Minnesota Legislature
HF 2060
as introduced - 91st Legislature (2019 - 2020) Posted on 03/07/2019 07:41pm
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 03/04/2019 |
Current Version - as introduced
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 4.31 4.32 4.33 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 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 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 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 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 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 12.32 12.33 12.34 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18
13.19
13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29
13.30 13.31 13.32 13.33 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
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
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 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27
17.28 17.29 17.30
17.31 17.32 17.33 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 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 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 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
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 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 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 26.33 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 27.32 27.33 27.34 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 28.33 28.34 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9
29.10
29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26
29.27
29.28 29.29 29.30 29.31
30.1
30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 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 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
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
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 36.32 36.33 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 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 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17
39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 40.1 40.2 40.3 40.4 40.5
40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19
40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 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 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 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15
44.16 44.17 44.18 44.19 44.20 44.21 44.22
44.23 44.24 44.25 44.26 44.27 44.28
44.29 44.30 44.31 44.32 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
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 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 49.1 49.2 49.3
49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16
49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 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
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 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 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 53.33 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 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 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 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 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 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 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 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 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 68.33 69.1 69.2 69.3 69.4 69.5 69.6 69.7
69.8
69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18
69.19
69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31
69.32
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 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 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 73.32 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17
74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 74.33 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9
75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 75.33
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 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 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 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 80.34 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 81.32 81.33 81.34 81.35 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 82.34 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 84.34 84.35 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33 85.34 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11
86.12
86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 86.33 86.34 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27
87.28 87.29 87.30 87.31 87.32 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 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 90.32 90.33 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 91.33 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
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 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
96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15
96.16
96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24
96.25 96.26 96.27 96.28 96.29 96.30 96.31 96.32 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 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 100.1 100.2
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
100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14
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
102.1 102.2
102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 105.33 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 106.33 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8
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
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
110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33 111.34
112.1
112.2 112.3 112.4
112.5
112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11
113.12
113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22
113.23
113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33
114.1
114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14
114.15
114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23
114.24
114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32
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
116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30
118.31
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
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
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
123.25 123.26 123.27 123.28 123.29 123.30 123.31 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9
124.10
124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 126.1 126.2 126.3 126.4
126.5
126.6 126.7 126.8 126.9
126.10
126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 127.33 127.34 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15
128.16
128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27
128.28
128.29 128.30 128.31 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9
