

(c) If the commissioner finds that the applicant or a home care provider required to be
licensed under sections 144A.43 to 144A.482 has not corrected violations by the date
specified in the correction order or conditional license resulting from a survey or complaint
investigation, the commissioner may impose a fine. A notice of noncompliance with a
correction order must be mailed to the applicant's or provider's last known address. The
noncompliance notice must list the violations not corrected.

(d) The license holder must pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies by paying the fine. A
timely appeal shall stay payment of the fine until the commissioner issues a final order.

(e) A license holder shall promptly notify the commissioner in writing when a violation
specified in the order is corrected. If upon reinspection the commissioner determines that
a violation has not been corrected as indicated by the order, the commissioner may issue a
second fine. The commissioner shall notify the license holder by mail to the last known
address in the licensing record that a second fine has been assessed. The license holder may
appeal the second fine as provided under this subdivision.

(f) A home care provider that has been assessed a fine under this subdivision has a right
to a reconsideration or a hearing under this section and chapter 14.

(g) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder shall be liable for payment of the fine.

(h) In addition to any fine imposed under this section, the commissioner may assess
costs related to an investigation that results in a final order assessing a fine or other
enforcement action authorized by this chapter.

(i) Fines collected under this subdivision shall be deposited in the state government
special revenue fund and credited to an account separate from the revenue collected under
section 144A.472. Subject to an appropriation by the legislature, the revenue from the fines
collected may must be used by the commissioner for special projects to improve home care
in Minnesota as recommended by the advisory council established in section 144A.4799.

Sec. 12.

Minnesota Statutes 2016, section 144A.4799, subdivision 3, is amended to read:


Subd. 3.

Duties.

(a) At the commissioner's request, the advisory council shall provide
advice regarding regulations of Department of Health licensed home care providers in this
chapter, including advice on the following:

(1) community standards for home care practices;

(2) enforcement of licensing standards and whether certain disciplinary actions are
appropriate;

(3) ways of distributing information to licensees and consumers of home care;

(4) training standards;

(5) identifying emerging issues and opportunities in the home care field, including the
use of technology in home and telehealth capabilities;

(6) allowable home care licensing modifications and exemptions, including a method
for an integrated license with an existing license for rural licensed nursing homes to provide
limited home care services in an adjacent independent living apartment building owned by
the licensed nursing home; and

(7) recommendations for studies using the data in section 62U.04, subdivision 4, including
but not limited to studies concerning costs related to dementia and chronic disease among
an elderly population over 60 and additional long-term care costs, as described in section
62U.10, subdivision 6.

(b) The advisory council shall perform other duties as directed by the commissioner.

(c) The advisory council shall annually review the balance of the account in the state
government special revenue fund described in section 144A.474, subdivision 11, paragraph
(i), and make annual recommendations by January 15 directly to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services regarding appropriations to the commissioner for the purposes in section 144A.474,
subdivision 11, paragraph (i).

Sec. 13.

Minnesota Statutes 2016, section 144A.70, is amended by adding a subdivision
to read:


Subd. 4a.

Nurse.

"Nurse" means a licensed practical nurse as defined in section 148.171,
subdivision 8, or a registered nurse as defined in section 148.171, subdivision 20.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 14.

Minnesota Statutes 2016, section 144A.70, subdivision 6, is amended to read:


Subd. 6.

Supplemental nursing services agency.

"Supplemental nursing services
agency" means a person, firm, corporation, partnership, or association engaged for hire in
the business of providing or procuring temporary employment in health care facilities for
nurses, nursing assistants, nurse aides, and orderlies, and other licensed health professionals.
Supplemental nursing services agency does not include an individual who only engages in
providing the individual's services on a temporary basis to health care facilities. Supplemental
nursing services agency does not include a professional home care agency licensed under
section 144A.471 that only provides staff to other home care providers.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 15.

[144H.01] DEFINITIONS.

Subdivision 1.

Application.

The terms defined in this section apply to this chapter.

Subd. 2.

Basic services.

"Basic services" includes but is not limited to:

(1) the development, implementation, and monitoring of a comprehensive protocol of
care that is developed in conjunction with the parent or guardian of a medically complex
or technologically dependent child and that specifies the medical, nursing, psychosocial,
and developmental therapies required by the medically complex or technologically dependent
child; and

(2) the caregiver training needs of the child's parent or guardian.

Subd. 3.

Commissioner.

"Commissioner" means the commissioner of health.

Subd. 4.

Licensee.

"Licensee" means an owner of a prescribed pediatric extended care
(PPEC) center licensed under this chapter.

Subd. 5.

Medically complex or technologically dependent child.

"Medically complex
or technologically dependent child" means a child under 21 years of age who, because of
a medical condition, requires continuous therapeutic interventions or skilled nursing
supervision which must be prescribed by a licensed physician and administered by, or under
the direct supervision of, a licensed registered nurse.

Subd. 6.

Owner.

"Owner" means an individual whose ownership interest provides
sufficient authority or control to affect or change decisions regarding the operation of the
PPEC center. An owner includes a sole proprietor, a general partner, or any other individual
whose ownership interest has the ability to affect the management and direction of the PPEC
center's policies.

Subd. 7.

Prescribed pediatric extended care center, PPEC center, or center.

"Prescribed pediatric extended care center," "PPEC center," or "center" means any facility
that provides nonresidential basic services to three or more medically complex or
technologically dependent children who require such services and who are not related to
the owner by blood, marriage, or adoption.

Subd. 8.

Supportive services or contracted services.

"Supportive services or contracted
services" include but are not limited to speech therapy, occupational therapy, physical
therapy, social work services, developmental services, child life services, and psychology
services.

Sec. 16.

[144H.02] LICENSURE REQUIRED.

A person may not own or operate a prescribed pediatric extended care center in this state
unless the person holds a temporary or current license issued under this chapter. A separate
license must be obtained for each PPEC center maintained on separate premises, even if
the same management operates the PPEC centers. Separate licenses are not required for
separate buildings on the same grounds. A center shall not be operated on the same grounds
as a child care center licensed under Minnesota Rules, chapter 9503.

Sec. 17.

[144H.03] EXEMPTIONS.

This chapter does not apply to:

(1) a facility operated by the United States government or a federal agency; or

(2) a health care facility licensed under chapter 144 or 144A.

Sec. 18.

[144H.04] LICENSE APPLICATION AND RENEWAL.

Subdivision 1.

Licenses.

A person seeking licensure for a PPEC center must submit a
completed application for licensure to the commissioner, in a form and manner determined
by the commissioner. The applicant must also submit the application fee, in the amount
specified in section 144H.05, subdivision 1. Effective January 1, 2018, the commissioner
shall issue a license for a PPEC center if the commissioner determines that the applicant
and center meet the requirements of this chapter and rules that apply to PPEC centers. A
license issued under this subdivision is valid for two years.

Subd. 2.

License renewal.

A license issued under subdivision 1 may be renewed for a
period of two years if the licensee:

(1) submits an application for renewal in a form and manner determined by the
commissioner, at least 30 days before the license expires. An application for renewal
submitted after the renewal deadline date must be accompanied by a late fee in the amount
specified in section 144H.05, subdivision 3;

(2) submits the renewal fee in the amount specified in section 144H.05, subdivision 2;

(3) demonstrates that the licensee has provided basic services at the PPEC center within
the past two years;

(4) provides evidence that the applicant meets the requirements for licensure; and

(5) provides other information required by the commissioner.

Subd. 3.

License not transferable.

A PPEC center license issued under this section is
not transferable to another party. Before acquiring ownership of a PPEC center, a prospective
applicant must apply to the commissioner for a new license.

Sec. 19.

[144H.05] FEES.

Subdivision 1.

Initial application fee.

The initial application fee for PPEC center
licensure is $3,820.

Subd. 2.

License renewal.

The fee for renewal of a PPEC center license is $1,800.

Subd. 3.

Late fee.

The fee for late submission of an application to renew a PPEC center
license is $25.

Subd. 4.

Change of ownership.

The fee for change of ownership of a PPEC center is
$4,200.

Subd. 4.

Nonrefundable; state government special revenue fund.

All fees collected
under this chapter are nonrefundable and must be deposited in the state treasury and credited
to the state government special revenue fund.

Sec. 20.

[144H.06] APPLICATION OF RULES FOR HOSPICE SERVICES AND
RESIDENTIAL HOSPICE FACILITIES.

Minnesota Rules, chapter 4664, shall apply to PPEC centers licensed under this chapter,
except that the following parts, subparts, items, and subitems do not apply:

(1) Minnesota Rules, part 4664.0003, subparts 2, 6, 7, 11, 12, 13, 14, and 38;

(2) Minnesota Rules, part 4664.0008;

(3) Minnesota Rules, part 4664.0010, subparts 3; 4, items A, subitem (6), and B; and 8;

(4) Minnesota Rules, part 4664.0020, subpart 13;

(5) Minnesota Rules, part 4664.0370, subpart 1;

(6) Minnesota Rules, part 4664.0390, subpart 1, items A, C, and E;

(7) Minnesota Rules, part 4664.0420;

(8) Minnesota Rules, part 4664.0425, subparts 3, item A; 4; and 6;

(9) Minnesota Rules, part 4664.0430, subparts 3, 4, 5, 7, 8, 9, 10, 11, and 12;

(10) Minnesota Rules, part 4664.0490; and

(11) Minnesota Rules, part 4664.0520.

Sec. 21.

[144H.07] SERVICES; LIMITATIONS.

Subdivision 1.

Services.

A PPEC center must provide basic services to medically complex
or technologically dependent children, based on a protocol of care established for each child.
A PPEC center may provide services up to 14 hours a day and up to six days a week.

Subd. 2.

Limitations.

A PPEC center must comply with the following standards related
to services:

(1) a child is prohibited from attending a PPEC center for more than 14 hours within a
24-hour period;

(2) a PPEC center is prohibited from providing services other than those provided to
medically complex or technologically dependent children; and

(3) the maximum capacity for medically complex or technologically dependent children
at a center shall not exceed 45 children.

Sec. 22.

[144H.08] ADMINISTRATION AND MANAGEMENT.

Subdivision 1.

Duties of owner.

(a) The owner of a PPEC center shall have full legal
authority and responsibility for the operation of the center. A PPEC center must be organized
according to a written table of organization, describing the lines of authority and
communication to the child care level. The organizational structure must be designed to
ensure an integrated continuum of services for the children served.

(b) The owner must designate one person as a center administrator, who is responsible
and accountable for overall management of the center.

Subd. 2.

Duties of administrator.

The center administrator is responsible and accountable
for overall management of the center. The administrator must:

(1) designate in writing a person to be responsible for the center when the administrator
is absent from the center for more than 24 hours;

(2) maintain the following written records, in a place and form and using a system that
allows for inspection of the records by the commissioner during normal business hours:

(i) a daily census record, which indicates the number of children currently receiving
services at the center;

(ii) a record of all accidents or unusual incidents involving any child or staff member
that caused, or had the potential to cause, injury or harm to a person at the center or to center
property;

(iii) copies of all current agreements with providers of supportive services or contracted
services;

(iv) copies of all current agreements with consultants employed by the center,
documentation of each consultant's visits, and written, dated reports; and

(v) a personnel record for each employee, which must include an application for
employment, references, employment history for the preceding five years, and copies of all
performance evaluations;

(3) develop and maintain a current job description for each employee;

(4) provide necessary qualified personnel and ancillary services to ensure the health,
safety, and proper care for each child; and

(5) develop and implement infection control policies that comply with rules adopted by
the commissioner regarding infection control.

Sec. 23.

[144H.09] ADMISSION, TRANSFER, AND DISCHARGE POLICIES;
CONSENT FORM.

Subdivision 1.

Written policies.

A PPEC center must have written policies and
procedures governing the admission, transfer, and discharge of children.

Subd. 2.

Notice of discharge.

At least ten days prior to a child's discharge from a PPEC
center, the PPEC center shall provide notice of the discharge to the child's parent or guardian.

Subd. 3.

Consent form.

A parent or guardian must sign a consent form outlining the
purpose of a PPEC center, specifying family responsibilities, authorizing treatment and
services, providing appropriate liability releases, and specifying emergency disposition
plans, before the child's admission to the center. The center must provide the child's parents
or guardians with a copy of the consent form and must maintain the consent form in the
child's medical record.

Sec. 24.

[144H.10] MEDICAL DIRECTOR.

A PPEC center must have a medical director who is a physician licensed in Minnesota
and certified by the American Board of Pediatrics.

Sec. 25.

[144H.11] NURSING SERVICES.

Subdivision 1.

Nursing director.

A PPEC center must have a nursing director who is
a registered nurse licensed in Minnesota, holds a current certification in cardiopulmonary
resuscitation, and has at least four years of general pediatric nursing experience, at least
one year of which must have been spent caring for medically fragile infants or children in
a pediatric intensive care, neonatal intensive care, PPEC center, or home care setting during
the previous five years. The nursing director is responsible for the daily operation of the
PPEC center.

Subd. 2.

Registered nurses.

A registered nurse employed by a PPEC center must be a
registered nurse licensed in Minnesota, hold a current certification in cardiopulmonary
resuscitation, and have experience in the previous 24 months in being responsible for the
care of acutely ill or chronically ill children.

Subd. 3.

Licensed practical nurses.

A licensed practical nurse employed by a PPEC
center must be supervised by a registered nurse and must be a licensed practical nurse
licensed in Minnesota, have at least two years of experience in pediatrics, and hold a current
certification in cardiopulmonary resuscitation.

Subd. 4.

Other direct care personnel.

(a) Direct care personnel governed by this
subdivision include nursing assistants and individuals with training and experience in the
field of education, social services, or child care.

(b) All direct care personnel employed by a PPEC center must work under the supervision
of a registered nurse and are responsible for providing direct care to children at the center.
Direct care personnel must have extensive, documented education and skills training in
providing care to infants and toddlers, provide employment references documenting skill
in the care of infants and children, and hold a current certification in cardiopulmonary
resuscitation.

Sec. 26.

[144H.12] TOTAL STAFFING FOR NURSING SERVICES AND DIRECT
CARE PERSONNEL.

A PPEC center must provide total staffing for nursing services and direct care personnel
at a ratio of one staff person for every three children at the center. The staffing ratio required
in this section is the minimum staffing permitted.

Sec. 27.

[144H.13] MEDICAL RECORD; PROTOCOL OF CARE.

A medical record and an individualized nursing protocol of care must be developed for
each child admitted to a PPEC center, must be maintained for each child, and must be signed
by authorized personnel.

Sec. 28.

[144H.14] QUALITY ASSURANCE PROGRAM.

A PPEC center must have a quality assurance program, in which quarterly reviews are
conducted of the PPEC center's medical records and protocols of care for at least half of
the children served by the PPEC center. The quarterly review sample must be randomly
selected so each child at the center has an equal opportunity to be included in the review.
The committee conducting quality assurance reviews must include the medical director,
administrator, nursing director, and three other committee members determined by the PPEC
center.

Sec. 29.

[144H.15] INSPECTIONS.

(a) The commissioner may inspect a PPEC center, including records held at the center,
at reasonable times as necessary to ensure compliance with this chapter and the rules that
apply to PPEC centers. During an inspection, a center must provide the commissioner with
access to all center records.

(b) The commissioner must inspect a PPEC center before issuing or renewing a license
under this chapter.

Sec. 30.

[144H.16] COMPLIANCE WITH OTHER LAWS.

Subdivision 1.

Reporting of maltreatment of minors.

A PPEC center must develop
policies and procedures for reporting suspected child maltreatment that fulfill the
requirements of section 626.556. The policies and procedures must include the telephone
numbers of the local county child protection agency for reporting suspected maltreatment.
The policies and procedures specified in this subdivision must be provided to the parents
or guardians of all children at the time of admission to the PPEC center and must be available
upon request.

Subd. 2.

Crib safety requirements.

A PPEC center must comply with the crib safety
requirements in section 245A.146, to the extent they are applicable.

Sec. 31.

[144H.17] DENIAL, SUSPENSION, REVOCATION, REFUSAL TO RENEW
A LICENSE.

(a) The commissioner may deny, suspend, revoke, or refuse to renew a license issued
under this chapter for:

(1) a violation of this chapter or rules adopted that apply to PPEC centers; or

(2) an intentional or negligent act by an employee or contractor at the center that
detrimentally affects the health or safety of children at the PPEC center.

(b) Prior to any suspension, revocation, or refusal to renew a license, a licensee shall be
entitled to a hearing and review as provided in sections 14.57 to 14.69.

Sec. 32.

[144H.18] FINES; CORRECTIVE ACTION PLANS.

Subdivision 1.

Corrective action plans.

If the commissioner determines that a PPEC
center is not in compliance with this chapter or rules that apply to PPEC centers, the
commissioner may require the center to submit a corrective action plan that demonstrates
a good-faith effort to remedy each violation by a specific date, subject to approval by the
commissioner.

Subd. 2.

Fines.

The commissioner may issue a fine to a PPEC center, employee, or
contractor if the commissioner determines the center, employee, or contractor violated this
chapter or rules that apply to PPEC centers. The fine amount shall not exceed an amount
for each violation and an aggregate amount established by the commissioner. The failure
to correct a violation by the date set by the commissioner, or a failure to comply with an
approved corrective action plan, constitutes a separate violation for each day the failure
continues, unless the commissioner approves an extension to a specific date. In determining
if a fine is to be imposed and establishing the amount of the fine, the commissioner shall
consider:

(1) the gravity of the violation, including the probability that death or serious physical
or emotional harm to a child will result or has resulted, the severity of the actual or potential
harm, and the extent to which the applicable laws were violated;

(2) actions taken by the owner or administrator to correct violations;

(3) any previous violations; and

(4) the financial benefit to the PPEC center of committing or continuing the violation.

Subd. 3.

Fines for violations of other statutes.

The commissioner shall impose a fine
of $250 on a PPEC center, employee, or contractor for each violation by that PPEC center,
employee, or contractor of section 245A.146 or 626.556.

Sec. 33.

[144H.19] CLOSING A PPEC CENTER.

When a PPEC center voluntarily closes, it must, at least 30 days before closure, inform
each child's parents or guardians of the closure and when the closure will occur.

Sec. 34.

[144H.20] PHYSICAL ENVIRONMENT.

Subdivision 1.

General requirements.

A PPEC center shall conform with or exceed
the physical environment requirements in this section and the physical environment
requirements for day care facilities in Minnesota Rules, part 9502.0425. If the physical
environment requirements in this section differ from the physical environment requirements
for day care facilities in Minnesota Rules, part 9502.0425, the requirements in this section
shall prevail. A PPEC center must have sufficient indoor and outdoor space to accommodate
at least six medically complex or technologically dependent children.

Subd. 2.

Specific requirements.

(a) The entrance to a PPEC center must be barrier-free,
have a wheelchair ramp, provide for traffic flow with a driveway area for entering and
exiting, and have storage space for supplies from home.

(b) A PPEC center must have a treatment room with a medication preparation area. The
medication preparation area must contain a work counter, refrigerator, sink with hot and
cold running water, and locked storage for biologicals and prescription drugs.

(c) A PPEC center must develop isolation procedures to prevent cross-infections and
must have an isolation room with at least one glass area for observation of a child in the
isolation room. The isolation room must be at least 100 square feet in size.

(d) A PPEC center must have:

(1) an outdoor play space adjacent to the center of at least 35 square feet per child in
attendance at the center, for regular use; or

(2) a park, playground, or play space within 1,500 feet of the center.

(e) A PPEC center must have at least 50 square feet of usable indoor space per child in
attendance at the center.

(f) Notwithstanding the Minnesota State Building Code and the Minnesota State Fire
Code, a new construction PPEC center or an existing building converted into a PPEC center
must meet the requirements of the International Building Code in Minnesota Rules, chapter
1305, for:

(1) Group R, Division 4 occupancy, if serving 12 or fewer children; or

(2) Group E, Division 4 occupancy or Group I, Division 4 occupancy, if serving 13 or
more children.

Sec. 35.

Minnesota Statutes 2016, 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, and;
609.3241, paragraph (c), clause (3); and 609.5315, subdivision 5c, clause (3);

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

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

(7) providing oversight of and technical support to regional navigators pursuant to section
145.4717;

(8) conducting a comprehensive evaluation of the statewide program for safe harbor of
sexually exploited youth; and

(9) 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. 36.

[256B.7651] PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS.

The commissioner shall set payment rates for services provided at prescribed pediatric
extended care centers licensed under chapter 144H in one-hour increments, at a rate equal
to 85 percent of the payment rate for one hour of complex home care nursing services. The
payment rate shall include services provided by nursing staff and direct care staff specified
in section 144H.11.

Sec. 37.

Minnesota Statutes 2016, section 609.5315, subdivision 5c, is amended to read:


Subd. 5c.

Disposition of money; prostitution.

Money forfeited under section 609.5312,
subdivision 1
, paragraph (b), must be distributed as follows:

(1) 40 percent must be forwarded to the appropriate agency for deposit as a supplement
to the agency's operating fund or similar fund for use in law enforcement;

(2) 20 percent must be forwarded to the prosecuting authority that handled the forfeiture
for deposit as a supplement to its operating fund or similar fund for prosecutorial purposes;
and

(3) the remaining 40 percent must be forwarded to the commissioner of public safety
health
to be deposited in the safe harbor for youth account in the special revenue fund and
is appropriated to the commissioner for distribution to crime victims services organizations
that provide services to sexually exploited youth, as defined in section 260C.007, subdivision
31
.

Sec. 38.

Minnesota Statutes 2016, section 626.556, subdivision 2, is amended to read:


Subd. 2.

Definitions.

As used in this section, the following terms have the meanings
given them unless the specific content indicates otherwise:

(a) "Accidental" means a sudden, not reasonably foreseeable, and unexpected occurrence
or event which:

(1) is not likely to occur and could not have been prevented by exercise of due care; and

(2) if occurring while a child is receiving services from a facility, happens when the
facility and the employee or person providing services in the facility are in compliance with
the laws and rules relevant to the occurrence or event.

(b) "Commissioner" means the commissioner of human services.

(c) "Facility" means:

(1) a licensed or unlicensed day care facility, residential facility, agency, hospital,
sanitarium, or other facility or institution required to be licensed under sections 144.50 to
144.58, 241.021, or 245A.01 to 245A.16, or chapter 144H or 245D;

(2) a school as defined in section 120A.05, subdivisions 9, 11, and 13; and chapter 124E;
or

(3) a nonlicensed personal care provider organization as defined in section 256B.0625,
subdivision 19a
.

(d) "Family assessment" means a comprehensive assessment of child safety, risk of
subsequent child maltreatment, and family strengths and needs that is applied to a child
maltreatment report that does not allege sexual abuse or substantial child endangerment.
Family assessment does not include a determination as to whether child maltreatment
occurred but does determine the need for services to address the safety of family members
and the risk of subsequent maltreatment.

(e) "Investigation" means fact gathering related to the current safety of a child and the
risk of subsequent maltreatment that determines whether child maltreatment occurred and
whether child protective services are needed. An investigation must be used when reports
involve sexual abuse or substantial child endangerment, and for reports of maltreatment in
facilities required to be licensed under chapter 245A or 245D; under sections 144.50 to
144.58 and 241.021; in a school as defined in section 120A.05, subdivisions 9, 11, and 13,
and chapter 124E; or in a nonlicensed personal care provider association as defined in section
256B.0625, subdivision 19a.

(f) "Mental injury" means an injury to the psychological capacity or emotional stability
of a child as evidenced by an observable or substantial impairment in the child's ability to
function within a normal range of performance and behavior with due regard to the child's
culture.

(g) "Neglect" means the commission or omission of any of the acts specified under
clauses (1) to (9), other than by accidental means:

(1) failure by a person responsible for a child's care to supply a child with necessary
food, clothing, shelter, health, medical, or other care required for the child's physical or
mental health when reasonably able to do so;

(2) failure to protect a child from conditions or actions that seriously endanger the child's
physical or mental health when reasonably able to do so, including a growth delay, which
may be referred to as a failure to thrive, that has been diagnosed by a physician and is due
to parental neglect;

(3) failure to provide for necessary supervision or child care arrangements appropriate
for a child after considering factors as the child's age, mental ability, physical condition,
length of absence, or environment, when the child is unable to care for the child's own basic
needs or safety, or the basic needs or safety of another child in their care;

(4) failure to ensure that the child is educated as defined in sections 120A.22 and
260C.163, subdivision 11, which does not include a parent's refusal to provide the parent's
child with sympathomimetic medications, consistent with section 125A.091, subdivision
5
;

(5) nothing in this section shall be construed to mean that a child is neglected solely
because the child's parent, guardian, or other person responsible for the child's care in good
faith selects and depends upon spiritual means or prayer for treatment or care of disease or
remedial care of the child in lieu of medical care; except that a parent, guardian, or caretaker,
or a person mandated to report pursuant to subdivision 3, has a duty to report if a lack of
medical care may cause serious danger to the child's health. This section does not impose
upon persons, not otherwise legally responsible for providing a child with necessary food,
clothing, shelter, education, or medical care, a duty to provide that care;

(6) prenatal exposure to a controlled substance, as defined in section 253B.02, subdivision
2, used by the mother for a nonmedical purpose, as evidenced by withdrawal symptoms in
the child at birth, results of a toxicology test performed on the mother at delivery or the
child at birth, medical effects or developmental delays during the child's first year of life
that medically indicate prenatal exposure to a controlled substance, or the presence of a
fetal alcohol spectrum disorder;

(7) "medical neglect" as defined in section 260C.007, subdivision 6, clause (5);

(8) chronic and severe use of alcohol or a controlled substance by a parent or person
responsible for the care of the child that adversely affects the child's basic needs and safety;
or

(9) emotional harm from a pattern of behavior which contributes to impaired emotional
functioning of the child which may be demonstrated by a substantial and observable effect
in the child's behavior, emotional response, or cognition that is not within the normal range
for the child's age and stage of development, with due regard to the child's culture.

(h) "Nonmaltreatment mistake" means:

(1) at the time of the incident, the individual was performing duties identified in the
center's child care program plan required under Minnesota Rules, part 9503.0045;

(2) the individual has not been determined responsible for a similar incident that resulted
in a finding of maltreatment for at least seven years;

(3) the individual has not been determined to have committed a similar nonmaltreatment
mistake under this paragraph for at least four years;

(4) any injury to a child resulting from the incident, if treated, is treated only with
remedies that are available over the counter, whether ordered by a medical professional or
not; and

(5) except for the period when the incident occurred, the facility and the individual
providing services were both in compliance with all licensing requirements relevant to the
incident.

This definition only applies to child care centers licensed under Minnesota Rules, chapter
9503. If clauses (1) to (5) apply, rather than making a determination of substantiated
maltreatment by the individual, the commissioner of human services shall determine that a
nonmaltreatment mistake was made by the individual.

(i) "Operator" means an operator or agency as defined in section 245A.02.

(j) "Person responsible for the child's care" means (1) an individual functioning within
the family unit and having responsibilities for the care of the child such as a parent, guardian,
or other person having similar care responsibilities, or (2) an individual functioning outside
the family unit and having responsibilities for the care of the child such as a teacher, school
administrator, other school employees or agents, or other lawful custodian of a child having
either full-time or short-term care responsibilities including, but not limited to, day care,
babysitting whether paid or unpaid, counseling, teaching, and coaching.

(k) "Physical abuse" means any physical injury, mental injury, or threatened injury,
inflicted by a person responsible for the child's care on a child other than by accidental
means, or any physical or mental injury that cannot reasonably be explained by the child's
history of injuries, or any aversive or deprivation procedures, or regulated interventions,
that have not been authorized under section 125A.0942 or 245.825.

Abuse does not include reasonable and moderate physical discipline of a child
administered by a parent or legal guardian which does not result in an injury. Abuse does
not include the use of reasonable force by a teacher, principal, or school employee as allowed
by section 121A.582. Actions which are not reasonable and moderate include, but are not
limited to, any of the following:

(1) throwing, kicking, burning, biting, or cutting a child;

(2) striking a child with a closed fist;

(3) shaking a child under age three;

(4) striking or other actions which result in any nonaccidental injury to a child under 18
months of age;

(5) unreasonable interference with a child's breathing;

(6) threatening a child with a weapon, as defined in section 609.02, subdivision 6;

(7) striking a child under age one on the face or head;

(8) striking a child who is at least age one but under age four on the face or head, which
results in an injury;

(9) purposely giving a child poison, alcohol, or dangerous, harmful, or controlled
substances which were not prescribed for the child by a practitioner, in order to control or
punish the child; or other substances that substantially affect the child's behavior, motor
coordination, or judgment or that results in sickness or internal injury, or subjects the child
to medical procedures that would be unnecessary if the child were not exposed to the
substances;

(10) unreasonable physical confinement or restraint not permitted under section 609.379,
including but not limited to tying, caging, or chaining; or

(11) in a school facility or school zone, an act by a person responsible for the child's
care that is a violation under section 121A.58.

(l) "Practice of social services," for the purposes of subdivision 3, includes but is not
limited to employee assistance counseling and the provision of guardian ad litem and
parenting time expeditor services.

(m) "Report" means any communication received by the local welfare agency, police
department, county sheriff, or agency responsible for child protection pursuant to this section
that describes neglect or physical or sexual abuse of a child and contains sufficient content
to identify the child and any person believed to be responsible for the neglect or abuse, if
known.

(n) "Sexual abuse" means the subjection of a child by a person responsible for the child's
care, by a person who has a significant relationship to the child, as defined in section 609.341,
or by a person in a position of authority, as defined in section 609.341, subdivision 10, to
any act which constitutes a violation of section 609.342 (criminal sexual conduct in the first
degree), 609.343 (criminal sexual conduct in the second degree), 609.344 (criminal sexual
conduct in the third degree), 609.345 (criminal sexual conduct in the fourth degree), or
609.3451 (criminal sexual conduct in the fifth degree). Sexual abuse also includes any act
which involves a minor which constitutes a violation of prostitution offenses under sections
609.321 to 609.324 or 617.246. Effective May 29, 2017, sexual abuse includes all reports
of known or suspected child sex trafficking involving a child who is identified as a victim
of sex trafficking. Sexual abuse includes child sex trafficking as defined in section 609.321,
subdivisions 7a
and 7b. Sexual abuse includes threatened sexual abuse which includes the
status of a parent or household member who has committed a violation which requires
registration as an offender under section 243.166, subdivision 1b, paragraph (a) or (b), or
required registration under section 243.166, subdivision 1b, paragraph (a) or (b).

(o) "Substantial child endangerment" means a person responsible for a child's care, by
act or omission, commits or attempts to commit an act against a child under their care that
constitutes any of the following:

(1) egregious harm as defined in section 260C.007, subdivision 14;

(2) abandonment under section 260C.301, subdivision 2;

(3) neglect as defined in paragraph (g), clause (2), that substantially endangers the child's
physical or mental health, including a growth delay, which may be referred to as failure to
thrive, that has been diagnosed by a physician and is due to parental neglect;

(4) murder in the first, second, or third degree under section 609.185, 609.19, or 609.195;

(5) manslaughter in the first or second degree under section 609.20 or 609.205;

(6) assault in the first, second, or third degree under section 609.221, 609.222, or 609.223;

(7) solicitation, inducement, and promotion of prostitution under section 609.322;

(8) criminal sexual conduct under sections 609.342 to 609.3451;

(9) solicitation of children to engage in sexual conduct under section 609.352;

(10) malicious punishment or neglect or endangerment of a child under section 609.377
or 609.378;

(11) use of a minor in sexual performance under section 617.246; or

(12) parental behavior, status, or condition which mandates that the county attorney file
a termination of parental rights petition under section 260C.503, subdivision 2.

(p) "Threatened injury" means a statement, overt act, condition, or status that represents
a substantial risk of physical or sexual abuse or mental injury. Threatened injury includes,
but is not limited to, exposing a child to a person responsible for the child's care, as defined
in paragraph (j), clause (1), who has:

(1) subjected a child to, or failed to protect a child from, an overt act or condition that
constitutes egregious harm, as defined in section 260C.007, subdivision 14, or a similar law
of another jurisdiction;

(2) been found to be palpably unfit under section 260C.301, subdivision 1, paragraph
(b), clause (4), or a similar law of another jurisdiction;

(3) committed an act that has resulted in an involuntary termination of parental rights
under section 260C.301, or a similar law of another jurisdiction; or

(4) committed an act that has resulted in the involuntary transfer of permanent legal and
physical custody of a child to a relative under Minnesota Statutes 2010, section 260C.201,
subdivision 11
, paragraph (d), clause (1), section 260C.515, subdivision 4, or a similar law
of another jurisdiction.

A child is the subject of a report of threatened injury when the responsible social services
agency receives birth match data under paragraph (q) from the Department of Human
Services.

(q) Upon receiving data under section 144.225, subdivision 2b, contained in a birth
record or recognition of parentage identifying a child who is subject to threatened injury
under paragraph (p), the Department of Human Services shall send the data to the responsible
social services agency. The data is known as "birth match" data. Unless the responsible
social services agency has already begun an investigation or assessment of the report due
to the birth of the child or execution of the recognition of parentage and the parent's previous
history with child protection, the agency shall accept the birth match data as a report under
this section. The agency may use either a family assessment or investigation to determine
whether the child is safe. All of the provisions of this section apply. If the child is determined
to be safe, the agency shall consult with the county attorney to determine the appropriateness
of filing a petition alleging the child is in need of protection or services under section
260C.007, subdivision 6, clause (16), in order to deliver needed services. If the child is
determined not to be safe, the agency and the county attorney shall take appropriate action
as required under section 260C.503, subdivision 2.

(r) Persons who conduct assessments or investigations under this section shall take into
account accepted child-rearing practices of the culture in which a child participates and
accepted teacher discipline practices, which are not injurious to the child's health, welfare,
and safety.

Sec. 39.

Minnesota Statutes 2016, section 626.556, subdivision 3, is amended to read:


Subd. 3.

Persons mandated to report; persons voluntarily reporting.

(a) A person
who knows or has reason to believe a child is being neglected or physically or sexually
abused, as defined in subdivision 2, or has been neglected or physically or sexually abused
within the preceding three years, shall immediately report the information to the local welfare
agency, agency responsible for assessing or investigating the report, police department,
county sheriff, tribal social services agency, or tribal police department if the person is:

(1) a professional or professional's delegate who is engaged in the practice of the healing
arts, social services, hospital administration, psychological or psychiatric treatment, child
care, education, correctional supervision, probation and correctional services, or law
enforcement; or

(2) employed as a member of the clergy and received the information while engaged in
ministerial duties, provided that a member of the clergy is not required by this subdivision
to report information that is otherwise privileged under section 595.02, subdivision 1,
paragraph (c).

(b) Any person may voluntarily report to the local welfare agency, agency responsible
for assessing or investigating the report, police department, county sheriff, tribal social
services agency, or tribal police department if the person knows, has reason to believe, or
suspects a child is being or has been neglected or subjected to physical or sexual abuse.

(c) A person mandated to report physical or sexual child abuse or neglect occurring
within a licensed facility shall report the information to the agency responsible for licensing
the facility under sections 144.50 to 144.58; 241.021; 245A.01 to 245A.16; or chapter 144H
or
245D; or a nonlicensed personal care provider organization as defined in section
256B.0625, subdivision 19 19a. A health or corrections agency receiving a report may
request the local welfare agency to provide assistance pursuant to subdivisions 10, 10a, and
10b. A board or other entity whose licensees perform work within a school facility, upon
receiving a complaint of alleged maltreatment, shall provide information about the
circumstances of the alleged maltreatment to the commissioner of education. Section 13.03,
subdivision 4
, applies to data received by the commissioner of education from a licensing
entity.

(d) Notification requirements under subdivision 10 apply to all reports received under
this section.

(e) For purposes of this section, "immediately" means as soon as possible but in no event
longer than 24 hours.

Sec. 40.

Minnesota Statutes 2016, section 626.556, subdivision 3c, is amended to read:


Subd. 3c.

Local welfare agency, Department of Human Services or Department of
Health responsible for assessing or investigating reports of maltreatment.

(a) The county
local welfare agency is the agency responsible for assessing or investigating allegations of
maltreatment in child foster care, family child care, legally unlicensed child care, juvenile
correctional facilities licensed under section 241.021 located in the local welfare agency's
county, and reports involving children served by an unlicensed personal care provider
organization under section 256B.0659. Copies of findings related to personal care provider
organizations under section 256B.0659 must be forwarded to the Department of Human
Services provider enrollment.

(b) The Department of Human Services is the agency responsible for assessing or
investigating allegations of maltreatment in facilities licensed under chapters 245A and
245D, except for child foster care and family child care.

(c) The Department of Health is the agency responsible for assessing or investigating
allegations of child maltreatment in facilities licensed under sections 144.50 to 144.58 and
144A.43 to 144A.482 or chapter 144H.

Sec. 41.

Minnesota Statutes 2016, section 626.556, subdivision 10d, is amended to read:


Subd. 10d.

Notification of neglect or abuse in facility.

(a) When a report is received
that alleges neglect, physical abuse, sexual abuse, or maltreatment of a child while in the
care of a licensed or unlicensed day care facility, residential facility, agency, hospital,
sanitarium, or other facility or institution required to be licensed according to sections 144.50
to 144.58; 241.021; or 245A.01 to 245A.16; or chapter 144H or 245D, or a school as defined
in section 120A.05, subdivisions 9, 11, and 13; and chapter 124E; or a nonlicensed personal
care provider organization as defined in section 256B.0625, subdivision 19a, the
commissioner of the agency responsible for assessing or investigating the report or local
welfare agency investigating the report shall provide the following information to the parent,
guardian, or legal custodian of a child alleged to have been neglected, physically abused,
sexually abused, or the victim of maltreatment of a child in the facility: the name of the
facility; the fact that a report alleging neglect, physical abuse, sexual abuse, or maltreatment
of a child in the facility has been received; the nature of the alleged neglect, physical abuse,
sexual abuse, or maltreatment of a child in the facility; that the agency is conducting an
assessment or investigation; any protective or corrective measures being taken pending the
outcome of the investigation; and that a written memorandum will be provided when the
investigation is completed.

(b) The commissioner of the agency responsible for assessing or investigating the report
or local welfare agency may also provide the information in paragraph (a) to the parent,
guardian, or legal custodian of any other child in the facility if the investigative agency
knows or has reason to believe the alleged neglect, physical abuse, sexual abuse, or
maltreatment of a child in the facility has occurred. In determining whether to exercise this
authority, the commissioner of the agency responsible for assessing or investigating the
report or local welfare agency shall consider the seriousness of the alleged neglect, physical
abuse, sexual abuse, or maltreatment of a child in the facility; the number of children
allegedly neglected, physically abused, sexually abused, or victims of maltreatment of a
child in the facility; the number of alleged perpetrators; and the length of the investigation.
The facility shall be notified whenever this discretion is exercised.

(c) When the commissioner of the agency responsible for assessing or investigating the
report or local welfare agency has completed its investigation, every parent, guardian, or
legal custodian previously notified of the investigation by the commissioner or local welfare
agency shall be provided with the following information in a written memorandum: the
name of the facility investigated; the nature of the alleged neglect, physical abuse, sexual
abuse, or maltreatment of a child in the facility; the investigator's name; a summary of the
investigation findings; a statement whether maltreatment was found; and the protective or
corrective measures that are being or will be taken. The memorandum shall be written in a
manner that protects the identity of the reporter and the child and shall not contain the name,
or to the extent possible, reveal the identity of the alleged perpetrator or of those interviewed
during the investigation. If maltreatment is determined to exist, the commissioner or local
welfare agency shall also provide the written memorandum to the parent, guardian, or legal
custodian of each child in the facility who had contact with the individual responsible for
the maltreatment. When the facility is the responsible party for maltreatment, the
commissioner or local welfare agency shall also provide the written memorandum to the
parent, guardian, or legal custodian of each child who received services in the population
of the facility where the maltreatment occurred. This notification must be provided to the
parent, guardian, or legal custodian of each child receiving services from the time the
maltreatment occurred until either the individual responsible for maltreatment is no longer
in contact with a child or children in the facility or the conclusion of the investigation. In
the case of maltreatment within a school facility, as defined in section 120A.05, subdivisions
9, 11, and 13
, and chapter 124E, the commissioner of education need not provide notification
to parents, guardians, or legal custodians of each child in the facility, but shall, within ten
days after the investigation is completed, provide written notification to the parent, guardian,
or legal custodian of any student alleged to have been maltreated. The commissioner of
education may notify the parent, guardian, or legal custodian of any student involved as a
witness to alleged maltreatment.

Sec. 42. BRAIN HEALTH PILOT PROGRAMS.

Subdivision 1.

Pilot programs selected.

(a) The commissioner shall competitively
award grants for up to five pilot programs to improve brain health in youth sports in
Minnesota. The commissioner shall issue a competitive request for pilot program proposals
by October 31, 2017, based on input from the youth sports concussion working group. The
commissioner shall include members of the working group in the scoring of proposals
received, but shall exclude any member of the working group with a financial interest in a
pilot program proposal.

(b) Each pilot program selected for a funding award must offer promise for improving
at least one of the following areas:

(1) objective identification of brain injury;

(2) assessment and treatment of brain injury;

(3) coordination of school and medical support services; or

(4) policy reform to improve brain health outcomes.

(c) The programs must be selected so that youth are served in each of the following
regions of the state:

(1) Central or West Central Minnesota;

(2) Southern, Southwest, or Southeast Minnesota;

(3) Northwest or Northland Minnesota; and

(4) the Twin Cities Metropolitan Area.

Subd. 2.

Funding for pilot programs.

Pilot programs selected under this section shall
receive funding for one year beginning January 1, 2018. No later than March 1, 2019, the
commissioner must report on the progress and outcomes of the pilot programs to the
legislative committees with jurisdiction over health policy and finance.

Sec. 43. COMPREHENSIVE PLAN TO END HIV/AIDS.

(a) The commissioner of health, in coordination with the commissioner of human services,
and in consultation with community stakeholders, shall develop a strategic statewide
comprehensive plan that establishes a set of priorities and actions to address the state's HIV
epidemic by reducing the number of newly infected individuals; ensuring that individuals
living with HIV have access to quality, life-extending care regardless of race, gender, sexual
orientation, or socioeconomic circumstances; and ensuring the coordination of a statewide
response to reach the ultimate goal of the elimination of HIV in Minnesota. The
commissioner, after consulting with stakeholders, may implement this section utilizing
existing efforts. The commissioner must develop the plan using existing resources available
for this purpose.

(b) The plan must identify strategies that are consistent with the National HIV/AIDS
Strategy plan, that reflect the scientific developments in HIV medical care and prevention
that have occurred, and that work toward the elimination of HIV. The plan must:

(1) determine the appropriate level of testing, care, and services necessary to achieve
the goal of the elimination of HIV, beginning with meeting the following outcomes:

(i) reduce the number of new diagnoses by at least 75 percent;

(ii) increase the percentage of individuals living with HIV who know their serostatus to
at least 90 percent;

(iii) increase the percentage of individuals living with HIV who are receiving HIV
treatment to at least 90 percent; and

(iv) increase the percentage of individuals living with HIV who are virally suppressed
to at least 90 percent;

(2) provide recommendations for the optimal allocation and alignment of existing state
and federal funding in order to achieve the greatest impact and ensure a coordinated statewide
effort; and

(3) provide recommendations for evaluating new and enhanced interventions and an
estimate of additional resources needed to provide these interventions.

(c) The commissioner shall submit the comprehensive plan and recommendations to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance by February 1, 2018.

Sec. 44. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FEDERAL
WAIVER AMENDMENTS.

The commissioner of human services shall submit necessary waiver amendments to the
Centers for Medicare and Medicaid Services to add services provided at prescribed pediatric
extended care centers licensed under Minnesota Statutes, chapter 144H, to the home and
community-based waivers authorized under Minnesota Statutes, sections 256B.092 and
256B.49. The commissioner shall submit all necessary waiver amendments by October 1,
2017.

Sec. 45. EARLY DENTAL DISEASE PREVENTION PILOT PROGRAM.

(a) The commissioner of health shall develop and implement a pilot program to increase
awareness and encourage early preventive dental disease intervention for infants and toddlers.
The commissioner shall award grants to five designated communities of color or communities
of recent immigrants to participate in the pilot program, with at least two designated
communities located outside the seven-county metropolitan area.

(b) The commissioner, in consultation with members of the designated communities,
shall distribute or cause to be distributed the educational materials and information developed
under Minnesota Statutes, section 144.061, to expectant and new parents within the
designated communities, including but not limited to making the materials available to
health care providers, community clinics, WIC sites, and other relevant sites within the
designated communities through a variety of communicative means, including oral, visual,
audio, and print.

(c) The commissioner shall work with members of each designated community to ensure
that the educational materials and information are distributed. The commissioner shall assist
the designated community with developing strategies, including outreach through ethnic
radio, webcasts, and local cable programs, and incentives to encourage and provide early
preventive dental disease intervention and care for infants and toddlers that are geared
toward the ethnic groups residing in the designated community.

(d) The commissioner shall develop measurable outcomes, establish a baseline
measurement, and evaluate performance within each designated community in order to
measure whether the educational materials, information, strategies, and incentives increased
the numbers of infants and toddlers receiving early preventive dental disease intervention
and care.

(e) By March 15, 2019, the commissioner shall submit a report to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care. The
report shall describe:

(1) the details of the program;

(2) the communities designated for the program;

(3) the strategies, including any incentives implemented;

(4) the outcome measures used; and

(5) the results of the evaluation for each designated community.

Sec. 46. RECOMMENDATIONS FOR SAFETY AND QUALITY IMPROVEMENT
PRACTICES FOR LONG-TERM CARE SERVICES AND SUPPORTS.

The commissioner of health shall consult with interested stakeholders to explore and
make recommendations on how to apply proven safety and quality improvement practices
and infrastructure to long-term care services and supports. Interested stakeholders with
whom the commissioner must consult shall include but are not limited to representatives
of the Minnesota Alliance for Patient Safety partner organizations, the Office of Ombudsman
for Long-Term Care, the Minnesota Elder Justice Center, providers of older adult services,
the Department of Health, and the Department of Human Services, and experts in the field
of long-term care safety and quality improvement. The recommendations shall include
mechanisms to apply a patient safety model to the senior care sector, including a system
for reporting adverse health events, education and prevention activities, and interim actions
to improve systems for processing reports and complaints submitted to the Office of Health
Facility Complaints. By January 15, 2018, the commissioner shall submit the
recommendations developed under this section, along with draft legislation to implement
the recommendations, to the chairs and ranking minority members of the legislative
committees with jurisdiction over long-term care.

Sec. 47. SAFE HARBOR FOR ALL; STATEWIDE SEX TRAFFICKING VICTIMS
STRATEGIC PLAN.

(a) By October 1, 2018, the commissioner of health, in consultation with the
commissioners of public safety and human services, shall adopt a comprehensive strategic
plan to address the needs of sex trafficking victims statewide.

(b) The commissioner of health shall issue a request for proposals to select an organization
to develop the comprehensive strategic plan. The selected organization shall seek
recommendations from professionals, community members, and stakeholders from across
the state, with an emphasis on the communities most impacted by sex trafficking. At a
minimum, the selected organization must seek input from the following groups: sex
trafficking survivors and their family members, statewide crime victim services coalitions,
victim services providers, nonprofit organizations, task forces, prosecutors, public defenders,
tribal governments, public safety and corrections professionals, public health professionals,
human services professionals, and impacted community members. The strategic plan shall
include recommendations regarding the expansion of Minnesota's Safe Harbor Law to adult
victims of sex trafficking.

(c) By January 15, 2019, the commissioner of health shall report to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services and criminal justice finance and policy on developing the statewide strategic plan,
including recommendations for additional legislation and funding.

(d) As used in this section, "sex trafficking victim" has the meaning given in Minnesota
Statutes, section 609.321, subdivision 7b.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 48. STUDY AND REPORT ON HOME CARE NURSING WORKFORCE
SHORTAGE.

(a) The chair and ranking minority member of the senate Human Services Reform
Finance and Policy Committee and the chair and ranking minority member of the house of
representatives Health and Human Services Finance Committee shall convene a working
group to study and report on the shortage of registered nurses and licensed practical nurses
available to provide low-complexity regular home care services to clients in need of such
services, especially clients covered by medical assistance, and to provide recommendations
for ways to address the workforce shortage. The working group shall consist of 14 members
appointed as follows:

(1) the chair of the senate Human Services Reform Finance and Policy Committee or a
designee;

(2) the ranking minority member of the senate Human Services Reform Finance and
Policy Committee or a designee;

(3) the chair of the house of representatives Health and Human Services Finance
Committee or a designee;

(4) the ranking minority member of the house of representatives Health and Human
Services Finance Committee or a designee;

(5) the commissioner of human services or a designee;

(6) the commissioner of health or a designee;

(7) one representative appointed by the Professional Home Care Coalition;

(8) one representative appointed by the Minnesota Home Care Association;

(9) one representative appointed by the Minnesota Board of Nursing;

(10) one representative appointed by the Minnesota Nurses Association;

(11) one representative appointed by the Minnesota Licensed Practical Nurses
Association;

(12) one representative appointed by the Minnesota Society of Medical Assistants;

(13) one client who receives regular home care nursing services and is covered by medical
assistance appointed by the commissioner of human services after consulting with the
appointing authorities identified in clauses (7) to (12); and

(14) one county public health nurse who is a certified assessor appointed by the
commissioner of health after consulting with the Minnesota Home Care Association.

(b) The appointing authorities must appoint members by August 1, 2017.

(c) The convening authorities shall convene the first meeting of the working group no
later than August 15, 2017, and caucus staff shall provide support and meeting space for
the working group. The Department of Health and the Department of Human Services shall
provide technical assistance to the working group, including providing data documenting
the current and projected workforce shortages in the area of regular home care nursing. The
home care and assisted living program advisory council established under Minnesota Statutes,
section 144A.4799, shall provide advice and recommendations to the working group.
Working group members shall serve without compensation and shall not be reimbursed for
expenses.

(d) The working group shall:

(1) quantify the number of low-complexity regular home care nursing hours that are
authorized but not provided to clients covered by medical assistance, due to the shortage
of registered nurses and licensed practical nurses available to provide these home care
services;

(2) quantify the current and projected workforce shortages of registered nurses and
licensed practical nurses available to provide low-complexity regular home care nursing
services to clients, especially clients covered by medical assistance;

(3) develop recommendations for actions to take in the next two years to address the
regular home care nursing workforce shortage, including identifying other health care
professionals who may be able to provide low-complexity regular home care nursing services
with additional training; what additional training may be necessary for these health care
professionals; and how to address scope of practice and licensing issues;

(4) compile reimbursement rates for regular home care nursing from other states and
determine Minnesota's national ranking with respect to reimbursement for regular home
care nursing;

(5) determine whether reimbursement rates for regular home care nursing fully reimburse
providers for the cost of providing the service and whether the discrepancy, if any, between
rates and costs contributes to lack of access to regular home care nursing; and

(6) by January 15, 2018, report on the findings and recommendations of the working
group to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance. The working group's report
shall include draft legislation.

(e) The working group shall elect a chair from among its members at its first meeting.

(f) The meetings of the working group shall be open to the public.

(g) This section expires January 16, 2018, or the day after submitting the report required
by this section, whichever is earlier.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 49. YOUTH SPORTS CONCUSSION WORKING GROUP.

Subdivision 1.

Working group established; duties and membership.

(a) The
commissioner of health shall convene a youth sports concussion working group of up to 30
members to:

(1) develop the report described in subdivision 4 to assess the causes and incidence of
brain injury in Minnesota youth sports; and

(2) evaluate the implementation of Minnesota Statutes, sections 121A.37 and 121A.38,
regarding concussions in youth athletic activity, and best practices for preventing, identifying,
evaluating, and treating brain injury in youth sports.

(b) In forming the working group, the commissioner shall solicit nominees from
individuals with expertise and experience in the areas of traumatic brain injury in youth and
sports, neuroscience, law and policy related to brain health, public health, neurotrauma,
provision of care to brain injured youth, and related fields. In selecting members of the
working group, the commissioner shall ensure geographic and professional diversity. The
working group shall elect a chair from among its members. The commissioner shall be
responsible for organizing meetings and preparing a draft report. Members of the working
group shall not receive monetary compensation for their participation in the group.

Subd. 2.

Working group goals defined.

The working group shall, at a minimum:

(1) gather and analyze available data on:

(i) the prevalence and causes of youth sports-related concussions including, where
possible, data on the number of officials and coaches receiving concussion training;

(ii) the number of coaches, officials, youth athletes, and parents or guardians receiving
information about the nature and risks of concussions;

(iii) the number of youth athletes removed from play and the nature and duration of
treatment before return to play; and

(iv) policies and procedures related to return to learn in the classroom;

(2) review the rules associated with relevant youth athletic activities and the concussion
education policies currently employed;

(3) identify innovative pilot projects in areas such as:

(i) objectively defining and measuring concussions;

(ii) rule changes designed to promote brain health;

(iii) use of technology to identify and treat concussions;

(iv) recognition of cumulative subconcussive effects; and

(v) postconcussion treatment, and return to learn protocols; and

(4) identify regulatory and legal barriers and burdens to achieving better brain health
outcomes.

Subd. 3.

Voluntary participation; no new reporting requirements created.

Participation in the working group study by schools, school districts, school governing
bodies, parents, athletes, and related individuals and organizations shall be voluntary, and
this study shall create no new reporting requirements by schools, school districts, school
governing bodies, parents, athletes, and related individuals and organizations.

Subd. 4.

Report.

By December 31, 2018, the youth sports concussion working group
shall provide an interim report, and by December 31, 2019, the working group shall provide
a final report to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and education with recommendations and proposals for a Minnesota
model for reducing brain injury in youth sports. The report shall make recommendations
regarding:

(1) best practices for reducing and preventing concussions in youth sports;

(2) best practices for schools to employ in order to identify and respond to occurrences
of concussions, including return to play and return to learn;

(3) opportunities to highlight and strengthen best practices with external grant support;

(4) opportunities to leverage Minnesota's strengths in brain science research and clinical
care for brain injury; and

(5) proposals to develop an innovative Minnesota model for identifying, evaluating, and
treating youth sports concussions.

Subd. 5.

Sunset.

The working group expires the day after submitting the report required
under subdivision 4, or January 15, 2020, whichever is earlier.

Sec. 50. REPEALER.

Minnesota Statutes 2016, section 144.4961, is repealed the day following final enactment.

ARTICLE 4

CHILDREN AND FAMILIES

Section 1.

Minnesota Statutes 2016, section 119B.011, is amended by adding a subdivision
to read:


Subd. 15a.

Law enforcement authority.

"Law enforcement authority" means a
government agency or department within or outside Minnesota with jurisdiction to investigate
or bring a civil or criminal action against a child care provider, including a county, city, or
district attorney's office, the Office of the Attorney General, a human services agency, a
United States attorney's office, or a law enforcement agency.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 2.

Minnesota Statutes 2016, section 119B.011, is amended by adding a subdivision
to read:


Subd. 19c.

Stop payment.

"Stop payment" means canceling a payment that was already
issued to a provider.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 3.

Minnesota Statutes 2016, section 119B.02, subdivision 5, is amended to read:


Subd. 5.

Program integrity.

For child care assistance programs under this chapter, the
commissioner shall enforce the requirements for program integrity and fraud prevention
investigations under sections 256.046, 256.98, and 256.983 and chapter 245E.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 4.

Minnesota Statutes 2016, section 119B.03, subdivision 4, is amended to read:


Subd. 4.

Funding priority.

(a) First priority for child care assistance under the basic
sliding fee program must be given to eligible non-MFIP families who do not have a high
school or general equivalency diploma or who need remedial and basic skill courses in order
to pursue employment or to pursue education leading to employment and who need child
care assistance to participate in the education program. This includes student parents as
defined under section 119B.011, subdivision 19b. Within this priority, the following
subpriorities must be used:

(1) child care needs of minor parents;

(2) child care needs of parents under 21 years of age; and

(3) child care needs of other parents within the priority group described in this paragraph.

(b) Second priority must be given to parents who have completed their MFIP or DWP
transition year, or parents who are no longer receiving or eligible for diversionary work
program supports.

(c) Third priority must be given to families who are eligible for portable basic sliding
fee assistance through the portability pool under subdivision 9.

(d) Fourth (c) Third priority must be given to families in which at least one parent is a
veteran as defined under section 197.447.

(d) Fourth priority must be given to eligible families who do not meet the specifications
of paragraph (a), (b), (c), or (e).

(e) Fifth priority must be given to eligible families receiving services under section
119B.011, subdivision 20a, if the parents have completed their MFIP or DWP transition
year, or the parents are no longer receiving or eligible for DWP supports.

(e) (f) Families under paragraph (b) (e) must be added to the basic sliding fee waiting
list on the date they begin the transition year under section 119B.011, subdivision 20, and
must be moved into the basic sliding fee program as soon as possible after they complete
their transition year
.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 5.

Minnesota Statutes 2016, section 119B.03, subdivision 6, is amended to read:


Subd. 6.

Allocation formula.

The allocation component of basic sliding fee state and
federal funds shall be allocated on a calendar year basis. Funds shall be allocated first in
amounts equal to each county's guaranteed floor according to subdivision 8, with any
remaining available funds allocated according to the following formula:

(a) One-fourth of the funds shall be allocated in proportion to each county's total
expenditures for the basic sliding fee child care program reported during the most recent
fiscal year completed at the time of the notice of allocation.

(b) Up to one-fourth of the funds shall be allocated in proportion to the number of families
participating in the transition year child care program as reported during and averaged over
the most recent six months completed at the time of the notice of allocation. Funds in excess
of the amount necessary to serve all families in this category shall be allocated according
to paragraph (f) (e).

(c) Up to one-fourth of the funds shall be allocated in proportion to the average of each
county's most recent six months of reported first, second, and third priority waiting list as
defined in subdivision 2 and the reinstatement list of those families whose assistance was
terminated with the approval of the commissioner under Minnesota Rules, part 3400.0183,
subpart 1. Funds in excess of the amount necessary to serve all families in this category
shall be allocated according to paragraph (f).

(d) (c) Up to one-fourth one-half of the funds shall be allocated in proportion to the
average of each county's most recent six 12 months of reported waiting list as defined in
subdivision 2 and the reinstatement list of those families whose assistance was terminated
with the approval of the commissioner under Minnesota Rules, part 3400.0183, subpart 1.
Funds in excess of the amount necessary to serve all families in this category shall be
allocated according to paragraph (f) (e).

(e) (d) The amount necessary to serve all families in paragraphs (b), (c), and (d) (c) shall
be calculated based on the basic sliding fee average cost of care per family in the county
with the highest cost in the most recently completed calendar year.

(f) (e) Funds in excess of the amount necessary to serve all families in paragraphs (b),
(c),
and (d) (c) shall be allocated in proportion to each county's total expenditures for the
basic sliding fee child care program reported during the most recent fiscal year completed
at the time of the notice of allocation.

(f) For calendar year 2018, the initial allocation shall be the average of the final allocation
for calendar year 2017 and the amount that would otherwise be the initial allocation using
the revised formula for calendar year 2018, adjusted proportionately up or down to match
the funds available.

EFFECTIVE DATE.

This section is effective January 1, 2018.

Sec. 6.

Minnesota Statutes 2016, section 119B.09, subdivision 9a, is amended to read:


Subd. 9a.

Child care centers; assistance.

(a) For the purposes of this subdivision,
"qualifying child" means a child who is not a child or dependent of an employee of the child
care provider.
A child care center may receive authorizations for 25 or fewer children who
are dependents of the center's employees. If a child care center is authorized for more than
25 children who are dependents of center employees, the county cannot authorize additional
dependents of an employee until the number of children falls below 25.

(b) Funds distributed under this chapter must not be paid for child care services that are
provided for a child or dependent of an employee under paragraph (a) unless at all times at
least 50 percent of the children for whom the child care provider is providing care are
qualifying children under paragraph (a).

(c) If a child care provider satisfies the requirements for payment under paragraph (b),
but the percentage of qualifying children under paragraph (a) for whom the provider is
providing care falls below 50 percent, the provider shall have four weeks to raise the
percentage of qualifying children for whom the provider is providing care to at least 50
percent before payments to the provider are discontinued for child care services provided
for a child who is not a qualifying child.

(d) This subdivision shall be implemented as follows:

(1) no later than August 1, 2014, the commissioner shall issue a notice to providers who
have been identified as ineligible for funds distributed under this chapter as described in
paragraph (b); and

(2) no later than January 5, 2015, payments to providers who do not comply with
paragraph (c) will be discontinued for child care services provided for children who are not
qualifying children.

(e) If a child's authorization for child care assistance is terminated under this subdivision,
the county shall send a notice of adverse action to the provider and to the child's parent or
guardian, including information on the right to appeal, under Minnesota Rules, part
3400.0185.

(f) (b) Funds paid to providers during the period of time between the issuance of a notice
under paragraph (d), clause (1), and discontinuation of payments under paragraph (d), clause
(2),
when a center is authorized for more than 25 children who are dependents of center
employees
must not be treated as overpayments under section 119B.11, subdivision 2a, due
to noncompliance with this subdivision.

(g) (c) Nothing in this subdivision precludes the commissioner from conducting fraud
investigations relating to child care assistance, imposing sanctions, and obtaining monetary
recovery as otherwise provided by law.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 7.

[119B.097] AUTHORIZATION WITH A SECONDARY PROVIDER.

(a) If a child uses any combination of the following providers paid by child care
assistance, a parent must choose one primary provider and one secondary provider per child
that can be paid by child care assistance:

(1) an individual or child care center licensed under chapter 245A;

(2) an individual or child care center or facility holding a valid child care license issued
by another state or tribe; or

(3) a child care center exempt from licensing under section 245A.03.

(b) The amount of child care authorized with the secondary provider cannot exceed 20
hours per two-week service period, per child, and the amount of care paid to a child's
secondary provider is limited under section 119B.13, subdivision 1. The total amount of
child care authorized with both the primary and secondary provider cannot exceed the
amount of child care allowed based on the parents' eligible activity schedule, the child's
school schedule, and any other factors relevant to the family's child care needs.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 8.

Minnesota Statutes 2016, section 119B.125, subdivision 4, is amended to read:


Subd. 4.

Unsafe care.

A county may deny authorization as a child care provider to any
applicant or rescind revoke the authorization of any provider when the county knows or has
reason to believe that the provider is unsafe or that the circumstances of the chosen child
care arrangement are unsafe. The county must include the conditions under which a provider
or care arrangement will be determined to be unsafe in the county's child care fund plan
under section 119B.08, subdivision 3.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 9.

Minnesota Statutes 2016, section 119B.125, subdivision 6, is amended to read:


Subd. 6.

Record-keeping requirement.

(a) As a condition of payment, all providers
receiving child care assistance payments must keep accurate and legible daily attendance
records at the site where services are delivered for children receiving child care assistance
and must make those records available immediately to the county or the commissioner upon
request. The attendance records must be completed daily and include the date, the first and
last name of each child in attendance, and the times when each child is dropped off and
picked up. To the extent possible, the times that the child was dropped off to and picked up
from the child care provider must be entered by the person dropping off or picking up the
child. The daily attendance records must be retained at the site where services are delivered
for six years after the date of service.

(b) A county or the commissioner may deny or revoke a provider's authorization as a
child care provider to any applicant, rescind authorization of any provider,
to receive child
care assistance payments under section 119B.13, subdivision 6, paragraph (d), pursue a
fraud disqualification under section 256.98, take an action against the provider under chapter
245E,
or establish an attendance record overpayment claim in the system under paragraph
(c)
against a current or former provider, when the county or the commissioner knows or
has reason to believe that the provider has not complied with the record-keeping requirement
in this subdivision. A provider's failure to produce attendance records as requested on more
than one occasion constitutes grounds for disqualification as a provider.

(c) To calculate an attendance record overpayment under this subdivision, the
commissioner or county agency subtracts the maximum daily rate from the total amount
paid to a provider for each day that a child's attendance record is missing, unavailable,
incomplete, illegible, inaccurate, or otherwise inadequate.

(d) The commissioner shall develop criteria to direct a county when the county must
establish an attendance overpayment under this subdivision.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 10.

Minnesota Statutes 2016, section 119B.13, subdivision 1, is amended to read:


Subdivision 1.

Subsidy restrictions.

(a) Beginning February 3, 2014, the maximum
rate paid for child care assistance in any county or county price cluster under the child care
fund shall be the greater of the 25th percentile of the 2011 child care provider rate survey
or the maximum rate effective November 28, 2011. For a child care provider located within
the boundaries of a city located in two or more of the counties of Benton, Sherburne, and
Stearns, the maximum rate paid for child care assistance shall be equal to the maximum
rate paid in the county with the highest maximum reimbursement rates or the provider's
charge, whichever is less.
The commissioner may: (1) assign a county with no reported
provider prices to a similar price cluster; and (2) consider county level access when
determining final price clusters.

(b) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.

(c) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.

(d) If a child uses one provider, the maximum payment to a provider for one day of care
must not exceed the daily rate. The maximum payment to a provider for one week of care
must not exceed the weekly rate.

(e) If a child uses two providers under section 119B.097, the maximum payment must
not exceed:

(1) the daily rate for one day of care;

(2) the weekly rate for one week of care by the child's primary provider; and

(3) two daily rates during two weeks of care by a child's secondary provider.

(d) (f) Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.

(e) When (g) If the provider charge is greater than the maximum provider rate allowed,
the parent is responsible for payment of the difference in the rates in addition to any family
co-payment fee.

(f) (h) All maximum provider rates changes shall be implemented on the Monday
following the effective date of the maximum provider rate.

(g) (i) Notwithstanding Minnesota Rules, part 3400.0130, subpart 7, maximum
registration fees in effect on January 1, 2013, shall remain in effect.

EFFECTIVE DATE.

Paragraph (a) is effective July 1, 2018. Paragraphs (d) to (i) are
effective April 23, 2018.

Sec. 11.

Minnesota Statutes 2016, section 119B.13, subdivision 6, is amended to read:


Subd. 6.

Provider payments.

(a) A provider must bill only for services documented
according to section 119B.125, subdivision 6.
The provider shall bill for services provided
within ten days of the end of the service period. If bills are submitted within ten days of the
end of the service period,
Payments under the child care fund shall be made within 30 21
days of receiving a complete bill from the provider. Counties or the state may establish
policies that make payments on a more frequent basis.

(b) If a provider has received an authorization of care and been issued a billing form for
an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be
paid.

(c) If a provider provided care for a time period without receiving an authorization of
care and a billing form for an eligible family, payment of child care assistance may only be
made retroactively for a maximum of six months from the date the provider is issued an
authorization of care and billing form.

(d) A county or the commissioner may refuse to issue a child care authorization to a
licensed or legal nonlicensed provider, revoke an existing child care authorization to a
licensed or legal nonlicensed provider, stop payment issued to a licensed or legal nonlicensed
provider, or refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:

(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;

(2) a county or the commissioner finds by a preponderance of the evidence that the
provider intentionally gave the county materially false information on the provider's billing
forms, or provided false attendance records to a county or the commissioner;

(3) the provider is in violation of child care assistance program rules, until the agency
determines those violations have been corrected;

(4) the provider is operating after:

(i) an order of suspension of the provider's license issued by the commissioner; or

(ii) an order of revocation of the provider's license; or

(iii) a final order of conditional license issued by the commissioner for as long as the
conditional license is in effect;

(5) the provider submits false an inaccurate attendance reports or refuses to provide
documentation of the child's attendance upon request; or
record;

(6) the provider gives false child care price information.; or

(7) the provider fails to grant access to a county or the commissioner during regular
business hours to examine all records necessary to determine the extent of services provided
to a child care assistance recipient and the appropriateness of a claim for payment.

(e) If a county or the commissioner finds that a provider violated paragraph (d), clause
(1) or (2), a county or the commissioner must deny or revoke the provider's authorization
and either pursue a fraud disqualification under section 256.98, subdivision 8, paragraph
(c), or refer the case to a law enforcement authority. A provider's rights related to an
authorization denial or revocation under this paragraph are established in section 119B.161.
If a provider's authorization is revoked or denied under this paragraph, the denial or
revocation lasts until either:

(1) all criminal, civil, and administrative proceedings related to the provider's alleged
misconduct conclude and any appeal rights are exhausted; or

(2) the commissioner decides, based on written evidence or argument submitted under
section 119B.161, to authorize the provider.

(f) If a county or the commissioner denies or revokes a provider's authorization under
paragraph (d), clause (4), the provider shall not be authorized until the order of suspension
or order of revocation against the provider is lifted.

(e) For purposes of (g) If a county or the commissioner finds that a provider violated
paragraph (d), clauses clause (3), (5), and or (6), the county or the commissioner may
withhold revoke or deny the provider's authorization or payment for a period of time not to
exceed three months beyond the time the condition has been corrected
. If a provider's
authorization is revoked or denied under this paragraph, the denial or revocation may last
up to 90 days from the date a county or the commissioner denies or revokes the provider's
authorization.

(h) If a county or the commissioner determines a provider violated paragraph (d), clause
(7), a county or the commissioner must deny or revoke the provider's authorization until a
county or the commissioner determines whether the records sought comply with this chapter
and chapter 245E. The provider's rights related to an authorization denial or revocation
under this paragraph are established in section 119B.161.

(f) (i) A county's payment policies must be included in the county's child care plan under
section 119B.08, subdivision 3. If payments are made by the state, in addition to being in
compliance with this subdivision, the payments must be made in compliance with section
16A.124.

EFFECTIVE DATE.

The amendments to paragraph (a) are effective September 25,
2017. The amendments to paragraphs (d) to (i) are effective April 23, 2018.

Sec. 12.

Minnesota Statutes 2016, section 119B.16, subdivision 1, is amended to read:


Subdivision 1.

Fair hearing allowed for applicants and recipients.

(a) An applicant
or recipient adversely affected by an action of a county agency action or the commissioner
may request and receive a fair hearing in accordance with this subdivision and section
256.045.

(b) A county agency must offer an informal conference to an applicant or recipient who
is entitled to a fair hearing under this section. A county agency shall advise an adversely
affected applicant or recipient that a request for a conference is optional and does not delay
or replace the right to a fair hearing.

(c) An applicant or recipient does not have a right to a fair hearing if a county agency
or the commissioner takes action against a provider.

(d) If a provider's authorization is suspended, denied, or revoked, a county agency or
the commissioner must mail notice to a child care assistance program recipient receiving
care from the provider.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 13.

Minnesota Statutes 2016, section 119B.16, subdivision 1a, is amended to read:


Subd. 1a.

Fair hearing allowed for providers.

(a) This subdivision applies to providers
caring for children receiving child care assistance.

(b) A provider to whom a county agency has assigned responsibility for an overpayment
may request a fair hearing in accordance with section 256.045 for the limited purpose of
challenging the assignment of responsibility for the overpayment and the amount of the
overpayment. The scope of the fair hearing does not include the issues of whether the
provider wrongfully obtained public assistance in violation of section 256.98 or was properly
disqualified under section 256.98, subdivision 8, paragraph (c), unless the fair hearing has
been combined with an administrative disqualification hearing brought against the provider
under section 256.046.

(b) A provider may request a fair hearing only as specified in this subdivision.

(c) A provider may request a fair hearing according to sections 256.045 and 256.046 if
a county agency or the commissioner:

(1) denies or revokes a provider's authorization, unless the action entitles the provider
to a consolidated contested case hearing under subdivision 3 or an administrative review
under section 119B.161;

(2) assigns responsibility for an overpayment to a provider under section 119B.11,
subdivision 2a;

(3) establishes an overpayment for failure to comply with section 119B.125, subdivision
6;

(4) seeks monetary recovery or recoupment under section 245E.02, subdivision 4,
paragraph (c), clause (2);

(5) initiates an administrative fraud disqualification hearing; or

(6) issues a payment and the provider disagrees with the amount of the payment.

(d) A provider may request a fair hearing by submitting a written request to the
Department of Human Services, Appeals Division. A provider's request must be received
by the appeals division no later than 30 days after the date a county or the commissioner
mails the notice. The provider's appeal request must contain the following:

(1) each disputed item, the reason for the dispute, and, if appropriate, an estimate of the
dollar amount involved for each disputed item;

(2) the computation the provider believes to be correct, if appropriate;

(3) the statute or rule relied on for each disputed item; and

(4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 14.

Minnesota Statutes 2016, section 119B.16, subdivision 1b, is amended to read:


Subd. 1b.

Joint fair hearings.

When a provider requests a fair hearing under subdivision
1a, the family in whose case the overpayment was created must be made a party to the fair
hearing. All other issues raised by the family must be resolved in the same proceeding.
When a family requests a fair hearing and claims that the county should have assigned
responsibility for an overpayment to a provider, the provider must be made a party to the
fair hearing.
The human services judge assigned to a fair hearing may join a family or a
provider as a party to the fair hearing whenever joinder of that party is necessary to fully
and fairly resolve overpayment issues raised in the appeal.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 15.

Minnesota Statutes 2016, section 119B.16, is amended by adding a subdivision
to read:


Subd. 1c.

Notice to providers.

(a) Before taking an action appealable under subdivision
1a, paragraph (c), a county agency or the commissioner must mail written notice to the
provider against whom the action is being taken.

(b) The notice shall state:

(1) the factual basis for the department's determination;

(2) the action the department intends to take;

(3) the dollar amount of the monetary recovery or recoupment, if known; and

(4) the right to appeal the department's proposed action.

(c) A county agency or the commissioner must mail the written notice at least 15 calendar
days before the adverse action's effective date.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 16.

Minnesota Statutes 2016, section 119B.16, is amended by adding a subdivision
to read:


Subd. 3.

Consolidated contested case hearing.

If a county agency or the commissioner
denies or revokes a provider's authorization based on a licensing action, the provider may
only appeal the denial or revocation in the same contested case proceeding that the provider
appeals the licensing action.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 17.

Minnesota Statutes 2016, section 119B.16, is amended by adding a subdivision
to read:


Subd. 4.

Final department action.

Unless the commissioner receives a timely and
proper request for an appeal, a county agency's or the commissioner's action shall be
considered a final department action.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 18.

[119B.161] ADMINISTRATIVE REVIEW.

Subdivision 1.

Temporary denial or revocation of authorization.

(a) A provider has
the rights listed under this section if:

(1) the provider's authorization was denied or revoked under section 119B.13, subdivision
6, paragraph (d), clause (1), (2), or (7);

(2) the provider's authorization was temporarily suspended under paragraph (b); or

(3) a payment was suspended under chapter 245E.

(b) Unless the commissioner receives a timely and proper request for an appeal, a county's
or the commissioner's action is a final department action.

(c) The commissioner may temporarily suspend a provider's authorization without prior
notice and opportunity for hearing if the commissioner determines either that there is a
credible allegation of fraud for which an investigation is pending under the child care
assistance program, or that the suspension is necessary for public safety and the best interests
of the child care assistance program. An allegation is considered credible if the allegation
has indications of reliability. The commissioner may determine that an allegation is credible,
if the commissioner reviewed all allegations, facts, and evidence carefully and acts judiciously
on a case-by-case basis.

Subd. 2.

Notice.

(a) A county or the commissioner must mail a provider notice within
five days of suspending, revoking, or denying a provider's authorization under subdivision
1.

(b) The notice must:

(1) state the provision under which a county or the commissioner is denying, revoking,
or suspending a provider's authorization or suspending payment to the provider;

(2) set forth the general allegations leading to the revocation, denial, or suspension of a
provider's authorization. The notice need not disclose any specific information concerning
an ongoing investigation;

(3) state that the suspension, revocation, or denial of a provider's authorization is for a
temporary period and explain the circumstances under which the action expires; and

(4) inform the provider of the right to submit written evidence and argument for
consideration by the commissioner.

(c) Notwithstanding Minnesota Rules, part 3400.0185, if a county or the commissioner
denies or revokes a provider's authorization under section 119B.13, subdivision 6, paragraph
(d), clause (1), (2), or (7); suspends a payment to a provider under chapter 245E; or
temporarily suspends a payment to a provider under subdivision 1, a county or the
commissioner must send notice of termination to an affected family. The termination sent
to an affected family is effective on the date the notice is created.

Subd. 3.

Duration.

If a provider's authorization is denied or revoked under section
119B.13, subdivision 6, paragraph (d), clause (1), (2), or (7); authorization is temporarily
suspended under this section; or payment is suspended under chapter 245E, the provider's
denial, revocation, temporary suspension, or payment suspension remains in effect until:

(1) the commissioner or a law enforcement authority determines that there is insufficient
evidence warranting the action and a county or the commissioner does not pursue an
additional administrative remedy under chapter 245E or section 256.98; or

(2) all criminal, civil, and administrative proceedings related to the provider's alleged
misconduct conclude and any appeal rights are exhausted.

Subd. 4.

Good cause exception.

A county or the commissioner may find that good cause
exists not to deny, revoke, or suspend a provider's authorization, or not to continue a denial,
revocation, or suspension of a provider's authorization if any of the following are applicable:

(1) a law enforcement authority specifically requested that a provider's authorization
not be denied, revoked, or suspended because it may compromise an ongoing investigation;

(2) a county or the commissioner determines that the denial, revocation, or suspension
should be removed based on the provider's written submission; or

(3) the commissioner determines that the denial, revocation, or suspension is not in the
best interests of the program.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 19.

Minnesota Statutes 2016, section 245.814, subdivision 2, is amended to read:


Subd. 2.

Application of coverage.

Coverage shall apply to all foster homes licensed by
the Department of Human Services, licensed by a federally recognized tribal government,
or established by the juvenile court and certified by the commissioner of corrections pursuant
to section 260B.198, subdivision 1, clause (3), item (v), to the extent that the liability is not
covered by the provisions of the standard homeowner's or automobile insurance policy. The
insurance shall not cover property owned by the individual foster home provider, damage
caused intentionally by a person over 12 years of age, or
property damage arising out of
business pursuits or the operation of any vehicle, machinery, or equipment.

Sec. 20.

Minnesota Statutes 2016, section 245.814, subdivision 3, is amended to read:


Subd. 3.

Compensation provisions.

If the commissioner of human services is unable
to obtain insurance through ordinary methods for coverage of foster home providers, the
appropriation shall be returned to the general fund and the state shall pay claims subject to
the following limitations.

(a) Compensation shall be provided only for injuries, damage, or actions set forth in
subdivision 1.

(b) Compensation shall be subject to the conditions and exclusions set forth in subdivision
2.

(c) The state shall provide compensation for bodily injury, property damage, or personal
injury resulting from the foster home providers activities as a foster home provider while
the foster child or adult is in the care, custody, and control of the foster home provider in
an amount not to exceed $250,000 for each occurrence.

(d) The state shall provide compensation for damage or destruction of property caused
or sustained by a foster child or adult in an amount not to exceed $250 $1,000 for each
occurrence.

(e) The compensation in paragraphs (c) and (d) is the total obligation for all damages
because of each occurrence regardless of the number of claims made in connection with
the same occurrence, but compensation applies separately to each foster home. The state
shall have no other responsibility to provide compensation for any injury or loss caused or
sustained by any foster home provider or foster child or foster adult.

This coverage is extended as a benefit to foster home providers to encourage care of
persons who need out-of-home care. Nothing in this section shall be construed to mean that
foster home providers are agents or employees of the state nor does the state accept any
responsibility for the selection, monitoring, supervision, or control of foster home providers
which is exclusively the responsibility of the counties which shall regulate foster home
providers in the manner set forth in the rules of the commissioner of human services.

Sec. 21.

Minnesota Statutes 2016, section 245A.02, subdivision 2b, is amended to read:


Subd. 2b.

Annual or annually.

With the exception of subdivision 2c, "annual" or
"annually" means prior to or within the same month of the subsequent calendar year.

Sec. 22.

Minnesota Statutes 2016, section 245A.02, is amended by adding a subdivision
to read:


Subd. 2c.

Annual or annually; family child care training requirements.

For the
purposes of section 245A.50, subdivisions 1 to 9, "annual" or "annually" means the 12-month
period beginning on the license effective date or the annual anniversary of the effective date
and ending on the day prior to the annual anniversary of the license effective date.

Sec. 23.

Minnesota Statutes 2016, section 245A.04, subdivision 4, is amended to read:


Subd. 4.

Inspections; waiver.

(a) Before issuing an initial license, the commissioner
shall conduct an inspection of the program. The inspection must include but is not limited
to:

(1) an inspection of the physical plant;

(2) an inspection of records and documents;

(3) an evaluation of the program by consumers of the program; and

(4) observation of the program in operation.

For the purposes of this subdivision, "consumer" means a person who receives the
services of a licensed program, the person's legal guardian, or the parent or individual having
legal custody of a child who receives the services of a licensed program.

(b) The evaluation required in paragraph (a), clause (3), or the observation in paragraph
(a), clause (4), is not required prior to issuing an initial license under subdivision 7. If the
commissioner issues an initial license under subdivision 7, these requirements must be
completed within one year after the issuance of an initial license.

(c) Before completing a licensing inspection in a family child care program or child care
center, the licensing agency must offer the license holder an exit interview to discuss
violations of law or rule observed during the inspection and offer technical assistance on
how to comply with applicable laws and rules. Nothing in this paragraph limits the ability
of the commissioner to issue a correction order or negative action for violations of law or
rule not discussed in an exit interview or in the event that a license holder chooses not to
participate in an exit interview.

EFFECTIVE DATE.

This section is effective October 1, 2017.

Sec. 24.

Minnesota Statutes 2016, section 245A.06, subdivision 8, is amended to read:


Subd. 8.

Requirement to post correction order.

(a) For licensed family child care
providers and child care centers, upon receipt of any correction order or order of conditional
license issued by the commissioner under this section, and notwithstanding a pending request
for reconsideration of the correction order or order of conditional license by the license
holder, the license holder shall post the correction order or order of conditional license in
a place that is conspicuous to the people receiving services and all visitors to the facility
for two years. When the correction order or order of conditional license is accompanied by
a maltreatment investigation memorandum prepared under section 626.556 or 626.557, the
investigation memoranda must be posted with the correction order or order of conditional
license.

(b) If the commissioner reverses or rescinds a violation in a correction order upon
reconsideration under subdivision 2, the commissioner shall issue an amended correction
order and the license holder shall post the amended order according to paragraph (a).

(c) If the correction order is rescinded or reversed in full upon reconsideration under
subdivision 2, the license holder shall remove the original correction order posted according
to paragraph (a).

Sec. 25.

Minnesota Statutes 2016, section 245A.06, is amended by adding a subdivision
to read:


Subd. 9.

Child care correction order quotas prohibited.

The commissioner and county
licensing agencies shall not order, mandate, require, or suggest to any person responsible
for licensing or inspecting a licensed family child care provider or child care center a quota
for the issuance of correction orders on a daily, weekly, monthly, quarterly, or yearly basis.

Sec. 26.

[245A.065] CHILD CARE FIX-IT TICKET.

(a) In lieu of a correction order under section 245A.06, the commissioner shall issue a
fix-it ticket to a family child care or child care center license holder if the commissioner
finds that:

(1) the license holder has failed to comply with a requirement in this chapter or Minnesota
Rules, chapter 9502 or 9503, that the commissioner determines to be eligible for a fix-it
ticket;

(2) the violation does not imminently endanger the health, safety, or rights of the persons
served by the program;

(3) the license holder did not receive a fix-it ticket or correction order for the violation
at the license holder's last licensing inspection;

(4) the violation can be corrected at the time of inspection or within 48 hours, excluding
Saturdays, Sundays, and holidays; and

(5) the license holder corrects the violation at the time of inspection or agrees to correct
the violation within 48 hours, excluding Saturdays, Sundays, and holidays.

(b) The fix-it ticket must state:

(1) the conditions that constitute a violation of the law or rule;

(2) the specific law or rule violated; and

(3) that the violation was corrected at the time of inspection or must be corrected within
48 hours, excluding Saturdays, Sundays, and holidays.

(c) The commissioner shall not publicly publish a fix-it ticket on the department's Web
site.

(d) Within 48 hours, excluding Saturdays, Sundays, and holidays, of receiving a fix-it
ticket, the license holder must correct the violation and within one week submit evidence
to the licensing agency that the violation was corrected.

(e) If the violation is not corrected at the time of inspection or within 48 hours, excluding
Saturdays, Sundays, and holidays, or the evidence submitted is insufficient to establish that
the license holder corrected the violation, the commissioner must issue a correction order
for the violation of Minnesota law or rule identified in the fix-it ticket according to section
245A.06.

(f) The commissioner shall, following consultation with family child care license holders,
child care center license holders, and county agencies, issue a report by October 1, 2017,
that identifies the violations of this chapter and Minnesota Rules, chapters 9502 and 9503,
that are eligible for a fix-it ticket. The commissioner shall provide the report to county
agencies and the chairs and ranking minority members of the legislative committees with
jurisdiction over child care, and shall post the report to the department's Web site.

EFFECTIVE DATE.

This section is effective October 1, 2017.

Sec. 27.

[245A.1434] INFORMATION FOR CHILD CARE LICENSE HOLDERS.

The commissioner shall inform family child care and child care center license holders
on a timely basis of changes to state and federal statute, rule, regulation, and policy relating
to the provision of licensed child care, the child care assistance program under chapter 119B,
the quality rating and improvement system under section 124D.142, and child care licensing
functions delegated to counties. Communications under this section shall include information
to promote license holder compliance with identified changes. Communications under this
section may be accomplished by electronic means and shall be made available to the public
online.

Sec. 28.

[245A.153] REPORT TO LEGISLATURE ON THE STATUS OF CHILD
CARE.

Subdivision 1.

Reporting requirements.

Beginning on February 1, 2018, and no later
than February 1 of each year thereafter, the commissioner of human services shall provide
a report on the status of child care in Minnesota to the chairs and ranking minority members
of the legislative committees with jurisdiction over child care.

Subd. 2.

Contents of report.

(a) The report must include the following:

(1) summary data on trends in child care center and family child care capacity and
availability throughout the state, including the number of centers and programs that have
opened and closed and the geographic locations of those centers and programs;

(2) a description of any changes to statutes, administrative rules, or agency policies and
procedures that were implemented in the year preceding the report;

(3) a description of the actions the department has taken to address or implement the
recommendations from the Legislative Task Force on Access to Affordable Child Care
Report dated January 15, 2017, including but not limited to actions taken in the areas of:

(i) encouraging uniformity in implementing and interpreting statutes, administrative
rules, and agency policies and procedures relating to child care licensing and access;

(ii) improving communication with county licensors and child care providers regarding
changes to statutes, administrative rules, and agency policies and procedures, ensuring that
information is directly and regularly transmitted;

(iii) providing notice to child care providers before issuing correction orders or negative
actions relating to recent changes to statutes, administrative rules, and agency policies and
procedures;

(iv) implementing confidential, anonymous communication processes for child care
providers to ask questions and receive prompt, clear answers from the department;

(v) streamlining processes to reduce duplication or overlap in paperwork and training
requirements for child care providers; and

(vi) compiling and distributing information detailing trends in the violations for which
correction orders and negative actions are issued;

(4) a description of the department's efforts to cooperate with counties while addressing
and implementing the task force recommendations;

(5) summary data on child care assistance programs including but not limited to state
funding and numbers of families served; and

(6) summary data on family child care correction orders, including:

(i) the number of licensed family child care provider appeals or requests for
reconsideration of correction orders to the Department of Human Services;

(ii) the number of family child care correction order appeals or requests for
reconsideration that the Department of Human Services grants; and

(iii) the number of family child care correction order appeals or requests for
reconsideration that the Department of Human Services denies.

(b) The commissioner may offer recommendations for legislative action.

Subd. 3.

Sunset.

This section expires February 2, 2020.

Sec. 29.

[245A.23] EXEMPTION FROM POSITIVE SUPPORT STRATEGIES
REQUIREMENTS.

A program licensed as a family day care facility or group family day care facility under
Minnesota Rules, chapter 9502, and a program licensed as a child care center under
Minnesota Rules, chapter 9503, are exempt from Minnesota Rules, chapter 9544, relating
to positive support strategies and restrictive interventions.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 30.

Minnesota Statutes 2016, section 245E.01, is amended by adding a subdivision
to read:


Subd. 6a.

Credible allegation of fraud.

"Credible allegation of fraud" has the meaning
given in section 256B.064, subdivision 2, paragraph (b), clause (2).

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 31.

Minnesota Statutes 2016, section 245E.02, subdivision 1, is amended to read:


Subdivision 1.

Investigating provider or recipient financial misconduct.

The
department shall investigate alleged or suspected financial misconduct by providers and
errors related to payments issued by the child care assistance program under this chapter.
Recipients, employees, agents and consultants, and staff may be investigated when the
evidence shows that their conduct is related to the financial misconduct of a provider, license
holder, or controlling individual. When the alleged or suspected financial misconduct relates
to acting as a recruiter offering conditional employment on behalf of a provider that has
received funds from the child care assistance program, the department may investigate the
provider, center owner, director, manager, license holder, or other controlling individual or
agent, who is alleged to have acted as a recruiter offering conditional employment.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 32.

Minnesota Statutes 2016, section 245E.02, subdivision 3, is amended to read:


Subd. 3.

Determination of investigation.

After completing its investigation, the
department shall issue one of the following determinations determine that:

(1) no violation of child care assistance requirements occurred;

(2) there is insufficient evidence to show that a violation of child care assistance
requirements occurred;

(3) a preponderance of evidence shows a violation of child care assistance program law,
rule, or policy; or

(4) there exists a credible allegation of fraud involving the child care assistance program.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 33.

Minnesota Statutes 2016, section 245E.02, subdivision 4, is amended to read:


Subd. 4.

Actions Referrals or administrative sanctions actions.

(a) After completing
the determination under subdivision 3, the department may take one or more of the actions
or sanctions specified in this subdivision.

(b) The department may take any of the following actions:

(1) refer the investigation to law enforcement or a county attorney for possible criminal
prosecution;

(2) refer relevant information to the department's licensing division, the background
studies division,
the child care assistance program, the Department of Education, the federal
child and adult care food program, or appropriate child or adult protection agency;

(3) enter into a settlement agreement with a provider, license holder, owner, agent,
controlling individual, or recipient; or

(4) refer the matter for review by a prosecutorial agency with appropriate jurisdiction
for possible civil action under the Minnesota False Claims Act, chapter 15C.

(c) In addition to section 256.98, the department may impose sanctions by:

(1) pursuing administrative disqualification through hearings or waivers;

(2) establishing and seeking monetary recovery or recoupment;

(3) issuing an order of corrective action that states the practices that are violations of
child care assistance program policies, laws, or regulations, and that they must be corrected;
or

(4) suspending, denying, or terminating payments to a provider.; or

(5) taking an action under section 119B.13, subdivision 6, paragraph (d).

(d) Upon a finding by If the commissioner determines that any child care provider, center
owner, director, manager, license holder, or other controlling individual of a child care
center has employed, used, or acted as a recruiter offering conditional employment for a
child care center that has received child care assistance program funding, the commissioner
shall:

(1) immediately suspend all program payments to all child care centers in which the
person employing, using, or acting as a recruiter offering conditional employment is an
owner, director, manager, license holder, or other controlling individual. The commissioner
shall suspend program payments under this clause even if services have already been
provided; and

(2) immediately and permanently revoke the licenses of all child care centers of which
the person employing, using, or acting as a recruiter offering conditional employment is an
owner, director, manager, license holder, or other controlling individual.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 34.

Minnesota Statutes 2016, section 245E.03, subdivision 2, is amended to read:


Subd. 2.

Failure to provide access.

Failure to provide access may result in denial or
termination of authorizations for or payments to a recipient, provider, license holder, or
controlling individual in the child care assistance program.
If a provider fails to grant the
department immediate access to records, the department may immediately suspend payments
under section 119B.161, or the department may deny or revoke the provider's authorization.
A provider, license holder, controlling individual, employee, or staff member must grant
the department access during any hours that the program is open to examine the provider's
program or the records listed in section 245E.05. A provider shall make records immediately
available at the provider's place of business at the time the department requests access,
unless the provider and the department both agree otherwise.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 35.

Minnesota Statutes 2016, section 245E.03, subdivision 4, is amended to read:


Subd. 4.

Continued or repeated failure to provide access.

If the provider continues
to fail to provide access at the expiration of the 15-day notice period, child care assistance
program payments to the provider must be denied suspended beginning the 16th day
following notice of the initial failure or refusal to provide access. The department may
rescind the denial based upon good cause if the provider submits in writing a good cause
basis for having failed or refused to provide access. The writing must be postmarked no
later than the 15th day following the provider's notice of initial failure to provide access.
A
provider's, license holder's, controlling individual's, employee's, staff member's, or recipient's
duty to provide access in this section continues after the provider's authorization is denied,
revoked, or suspended.
Additionally, the provider, license holder, or controlling individual
must immediately provide complete, ongoing access to the department. Repeated failures
to provide access must, after the initial failure or for any subsequent failure, result in
termination from participation in the child care assistance program.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 36.

Minnesota Statutes 2016, section 245E.04, is amended to read:


245E.04 HONEST AND TRUTHFUL STATEMENTS.