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
130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 131.1 131.2
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
131.26 131.27 131.28 131.29 131.30 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8
132.9
132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18
132.19
132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25
133.26
133.27 133.28 133.29 133.30 133.31 133.32 133.33 133.34
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
134.29 134.30 134.31 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 135.32 135.33 135.34 135.35 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 136.33 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 137.34 138.1 138.2
138.3
138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 143.1 143.2 143.3 143.4 143.5 143.6 143.7
143.8
143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24
144.25
144.26 144.27 144.28 144.29 144.30 144.31 144.32 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13
145.14
145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 147.33 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10
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
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
150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15
151.16
151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 153.1 153.2 153.3 153.4 153.5
153.6
153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10
155.11
155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27
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
157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28
158.29
158.30 158.31 158.32 158.33 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12
159.13
159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 159.32
160.1
160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8
161.9
161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17
161.18
161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 162.1 162.2 162.3 162.4 162.5 162.6
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
162.23 162.24 162.25 162.26 162.27 162.28 162.29 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15
163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10
164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26
166.27
166.28 166.29 166.30 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14
174.15
174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17
175.18
175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8
176.9
176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18
176.19
176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18
177.19
177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 177.33 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 178.34 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14
179.15
179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 180.33 180.34 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 181.33 181.34 181.35 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 182.34 182.35 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 183.35 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 184.34 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 185.34 186.1 186.2 186.3 186.4 186.5 186.6 186.7
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
186.30 186.31 186.32 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 187.33 187.34 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8
188.9
188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 188.32 188.33 188.34 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31
189.32
190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 190.33 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11
192.12
192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33 192.34 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16
193.17
193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13
194.14
194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31
195.32
196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28
196.29
196.30 196.31 196.32 196.33 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21
197.22
197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 197.33 198.1 198.2 198.3 198.4
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
199.1 199.2 199.3 199.4
199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31
199.32 199.33 200.1 200.2
200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11
200.12
200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21
200.22 200.23 200.24
200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26
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
204.1 204.2 204.3 204.4 204.5 204.6
204.7
204.8 204.9 204.10 204.11
204.12
204.13 204.14 204.15 204.16 204.17 204.18
204.19
204.20 204.21 204.22 204.23 204.24 204.25
204.26
204.27 204.28 204.29 205.1 205.2
205.3
205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25
205.26 205.27 205.28 205.29 205.30 205.31 206.1 206.2 206.3 206.4
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
206.28 206.29 206.30 206.31 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 207.34 207.35 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22
210.23
210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 210.32 211.1 211.2 211.3
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
212.27 212.28 212.29 212.30 212.31 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 214.33 215.1 215.2 215.3 215.4 215.5 215.6 215.7
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
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
216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 217.33 217.34 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33
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
220.28 220.29 220.30 220.31 220.32 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24
221.25
221.26 221.27 221.28 221.29 221.30 221.31 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20
222.21
222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 222.33 222.34 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 223.33 223.34 223.35 224.1 224.2 224.3
224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 224.33 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30
226.31
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
227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16
228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 228.32 228.33 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8
229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 230.33 230.34 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 231.33 231.34 231.35 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18
232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 232.32 232.33 232.34 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 233.33 233.34 233.35 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31
234.32 234.33 234.34 234.35 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 235.33
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
236.28 236.29 236.30 236.31 236.32 236.33 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14