It shall be unlawful for a provider, license holder, controlling individual, or recipient to:

(1) falsify, conceal, or cover up by any trick, scheme, or device a material fact means;

(2) make any materially false, fictitious, or fraudulent statement or representation; or

(3) make or use any false writing or document knowing the same to contain any materially
false, fictitious, or fraudulent statement or entry related to any child care assistance program
services that the provider, license holder, or controlling individual supplies or in relation to
any child care assistance payments received by a provider, license holder, or controlling
individual or to any fraud investigator or law enforcement officer conducting a financial
misconduct investigation.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 37.

Minnesota Statutes 2016, section 245E.05, subdivision 1, is amended to read:


Subdivision 1.

Records required to be retained.

The following records must be
maintained, controlled, and made immediately accessible to license holders, providers, and
controlling individuals. The records must be organized and labeled to correspond to categories
that make them easy to identify so that they can be made available immediately upon request
to an investigator acting on behalf of the commissioner at the provider's place of business:

(1) payroll ledgers, canceled checks, bank deposit slips, and any other accounting records;

(2) daily attendance records required by and that comply with section 119B.125,
subdivision 6;

(3) billing transmittal forms requesting payments from the child care assistance program
and billing adjustments related to child care assistance program payments;

(4) records identifying all persons, corporations, partnerships, and entities with an
ownership or controlling interest in the provider's child care business;

(5) employee or contractor records identifying those persons currently employed by the
provider's child care business or who have been employed by the business at any time within
the previous five years. The records must include each employee's name, hourly and annual
salary, qualifications, position description, job title, and dates of employment. In addition,
employee records that must be made available include the employee's time sheets, current
home address of the employee or last known address of any former employee, and
documentation of background studies required under chapter 119B or 245C;

(6) records related to transportation of children in care, including but not limited to:

(i) the dates and times that transportation is provided to children for transportation to
and from the provider's business location for any purpose. For transportation related to field
trips or locations away from the provider's business location, the names and addresses of
those field trips and locations must also be provided;

(ii) the name, business address, phone number, and Web site address, if any, of the
transportation service utilized; and

(iii) all billing or transportation records related to the transportation.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 38.

Minnesota Statutes 2016, section 245E.06, subdivision 1, is amended to read:


Subdivision 1.

Factors regarding imposition of administrative sanctions actions.

(a)
The department shall consider the following factors in determining the administrative
sanctions actions to be imposed:

(1) nature and extent of financial misconduct;

(2) history of financial misconduct;

(3) actions taken or recommended by other state agencies, other divisions of the
department, and court and administrative decisions;

(4) prior imposition of sanctions actions;

(5) size and type of provider;

(6) information obtained through an investigation from any source;

(7) convictions or pending criminal charges; and

(8) any other information relevant to the acts or omissions related to the financial
misconduct.

(b) Any single factor under paragraph (a) may be determinative of the department's
decision of whether and what sanctions are imposed actions to take.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 39.

Minnesota Statutes 2016, section 245E.06, subdivision 2, is amended to read:


Subd. 2.

Written notice of department sanction action; sanction action effective
date; informal meeting.

(a) The department shall give notice in writing to a person of an
administrative sanction that is to be imposed. The notice shall be sent by mail as defined in
section 245E.01, subdivision 11.

(b) The notice shall state:

(1) the factual basis for the department's determination;

(2) the sanction the department intends to take;

(3) the dollar amount of the monetary recovery or recoupment, if any;

(4) how the dollar amount was computed;

(5) the right to dispute the department's determination and to provide evidence;

(6) the right to appeal the department's proposed sanction; and

(7) the option to meet informally with department staff, and to bring additional
documentation or information, to resolve the issues.

(c) In cases of determinations resulting in denial or termination of payments, in addition
to the requirements of paragraph (b), the notice must state:

(1) the length of the denial or termination;

(2) the requirements and procedures for reinstatement; and

(3) the provider's right to submit documents and written arguments against the denial
or termination of payments for review by the department before the effective date of denial
or termination.

(d) The submission of documents and written argument for review by the department
under paragraph (b), clause (5) or (7), or paragraph (c), clause (3), does not stay the deadline
for filing an appeal.

(a) When taking an action against a provider, the department must give notice to:

(1) the provider as specified in section 119B.16 or 119B.161; and

(2) a family as specified under section 119B.161 or Minnesota Rules, part 3400.0185.

(e) (b) Notwithstanding section 245E.03, subdivision 4, and except for a payment
suspension or action under section 119B.161, subdivision 1,
the effective date of the proposed
sanction action under this chapter shall be 30 days after the license holder's, provider's,
controlling individual's, or recipient's receipt of the notice, unless timely appealed. If a
timely appeal is made, the proposed sanction action shall be delayed pending the final
outcome of the appeal. Implementation of a proposed sanction action following the resolution
of a timely appeal may be postponed if, in the opinion of the department, the delay of
sanction action is necessary to protect the health or safety of children in care. The department
may consider the economic hardship of a person in implementing the proposed sanction,
but economic hardship shall not be a determinative factor in implementing the proposed
sanction.

(f) Requests for an informal meeting to attempt to resolve issues and requests for appeals
must be sent or delivered to the department's Office of Inspector General, Financial Fraud
and Abuse Division.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 40.

Minnesota Statutes 2016, section 245E.06, subdivision 3, is amended to read:


Subd. 3.

Appeal of department sanction action.

(a) If the department does not pursue
a criminal action against a provider, license holder, controlling individual, or recipient for
financial misconduct, but the department imposes an administrative sanction under section
245E.02, subdivision 4, paragraph (c), any individual or entity against whom the sanction
was imposed may appeal the department's administrative sanction under this section pursuant
to section 119B.16 or 256.045 with the additional requirements in clauses (1) to (4). An
appeal must specify:

(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item, if appropriate;

(2) the computation that is believed to be correct, if appropriate;

(3) the authority in the statute or rule relied upon for each disputed item; and

(4) the name, address, and phone number of the person at the provider's place of business
with whom contact may be made regarding the appeal.

(b) Notwithstanding section 245E.03, subdivision 4, an appeal is considered timely only
if postmarked or received by the department's Appeals Division within 30 days after receiving
a notice of department sanction.

(c) Before the appeal hearing, the department may deny or terminate authorizations or
payment to the entity or individual if the department determines that the action is necessary
to protect the public welfare or the interests of the child care assistance program.

A provider's rights related to an action taken under this chapter are established in sections
119B.16 and 119B.161.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 41.

Minnesota Statutes 2016, section 245E.07, subdivision 1, is amended to read:


Subdivision 1.

Grounds for and methods of monetary recovery.

(a) The department
may obtain monetary recovery from a provider who has been improperly paid by the child
care assistance program, regardless of whether the error was on the part of the provider, the
department, or the county and regardless of whether the error
was intentional or county
error
. The department does not need to establish a pattern as a precondition of monetary
recovery
of erroneous or false billing claims, duplicate billing claims, or billing claims
based on false statements or financial misconduct.

(b) The department shall obtain monetary recovery from providers by the following
means:

(1) permitting voluntary repayment of money, either in lump-sum payment or installment
payments;

(2) using any legal collection process;

(3) deducting or withholding program payments; or

(4) utilizing the means set forth in chapter 16D.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 42.

Minnesota Statutes 2016, section 256.98, subdivision 8, is amended to read:


Subd. 8.

Disqualification from program.

(a) Any person found to be guilty of
wrongfully obtaining assistance by a federal or state court or by an administrative hearing
determination, or waiver thereof, through a disqualification consent agreement, or as part
of any approved diversion plan under section 401.065, or any court-ordered stay which
carries with it any probationary or other conditions, in the Minnesota family investment
program and any affiliated program to include the diversionary work program and the work
participation cash benefit program, the food stamp or food support program, the general
assistance program, the group residential housing program, or the Minnesota supplemental
aid program shall be disqualified from that program. In addition, any person disqualified
from the Minnesota family investment program shall also be disqualified from the food
stamp or food support program. The needs of that individual shall not be taken into
consideration in determining the grant level for that assistance unit:

(1) for one year after the first offense;

(2) for two years after the second offense; and

(3) permanently after the third or subsequent offense.

The period of program disqualification shall begin on the date stipulated on the advance
notice of disqualification without possibility of postponement for administrative stay or
administrative hearing and shall continue through completion unless and until the findings
upon which the sanctions were imposed are reversed by a court of competent jurisdiction.
The period for which sanctions are imposed is not subject to review. The sanctions provided
under this subdivision are in addition to, and not in substitution for, any other sanctions that
may be provided for by law for the offense involved. A disqualification established through
hearing or waiver shall result in the disqualification period beginning immediately unless
the person has become otherwise ineligible for assistance. If the person is ineligible for
assistance, the disqualification period begins when the person again meets the eligibility
criteria of the program from which they were disqualified and makes application for that
program.

(b) A family receiving assistance through child care assistance programs under chapter
119B with a family member who is found to be guilty of wrongfully obtaining child care
assistance by a federal court, state court, or an administrative hearing determination or
waiver, through a disqualification consent agreement, as part of an approved diversion plan
under section 401.065, or a court-ordered stay with probationary or other conditions, is
disqualified from child care assistance programs. The disqualifications must be for periods
of one year and two years for the first and second offenses, respectively. Subsequent
violations must result in permanent disqualification. During the disqualification period,
disqualification from any child care program must extend to all child care programs and
must be immediately applied.

(c) A provider caring for children receiving assistance through child care assistance
programs under chapter 119B is disqualified from receiving payment for child care services
from the child care assistance program under chapter 119B when the provider is found to
have wrongfully obtained child care assistance by a federal court, state court, or an
administrative hearing determination or waiver under section 256.046, through a
disqualification consent agreement, as part of an approved diversion plan under section
401.065, or a court-ordered stay with probationary or other conditions. The disqualification
must be for a period of one year two years for the first offense and two years for the second
offense
. Any subsequent violation must result in permanent disqualification. The
disqualification period must be imposed immediately after a determination is made under
this paragraph. During the disqualification period, the provider is disqualified from receiving
payment from any child care program under chapter 119B.

(d) Any person found to be guilty of wrongfully obtaining MinnesotaCare for adults
without children and upon federal approval, all categories of medical assistance and
remaining categories of MinnesotaCare, except for children through age 18, by a federal or
state court or by an administrative hearing determination, or waiver thereof, through a
disqualification consent agreement, or as part of any approved diversion plan under section
401.065, or any court-ordered stay which carries with it any probationary or other conditions,
is disqualified from that program. The period of disqualification is one year after the first
offense, two years after the second offense, and permanently after the third or subsequent
offense. The period of program disqualification shall begin on the date stipulated on the
advance notice of disqualification without possibility of postponement for administrative
stay or administrative hearing and shall continue through completion unless and until the
findings upon which the sanctions were imposed are reversed by a court of competent
jurisdiction. The period for which sanctions are imposed is not subject to review. The
sanctions provided under this subdivision are in addition to, and not in substitution for, any
other sanctions that may be provided for by law for the offense involved.

EFFECTIVE DATE.

This section is effective April 23, 2018.

Sec. 43.

Minnesota Statutes 2016, section 256I.04, subdivision 1, is amended to read:


Subdivision 1.

Individual eligibility requirements.

An individual is eligible for and
entitled to a group residential housing payment to be made on the individual's behalf if the
agency has approved the individual's residence in a group residential housing setting and
the individual meets the requirements in paragraph (a) or, (b), or (c).

(a) The individual is aged, blind, or is over 18 years of age and disabled as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2
, is less than the monthly rate specified in the agency's agreement with the
provider of group residential housing in which the individual resides.

(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (5) to (9), and (14), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of group residential housing in which
the individual resides.

(c) The individual receives licensed residential crisis stabilization services under section
256B.0624, subdivision 7, and is receiving medical assistance. The individual may receive
concurrent group residential housing payments if receiving licensed residential crisis
stabilization services under section 256B.0624, subdivision 7.

EFFECTIVE DATE.

This section is effective October 1, 2017.

Sec. 44.

Minnesota Statutes 2016, section 256I.04, subdivision 3, is amended to read:


Subd. 3.

Moratorium on development of group residential housing beds.

(a) Agencies
shall not enter into agreements for new group residential housing beds with total rates in
excess of the MSA equivalent rate except:

(1) for group residential housing establishments licensed under chapter 245D provided
the facility is needed to meet the census reduction targets for persons with developmental
disabilities at regional treatment centers;

(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a
, paragraph (b);

(3) notwithstanding the provisions of subdivision 2a, for up to 190 226 supportive
housing units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a
mental illness, a history of substance abuse, or human immunodeficiency virus or acquired
immunodeficiency syndrome. For purposes of this section, "homeless adult" means a person
who is living on the street or in a shelter or discharged from a regional treatment center,
community hospital, or residential treatment program and has no appropriate housing
available and lacks the resources and support necessary to access appropriate housing. At
least 70 percent of the supportive housing units must serve homeless adults with mental
illness, substance abuse problems, or human immunodeficiency virus or acquired
immunodeficiency syndrome who are about to be or, within the previous six months, has
been discharged from a regional treatment center, or a state-contracted psychiatric bed in
a community hospital, or a residential mental health or chemical dependency treatment
program. If a person meets the requirements of subdivision 1, paragraph (a), and receives
a federal or state housing subsidy, the group residential housing rate for that person is limited
to the supplementary rate under section 256I.05, subdivision 1a, and is determined by
subtracting the amount of the person's countable income that exceeds the MSA equivalent
rate from the group residential housing supplementary rate. A resident in a demonstration
project site who no longer participates in the demonstration program shall retain eligibility
for a group residential housing payment in an amount determined under section 256I.06,
subdivision 8
, using the MSA equivalent rate. Service funding under section 256I.05,
subdivision 1a
, will end June 30, 1997, if federal matching funds are available and the
services can be provided through a managed care entity. If federal matching funds are not
available, then service funding will continue under section 256I.05, subdivision 1a;

(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a group residential housing contract with the county and has been licensed as a board
and lodge facility with special services since 1980;

(5) for a group residential housing provider located in the city of St. Cloud, or a county
contiguous to the city of St. Cloud, that operates a 40-bed facility, that received financing
through the Minnesota Housing Finance Agency Ending Long-Term Homelessness Initiative
and serves chemically dependent clientele, providing 24-hour-a-day supervision;

(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a group residential housing provider that currently operates a 304-bed
facility in Minneapolis, and a 44-bed facility in Duluth;

(7) for a group residential housing provider that operates two ten-bed facilities, one
located in Hennepin County and one located in Ramsey County, that provide community
support and 24-hour-a-day supervision to serve the mental health needs of individuals who
have chronically lived unsheltered; and

(8) for a group residential facility in Hennepin County with a capacity of up to 48 beds
that has been licensed since 1978 as a board and lodging facility and that until August 1,
2007, operated as a licensed chemical dependency treatment program.

(b) An agency may enter into a group residential housing agreement for beds with rates
in excess of the MSA equivalent rate in addition to those currently covered under a group
residential housing agreement if the additional beds are only a replacement of beds with
rates in excess of the MSA equivalent rate which have been made available due to closure
of a setting, a change of licensure or certification which removes the beds from group
residential housing payment, or as a result of the downsizing of a group residential housing
setting. The transfer of available beds from one agency to another can only occur by the
agreement of both agencies.

Sec. 45.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1p.

Supplementary rate; St. Louis County.

(a) Notwithstanding the provisions
of subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700 per
month, including any legislatively authorized inflationary adjustments, for a group residential
housing provider that:

(1) is located in St. Louis County and has had a group residential housing contract with
the county since July 2016;

(2) operates a 35-bed facility;

(3) serves women who are chemically dependent, mentally ill, or both;

(4) provides 24-hour per day supervision;

(5) provides on-site support with skilled professionals, including a licensed practical
nurse, registered nurses, peer specialists, and resident counselors; and

(6) provides independent living skills training and assistance with family reunification.

Sec. 46.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1q.

Supplemental rate; Anoka County.

Notwithstanding the provisions in this
section, a county agency shall negotiate a supplemental rate for 42 beds in addition to the
rate specified in subdivision 1, not to exceed the maximum rate allowed under subdivision
1a, including any legislatively authorized inflationary adjustments, for a group residential
housing provider that is located in Anoka County and provides emergency housing on the
former Anoka Regional Treatment Center campus. Notwithstanding any other law or rule
to the contrary, Anoka County is not responsible for any additional costs associated with
the supplemental rate provided for in this subdivision.

Sec. 47.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1r.

Supplemental rate; Olmsted County.

Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per
month, including any legislatively authorized inflationary adjustments, for a group residential
housing provider located in Olmsted County that operates long-term residential facilities
with a total of 104 beds that serve chemically dependent men and women and provide
24-hour-a-day supervision and other support services.

Sec. 48.

Minnesota Statutes 2016, section 256I.05, is amended by adding a subdivision
to read:


Subd. 11.

Transfer of emergency shelter funds.

(a) The commissioner shall make a
cost-neutral transfer of funding from the group residential housing fund to county human
service agencies for emergency shelter beds removed from the group residential housing
census under a biennial plan submitted by the county and approved by the commissioner.
The biennial plan is due August 1, beginning August 1, 2017. The plan must describe: (1)
anticipated and actual outcomes for persons experiencing homelessness in emergency
shelters; (2) improved efficiencies in administration; (3) requirements for individual
eligibility; and (4) plans for quality assurance monitoring and quality assurance outcomes.
The commissioner shall review the county plan to monitor implementation and outcomes
at least biennially, and more frequently if the commissioner deems necessary.

(b) The funding under paragraph (a) may be used for the provision of room and board
or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
annually, and the room and board portion of the allocation shall be adjusted according to
the percentage change in the group residential housing room and board rate. The room and
board portion of the allocation shall be determined at the time of transfer. The commissioner
or county may return beds to the group residential housing fund with 180 days' notice,
including financial reconciliation.

EFFECTIVE DATE.

This section is effective July 1, 2017.

Sec. 49.

Minnesota Statutes 2016, section 256I.06, subdivision 8, is amended to read:


Subd. 8.

Amount of group residential housing payment.

(a) The amount of a group
residential housing payment to be made on behalf of an eligible individual is determined
by subtracting the individual's countable income under section 256I.04, subdivision 1, for
a whole calendar month from the group residential housing charge for that same month.
The group residential housing charge is determined by multiplying the group residential
housing rate times the period of time the individual was a resident or temporarily absent
under section 256I.05, subdivision 1c, paragraph (d).

(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.

(c) For an individual who receives licensed residential crisis stabilization services under
section 256B.0624, subdivision 7, the amount of group residential housing payment is
determined by multiplying the group residential housing rate times the period of time the
individual was a resident.

EFFECTIVE DATE.

This section is effective October 1, 2017.

Sec. 50.

Minnesota Statutes 2016, section 256J.45, subdivision 2, is amended to read:


Subd. 2.

General information.

The MFIP orientation must consist of a presentation
that informs caregivers of:

(1) the necessity to obtain immediate employment;

(2) the work incentives under MFIP, including the availability of the federal earned
income tax credit and the Minnesota working family tax credit;

(3) the requirement to comply with the employment plan and other requirements of the
employment and training services component of MFIP, including a description of the range
of work and training activities that are allowable under MFIP to meet the individual needs
of participants;

(4) the consequences for failing to comply with the employment plan and other program
requirements, and that the county agency may not impose a sanction when failure to comply
is due to the unavailability of child care or other circumstances where the participant has
good cause under subdivision 3;

(5) the rights, responsibilities, and obligations of participants;

(6) the types and locations of child care services available through the county agency;

(7) the availability and the benefits of the early childhood health and developmental
screening under sections 121A.16 to 121A.19; 123B.02, subdivision 16; and 123B.10;

(8) the caregiver's eligibility for transition year child care assistance under section
119B.05;

(9) the availability of all health care programs, including transitional medical assistance;

(10) the caregiver's option to choose an employment and training provider and information
about each provider, including but not limited to, services offered, program components,
job placement rates, job placement wages, and job retention rates;

(11) the caregiver's option to request approval of an education and training plan according
to section 256J.53;

(12) the work study programs available under the higher education system; and

(13) information about the 60-month time limit exemptions under the family violence
waiver and referral information about shelters and programs for victims of family violence.;
and

(14) information about the income exclusions under section 256P.06, subdivision 2.

EFFECTIVE DATE.

This section is effective July 1, 2018.

Sec. 51.

[256N.261] SUPPORT FOR ADOPTIVE, FOSTER, AND KINSHIP
FAMILIES.

Subdivision 1.

Program established.

The commissioner of human services shall design
and implement a coordinated program to reduce the need for placement changes or
out-of-home placements of children and youth in foster care, adoptive placements, and
permanent physical and legal custody kinship placements, and to improve the functioning
and stability of these families. To the extent federal funds are available, the commissioner
shall provide the following adoption and foster care-competent services and ensure that
placements are trauma informed and child and family centered:

(1) a program providing information, referrals, a parent-to-parent support network, peer
support for youth, family activities, respite care, crisis services, educational support, and
mental health services for children and youth in adoption, foster care, and kinship placements
and adoptive, foster, and kinship families from across Minnesota;

(2) training offered around Minnesota for adoptive and kinship families, and additional
training for foster families, and the professionals who serve the families, on the effects of
trauma, common disabilities of adopted children and children in foster care, and kinship
placements, and challenges in adoption, foster care, and kinship placements; and

(3) periodic evaluation of these services to ensure program effectiveness in preserving
and improving the success of adoptive, foster, and kinship placements.

Subd. 2.

Definitions.

(a) The definitions in this subdivision apply to this section.

(b) "Child and family centered" means individualized services that respond to a child's
or youth's strengths, interests, and current developmental stage, including social, cognitive,
emotional, physical, cultural, racial, and spiritual needs, and offer support to the entire
adoptive, foster, or kinship family.

(c) "Trauma informed" means care that acknowledges the effect trauma has on children
and the children's families, modifies services to respond to the effects of trauma, emphasizes
skill and strength building rather than symptom management, and focuses on the physical
and psychological safety of the child and family.

Sec. 52.

Minnesota Statutes 2016, section 256P.06, subdivision 2, is amended to read:


Subd. 2.

Exempted individuals.

(a) The following members of an assistance unit under
chapters 119B and 256J are exempt from having their earned income count towards the
income of an assistance unit:

(1) children under six years old;

(2) caregivers under 20 years of age enrolled at least half-time in school; and

(3) minors enrolled in school full time.

(b) The following members of an assistance unit are exempt from having their earned
and unearned income count toward the income of an assistance unit for 18 consecutive
calendar months, beginning the month following the marriage date, for benefits under chapter
256J if the household income does not exceed 275 percent of the federal poverty guidelines:

(1) a new spouse to a caretaker in an existing assistance unit; and

(2) the spouse designated by a newly married couple, when both spouses were already
members of an assistance unit under chapter 256J.

(c) If members of an assistance unit identified in paragraph (b) also receive assistance
under section 119B.05, they are exempt from having their earned income count toward the
income of the assistance unit if the household income prior to the exemption does not exceed
67 percent of the state median income for recipients under section 119B.05 for 39 consecutive
biweekly periods beginning the second biweekly period after the marriage date.

EFFECTIVE DATE.

This section is effective July 1, 2018.

Sec. 53.

Minnesota Statutes 2016, section 260C.451, subdivision 6, is amended to read:


Subd. 6.

Reentering foster care and accessing services after 18 years of age and up
to 21 years of age.

(a) Upon request of an individual who had been under the guardianship
of the commissioner and who has left foster care without being adopted, the responsible
social services agency which had been the commissioner's agent for purposes of the
guardianship shall develop with the individual a plan to increase the individual's ability to
live safely and independently using the plan requirements of section 260C.212, subdivision
1
, paragraph (c), clause (12), and to assist the individual to meet one or more of the eligibility
criteria in subdivision 4 if the individual wants to reenter foster care. The responsible social
services agency shall provide foster care as required to implement the plan. The responsible
social services agency shall enter into a voluntary placement agreement under section
260C.229 with the individual if the plan includes foster care.

(b) Individuals who had not been under the guardianship of the commissioner of human
services prior to 18 years of age may ask to reenter foster care after age 18 and, to the extent
funds are available,
the responsible social services agency that had responsibility for planning
for the individual before discharge from foster care may shall provide foster care or other
services to the individual for the purpose of increasing the individual's ability to live safely
and independently and to meet the eligibility criteria in subdivision 3a, if the individual:

(1) was in foster care for the six consecutive months prior to the person's 18th birthday,
or left foster care within six months prior to the person's 18th birthday,
and was not
discharged home, adopted, or received into a relative's home under a transfer of permanent
legal and physical custody under section 260C.515, subdivision 4; or

(2) was discharged from foster care while on runaway status after age 15.

(c) In conjunction with a qualifying and eligible individual under paragraph (b) and
other appropriate persons, the responsible social services agency shall develop a specific
plan related to that individual's vocational, educational, social, or maturational needs and,
to the extent funds are available, provide foster care as required to implement the plan. The
responsible social services agency shall enter into a voluntary placement agreement with
the individual if the plan includes foster care.

(d) A child who left foster care while under guardianship of the commissioner of human
services retains eligibility for foster care for placement at any time prior to 21 years of age.

Sec. 54.

Minnesota Statutes 2016, section 626.556, subdivision 3c, is amended to read:


Subd. 3c.

Local welfare agency, Department of Human Services or Department of
Health responsible for assessing or investigating reports of maltreatment.

(a) The county
local welfare agency is the agency responsible for assessing or investigating allegations of
maltreatment in child foster care, family child care, legally unlicensed child care, juvenile
correctional facilities licensed under section 241.021 located in the local welfare agency's
county,
and reports involving children served by an unlicensed personal care provider
organization under section 256B.0659. Copies of findings related to personal care provider
organizations under section 256B.0659 must be forwarded to the Department of Human
Services provider enrollment.

(b) The Department of Human Services is the agency responsible for assessing or
investigating allegations of maltreatment in juvenile correctional facilities licensed by the
Department of Corrections under section 241.021 and
in facilities licensed under chapters
245A and 245D, except for child foster care and family child care.

(c) The Department of Health is the agency responsible for assessing or investigating
allegations of child maltreatment in facilities licensed under sections 144.50 to 144.58 and
144A.43 to 144A.482.

Sec. 55. MOBILE FOOD SHELF GRANTS.

Subdivision 1.

Grant amount.

Hunger Solutions shall award grants on a priority basis
under subdivision 3. A grant to sustain an existing mobile program shall not exceed $25,000.
A grant to create a new mobile program shall not exceed $75,000.

Subd. 2.

Application contents.

An applicant for a grant under this section must provide
the following information to Hunger Solutions:

(1) the location of the project;

(2) a description of the mobile program, including the program's size and scope;

(3) evidence regarding the unserved or underserved nature of the community in which
the project is to be located;

(4) evidence of community support for the project;

(5) the total cost of the project;

(6) the amount of the grant request and how funds will be used;

(7) sources of funding or in-kind contributions for the project that may supplement any
grant award;

(8) the applicant's commitment to maintain the mobile program; and

(9) any additional information requested by Hunger Solutions.

Subd. 3.

Awarding grants.

In evaluating applications and awarding grants, Hunger
Solutions must give priority to an applicant who:

(1) serves unserved or underserved areas;

(2) creates a new mobile program or expands an existing mobile program;

(3) serves areas where a high level of need is identified;

(4) provides evidence of strong support for the project from residents and other institutions
in the community;

(5) leverages funding for the project from other private and public sources; and

(6) commits to maintaining the program on a multiyear basis.

Sec. 56. MINNESOTA PATHWAYS TO PROSPERITY DAKOTA AND OLMSTED
COUNTIES' PILOT PROJECT.

Subdivision 1.

Authorization.

The commissioners of human services, health, education,
Minnesota Housing Finance Agency, and management and budget, and hereinafter, the
executive branch team, shall work together with Dakota and Olmsted Counties, and other
interested stakeholders, to consider the design of a pilot that tests an alternative financing
model for the distribution of publicly funded benefits in Dakota and Olmsted Counties.

Subd. 2.

Pilot project design and goals.

The goals of the pilot project are to reduce the
historical separation between the state funds and systems affecting families who are receiving
public assistance. The pilot project shall eliminate, where possible, funding restrictions to
allow a more comprehensive approach to the needs of the families in the pilot project, and
focus on upstream, prevention-oriented supports and interventions.

Subd. 3.

Executive team work.

When planning a potential pilot project, the executive
branch team must consider whether a pilot project participant:

(1) is 26 years of age or younger with a minimum of one child;

(2) voluntarily agrees to participate in the pilot project;

(3) is eligible for, applying for, or receiving public benefits including but not limited to
housing assistance, education supports, employment supports, child care, transportation
supports, medical assistance, earned income tax credit, or the child care tax credit; and

(4) is enrolled in an education program that is focused on obtaining a career that will
likely result in a livable wage.

Sec. 57. CHILD CARE CORRECTION ORDER POSTING GUIDELINES.

No later than November 1, 2017, the commissioner shall develop guidelines for posting
public licensing data for licensed child care programs. In developing the guidelines, the
commissioner shall consult with stakeholders, including licensed child care center providers,
family child care providers, and county agencies.

Sec. 58. DIRECTION TO COMMISSIONER; GROUP RESIDENTIAL HOUSING
STUDY.

Within available appropriations, the commissioner of human services shall study the
group residential housing supplementary service rates under Minnesota Statutes, section
256I.05, and make recommendations on the supplementary service rate structure to the
chairs and ranking minority members of the legislative committees with jurisdiction over
human services policy and finance by January 15, 2018.

Sec. 59. REPEALER.

(a) Minnesota Statutes 2016, sections 179A.50; 179A.51; 179A.52; and 179A.53, are
repealed.

(b) Minnesota Statutes 2016, sections 119B.16, subdivision 2; 245E.03, subdivision 3;
and 245E.06, subdivisions 4 and 5,
and Minnesota Rules, part 3400.0185, subpart 5, are
repealed effective April 23, 2018.

ARTICLE 5

HEALTH OCCUPATIONS

Section 1.

[147.033] PRACTICE OF TELEMEDICINE.

Subdivision 1.

Definition.

For the purposes of this section, "telemedicine" means the
delivery of health care services or consultations while the patient is at an originating site
and the licensed health care provider is at a distant site. A communication between licensed
health care providers that consists solely of a telephone conversation, e-mail, or facsimile
transmission does not constitute telemedicine consultations or services. A communication
between a licensed health care provider and a patient that consists solely of an e-mail or
facsimile transmission does not constitute telemedicine consultations or services.
Telemedicine may be provided by means of real-time two-way interactive audio, and visual
communications, including the application of secure video conferencing or store-and-forward
technology to provide or support health care delivery, that facilitate the assessment, diagnosis,
consultation, treatment, education, and care management of a patient's health care.

Subd. 2.

Physician-patient relationship.

A physician-patient relationship may be
established through telemedicine.

Subd. 3.

Standards of practice and conduct.

A physician providing health care services
by telemedicine in this state shall be held to the same standards of practice and conduct as
provided in this chapter for in-person health care services.

Sec. 2.

Minnesota Statutes 2016, section 148.171, subdivision 7b, is amended to read:


Subd. 7b.

Intervention Encumbered.

"Intervention" means any act or action, based
upon clinical judgment and knowledge that a nurse performs to enhance the health outcome
of a patient
"Encumbered" means (1) a license that is revoked, suspended, or contains
limitations on the full and unrestricted practice of nursing when the revocation, suspension,
or limitation is imposed by a state licensing board, or (2) a license that is voluntarily
surrendered
.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 3.

Minnesota Statutes 2016, section 148.171, is amended by adding a subdivision to
read:


Subd. 7c.

Intervention.

"Intervention" means any act or action based upon clinical
judgment and knowledge that a nurse performs to enhance the health outcome of a patient.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 4.

Minnesota Statutes 2016, section 148.211, subdivision 1a, is amended to read:


Subd. 1a.

Advanced practice registered nurse licensure.

(a) Effective January 1, 2015,
No advanced practice nurse shall practice as an advanced practice registered nurse unless
the advanced practice nurse is licensed by the board under this section.

(b) An applicant for a license to practice as an advanced practice registered nurse (APRN)
shall apply to the board in a format prescribed by the board and pay a fee in an amount
determined under section 148.243.

(c) To be eligible for licensure an applicant:

(1) must hold a current Minnesota professional nursing license or demonstrate eligibility
for licensure as a registered nurse in this state;

(2) must not hold an encumbered license as a registered nurse in any state or territory;

(3)(i) must have completed a graduate level APRN program accredited by a nursing or
nursing-related accrediting body that is recognized by the United States Secretary of
Education or the Council for Higher Education Accreditation as acceptable to the board.
The education must be in one of the four APRN roles for at least one population focus;. For
APRN programs completed on or after January 1, 2016, the program must include at least
one graduate-level course in each of the following areas: advanced physiology and
pathophysiology; advanced health assessment; and pharmacokinetics and
pharmacotherapeutics of all broad categories of agents; or

(ii) must demonstrate compliance with the advanced practice nursing educational
requirements that were in effect in Minnesota at the time the applicant completed the
advanced practice nursing education program;

(4) must be currently certified by a national certifying body recognized by the board in
the APRN role and population foci appropriate to educational preparation;

(5) must report any criminal conviction, nolo contendere plea, Alford plea, or other plea
arrangement in lieu of conviction; and

(6) must not have committed any acts or omissions which are grounds for disciplinary
action in another jurisdiction or, if these acts have been committed and would be grounds
for disciplinary action as set forth in section 148.261, the board has found, after investigation,
that sufficient restitution has been made.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 5.

Minnesota Statutes 2016, section 148.211, subdivision 1c, is amended to read:


Subd. 1c.

Postgraduate practice.

A nurse practitioner or clinical nurse specialist who
qualifies for licensure as an advanced practice registered nurse must practice for at least
2,080 hours, within the context of a collaborative agreement, within a hospital or integrated
clinical setting where advanced practice registered nurses and physicians work together to
provide patient care. The nurse practitioner or clinical nurse specialist shall submit written
evidence to the board with the application, or upon completion of the required collaborative
practice experience. For purposes of this subdivision, a collaborative agreement is a mutually
agreed upon plan for the overall working relationship between a nurse practitioner or clinical
nurse specialist, and one or more physicians licensed under chapter 147 or in another state
or United States territory
, or one or more advanced practice registered nurses licensed under
this section that designates the scope of collaboration necessary to manage the care of
patients. The nurse practitioner or clinical nurse specialist, and one of the collaborating
physicians or advanced practice registered nurses, must have experience in providing care
to patients with the same or similar medical problems.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 6.

Minnesota Statutes 2016, section 148.211, subdivision 2, is amended to read:


Subd. 2.

Licensure by endorsement.

(a) The board shall issue a license to practice
professional nursing or practical nursing without examination to an applicant who has been
duly licensed or registered as a nurse under the laws of another state, territory, or country,
if in the opinion of the board the applicant has the qualifications equivalent to the
qualifications required in this state as stated in subdivision 1, all other laws not inconsistent
with this section, and rules promulgated by the board.

(b) Effective January 1, 2015, an applicant for advanced practice registered nurse licensure
by endorsement is eligible for licensure if the applicant meets the requirements in paragraph
(a) and demonstrates:

(1) current national certification or recertification in the advanced role and population
focus area; and

(2) compliance with the advanced practice nursing educational requirements that were
in effect in Minnesota at the time the advanced practice registered nurse completed the
advanced practice nursing education program.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 7.

Minnesota Statutes 2016, section 148.881, is amended to read:


148.881 DECLARATION OF POLICY.

The practice of psychology in Minnesota affects the public health, safety, and welfare.
The regulations in sections 148.88 to 148.98 the Minnesota Psychology Practice Act as
enforced by the Board of Psychology
protect the public from the practice of psychology by
unqualified persons and from unethical or unprofessional conduct by persons licensed to
practice psychology
through licensure and regulation to promote access to safe, ethical, and
competent psychological services
.

Sec. 8.

Minnesota Statutes 2016, section 148.89, is amended to read:


148.89 DEFINITIONS.

Subdivision 1.

Applicability.

For the purposes of sections 148.88 to 148.98, the following
terms have the meanings given them.

Subd. 2.

Board of Psychology or board.

"Board of Psychology" or "board" means the
board established under section 148.90.

Subd. 2a.

Client.

"Client" means each individual or legal, religious, academic,
organizational, business, governmental, or other entity that receives, received, or should
have received, or arranged for another individual or entity to receive services from an
individual regulated under sections 148.88 to 148.98. Client also means an individual's
legally authorized representative, such as a parent or guardian. For the purposes of sections
148.88 to 148.98, "client" may include patient, resident, counselee, evaluatee, and, as limited
in the rules of conduct, student, supervisee, or research subject. In the case of dual clients,
the licensee or applicant for licensure must be aware of the responsibilities to each client,
and of the potential for divergent interests of each client
a direct recipient of psychological
services within the context of a professional relationship that may include a child, adolescent,
adult, couple, family, group, organization, community, or other entity. The client may be
the person requesting the psychological services or the direct recipient of the services
.

Subd. 2b.

Credentialed.

"Credentialed" means having a license, certificate, charter,
registration, or similar authority to practice in an occupation regulated by a governmental
board or agency.

Subd. 2c.

Designated supervisor.

"Designated supervisor" means a qualified individual
who is designated identified and assigned by the primary supervisor to provide additional
supervision and training to a licensed psychological practitioner or to an individual who is
obtaining required predegree supervised professional experience or postdegree supervised
psychological employment.

Subd. 2d.

Direct services.

"Direct services" means the delivery of preventive, diagnostic,
assessment, or therapeutic intervention services where the primary purpose is to benefit a
client who is the direct recipient of the service.

Subd. 2e.

Full-time employment.

"Full-time employment" means a minimum of 35
clock hours per week.

Subd. 3.

Independent practice.

"Independent practice" means the practice of psychology
without supervision.

Subd. 3a.

Jurisdiction.

"Jurisdiction" means the United States, United States territories,
or Canadian provinces or territories.

Subd. 4.

Licensee.

"Licensee" means a person who is licensed by the board as a licensed
psychologist or as a licensed psychological practitioner
.

Subd. 4a.

Provider or provider of services.

"Provider" or "provider of services" means
any individual who is regulated by the board, and includes a licensed psychologist, a licensed
psychological practitioner, a licensee, or an applicant
.

Subd. 4b.

Primary supervisor.

"Primary supervisor" means a psychologist licensed in
Minnesota or other qualified individual who provides the principal supervision to a licensed
psychological practitioner or
to an individual who is obtaining required predegree supervised
professional experience or postdegree supervised psychological employment.

Subd. 5.

Practice of psychology.

"Practice of psychology" means the observation,
description, evaluation, interpretation, or prediction, or modification of human behavior by
the application of psychological principles, methods, or procedures for any reason, including
to prevent, eliminate, or manage
the purpose of preventing, eliminating, evaluating, assessing,
or predicting
symptomatic, maladaptive, or undesired behavior; applying psychological
principles in legal settings;
and to enhance enhancing interpersonal relationships, work, life
and developmental adjustment, personal and organizational effectiveness, behavioral health,
and mental health. The practice of psychology includes, but is not limited to, the following
services, regardless of whether the provider receives payment for the services:

(1) psychological research and teaching of psychology subject to the exemptions in
section 148.9075
;

(2) assessment, including psychological testing and other means of evaluating personal
characteristics such as intelligence, personality, abilities, interests, aptitudes, and
neuropsychological functioning
psychological testing and the evaluation or assessment of
personal characteristics, such as intelligence, personality, cognitive, physical and emotional
abilities, skills, interests, aptitudes, and neuropsychological functioning
;

(3) a psychological report, whether written or oral, including testimony of a provider as
an expert witness, concerning the characteristics of an individual or entity
counseling,
psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy
;

(4) psychotherapy, including but not limited to, categories such as behavioral, cognitive,
emotive, systems, psychophysiological, or insight-oriented therapies; counseling; hypnosis;
and diagnosis and treatment of:

(i) mental and emotional disorder or disability;

(ii) alcohol and substance dependence or abuse;

(iii) disorders of habit or conduct;

(iv) the psychological aspects of physical illness or condition, accident, injury, or
disability, including the psychological impact of medications;

(v) life adjustment issues, including work-related and bereavement issues; and

(vi) child, family, or relationship issues

(4) diagnosis, treatment, and management of mental or emotional disorders or disabilities,
substance use disorders, disorders of habit or conduct, and the psychological aspects of
physical illness, accident, injury, or disability
;

(5) psychoeducational services and treatment psychoeducational evaluation, therapy,
and remediation
; and

(6) consultation and supervision with physicians, other health care professionals, and
clients regarding available treatment options, including medication, with respect to the
provision of care for a specific client;

(7) provision of direct services to individuals or groups for the purpose of enhancing
individual and organizational effectiveness, using psychological principles, methods, and
procedures to assess and evaluate individuals on personal characteristics for individual
development or behavior change or for making decisions about the individual; and

(8) supervision and consultation related to any of the services described in this
subdivision
.

Subd. 6.

Telesupervision.

"Telesupervision" means the clinical supervision of
psychological services through a synchronous audio and video format where the supervisor
is not physically in the same facility as the supervisee.

Sec. 9.

Minnesota Statutes 2016, section 148.90, subdivision 1, is amended to read:


Subdivision 1.

Board of Psychology.

(a) The Board of Psychology is created with the
powers and duties described in this section. The board has 11 members who consist of:

(1) three four individuals licensed as licensed psychologists who have doctoral degrees
in psychology;

(2) two individuals licensed as licensed psychologists who have master's degrees in
psychology;

(3) two psychologists, not necessarily licensed, one with a who have doctoral degree
degrees
in psychology and one with either a doctoral or master's degree in psychology
representing different training programs in psychology;

(4) one individual licensed or qualified to be licensed as: (i) through December 31, 2010,
a licensed psychological practitioner; and (ii) after December 31, 2010, a licensed
psychologist;
and

(5) (4) three public members.

(b) After the date on which fewer than 30 percent of the individuals licensed by the
board as licensed psychologists qualify for licensure under section 148.907, subdivision 3,
paragraph (b), vacancies filled under paragraph (a), clause (2), shall be filled by an individual
with either a master's or doctoral degree in psychology licensed or qualified to be licensed
as a licensed psychologist.

(c) After the date on which fewer than 15 percent of the individuals licensed by the board
as licensed psychologists qualify for licensure under section 148.907, subdivision 3,
paragraph (b), vacancies under paragraph (a), clause (2), shall be filled by an individual
with either a master's or doctoral degree in psychology licensed or qualified to be licensed
as a licensed psychologist.

Sec. 10.

Minnesota Statutes 2016, section 148.90, subdivision 2, is amended to read:


Subd. 2.

Members.

(a) The members of the board shall:

(1) be appointed by the governor;

(2) be residents of the state;

(3) serve for not more than two consecutive terms;

(4) designate the officers of the board; and

(5) administer oaths pertaining to the business of the board.

(b) A public member of the board shall represent the public interest and shall not:

(1) be a psychologist, psychological practitioner, or have engaged in the practice of
psychology;

(2) be an applicant or former applicant for licensure;

(3) be a member of another health profession and be licensed by a health-related licensing
board as defined under section 214.01, subdivision 2; the commissioner of health; or licensed,
certified, or registered by another jurisdiction
;

(4) be a member of a household that includes a psychologist or psychological practitioner;
or

(5) have conflicts of interest or the appearance of conflicts with duties as a board member.

Sec. 11.

Minnesota Statutes 2016, section 148.905, subdivision 1, is amended to read:


Subdivision 1.

General.

The board shall:

(1) adopt and enforce rules for licensing psychologists and psychological practitioners
and for regulating their professional conduct;

(2) adopt and enforce rules of conduct governing the practice of psychology;

(3) adopt and implement rules for examinations which shall be held at least once a year
to assess applicants' knowledge and skills. The examinations may be written or oral or both,
and may be administered by the board or by institutions or individuals designated by the
board;. Before the adoption and implementation of a new national examination, the board
must consider whether the examination:

(i) demonstrates reasonable reliability and external validity;

(ii) is normed on a reasonable representative and diverse national sample; and

(iii) is intended to assess an applicant's education, training, and experience for the purpose
of public protection;

(4) issue licenses to individuals qualified under sections 148.907 and 148.908, 148.909,
148.915, and 148.916
, according to the procedures for licensing in Minnesota Rules;

(5) issue copies of the rules for licensing to all applicants;

(6) establish and maintain annually a register of current licenses;

(7) establish and collect fees for the issuance and renewal of licenses and other services
by the board. Fees shall be set to defray the cost of administering the provisions of sections
148.88 to 148.98 including costs for applications, examinations, enforcement, materials,
and the operations of the board;

(8) educate the public about on the requirements for licensing of psychologists and of
psychological practitioners
licenses issued by the board and about on the rules of conduct,
to
;

(9) enable the public to file complaints against applicants or licensees who may have
violated the Psychology Practice Act; and

(9) (10) adopt and implement requirements for continuing education; and

(11) establish or approve programs that qualify for professional psychology continuing
educational credit. The board may hire consultants, agencies, or professional psychological
associations to establish and approve continuing education courses.

Sec. 12.

Minnesota Statutes 2016, section 148.907, subdivision 1, is amended to read:


Subdivision 1.

Effective date.

After August 1, 1991, No person shall engage in the
independent practice of psychology unless that person is licensed as a licensed psychologist
or is exempt under section 148.9075
.

Sec. 13.

Minnesota Statutes 2016, section 148.907, subdivision 2, is amended to read:


Subd. 2.

Requirements for licensure as licensed psychologist.

To become licensed
by the board as a licensed psychologist, an applicant shall comply with the following
requirements:

(1) pass an examination in psychology;

(2) pass a professional responsibility examination on the practice of psychology;

(3) pass any other examinations as required by board rules;

(4) pay nonrefundable fees to the board for applications, processing, testing, renewals,
and materials;

(5) have attained the age of majority, be of good moral character, and have no unresolved
disciplinary action or complaints pending in the state of Minnesota or any other jurisdiction;

(6) have earned a doctoral degree with a major in psychology from a regionally accredited
educational institution meeting the standards the board has established by rule; and

(7) have completed at least one full year or the equivalent in part time of postdoctoral
supervised psychological employment in no less than 12 months and no more than 60
months. If the postdoctoral supervised psychological employment goes beyond 60 months,
the board may grant a variance to this requirement
.

Sec. 14.

[148.9075] EXEMPTIONS TO LICENSE REQUIREMENT.

Subdivision 1.

General.

(a) Nothing in sections 148.88 to 148.98 shall prevent members
of other professions or occupations from performing functions for which they are competent
and properly authorized by law. The following individuals are exempt from the licensure
requirements of the Minnesota Psychology Practice Act, provided they operate in compliance
with the stated exemption:

(1) individuals licensed by a health-related licensing board as defined under section
214.01, subdivision 2, or by the commissioner of health;

(2) individuals authorized as mental health practitioners as defined under section 245.462,
subdivision 17; and

(3) individuals authorized as mental health professionals under section 245.462,
subdivision 18.

(b) Any of these individuals must not hold themselves out to the public by any title or
description stating or implying they are licensed to engage in the practice of psychology
unless they are licensed under sections 148.88 to 148.98 or are using a title in compliance
with section 148.96.

Subd. 2.

Business or industrial organization.

Nothing in sections 148.88 to 148.98
shall prevent the use of psychological techniques by a business or industrial organization
for its own personnel purposes or by an employment agency or state vocational rehabilitation
agency for the evaluation of the agency's clients prior to a recommendation for employment.
However, a representative of an industrial or business firm or corporation may not sell,
offer, or provide psychological services as specified in section 148.89, unless the services
are performed or supervised by an individual licensed under sections 148.88 to 148.98.

Subd. 3.

School psychologist.

(a) Nothing in sections 148.88 to 148.98 shall be construed
to prevent a person who holds a license or certificate issued by the State Board of Teaching
in accordance with chapters 122A and 129 from practicing school psychology within the
scope of employment if authorized by a board of education or by a private school that meets
the standards prescribed by the State Board of Teaching, or from practicing as a school
psychologist within the scope of employment in a program for children with disabilities.

(b) Any person exempted under this subdivision shall not offer psychological services
to any other individual, organization, or group for remuneration, monetary or otherwise,
unless the person is licensed by the Board of Psychology under sections 148.88 to 148.98.

Subd. 4.

Clergy or religious officials.

Nothing in sections 148.88 to 148.98 shall be
construed to prevent recognized religious officials, including ministers, priests, rabbis,
imams, Christian Science practitioners, and other persons recognized by the board, from
conducting counseling activities that are within the scope of the performance of their regular
recognizable religious denomination or sect, as defined in current federal tax regulations,
if the religious official does not refer to the official's self as a psychologist and the official
remains accountable to the established authority of the religious denomination or sect.

Subd. 5.

Teaching and research.

Nothing in sections 148.88 to 148.98 shall be construed
to prevent a person employed in a secondary, postsecondary, or graduate institution from
teaching and conducting research in psychology within an educational institution that is
recognized by a regional accrediting organization or by a federal, state, county, or local
government institution, agency, or research facility, so long as:

(1) the institution, agency, or facility provides appropriate oversight mechanisms to
ensure public protections; and

(2) the person is not providing direct clinical services to a client or clients as defined in
sections 148.88 to 148.98.

Subd. 6.

Psychologist in disaster or emergency relief.

Nothing in sections 148.88 to
148.98 shall be construed to prevent a psychologist sent to this state for the sole purpose of
responding to a disaster or emergency relief effort of the state government, the federal
government, the American Red Cross, or other disaster or emergency relief organization as
long as the psychologist is not practicing in Minnesota longer than 30 days and the sponsoring
organization can certify the psychologist's assignment to this state. The board or its designee,
at its discretion, may grant an extension to the 30-day time limitation of this subdivision.

Subd. 7.

Psychological consultant.

A license under sections 148.88 to 148.98 is not
required by a nonresident of the state, serving as an expert witness, organizational consultant,
presenter, or educator on a limited basis provided the person is appropriately trained,
educated, or has been issued a license, certificate, or registration by another jurisdiction.

Subd. 8.

Students.

Nothing in sections 148.88 to 148.98 shall prohibit the practice of
psychology under qualified supervision by a practicum psychology student, a predoctoral
psychology intern, or an individual who has earned a doctoral degree in psychology and is
in the process of completing their postdoctoral supervised psychological employment. A
student trainee or intern shall use the titles as required under section 148.96, subdivision 3.

Subd. 9.

Other professions.

Nothing in sections 148.88 to 148.98 shall be construed to
authorize a person licensed under sections 148.88 to 148.98 to engage in the practice of any
profession regulated under Minnesota law, unless the individual is duly licensed or registered
in that profession.

Sec. 15.

[148.9077] RELICENSURE.

A former licensee may apply to the board for licensure after complying with all laws
and rules required for applicants for licensure that were in effect on the date the initial
Minnesota license was granted. The former licensee must verify to the board that the former
licensee has not engaged in the practice of psychology in this state since the last date of
active licensure, except as permitted under statutory licensure exemption, and must submit
a fee for relicensure.

Sec. 16.

Minnesota Statutes 2016, section 148.9105, subdivision 1, is amended to read:


Subdivision 1.

Application.

Retired providers who are licensed or were formerly licensed
to practice psychology in the state according to the Minnesota Psychology Practice Act may
apply to the board for psychologist emeritus registration or psychological practitioner
emeritus registration
if they declare that they are retired from the practice of psychology in
Minnesota, have not been the subject of disciplinary action in any jurisdiction, and have no
unresolved complaints in any jurisdiction. Retired providers shall complete the necessary
forms provided by the board and pay a onetime, nonrefundable fee of $150 at the time of
application.

Sec. 17.

Minnesota Statutes 2016, section 148.9105, subdivision 4, is amended to read:


Subd. 4.

Documentation of status.

A provider granted emeritus registration shall receive
a document certifying that emeritus status has been granted by the board and that the
registrant has completed the registrant's active career as a psychologist or psychological
practitioner
licensed in good standing with the board.

Sec. 18.

Minnesota Statutes 2016, section 148.9105, subdivision 5, is amended to read:


Subd. 5.

Representation to public.

In addition to the descriptions allowed in section
148.96, subdivision 3, paragraph (e), former licensees who have been granted emeritus
registration may represent themselves as "psychologist emeritus" or "psychological
practitioner emeritus,"
but shall not represent themselves or allow themselves to be
represented to the public as "licensed" or otherwise as current licensees of the board.

Sec. 19.

Minnesota Statutes 2016, section 148.916, subdivision 1, is amended to read:


Subdivision 1.

Generally.

If (a) A nonresident of the state of Minnesota, who is not
seeking licensure in this state, and who has been issued a license, certificate, or registration
by another jurisdiction to practice psychology at the doctoral level, wishes and who intends
to practice in Minnesota for more than seven calendar 30 days, the person shall apply to the
board for guest licensure, provided that. The psychologist's practice in Minnesota is limited
to no more than nine consecutive months per calendar year. Application under this section
shall be made no less than 30 days prior to the expected date of practice in Minnesota and
shall be subject to approval by the board or its designee. The board shall charge a
nonrefundable fee for guest licensure. The board shall adopt rules to implement this section.

(b) To be eligible for licensure under this section, the applicant must:

(1) have a license, certification, or registration to practice psychology from another
jurisdiction;

(2) have a doctoral degree in psychology from a regionally accredited institution;

(3) be of good moral character;

(4) have no pending complaints or active disciplinary or corrective actions in any
jurisdiction;

(5) pass a professional responsibility examination designated by the board; and

(6) pay a fee to the board.

Sec. 20.

Minnesota Statutes 2016, section 148.916, subdivision 1a, is amended to read:


Subd. 1a.

Applicants for licensure.

(a) An applicant who is seeking licensure in this
state, and who, at the time of application, is licensed, certified, or registered to practice
psychology in another jurisdiction at the doctoral level may apply to the board for guest
licensure in order to begin practicing psychology in this state while their application is being
processed if the applicant is of good moral character and has no complaints, corrective, or
disciplinary action pending in any jurisdiction.

(b) Application under this section subdivision shall be made no less than 30 days prior
to the expected date of practice in this state, and must be made concurrently or after
submission of an application for licensure as a licensed psychologist if applicable.
Applications under this section subdivision are subject to approval by the board or its
designee. The board shall charge a fee for guest licensure under this subdivision.

(b) The board shall charge a nonrefundable fee for guest licensure under this subdivision.

(c) A guest license issued under this subdivision shall be valid for one year from the
date of issuance, or until the board has either issued a license or has denied the applicant's
application for licensure, whichever is earlier. Guest licenses issued under this section
subdivision
may be renewed annually until the board has denied the applicant's application
for licensure.

Sec. 21.

Minnesota Statutes 2016, section 148.925, is amended to read:


148.925 SUPERVISION.

Subdivision 1.

Supervision.

For the purpose of meeting the requirements of this section
the Minnesota Psychology Practice Act
, supervision means documented in-person
consultation, which may include interactive, visual electronic communication, between
either: (1) a primary supervisor and a licensed psychological practitioner; or (2) a
that
employs a collaborative relationship that has both facilitative and evaluative components
with the goal of enhancing the professional competence and science, and practice-informed
professional work of the supervisee. Supervision may include telesupervision between
primary or designated supervisor supervisors and an applicant for licensure as a licensed
psychologist
the supervisee. The supervision shall be adequate to assure the quality and
competence of the activities supervised. Supervisory consultation shall include discussions
on the nature and content of the practice of the supervisee, including, but not limited to, a
review of a representative sample of psychological services in the supervisee's practice.

Subd. 2.

Postdegree supervised psychological employment.

Postdegree supervised
psychological employment means required paid or volunteer work experience and postdegree
training of an individual seeking to be licensed as a licensed psychologist that involves the
professional oversight by a primary supervisor and satisfies the supervision requirements
in subdivisions 3 and 5 the Minnesota Psychology Practice Act.

Subd. 3.

Individuals qualified to provide supervision.

(a) Supervision of a master's
level applicant for licensure as a licensed psychologist shall be provided by an individual:

(1) who is a psychologist licensed in Minnesota with competence both in supervision
in the practice of psychology and in the activities being supervised;

(2) who has a doctoral degree with a major in psychology, who is employed by a
regionally accredited educational institution or employed by a federal, state, county, or local
government institution, agency, or research facility, and who has competence both in
supervision in the practice of psychology and in the activities being supervised, provided
the supervision is being provided and the activities being supervised occur within that
regionally accredited educational institution or federal, state, county, or local government
institution, agency, or research facility;

(3) who is licensed or certified as a psychologist in another jurisdiction and who has
competence both in supervision in the practice of psychology and in the activities being
supervised; or

(4) who, in the case of a designated supervisor, is a master's or doctorally prepared
mental health professional.

(b) Supervision of a doctoral level an applicant for licensure as a licensed psychologist
shall be provided by an individual:

(1) who is a psychologist licensed in Minnesota with a doctoral degree and competence
both in supervision in the practice of psychology and in the activities being supervised;

(2) who has a doctoral degree with a major in psychology, who is employed by a
regionally accredited educational institution or is employed by a federal, state, county, or
local government institution, agency, or research facility, and who has competence both in
supervision in the practice of psychology and in the activities being supervised, provided
the supervision is being provided and the activities being supervised occur within that
regionally accredited educational institution or federal, state, county, or local government
institution, agency, or research facility;

(3) who is licensed or certified as a psychologist in another jurisdiction and who has
competence both in supervision in the practice of psychology and in the activities being
supervised;

(4) who is a psychologist licensed in Minnesota who was licensed before August 1,
1991, with competence both in supervision in the practice of psychology and in the activities
being supervised; or

(5) who, in the case of a designated supervisor, is a master's or doctorally prepared
mental health professional.

Subd. 4.

Supervisory consultation for a licensed psychological practitioner.

Supervisory consultation between a supervising licensed psychologist and a supervised
licensed psychological practitioner shall be at least one hour in duration and shall occur on
an individual, in-person basis. A minimum of one hour of supervision per month is required
for the initial 20 or fewer hours of psychological services delivered per month. For each
additional 20 hours of psychological services delivered per month, an additional hour of
supervision per month is required. When more than 20 hours of psychological services are
provided in a week, no more than one hour of supervision is required per week.

Subd. 5.

Supervisory consultation for an applicant for licensure as a licensed
psychologist.

Supervision of an applicant for licensure as a licensed psychologist shall
include at least two hours of regularly scheduled in-person consultations per week for
full-time employment, one hour of which shall be with the supervisor on an individual basis.
The remaining hour may be with a designated supervisor. The board may approve an
exception to the weekly supervision requirement for a week when the supervisor was ill or
otherwise unable to provide supervision. The board may prorate the two hours per week of
supervision for individuals preparing for licensure on a part-time basis. Supervised
psychological employment does not qualify for licensure when the supervisory consultation
is not adequate as described in subdivision 1, or in the board rules.

Subd. 6.

Supervisee duties.

Individuals Applicants preparing for licensure as a licensed
psychologist during their postdegree supervised psychological employment may perform
as part of their training any functions of the services specified in section 148.89, subdivision
5
, but only under qualified supervision.

Subd. 7.

Variance from supervision requirements.

(a) An applicant for licensure as
a licensed psychologist who entered supervised employment before August 1, 1991, may
request a variance from the board from the supervision requirements in this section in order
to continue supervision under the board rules in effect before August 1, 1991.

(b) After a licensed psychological practitioner has completed two full years, or the
equivalent, of supervised post-master's degree employment meeting the requirements of
subdivision 5 as it relates to preparation for licensure as a licensed psychologist, the board
shall grant a variance from the supervision requirements of subdivision 4 or 5 if the licensed
psychological practitioner presents evidence of:

(1) endorsement for specific areas of competency by the licensed psychologist who
provided the two years of supervision;

(2) employment by a hospital or by a community mental health center or nonprofit mental
health clinic or social service agency providing services as a part of the mental health service
plan required by the Comprehensive Mental Health Act;

(3) the employer's acceptance of clinical responsibility for the care provided by the
licensed psychological practitioner; and

(4) a plan for supervision that includes at least one hour of regularly scheduled individual
in-person consultations per week for full-time employment. The board may approve an
exception to the weekly supervision requirement for a week when the supervisor was ill or
otherwise unable to provide supervision.

(c) Following the granting of a variance under paragraph (b), and completion of two
additional full years or the equivalent of supervision and post-master's degree employment
meeting the requirements of paragraph (b), the board shall grant a variance to a licensed
psychological practitioner who presents evidence of:

(1) endorsement for specific areas of competency by the licensed psychologist who
provided the two years of supervision under paragraph (b);

(2) employment by a hospital or by a community mental health center or nonprofit mental
health clinic or social service agency providing services as a part of the mental health service
plan required by the Comprehensive Mental Health Act;

(3) the employer's acceptance of clinical responsibility for the care provided by the
licensed psychological practitioner; and

(4) a plan for supervision which includes at least one hour of regularly scheduled
individual in-person supervision per month.

(d) The variance allowed under this section must be deemed to have been granted to an
individual who previously received a variance under paragraph (b) or (c) and is seeking a
new variance because of a change of employment to a different employer or employment
setting. The deemed variance continues until the board either grants or denies the variance.
An individual who has been denied a variance under this section is entitled to seek
reconsideration by the board.

Sec. 22.

Minnesota Statutes 2016, section 148.96, subdivision 3, is amended to read:


Subd. 3.

Requirements for representations to public.

(a) Unless licensed under sections
148.88 to 148.98, except as provided in paragraphs (b) through (e), persons shall not represent
themselves or permit themselves to be represented to the public by:

(1) using any title or description of services incorporating the words "psychology,"
"psychological," "psychological practitioner," or "psychologist"; or

(2) representing that the person has expert qualifications in an area of psychology.

(b) Psychologically trained individuals who are employed by an educational institution
recognized by a regional accrediting organization, by a federal, state, county, or local
government institution, agency, or research facility, may represent themselves by the title
designated by that organization provided that the title does not indicate that the individual
is credentialed by the board.

(c) A psychologically trained individual from an institution described in paragraph (b)
may offer lecture services and is exempt from the provisions of this section.

(d) A person who is preparing for the practice of psychology under supervision in
accordance with board statutes and rules may be designated as a "psychological intern,"
"psychology fellow," "psychological trainee," or by other terms clearly describing the
person's training status.

(e) Former licensees who are completely retired from the practice of psychology may
represent themselves using the descriptions in paragraph (a), clauses (1) and (2), but shall
not represent themselves or allow themselves to be represented as current licensees of the
board.

(f) Nothing in this section shall be construed to prohibit the practice of school psychology
by a person licensed in accordance with chapters 122A and 129.

Sec. 23.

Minnesota Statutes 2016, section 148B.53, subdivision 1, is amended to read:


Subdivision 1.

General requirements.

(a) To be licensed as a licensed professional
counselor (LPC), an applicant must provide evidence satisfactory to the board that the
applicant:

(1) is at least 18 years of age;

(2) is of good moral character;

(3) has completed a master's or doctoral degree program in counseling or a related field,
as determined by the board based on the criteria in paragraph (b), that includes a minimum
of 48 semester hours or 72 quarter hours and a supervised field experience of not fewer than
700 hours that is counseling in nature;

(4) has submitted to the board a plan for supervision during the first 2,000 hours of
professional practice or has submitted proof of supervised professional practice that is
acceptable to the board; and

(5) has demonstrated competence in professional counseling by passing the National
Counseling Exam (NCE) administered by the National Board for Certified Counselors, Inc.
(NBCC) or an equivalent national examination as determined by the board, and ethical,
oral, and situational examinations if prescribed by the board.

(b) The degree described in paragraph (a), clause (3), must be from a counseling program
recognized by the Council for Accreditation of Counseling and Related Education Programs
(CACREP) or from an institution of higher education that is accredited by a regional
accrediting organization recognized by the Council for Higher Education Accreditation
(CHEA). Specific academic course content and training must include course work in each
of the following subject areas:

(1) the helping relationship, including counseling theory and practice;

(2) human growth and development;

(3) lifestyle and career development;

(4) group dynamics, processes, counseling, and consulting;

(5) assessment and appraisal;

(6) social and cultural foundations, including multicultural issues;

(7) principles of etiology, treatment planning, and prevention of mental and emotional
disorders and dysfunctional behavior;

(8) family counseling and therapy;

(9) research and evaluation; and

(10) professional counseling orientation and ethics.

(c) To be licensed as a professional counselor, a psychological practitioner licensed
under section 148.908 need only show evidence of licensure under that section and is not
required to comply with paragraph (a), clauses (1) to (3) and (5), or paragraph (b).

(d) (c) To be licensed as a professional counselor, a Minnesota licensed psychologist
need only show evidence of licensure from the Minnesota Board of Psychology and is not
required to comply with paragraph (a) or (b).

Sec. 24.

Minnesota Statutes 2016, section 150A.06, subdivision 3, is amended to read:


Subd. 3.

Waiver of examination.

(a) All or any part of the examination for dentists or,
dental therapists,
dental hygienists, or dental assistants, except that pertaining to the law of
Minnesota relating to dentistry and the rules of the board, may, at the discretion of the board,
be waived for an applicant who presents a certificate of having passed all components of
the National Board Dental Examinations or evidence of having maintained an adequate
scholastic standing as determined by the board, in dental school as to dentists, or dental
hygiene school as to dental hygienists
.

(b) The board shall waive the clinical examination required for licensure for any dentist
applicant who is a graduate of a dental school accredited by the Commission on Dental
Accreditation, who has passed all components of the National Board Dental Examinations,
and who has satisfactorily completed a Minnesota-based postdoctoral general dentistry
residency program (GPR) or an advanced education in general dentistry (AEGD) program
after January 1, 2004. The postdoctoral program must be accredited by the Commission on
Dental Accreditation, be of at least one year's duration, and include an outcome assessment
evaluation assessing the resident's competence to practice dentistry. The board may require
the applicant to submit any information deemed necessary by the board to determine whether
the waiver is applicable.

Sec. 25.

Minnesota Statutes 2016, section 150A.06, subdivision 8, is amended to read:


Subd. 8.

Licensure by credentials.

(a) Any dental assistant may, upon application and
payment of a fee established by the board, apply for licensure based on an evaluation of the
applicant's education, experience, and performance record in lieu of completing a
board-approved dental assisting program for expanded functions as defined in rule, and
may be interviewed by the board to determine if the applicant:

(1) has graduated from an accredited dental assisting program accredited by the
Commission on Dental Accreditation, or and is currently certified by the Dental Assisting
National Board;

(2) is not subject to any pending or final disciplinary action in another state or Canadian
province, or if not currently certified or registered, previously had a certification or
registration in another state or Canadian province in good standing that was not subject to
any final or pending disciplinary action at the time of surrender;

(3) is of good moral character and abides by professional ethical conduct requirements;

(4) at board discretion, has passed a board-approved English proficiency test if English
is not the applicant's primary language; and

(5) has met all expanded functions curriculum equivalency requirements of a Minnesota
board-approved dental assisting program.

(b) The board, at its discretion, may waive specific licensure requirements in paragraph
(a).

(c) An applicant who fulfills the conditions of this subdivision and demonstrates the
minimum knowledge in dental subjects required for licensure under subdivision 2a must
be licensed to practice the applicant's profession.

(d) If the applicant does not demonstrate the minimum knowledge in dental subjects
required for licensure under subdivision 2a, the application must be denied. If licensure is
denied, the board may notify the applicant of any specific remedy that the applicant could
take which, when passed, would qualify the applicant for licensure. A denial does not
prohibit the applicant from applying for licensure under subdivision 2a.

(e) A candidate whose application has been denied may appeal the decision to the board
according to subdivision 4a.

Sec. 26.

Minnesota Statutes 2016, section 150A.10, subdivision 4, is amended to read:


Subd. 4.

Restorative procedures.

(a) Notwithstanding subdivisions 1, 1a, and 2, a
licensed dental hygienist or licensed dental assistant may perform the following restorative
procedures:

(1) place, contour, and adjust amalgam restorations;

(2) place, contour, and adjust glass ionomer;

(3) adapt and cement stainless steel crowns; and

(4) place, contour, and adjust class I and class V supragingival composite restorations
where the margins are entirely within the enamel; and

(5) (4) place, contour, and adjust class I, II, and class V supragingival composite
restorations on primary teeth and permanent dentition.

(b) The restorative procedures described in paragraph (a) may be performed only if:

(1) the licensed dental hygienist or licensed dental assistant has completed a
board-approved course on the specific procedures;

(2) the board-approved course includes a component that sufficiently prepares the licensed
dental hygienist or licensed dental assistant to adjust the occlusion on the newly placed
restoration;

(3) a licensed dentist or licensed advanced dental therapist has authorized the procedure
to be performed; and

(4) a licensed dentist or licensed advanced dental therapist is available in the clinic while
the procedure is being performed.

(c) The dental faculty who teaches the educators of the board-approved courses specified
in paragraph (b) must have prior experience teaching these procedures in an accredited
dental education program.

Sec. 27.

[181.987] HEALTH CARE PRACTITIONER RESTRICTIVE COVENANTS
VOID.

Subdivision 1.

Health care practitioner.

For the purposes of this section, "health care
practitioner" means a physician licensed under chapter 147, a physician assistant licensed
under chapter 147A and acting within the authorized scope of practice, or an advanced
practice registered nurse licensed under sections 148.171 to 148.285.

Subd. 2.

Health care practitioner restrictive covenants.

Any contract by which a
health care practitioner is restrained from engaging in a lawful profession, trade, or business
of any kind, within Wabasha County, is to that extent void and unenforceable.

EFFECTIVE DATE.

This section is effective the day following final enactment and
applies to a contract in effect on, or entered into on or after, that date.

Sec. 28. REVISOR'S INSTRUCTION.

The revisor of statutes shall change the headnote of Minnesota Statutes, section 147.0375,
to read "LICENSURE OF EMINENT PHYSICIANS."

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 29. REPEALER.

Minnesota Statutes 2016, sections 147.0375, subdivision 7; 148.211, subdivision 1b;
148.243, subdivision 15; 148.906; 148.907, subdivision 5; 148.908; 148.909, subdivision
7; and 148.96, subdivisions 4 and 5,
are repealed.

EFFECTIVE DATE.

This section is effective the day following final enactment.

ARTICLE 6

CHEMICAL AND MENTAL HEALTH

Section 1.

Minnesota Statutes 2016, section 245.462, subdivision 9, is amended to read:


Subd. 9.

Diagnostic assessment.

(a) "Diagnostic assessment" means a written summary
of the history, diagnosis, strengths, vulnerabilities, and general service needs of an adult
with a mental illness using diagnostic, interview, and other relevant mental health techniques
provided by a mental health professional used in developing an individual treatment plan
or individual community support plan
standard, extended, or brief diagnostic assessment,
or an adult update, and has the meaning given in Minnesota Rules, part 9505.0370, subpart
11, and is delivered as provided in Minnesota Rules, part 9505.0372, subpart 1, items A,
B, C, and E
.

(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:

(1) age;

(2) description of symptoms, including reason for referral;

(3) history of mental health treatment;

(4) cultural influences and their impact on the client; and

(5) mental status examination.

(c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.

(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.

(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.

(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three.

(g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.

Sec. 2.

Minnesota Statutes 2016, section 245.4871, is amended by adding a subdivision
to read:


Subd. 11a.

Diagnostic assessment.

(a) "Diagnostic assessment" means a standard,
extended, or brief diagnostic assessment, or an adult update, and has the meaning given in
Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E.

(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:

(1) age;

(2) description of symptoms, including reason for referral;

(3) history of mental health treatment;

(4) cultural influences and their impact on the client; and

(5) mental status examination.

(c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.

(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.

(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.

(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three.

(g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.

Sec. 3.

Minnesota Statutes 2016, section 245.4876, subdivision 2, is amended to read:


Subd. 2.

Diagnostic assessment.

All residential treatment facilities and acute care
hospital inpatient treatment facilities that provide mental health services for children must
complete a diagnostic assessment for each of their child clients within five working days
of admission. Providers of outpatient and day treatment services for children must complete
a diagnostic assessment within five days after the child's second visit or 30 days after intake,
whichever occurs first. In cases where a diagnostic assessment is available and has been
completed within 180 days preceding admission, only updating is necessary. "Updating"
means a written summary by a mental health professional of the child's current mental health
status and service needs. If the child's mental health status has changed markedly since the
child's most recent diagnostic assessment, a new diagnostic assessment is required.
Compliance with the provisions of this subdivision does not ensure eligibility for medical
assistance reimbursement under chapter 256B.

Sec. 4.

Minnesota Statutes 2016, section 245A.03, subdivision 2, is amended to read:


Subd. 2.

Exclusion from licensure.

(a) This chapter does not apply to:

(1) residential or nonresidential programs that are provided to a person by an individual
who is related unless the residential program is a child foster care placement made by a
local social services agency or a licensed child-placing agency, except as provided in
subdivision 2a;

(2) nonresidential programs that are provided by an unrelated individual to persons from
a single related family;

(3) residential or nonresidential programs that are provided to adults who do not abuse
chemicals or who do not have a chemical dependency, a mental illness, a developmental
disability, a functional impairment, or a physical disability;

(4) sheltered workshops or work activity programs that are certified by the commissioner
of employment and economic development;

(5) programs operated by a public school for children 33 months or older;

(6) nonresidential programs primarily for children that provide care or supervision for
periods of less than three hours a day while the child's parent or legal guardian is in the
same building as the nonresidential program or present within another building that is
directly contiguous to the building in which the nonresidential program is located;

(7) nursing homes or hospitals licensed by the commissioner of health except as specified
under section 245A.02;

(8) board and lodge facilities licensed by the commissioner of health that do not provide
children's residential services under Minnesota Rules, chapter 2960, mental health or chemical
dependency treatment;

(9) homes providing programs for persons placed by a county or a licensed agency for
legal adoption, unless the adoption is not completed within two years;

(10) programs licensed by the commissioner of corrections;

(11) recreation programs for children or adults that are operated or approved by a park
and recreation board whose primary purpose is to provide social and recreational activities;

(12) programs operated by a school as defined in section 120A.22, subdivision 4; YMCA
as defined in section 315.44; YWCA as defined in section 315.44; or JCC as defined in
section 315.51, whose primary purpose is to provide child care or services to school-age
children;

(13) Head Start nonresidential programs which operate for less than 45 days in each
calendar year;

(14) noncertified boarding care homes unless they provide services for five or more
persons whose primary diagnosis is mental illness or a developmental disability;

(15) programs for children such as scouting, boys clubs, girls clubs, and sports and art
programs, and nonresidential programs for children provided for a cumulative total of less
than 30 days in any 12-month period;

(16) residential programs for persons with mental illness, that are located in hospitals;

(17) the religious instruction of school-age children; Sabbath or Sunday schools; or the
congregate care of children by a church, congregation, or religious society during the period
used by the church, congregation, or religious society for its regular worship;

(18) camps licensed by the commissioner of health under Minnesota Rules, chapter
4630;

(19) mental health outpatient services for adults with mental illness or children with
emotional disturbance;

(20) residential programs serving school-age children whose sole purpose is cultural or
educational exchange, until the commissioner adopts appropriate rules;

(21) community support services programs as defined in section 245.462, subdivision
6
, and family community support services as defined in section 245.4871, subdivision 17;

(22) the placement of a child by a birth parent or legal guardian in a preadoptive home
for purposes of adoption as authorized by section 259.47;

(23) settings registered under chapter 144D which provide home care services licensed
by the commissioner of health to fewer than seven adults;

(24) chemical dependency or substance abuse treatment activities of licensed professionals
in private practice as defined in Minnesota Rules, part 9530.6405, subpart 15, when the
treatment activities are not paid for by the consolidated chemical dependency treatment
fund
;

(25) consumer-directed community support service funded under the Medicaid waiver
for persons with developmental disabilities when the individual who provided the service
is:

(i) the same individual who is the direct payee of these specific waiver funds or paid by
a fiscal agent, fiscal intermediary, or employer of record; and

(ii) not otherwise under the control of a residential or nonresidential program that is
required to be licensed under this chapter when providing the service;

(26) a program serving only children who are age 33 months or older, that is operated
by a nonpublic school, for no more than four hours per day per child, with no more than 20
children at any one time, and that is accredited by:

(i) an accrediting agency that is formally recognized by the commissioner of education
as a nonpublic school accrediting organization; or

(ii) an accrediting agency that requires background studies and that receives and
investigates complaints about the services provided.

A program that asserts its exemption from licensure under item (ii) shall, upon request
from the commissioner, provide the commissioner with documentation from the accrediting
agency that verifies: that the accreditation is current; that the accrediting agency investigates
complaints about services; and that the accrediting agency's standards require background
studies on all people providing direct contact services; or

(27) a program operated by a nonprofit organization incorporated in Minnesota or another
state that serves youth in kindergarten through grade 12; provides structured, supervised
youth development activities; and has learning opportunities take place before or after
school, on weekends, or during the summer or other seasonal breaks in the school calendar.
A program exempt under this clause is not eligible for child care assistance under chapter
119B. A program exempt under this clause must:

(i) have a director or supervisor on site who is responsible for overseeing written policies
relating to the management and control of the daily activities of the program, ensuring the
health and safety of program participants, and supervising staff and volunteers;

(ii) have obtained written consent from a parent or legal guardian for each youth
participating in activities at the site; and

(iii) have provided written notice to a parent or legal guardian for each youth at the site
that the program is not licensed or supervised by the state of Minnesota and is not eligible
to receive child care assistance payments.;

(28) a county that is an eligible vendor under section 254B.05 to provide care coordination
and comprehensive assessment services; or

(29) a recovery community organization that is an eligible vendor under section 254B.05
to provide peer recovery support services.

(b) For purposes of paragraph (a), clause (6), a building is directly contiguous to a
building in which a nonresidential program is located if it shares a common wall with the
building in which the nonresidential program is located or is attached to that building by
skyway, tunnel, atrium, or common roof.

(c) Except for the home and community-based services identified in section 245D.03,
subdivision 1
, nothing in this chapter shall be construed to require licensure for any services
provided and funded according to an approved federal waiver plan where licensure is
specifically identified as not being a condition for the services and funding.

Sec. 5.

Minnesota Statutes 2016, section 245A.191, is amended to read:


245A.191 PROVIDER ELIGIBILITY FOR PAYMENTS FROM THE CHEMICAL
DEPENDENCY CONSOLIDATED TREATMENT FUND.

(a) When a chemical dependency treatment provider licensed under Minnesota Rules,
parts 2960.0430 to 2960.0490 or 9530.6405 to 9530.6505, agrees to meet the applicable
requirements under section 254B.05, subdivision 5, paragraphs (b), clauses (1) to (4) (8)
and (6) (10), (c), and (e), to be eligible for enhanced funding from the chemical dependency
consolidated treatment fund, the applicable requirements under section 254B.05 are also
licensing requirements that may be monitored for compliance through licensing investigations
and licensing inspections.

(b) Noncompliance with the requirements identified under paragraph (a) may result in:

(1) a correction order or a conditional license under section 245A.06, or sanctions under
section 245A.07;

(2) nonpayment of claims submitted by the license holder for public program
reimbursement;

(3) recovery of payments made for the service;

(4) disenrollment in the public payment program; or

(5) other administrative, civil, or criminal penalties as provided by law.

Sec. 6.

Minnesota Statutes 2016, section 254A.03, subdivision 3, is amended to read:


Subd. 3.

Rules for chemical dependency care.

(a) The commissioner of human services
shall establish by rule criteria to be used in determining the appropriate level of chemical
dependency care for each recipient of public assistance seeking treatment for alcohol or
other drug dependency and abuse problems.

(b) Notwithstanding the criteria in Minnesota Rules, parts 9530.6600 to 9530.6655, upon
federal approval of comprehensive assessment as a Medicaid benefit, an eligible vendor of
comprehensive assessments under section 254A.19 may determine and approve the
appropriate level of substance use disorder treatment for a recipient of public assistance
who is seeking treatment. The commissioner shall develop and implement a utilization
review process for publicly funded treatment placements to monitor and review the clinical
appropriateness and timeliness of all publicly funded placements in treatment.

(c) The process for determining an individual's financial eligibility for the consolidated
chemical dependency treatment fund or determining an individual's enrollment in or eligibility
for a publicly subsidized health plan is not affected by the individual's choice to access a
comprehensive assessment by a vendor for approval of treatment.

Sec. 7.

Minnesota Statutes 2016, section 254A.08, subdivision 2, is amended to read:


Subd. 2.

Program requirements.

For the purpose of this section, a detoxification
program means a social rehabilitation program licensed by the commissioner under Minnesota
Rules, parts 9530.6510 to 9530.6590, and
established for the purpose of facilitating access
into care and treatment by detoxifying and evaluating the person and providing entrance
into a comprehensive program. Evaluation of the person shall include verification by a
professional, after preliminary examination, that the person is intoxicated or has symptoms
of chemical dependency and appears to be in imminent danger of harming self or others. A
detoxification program shall have available the services of a licensed physician for medical
emergencies and routine medical surveillance. A detoxification program licensed by the
Department of Human Services to serve both adults and minors at the same site must provide
for separate sleeping areas for adults and minors.

Sec. 8.

Minnesota Statutes 2016, section 254B.01, is amended by adding a subdivision to
read:


Subd. 8.

Recovery community organization.

"Recovery community organization"
means an independent organization led and governed by representatives of local communities
of recovery. A recovery community organization mobilizes resources within and outside
of the recovery community to increase the prevalence and quality of long-term recovery
from alcohol and other drug addiction. Recovery community organizations provide
peer-based recovery support activities such as training of recovery peers. Recovery
community organizations provide mentorship and ongoing support to individuals dealing
with a substance use disorder and connect the individuals with resources that can support
each individual's recovery. A recovery community organization also promotes a
recovery-focused orientation in community education and outreach programming and
organizes recovery-focused policy advocacy activities to foster healthy communities and
reduce the stigma of substance use disorders.

Sec. 9.

Minnesota Statutes 2016, section 254B.03, subdivision 2, is amended to read:


Subd. 2.

Chemical dependency fund payment.

(a) Payment from the chemical
dependency fund is limited to payments for services other than detoxification services
licensed under Minnesota Rules, parts 9530.6405 to 9530.6505,
that, if located outside of
federally recognized tribal lands, would be required to be licensed by the commissioner as
a chemical dependency treatment or rehabilitation program under sections 245A.01 to
245A.16, and services other than detoxification provided in another state that would be
required to be licensed as a chemical dependency program if the program were in the state.
Out of state vendors must also provide the commissioner with assurances that the program
complies substantially with state licensing requirements and possesses all licenses and
certifications required by the host state to provide chemical dependency treatment. Except
for chemical dependency transitional rehabilitation programs, vendors receiving payments
from the chemical dependency fund must not require co-payment from a recipient of benefits
for services provided under this subdivision. Payment from the chemical dependency fund
shall be made for necessary room and board costs provided by vendors certified according
to section 254B.05, or in a community hospital licensed by the commissioner of health
according to sections 144.50 to 144.56 to a client who is:

(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and

(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the chemical dependency fund.

(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.

(c) The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.

Sec. 10.

Minnesota Statutes 2016, section 254B.05, subdivision 1, is amended to read:


Subdivision 1.

Licensure required.

(a) Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
chemical dependency primary treatment, extended care, transitional residence, or outpatient
treatment services, and are licensed by tribal government are eligible vendors. Detoxification
programs are not eligible vendors. Programs that are not licensed as a chemical dependency
residential or nonresidential treatment program by the commissioner or by tribal government
or do not meet the requirements of subdivisions 1a and 1b are not eligible vendors.

(b) Upon federal approval, a licensed professional in private practice as defined in
Minnesota Rules, part 9530.6405, subpart 15, is an eligible vendor of comprehensive
assessments and individual substance use disorder treatment services.

(c) Upon federal approval, a county is an eligible vendor for comprehensive assessment
services when the service is provided by a licensed professional in private practice as defined
in Minnesota Rules, part 9530.6405, subpart 15. Upon federal approval, a county is an
eligible vendor of care coordination services when the service is provided by an individual
who meets certification requirements identified by the commissioner.

(d) Upon federal approval, a recovery community organization that meets certification
requirements identified by the commissioner is an eligible vendor of peer support services
provided one-to-one by an individual in recovery from substance use disorder.

(e) A detoxification program licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, is not an eligible vendor. A program that is not licensed as a chemical dependency
residential or nonresidential treatment or withdrawal management program by the
commissioner or by tribal government or does not meet the requirements of subdivisions
1a and 1b is not an eligible vendor.

Sec. 11.

Minnesota Statutes 2016, section 254B.05, subdivision 5, is amended to read:


Subd. 5.

Rate requirements.

(a) The commissioner shall establish rates for chemical
dependency services and service enhancements funded under this chapter.

(b) Eligible chemical dependency treatment services include:

(1) outpatient treatment services that are licensed according to Minnesota Rules, parts
9530.6405 to 9530.6480, or applicable tribal license;

(2) comprehensive assessment services, on July 1, 2018, or upon federal approval,
whichever is later;

(3) care coordination services, on July 1, 2018, or upon federal approval, whichever is
later;

(4) peer recovery support services, on July 1, 2018, or upon federal approval, whichever
is later;

(5) withdrawal management services provided according to chapter 245F, on July 1,
2019, or upon federal approval, whichever is later;

(2) (6) medication-assisted therapy services that are licensed according to Minnesota
Rules, parts 9530.6405 to 9530.6480 and 9530.6500, or applicable tribal license;

(3) (7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (2) (6) and provide nine hours of clinical services each week;

(4) (8) high, medium, and low intensity residential treatment services that are licensed
according to Minnesota Rules, parts 9530.6405 to 9530.6480 and 9530.6505, or applicable
tribal license which provide, respectively, 30, 15, and five hours of clinical services each
week;

(5) (9) hospital-based treatment services that are licensed according to Minnesota Rules,
parts 9530.6405 to 9530.6480, or applicable tribal license and licensed as a hospital under
sections 144.50 to 144.56;

(6) (10) adolescent treatment programs that are licensed as outpatient treatment programs
according to Minnesota Rules, parts 9530.6405 to 9530.6485, or as residential treatment
programs according to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to
2960.0490, or applicable tribal license;

(7) (11) high-intensity residential treatment services that are licensed according to
Minnesota Rules, parts 9530.6405 to 9530.6480 and 9530.6505, or applicable tribal license,
which provide 30 hours of clinical services each week provided by a state-operated vendor
or to clients who have been civilly committed to the commissioner, present the most complex
and difficult care needs, and are a potential threat to the community; and

(8) (12) room and board facilities that meet the requirements of subdivision 1a.

(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:

(1) programs that serve parents with their children if the program:

(i) provides on-site child care during the hours of treatment activity that:

(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or

(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under Minnesota Rules, part 9530.6490, subpart
4; or

(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:

(A) a child care center under Minnesota Rules, chapter 9503; or

(B) a family child care home under Minnesota Rules, chapter 9502;

(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:

(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;

(ii) is governed with significant input from individuals of that specific background; and

(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;

(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and

(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:

(i) the program meets the co-occurring requirements in Minnesota Rules, part 9530.6495;

(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;

(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;

(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;

(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and

(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.

(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in Minnesota Rules, part
9530.6490.

(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).

(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. The use of
two-way interactive video must be medically appropriate to the condition and needs of the
person being served. Reimbursement shall be at the same rates and under the same conditions
that would otherwise apply to direct face-to-face services. The interactive video equipment
and connection must comply with Medicare standards in effect at the time the service is
provided.

Sec. 12.

Minnesota Statutes 2016, section 254B.12, is amended by adding a subdivision
to read:


Subd. 3.

Chemical dependency provider rate increase.

For the chemical dependency
services listed in section 254B.05, subdivision 5, and provided on or after July 1, 2017,
payment rates shall be increased by three percent over the rates in effect on January 1, 2017,
for vendors who meet the requirements of section 254B.05.

Sec. 13.

Minnesota Statutes 2016, section 256B.0621, subdivision 10, is amended to read:


Subd. 10.

Payment rates.

The commissioner shall set payment rates for targeted case
management under this subdivision. Case managers may bill according to the following
criteria:

(1) for relocation targeted case management, case managers may bill for direct case
management activities, including face-to-face and contact, telephone contacts contact, and
interactive video contact according to section 256B.0924, subdivision 4a,
in the lesser of:

(i) 180 days preceding an eligible recipient's discharge from an institution; or

(ii) the limits and conditions which apply to federal Medicaid funding for this service;

(2) for home care targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts; and

(3) billings for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.

Sec. 14.

Minnesota Statutes 2016, section 256B.0625, subdivision 20, is amended to read:


Subd. 20.

Mental health case management.

(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.

(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.

(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:

(1) at least a face-to-face contact with the adult or the adult's legal representative or a
contact by interactive video that meets the requirements of subdivision 20b
; or

(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact or a contact by interactive video that meets the requirements
of subdivision 20b
with the adult or the adult's legal representative within the preceding
two months.

(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.

(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.

(f) Payment for mental health case management provided by vendors who contract with
a county or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribe. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribe may negotiate a team rate with a vendor who is a member of the team. The team
shall determine how to distribute the rate among its members. No reimbursement received
by contracted vendors shall be returned to the county or tribe, except to reimburse the county
or tribe for advance funding provided by the county or tribe to the vendor.

(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.

(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.

(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.

(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.

(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:

(1) the costs of developing and implementing this section; and

(2) programming the information systems.

(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.

(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.

(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:

(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or

(2) the limits and conditions which apply to federal Medicaid funding for this service.

(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.

(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.

Sec. 15.

Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
to read:


Subd. 20b.

Mental health targeted case management through interactive video.

(a)
Subject to federal approval, contact made for targeted case management by interactive video
shall be eligible for payment if:

(1) the person receiving targeted case management services is residing in:

(i) a hospital;

(ii) a nursing facility; or

(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
establishment or lodging establishment that provides supportive services or health supervision
services according to section 157.17 that is staffed 24 hours a day, seven days a week;

(2) interactive video is in the best interests of the person and is deemed appropriate by
the person receiving targeted case management or the person's legal guardian, the case
management provider, and the provider operating the setting where the person is residing;

(3) the use of interactive video is approved as part of the person's written personal service
or case plan, taking into consideration the person's vulnerability and active personal
relationships; and

(4) interactive video is used for up to, but not more than, 50 percent of the minimum
required face-to-face contact.

(b) The person receiving targeted case management or the person's legal guardian has
the right to choose and consent to the use of interactive video under this subdivision and
has the right to refuse the use of interactive video at any time.

(c) The commissioner shall establish criteria that a targeted case management provider
must attest to in order to demonstrate the safety or efficacy of delivering the service via
interactive video. The attestation may include that the case management provider has:

(1) written policies and procedures specific to interactive video services that are regularly
reviewed and updated;

(2) policies and procedures that adequately address client safety before, during, and after
the interactive video services are rendered;

(3) established protocols addressing how and when to discontinue interactive video
services; and

(4) established a quality assurance process related to interactive video services.

(d) As a condition of payment, the targeted case management provider must document
the following for each occurrence of targeted case management provided by interactive
video:

(1) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(2) the basis for determining that interactive video is an appropriate and effective means
for delivering the service to the person receiving case management services;

(3) the mode of transmission of the interactive video services and records evidencing
that a particular mode of transmission was utilized;

(4) the location of the originating site and the distant site; and

(5) compliance with the criteria attested to by the targeted case management provider
as provided in paragraph (c).

Sec. 16.

Minnesota Statutes 2016, section 256B.0924, is amended by adding a subdivision
to read:


Subd. 4a.

Targeted case management through interactive video.

(a) Subject to federal
approval, contact made for targeted case management by interactive video shall be eligible
for payment under subdivision 6 if:

(1) the person receiving targeted case management services is residing in:

(i) a hospital;

(ii) a nursing facility; or

(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
establishment or lodging establishment that provides supportive services or health supervision
services according to section 157.17 that is staffed 24 hours a day, seven days a week;

(2) interactive video is in the best interests of the person and is deemed appropriate by
the person receiving targeted case management or the person's legal guardian, the case
management provider, and the provider operating the setting where the person is residing;

(3) the use of interactive video is approved as part of the person's written personal service
or case plan; and

(4) interactive video is used for up to, but not more than, 50 percent of the minimum
required face-to-face contact.

(b) The person receiving targeted case management or the person's legal guardian has
the right to choose and consent to the use of interactive video under this subdivision and
has the right to refuse the use of interactive video at any time.

(c) The commissioner shall establish criteria that a targeted case management provider
must attest to in order to demonstrate the safety or efficacy of delivering the service via
interactive video. The attestation may include that the case management provider has:

(1) written policies and procedures specific to interactive video services that are regularly
reviewed and updated;

(2) policies and procedures that adequately address client safety before, during, and after
the interactive video services are rendered;

(3) established protocols addressing how and when to discontinue interactive video
services; and

(4) established a quality assurance process related to interactive video services.

(d) As a condition of payment, the targeted case management provider must document
the following for each occurrence of targeted case management provided by interactive
video:

(1) the time the service began and the time the service ended, including an a.m. and p.m.
designation;

(2) the basis for determining that interactive video is an appropriate and effective means
for delivering the service to the person receiving case management services;

(3) the mode of transmission of the interactive video services and records evidencing
that a particular mode of transmission was utilized;

(4) the location of the originating site and the distant site; and

(5) compliance with the criteria attested to by the targeted case management provider
as provided in paragraph (c).

Sec. 17.

Minnesota Statutes 2016, section 256B.763, is amended to read:


256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.