237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 237.33 238.1 238.2
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
238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9
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
239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29
240.30 240.31 240.32 241.1 241.2 241.3 241.4 241.5 241.6 241.7
241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17
241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 241.32 242.1 242.2
242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11
242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 243.1 243.2
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
243.29 243.30 243.31 243.32 243.33 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 244.33 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21
245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31
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
246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 247.1 247.2
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
247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16
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
249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 249.32 249.33 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 250.32 250.33 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29
252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32
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
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
254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 254.32 254.33 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10
255.11
255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 256.1 256.2 256.3
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
256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 256.32 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8
257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 258.1 258.2 258.3 258.4
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
258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 259.1 259.2 259.3 259.4 259.5 259.6
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
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
260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 261.33 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14
262.15 262.16
262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9
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
264.27 264.28 264.29 264.30 264.31 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 266.33 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 267.33 267.34 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27
268.28 268.29 268.30 268.31
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
269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 269.33 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 270.33 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 271.33 271.34 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 272.33 272.34 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11
273.12
273.13 273.14 273.15 273.16
273.17 273.18 273.19 273.20
273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 273.32 274.1 274.2 274.3
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
274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24
275.25 275.26 275.27 275.28
275.29 275.30 275.31 275.32 275.33 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 276.32 276.33 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10
278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18
278.19
278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 279.33 280.1 280.2 280.3 280.4 280.5 280.6
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
282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17
283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28
284.29 284.30 284.31 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25
285.26 285.27 285.28 285.29 285.30 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15
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
287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 287.33 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14
288.15 288.16 288.17 288.18
288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32 288.33 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 289.33 289.34 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 290.33 290.34 290.35 291.1 291.2
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
291.30 291.31 292.1 292.2
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
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
293.31 293.32 294.1 294.2
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
295.29 295.30 295.31 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28
296.29 296.30 296.31 296.32
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
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
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
299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32 299.33 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21
300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 300.32
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
301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19
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
303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 304.32 305.1 305.2 305.3
305.4 305.5 305.6 305.7 305.8
305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 305.33 305.34 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 306.32 306.33 306.34 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 307.32 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 309.1 309.2 309.3 309.4 309.5
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
309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 310.33 310.34 311.1 311.2 311.3
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
314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 314.32 315.1 315.2
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
315.28 315.29 315.30 315.31 315.32 315.33 316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 316.32 317.1 317.2 317.3 317.4 317.5
317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13
317.14 317.15 317.16 317.17
317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15
318.16 318.17 318.18 318.19
318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16
319.17 319.18 319.19 319.20
319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32
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
321.25 321.26 321.27 321.28 321.29 321.30 321.31 321.32 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 322.33 323.1 323.2 323.3 323.4
323.5 323.6 323.7 323.8
323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13
325.14 325.15 325.16 325.17
325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19
326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30
328.31
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
329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 329.33 329.34 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 330.33 330.34 330.35 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 331.35 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 332.33 332.34 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19