(a) For services defined in paragraph (b) and rendered on or after July 1, 2007, payment
rates shall be increased by 23.7 percent over the rates in effect on January 1, 2006, for:

(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;

(2) community mental health centers under section 256B.0625, subdivision 5; and

(3) mental health clinics and centers certified under Minnesota Rules, parts 9520.0750
to 9520.0870, or hospital outpatient psychiatric departments that are designated as essential
community providers under section 62Q.19.

(b) This increase applies to group skills training when provided as a component of
children's therapeutic services and support, psychotherapy, medication management,
evaluation and management, diagnostic assessment, explanation of findings, psychological
testing, neuropsychological services, direction of behavioral aides, and inpatient consultation.

(c) This increase does not apply to rates that are governed by section 256B.0625,
subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are negotiated
with the county, rates that are established by the federal government, or rates that increased
between January 1, 2004, and January 1, 2005.

(d) The commissioner shall adjust rates paid to prepaid health plans under contract with
the commissioner to reflect the rate increases provided in paragraphs (a), (e), and (f). The
prepaid health plan must pass this rate increase to the providers identified in paragraphs (a),
(e), (f), and (g).

(e) Payment rates shall be increased by 23.7 percent over the rates in effect on December
31, 2007, for:

(1) medication education services provided on or after January 1, 2008, by adult
rehabilitative mental health services providers certified under section 256B.0623; and

(2) mental health behavioral aide services provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.

(f) For services defined in paragraph (b) and rendered on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943 and
not already included in paragraph (a), payment rates shall be increased by 23.7 percent over
the rates in effect on December 31, 2007.

(g) Payment rates shall be increased by 2.3 percent over the rates in effect on December
31, 2007, for individual and family skills training provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.

(h) For services described in paragraphs (b), (e), and (g) and rendered on or after July
1, 2017, payment rates for mental health clinics and centers certified under Minnesota Rules,
parts 9520.0750 to 9520.0870, that are not designated as essential community providers
under section 62Q.19 shall be equal to payment rates for mental health clinics and centers
certified under Minnesota Rules, parts 9520.0750 to 9520.0870, that are designated as
essential community providers under section 62Q.19. In order to receive increased payment
rates under this paragraph, a provider must demonstrate a commitment to serve low-income
and underserved populations by:

(1) charging for services on a sliding-fee schedule based on current poverty income
guidelines; and

(2) not restricting access or services because of a client's financial limitation.

Sec. 18. GRANT PROGRAM; MENTAL HEALTH INNOVATION.

Subdivision 1.

Definitions.

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

(b) "Community partnership" means a project involving the collaboration of two or more
eligible applicants.

(c) "Eligible applicant" means an eligible county, Indian tribe, mental health service
provider, hospital, or community partnership. Eligible applicant does not include a
state-operated direct care and treatment facility or program under chapter 246.

(d) "Intensive residential treatment services" has the meaning given in section 256B.0622,
subdivision 2.

(e) "Metropolitan area" means the seven-county metropolitan area, as defined in section
473.121, subdivision 2.

Subd. 2.

Grants authorized.

The commissioner of human services shall award grants
to eligible applicants to plan, establish, or operate programs to improve accessibility and
quality of community-based, outpatient mental health services and reduce the number of
clients admitted to regional treatment centers and community behavioral health hospitals.
This is a onetime appropriation that is available until June 30, 2021. The commissioner
shall award half of all grant funds to eligible applicants in the metropolitan area and half of
all grant funds to eligible applicants outside the metropolitan area. An applicant may apply
for and the commissioner may award grants for one-year or two-year periods.

Subd. 3.

Allocation of grants.

(a) An application must be on a form and contain
information as specified by the commissioner but at a minimum must contain:

(1) a description of the purpose or project for which grant funds will be used;

(2) a description of the specific problem the grant funds will address;

(3) a description of achievable objectives, a work plan, and a timeline for implementation
and completion of processes or projects enabled by the grant; and

(4) a process for documenting and evaluating results of the grant.

(b) The commissioner shall review each application to determine whether the application
is complete and whether the applicant and the project are eligible for a grant. In evaluating
applications according to paragraph (c), the commissioner shall establish criteria including,
but not limited to: the eligibility of the project; the applicant's thoroughness and clarity in
describing the problem grant funds are intended to address; a description of the applicant's
proposed project; a description of the population demographics and service area of the
proposed project; the manner in which the applicant will demonstrate the effectiveness of
any projects undertaken; and evidence of efficiencies and effectiveness gained through
collaborative efforts. The commissioner may also consider other relevant factors, including,
but not limited to, the proposed project's longevity and financial sustainability. In evaluating
applications, the commissioner may request additional information regarding a proposed
project, including information on project cost. An applicant's failure to provide the
information requested disqualifies an applicant. The commissioner shall determine the
number of grants awarded.

(c) In determining whether eligible applicants receive grants under this section, the
commissioner shall give preference to grant applications for the following purposes:

(1) intensive residential treatment services providing time-limited mental health services
in a residential setting;

(2) the creation of stand-alone urgent care centers for mental health and psychiatric
consultation services, crisis residential services, or collaboration between crisis teams and
critical access hospitals;

(3) establishing new community mental health services or expanding the capacity of
existing services, including supportive housing; and

(4) other innovative projects that improve options for mental health services in community
settings and reduce the number of clients who remain in regional treatment centers and
community behavioral health hospitals beyond when discharge is determined to be clinically
appropriate.

Subd. 4.

Report to legislature.

By December 1, 2019, the commissioner of human
services shall deliver a report to the chairs and ranking minority members of the legislative
committees with jurisdiction over mental health issues on the outcomes of the projects
funded under this section. The report shall, at a minimum, include the amount of funding
awarded for each project, a description of the programs and services funded, plans for the
long-term sustainability of the projects, and data on outcomes for the programs and services
funded. Grantees must provide information and data requested by the commissioner to
support the development of this report.

Sec. 19. RESIDENTIAL TREATMENT AND PAYMENT RATE REFORM.

The commissioner shall contract with an outside expert to identify recommendations
for the development of a substance use disorder residential treatment program model and
payment structure that is not subject to the federal institutions for mental diseases exclusion
and that is financially sustainable for providers, while incentivizing best practices and
improved treatment outcomes. The analysis must include recommendations and a timeline
for supporting providers to transition to the new models of care delivery. No later than
December 15, 2018, the commissioner shall deliver a report with recommendations to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance.

Sec. 20. COMMISSIONER'S DUTY TO SEEK FEDERAL APPROVAL.

The commissioner of human services shall seek federal approval that is necessary to
implement Minnesota Statutes, sections 256B.0621, subdivision 10; and 256B.0625,
subdivision 20, for interactive video contact.

Sec. 21. REPEALER.

Minnesota Statutes 2016, section 256B.7631, is repealed.

ARTICLE 7

OPIATE ABUSE PREVENTION

Section 1.

Minnesota Statutes 2016, section 152.11, is amended by adding a subdivision
to read:


Subd. 4.

Limit on quantity of opiates prescribed for acute dental and ophthalmic
pain.

(a) When used for the treatment of acute dental pain or acute pain associated with
refractive surgery, prescriptions for opiate or narcotic pain relievers listed in Schedules II
through IV of section 152.02 shall not exceed a four-day supply. The quantity prescribed
shall be consistent with the dosage listed in the professional labeling for the drug that has
been approved by the United States Food and Drug Administration.

(b) For the purposes of this subdivision, "acute pain" means pain resulting from disease,
accidental or intentional trauma, surgery, or another cause, that the practitioner reasonably
expects to last only a short period of time. Acute pain does not include chronic pain or pain
being treated as part of cancer care, palliative care, or hospice or other end-of-life care.

(c) Notwithstanding paragraph (a), if in the professional clinical judgment of a practitioner
more than a four-day supply of a prescription listed in Schedules II through IV of section
152.02 is required to treat a patient's acute pain, the practitioner may issue a prescription
for the quantity needed to treat such acute pain.

Sec. 2.

[152.121] REQUIRED DISCLOSURES FOR PRESCRIPTION OPIOIDS.

Subdivision 1.

Required information.

(a) When dispensing prescription opioids, a
dispenser must provide to a patient, the patient's agent, or the patient's caregiver, clear and
conspicuous written information, in plain language, about:

(1) the addictive nature of opioids and the risks of opioid abuse; and

(2) safe disposal of unused prescription opioids. This information must be consistent
with the requirements of section 152.105.

(b) For purposes of this section, "dispenser" has the meaning provided in section 152.126,
subdivision 1.

Subd. 2.

Board of Pharmacy development of materials.

The Board of Pharmacy shall
develop concise written text in plain language that a dispenser may use to comply with the
requirements of subdivision 1. The board shall make this text available to dispensers in the
state by posting it on the board's Web site in a format that allows dispensers to download
and print it for distribution.

EFFECTIVE DATE.

This section is effective January 1, 2018.

Sec. 3.

Minnesota Statutes 2016, section 256B.072, is amended to read:


256B.072 PERFORMANCE REPORTING AND QUALITY IMPROVEMENT
SYSTEM.

Subdivision 1.

Performance measures.

(a) The commissioner of human services shall
establish a performance reporting system for health care providers who provide health care
services to public program recipients covered under chapters 256B, 256D, and 256L,
reporting separately for managed care and fee-for-service recipients.

(b) The measures used for the performance reporting system for medical groups shall
include measures of care for asthma, diabetes, hypertension, and coronary artery disease
and measures of preventive care services. The measures used for the performance reporting
system for inpatient hospitals shall include measures of care for acute myocardial infarction,
heart failure, and pneumonia, and measures of care and prevention of surgical infections.
In the case of a medical group, the measures used shall be consistent with measures published
by nonprofit Minnesota or national organizations that produce and disseminate health care
quality measures or evidence-based health care guidelines. In the case of inpatient hospital
measures, the commissioner shall appoint the Minnesota Hospital Association and Stratis
Health to advise on the development of the performance measures to be used for hospital
reporting. To enable a consistent measurement process across the community, the
commissioner may use measures of care provided for patients in addition to those identified
in paragraph (a). The commissioner shall ensure collaboration with other health care reporting
organizations so that the measures described in this section are consistent with those reported
by those organizations and used by other purchasers in Minnesota.

(c) The commissioner may require providers to submit information in a required format
to a health care reporting organization or to cooperate with the information collection
procedures of that organization. The commissioner may collaborate with a reporting
organization to collect information reported and to prevent duplication of reporting.

(d) By October 1, 2007, and annually thereafter, the commissioner shall report through
a public Web site the results by medical groups and hospitals, where possible, of the measures
under this section, and shall compare the results by medical groups and hospitals for patients
enrolled in public programs to patients enrolled in private health plans. To achieve this
reporting, the commissioner may collaborate with a health care reporting organization that
operates a Web site suitable for this purpose.

(e) Performance measures must be stratified as provided under section 62U.02,
subdivision 1, paragraph (b), and risk-adjusted as specified in section 62U.02, subdivision
3, paragraph (b).

(f) Assessment of patient satisfaction with pain management for the purpose of
determining compensation or quality incentive payments is prohibited. The commissioner
shall require managed care plans, county-based purchasing plans, and integrated health
partnerships to comply with this requirement as a condition of contract. This prohibition
does not apply to:

(1) assessing patient satisfaction with pain management for the purpose of quality
improvement; and

(2) pain management as a part of a palliative care treatment plan to treat patients with
cancer or patients receiving hospice care.

Subd. 2.

Adjustment of quality metrics for special populations.

Notwithstanding
subdivision 1, paragraph (b), by January 1, 2019, the commissioner shall consider and
appropriately adjust quality metrics and benchmarks for providers who primarily serve
socio-economically complex patient populations and request to be scored on additional
measures in this subdivision. This requirement applies to all medical assistance and
MinnesotaCare programs and enrollees, including persons enrolled in managed care and
county-based purchasing plans or other managed care organizations, persons receiving care
under fee-for-service, and persons receiving care under value-based purchasing arrangements,
including but not limited to initiatives operating under sections 256B.0751, 256B.0753,
256B.0755, 256B.0756, and 256B.0757.

Sec. 4. OPIOID ABUSE PREVENTION.

(a) The commissioner of health shall establish opioid abuse prevention pilot projects in
geographic areas throughout the state, to reduce opioid abuse through the use of controlled
substance care teams and community-wide coordination of abuse-prevention initiatives.
The commissioner shall award grants to health care providers, health plan companies, local
units of government, or other entities to establish pilot projects.

(b) Each pilot project must:

(1) be designed to reduce emergency room and other health care provider visits resulting
from opioid use or abuse, and reduce rates of opioid addiction in the community;

(2) establish multidisciplinary controlled substance care teams, that may consist of
physicians, pharmacists, social workers, nurse care coordinators, and mental health
professionals;

(3) deliver health care services and care coordination, through controlled substance care
teams, to reduce the inappropriate use of opioids by patients and rates of opioid addiction;

(4) address any unmet social service needs that create barriers to managing pain
effectively and obtaining optimal health outcomes;

(5) provide prescriber and dispenser education and assistance to reduce the inappropriate
prescribing and dispensing of opioids;

(6) promote the adoption of best practices related to opioid disposal and reducing
opportunities for illegal access to opioids; and

(7) engage partners outside of the health care system, including schools, law enforcement,
and social services, to address root causes of opioid abuse and addiction at the community
level.

(c) The commissioner shall contract with an accountable community for health that
operates an opioid abuse prevention project, and can document success in reducing opioid
use through the use of controlled substance care teams, to assist the commissioner in
administering this section, and to provide technical assistance to the commissioner and to
entities selected to operate a pilot project.

(d) The contract under paragraph (c) shall require the accountable community for health
to evaluate the extent to which the pilot projects were successful in reducing the inappropriate
use of opioids. The evaluation must analyze changes in the number of opioid prescriptions,
the number of emergency room visits related to opioid use, and other relevant measures.
The accountable community for health shall report evaluation results to the chairs and
ranking minority members of the legislative committees with jurisdiction over health and
human services policy and finance and public safety by December 15, 2019.

Sec. 5. REPORT ON OPIOID CRISIS GRANT; USE OF GRANT FUNDS.

(a) The commissioner of human services, by October 1, 2017, shall report to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
and human services policy and finance on:

(1) funds received under the 21st Century Cures Act, Public Law 114-255, section 1003,
Substance Abuse and Mental Health Services Administration (SAMHSA) State Targeted
Response to the Opioid Crisis Grants; and

(2) uses of the funds received, including a listing of grants provided and the amount
expended on personnel and administrative costs, travel, and public service announcements.

(b) The commissioner shall use remaining Opioid Crisis Grant funds, and any additional
funds received from other sources, to provide grants to counties for opioid abuse prevention
initiatives, increase public awareness of opioid abuse, and prevent opioid abuse through the
use of data analytics.

Sec. 6. CHRONIC PAIN REHABILITATION THERAPY DEMONSTRATION
PROJECT.

Subdivision 1.

Establishment.

The commissioner of human services shall develop and
authorize a two-year demonstration project with a rehabilitation institute located in
Minneapolis operated by a nonprofit foundation, for a bundled payment arrangement for
chronic pain rehabilitation therapy for adults who are eligible for fee-for-service medical
assistance under Minnesota Statutes, section 256B.055, subdivision 7, 15, 16, or 17. The
chronic pain rehabilitation therapy demonstration project must include: nonnarcotic
medication management, including opioid tapering; interdisciplinary care coordination; and
group and individual therapy in cognitive behavioral therapy and physical therapy. The
project may include self-management education in nutrition, stress, mental health, substance
use, or other modalities, if clinically appropriate.

Subd. 2.

Performance and cost savings indicators.

In developing the demonstration
project, the commissioner shall identify cost savings indicators in addition to performance
indicators including:

(1) reduction in medications, including opioids, taken for pain;

(2) reduction in emergency department and outpatient clinic utilization related to pain;

(3) improved ability to return to work, job search, or school;

(4) patient satisfaction; and

(5) rate of program completion.

Subd. 3.

Eligibility.

To be eligible to participate in the demonstration project, an
individual must:

(1) be 18 years of age or older;

(2) be eligible for fee-for-service medical assistance under Minnesota Statutes, section
256B.055, subdivision 7, 15, 16, or 17;

(3) have moderate to severe pain lasting longer than four months;

(4) have an impairment in daily functioning, including work or activities of daily living;

(5) have a referral from a physician or other qualified medical professional indicating
that all reasonable medical and surgical options have been exhausted; and

(6) be willing to engage in chronic pain rehabilitation therapies, including opioid tapering.

Subd. 4.

Integrated health partnerships.

The chronic pain rehabilitation therapy
demonstration project and participating individuals may be incorporated into the
demonstration site's health care delivery systems demonstration under Minnesota Statutes,
section 256B.0755, subdivision 1.

Subd. 5.

Report.

The rehabilitation institute, for the duration of the demonstration
project, must annually report on cost savings and performance indicators described in
subdivision 2 to the commissioner of human services. Three months after the completion
of the demonstration project, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health care. The report must include successes and limitations of the chronic pain
rehabilitation therapy demonstration project and recommendations to increase an individual's
access to chronic pain rehabilitation therapy through Minnesota health care programs.

Sec. 7. SUBSTANCE USE DISORDER PROVIDER CAPACITY GRANT
PROGRAM.

The commissioner of human services shall design and implement a grant program to
assist providers to purchase the first dose of a nonnarcotic injectable or implantable
medication to treat substance use disorder for medical assistance enrollees. Grants shall be
distributed between July 1, 2017, and June 30, 2019. The commissioner shall conduct
outreach to providers regarding the availability of this grant and ensure a simplified grant
application process. The commissioner shall provide technical assistance to assist providers
in building operational capacity to treat substance use disorders with nonnarcotic injectable
or implantable medications. The commissioner, in collaboration with stakeholders, shall
analyze the impact of the grant program under this section and the actual or perceived
barriers for providers to access and be reimbursed for nonnarcotic injectable or implantable
substance use disorder medications and develop recommendations for addressing identified
barriers. The commissioner shall provide a report to the chairs and ranking minority members
of the legislative committees with jurisdiction over health and human services policy and
finance by September 1, 2019.

ARTICLE 8

MISCELLANEOUS

Section 1.

Minnesota Statutes 2016, section 62A.671, subdivision 6, is amended to read:


Subd. 6.

Licensed health care provider.

"Licensed health care provider" means a health
care provider who is:

(1) licensed under chapter 147, 147A, 148, 148B, 148E, 148F, 150A, or 153; a mental
health professional as defined under section 245.462, subdivision 18, or 245.4871,
subdivision 27; a mental health practitioner as defined under section 245.462, subdivision
17, or 245.4871, subdivision 26, working under the general supervision of a mental health
professional;
or a vendor of medical care defined in section 256B.02, subdivision 7; and

(2) authorized within their respective scope of practice to provide the particular service
with no supervision or under general supervision.

EFFECTIVE DATE.

This section is effective January 1, 2018.

Sec. 2.

Minnesota Statutes 2016, section 151.01, subdivision 5, is amended to read:


Subd. 5.

Drug.

"Drug" means all medicinal substances and preparations recognized by
the United States Pharmacopoeia and National Formulary, or any revision thereof, vaccines
and biologicals, and
; biological products, other than blood or blood components; all
substances and preparations intended for external and internal use in the diagnosis, cure,
mitigation, treatment, or prevention of disease in humans or other animals,; and all substances
and preparations, other than food, intended to affect the structure or any function of the
bodies of humans or other animals. The term drug shall also mean any compound, substance,
or derivative that is not approved for human consumption by the United States Food and
Drug Administration or specifically permitted for human consumption under Minnesota
law, and, when introduced into the body, induces an effect similar to that of a Schedule I
or Schedule II controlled substance listed in section 152.02, subdivisions 2 and 3, or
Minnesota Rules, parts 6800.4210 and 6800.4220, regardless of whether the substance is
marketed for the purpose of human consumption.

Sec. 3.

Minnesota Statutes 2016, section 151.01, is amended by adding a subdivision to
read:


Subd. 40.

Biological product.

"Biological product" has the meaning given in United
States Code, title 42, section 262.

Sec. 4.

Minnesota Statutes 2016, section 151.01, is amended by adding a subdivision to
read:


Subd. 41.

Interchangeable biological product.

"Interchangeable biological product"
means a biological product that the United States Food and Drug Administration has:

(1) licensed, and determined to meet the standards for interchangeability under United
States Code, title 42, section 262(k)(4); or

(2) determined to be therapeutically equivalent, as set forth in the most recent edition
or supplement of the United States Food and Drug Administration publication titled
"Approved Drug Products with Therapeutic Equivalence Evaluations."

Sec. 5.

Minnesota Statutes 2016, section 151.21, is amended to read:


151.21 SUBSTITUTION.

Subdivision 1.

Generally.

Except as provided in this section, it shall be unlawful for
any pharmacist or pharmacist intern who dispenses prescriptions, drugs, and medicines to
substitute an article different from the one ordered, or deviate in any manner from the
requirements of an order or a prescription drug order without the approval of the prescriber.

Subd. 2.

Brand name specified Dispense as written prescription drug orders.

When
a pharmacist receives a paper or hard copy prescription drug order on which the prescriber
has personally written in handwriting "dispense as written" or "D.A.W.," a prescription sent
by electronic transmission on which the prescriber has expressly indicated in a manner
consistent with the standards for electronic prescribing under Code of Federal Regulations,
title 42, section 423, that the prescription is to be dispensed as transmitted and which bears
the prescriber's electronic signature, or an oral prescription in for which the prescriber has
expressly indicated that the prescription is to be dispensed as communicated, the pharmacist
shall dispense the brand name legend drug as prescribed.

Subd. 3.

Brand name not specified Other prescription drug orders.

When a pharmacist
receives a paper or hard copy prescription on which the prescriber has not personally written
in handwriting "dispense as written" or "D.A.W.," a prescription sent by electronic
transmission on which the prescriber has not expressly indicated in a manner consistent
with the standards for electronic prescribing under Code of Federal Regulations, title 42,
section 423, that the prescription is to be dispensed as transmitted and which bears the
prescriber's electronic signature, or an oral prescription in which the prescriber has not
expressly indicated that the prescription is to be dispensed as communicated, and there is
available in the pharmacist's stock a less expensive generically equivalent drug that, in the
pharmacist's professional judgment, is safely interchangeable with the prescribed drug
or,
if a biological product is prescribed, a less expensive interchangeable biological product
,
then the pharmacist shall, after disclosing the substitution to the purchaser, dispense the
generic generically equivalent drug or the interchangeable biological product, unless the
purchaser objects. A pharmacist may also substitute pursuant to the oral instructions of the
prescriber. A pharmacist may not substitute a generically equivalent drug product unless,
in the pharmacist's professional judgment, the substituted drug is therapeutically equivalent
and interchangeable to the prescribed drug. A pharmacist may not substitute a biological
product unless the United States Food and Drug Administration has determined the
substituted biological product to be interchangeable with the prescribed biological product.

A pharmacist shall notify the purchaser if the pharmacist is dispensing a drug or biological
product
other than the brand name specific drug or biological product prescribed.

Subd. 3a.

Prescriptions by electronic transmission.

Nothing in this section permits a
prescriber to maintain "dispense as written" or "D.A.W." as a default on all prescriptions.
Prescribers must add the "dispense as written" or "D.A.W." designation to electronic
prescriptions individually, as appropriate.

Subd. 4.

Pricing.

A pharmacist dispensing a drug under the provisions of subdivision
3 shall not dispense a drug of a higher retail price than that of the brand name drug prescribed.
If more than one safely interchangeable generic drug is available in a pharmacist's stock,
then the pharmacist shall dispense the least expensive alternative. Any difference between
acquisition cost to the pharmacist of the drug dispensed and the brand name drug prescribed
shall be passed on to the purchaser.

Subd. 4a.

Sign.

A pharmacy must post a sign in a conspicuous location and in a typeface
easily seen at the counter where prescriptions are dispensed stating: "In order to save you
money, this pharmacy will substitute whenever possible an FDA-approved, less expensive,
generic drug product, which is therapeutically equivalent to and safely interchangeable with
the one prescribed by your doctor, unless you object to this substitution."

Subd. 5.

Reimbursement.

Nothing in this section requires a pharmacist to substitute a
generic drug if the substitution will make the transaction ineligible for third-party
reimbursement.

Subd. 6.

Disclosure.

When a pharmacist dispenses a brand name legend drug and, at
that time, a less expensive generically equivalent drug or interchangeable biological product
is also available in the pharmacist's stock, the pharmacist shall disclose to the purchaser
that a generic generically equivalent drug or interchangeable biological product is available.

Subd. 7.

Drug formulary.

This section does not apply when a pharmacist is dispensing
a prescribed drug to persons covered under a managed health care plan that maintains a
mandatory or closed drug formulary.

Subd. 8.

List of excluded products.

The Drug Formulary Committee established under
section 256B.0625, subdivision 13, shall establish a list of drug products that are to be
excluded from this section. This list shall be updated on an annual basis and shall be provided
to the board for dissemination to pharmacists licensed in the state.

Subd. 9.

Extended supply.

(a) After a patient has obtained an initial 30-day supply of
a prescription drug, and the patient returns to the pharmacy to obtain a refill, a pharmacist
may dispense up to a 90-day supply of that prescription drug to the patient when the following
requirements are met:

(1) the total quantity of dosage units dispensed by the pharmacist does not exceed the
total quantity of dosage units of the remaining refills authorized by the prescriber; and

(2) the pharmacist is exercising the pharmacist's professional judgment.

(b) The initial 30-day supply requirement in paragraph (a) is not required if the
prescription has previously been filled with a 90-day supply.

(c) Notwithstanding paragraph (a), a pharmacist may not exceed the number of dosage
units authorized by a prescriber for an initial prescription or subsequent refills if:

(1) the prescriber has specified on the prescription that, due to medical necessity, the
pharmacist may not exceed the number of dosage units identified on the prescription; or

(2) the prescription drug is a controlled substance, as defined in section 152.01,
subdivision 4.

Subd. 10.

Electronic entry.

(a) Within five business days following the dispensing of
a biological product, the dispensing pharmacist or the pharmacist's designee shall
communicate to the prescriber the name and manufacturer of the biological product
dispensed.

(b) The communication shall be conveyed by making an entry that is electronically
accessible to the prescriber through:

(1) an interoperable electronic medical records system;

(2) an electronic prescribing technology;

(3) a pharmacy benefit management system; or

(4) a pharmacy record.

(c) Entry into an electronic records system as described in paragraph (b) is presumed to
provide notice to the prescriber.

(d) When electronic communication as specified in paragraph (b) is not possible, the
pharmacist or the pharmacist's designee shall communicate to the prescriber the name and
manufacturer of the biological product dispensed by using mail, facsimile, telephone, or
other secure means of electronic transmission.

(e) Communication of the name and manufacturer of the biological product dispensed
shall not be required if:

(1) there is no United States Food and Drug Administration-approved interchangeable
biological product for the product prescribed; or

(2) a prescription is being refilled and the biological product being dispensed is the same
product dispensed on the prior filling of the prescription.

Sec. 6.

Minnesota Statutes 2016, section 245A.02, subdivision 5a, is amended to read:


Subd. 5a.

Controlling individual.

(a) "Controlling individual" means a public body,
governmental agency, business entity, officer, owner, or managerial official whose
responsibilities include the direction of the management or policies of a program. For
purposes of this subdivision, owner means an individual who has direct or indirect ownership
interest in a corporation, partnership, or other business association issued a license under
this chapter. For purposes of this subdivision, managerial official means those individuals
who have the decision-making authority related to the operation of the program, and the
responsibility for the ongoing management of or direction of the policies, services, or
employees of the program. A site director who has no ownership interest in the program is
not considered to be a managerial official for purposes of this definition. Controlling
individual does not include
an owner of a program or service provider licensed under this
chapter and the following individuals, if applicable
:

(1) each officer of the organization, including the chief executive officer and chief
financial officer;

(2) the individual designated as the authorized agent under section 245A.04, subdivision
1, paragraph (b);

(3) the individual designated as the compliance officer under section 256B.04, subdivision
21, paragraph (b); and

(4) each managerial official whose responsibilities include the direction of the
management or policies of a program.

(b) Controlling individual does not include:

(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;

(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program, receives remuneration from the program, or
owns any of the beneficial interests not excluded in this subdivision;

(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:

(i) whose securities are exempt under section 80A.45, clause (6); or

(ii) whose transactions are exempt under section 80A.46, clause (2); or

(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation.; or

(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).

(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.

Sec. 7.

Minnesota Statutes 2016, section 245A.02, is amended by adding a subdivision to
read:


Subd. 10b.

Owner.

"Owner" means an individual or organization that has a direct or
indirect ownership interest of five percent or more in a program licensed under this chapter.
For purposes of this subdivision, "direct ownership interest" means the possession of equity
in capital, stock, or profits of an organization, and "indirect ownership interest" means a
direct ownership interest in an entity that has a direct or indirect ownership interest in a
licensed program. For purposes of this chapter, "owner of a nonprofit corporation" means
the president and treasurer of the board of directors or, for an entity owned by an employee
stock ownership plan, means the president and treasurer of the entity. A government entity
that is issued a license under this chapter shall be designated the owner.

Sec. 8.

[256.999] LEGISLATIVE NOTICE AND APPROVAL REQUIRED FOR
CERTAIN FEDERAL WAIVERS OR APPROVALS.

(a) Before submitting an application for a federal waiver or approval (1) under section
1332 of the Affordable Care Act or section 1115 of the Social Security Act, or (2) to modify
or add a benefit covered by medical assistance or otherwise amend the state's Medicaid
plan, the commissioner, governing board, or director of a state agency seeking the federal
waiver or approval must provide notice and a copy of the application for the federal waiver
or approval to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance and commerce.

(b) If a federal waiver or approval (1) under section 1332 of the Affordable Care Act or
section 1115 of the Social Security Act, or (2) to modify or add a benefit covered by medical
assistance or otherwise amend the state's Medicaid plan, is received or granted during a
legislative session, a commissioner, governing board, or director of a state agency is
prohibited from implementing or otherwise acting on the federal waiver or approval received
or granted, unless the federal waiver or approval is specifically authorized by law on a date
after receipt of the federal waiver or approval.

(c) If a federal waiver or approval (1) under section 1332 of the Affordable Care Act or
section 1115 of the Social Security Act, or (2) to modify or add a benefit covered by medical
assistance or otherwise amend the state's Medicaid plan, is received or granted while the
legislature is not in session, a commissioner, governing board, or director of a state agency
is prohibited from implementing or otherwise acting on the federal waiver or approval
received or granted, unless the federal waiver or approval is submitted to the Legislative
Advisory Commission and the commission makes a positive recommendation. If the
commission makes no recommendation, a negative recommendation, or a recommendation
for further review, the commissioner, governing board, or director shall not implement or
otherwise act on the federal waiver or approval received or granted.

EFFECTIVE DATE.

This section is effective the day following final enactment and
applies to initial requests for federal waivers or approvals sought on or after that date.

Sec. 9.

ESTABLISHMENT OF FEDERALLY FACILITATED MARKETPLACE.

Subdivision 1.

Establishment.

(a) The commissioner of commerce, in cooperation with
the secretary of the United States Department of Health and Human Services, shall establish
a federally facilitated marketplace for Minnesota for coverage beginning January 1, 2019.
The federally facilitated marketplace shall take the place of MNsure, established under
Minnesota Statutes, chapter 62V. In working with the secretary of the United States
Department of Health and Human Services to implement the federally facilitated marketplace
in Minnesota, the commissioner of commerce shall:

(1) seek to incorporate, where appropriate and cost-effective, elements of the Minnesota
eligibility system as defined in Minnesota Statutes, section 62V.055, subdivision 1;

(2) regularly consult with stakeholder groups, including but not limited to representatives
of state agencies, health care providers, health plan companies, brokers, and consumers;
and

(3) seek all available federal grants and funds for state planning and development costs.

(b) All health plans that are offered to Minnesota residents through the federally facilitated
marketplace, when implemented, and that are offered by a health carrier that meets the
applicability criteria in Minnesota Statutes, section 62K.10, subdivision 1, must satisfy
requirements for:

(1) geographic accessibility to providers that at least satisfy the maximum distance or
travel times specified in Minnesota Statutes, section 62K.10, subdivisions 2 and 3; and

(2) provider network adequacy that guarantees at least the level of network adequacy
required by Minnesota Statutes, section 62K.10, subdivision 4.

For purposes of this paragraph, "health plan" has the meaning given in Minnesota Statutes,
section 62A.011, subdivision 3, and "health carrier" has the meaning given in Minnesota
Statutes, section 62A.011, subdivision 2.

Subd. 2.

Implementation plan; draft legislation.

The commissioner of commerce, in
consultation with the commissioner of human services, the chief information officer of
MN.IT, and the MNsure board, shall develop and present to the 2018 legislature an
implementation plan for conversion to a federally facilitated marketplace. The plan must:

(1) address and provide recommendations on the following issues:

(i) the state agency or other entity responsible for state oversight and administration
related to the state's use of the federally facilitated marketplace;

(ii) plan management functions, including certification of qualified health plans;

(iii) the operation of navigator and in-person assister programs, and the operation of a
call center and Web site; and

(iv) funding for federally facilitated marketplace activities, including a user fee rate that
shall not exceed the federal platform user fee rate of two percent of premiums charged for
a coverage year; and

(2) include draft legislation for any changes in state law necessary to implement a
federally facilitated marketplace, including but not limited to necessary changes to Laws
2013, chapter 84, and technical and conforming changes related to the repeal of Minnesota
Statutes, chapter 62V.

Subd. 3.

Vendor contract.

The commissioner of commerce, in consultation with the
commissioner of human services, the chief information officer of MN.IT, and the MNsure
board, shall contract with a vendor to provide technical assistance in developing and
implementing the plan for conversion to a federally facilitated marketplace.

Sec. 10. REPEALER.

Minnesota Statutes 2016, sections 62V.01; 62V.02; 62V.03; 62V.04; 62V.05; 62V.051;
62V.055; 62V.06; 62V.07; 62V.08; 62V.09; 62V.10; and 62V.11,
are repealed effective
January 1, 2019.

ARTICLE 9

NURSING FACILITY TECHNICAL CORRECTIONS

Section 1.

Minnesota Statutes 2016, section 144.0722, subdivision 1, is amended to read:


Subdivision 1.

Resident reimbursement 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 section 144.0721, or under
rules established by the commissioner of human services under sections 256B.41 to 256B.48
chapter 256R
. The reimbursement classifications established by the commissioner must
conform to the rules established by the commissioner of human services.

Sec. 2.

Minnesota Statutes 2016, section 144.0724, subdivision 1, is amended to read:


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 256R.17.

Sec. 3.

Minnesota Statutes 2016, section 144.0724, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(a) "Assessment reference date" 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 chapter 256R;

(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.

Sec. 4.

Minnesota Statutes 2016, section 144.0724, subdivision 9, is amended to read:


Subd. 9.

Audit authority.

(a) The commissioner shall audit the accuracy of resident
assessments performed under section 256B.438 256R.17 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.

Sec. 5.

Minnesota Statutes 2016, section 144A.071, subdivision 3, is amended to read:


Subd. 3.

Exceptions authorizing increase in beds; hardship areas.

(a) The
commissioner of health, in coordination with the commissioner of human services, may
approve the addition of new licensed and Medicare and Medicaid certified nursing home
beds, using the criteria and process set forth in this subdivision.

(b) The commissioner, in cooperation with the commissioner of human services, shall
consider the following criteria when determining that an area of the state is a hardship area
with regard to access to nursing facility services:

(1) a low number of beds per thousand in a specified area using as a standard the beds
per thousand people age 65 and older, in five year age groups, using data from the most
recent census and population projections, weighted by each group's most recent nursing
home utilization, of the county at the 20th percentile, as determined by the commissioner
of human services;

(2) a high level of out-migration for nursing facility services associated with a described
area from the county or counties of residence to other Minnesota counties, as determined
by the commissioner of human services, using as a standard an amount greater than the
out-migration of the county ranked at the 50th percentile;

(3) an adequate level of availability of noninstitutional long-term care services measured
as public spending for home and community-based long-term care services per individual
age 65 and older, in five year age groups, using data from the most recent census and
population projections, weighted by each group's most recent nursing home utilization, as
determined by the commissioner of human services using as a standard an amount greater
than the 50th percentile of counties;

(4) there must be a declaration of hardship resulting from insufficient access to nursing
home beds by local county agencies and area agencies on aging; and

(5) other factors that may demonstrate the need to add new nursing facility beds.

(c) On August 15 of odd-numbered years, the commissioner, in cooperation with the
commissioner of human services, may publish in the State Register a request for information
in which interested parties, using the data provided under section 144A.351, along with any
other relevant data, demonstrate that a specified area is a hardship area with regard to access
to nursing facility services. For a response to be considered, the commissioner must receive
it by November 15. The commissioner shall make responses to the request for information
available to the public and shall allow 30 days for comment. The commissioner shall review
responses and comments and determine if any areas of the state are to be declared hardship
areas.

(d) For each designated hardship area determined in paragraph (c), the commissioner
shall publish a request for proposals in accordance with section 144A.073 and Minnesota
Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the
State Register by March 15 following receipt of responses to the request for information.
The request for proposals must specify the number of new beds which may be added in the
designated hardship area, which must not exceed the number which, if added to the existing
number of beds in the area, including beds in layaway status, would have prevented it from
being determined to be a hardship area under paragraph (b), clause (1). Beginning July 1,
2011, the number of new beds approved must not exceed 200 beds statewide per biennium.
After June 30, 2019, the number of new beds that may be approved in a biennium must not
exceed 300 statewide. For a proposal to be considered, the commissioner must receive it
within six months of the publication of the request for proposals. The commissioner shall
review responses to the request for proposals and shall approve or disapprove each proposal
by the following July 15, in accordance with section 144A.073 and Minnesota Rules, parts
4655.1070 to 4655.1098. The commissioner shall base approvals or disapprovals on a
comparison and ranking of proposals using only the criteria in subdivision 4a. Approval of
a proposal expires after 18 months unless the facility has added the new beds using existing
space, subject to approval by the commissioner, or has commenced construction as defined
in section 144A.071, subdivision 1a, paragraph (d). If, after the approved beds have been
added, fewer than 50 percent of the beds in a facility are newly licensed, the operating
payment rates previously in effect shall remain. If, after the approved beds have been added,
50 percent or more of the beds in a facility are newly licensed, operating payment rates shall
be determined according to Minnesota Rules, part 9549.0057, using the limits under section
256B.441
sections 256R.23, subdivision 5, and 256R.24, subdivision 3. External fixed costs
payment rates must be determined according to section 256B.441, subdivision 53 256R.25.
Property payment rates for facilities with beds added under this subdivision must be
determined in the same manner as rate determinations resulting from projects approved and
completed under section 144A.073.

(e) The commissioner may:

(1) certify or license new beds in a new facility that is to be operated by the commissioner
of veterans affairs or when the costs of constructing and operating the new beds are to be
reimbursed by the commissioner of veterans affairs or the United States Veterans
Administration; and

(2) license or certify beds in a facility that has been involuntarily delicensed or decertified
for participation in the medical assistance program, provided that an application for
relicensure or recertification is submitted to the commissioner by an organization that is
not a related organization as defined in section 256B.441, subdivision 34 256R.02,
subdivision 43
, to the prior licensee within 120 days after delicensure or decertification.

Sec. 6.

Minnesota Statutes 2016, section 144A.071, subdivision 4a, is amended to read:


Subd. 4a.

Exceptions for replacement beds.

It is in the best interest of the state to
ensure that nursing homes and boarding care homes continue to meet the physical plant
licensing and certification requirements by permitting certain construction projects. Facilities
should be maintained in condition to satisfy the physical and emotional needs of residents
while allowing the state to maintain control over nursing home expenditure growth.

The commissioner of health in coordination with the commissioner of human services,
may approve the renovation, replacement, upgrading, or relocation of a nursing home or
boarding care home, under the following conditions:

(a) to license or certify beds in a new facility constructed to replace a facility or to make
repairs in an existing facility that was destroyed or damaged after June 30, 1987, by fire,
lightning, or other hazard provided:

(i) destruction was not caused by the intentional act of or at the direction of a controlling
person of the facility;

(ii) at the time the facility was destroyed or damaged the controlling persons of the
facility maintained insurance coverage for the type of hazard that occurred in an amount
that a reasonable person would conclude was adequate;

(iii) the net proceeds from an insurance settlement for the damages caused by the hazard
are applied to the cost of the new facility or repairs;

(iv) the number of licensed and certified beds in the new facility does not exceed the
number of licensed and certified beds in the destroyed facility; and

(v) the commissioner determines that the replacement beds are needed to prevent an
inadequate supply of beds.

Project construction costs incurred for repairs authorized under this clause shall not be
considered in the dollar threshold amount defined in subdivision 2;

(b) to license or certify beds that are moved from one location to another within a nursing
home facility, provided the total costs of remodeling performed in conjunction with the
relocation of beds does not exceed $1,000,000;

(c) to license or certify beds in a project recommended for approval under section
144A.073;

(d) to license or certify beds that are moved from an existing state nursing home to a
different state facility, provided there is no net increase in the number of state nursing home
beds;

(e) to certify and license as nursing home beds boarding care beds in a certified boarding
care facility if the beds meet the standards for nursing home licensure, or in a facility that
was granted an exception to the moratorium under section 144A.073, and if the cost of any
remodeling of the facility does not exceed $1,000,000. If boarding care beds are licensed
as nursing home beds, the number of boarding care beds in the facility must not increase
beyond the number remaining at the time of the upgrade in licensure. The provisions
contained in section 144A.073 regarding the upgrading of the facilities do not apply to
facilities that satisfy these requirements;

(f) to license and certify up to 40 beds transferred from an existing facility owned and
operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
same location as the existing facility that will serve persons with Alzheimer's disease and
other related disorders. The transfer of beds may occur gradually or in stages, provided the
total number of beds transferred does not exceed 40. At the time of licensure and certification
of a bed or beds in the new unit, the commissioner of health shall delicense and decertify
the same number of beds in the existing facility. As a condition of receiving a license or
certification under this clause, the facility must make a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate as a result of the transfers allowed under this paragraph;

(g) to license and certify nursing home beds to replace currently licensed and certified
boarding care beds which may be located either in a remodeled or renovated boarding care
or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
nursing home facility within the identifiable complex of health care facilities in which the
currently licensed boarding care beds are presently located, provided that the number of
boarding care beds in the facility or complex are decreased by the number to be licensed as
nursing home beds and further provided that, if the total costs of new construction,
replacement, remodeling, or renovation exceed ten percent of the appraised value of the
facility or $200,000, whichever is less, the facility makes a written commitment to the
commissioner of human services that it will not seek to receive an increase in its
property-related payment rate by reason of the new construction, replacement, remodeling,
or renovation. The provisions contained in section 144A.073 regarding the upgrading of
facilities do not apply to facilities that satisfy these requirements;

(h) to license as a nursing home and certify as a nursing facility a facility that is licensed
as a boarding care facility but not certified under the medical assistance program, but only
if the commissioner of human services certifies to the commissioner of health that licensing
the facility as a nursing home and certifying the facility as a nursing facility will result in
a net annual savings to the state general fund of $200,000 or more;

(i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing home
beds in a facility that was licensed and in operation prior to January 1, 1992;

(j) to license and certify new nursing home beds to replace beds in a facility acquired
by the Minneapolis Community Development Agency as part of redevelopment activities
in a city of the first class, provided the new facility is located within three miles of the site
of the old facility. Operating and property costs for the new facility must be determined and
allowed under section 256B.431 or 256B.434 or chapter 256R;

(k) to license and certify up to 20 new nursing home beds in a community-operated
hospital and attached convalescent and nursing care facility with 40 beds on April 21, 1991,
that suspended operation of the hospital in April 1986. The commissioner of human services
shall provide the facility with the same per diem property-related payment rate for each
additional licensed and certified bed as it will receive for its existing 40 beds;

(l) to license or certify beds in renovation, replacement, or upgrading projects as defined
in section 144A.073, subdivision 1, so long as the cumulative total costs of the facility's
remodeling projects do not exceed $1,000,000;

(m) to license and certify beds that are moved from one location to another for the
purposes of converting up to five four-bed wards to single or double occupancy rooms in
a nursing home that, as of January 1, 1993, was county-owned and had a licensed capacity
of 115 beds;

(n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified nursing
facility located in Minneapolis to layaway all of its licensed and certified nursing home
beds. These beds may be relicensed and recertified in a newly constructed teaching nursing
home facility affiliated with a teaching hospital upon approval by the legislature. The
proposal must be developed in consultation with the interagency committee on long-term
care planning. The beds on layaway status shall have the same status as voluntarily delicensed
and decertified beds, except that beds on layaway status remain subject to the surcharge in
section 256.9657. This layaway provision expires July 1, 1998;

(o) to allow a project which will be completed in conjunction with an approved
moratorium exception project for a nursing home in southern Cass County and which is
directly related to that portion of the facility that must be repaired, renovated, or replaced,
to correct an emergency plumbing problem for which a state correction order has been
issued and which must be corrected by August 31, 1993;

(p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified nursing
facility located in Minneapolis to layaway, upon 30 days prior written notice to the
commissioner, up to 30 of the facility's licensed and certified beds by converting three-bed
wards to single or double occupancy. Beds on layaway status shall have the same status as
voluntarily delicensed and decertified beds except that beds on layaway status remain subject
to the surcharge in section 256.9657, remain subject to the license application and renewal
fees under section 144A.07 and shall be subject to a $100 per bed reactivation fee. In
addition, at any time within three years of the effective date of the layaway, the beds on
layaway status may be:

(1) relicensed and recertified upon relocation and reactivation of some or all of the beds
to an existing licensed and certified facility or facilities located in Pine River, Brainerd, or
International Falls; provided that the total project construction costs related to the relocation
of beds from layaway status for any facility receiving relocated beds may not exceed the
dollar threshold provided in subdivision 2 unless the construction project has been approved
through the moratorium exception process under section 144A.073;

(2) relicensed and recertified, upon reactivation of some or all of the beds within the
facility which placed the beds in layaway status, if the commissioner has determined a need
for the reactivation of the beds on layaway status.

The property-related payment rate of a facility placing beds on layaway status must be
adjusted by the incremental change in its rental per diem after recalculating the rental per
diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for a facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than three years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;

(q) to license and certify beds in a renovation and remodeling project to convert 12
four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
home that, as of January 1, 1994, met the following conditions: the nursing home was located
in Ramsey County; had a licensed capacity of 154 beds; and had been ranked among the
top 15 applicants by the 1993 moratorium exceptions advisory review panel. The total
project construction cost estimate for this project must not exceed the cost estimate submitted
in connection with the 1993 moratorium exception process;

(r) to license and certify up to 117 beds that are relocated from a licensed and certified
138-bed nursing facility located in St. Paul to a hospital with 130 licensed hospital beds
located in South St. Paul, provided that the nursing facility and hospital are owned by the
same or a related organization and that prior to the date the relocation is completed the
hospital ceases operation of its inpatient hospital services at that hospital. After relocation,
the nursing facility's status shall be the same as it was prior to relocation. The nursing
facility's property-related payment rate resulting from the project authorized in this paragraph
shall become effective no earlier than April 1, 1996. For purposes of calculating the
incremental change in the facility's rental per diem resulting from this project, the allowable
appraised value of the nursing facility portion of the existing health care facility physical
plant prior to the renovation and relocation may not exceed $2,490,000;

(s) to license and certify two beds in a facility to replace beds that were voluntarily
delicensed and decertified on June 28, 1991;

(t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed nursing
home and 21-bed boarding care home facility in Minneapolis, notwithstanding the licensure
and certification after July 1, 1995, of the Minneapolis facility as a 147-bed nursing home
facility after completion of a construction project approved in 1993 under section 144A.073,
to be laid away upon 30 days' prior written notice to the commissioner. Beds on layaway
status shall have the same status as voluntarily delicensed or decertified beds except that
they shall remain subject to the surcharge in section 256.9657. The 16 beds on layaway
status may be relicensed as nursing home beds and recertified at any time within five years
of the effective date of the layaway upon relocation of some or all of the beds to a licensed
and certified facility located in Watertown, provided that the total project construction costs
related to the relocation of beds from layaway status for the Watertown facility may not
exceed the dollar threshold provided in subdivision 2 unless the construction project has
been approved through the moratorium exception process under section 144A.073.

The property-related payment rate of the facility placing beds on layaway status must
be adjusted by the incremental change in its rental per diem after recalculating the rental
per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The property-related
payment rate for the facility relicensing and recertifying beds from layaway status must be
adjusted by the incremental change in its rental per diem after recalculating its rental per
diem using the number of beds after the relicensing to establish the facility's capacity day
divisor, which shall be effective the first day of the month following the month in which
the relicensing and recertification became effective. Any beds remaining on layaway status
more than five years after the date the layaway status became effective must be removed
from layaway status and immediately delicensed and decertified;

(u) to license and certify beds that are moved within an existing area of a facility or to
a newly constructed addition which is built for the purpose of eliminating three- and four-bed
rooms and adding space for dining, lounge areas, bathing rooms, and ancillary service areas
in a nursing home that, as of January 1, 1995, was located in Fridley and had a licensed
capacity of 129 beds;

(v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County to
a 160-bed facility in Crow Wing County, provided all the affected beds are under common
ownership;

(w) to license and certify a total replacement project of up to 49 beds located in Norman
County that are relocated from a nursing home destroyed by flood and whose residents were
relocated to other nursing homes. The operating cost payment rates for the new nursing
facility shall be determined based on the interim and settle-up payment provisions of
Minnesota Rules, part 9549.0057, and the reimbursement provisions of section 256B.431
chapter 256R
. Property-related reimbursement rates shall be determined under section
256B.431 256R.26, taking into account any federal or state flood-related loans or grants
provided to the facility;

(x) to license and certify to the licensee of a nursing home in Polk County that was
destroyed by flood in 1997 replacement projects with a total of up to 129 beds, with at least
25 beds to be located in Polk County and up to 104 beds distributed among up to three other
counties. These beds may only be distributed to counties with fewer than the median number
of age intensity adjusted beds per thousand, as most recently published by the commissioner
of human services. If the licensee chooses to distribute beds outside of Polk County under
this paragraph, prior to distributing the beds, the commissioner of health must approve the
location in which the licensee plans to distribute the beds. The commissioner of health shall
consult with the commissioner of human services prior to approving the location of the
proposed beds. The licensee may combine these beds with beds relocated from other nursing
facilities as provided in section 144A.073, subdivision 3c. The operating payment rates for
the new nursing facilities shall be determined based on the interim and settle-up payment
provisions of section 256B.431, 256B.434, or 256B.441 or Minnesota Rules, parts 9549.0010
to 9549.0080. Property-related reimbursement rates shall be determined under section
256B.431, 256B.434, or 256B.441 256R.26. If the replacement beds permitted under this
paragraph are combined with beds from other nursing facilities, the rates shall be calculated
as the weighted average of rates determined as provided in this paragraph and section
256B.441, subdivision 60 256R.50;

(y) to license and certify beds in a renovation and remodeling project to convert 13
three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and add
improvements in a nursing home that, as of January 1, 1994, met the following conditions:
the nursing home was located in Ramsey County, was not owned by a hospital corporation,
had a licensed capacity of 64 beds, and had been ranked among the top 15 applicants by
the 1993 moratorium exceptions advisory review panel. The total project construction cost
estimate for this project must not exceed the cost estimate submitted in connection with the
1993 moratorium exception process;

(z) to license and certify up to 150 nursing home beds to replace an existing 285 bed
nursing facility located in St. Paul. The replacement project shall include both the renovation
of existing buildings and the construction of new facilities at the existing site. The reduction
in the licensed capacity of the existing facility shall occur during the construction project
as beds are taken out of service due to the construction process. Prior to the start of the
construction process, the facility shall provide written information to the commissioner of
health describing the process for bed reduction, plans for the relocation of residents, and
the estimated construction schedule. The relocation of residents shall be in accordance with
the provisions of law and rule;

(aa) to allow the commissioner of human services to license an additional 36 beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
the total number of licensed and certified beds at the facility does not increase;

(bb) to license and certify a new facility in St. Louis County with 44 beds constructed
to replace an existing facility in St. Louis County with 31 beds, which has resident rooms
on two separate floors and an antiquated elevator that creates safety concerns for residents
and prevents nonambulatory residents from residing on the second floor. The project shall
include the elimination of three- and four-bed rooms;

(cc) to license and certify four beds in a 16-bed certified boarding care home in
Minneapolis to replace beds that were voluntarily delicensed and decertified on or before
March 31, 1992. The licensure and certification is conditional upon the facility periodically
assessing and adjusting its resident mix and other factors which may contribute to a potential
institution for mental disease declaration. The commissioner of human services shall retain
the authority to audit the facility at any time and shall require the facility to comply with
any requirements necessary to prevent an institution for mental disease declaration, including
delicensure and decertification of beds, if necessary;

(dd) to license and certify 72 beds in an existing facility in Mille Lacs County with 80
beds as part of a renovation project. The renovation must include construction of an addition
to accommodate ten residents with beginning and midstage dementia in a self-contained
living unit; creation of three resident households where dining, activities, and support spaces
are located near resident living quarters; designation of four beds for rehabilitation in a
self-contained area; designation of 30 private rooms; and other improvements;

(ee) to license and certify beds in a facility that has undergone replacement or remodeling
as part of a planned closure under section 256B.437 256R.40;

(ff) to license and certify a total replacement project of up to 124 beds located in Wilkin
County that are in need of relocation from a nursing home significantly damaged by flood.
The operating cost payment rates for the new nursing facility shall be determined based on
the interim and settle-up payment provisions of Minnesota Rules, part 9549.0057, and the
reimbursement provisions of section 256B.431 chapter 256R. Property-related reimbursement
rates shall be determined under section 256B.431 256R.26, taking into account any federal
or state flood-related loans or grants provided to the facility;

(gg) to allow the commissioner of human services to license an additional nine beds to
provide residential services for the physically disabled under Minnesota Rules, parts
9570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
total number of licensed and certified beds at the facility does not increase;

(hh) to license and certify up to 120 new nursing facility beds to replace beds in a facility
in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the new
facility is located within four miles of the existing facility and is in Anoka County. Operating
and property rates shall be determined and allowed under section 256B.431 chapter 256R
and Minnesota Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 256B.441; or

(ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County that,
as of March 25, 2001, is in the active process of closing, to a 122-licensed bed nonprofit
nursing facility located in the city of Columbia Heights or its affiliate. The transfer is effective
when the receiving facility notifies the commissioner in writing of the number of beds
accepted. The commissioner shall place all transferred beds on layaway status held in the
name of the receiving facility. The layaway adjustment provisions of section 256B.431,
subdivision 30, do not apply to this layaway. The receiving facility may only remove the
beds from layaway for recertification and relicensure at the receiving facility's current site,
or at a newly constructed facility located in Anoka County. The receiving facility must
receive statutory authorization before removing these beds from layaway status, or may
remove these beds from layaway status if removal from layaway status is part of a
moratorium exception project approved by the commissioner under section 144A.073.

Sec. 7.

Minnesota Statutes 2016, section 144A.071, subdivision 4c, is amended to read:


Subd. 4c.

Exceptions for replacement beds after June 30, 2003.

(a) The commissioner
of health, in coordination with the commissioner of human services, may approve the
renovation, replacement, upgrading, or relocation of a nursing home or boarding care home,
under the following conditions:

(1) to license and certify an 80-bed city-owned facility in Nicollet County to be
constructed on the site of a new city-owned hospital to replace an existing 85-bed facility
attached to a hospital that is also being replaced. The threshold allowed for this project
under section 144A.073 shall be the maximum amount available to pay the additional
medical assistance costs of the new facility;

(2) to license and certify 29 beds to be added to an existing 69-bed facility in St. Louis
County, provided that the 29 beds must be transferred from active or layaway status at an
existing facility in St. Louis County that had 235 beds on April 1, 2003.

The licensed capacity at the 235-bed facility must be reduced to 206 beds, but the payment
rate at that facility shall not be adjusted as a result of this transfer. The operating payment
rate of the facility adding beds after completion of this project shall be the same as it was
on the day prior to the day the beds are licensed and certified. This project shall not proceed
unless it is approved and financed under the provisions of section 144A.073;

(3) to license and certify a new 60-bed facility in Austin, provided that: (i) 45 of the new
beds are transferred from a 45-bed facility in Austin under common ownership that is closed
and 15 of the new beds are transferred from a 182-bed facility in Albert Lea under common
ownership; (ii) the commissioner of human services is authorized by the 2004 legislature
to negotiate budget-neutral planned nursing facility closures; and (iii) money is available
from planned closures of facilities under common ownership to make implementation of
this clause budget-neutral to the state. The bed capacity of the Albert Lea facility shall be
reduced to 167 beds following the transfer. Of the 60 beds at the new facility, 20 beds shall
be used for a special care unit for persons with Alzheimer's disease or related dementias;

(4) to license and certify up to 80 beds transferred from an existing state-owned nursing
facility in Cass County to a new facility located on the grounds of the Ah-Gwah-Ching
campus. The operating cost payment rates for the new facility shall be determined based
on the interim and settle-up payment provisions of Minnesota Rules, part 9549.0057, and
the reimbursement provisions of section 256B.431 chapter 256R. The property payment
rate for the first three years of operation shall be $35 per day. For subsequent years, the
property payment rate of $35 per day shall be adjusted for inflation as provided in section
256B.434, subdivision 4, paragraph (c), as long as the facility has a contract under section
256B.434;

(5) to initiate a pilot program to license and certify up to 80 beds transferred from an
existing county-owned nursing facility in Steele County relocated to the site of a new acute
care facility as part of the county's Communities for a Lifetime comprehensive plan to create
innovative responses to the aging of its population. Upon relocation to the new site, the
nursing facility shall delicense 28 beds. The payment rate for external fixed costs for the
new facility shall be increased by an amount as calculated according to items (i) to (v):

(i) compute the estimated decrease in medical assistance residents served by the nursing
facility by multiplying the decrease in licensed beds by the historical percentage of medical
assistance resident days;

(ii) compute the annual savings to the medical assistance program from the delicensure
of 28 beds by multiplying the anticipated decrease in medical assistance residents, determined
in item (i), by the existing facility's weighted average payment rate multiplied by 365;

(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the nursing facility,
determined in item (i), by the average monthly elderly waiver service costs for individuals
in Steele County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) divide the amount in item (iv) by an amount equal to the relocated nursing facility's
occupancy factor under section 256B.431, subdivision 3f, paragraph (c), multiplied by the
historical percentage of medical assistance resident days; and

(6) to consolidate and relocate nursing facility beds to a new site in Goodhue County
and to integrate these services with other community-based programs and services under a
communities for a lifetime pilot program and comprehensive plan to create innovative
responses to the aging of its population. Two nursing facilities, one for 84 beds and one for
65 beds, in the city of Red Wing licensed on July 1, 2015, shall be consolidated into a newly
renovated 64-bed nursing facility resulting in the delicensure of 85 beds. Notwithstanding
the carryforward of the approval authority in section 144A.073, subdivision 11, the funding
approved in April 2009 by the commissioner of health for a project in Goodhue County
shall not carry forward. The closure of the 85 beds shall not be eligible for a planned closure
rate adjustment under section 256B.437 256R.40. The construction project permitted in this
clause shall not be eligible for a threshold project rate adjustment under section 256B.434,
subdivision 4f
. The payment rate for external fixed costs for the new facility shall be
increased by an amount as calculated according to items (i) to (vi):

(i) compute the estimated decrease in medical assistance residents served by both nursing
facilities by multiplying the difference between the occupied beds of the two nursing facilities
for the reporting year ending September 30, 2009, and the projected occupancy of the facility
at 95 percent occupancy by the historical percentage of medical assistance resident days;

(ii) compute the annual savings to the medical assistance program from the delicensure
by multiplying the anticipated decrease in the medical assistance residents, determined in
item (i), by the hospital-owned nursing facility weighted average payment rate multiplied
by 365;

(iii) compute the anticipated annual costs for community-based services by multiplying
the anticipated decrease in medical assistance residents served by the facilities, determined
in item (i), by the average monthly elderly waiver service costs for individuals in Goodhue
County multiplied by 12;

(iv) subtract the amount in item (iii) from the amount in item (ii);

(v) multiply the amount in item (iv) by 57.2 percent; and

(vi) divide the difference of the amount in item (iv) and the amount in item (v) by an
amount equal to the relocated nursing facility's occupancy factor under section 256B.431,
subdivision 3f, paragraph (c), multiplied by the historical percentage of medical assistance
resident days.

(b) Projects approved under this subdivision shall be treated in a manner equivalent to
projects approved under subdivision 4a.

Sec. 8.

Minnesota Statutes 2016, section 144A.071, subdivision 4d, is amended to read:


Subd. 4d.

Consolidation of nursing facilities.

(a) The commissioner of health, in
consultation with the commissioner of human services, may approve a request for
consolidation of nursing facilities which includes the closure of one or more facilities and
the upgrading of the physical plant of the remaining nursing facility or facilities, the costs
of which exceed the threshold project limit under subdivision 2, clause (a). The
commissioners shall consider the criteria in this section, section 144A.073, and section
256B.437 256R.40, in approving or rejecting a consolidation proposal. In the event the
commissioners approve the request, the commissioner of human services shall calculate an
external fixed costs rate adjustment according to clauses (1) to (3):

(1) the closure of beds shall not be eligible for a planned closure rate adjustment under
section 256B.437, subdivision 6 256R.40, subdivision 5;

(2) the construction project permitted in this clause shall not be eligible for a threshold
project rate adjustment under section 256B.434, subdivision 4f, or a moratorium exception
adjustment under section 144A.073; and

(3) the payment rate for external fixed costs for a remaining facility or facilities shall
be increased by an amount equal to 65 percent of the projected net cost savings to the state
calculated in paragraph (b), divided by the state's medical assistance percentage of medical
assistance dollars, and then divided by estimated medical assistance resident days, as
determined in paragraph (c), of the remaining nursing facility or facilities in the request in
this paragraph. The rate adjustment is effective on the later of the first day of the month
following completion of the construction upgrades in the consolidation plan or the first day
of the month following the complete closure of a facility designated for closure in the
consolidation plan. If more than one facility is receiving upgrades in the consolidation plan,
each facility's date of construction completion must be evaluated separately.

(b) For purposes of calculating the net cost savings to the state, the commissioner shall
consider clauses (1) to (7):

(1) the annual savings from estimated medical assistance payments from the net number
of beds closed taking into consideration only beds that are in active service on the date of
the request and that have been in active service for at least three years;

(2) the estimated annual cost of increased case load of individuals receiving services
under the elderly waiver;

(3) the estimated annual cost of elderly waiver recipients receiving support under group
residential housing;

(4) the estimated annual cost of increased case load of individuals receiving services
under the alternative care program;

(5) the annual loss of license surcharge payments on closed beds;

(6) the savings from not paying planned closure rate adjustments that the facilities would
otherwise be eligible for under section 256B.437 256R.40; and

(7) the savings from not paying external fixed costs payment rate adjustments from
submission of renovation costs that would otherwise be eligible as threshold projects under
section 256B.434, subdivision 4f.

(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
assistance resident days of the remaining facility or facilities shall be computed assuming
95 percent occupancy multiplied by the historical percentage of medical assistance resident
days of the remaining facility or facilities, as reported on the facility's or facilities' most
recent nursing facility statistical and cost report filed before the plan of closure is submitted,
multiplied by 365.

(d) For purposes of net cost of savings to the state in paragraph (b), the average occupancy
percentages will be those reported on the facility's or facilities' most recent nursing facility
statistical and cost report filed before the plan of closure is submitted, and the average
payment rates shall be calculated based on the approved payment rates in effect at the time
the consolidation request is submitted.

(e) To qualify for the external fixed costs payment rate adjustment under this subdivision,
the closing facilities shall:

(1) submit an application for closure according to section 256B.437, subdivision 3
256R.40, subdivision 2
; and

(2) follow the resident relocation provisions of section 144A.161.

(f) The county or counties in which a facility or facilities are closed under this subdivision
shall not be eligible for designation as a hardship area under subdivision 3 for five years
from the date of the approval of the proposed consolidation. The applicant shall notify the
county of this limitation and the county shall acknowledge this in a letter of support.

Sec. 9.

Minnesota Statutes 2016, section 144A.073, subdivision 3c, is amended to read:


Subd. 3c.

Cost neutral relocation projects.

(a) Notwithstanding subdivision 3, the
commissioner may at any time accept proposals, or amendments to proposals previously
approved under this section, for relocations that are cost neutral with respect to state costs
as defined in section 144A.071, subdivision 5a. The commissioner, in consultation with the
commissioner of human services, shall evaluate proposals according to subdivision 4a,
clauses (1), (4), (5), (6), and (8), and other criteria established in rule or law. The
commissioner of human services shall determine the allowable payment rates of the facility
receiving the beds in accordance with section 256B.441, subdivision 60 256R.50. The
commissioner shall approve or disapprove a project within 90 days.

(b) For the purposes of paragraph (a), cost neutrality shall be measured over the first
three 12-month periods of operation after completion of the project.

Sec. 10.

Minnesota Statutes 2016, section 144A.10, subdivision 4, is amended to read:


Subd. 4.

Correction orders.

Whenever a duly authorized representative of the
commissioner of health finds upon inspection of a nursing home, that the facility or a
controlling person or an employee of the facility is not in compliance with sections 144.411
to 144.417, 144.651, 144.6503, 144A.01 to 144A.155, or 626.557 or the rules promulgated
thereunder, a correction order shall be issued to the facility. The correction order shall state
the deficiency, cite the specific rule or statute violated, state the suggested method of
correction, and specify the time allowed for correction. If the commissioner finds that the
nursing home had uncorrected or repeated violations which create a risk to resident care,
safety, or rights, the commissioner shall notify the commissioner of human services who
shall require the facility to use any efficiency incentive payments received under section
256B.431, subdivision 2b, paragraph (d), to correct the violations and shall require the
facility to forfeit incentive payments for failure to correct the violations as provided in
section 256B.431, subdivision 2n. The forfeiture shall not apply to correction orders issued
for physical plant deficiencies
.

Sec. 11.

Minnesota Statutes 2016, section 144A.15, subdivision 2, is amended to read:


Subd. 2.

Appointment of receiver, rental.

If, after hearing, the court finds that
receivership is necessary as a means of protecting the health, safety, or welfare of a resident
of the facility, the court shall appoint the commissioner of health as a receiver to take charge
of the facility. The commissioner may enter into an agreement for a managing agent to work
on the commissioner's behalf in operating the facility during the receivership. The court
shall determine a fair monthly rental for the facility, taking into account all relevant factors
including the condition of the facility. This rental fee shall be paid by the receiver to the
appropriate controlling person for each month that the receivership remains in effect but
shall be reduced by the amount that the costs of the receivership provided under section
256B.495 256R.52 are in excess of the facility rate. The controlling person may agree to
waive the fair monthly rent by affidavit to the court. Notwithstanding any other law to the
contrary, no payment made to a controlling person by any state agency during a period of
receivership shall include any allowance for profit or be based on any formula which includes
an allowance for profit.

Notwithstanding state contracting requirements in chapter 16C, the commissioner shall
establish and maintain a list of qualified licensed nursing home administrators, or other
qualified persons or organizations with experience in delivering skilled health care services
and the operation of long-term care facilities for those interested in being a managing agent
on the commissioner's behalf during a state receivership of a facility. This list will be a
resource for choosing a managing agent and the commissioner may update the list at any
time. A managing agent cannot be someone who: (1) is the owner, licensee, or administrator
of the facility; (2) has a financial interest in the facility at the time of the receivership or is
a related party to the owner, licensee, or administrator; or (3) has owned or operated any
nursing facility or boarding care home that has been ordered into receivership.

Sec. 12.

Minnesota Statutes 2016, section 144A.154, is amended to read:


144A.154 RATE RECOMMENDATION.

The commissioner may recommend to the commissioner of human services a review of
the rates for a nursing home or boarding care home that participates in the medical assistance
program that is in voluntary or involuntary receivership, and that has needs or deficiencies
documented by the Department of Health. If the commissioner of health determines that a
review of the rate under section 256B.495 256R.52 is needed, the commissioner shall provide
the commissioner of human services with:

(1) a copy of the order or determination that cites the deficiency or need; and

(2) the commissioner's recommendation for additional staff and additional annual hours
by type of employee and additional consultants, services, supplies, equipment, or repairs
necessary to satisfy the need or deficiency.

Sec. 13.

Minnesota Statutes 2016, section 144A.161, subdivision 10, is amended to read:


Subd. 10.

Facility closure rate adjustment.

Upon the request of a closing facility, the
commissioner of human services must allow the facility a closure rate adjustment equal to
a 50 percent payment rate increase to reimburse relocation costs or other costs related to
facility closure. This rate increase is effective on the date the facility's occupancy decreases
to 90 percent of capacity days after the written notice of closure is distributed under
subdivision 5 and shall remain in effect for a period of up to 60 days. The commissioner
shall delay the implementation of rate adjustments under section 256B.437, subdivisions
3, paragraph (b)
, and 6, paragraph (a)
256R.40, subdivisions 5 and 6, to offset the cost of
this rate adjustment.

Sec. 14.

Minnesota Statutes 2016, section 144A.1888, is amended to read:


144A.1888 REUSE OF FACILITIES.

Notwithstanding any local ordinance related to development, planning, or zoning to the
contrary, the conversion or reuse of a nursing home that closes or that curtails, reduces, or
changes operations shall be considered a conforming use permitted under local law, provided
that the facility is converted to another long-term care service approved by a regional
planning group under section 256B.437 256R.40 that serves a smaller number of persons
than the number of persons served before the closure or curtailment, reduction, or change
in operations.

Sec. 15.

Minnesota Statutes 2016, section 144A.611, subdivision 1, is amended to read:


Subdivision 1.

Nursing homes and certified boarding care homes.

The actual costs
of tuition and textbooks and reasonable expenses for the competency evaluation or the
nursing assistant training program and competency evaluation approved under section
144A.61, which are paid to nursing assistants or adult training programs pursuant to
subdivisions 2 and 4, are a reimbursable expense for nursing homes and certified boarding
care homes under section 256B.431, subdivision 36 256R.37.

Sec. 16.

Minnesota Statutes 2016, section 144A.74, is amended to read:


144A.74 MAXIMUM CHARGES.

A supplemental nursing services agency must not bill or receive payments from a nursing
home licensed under this chapter at a rate higher than 150 percent of the sum of the weighted
average wage rate, plus a factor determined by the commissioner to incorporate payroll
taxes as defined in Minnesota Rules, part 9549.0020, subpart 33 section 256R.02, subdivision
37
, for the applicable employee classification for the geographic group to which the nursing
home is assigned under Minnesota Rules, part 9549.0052. The weighted average wage rates
must be determined by the commissioner of human services and reported to the commissioner
of health on an annual basis. Wages are defined as hourly rate of pay and shift differential,
including weekend shift differential and overtime. Facilities shall provide information
necessary to determine weighted average wage rates to the commissioner of human services
in a format requested by the commissioner. The maximum rate must include all charges for
administrative fees, contract fees, or other special charges in addition to the hourly rates for
the temporary nursing pool personnel supplied to a nursing home.

Sec. 17.

Minnesota Statutes 2016, section 256.9657, subdivision 1, is amended to read:


Subdivision 1.

Nursing home license surcharge.

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

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

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

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

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

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

Sec. 18.

Minnesota Statutes 2016, section 256B.0915, subdivision 3e, is amended to read:


Subd. 3e.

Customized living service rate.

(a) Payment for customized living services
shall be a monthly rate authorized by the lead agency within the parameters established by
the commissioner. The payment agreement must delineate the amount of each component
service included in the recipient's customized living service plan. The lead agency, with
input from the provider of customized living services, shall ensure that there is a documented
need within the parameters established by the commissioner for all component customized
living services authorized.

(b) The payment rate must be based on the amount of component services to be provided
utilizing component rates established by the commissioner. Counties and tribes shall use
tools issued by the commissioner to develop and document customized living service plans
and rates.

(c) Component service rates must not exceed payment rates for comparable elderly
waiver or medical assistance services and must reflect economies of scale. Customized
living services must not include rent or raw food costs.

(d) With the exception of individuals described in subdivision 3a, paragraph (b), the
individualized monthly authorized payment for the customized living service plan shall not
exceed 50 percent of the greater of either the statewide or any of the geographic groups'
weighted average monthly nursing facility rate of the case mix resident class to which the
elderly waiver eligible client would be assigned under Minnesota Rules, parts 9549.0051
to 9549.0059, less the maintenance needs allowance as described in subdivision 1d, paragraph
(a). Effective on July 1 of the state fiscal year in which the resident assessment system as
described in section 256B.438 256R.17 for nursing home rate determination is implemented
and July 1 of each subsequent state fiscal year, the individualized monthly authorized
payment for the services described in this clause shall not exceed the limit which was in
effect on June 30 of the previous state fiscal year updated annually based on legislatively
adopted changes to all service rate maximums for home and community-based service
providers.

(e) Effective July 1, 2011, the individualized monthly payment for the customized living
service plan for individuals described in subdivision 3a, paragraph (b), must be the monthly
authorized payment limit for customized living for individuals classified as case mix A,
reduced by 25 percent. This rate limit must be applied to all new participants enrolled in
the program on or after July 1, 2011, who meet the criteria described in subdivision 3a,
paragraph (b). This monthly limit also applies to all other participants who meet the criteria
described in subdivision 3a, paragraph (b), at reassessment.

(f) Customized living services are delivered by a provider licensed by the Department
of Health as a class A or class F home care provider and provided in a building that is
registered as a housing with services establishment under chapter 144D. Licensed home
care providers are subject to section 256B.0651, subdivision 14.

(g) A provider may not bill or otherwise charge an elderly waiver participant or their
family for additional units of any allowable component service beyond those available under
the service rate limits described in paragraph (d), nor for additional units of any allowable
component service beyond those approved in the service plan by the lead agency.

(h) Effective July 1, 2016, and each July 1 thereafter, individualized service rate limits
for customized living services under this subdivision shall be increased by the difference
between any legislatively adopted home and community-based provider rate increases
effective on July 1 or since the previous July 1 and the average statewide percentage increase
in nursing facility operating payment rates under sections 256B.431, 256B.434, and 256B.441
chapter 256R
, effective the previous January 1. This paragraph shall only apply if the average
statewide percentage increase in nursing facility operating payment rates is greater than any
legislatively adopted home and community-based provider rate increases effective on July
1, or occurring since the previous July 1.

Sec. 19.

Minnesota Statutes 2016, section 256B.35, subdivision 4, is amended to read:


Subd. 4.

Field audits required.

The commissioner of human services shall conduct
field audits at the same time as cost report audits required under section 256B.27, subdivision
2a
256R.13, subdivision 1, and at any other time but at least once every four years, without
notice, to determine whether this section was complied with and that the funds provided
residents for their personal needs were actually expended for that purpose.

Sec. 20.

Minnesota Statutes 2016, section 256B.431, subdivision 30, is amended to read:


Subd. 30.

Bed layaway and delicensure.

(a) For rate years beginning on or after July
1, 2000, a nursing facility reimbursed under this section which has placed beds on layaway
shall, for purposes of application of the downsizing incentive in subdivision 3a, paragraph
(c), and calculation of the rental per diem, have those beds given the same effect as if the
beds had been delicensed so long as the beds remain on layaway. At the time of a layaway,
a facility may change its single bed election for use in calculating capacity days under
Minnesota Rules, part 9549.0060, subpart 11. The property payment rate increase shall be
effective the first day of the month following the month in which the layaway of the beds
becomes effective under section 144A.071, subdivision 4b.

(b) For rate years beginning on or after July 1, 2000, notwithstanding any provision to
the contrary under section 256B.434 or chapter 256R, a nursing facility reimbursed under
that section or chapter which has placed beds on layaway shall, for so long as the beds
remain on layaway, be allowed to:

(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the layaway
and the number of beds after the layaway.

The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the layaway of beds and clauses (1), (2), and
(3). If a facility reimbursed under section 256B.434 or chapter 256R completes a moratorium
exception project after its base year, the base year property rate shall be the moratorium
project property rate. The base year rate shall be inflated by the factors in section 256B.434,
subdivision 4
, paragraph (c). The property payment rate increase shall be effective the first
day of the month following the month in which the layaway of the beds becomes effective.

(c) If a nursing facility removes a bed from layaway status in accordance with section
144A.071, subdivision 4b, the commissioner shall establish capacity days based on the
number of licensed and certified beds in the facility not on layaway and shall reduce the
nursing facility's property payment rate in accordance with paragraph (b).

(d) For the rate years beginning on or after July 1, 2000, notwithstanding any provision
to the contrary under section 256B.434 or chapter 256R, a nursing facility reimbursed under
that section or chapter, which has delicensed beds after July 1, 2000, by giving notice of
the delicensure to the commissioner of health according to the notice requirements in section
144A.071, subdivision 4b, shall be allowed to:

(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;

(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and

(3) establish capacity days based on the number of beds immediately prior to the
delicensure and the number of beds after the delicensure.

The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the delicensure of beds and clauses (1), (2),
and (3). If a facility reimbursed under section 256B.434 completes a moratorium exception
project after its base year, the base year property rate shall be the moratorium project property
rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
paragraph (c). The property payment rate increase shall be effective the first day of the
month following the month in which the delicensure of the beds becomes effective.

(e) For nursing facilities reimbursed under this section or, section 256B.434, or chapter
256R,
any beds placed on layaway shall not be included in calculating facility occupancy
as it pertains to leave days defined in Minnesota Rules, part 9505.0415.

(f) For nursing facilities reimbursed under this section or, section 256B.434, or chapter
256R,
the rental rate calculated after placing beds on layaway may not be less than the rental
rate prior to placing beds on layaway.

(g) A nursing facility receiving a rate adjustment as a result of this section shall comply
with section 256B.47, subdivision 2 256R.06, subdivision 5.

(h) A facility that does not utilize the space made available as a result of bed layaway
or delicensure under this subdivision to reduce the number of beds per room or provide
more common space for nursing facility uses or perform other activities related to the
operation of the nursing facility shall have its property rate increase calculated under this
subdivision reduced by the ratio of the square footage made available that is not used for
these purposes to the total square footage made available as a result of bed layaway or
delicensure.

Sec. 21.

Minnesota Statutes 2016, section 256B.50, subdivision 1, is amended to read:


Subdivision 1.

Scope.

A provider may appeal from a determination of a payment rate
established pursuant to this chapter or allowed costs under section 256B.441 chapter 256R
if the appeal, if successful, would result in a change to the provider's payment rate or to the
calculation of maximum charges to therapy vendors as provided by section 256B.433,
subdivision 3
256R.54. Appeals must be filed in accordance with procedures in this section.
This section does not apply to a request from a resident or long-term care facility for
reconsideration of the classification of a resident under section 144.0722.

Sec. 22. EFFECTIVE DATE.

Sections 1 to 21 are effective the day following final enactment.

ARTICLE 10

HUMAN SERVICES FORECAST ADJUSTMENTS

Section 1. DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.

The dollar amounts shown are added to or, if shown in parentheses, are subtracted from
the appropriations in Laws 2015, chapter 71, article 14, as amended by Laws 2016, chapter
189, articles 22 and 23, from the general fund, or any other fund named, to the Department
of Human Services for the purposes specified in this article, to be available for the fiscal
years indicated for each purpose. The figure "2017" used in this article means that the
appropriations listed are available for the fiscal year ending June 30, 2017.

APPROPRIATIONS
Available for the Year
Ending June 30
2017

Sec. 2. COMMISSIONER OF HUMAN
SERVICES

Subdivision 1.

Total Appropriation

$
(342,045,000)
Appropriations by Fund
2017
General Fund
(198,450,000)
Health Care Access
(146,590,000)
TANF
2,995,000

Subd. 2.

Forecasted Programs

(a) MFIP/DWP Grants
Appropriations by Fund
General Fund
(2,111,000)
TANF
2,579,000
(b) MFIP Child Care Assistance Grants
(6,513,000)
(c) General Assistance Grants
(4,219,000)
(d) Minnesota Supplemental Aid Grants
(581,000)
(e) Group Residential Housing Grants
(533,000)
(f) Northstar Care for Children
2,613,000
(g) MinnesotaCare Grants
(145,883,000)

This appropriation is from the health care
access fund.

(h) Medical Assistance Grants
Appropriations by Fund
General Fund
(192,744,000)
Health Care Access
(707,000)
(i) Alternative Care Grants
-0-
(j) CD Entitlement Grants
5,638,000

Subd. 3.

Technical Activities

416,000

This appropriation is from the TANF fund.

Sec. 3. EFFECTIVE DATE.

Sections 1 and 2 are effective the day following final enactment.

ARTICLE 11

APPROPRIATIONS

Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2018" and "2019" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2018, or June 30, 2019, respectively.
"The first year" is fiscal year 2018. "The second year" is fiscal year 2019. "The biennium"
is fiscal years 2018 and 2019.

APPROPRIATIONS
Available for the Year
Ending June 30
2018
2019

Sec. 2. COMMISSIONER OF HUMAN
SERVICES

Subdivision 1.

Total Appropriation

$
7,304,457,000
$
7,358,183,000
Appropriations by Fund
2018
2019
General
6,756,212,000
6,811,923,000
State Government
Special Revenue
4,274,000
4,274,000
Health Care Access
263,748,000
279,216,000
Federal TANF
278,051,000
260,497,000
Lottery Prize
1,896,000
1,896,000

The amounts that may be spent for each
purpose are specified in the following
subdivisions.

Subd. 2.

TANF Maintenance of Effort

(a) The commissioner shall ensure that
sufficient qualified nonfederal expenditures
are made each year to meet the state's
maintenance of effort (MOE) requirements of
the TANF block grant specified under Code
of Federal Regulations, title 45, section 263.1.
In order to meet these basic TANF/MOE
requirements, the commissioner may report
as TANF/MOE expenditures only nonfederal
money expended for allowable activities listed
in the following clauses:

(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;

(2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;

(3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;

(4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;

(5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;

(6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;

(7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and

(8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.

(b) For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.

(c) The commissioner shall ensure that the
MOE used by the commissioner of
management and budget for the February and
November forecasts required under Minnesota
Statutes, section 16A.103, contains
expenditures under paragraph (a), clause (1),
equal to at least 16 percent of the total required
under Code of Federal Regulations, title 45,
section 263.1.

(d) The commissioner may not claim an
amount of TANF/MOE in excess of the 75
percent standard in Code of Federal
Regulations, title 45, section 263.1(a)(2),
except:

(1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;

(2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and

(3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section 261.43
(a)(2).

(e) For the purposes of paragraph (d), the
commissioner may supplement the MOE claim
with working family credit expenditures or
other qualified expenditures to the extent such
expenditures are otherwise available after
considering the expenditures allowed in this
subdivision.

(f) The requirement in Minnesota Statutes,
section 256.011, subdivision 3, that federal
grants or aids secured or obtained under that
subdivision be used to reduce any direct
appropriations provided by law, does not apply
if the grants or aids are federal TANF funds.

(g) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.

(h) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.

Subd. 3.

Central Office; Operations

Appropriations by Fund
General
105,512,000
103,607,000
State Government
Special Revenue
4,149,000
4,149,000
Health Care Access
20,025,000
20,025,000
Federal TANF
100,000
100,000

(a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:

(1) Minnesota Statutes, section 125A.744,
subdivision 3;

(2) Minnesota Statutes, section 245.495,
paragraph (b);

(3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);

(4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);

(5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and

(6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).

(b) Base Level Adjustments. The general
fund base is $103,957,000 in fiscal year 2020
and $103,962,000 in fiscal year 2021.

Subd. 4.

Central Office; Children and Families

Appropriations by Fund
General
9,509,000
9,499,000
Federal TANF
2,582,000
2,582,000

(a) Financial Institution Data Match and
Payment of Fees.
The commissioner is
authorized to allocate up to $310,000 each
year in fiscal year 2018 and fiscal year 2019
from the systems special revenue account to
make payments to financial institutions in
exchange for performing data matches
between account information held by financial
institutions and the public authority's database
of child support obligors as authorized by
Minnesota Statutes, section 13B.06,
subdivision 7.

(b) Base Level Adjustment. The general fund
base is $9,499,000 in fiscal year 2020 and
$9,499,000 in fiscal year 2021.

Subd. 5.

Central Office; Health Care

Appropriations by Fund
General
17,627,000
16,214,000
Health Care Access
19,585,000
19,692,000

(a) Rates Study. $227,000 in fiscal year 2018
is from the general fund for the medical
assistance payment rate study. This is a
onetime appropriation.

(b) Implementation and Operation of an
Electronic Service Delivery Documentation
System.
$225,000 in fiscal year 2018 and
$183,000 in fiscal year 2019 are from the
general fund for the development and
implementation of an electronic service
delivery documentation system. This is a
onetime appropriation.

(c) Audits. $153,000 in fiscal year 2018 and
$153,000 in fiscal year 2019 are from the
general fund for transfer to the Office of the
Legislative Auditor for the auditor to establish
and maintain a team of auditors with the
training and experience necessary to fulfill the
requirements in Minnesota Statutes, section
3.972, subdivision 2a.

(d) Savings from Improved Eligibility
Verification.
The commissioner of human
services shall implement periodic data
matching under Minnesota Statutes, section
256B.0561, the recommendations of the
legislative auditor provided under Minnesota
Statutes, section 3.972, subdivision 2a, and
other eligibility verification initiatives for
enrollees or beneficiaries of all health care,
income maintenance, and social service
programs administered by the commissioner,
in a manner sufficient to achieve savings of
$80,000,000 in fiscal year 2018 and
$90,000,000 in fiscal year 2019.

(e) Chronic Pain Rehabilitation Therapy
Demonstration Project.
$1,000,000 in fiscal
year 2018 is from the general fund for a
chronic pain rehabilitation therapy
demonstration project with a rehabilitation
institute. This is a onetime appropriation.

(f) Base Level Adjustments. The general fund
base is $16,207,000 in fiscal year 2020 and
$16,205,000 in fiscal year 2021. The health
care access fund base is $19,692,000 in fiscal
year 2020 and $19,692,000 in fiscal year 2021.

Subd. 6.

Central Office; Continuing Care for
Older Adults

Appropriations by Fund
General
14,386,000
14,357,000
State Government
Special Revenue
125,000
125,000

(a) Alzheimer's Disease Working Group.
$83,000 in fiscal year 2018 and $71,000 in
fiscal year 2019 are from the general fund for
the Alzheimer's disease working group. This
is a onetime appropriation.

(b) Base Level Adjustment. The general fund
base is $14,297,000 in fiscal year 2020 and
$14,297,000 in fiscal year 2021.

Subd. 7.

Central Office; Community Supports

Appropriations by Fund
General
28,103,000
27,011,000
Lottery Prize
163,000
163,000

(a) Deaf and Hard-of-Hearing Services.
$850,000 in fiscal year 2018 and $700,000 in
fiscal year 2019 are from the general fund for
the Deaf and Hard-of-Hearing Services
Division under Minnesota Statutes, section
256C.233. $150,000 of this appropriation each
year must be used for technology
improvements, technology support, and
training for staff on the use of technology for
external-facing services to implement
Minnesota Statutes, section 256C.24,
subdivision 2, paragraph (a), clause (12).

(b) Individual Budgeting Model. $435,000
in fiscal year 2018 and $65,000 in fiscal year
2019 are from the general fund for the
commissioner of human services to study and
develop an individual budgeting model for
disability waiver recipients and those
accessing services through consumer-directed
community supports. The commissioner shall
submit recommendations to the chairs and
ranking minority members of the legislative
committees with jurisdiction over these
programs by January 15, 2019. This is a
onetime appropriation.

(c) Home and Community-Based Services
Reform Waiver Consolidation.
$72,000 in
fiscal year 2018 and $105,000 in fiscal year
2019 are from the general fund for the
commissioner to conduct a study on
consolidating the four disability home and
community-based services waivers into one
program. This is a onetime appropriation and
the unencumbered balance in the first year
does not cancel but is available in the second
year. Based on the finding of the consolidation
study, the commissioner shall submit
recommendations for consolidation of the four
home and community-based services waivers
into one program to the chairs and ranking
minority members of the legislative
committees with jurisdiction over health and
human services by January 15, 2019.

(d) Base Level Adjustment. The general fund
base is $26,012,000 in fiscal year 2020 and
$26,012,000 in fiscal year 2021.

Subd. 8.

Forecasted Programs; MFIP/DWP

Appropriations by Fund
General
88,930,000
98,537,000
Federal TANF
92,732,000
75,025,000

Subd. 9.

Forecasted Programs; MFIP Child Care
Assistance

112,133,000
108,706,000

Subd. 10.

Forecasted Programs; General
Assistance

55,536,000
57,221,000

(a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.

(b) Emergency General Assistance. The
amount appropriated for emergency general
assistance is limited to no more than
$6,729,812 in fiscal year 2018 and $6,729,812
in fiscal year 2019. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.

Subd. 11.

Forecasted Programs; Minnesota
Supplemental Aid

40,484,000
41,634,000

Subd. 12.

Forecasted Programs; Group
Residential Housing

170,337,000
180,668,000

Subd. 13.

Forecasted Programs; Northstar Care
for Children

80,542,000
96,433,000

Subd. 14.

Forecasted Programs; MinnesotaCare

12,172,000
12,763,000

This appropriation is from the health care
access fund.

Subd. 15.

Forecasted Programs; Medical
Assistance

Appropriations by Fund
General
5,148,894,000
5,165,018,000
Health Care Access
210,866,000
225,636,000

(a) Behavioral Health Services. $1,000,000
each fiscal year is for behavioral health
services provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).

(b) Integrated Health Partnerships.
$500,000 in fiscal year 2018 and $500,000 in
fiscal year 2019 are from the general fund for
the commissioner to provide financial
assistance to participating providers for costs
required to establish an integrated health
partnership, including but not limited to
collecting and reporting information on health
outcomes, quality of care, and health care
costs; training practitioners and staff to use
new care models and participate in care
coordination; or participating in research and
evaluation of the projects. This is a onetime
appropriation.

(c) Contingent Rate Reductions. If the
commissioner determines that competitive
bidding reform, health care delivery pilot
projects, and hospital and managed care
organization outcomes will not achieve a state
general fund savings of $204,905,000 for the
biennium beginning July 1, 2017, the
commissioner shall calculate an estimate of
the shortfall in savings and, for fiscal year
2019, shall reduce medical assistance provider
payment rates, including but not limited to
rates to individual health care providers and
provider agencies, hospitals, other residential
settings, and capitation rates provided to
managed care and county-based purchasing
plans, but excluding nursing facilities, by the
amount necessary to recoup the shortfall in
savings over that fiscal year.

(d) Provider capacity grant. $425,000 in
fiscal year 2018 and $400,000 in fiscal year
2019 from the general fund are for the
commissioner of human services to provide
substance use disorder provider capacity
grants. Of the appropriation for fiscal year
2018, $25,000 is for administrative costs. This
appropriation is onetime.

(e) Base Level Adjustment. The health care
access fund base for medical assistance is
$225,636,000 in fiscal year 2020 and
$225,636,000 in fiscal year 2021.

Subd. 16.

Forecasted Programs; Alternative
Care

44,250,000
44,833,000

Alternative Care Transfer. Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.

Subd. 17.

Forecasted Programs; Chemical
Dependency Treatment Fund

119,251,000
138,117,000

Subd. 18.

Grant Programs; Support Services
Grants

Appropriations by Fund
General
8,715,000
8,715,000
Federal TANF
96,311,000
96,311,000

Subd. 19.

Grant Programs; Basic Sliding Fee
Child Care Assistance Grants

51,932,000
48,059,000

Base Level Adjustment. The general fund
base is $48,037,000 in fiscal year 2020 and
$48,020,000 in fiscal year 2021.

Subd. 20.

Grant Programs; Child Care
Development Grants

1,737,000
1,737,000

Subd. 21.

Grant Programs; Child Support
Enforcement Grants

50,000
50,000

Subd. 22.

Grant Programs; Children's Services
Grants

Appropriations by Fund
General
40,465,000
40,265,000
Federal TANF
140,000
140,000

(a) Title IV-E Adoption Assistance.
Additional federal reimbursement to the state
as a result of the Fostering Connections to
Success and Increasing Adoptions Act's
expanded eligibility for title IV-E adoption
assistance is appropriated to the commissioner
for postadoption, foster care, adoption, and
kinship services, including a parent-to-parent
support network.

(b) Adoption Assistance Incentive Grants.
Federal funds available during fiscal years
2018 and 2019 for adoption incentive grants
are appropriated to the commissioner for
postadoption, foster care, adoption, and
kinship services, including a parent-to-parent
support network.

(c) Crisis Nursery Services. $200,000 in
fiscal year 2018 is from the general fund for
a grant to an organization in Minneapolis that
provides free, voluntary crisis nursery services
for families in crisis 24 hours per day, 365
days per year; crisis counseling; overnight
residential child care; a 24-hour crisis hotline;
and parent education to provide a
trauma-informed continuum of care for
families living in poverty, to continue efforts
to prevent child abuse and neglect, and to
develop practices that can be shared with
organizations around the state to reduce child
abuse and neglect. This is a onetime
appropriation.

(d) White Earth Band of Ojibwe Child
Welfare Services.
$1,600,000 in fiscal year
2018 and $1,600,000 in fiscal year 2019 are
from the general fund for a grant to the White
Earth Band of Ojibwe for purposes of
delivering child welfare services.

Subd. 23.

Grant Programs; Children and
Community Service Grants

58,201,000
58,201,000

Subd. 24.

Grant Programs; Children and
Economic Support Grants

35,760,000
33,000,000

(a) Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2018 do not
cancel but are available for this purpose in
fiscal year 2019.

(b) Long-term Homeless Supportive
Services.
$500,000 in fiscal year 2018 and
$500,000 in fiscal year 2019 are for the
long-term homeless supportive services fund
under Minnesota Statutes, section 256K.26.
This is a onetime appropriation.

(c) Housing with Supports. $750,000 in fiscal
year 2018 and $750,000 in fiscal year 2019
are for the housing with supports for adults
with serious mental illness grant under
Minnesota Statutes, section 245.4661,
subdivision 9, paragraph (a), clause (2). This
is a onetime appropriation.

(d) Transitional Housing. $250,000 in fiscal
year 2018 and $250,000 in fiscal year 2019
are for the transitional housing program under
Minnesota Statutes, section 256E.33. This is
a onetime appropriation.

(e) Emergency Services Program. $125,000
in fiscal year 2018 and $125,000 in fiscal year
2019 are for the emergency services program,
which provides services and emergency shelter
for homeless Minnesotans under Minnesota
Statutes, section 256E.36. This is a onetime
appropriation.

(f) Mobile Food Shelf Grants. $2,000,000 in
fiscal year 2018 is for mobile food shelf
grants. Of this amount, $1,000,000 is for
sustaining existing mobile programs and
$1,000,000 is for creating new mobile
programs. The unencumbered balance in the
first year does not cancel but is available for
the second year. This is a onetime
appropriation.

(g) Food Shelf Programs. $565,000 in fiscal
year 2018 and $565,000 in fiscal year 2019
are for food shelf programs under Minnesota
Statutes, section 256E.34. This appropriation
may be used to purchase proteins, fruits,
vegetables, and diapers.

(h) Dental Services Grants. $500,000 in
fiscal year 2018 and $500,000 in fiscal year
2019 are for the commissioner to award dental
services grants. This is a onetime
appropriation. The commissioner may award
grants under this section to:

(1) nonprofit community clinics;

(2) federally qualified health centers, rural
health clinics, and public health clinics;

(3) hospital-based dental clinics owned and
operated by a city, county, or former state
hospital as defined in Minnesota Statutes,
section 62Q.19, subdivision 1, paragraph (a),
clause (4); and

(4) a dental clinic owned and operated by the
University of Minnesota or the Minnesota
State Colleges and Universities system.

Grants may be used to fund costs related to
maintaining, coordinating, and improving
access for medical assistance and
MinnesotaCare enrollees to dental care in a
region.

The commissioner shall consider the following
in awarding the grants: experience in
delivering dental services to medical assistance
and MinnesotaCare enrollees in urban and
rural communities; the potential to
successfully maintain or expand access to
dental services for medical assistance and
MinnesotaCare enrollees; and demonstrated
capability to provide access to care for
children, adults, and seniors with special
needs, individuals with complex medical and
dental needs, recent immigrants and
non-English speakers, and students attending
schools with a high percentage of low-income
students.

(i) Community Action Grants. $1,000,000
in fiscal year 2018 and $1,000,000 in fiscal
year 2019 are for purposes of community
action grants under Minnesota Statutes,
sections 256E.30 to 256E.32. This is a onetime
appropriation.

(j) Health and Wellness Center. $200,000
in fiscal year 2018 and $200,000 in fiscal year
2019 are for a grant to a health and wellness
center located in North Minneapolis that is a
federally qualified health center. This is a
onetime appropriation. The center must use
the grant money to offer coparent services to
unmarried parents. The center must develop
a process to inform and educate unmarried
parents about the center's coparent services.
The coparent services must include the
following:

(1) coparenting workshops for the unmarried
parents;

(2) assistance to the unmarried parents in
developing a parenting plan that specifies a
schedule of the time each parent spends with
the child, child support obligations, and a
designation of decision-making responsibilities
regarding the child's education, medical needs,
and religious upbringing;

(3) an assessment of social services needs for
each parent; and

(4) additional social services support,
including support related to employment,
education, and housing.

The parenting plan assistance must include
the option of using private mediation.

The coparent workshops must focus at a
minimum on (i) the benefits to the child of
having both parents involved in a child's life,
(ii) promoting both parents' participation in a
child's life, (iii) building coparenting and
communication skills, (iv) information on
establishing paternity, (v) assisting parents in
developing a parenting plan, and (vi) educating
participants on how to foster a nonresident
parent's continued involvement in a child's
life.

(k) Safe Harbor Program. $300,000 in fiscal
year 2018 and $300,000 in fiscal year 2019
are for emergency shelter and transitional and
long-term housing beds for sexually exploited
youth and youth at risk of sexual exploitation.
Youth 24 years of age or younger are eligible
for shelter and housing beds under this
paragraph. In funding shelter and housing
beds, the commissioner shall emphasize
activities that promote capacity-building and
development of resources in greater
Minnesota.

(l) Family Assets for Independence in
Minnesota.
$250,000 in fiscal year 2018 and
$250,000 in fiscal year 2019 are for the
purposes described in Minnesota Statutes,
section 256E.35, family assets for
independence in Minnesota.

(m) Girls' Ranch, Benson. $970,000 in fiscal
year 2018 is for a grant to a girls' ranch in
Benson that provides housing, supportive
services, educational services, and equine
therapy, for purposes of predesigning,
designing, constructing, furnishing, and
equipping a house with capacity for ten beds,
and a second horse riding arena. This is a
onetime appropriation.

(n) Base Level Adjustment. The general fund
base is $29,425,000 in fiscal year 2020 and
$29,425,000 in fiscal year 2021.

Subd. 25.

Grant Programs; Health Care Grants

Appropriations by Fund
General
4,119,000
3,711,000
Health Care Access
350,000
350,000

Subd. 26.

Grant Programs; Other Long-Term
Care Grants

1,500,000
1,925,000

Subd. 27.

Grant Programs; Aging and Adult
Services Grants

28,837,000
28,362,000

(a) Caregiver Support Programs. $200,000
in fiscal year 2018 and $200,000 in fiscal year
2019 are for the purposes of caregiver support
programs under Minnesota Statutes, section
256.9755.

(b) Advanced In-Home Activity-Monitoring
Systems.
$40,000 in fiscal year 2018 is for a
grant to a local research organization with
expertise in identifying current and potential
support systems and examining the capacity
of those systems to meet the needs of the
growing population of elderly persons to
conduct a comprehensive assessment of
current literature, past research, and an
environmental scan of the field related to
advanced in-home activity-monitoring systems
for elderly persons. The commissioner must
report the results of the assessment by January
15, 2018, to the legislative committees and
divisions with jurisdiction over health and
human services policy and finance. This is a
onetime appropriation.

(c) Base Level Adjustment. The general fund
base is $28,797,000 in fiscal year 2020 and
$28,362,000 in fiscal year 2021.

Subd. 28.

Grant Programs; Deaf and
Hard-of-Hearing Grants

2,625,000
2,775,000

Deaf and Hard-of-Hearing Grants. $750,000
in fiscal year 2018 and $900,000 in fiscal year
2019 are for deaf and hard-of-hearing grants.
The funds must be used to provide services to
Minnesotans who are deafblind under
Minnesota Statutes, section 256C.261, to
provide culturally affirmative psychiatric
services, and to provide linguistically and
culturally appropriate mental health services
to children who are deaf, children who are
deafblind, and children who are
hard-of-hearing. Of this appropriation,
$103,000 each year is to increase the grant to
provide mentors who have hearing loss to
parents of infants and children with newly
identified hearing loss. Each year the division
must provide funds for training in ProTactile
American Sign Language or other
communication systems used by people who
are deafblind. Training shall be provided to
persons who are deafblind and to interpreters,
support service providers, and intervenors who
work with persons who are deafblind.

Subd. 29.

Grant Programs; Disabilities Grants

23,770,000
24,770,000

(a) Minnesota Organization on Fetal
Alcohol Syndrome.
$500,000 in fiscal year
2018 and $500,000 in fiscal year 2019 are for
a grant to the Minnesota Organization on Fetal
Alcohol Syndrome (MOFAS). This is a
onetime appropriation. Of this amount,
MOFAS shall make grants to eligible regional
collaboratives that fulfill the requirements in
this paragraph. "Eligible regional
collaboratives" means a partnership between
at least one local government and at least one
community-based organization and, where
available, a family home visiting program. For
purposes of this paragraph, a local government
includes a county or multicounty organization,
a tribal government, a county-based
purchasing entity, or a community health
board. Eligible regional collaboratives must
use grant funds to reduce the incidence of fetal
alcohol syndrome disorders and other prenatal
drug-related effects in children in Minnesota
by identifying and serving pregnant women
suspected of or known to use or abuse alcohol
or other drugs. The eligible regional
collaboratives must provide intensive services
to chemically dependent women to increase
positive birth outcomes. MOFAS must make
grants to eligible regional collaboratives from
both rural and urban areas. A grant recipient
must report to the commissioner of human
services annually by January 15 on the
services and programs funded by the
appropriation. The report must include
measurable outcomes for the previous year,
including the number of pregnant women
served and the number of toxic-free babies
born.

(b) Services for Persons with Intellectual
and Developmental Disabilities.
$143,000
in fiscal year 2018 and $143,000 in fiscal year
2019 are for a grant to an organization
governed by persons with intellectual and
developmental disabilities and administering
a statewide network of disability groups to
maintain and promote self-advocacy services
and supports for persons with intellectual and
developmental disabilities throughout the state.
Grant funds must be used for the following
purposes:

(1) to maintain the infrastructure needed to
train and support the activities of a statewide
network of peer-to-peer mentors for persons
with developmental disabilities, focused on
building awareness of service options and
advocacy skills necessary to move toward full
inclusion in community life, including the
development and delivery of the curriculum
to support the peer-to-peer network;

(2) to provide outreach activities, including
statewide conferences and disability
networking opportunities focused on
self-advocacy, informed choice, and
community engagement skills;

(3) to provide an annual leadership program
for persons with intellectual and
developmental disabilities; and

(4) to provide for administrative and general
operating costs associated with managing and
maintaining facilities, program delivery,
evaluation, staff, and technology.

(c) Outreach to Persons in Institutional
Settings.
$105,000 in fiscal year 2018 and
$105,000 in fiscal year 2019 are for a grant to
an organization governed by persons with
intellectual and developmental disabilities and
administering a statewide network of disability
groups to be used for subgrants to
organizations in Minnesota to conduct
outreach to persons working and living in
institutional settings to provide education and
information about community options. Grant
funds must be used to deliver peer-led skill
training sessions in six regions of the state to
help persons with intellectual and
developmental disabilities understand
community service options related to:

(1) housing;

(2) employment;

(3) education;

(4) transportation;

(5) emerging service reform initiatives
contained in the state's Olmstead plan; the
Workforce Innovation and Opportunity Act,
Public Law 113-128; and federal home and
community-based services regulations; and

(6) connecting with individuals who can help
persons with intellectual and developmental
disabilities make an informed choice and plan
for a transition in services.

(d) Life Skills Training for Individuals with
Autism Spectrum Disorder.
$250,000 in
fiscal year 2018 and $250,000 in fiscal year
2019 are for a grant to an organization located
in Richfield that provides life skills training
to young adults with learning disabilities to
meet the needs of individuals with autism
spectrum disorder. This appropriation may be
used to:

(1) create a best practices curriculum for
serving individuals with autism spectrum
disorder in residential placements with
therapeutic programming; and

(2) expand facilities by adding safety features,
living spaces, and academic areas.

Any unexpended balance in the first year is
available in the second year.

(e) Disability Waiver Rate System
Transition Grants.
$2,000,000 in fiscal year
2018 and $3,000,000 in fiscal year 2019 are
from the general fund for grants to home and
community-based waiver services providers
that will receive at least a ten-percent decrease
in revenues due to the transition to rates
calculated under Minnesota Statutes, section
256B.4914. Grants shall ensure ongoing
access for individuals currently receiving these
services and provide stability to provider
organizations as they transition to new service
delivery models. The base for fiscal year 2020
is $1,000,000. This is a onetime appropriation.

(f) Base Level Adjustment. The general fund
base is $22,022,000 in fiscal year 2020 and
$21,022,000 in fiscal year 2021.

Subd. 30.

Grant Programs; Adult Mental Health
Grants

Appropriations by Fund
General
88,626,000
83,949,000
Health Care Access
750,000
750,000
Lottery Prize
1,733,000
1,733,000

(a) Mental Health Innovation Grant
Program.
$4,000,000 in fiscal year 2018 is
from the general fund for the mental health
innovation grant program. This is a onetime
appropriation and is available until June 30,
2021.

(b) Housing Options for Persons with
Serious Mental Illness.
$1,250,000 in fiscal
year 2018 and $1,250,000 in fiscal year 2019
are from the general fund to the commissioner
for adult mental health grants under Minnesota
Statutes, section 245.4661, subdivision 9,
paragraph (a), clause (2), to support increased
availability of housing options with supports
for persons with serious mental illness. This
is a onetime appropriation.

(c) Assertive Community Treatment.
$500,000 in fiscal year 2018 and $500,000 in
fiscal year 2019 are from the general fund to
the commissioner for adult mental health
grants under Minnesota Statutes, section
256B.0622, subdivision 12, to expand
assertive community treatment services. This
is a onetime appropriation.

(d) Mental Health Crisis Services.
$1,000,000 in fiscal year 2018 and $1,000,000
in fiscal year 2019 are from the general fund
to the commissioner for adult mental health
grants under Minnesota Statutes, section
245.4661, and children's mental health grants
under Minnesota Statutes, section 245.4889,
to expand mental health crisis services,
including:

(1) mobile crisis services;

(2) residential crisis services;

(3) colocation of mobile crisis services in
urgent care clinics and psychiatric emergency
departments; and

(4) development of co-responder mental health
crisis response models.

This is a onetime appropriation.

(e) Text Message Suicide Prevention and
Mental Health Crisis Response Program.

$657,000 in fiscal year 2018 is from the
general fund for a grant to a nonprofit to make
the text message suicide prevention and mental
health crisis response program available
statewide. This is a onetime appropriation.
The nonprofit shall use grant funds to:

(1) operate the text message suicide prevention
and mental health crisis response program
statewide and provide a method of response
that triages inquiries, provides immediate
access to suicide prevention and crisis
counseling over the telephone or via text
messaging, and provides individual, family,
or community education;

(2) connect individuals with trained crisis
counselors and access to local resources,
including referrals to community mental health
options, emergency departments, and locally
available mobile crisis teams, when
appropriate;

(3) maximize availability of services and
access across the state, in conjunction with
other suicide prevention programs and
services; and

(4) provide community education on the
availability of the program and how to access
the program.

Subd. 31.

Grant Programs; Child Mental Health
Grants

21,793,000
21,858,000

(a) First Psychotic Episode Funding.
$750,000 in fiscal year 2018 and $750,000 in
fiscal year 2019 are to fund grants under
Minnesota Statutes, section 245.4889,
subdivision 1, paragraph (b), clause (15).
Funding shall be used to:

(1) provide intensive treatment and supports
to adolescents and adults experiencing or at
risk of a first psychotic episode. Intensive
treatment and support includes medication
management, psychoeducation for the
individual and family, case management,
employment supports, education supports,
cognitive behavioral approaches, social skills
training, peer support, crisis planning, and
stress management. Projects must use all
available funding streams;

(2) conduct outreach, training, and guidance
to mental health and health care professionals,
including postsecondary health clinics, on
early psychosis symptoms, screening tools,
and best practices; and

(3) ensure access to first psychotic episode
psychosis services under this section,
including ensuring access for individuals who
live in rural areas. Funds may be used to pay
for housing or travel or to address other
barriers to individuals and their families
participating in first psychotic episode
services.

(b) Children's School-Linked Mental Health
Grants.
$2,000,000 in fiscal year 2018 and
$2,000,000 in fiscal year 2019 are for
children's school-linked mental health grants
under Minnesota Statutes, section 245.4889,
subdivision 1, paragraph (b), clause (8), to
expand services to school districts or counties
in which school-linked mental health services
are not available and to fund transportation
for children using school-linked mental health
services when school is not in session. The
commissioner shall require grantees to use all
available third-party reimbursement sources
as a condition of the receipt of grant funds.
For purposes of this appropriation, a
third-party reimbursement source does not
include a public school under Minnesota
Statutes, section 120A.20, subdivision 1.

(c) Respite Care Services. $282,000 in fiscal
year 2018 and $282,000 in fiscal year 2019
are for children's mental health grants under
Minnesota Statutes, section 245.4889,
subdivision 1, paragraph (b), clause (3), to
provide respite care services to families of
children with serious mental illness. This is a
onetime appropriation.

(d) Base Level Adjustment. The general fund
base is $21,576,000 in fiscal year 2020 and
$21,576,000 in fiscal year 2021.

Subd. 32.

Grant Programs; Chemical
Dependency Treatment Support Grants

2,136,000
2,136,000

Problem Gambling. $225,000 in fiscal year
2018 and $225,000 in fiscal year 2019 are
from the lottery prize fund for a grant to the
state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
and training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.

Subd. 33.

Direct Care and Treatment - Generally

(a) Transfer Authority. Money appropriated
to budget activities under subdivisions 34, 35,
36, 37, and 38 may be transferred between
budget activities and between years of the
biennium with the approval of the
commissioner of management and budget.

(b) Dedicated Receipts Available. Of the
revenue received under Minnesota Statutes,
section 246.18, subdivision 8, paragraph (a),
up to $1,000,000 each year is available for the
purposes of Minnesota Statutes, section
246.18, subdivision 8, paragraph (b), clause
(1); and up to $2,713,000 each year is
available for the purposes of Minnesota
Statutes, section 246.18, subdivision 8,
paragraph (b), clause (2).

Subd. 34.

Direct Care and Treatment - Mental
Health and Substance Abuse

114,521,000
114,607,000

(a) DCT Operating Adjustment (CARE).
$431,000 in fiscal year 2018 and $835,000 in
fiscal year 2019 are from the general fund for
Community Addiction Recover Enterprise
(CARE) operating adjustments. The
commissioner must transfer $431,000 in fiscal
year 2018 and $835,000 in fiscal year 2019 to
the enterprise fund for CARE.

(b) Child and Adolescent Behavioral Health
Services.
$405,000 in fiscal year 2018 and
$491,000 in fiscal year 2019 are to continue
to operate the child and adolescent behavioral
health services program under Minnesota
Statutes, section 246.014.

(c) Base Level Adjustment. The general fund
base is $114,607,000 in fiscal year 2020 and
$114,607,000 in fiscal year 2021.

Subd. 35.

Direct Care and Treatment -
Community-Based Services

15,298,000
15,298,000

Base Level Adjustment. The general fund
base is $15,298,000 in fiscal year 2020 and
$15,298,000 in fiscal year 2021.

Subd. 36.

Direct Care and Treatment - Forensic
Services

91,658,000
91,675,000

Base Level Adjustment. The general fund
base is $91,675,000 in fiscal year 2020 and
$91,675,000 in fiscal year 2021.

Subd. 37.

Direct Care and Treatment - Sex
Offender Program

86,731,000
86,731,000

Transfer Authority. Money appropriated for
the Minnesota sex offender program may be
transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.

Subd. 38.

Direct Care and Treatment -
Operations

42,244,000
42,244,000

Base Level Adjustment. The general fund
base is $42,244,000 in fiscal year 2020 and
$42,244,000 in fiscal year 2021.

Subd. 39.

Technical Activities

86,186,000
86,339,000

(a) This appropriation is from the federal
TANF fund.

(b) Base Level Adjustment. The TANF fund
appropriation is $86,346,000 in fiscal year
2020 and $86,355,000 in fiscal year 2021.

Sec. 3. COMMISSIONER OF HEALTH

Subdivision 1.

Total Appropriation

$
205,103,000
$
197,889,000
Appropriations by Fund
2018
2019
General
103,281,000
96,734,000
State Government
Special Revenue
52,543,000
52,463,000
Health Care Access
37,566,000
36,979,000
Federal TANF
11,713,000
11,713,000

The amounts that may be spent for each
purpose are specified in the following
subdivisions.

Subd. 2.

Health Improvement

Appropriations by Fund
General
80,584,000
74,111,000
State Government
Special Revenue
6,215,000
6,182,000
Health Care Access
37,566,000
36,979,000
Federal TANF
11,713,000
11,713,000

(a) Palliative Care Advisory Council.
$44,000 in fiscal year 2018 and $44,000 in
fiscal year 2019 are from the general fund for
the Palliative Care Advisory Council under
Minnesota Statutes, section 144.059.

(b) Grants for Drug Deactivation and
Disposal.
$500,000 in fiscal year 2018 and
$500,000 in fiscal year 2019 are from the
general fund for the commissioner to provide
grants to pharmacists and other prescription
drug dispensers, local public health and human
services agencies, local law enforcement,
health care providers, and other entities to
purchase omni-degradable, at-home
prescription drug deactivation and disposal
products to assist the public in the disposal of
prescription drugs in a safe, environmentally
sound manner. A grant recipient must provide
these deactivation and disposal products free
of charge to members of the public. This is a
onetime appropriation.

(c) Opioid Abuse Prevention. $1,000,000 in
fiscal year 2018 is from the general fund for
the commissioner to implement opioid abuse
prevention pilot projects and to contract with
an accountable community for health for
administrative and technical assistance and
for an evaluation of the pilot projects. This is
a onetime appropriation and is available
through June 30, 2019.

(d) Early Dental Disease Prevention Pilot
Program.
$500,000 in fiscal year 2018 and
$500,000 in fiscal year 2019 are from the
general fund to implement a pilot program to
increase awareness and encourage early
preventive dental disease intervention and care
for infants and toddlers.

(e) TANF Appropriations. (1) $1,156,000
of the TANF fund is appropriated each year
of the biennium to the commissioner for
family planning grants under Minnesota
Statutes, section 145.925.

(2) $3,579,000 of the TANF fund is
appropriated each year of the biennium to the
commissioner for home visiting and nutritional
services listed under Minnesota Statutes,
section 145.882, subdivision 7, clauses (6) and
(7). Funds must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1.

(3) $2,000,000 of the TANF fund is
appropriated each year of the biennium to the
commissioner for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7.

(4) $4,978,000 of the TANF fund is
appropriated each year of the biennium to the
commissioner for the family home visiting
grant program according to Minnesota
Statutes, section 145A.17. $4,000,000 of the
funding must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1. $978,000 of
the funding must be distributed to tribal
governments as provided in Minnesota
Statutes, section 145A.14, subdivision 2a.

(5) The commissioner may use up to 6.23
percent of the funds appropriated each fiscal
year to conduct the ongoing evaluations
required under Minnesota Statutes, section
145A.17, subdivision 7, and training and
technical assistance as required under
Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.

(f) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.

(g) Minnesota Biomedicine and Bioethics
Innovation Grants.
$5,000,000 in fiscal year
2018 is from the general fund for Minnesota
biomedicine and bioethics innovation grants
under Minnesota Statutes, section 144.88. This
is a onetime appropriation and is available
until June 30, 2021.

(h) Statewide Tobacco Quitline Service. Of
the health care access fund appropriation for
the statewide health improvement program,
$461,000 in fiscal year 2018 and $2,969,000
in fiscal year 2019 are for administering or
contracting for the administration of the
statewide tobacco quitline service established
under Minnesota Statutes, section 144.397.

(i) Home and Community-Based Services
Employee Scholarship Program.
$1,000,000
in fiscal year 2018 and $1,000,000 in fiscal
year 2019 are from the general fund for the
home and community-based services
employee scholarship program under
Minnesota Statutes, section 144.1503.

(j) Senior Care Workforce Innovation
Grant Program.
$1,000,000 in fiscal year
2018 and $1,000,000 in fiscal year 2019 are
from the general fund for the senior care
workforce innovation grant program under
Minnesota Statutes, section 144.1504.

(k) Primary Care and Mental Health
Professions Clinical Training Expansion
Grant Program.
$1,000,000 in fiscal year
2018 and $1,000,000 in fiscal year 2019 are
from the general fund for the primary care and
mental health professions clinical training
expansion grant program under Minnesota
Statutes, section 144.1505.

(l) Physician Residency Expansion Grant
Program.
$1,500,00 in fiscal year 2018 and
$1,500,000 in fiscal 2019 are from the health
care access fund for the physician residency
expansion grant program under Minnesota
Statutes, section 144.1506.

(m) Comprehensive Advanced Life Support
Educational Program.
$100,000 in fiscal
year 2018 and $100,000 in fiscal year 2019
are from the general fund for the
comprehensive advanced life support
educational program under Minnesota Statutes,
section 144.6062. This is a onetime
appropriation.

(n) Advanced Care Planning. $500,000 in
fiscal year 2018 and $500,000 in fiscal year
2019 are from the general fund for a grant to
a statewide advanced care planning resource
organization that has expertise in convening
and coordinating community-based strategies
to encourage individuals, families, caregivers,
and health care providers to begin
conversations regarding end-of-life care
choices that express an individual's health care
values and preferences and are based on
informed health care decisions.

(o) Plan and Report on Safe Harbor for All
Model.
$73,000 in fiscal year 2018 is from
the general fund to develop a statewide sex
trafficking victims strategic plan and report.
This is a onetime appropriation.

(p) Safe Harbor Program. $420,000 in fiscal
year 2018 and $420,000 in fiscal year 2019
are from the general fund for trauma-informed,
culturally specific services for sexually
exploited youth 24 years of age or younger
and for training, technical assistance, protocol
implementation, and evaluation activities
related to the safe harbor program. In funding
services and activities under this paragraph,
the commissioner of health shall emphasize
activities that promote capacity-building and
development of resources in greater
Minnesota. This is a onetime appropriation.

(q) Youth Sports Concussion Working
Group and Brain Health Pilot Programs.

$450,000 in fiscal year 2018 is from the
general fund for the youth sports concussion
working group and brain health pilot
programs. This is a onetime appropriation. Of
this appropriation:

(1) $150,000 is for the youth sports concussion
working group, including any required
incidence research; and

(2) $300,000 is for the brain health pilot
programs.

(r) Base Level Adjustments. The general fund
base is $72,961,000 in fiscal year 2020 and
$73,011,000 in fiscal year 2021. The health
care access fund base is $37,579,000 in fiscal
year 2020 and $36,979,000 in fiscal year 2021.

Subd. 3.

Health Protection

Appropriations by Fund
General
14,552,000
14,478,000
State Government
Special Revenue
46,328,000
46,281,000

(a) Prescribed Pediatric Extended Care
Center Licensure Activities.
$7,000 in fiscal
year 2018 and $13,000 in fiscal year 2019 are
from the state government special revenue
fund for licensure of prescribed pediatric
extended care centers under Minnesota
Statutes, chapter 144H.

(b) Vulnerable Adults in Health Care
Settings.
$633,000 in fiscal year 2018 and
$559,000 in fiscal year 2019 are from the
general fund for regulating health care and
home care settings.

(c) Base Level Adjustment. The general fund
base is $14,867,000 in fiscal year 2020 and
$14,777,000 in fiscal year 2021. The state
government special revenue fund base is
$46,266,000 in fiscal year 2020 and
$46,266,000 in fiscal year 2021.

Subd. 4.

Health Operations

Appropriations by Fund
General
8,145,000
8,145,000

Sec. 4. HEALTH-RELATED BOARDS

Subdivision 1.

Total Appropriation

$
24,979,000
$
23,172,000

This appropriation is from the state
government special revenue fund. The
amounts that may be spent for each purpose
are specified in the following subdivisions.

Subd. 2.

Board of Chiropractic Examiners

565,000
571,000

Base Level Adjustment. The base is $576,000
in fiscal year 2020 and $576,000 in fiscal year
2021.

Subd. 3.

Board of Dentistry

1,396,000
1,408,000

Subd. 4.

Board of Dietetics and Nutrition
Practice

130,000
132,000

Subd. 5.

Board of Marriage and Family Therapy

360,000
357,000

Base Level Adjustment. The base is $360,000
in fiscal year 2020 and $362,000 in fiscal year
2021.

Subd. 6.

Board of Medical Practice

5,207,000
5,243,000

This appropriation includes $964,000 in fiscal
year 2018 and $964,000 in fiscal year 2019
for the health professional services program.
The base for this program is $924,000 in fiscal
year 2020 and $924,000 in fiscal year 2021.

Base Level Adjustment. The base is
$5,205,000 in fiscal year 2020 and $5,205,000
in fiscal year 2021.

Subd. 7.

Board of Nursing

6,380,000
4,783,000

Subd. 8.

Board of Nursing Home Administrators

3,397,000
3,202,000

(a) Administrative Services Unit - Operating
Costs.
Of this appropriation, $2,260,000 in
fiscal year 2018 and $2,287,000 in fiscal year
2019 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.

(b) Administrative Services Unit - Volunteer
Health Care Provider Program.
Of this
appropriation, $150,000 in fiscal year 2018
and $150,000 in fiscal year 2019 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.

(c) Administrative Services Unit -
Retirement Costs.
Of this appropriation,
$378,000 in fiscal year 2019 is a onetime
appropriation to the administrative services
unit to pay for the retirement costs of
health-related board employees. This funding
may be transferred to the health board
incurring retirement costs. Any board that has
an unexpended balance for an amount
transferred under this paragraph shall transfer
the unexpended amount to the administrative
services unit. These funds are available either
year of the biennium.

(d) Administrative Services Unit -
Health-Related Licensing Boards Operating
Costs.
Of this appropriation, $194,000 in
fiscal year 2018 and $350,000 in fiscal year
2019 shall be transferred to the health-related
boards funded under this section for operating
costs. The administrative services unit shall
determine transfer amounts in consultation
with the health-related boards funded under
this section.

(e) Administrative Services Unit - Contested
Cases and Other Legal Proceedings.
Of this
appropriation, $200,000 in fiscal year 2018
and $200,000 in fiscal year 2019 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval of
the commissioner of management and budget.
The commissioner of management and budget
must require any board that has an unexpended
balance for an amount transferred under this
paragraph to transfer the unexpended amount
to the administrative services unit to be
deposited in the state government special
revenue fund.

Subd. 9.

Board of Optometry

156,000
157,000

Subd. 10.

Board of Pharmacy

3,124,000
3,164,000

Base Level Adjustment. The base is
$3,189,000 in fiscal year 2020 and $3,226,000
in fiscal year 2021.

Subd. 11.

Board of Physical Therapy

507,000
508,000

Base Level Adjustment. The base is $510,000
in fiscal year 2020 and $512,000 in fiscal year
2021.

Subd. 12.

Board of Podiatric Medicine

198,000
198,000

Subd. 13.

Board of Psychology

1,220,000
1,240,000

Base Level Adjustment. The base is
$1,247,000 in fiscal year 2020 and $1,247,000
in fiscal year 2021.

Subd. 14.

Board of Social Work

1,254,000
1,246,000

Base Level Adjustment. The base is
$1,248,000 in fiscal year 2020 and $1,250,000
in fiscal year 2021.

Subd. 15.

Board of Veterinary Medicine

314,000
320,000

Base Level Adjustment. The base is $327,000
in fiscal year 2020 and $333,000 in fiscal year
2021.

Subd. 16.

Board of Behavioral Health and
Therapy

771,000
643,000

Sec. 5. EMERGENCY MEDICAL SERVICES
REGULATORY BOARD

$
4,509,000
$
4,438,000

(a) Cooper/Sams Volunteer Ambulance
Program.
$1,300,000 in fiscal year 2018 and
$1,300,000 in fiscal year 2019 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
The base for this program is $700,000 in fiscal
year 2020 and $700,000 in fiscal year 2021.

(1) Of this amount, $1,211,000 in fiscal year
2018 and $1,211,000 in fiscal year 2019 are
for the ambulance service personnel longevity
award and incentive program under Minnesota
Statutes, section 144E.40. The base for this
program is $611,000 in fiscal year 2020 and
$611,000 in fiscal year 2021.

(2) Of this amount, $89,000 in fiscal year 2018
and $89,000 in fiscal year 2019 are for the
operations of the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.

(b) EMSRB Board Operations. $1,360,000
in fiscal year 2018 and $1,360,000 in fiscal
year 2019 are for board operations.

(c) Base Level Adjustment. The base is
$3,840,000 in fiscal year 2020 and $3,840,000
in fiscal year 2021.

(d) Regional Grants. $585,000 in fiscal year
2018 and $585,000 in fiscal year 2019 are for
regional emergency medical services
programs, to be distributed equally to the eight
emergency medical service regions under
Minnesota Statutes, section 144E.52.

(e) Ambulance Training Grant. $361,000
in fiscal year 2018 and $361,000 in fiscal year
2019 are for training grants under Minnesota
Statutes, section 144E.35.

Sec. 6. COUNCIL ON DISABILITY

$
1,002,000
$
1,002,000

Base Level Adjustment. The base is $966,000
in fiscal year 2020 and $968,000 in fiscal year
2021.

Sec. 7. OMBUDSMAN FOR MENTAL
HEALTH AND DEVELOPMENTAL
DISABILITIES

$
2,407,000
$
2,427,000

Department of Psychology Monitoring.
$100,000 in fiscal year 2018 and $100,000 in
fiscal year 2019 are for monitoring the
Department of Psychology at the University
of Minnesota.

Sec. 8. OMBUDSPERSONS FOR FAMILIES

$
543,000
$
551,000

Sec. 9. COMMISSIONER OF COMMERCE

$
1,194,000
$
1,194,000

Sec. 10. TRANSFERS.

Subdivision 1.

Grants.

The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2019, within fiscal years among the MFIP, general
assistance, medical assistance, MinnesotaCare, MFIP child care assistance under Minnesota
Statutes, section 119B.05, Minnesota supplemental aid, and group residential housing
programs, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance and Policy
Committee, the senate Human Services Reform Finance and Policy Committee, and the
house of representatives Health and Human Services Finance Committee quarterly about
transfers made under this subdivision.

Subd. 2.

Administration.

Positions, salary money, and nonsalary administrative money
may be transferred within the Departments of Health and Human Services as the
commissioners consider necessary, with the advance approval of the commissioner of
management and budget. The commissioner shall inform the chairs and ranking minority
members of the senate Health and Human Services Finance and Policy Committee, the
senate Human Services Reform Finance and Policy Committee, and the house of
representatives Health and Human Services Finance Committee quarterly about transfers
made under this subdivision.

Sec. 11. INDIRECT COSTS NOT TO FUND PROGRAMS.

The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.

Sec. 12. EXPIRATION OF UNCODIFIED LANGUAGE.

All uncodified language contained in this article expires on June 30, 2019, unless a
different expiration date is explicit.

Sec. 13. EFFECTIVE DATE.

This article is effective July 1, 2017, unless a different effective date is specified.

APPENDIX

Repealed Minnesota Statutes: H0945-1

62V.01 TITLE.

This chapter may be cited as the "MNsure Act."

62V.02 DEFINITIONS.

Subdivision 1.

Scope.

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

Subd. 2.

Board.

"Board" means the Board of Directors of MNsure specified in section 62V.04.

Subd. 3.

Dental plan.

"Dental plan" has the meaning defined in section 62Q.76, subdivision 3.

Subd. 4.

Health plan.

"Health plan" means a policy, contract, certificate, or agreement defined in section 62A.011, subdivision 3.

Subd. 5.

Health carrier.

"Health carrier" has the meaning defined in section 62A.011.

Subd. 6.

Individual market.

"Individual market" means the market for health insurance coverage offered to individuals.

Subd. 7.

Insurance producer.

"Insurance producer" has the meaning defined in section 60K.31.

Subd. 8.

MNsure.

"MNsure" means the state health benefit exchange as described in section 1311 of the federal Patient Protection and Affordable Care Act, Public Law 111-148, and further defined through amendments to the act and regulations issued under the act.

Subd. 9.

Navigator.

"Navigator" has the meaning described in section 1311(i) of the federal Patient Protection and Affordable Care Act, Public Law 111-148, and further defined through amendments to the act and regulations issued under the act.

Subd. 10.

Public health care program.

"Public health care program" means any public health care program administered by the commissioner of human services.

Subd. 11.

Qualified health plan.

"Qualified health plan" means a health plan that meets the definition in section 1301(a) of the Affordable Care Act, Public Law 111-148, and has been certified by the board in accordance with section 62V.05, subdivision 5, to be offered through MNsure.

Subd. 12.

Small group market.

"Small group market" means the market for health insurance coverage offered to small employers as defined in section 62L.02, subdivision 26.

Subd. 13.

Web site.

"Web site" means a site maintained on the World Wide Web by MNsure that allows for access to information and services provided by MNsure.

62V.03 MNSURE; ESTABLISHMENT.

Subdivision 1.

Creation.

MNsure is created as a board under section 15.012, paragraph (a), to:

(1) promote informed consumer choice, innovation, competition, quality, value, market participation, affordability, suitable and meaningful choices, health improvement, care management, reduction of health disparities, and portability of health plans;

(2) facilitate and simplify the comparison, choice, enrollment, and purchase of health plans for individuals purchasing in the individual market through MNsure and for employees and employers purchasing in the small group market through MNsure;

(3) assist small employers with access to small business health insurance tax credits and to assist individuals with access to public health care programs, premium assistance tax credits and cost-sharing reductions, and certificates of exemption from individual responsibility requirements;

(4) facilitate the integration and transition of individuals between public health care programs and health plans in the individual or group market and develop processes that, to the maximum extent possible, provide for continuous coverage; and

(5) establish and modify as necessary a name and brand for MNsure based on market studies that show maximum effectiveness in attracting the uninsured and motivating them to take action.

Subd. 2.

Application of other law.

(a) MNsure must be reviewed by the legislative auditor under section 3.971. The legislative auditor shall audit the books, accounts, and affairs of MNsure once each year or less frequently as the legislative auditor's funds and personnel permit. Upon the audit of the financial accounts and affairs of MNsure, MNsure is liable to the state for the total cost and expenses of the audit, including the salaries paid to the examiners while actually engaged in making the examination. The legislative auditor may bill MNsure either monthly or at the completion of the audit. All collections received for the audits must be deposited in the general fund and are appropriated to the legislative auditor. Pursuant to section 3.97, subdivision 3a, the Legislative Audit Commission is requested to direct the legislative auditor to report by March 1, 2014, to the legislature on any duplication of services that occurs within state government as a result of the creation of MNsure. The legislative auditor may make recommendations on consolidating or eliminating any services deemed duplicative. The board shall reimburse the legislative auditor for any costs incurred in the creation of this report.

(b) Board members of MNsure are subject to sections 10A.07 and 10A.09. Board members and the personnel of MNsure are subject to section 10A.071.

(c) All meetings of the board and of the Minnesota Eligibility System Executive Steering Committee established under section 62V.055 shall comply with the open meeting law in chapter 13D.

(d) The board and the Web site are exempt from chapter 60K. Any employee of MNsure who sells, solicits, or negotiates insurance to individuals or small employers must be licensed as an insurance producer under chapter 60K.

(e) Section 3.3005 applies to any federal funds received by MNsure.

(f) A MNsure decision that requires a vote of the board, other than a decision that applies only to hiring of employees or other internal management of MNsure, is an "administrative action" under section 10A.01, subdivision 2.

Subd. 3.

Continued operation of a private marketplace.

(a) Nothing in this chapter shall be construed to prohibit: (1) a health carrier from offering outside of MNsure a health plan to a qualified individual or qualified employer; and (2) a qualified individual from enrolling in, or a qualified employer from selecting for its employees, a health plan offered outside of MNsure.

(b) Nothing in this chapter shall be construed to restrict the choice of a qualified individual to enroll or not enroll in a qualified health plan or to participate in MNsure. Nothing in this chapter shall be construed to compel an individual to enroll in a qualified health plan or to participate in MNsure.

(c) For purposes of this subdivision, "qualified individual" and "qualified employer" have the meanings given in section 1312 of the Affordable Care Act, Public Law 111-148, and further defined through amendments to the act and regulations issued under the act.

62V.04 GOVERNANCE.

Subdivision 1.

Board.

MNsure is governed by a board of directors with seven members.

Subd. 2.

Appointment.

(a) Board membership of MNsure consists of the following:

(1) three members appointed by the governor with the advice and consent of both the senate and the house of representatives acting separately in accordance with paragraph (d), with one member representing the interests of individual consumers eligible for individual market coverage, one member representing individual consumers eligible for public health care program coverage, and one member representing small employers. Members are appointed to serve four-year terms following the initial staggered-term lot determination;

(2) three members appointed by the governor with the advice and consent of both the senate and the house of representatives acting separately in accordance with paragraph (d) who have demonstrated expertise, leadership, and innovation in the following areas: one member representing the areas of health administration, health care finance, health plan purchasing, and health care delivery systems; one member representing the areas of public health, health disparities, public health care programs, and the uninsured; and one member representing health policy issues related to the small group and individual markets. Members are appointed to serve four-year terms following the initial staggered-term lot determination; and

(3) the commissioner of human services or a designee.

(b) Section 15.0597 shall apply to all appointments, except for the commissioner.

(c) The governor shall make appointments to the board that are consistent with federal law and regulations regarding its composition and structure. All board members appointed by the governor must be legal residents of Minnesota.

(d) Upon appointment by the governor, a board member shall exercise duties of office immediately. If both the house of representatives and the senate vote not to confirm an appointment, the appointment terminates on the day following the vote not to confirm in the second body to vote.

(e) Initial appointments shall be made by April 30, 2013.

(f) One of the six members appointed under paragraph (a), clause (1) or (2), must have experience in representing the needs of vulnerable populations and persons with disabilities.

(g) Membership on the board must include representation from outside the seven-county metropolitan area, as defined in section 473.121, subdivision 2.

Subd. 3.

Terms.

(a) Board members may serve no more than two consecutive terms, except for the commissioner or the commissioner's designee, who shall serve until replaced by the governor.

(b) A board member may resign at any time by giving written notice to the board.

(c) The appointed members under subdivision 2, paragraph (a), clauses (1) and (2), shall have an initial term of two, three, or four years, determined by lot by the secretary of state.

Subd. 4.

Conflicts of interest.

(a) Within one year prior to or at any time during their appointed term, board members appointed under subdivision 2, paragraph (a), clauses (1) and (2), shall not be employed by, be a member of the board of directors of, or otherwise be a representative of a health carrier, institutional health care provider or other entity providing health care, navigator, insurance producer, or other entity in the business of selling items or services of significant value to or through MNsure. For purposes of this paragraph, "health care provider or entity" does not include an academic institution.

(b) Board members must recuse themselves from discussion of and voting on an official matter if the board member has a conflict of interest. A conflict of interest means an association including a financial or personal association that has the potential to bias or have the appearance of biasing a board member's decisions in matters related to MNsure or the conduct of activities under this chapter.

(c) No board member shall have a spouse who is an executive of a health carrier.

(d) No member of the board may currently serve as a lobbyist, as defined under section 10A.01, subdivision 21.

Subd. 5.

Acting chair; first meeting; supervision.

(a) The governor shall designate as acting chair one of the appointees described in subdivision 2.

(b) The board shall hold its first meeting within 60 days of enactment.

(c) The board shall elect a chair to replace the acting chair at the first meeting.

Subd. 6.

Chair.

The board shall have a chair, elected by a majority of members. The chair shall serve for one year.

Subd. 7.

Officers.

The members of the board shall elect officers by a majority of members. The officers shall serve for one year.

Subd. 8.

Vacancies.

If a vacancy occurs, the governor shall appoint a new member within 90 days, and the newly appointed member shall be subject to the same confirmation process described in subdivision 2.

Subd. 9.

Removal.

(a) A board member may be removed by the appointing authority and a majority vote of the board following notice and hearing before the board. For purposes of this subdivision, the appointing authority or a designee of the appointing authority shall be a voting member of the board for purposes of constituting a quorum.

(b) A conflict of interest as defined in subdivision 4, shall be cause for removal from the board.

Subd. 10.

Meetings.

The board shall meet at least quarterly.

Subd. 11.

Quorum.

A majority of the members of the board constitutes a quorum, and the affirmative vote of a majority of members of the board is necessary and sufficient for action taken by the board.

Subd. 12.

Compensation.

(a) The board members shall be paid a salary not to exceed the salary limits established under section 15A.0815, subdivision 4. The salary for board members shall be set in accordance with this subdivision and section 15A.0815, subdivision 5. This paragraph expires December 31, 2015.

(b) Beginning January 1, 2016, the board members may be compensated in accordance with section 15.0575.

Subd. 13.

Advisory committees.

(a) The board shall establish and maintain advisory committees to provide insurance producers, health care providers, the health care industry, consumers, and other stakeholders with the opportunity to advise the board regarding the operation of MNsure as required under section 1311(d)(6) of the Affordable Care Act, Public Law 111-148. The board shall regularly consult with the advisory committees. The advisory committees established under this paragraph shall not expire.

(b) The board may establish additional advisory committees, as necessary, to gather and provide information to the board in order to facilitate the operation of MNsure. The advisory committees established under this paragraph shall not expire, except by action of the board.

(c) Section 15.0597 shall not apply to any advisory committee established by the board under this subdivision.

(d) The board may provide compensation and expense reimbursement under section 15.059, subdivision 3, to members of the advisory committees.

62V.05 RESPONSIBILITIES AND POWERS OF MNSURE.

Subdivision 1.

General.

(a) The board shall operate MNsure according to this chapter and applicable state and federal law.

(b) The board has the power to:

(1) employ personnel and delegate administrative, operational, and other responsibilities to the director and other personnel as deemed appropriate by the board. This authority is subject to chapters 43A and 179A. The director and managerial staff of MNsure shall serve in the unclassified service and shall be governed by a compensation plan prepared by the board, submitted to the commissioner of management and budget for review and comment within 14 days of its receipt, and approved by the Legislative Coordinating Commission and the legislature under section 3.855, except that section 15A.0815, subdivision 5, paragraph (e), shall not apply;

(2) establish the budget of MNsure;

(3) seek and accept money, grants, loans, donations, materials, services, or advertising revenue from government agencies, philanthropic organizations, and public and private sources to fund the operation of MNsure. No health carrier or insurance producer shall advertise on MNsure;

(4) contract for the receipt and provision of goods and services;

(5) enter into information-sharing agreements with federal and state agencies and other entities, provided the agreements include adequate protections with respect to the confidentiality and integrity of the information to be shared, and comply with all applicable state and federal laws, regulations, and rules, including the requirements of section 62V.06; and

(6) exercise all powers reasonably necessary to implement and administer the requirements of this chapter and the Affordable Care Act, Public Law 111-148.

(c) The board shall establish policies and procedures to gather public comment and provide public notice in the State Register.

(d) Within 180 days of enactment, the board shall establish bylaws, policies, and procedures governing the operations of MNsure in accordance with this chapter.

Subd. 2.

Operations funding.

(a) Prior to January 1, 2015, MNsure shall retain or collect up to 1.5 percent of total premiums for individual and small group market health plans and dental plans sold through MNsure to fund the cash reserves of MNsure, but the amount collected shall not exceed a dollar amount equal to 25 percent of the funds collected under section 62E.11, subdivision 6, for calendar year 2012.

(b) Beginning January 1, 2015, MNsure shall retain or collect up to 3.5 percent of total premiums for individual and small group market health plans and dental plans sold through MNsure to fund the operations of MNsure, but the amount collected shall not exceed a dollar amount equal to 50 percent of the funds collected under section 62E.11, subdivision 6, for calendar year 2012.

(c) Beginning January 1, 2016, MNsure shall retain or collect up to 3.5 percent of total premiums for individual and small group market health plans and dental plans sold through MNsure to fund the operations of MNsure, but the amount collected may never exceed a dollar amount greater than 100 percent of the funds collected under section 62E.11, subdivision 6, for calendar year 2012.

(d) For fiscal years 2014 and 2015, the commissioner of management and budget is authorized to provide cash flow assistance of up to $20,000,000 from the special revenue fund or the statutory general fund under section 16A.671, subdivision 3, paragraph (a), to MNsure. Any funds provided under this paragraph shall be repaid, with interest, by June 30, 2015.

(e) Funding for the operations of MNsure shall cover any compensation provided to navigators participating in the navigator program.

Subd. 3.

Insurance producers.

(a) By April 30, 2013, the board, in consultation with the commissioner of commerce, shall establish certification requirements that must be met by insurance producers in order to assist individuals and small employers with purchasing coverage through MNsure. Prior to January 1, 2015, the board may amend the requirements, only if necessary, due to a change in federal rules.

(b) Certification requirements shall not exceed the requirements established under Code of Federal Regulations, title 45, part 155.220. Certification shall include training on health plans available through MNsure, available tax credits and cost-sharing arrangements, compliance with privacy and security standards, eligibility verification processes, online enrollment tools, and basic information on available public health care programs. Training required for certification under this subdivision shall qualify for continuing education requirements for insurance producers required under chapter 60K, and must comply with course approval requirements under chapter 45.

(c) Producer compensation shall be established by health carriers that provide health plans through MNsure. The structure of compensation to insurance producers must be similar for health plans sold through MNsure and outside MNsure.

(d) Any insurance producer compensation structure established by a health carrier for the small group market must include compensation for defined contribution plans that involve multiple health carriers. The compensation offered must be commensurate with other small group market defined health plans.

(e) Any insurance producer assisting an individual or small employer with purchasing coverage through MNsure must disclose, orally and in writing, to the individual or small employer at the time of the first solicitation with the prospective purchaser the following:

(1) the health carriers and qualified health plans offered through MNsure that the producer is authorized to sell, and that the producer may not be authorized to sell all the qualified health plans offered through MNsure;

(2) that the producer may be receiving compensation from a health carrier for enrolling the individual or small employer into a particular health plan; and

(3) that information on all qualified health plans offered through MNsure is available through the MNsure Web site.

For purposes of this paragraph, "solicitation" means any contact by a producer, or any person acting on behalf of a producer made for the purpose of selling or attempting to sell coverage through MNsure. If the first solicitation is made by telephone, the disclosures required under this paragraph need not be made in writing, but the fact that disclosure has been made must be acknowledged on the application.

(f) Beginning January 15, 2015, each health carrier that offers or sells qualified health plans through MNsure shall report in writing to the board and the commissioner of commerce the compensation and other incentives it offers or provides to insurance producers with regard to each type of health plan the health carrier offers or sells both inside and outside of MNsure. Each health carrier shall submit a report annually and upon any change to the compensation or other incentives offered or provided to insurance producers.

(g) Nothing in this chapter shall prohibit an insurance producer from offering professional advice and recommendations to a small group purchaser based upon information provided to the producer.

(h) An insurance producer that offers health plans in the small group market shall notify each small group purchaser of which group health plans qualify for Internal Revenue Service approved section 125 tax benefits. The insurance producer shall also notify small group purchasers of state law provisions that benefit small group plans when the employer agrees to pay 50 percent or more of its employees' premium. Individuals who are eligible for cost-effective medical assistance will count toward the 75 percent participation requirement in section 62L.03, subdivision 3.

(i) Nothing in this subdivision shall be construed to limit the licensure requirements or regulatory functions of the commissioner of commerce under chapter 60K.

Subd. 4.

Navigator; in-person assisters; call center.

(a) The board shall establish policies and procedures for the ongoing operation of a navigator program, in-person assister program, call center, and customer service provisions for MNsure to be implemented beginning January 1, 2015.

(b) Until the implementation of the policies and procedures described in paragraph (a), the following shall be in effect:

(1) the navigator program shall be met by section 256.962;

(2) entities eligible to be navigators, including entities defined in Code of Federal Regulations, title 45, part 155.210 (c)(2), may serve as in-person assisters;

(3) the board shall establish requirements and compensation for the navigator program and the in-person assister program by April 30, 2013. Compensation for navigators and in-person assisters must take into account any other compensation received by the navigator or in-person assister for conducting the same or similar services; and

(4) call center operations shall utilize existing state resources and personnel, including referrals to counties for medical assistance.

(c) The board shall establish a toll-free number for MNsure and may hire and contract for additional resources as deemed necessary.

(d) The navigator program and in-person assister program must meet the requirements of section 1311(i) of the Affordable Care Act, Public Law 111-148. In establishing training standards for the navigators and in-person assisters, the board must ensure that all entities and individuals carrying out navigator and in-person assister functions have training in the needs of underserved and vulnerable populations; eligibility and enrollment rules and procedures; the range of available public health care programs and qualified health plan options offered through MNsure; and privacy and security standards. For calendar year 2014, the commissioner of human services shall ensure that the navigator program under section 256.962 provides application assistance for both qualified health plans offered through MNsure and public health care programs.

(e) The board must ensure that any information provided by navigators, in-person assisters, the call center, or other customer assistance portals be accessible to persons with disabilities and that information provided on public health care programs include information on other coverage options available to persons with disabilities.

Subd. 5.

Health carrier and health plan requirements; participation.

(a) Beginning January 1, 2015, the board may establish certification requirements for health carriers and health plans to be offered through MNsure that satisfy federal requirements under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.

(b) Paragraph (a) does not apply if by June 1, 2013, the legislature enacts regulatory requirements that:

(1) apply uniformly to all health carriers and health plans in the individual market;

(2) apply uniformly to all health carriers and health plans in the small group market; and

(3) satisfy minimum federal certification requirements under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.

(c) In accordance with section 1311(e) of the Affordable Care Act, Public Law 111-148, the board shall establish policies and procedures for certification and selection of health plans to be offered as qualified health plans through MNsure. The board shall certify and select a health plan as a qualified health plan to be offered through MNsure, if:

(1) the health plan meets the minimum certification requirements established in paragraph (a) or the market regulatory requirements in paragraph (b);

(2) the board determines that making the health plan available through MNsure is in the interest of qualified individuals and qualified employers;

(3) the health carrier applying to offer the health plan through MNsure also applies to offer health plans at each actuarial value level and service area that the health carrier currently offers in the individual and small group markets; and

(4) the health carrier does not apply to offer health plans in the individual and small group markets through MNsure under a separate license of a parent organization or holding company under section 60D.15, that is different from what the health carrier offers in the individual and small group markets outside MNsure.

(d) In determining the interests of qualified individuals and employers under paragraph (c), clause (2), the board may not exclude a health plan for any reason specified under section 1311(e)(1)(B) of the Affordable Care Act, Public Law 111-148. The board may consider:

(1) affordability;

(2) quality and value of health plans;

(3) promotion of prevention and wellness;

(4) promotion of initiatives to reduce health disparities;

(5) market stability and adverse selection;

(6) meaningful choices and access;

(7) alignment and coordination with state agency and private sector purchasing strategies and payment reform efforts; and

(8) other criteria that the board determines appropriate.

(e) For qualified health plans offered through MNsure on or after January 1, 2015, the board shall establish policies and procedures under paragraphs (c) and (d) for selection of health plans to be offered as qualified health plans through MNsure by February 1 of each year, beginning February 1, 2014. The board shall consistently and uniformly apply all policies and procedures and any requirements, standards, or criteria to all health carriers and health plans. For any policies, procedures, requirements, standards, or criteria that are defined as rules under section 14.02, subdivision 4, the board may use the process described in subdivision 9.

(f) For 2014, the board shall not have the power to select health carriers and health plans for participation in MNsure. The board shall permit all health plans that meet the certification requirements under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148, to be offered through MNsure.

(g) Under this subdivision, the board shall have the power to verify that health carriers and health plans are properly certified to be eligible for participation in MNsure.

(h) The board has the authority to decertify health carriers and health plans that fail to maintain compliance with section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.

(i) For qualified health plans offered through MNsure beginning January 1, 2015, health carriers must use the most current addendum for Indian health care providers approved by the Centers for Medicare and Medicaid Services and the tribes as part of their contracts with Indian health care providers. MNsure shall comply with all future changes in federal law with regard to health coverage for the tribes.

Subd. 6.

Appeals.

(a) The board may conduct hearings, appoint hearing officers, and recommend final orders related to appeals of any MNsure determinations, except for those determinations identified in paragraph (d). An appeal by a health carrier regarding a specific certification or selection determination made by MNsure under subdivision 5 must be conducted as a contested case proceeding under chapter 14, with the report or order of the administrative law judge constituting the final decision in the case, subject to judicial review under sections 14.63 to 14.69. For other appeals, the board shall establish hearing processes which provide for a reasonable opportunity to be heard and timely resolution of the appeal and which are consistent with the requirements of federal law and guidance. An appealing party may be represented by legal counsel at these hearings, but this is not a requirement.

(b) MNsure may establish service-level agreements with state agencies to conduct hearings for appeals. Notwithstanding section 471.59, subdivision 1, a state agency is authorized to enter into service-level agreements for this purpose with MNsure.

(c) For proceedings under this subdivision, MNsure may be represented by an attorney who is an employee of MNsure.

(d) This subdivision does not apply to appeals of determinations where a state agency hearing is available under section 256.045.

(e) An appellant aggrieved by an order of MNsure issued in an eligibility appeal, as defined in Minnesota Rules, part 7700.0101, may appeal the order to the district court of the appellant's county of residence by serving a written copy of a notice of appeal upon MNsure and any other adverse party of record within 30 days after the date MNsure issued the order, the amended order, or order affirming the original order, and by filing the original notice and proof of service with the court administrator of the district court. Service may be made personally or by mail; service by mail is complete upon mailing; no filing fee shall be required by the court administrator in appeals taken pursuant to this subdivision. MNsure shall furnish all parties to the proceedings with a copy of the decision and a transcript of any testimony, evidence, or other supporting papers from the hearing held before the appeals examiner within 45 days after service of the notice of appeal.

(f) Any party aggrieved by the failure of an adverse party to obey an order issued by MNsure may compel performance according to the order in the manner prescribed in sections 586.01 to 586.12.

(g) Any party may obtain a hearing at a special term of the district court by serving a written notice of the time and place of the hearing at least ten days prior to the date of the hearing. The court may consider the matter in or out of chambers, and shall take no new or additional evidence unless it determines that such evidence is necessary for a more equitable disposition of the appeal.

(h) Any party aggrieved by the order of the district court may appeal the order as in other civil cases. No costs or disbursements shall be taxed against any party nor shall any filing fee or bond be required of any party.

(i) If MNsure or district court orders eligibility for qualified health plan coverage through MNsure, or eligibility for federal advance payment of premium tax credits or cost-sharing reductions contingent upon full payment of respective premiums, the premiums must be paid or provided pending appeal to the district court, Court of Appeals, or Supreme Court. Provision of eligibility by MNsure pending appeal does not render moot MNsure's position in a court of law.

Subd. 7.

Agreements; consultation.

(a) The board shall:

(1) establish and maintain an agreement with the commissioner of human services for cost allocation and services regarding eligibility determinations and enrollment for public health care programs that use a modified adjusted gross income standard to determine program eligibility. The board may establish and maintain an agreement with the commissioner of human services for other services;

(2) establish and maintain an agreement with the commissioners of commerce and health for services regarding enforcement of MNsure certification requirements for health plans and dental plans offered through MNsure. The board may establish and maintain agreements with the commissioners of commerce and health for other services; and

(3) establish interagency agreements to transfer funds to other state agencies for their costs related to implementing and operating MNsure, excluding medical assistance allocatable costs.

(b) The board shall consult with the commissioners of commerce and health regarding the operations of MNsure.

(c) The board shall consult with Indian tribes and organizations regarding the operation of MNsure.

(d) Beginning March 15, 2016, and each March 15 thereafter, the board shall submit a report to the chairs and ranking minority members of the committees in the senate and house of representatives with primary jurisdiction over commerce, health, and human services on all the agreements entered into with the chief information officer of the Office of MN.IT Services, or the commissioners of human services, health, or commerce in accordance with this subdivision. The report shall include the agency in which the agreement is with; the time period of the agreement; the purpose of the agreement; and a summary of the terms of the agreement. A copy of the agreement must be submitted to the extent practicable.

Subd. 8.

Rulemaking.

The board may adopt rules to implement any provisions in this chapter using the expedited rulemaking process in section 14.389.

Subd. 9.

Dental plans.

(a) The provisions of this section that apply to health plans shall apply to dental plans offered as stand-alone dental plans through MNsure, to the extent practicable.

(b) A stand-alone dental plan offered through MNsure must meet all certification requirements under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148, that are applicable to health plans, except for certification requirements that cannot be met because the dental plan only covers dental benefits.

Subd. 10.

Limitations; risk-bearing.

(a) The board shall not bear insurance risk or enter into any agreement with health care providers to pay claims.

(b) Nothing in this subdivision shall prevent MNsure from providing insurance for its employees.

Subd. 11.

Prohibition on other product lines.

MNsure is prohibited from certifying, selecting, or offering products and policies of coverage that do not meet the definition of health plan or dental plan as provided in section 62V.02.

Subd. 12.

Reports on interagency agreements and intra-agency transfers.

The MNsure Board shall provide quarterly reports to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and finance on:

(1) interagency agreements or service-level agreements and any renewals or extensions of existing interagency or service-level agreements with a state department under section 15.01, state agency under section 15.012, or the Office of MN.IT Services, with a value of more than $100,000, or related agreements with the same department or agency with a cumulative value of more than $100,000; and

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

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

62V.051 MNSURE; CONSUMER RETROACTIVE APPOINTMENT OF A NAVIGATOR OR PRODUCER PERMITTED.

Notwithstanding any other law or rule to the contrary, for up to six months after the effective date of the qualified health plan, MNsure must permit a qualified health plan policyholder, who has not designated a navigator or an insurance producer, to retroactively appoint a navigator or insurance producer. MNsure must provide notice of the retroactive appointment to the health carrier. The health carrier must retroactively pay commissions to the insurance producer if the producer can demonstrate that they were certified by MNsure at the time of the original enrollment, were appointed by the selected health carrier at the time of the enrollment, and that an agent of record agreement was executed prior to or at the time of the effective date of the policy. MNsure must adopt a standard form of agent of record agreement for purposes of this section.

62V.055 MINNESOTA ELIGIBILITY SYSTEM EXECUTIVE STEERING COMMITTEE.

Subdivision 1.

Definition; Minnesota eligibility system.

For purposes of this section, "Minnesota eligibility system" means the system that supports eligibility determinations using a modified adjusted gross income methodology for medical assistance under section 256B.056, subdivision 1a, paragraph (b), clause (1); MinnesotaCare under chapter 256L; and qualified health plan enrollment under section 62V.05, subdivision 5, paragraph (c).

Subd. 2.

Establishment; committee membership; costs.

(a) The Minnesota Eligibility System Executive Steering Committee is established to provide recommendations to the MNsure board, the commissioner of human services, and the commissioner of MN.IT services on the governance, administration, and business operations of the Minnesota eligibility system. The steering committee shall be composed of:

(1) two members appointed by the commissioner of human services;

(2) two members appointed by the board;

(3) two members appointed jointly by the Association of Minnesota Counties, the Minnesota Inter-County Association, and the Minnesota Association of County Social Service Administrators. One member appointed under this clause shall represent counties within the seven-county metropolitan area, and one member shall represent counties outside the seven-county metropolitan area; and

(4) two nonvoting members appointed by the commissioner of MN.IT services.

(b) One member appointed by the commissioner of human services and one member appointed by the commissioner of MN.IT services shall serve as co-chairpersons for the steering committee.

(c) Steering committee costs must be paid from the budgets of the Department of Human Services, the Office of MN.IT Services, and MNsure.

Subd. 3.

Duties.

The Minnesota Eligibility System Executive Steering Committee shall provide recommendations on an overall governance structure for the Minnesota eligibility system and the ongoing administration and business operations of the Minnesota eligibility system. The steering committee shall make recommendations on setting system goals and priorities, allocating the system's resources, making major system decisions, and tracking total funding and expenditures for the system from all sources. The steering committee shall also report to the Legislative Oversight Committee on a quarterly basis on Minnesota eligibility system funding and expenditures, including amounts received in the most recent quarter by funding source and expenditures made in the most recent quarter by funding source.

Subd. 4.

Meetings.

(a) All meetings of the steering committee must:

(1) be held in the State Office Building, the Minnesota Senate Building, or when approved by the Legislative Oversight Committee, another public location with the capacity to live stream steering committee meetings; and

(2) whenever possible, be made available on a Web site for live audio or video streaming and be archived on a Web site for playback at a later time.

(b) The steering committee must:

(1) as part of every steering committee meeting, provide the opportunity for oral and written public testimony and comments on steering committee recommendations for the governance, administration, and business operations of the Minnesota eligibility system; and

(2) provide documents under discussion or review by the steering committee to be electronically posted on MNsure's Web site. Documents must be provided and posted prior to the meeting at which the documents are scheduled for review or discussion.

(c) All votes of the steering committee must be recorded, with each member's vote identified.

Subd. 5.

Administrative structure.

The Office of MN.IT Services shall be responsible for the design, build, maintenance, operation, and upgrade of the information technology for the Minnesota eligibility system. In carrying out its duties, the office shall consider recommendations made by the steering committee.

62V.06 DATA PRACTICES.

Subdivision 1.

Applicability.

MNsure is a state agency for purposes of the Minnesota Government Data Practices Act and is subject to all provisions of chapter 13, in addition to the requirements contained in this section.

Subd. 2.

Definitions.

As used in this section:

(1) "individual" means an individual according to section 13.02, subdivision 8, but does not include a vendor of services; and

(2) "participating" means that an individual, employee, or employer is seeking, or has sought an eligibility determination, enrollment processing, or premium processing through MNsure.

Subd. 3.

General data classifications.

The following data collected, created, or maintained by MNsure are classified as private data on individuals, as defined in section 13.02, subdivision 12, or nonpublic data, as defined in section 13.02, subdivision 9:

(1) data on any individual participating in MNsure;

(2) data on any individuals participating in MNsure as employees of an employer participating in MNsure; and

(3) data on employers participating in MNsure.

Subd. 4.

Application and certification data.

(a) Data submitted by an insurance producer in an application for certification to sell a health plan through MNsure, or submitted by an applicant seeking permission or a commission to act as a navigator or in-person assister, are classified as follows:

(1) at the time the application is submitted, all data contained in the application are private data, as defined in section 13.02, subdivision 12, or nonpublic data as defined in section 13.02, subdivision 9, except that the name of the applicant is public; and

(2) upon a final determination related to the application for certification by MNsure, all data contained in the application are public, with the exception of trade secret data as defined in section 13.37.

(b) Data created or maintained by a government entity as part of the evaluation of an application are protected nonpublic data, as defined in section 13.02, subdivision 13, until a final determination as to certification is made and all rights of appeal have been exhausted. Upon a final determination and exhaustion of all rights of appeal, these data are public, with the exception of trade secret data as defined in section 13.37 and data subject to attorney-client privilege or other protection as provided in section 13.393.

(c) If an application is denied, the public data must include the criteria used by the board to evaluate the application and the specific reasons for the denial, and these data must be published on the MNsure Web site.

Subd. 5.

Data sharing.

(a) MNsure may share or disseminate data classified as private or nonpublic in subdivision 3 as follows:

(1) to the subject of the data, as provided in section 13.04;

(2) according to a court order;

(3) according to a state or federal law specifically authorizing access to the data;

(4) with other state or federal agencies, only to the extent necessary to verify the identity of, determine the eligibility of, process premiums for, process enrollment of, or investigate fraud related to an individual, employer, or employee participating in MNsure, provided that MNsure must enter into a data-sharing agreement with the agency prior to sharing data under this clause; and

(5) with a nongovernmental person or entity, only to the extent necessary to verify the identity of, determine the eligibility of, process premiums for, process enrollment of, or investigate fraud related to an individual, employer, or employee participating in MNsure, provided that MNsure must enter into a contract with the person or entity, as provided in section 13.05, subdivision 6 or 11, prior to disseminating data under this clause.

(b) MNsure may share or disseminate data classified as private or nonpublic in subdivision 4 as follows:

(1) to the subject of the data, as provided in section 13.04;

(2) according to a court order;

(3) according to a state or federal law specifically authorizing access to the data;

(4) with other state or federal agencies, only to the extent necessary to carry out the functions of MNsure, provided that MNsure must enter into a data-sharing agreement with the agency prior to sharing data under this clause; and

(5) with a nongovernmental person or entity, only to the extent necessary to carry out the functions of MNsure, provided that MNsure must enter a contract with the person or entity, as provided in section 13.05, subdivision 6 or 11, prior to disseminating data under this clause.

(c) Sharing or disseminating data outside of MNsure in a manner not authorized by this subdivision is prohibited. The list of authorized dissemination and sharing contained in this subdivision must be included in the Tennessen warning required by section 13.04, subdivision 2.

(d) Until July 1, 2014, state agencies must share data classified as private or nonpublic on individuals, employees, or employers participating in MNsure with MNsure, only to the extent such data are necessary to verify the identity of, determine the eligibility of, process premiums for, process enrollment of, or investigate fraud related to a MNsure participant. The agency must enter into a data-sharing agreement with MNsure prior to sharing any data under this paragraph.

Subd. 6.

Notice and disclosures.

(a) In addition to the Tennessen warning required by section 13.04, subdivision 2, MNsure must provide any data subject asked to supply private data with:

(1) a notice of rights related to the handling of genetic information, pursuant to section 13.386; and

(2) a notice of the records retention policy of MNsure, detailing the length of time MNsure will retain data on the individual and the manner in which it will be destroyed upon expiration of that time.

(b) All notices required by this subdivision, including the Tennessen warning, must be provided in an electronic format suitable for downloading or printing.

Subd. 7.

Summary data.

In addition to creation and disclosure of summary data derived from private data on individuals, as permitted by section 13.05, subdivision 7, MNsure may create and disclose summary data derived from data classified as nonpublic under this section.

Subd. 8.

Access to data; audit trail.

(a) Only individuals with explicit authorization from the board may enter, update, or access not public data collected, created, or maintained by MNsure. The ability of authorized individuals to enter, update, or access data must be limited through the use of role-based access that corresponds to the official duties or training level of the individual, and the statutory authorization that grants access for that purpose. All queries and responses, and all actions in which data are entered, updated, accessed, or shared or disseminated outside of MNsure, must be recorded in a data audit trail. Data contained in the audit trail are public, to the extent that the data are not otherwise classified by this section.

The board shall immediately and permanently revoke the authorization of any individual determined to have willfully entered, updated, accessed, shared, or disseminated data in violation of this section, or any provision of chapter 13. If an individual is determined to have willfully gained access to data without explicit authorization from the board, the board shall forward the matter to the county attorney for prosecution.

(b) This subdivision shall not limit or affect the authority of the legislative auditor to access data needed to conduct audits, evaluations, or investigations of MNsure or the obligation of the board and MNsure employees to comply with section 3.978, subdivision 2.

(c) This subdivision does not apply to actions taken by a MNsure participant to enter, update, or access data held by MNsure, if the participant is the subject of the data that is entered, updated, or accessed.

Subd. 9.

Sale of data prohibited.

MNsure may not sell any data collected, created, or maintained by MNsure, regardless of its classification, for commercial or any other purposes.

Subd. 10.

Gun and firearm ownership.

MNsure shall not collect information that indicates whether or not an individual owns a gun or has a firearm in the individual's home.

62V.07 FUNDS.

(a) The MNsure account is created in the special revenue fund of the state treasury. All funds received by MNsure shall be deposited in the account. Funds in the account are appropriated to MNsure for the operation of MNsure. Notwithstanding section 11A.20, all investment income and all investment losses attributable to the investment of the MNsure account not currently needed, shall be credited to the MNsure account.

(b) The budget submitted to the legislature under section 16A.11 must include budget information for MNsure.

62V.08 REPORTS.

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

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

62V.09 EXPIRATION AND SUNSET EXCLUSION.

Notwithstanding section 15.059, the board and its advisory committees shall not expire, except as specified in section 62V.04, subdivision 13. The board and its advisory committees are not subject to review or sunsetting under chapter 3D.

62V.10 RIGHT NOT TO PARTICIPATE.

Nothing in this chapter infringes on the right of a Minnesota citizen not to participate in MNsure.

62V.11 LEGISLATIVE OVERSIGHT COMMITTEE.

Subdivision 1.

Legislative oversight.

(a) The Legislative Oversight Committee is established to provide oversight to the implementation of this chapter and the operation of MNsure.

(b) The committee shall review the operations of MNsure at least annually and shall recommend necessary changes in policy, implementation, and statutes to the board and to the legislature.

(c) MNsure shall present to the committee the annual report required in section 62V.08, the appeals process under section 62V.05, subdivision 6, and the actions taken regarding the treatment of multiemployer plans.

Subd. 2.

Membership; meetings; compensation.

(a) The Legislative Oversight Committee shall consist of five members of the senate, three members appointed by the majority leader of the senate, and two members appointed by the minority leader of the senate; and five members of the house of representatives, three members appointed by the speaker of the house, and two members appointed by the minority leader of the house of representatives.

(b) Appointed legislative members serve at the pleasure of the appointing authority and shall continue to serve until their successors are appointed.

(c) The first meeting of the committee shall be convened by the chair of the Legislative Coordinating Commission. Members shall elect a chair at the first meeting. The chair must convene at least one meeting annually, and may convene other meetings as deemed necessary.

Subd. 4.

Review of costs.

The board shall submit for review the annual budget of MNsure for the next fiscal year by March 15 of each year, beginning March 15, 2014.

Subd. 5.

Review of Minnesota eligibility system funding and expenditures.

The committee shall review quarterly reports submitted by the Minnesota Eligibility System Executive Steering Committee under section 62V.055, subdivision 3, regarding Minnesota eligibility system funding and expenditures.

119B.16 FAIR HEARING PROCESS.

Subd. 2.

Informal conference.

The county agency shall offer an informal conference to applicants and recipients adversely affected by an agency action to attempt to resolve the dispute. The county agency shall offer an informal conference to providers to whom the county agency has assigned responsibility for an overpayment in an attempt to resolve the dispute. The county agency or the provider may ask the family in whose case the overpayment arose to participate in the informal conference, but the family may refuse to do so. The county agency shall advise adversely affected applicants, recipients, and providers that a request for a conference with the agency is optional and does not delay or replace the right to a fair hearing.

144.4961 MINNESOTA RADON LICENSING ACT.

Subdivision 1.

Citation.

This section may be cited as the "Minnesota Radon Licensing Act."

Subd. 2.

Definitions.

(a) As used in this section, the following terms have the meanings given them.

(b) "Mitigation" means the act of repairing or altering a building or building design for the purpose in whole or in part of reducing the concentration of radon in the indoor atmosphere.

(c) "Radon" means both the radioactive, gaseous element produced by the disintegration of radium, and the short-lived radionuclides that are decay products of radon.

Subd. 3.

Rulemaking.

The commissioner of health shall adopt rules establishing licensure requirements and work standards relating to indoor radon in dwellings and other buildings, with the exception of newly constructed Minnesota homes according to section 326B.106, subdivision 6. The commissioner shall coordinate, oversee, and implement all state functions in matters concerning the presence, effects, measurement, and mitigation of risks of radon in dwellings and other buildings.

Subd. 4.

System tag.

All radon mitigation systems installed in Minnesota on or after January 1, 2018, must have a radon mitigation system tag provided by the commissioner. A radon mitigation professional must attach the tag to the radon mitigation system in a visible location.

Subd. 5.

License required annually.

Effective January 1, 2018, a license is required annually for every person, firm, or corporation that performs a service for compensation to detect the presence of radon in the indoor atmosphere, performs laboratory analysis, or performs a service to mitigate radon in the indoor atmosphere.

Subd. 6.

Exemptions.

This section does not apply to:

(1) employees of a firm or corporation that installs radon control systems in newly constructed Minnesota homes as specified in subdivision 11;

(2) a person authorized as a building official under Minnesota Rules, part 1300.0070, or that person's designee; or

(3) any person, firm, corporation, or entity that distributes radon testing devices or information for general educational purposes.

Subd. 7.

License applications and other reports.

The professionals, companies, and laboratories listed in subdivision 8 must submit applications for licenses, system tags, and any other reporting required under this section and Minnesota Rules on forms prescribed by the commissioner.

Subd. 8.

Licensing fees.

(a) All radon license applications submitted to the commissioner of health must be accompanied by the required fees. If the commissioner determines that insufficient fees were paid, the necessary additional fees must be paid before the commissioner approves the application. The commissioner shall charge the following fees for each radon license:

(1) Each measurement professional license, $150 per year. "Measurement professional" means any person who performs a test to determine the presence and concentration of radon in a building the person does not own or lease.

(2) Each mitigation professional license, $250 per year. "Mitigation professional" means an individual who installs or designs a radon mitigation system in a building the individual does not own or lease, or provides on-site supervision of radon mitigation and mitigation technicians. "On-site supervision" means a review at the property of mitigation work upon completion of the work and attachment of a system tag. Employees or subcontractors who are supervised by a licensed mitigation professional are not required to be licensed under this clause. This license also permits the licensee to perform the activities of a measurement professional described in clause (1).

(3) Each mitigation company license, $100 per year. "Mitigation company" means any business or government entity that performs or authorizes employees to perform radon mitigation. This fee is waived if the mitigation company employs only one licensed mitigation professional.

(4) Each radon analysis laboratory license, $500 per year. "Radon analysis laboratory" means a business entity or government entity that analyzes passive radon detection devices to determine the presence and concentration of radon in the devices. This fee is waived if the laboratory is a government entity and is only distributing test kits for the general public to use in Minnesota.

(5) Each Minnesota Department of Health radon mitigation system tag, $75 per tag. "Minnesota Department of Health radon mitigation system tag" or "system tag" means a unique identifiable radon system label provided by the commissioner of health.

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

Subd. 9.

Enforcement.

The commissioner shall enforce this section under the provisions of sections 144.989 to 144.993.

Subd. 10.

Local inspections or permits.

This section does not preclude local units of government from requiring additional permits or inspections for radon control systems, and does not supersede any local inspection or permit requirements.

Subd. 11.

Application; newly constructed homes.

This section does not apply to newly constructed Minnesota homes according to section 326B.106, subdivision 6, prior to the issuance of a certificate of occupancy.

147.0375 MEDICAL FACULTY LICENSE.

Subd. 7.

Expiration.

This section expires July 1, 2018.

148.211 LICENSING.

Subd. 1b.

Advanced practice registered nurse grandfather provision.

(a) The board shall issue a license to an applicant who does not meet the education requirements in subdivision 1a, paragraph (c), clause (3), if the applicant:

(1) is recognized by the board to practice as an advanced practice registered nurse in this state on July 1, 2014;

(2) submits an application to the board in a format prescribed by the board and the applicable fee as determined under section 148.243 by January 1, 2015; and

(3) meets the requirements under subdivision 1a, paragraph (c), clauses (1), (2), (4), (5), and (6).

(b) An advanced practice registered nurse licensed under this subdivision shall maintain all practice privileges provided to licensed advanced practice registered nurses under this chapter.

148.243 FEE AMOUNTS.

Subd. 15.

Practicing without current APRN certification.

The fee for practicing without current APRN certification is $200 for the first month or any part thereof, plus $100 for each subsequent month or part thereof.

148.906 LEVELS OF PRACTICE.

The board may grant licenses for levels of psychological practice to be known as (1) licensed psychologist and (2) licensed psychological practitioner.

148.907 LICENSED PSYCHOLOGIST.

Subd. 5.

Converting from licensed psychological practitioner to licensed psychologist.

Notwithstanding subdivision 3, to convert from licensure as a licensed psychological practitioner to licensure as a licensed psychologist, a licensed psychological practitioner shall have:

(1) completed an application provided by the board for conversion from licensure as a licensed psychological practitioner to licensure as a licensed psychologist;

(2) paid a nonrefundable fee of $500;

(3) documented successful completion of two full years, or the equivalent, of supervised postlicensure employment meeting the requirements of section 148.925, subdivision 5, as it relates to preparation for licensure as a licensed psychologist as follows:

(i) for individuals licensed as licensed psychological practitioners on or before December 31, 2006, the supervised practice must be completed by December 31, 2010; and

(ii) for individuals licensed as licensed psychological practitioners after December 31, 2006, the supervised practice must be completed within four years from the date of licensure; and

(4) no unresolved disciplinary action or complaints pending, or incomplete disciplinary orders or corrective action agreements in Minnesota or any other jurisdiction.

148.908 LICENSED PSYCHOLOGICAL PRACTITIONER.

Subdivision 1.

Scope of practice.

A licensed psychological practitioner shall practice only under supervision that satisfies the requirements of section 148.925 and while employed by either a licensed psychologist or a health care or social service agency which employs or contracts with a supervising licensed psychologist who shares clinical responsibility for the care provided by the licensed psychological practitioner.

Subd. 2.

Requirements for licensure as licensed psychological practitioner.

To become licensed by the board as a licensed psychological practitioner, an applicant shall comply with the following requirements:

(1) have earned a doctoral or master's degree or the equivalent of a master's degree in a doctoral program with a major in psychology from a regionally accredited educational institution meeting the standards the board has established by rule. The degree requirements must be completed by December 31, 2005;

(2) complete an application for admission to the examination for professional practice in psychology and pay the nonrefundable application fee by December 31, 2005;

(3) complete an application for admission to the professional responsibility examination and pay the nonrefundable application fee by December 31, 2005;

(4) pass the examination for professional practice in psychology by December 31, 2006;

(5) pass the professional responsibility examination by December 31, 2006;

(6) complete an application for licensure as a licensed psychological practitioner and pay the nonrefundable application fee by March 1, 2007; and

(7) have attained the age of majority, be of good moral character, and have no unresolved disciplinary action or complaints pending in the state of Minnesota or any other jurisdiction.

Subd. 3.

Termination of licensure.

Effective December 31, 2011, the licensure of all licensed psychological practitioners shall be terminated without further notice and licensure as a licensed psychological practitioner in Minnesota shall be eliminated.

148.909 LICENSURE FOR VOLUNTEER PRACTICE.

Subd. 7.

Continuing education requirements.

A provider licensed under this section is subject to the same continuing education requirements as a licensed psychologist under section 148.911.

148.96 PRESENTATION TO PUBLIC.

Subd. 4.

Persons or techniques not regulated by this board.

(a) Nothing in sections 148.88 to 148.98 shall be construed to limit the occupational pursuits consistent with their training and codes of ethics of professionals such as teachers in recognized public and private schools, members of the clergy, physicians, social workers, school psychologists, alcohol or drug counselors, optometrists, or attorneys. However, in such performance any title used shall be in accordance with section 148.96.

(b) Use of psychological techniques by business and industrial organizations for their own personnel purposes or by employment agencies or state vocational rehabilitation agencies for the evaluation of their own clients prior to recommendation for employment is also specifically allowed. However, no representative of an industrial or business firm or corporation may sell, offer, or provide any psychological services as specified in section 148.89 unless such services are performed or supervised by individuals licensed under sections 148.88 to 148.98.

Subd. 5.

Other professions not authorized.

Nothing in sections 148.88 to 148.98 shall be construed to authorize a person licensed under sections 148.88 to 148.98 to engage in the practice of any profession regulated under Minnesota law unless the person is duly licensed or registered in that profession.

179A.50 REPRESENTATION OF FAMILY CHILD CARE PROVIDERS.

Sections 179A.50 to 179A.52 shall be known as the Family Child Care Providers Representation Act.

179A.51 DEFINITIONS.

Subdivision 1.

Scope.

For the purposes of sections 179A.50 to 179A.52, the terms in this section have the meanings given them.

Subd. 2.

Commissioner.

"Commissioner" means the commissioner of mediation services.

Subd. 3.

Exclusive representative.

"Exclusive representative" means an employee organization that has been elected and certified under section 179A.52, thereby maintaining the right to represent family child care providers in their relations with the state.

Subd. 4.

Family child care provider.

"Family child care provider" means an individual, either licensed or unlicensed, who provides legal child care services as defined under section 245A.03, except for providers licensed under Minnesota Rules, chapter 9503, or excluded from licensure under section 245A.03, subdivision 2, paragraph (a), clause (5), and who receives child care assistance to subsidize child care services for a child or children currently in the individual's care, under sections 119B.03; 119B.05; and 119B.011, subdivisions 20 and 20a.

179A.52 RIGHT TO ORGANIZE.

Subdivision 1.

Rights of individual providers and participants.

For the purposes of the Public Employment Labor Relations Act, under chapter 179A, family child care providers shall be considered, by virtue of this section, executive branch state employees employed by the commissioner of management and budget or the commissioner's representative. This section does not require the treatment of family child care providers as public employees for any other purpose. Family child care providers are not state employees for purposes of section 3.736. Chapter 179A shall apply to family child care providers except as otherwise provided in this section. Notwithstanding section 179A.03, subdivision 14, paragraph (a), clause (5), chapter 179A shall apply to family child care providers regardless of part-time or full-time employment status. Family child care providers shall not have the right to strike.

Subd. 2.

Appropriate unit.

The only appropriate unit under this section shall be a statewide unit of all family child care providers who meet the definition in section 179A.51, and who have had an active registration under chapter 119B within the previous 12 months. The unit shall be treated as an appropriate unit under section 179A.10, subdivision 2.

Subd. 3.

Compilation of list.

The commissioner of human services shall, by July 1, 2013, and monthly thereafter, compile and maintain a list of the names and addresses of all family child care providers who meet the definition in section 179A.51, and who have had an active registration under chapter 119B within the previous 12 months. The list shall not include the name of any participant, or indicate that an individual provider is a relative of a participant or has the same address as a participant. The commissioner of human services shall share the lists with others as needed for the state to meet its obligations under chapter 179A as modified and made applicable to family child care providers under this section, and to facilitate the representational processes under this section.

Subd. 4.

List access.

Beginning July 1, 2013, upon a showing made to the commissioner of the Bureau of Mediation Services by any employee organization wishing to represent the appropriate unit of family child care providers that at least 500 family child care providers support such representation, the commissioner of human services shall provide to such organization within seven days the most recent list of actively registered family child care providers compiled under subdivision 3, and subsequent monthly lists upon request for an additional three months. When the list is made available to an employee organization under this subdivision, the list must be made publicly available.

Subd. 5.

Elections for exclusive representative.

After July 31, 2013, any employee organization wishing to represent the appropriate unit of family child care providers may seek exclusive representative status pursuant to section 179A.12. Certification elections for family child care providers shall be conducted by mail ballot, and such election shall be conducted upon an appropriate petition stating that at least 30 percent of the appropriate unit wishes to be represented by the petitioner. The family child care providers eligible to vote in any such election shall be those family child care providers on the monthly list of family child care providers compiled under this section, most recently preceding the filing of the election petition. Except as otherwise provided, elections under this subdivision shall be conducted in accordance with section 179A.12.

Subd. 6.

Meet and negotiate.

If the commissioner certifies an employee organization as the majority exclusive representative, the state, through the governor or the governor's designee, shall meet and negotiate in good faith with the exclusive representative of the family child care provider unit regarding grievance issues, child care assistance reimbursement rates under chapter 119B, and terms and conditions of service, but this obligation does not compel the state or its representatives to agree to a proposal or require the making of a concession. The governor or the governor's designee is authorized to enter into agreements with the exclusive representative. Negotiated agreements and arbitration decisions must be submitted to the legislature to be accepted or rejected in accordance with sections 3.855 and 179A.22.

Subd. 7.

Meet and confer.

The state has an obligation to meet and confer under chapter 179A with family child care providers to discuss policies and other matters relating to their service that are not terms and conditions of service.

Subd. 8.

Terms and conditions of service.

For purposes of this section, "terms and conditions of service" has the same meaning as given in section 179A.03, subdivision 19.

Subd. 9.

Rights.

Nothing in this section shall be construed to interfere with:

(1) parental rights to select and deselect family child care providers or the ability of family child care providers to establish the rates they charge to parents;

(2) the right or obligation of any state agency to communicate or meet with any citizen or organization concerning family child care legislation, regulation, or policy; or

(3) the rights and responsibilities of family child care providers under federal law.

Subd. 10.

Membership status and eligibility for subsidies.

Membership status in an employee organization shall not affect the eligibility of a family child care provider to receive payments under, or serve a child who receives payments under, chapter 119B.

179A.53 NO USE OF SCHOLARSHIPS FOR DUES OR FEES.

Early learning scholarships shall not be applied, through state withholding or otherwise, toward payment of dues or fees that are paid to exclusive representatives of family child care providers.

245E.03 DUTY TO PROVIDE ACCESS.

Subd. 3.

Notice of denial or termination.

When a provider fails to provide access, a 15-day notice of denial or termination must be issued to the provider, which prohibits the provider from participating in the child care assistance program. Notice must be sent to recipients whose children are under the provider's care pursuant to Minnesota Rules, part 3400.0185.

245E.06 ADMINISTRATIVE SANCTIONS.

Subd. 4.

Consolidated hearings with licensing sanction.

If a financial misconduct sanction has an appeal hearing right and it is timely appealed, and a licensing sanction exists for which there is an appeal hearing right and the sanction is timely appealed, and the overpayment recovery action and licensing sanction involve the same set of facts, the overpayment recovery action and licensing sanction must be consolidated in the contested case hearing related to the licensing sanction.

Subd. 5.

Effect of department's administrative determination or sanction.

Unless a timely and proper appeal is received by the department, the department's administrative determination or sanction shall be considered a final department determination.

256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE SETTING.

Subd. 16.

Budget neutrality adjustments.

(a) The commissioner shall use the following adjustments to the rate generated by the framework to assure budget neutrality until the rate information is available to implement paragraph (b). The rate generated by the framework shall be multiplied by the appropriate factor, as designated below:

(1) for residential services: 1.003;

(2) for day services: 1.000;

(3) for unit-based services with programming: 0.941; and

(4) for unit-based services without programming: 0.796.

(b) Within 12 months of January 1, 2014, the commissioner shall compare estimated spending for all home and community-based waiver services under the new payment rates defined in subdivisions 6 to 9 with estimated spending for the same recipients and services under the rates in effect on July 1, 2013. This comparison must distinguish spending under each of subdivisions 6, 7, 8, and 9. The comparison must be based on actual recipients and services for one or more service months after the new rates have gone into effect. The commissioner shall consult with the commissioner of management and budget on this analysis to ensure budget neutrality. If estimated spending under the new rates for services under one or more subdivisions differs in this comparison by 0.3 percent or more, the commissioner shall assure aggregate budget neutrality across all service areas by adjusting the budget neutrality factor in paragraph (a) in each subdivision so that total estimated spending for each subdivision under the new rates matches estimated spending under the rates in effect on July 1, 2013.

256B.7631 CHEMICAL DEPENDENCY PROVIDER RATE INCREASE.

For the chemical dependency services listed in section 254B.05, subdivision 5, and provided on or after July 1, 2015, payment rates shall be increased by two percent over the rates in effect on January 1, 2014, for vendors who meet the requirements of section 254B.05.

256C.23 DEFINITIONS.

Subd. 3.

Regional service center.

"Regional service center" means a facility designed to provide an entry point for deaf, deafblind, and hard-of-hearing persons of that region in need of education, employment, social, human, or other services.

256C.233 DUTIES OF STATE AGENCIES.

Subd. 4.

State commissioners.

The commissioners of all state agencies shall consult with the Deaf and Hard-of-Hearing Services Division concerning the promulgation of public policies, regulations, and programs necessary to address the needs of deaf, deafblind, and hard-of-hearing Minnesotans. Each state agency shall consult with the Deaf and Hard-of-Hearing Services Division concerning the need to forward legislative initiatives to the governor to address the concerns of deaf, deafblind, and hard-of-hearing Minnesotans.

256C.25 INTERPRETER SERVICES.

Subdivision 1.

Establishment.

The Deaf and Hard-of-Hearing Services Division shall maintain and coordinate statewide interpreting or interpreter referral services for use by any public or private agency or individual in the state. The division shall directly coordinate these services but may contract with an appropriate agency to provide this service. The division may collect a $3 fee per referral for interpreter referral services and the actual costs of interpreter services provided by department staff. Fees and payments collected shall be deposited in the general fund. The $3 referral fee shall not be collected from state agencies or local units of government or deaf or hard-of-hearing consumers or interpreters.

Subd. 2.

Duties.

Interpreting or interpreter referral services must include:

(1) statewide access to interpreter referral and direct interpreting services, coordinated with the regional service centers;

(2) maintenance of a statewide directory of qualified interpreters;

(3) assessment of the present and projected supply and demand for interpreter services statewide; and

(4) coordination with the regional service centers on projects to train interpreters and advocate for and evaluate interpreter services.

Repealed Minnesota Rule: H0945-1

3400.0185 TERMINATION AND ADVERSE ACTIONS; NOTICE REQUIRED.

Subp. 5.

Notice to providers of actions adverse to the provider.

The county must give a provider written notice of the following actions adverse to the provider: a denial of authorization, a termination of authorization, a reduction in the number of hours of care with that provider, and a determination that the provider has an overpayment. The notice must include the following information:

A.

a description of the adverse action;

B.

the effective date of the adverse action; and

C.

a statement that unless a family appeals the adverse action before the effective date or the provider appeals the overpayment determination, the adverse action will occur on the effective date. The notice must be mailed to the provider at least 15 calendar days before the effective date of the adverse action.