333.20 333.21 333.22 333.23
333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23
334.24 334.25 334.26 334.27
334.28 334.29 334.30 334.31 334.32 334.33 334.34 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16
335.17 335.18 335.19 335.20
335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 338.34 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8
341.9 341.10 341.11 341.12
341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 342.1 342.2 342.3
342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29
344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30
346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16
348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26
349.27 349.28 349.29 349.30 349.31 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25
350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21
351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28
353.29 353.30 353.31 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17
354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 354.32 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16
356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24
358.25 358.26 358.27 358.28 358.29 358.30 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 360.1 360.2 360.3 360.4
360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 361.32 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9
362.10 362.11 362.12 362.13
362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29 362.30 362.31 362.32 362.33 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14
363.15 363.16 363.17 363.18
363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 363.32 363.33 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 367.1 367.2 367.3 367.4 367.5 367.6 367.7
367.8 367.9 367.10 367.11
367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 368.1 368.2
368.3 368.4 368.5 368.6
368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25
368.26 368.27 368.28 368.29
369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19
369.20 369.21 369.22 369.23
369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 369.32
370.1 370.2 370.3 370.4
370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17
370.18 370.19 370.20 370.21
370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 370.32 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10
371.11 371.12 371.13 371.14
371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30 372.31 372.32 372.33 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 373.32 373.33 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 375.32 375.33 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29
377.30 377.31 377.32 377.33
378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 378.32 378.33 378.34
379.1 379.2 379.3 379.4
379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21
379.22 379.23 379.24 379.25
379.26 379.27 379.28 379.29 379.30 379.31 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24
380.25 380.26 380.27 380.28
380.29 380.30 380.31 380.32 380.33 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 381.33 381.34 381.35 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16
382.17 382.18 382.19 382.20
382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 382.33
383.1 383.2 383.3 383.4
383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28
383.29 383.30 383.31 383.32
384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 385.1 385.2
385.3 385.4 385.5
385.6 385.7 385.8 385.9 385.10 385.11
385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21
385.22 385.23 385.24 385.25 385.26
385.27 385.28 385.29 385.30
A bill for an act
relating to human services; modifying policy provisions relating to housing, health
care, chemical and mental health, continuing care for older adults, operations,
direct care and treatment, child and families services, and disability services;
requiring a report; amending Minnesota Statutes 2018, sections 13.46, subdivisions
2, 3; 13.461, subdivision 28; 62U.03; 62U.04, subdivision 11; 119B.02, subdivision
6; 144.216, by adding subdivisions; 144.218, by adding a subdivision; 144.225,
subdivision 2b; 144.226, subdivision 1; 144A.471, subdivision 8; 144A.475,
subdivision 6; 145.902; 176.011, subdivision 9; 216C.435, subdivision 13; 245.095;
245A.02, subdivisions 3, 8, 9, 12, 14, by adding subdivisions; 245A.03,
subdivisions 1, 3, 7; 245A.04, subdivisions 1, 2, 4, 6, 7, 10, by adding a subdivision;
245A.05; 245A.07, subdivisions 1, 2, 2a, 3; 245C.03, subdivision 2; 245C.04,
subdivision 3; 245C.08, subdivision 1; 245C.10, subdivision 3; 245C.16,
subdivision 1; 245D.03, subdivision 1; 245D.071, subdivisions 1, 3; 245D.09,
subdivision 4a; 245D.091, subdivisions 2, 3, 4; 245E.01, subdivision 8; 245E.02,
subdivision 4, by adding subdivisions; 245G.01, subdivisions 8, 21, by adding
subdivisions; 245G.04; 245G.05; 245G.06, subdivisions 1, 2, 4; 245G.07; 245G.08,
subdivision 3; 245G.10, subdivision 4; 245G.11, subdivisions 7, 8; 245G.12;
245G.13, subdivision 1; 245G.15, subdivisions 1, 2; 245G.18, subdivisions 3, 5;
245G.22, subdivisions 1, 2, 3, 4, 6, 7, 15, 16, 17, 19; 252.32, subdivisions 1a, 3a;
253B.18, subdivision 13, by adding subdivisions; 253D.28, subdivision 3; 254B.04,
by adding a subdivision; 254B.05, subdivisions 1, 5; 256.01, subdivision 29;
256.021, subdivision 2; 256.045, subdivisions 3, 4, 5, 6, 10; 256.0451, subdivisions
1, 3, 5, 6, 7, 9, 10, 11, 12, 13, 19, 21, 22, 23, 24; 256.046, subdivision 1; 256.9685,
subdivision 1; 256B.02, subdivision 7; 256B.038; 256B.04, subdivision 21;
256B.043, subdivision 1; 256B.056, subdivisions 1a, 4, 7, 7a, 10; 256B.0561,
subdivision 2; 256B.057, subdivision 1; 256B.0575, subdivision 2; 256B.0621,
subdivision 2; 256B.0625, subdivisions 1, 3c, 3d, 3e, 27, 53, by adding a
subdivision; 256B.0638, subdivision 3; 256B.064, subdivisions 1a, 1b, 2, by adding
subdivisions; 256B.0651, subdivisions 1, 2, 12, 13, 17; 256B.0652, subdivisions
2, 5, 8, 10, 12; 256B.0653, subdivision 3; 256B.0659, subdivisions 3a, 12;
256B.0705, subdivisions 1, 2; 256B.0711, subdivisions 1, 2; 256B.0751;
256B.0753, subdivision 1, by adding a subdivision; 256B.0911, subdivisions 1a,
3a, 3f, 6; 256B.0913, subdivision 5a; 256B.0915, subdivisions 3a, 6; 256B.0916,
subdivision 9; 256B.0918, subdivision 2; 256B.092, subdivision 1b; 256B.093,
subdivision 4; 256B.0941, subdivisions 1, 3; 256B.097, subdivision 1; 256B.27,
subdivision 3; 256B.439, subdivision 1; 256B.49, subdivisions 13, 14, 17;
256B.4912, by adding subdivisions; 256B.4914, subdivisions 2, 3, 14; 256B.501,
subdivision 4a; 256B.69, subdivision 5a; 256B.75; 256B.765; 256B.85, subdivisions
1, 2, 4, 5, 6, 8, 9, 10, 11, 11b, 12, 12b, 13a, 18a, by adding a subdivision; 256D.44,
subdivision 5; 256E.21, subdivision 5; 256I.03, subdivisions 8, 15; 256I.04,
subdivisions 1, 2a, 2b, by adding subdivisions; 256I.05, subdivisions 1a, 1c;
256J.21, subdivision 2; 256J.45, subdivision 3; 256L.03, subdivision 1; 256L.15,
subdivision 1; 256M.41, subdivision 3, by adding a subdivision; 256N.02,
subdivisions 10, 16, 17, 18; 256N.22, subdivision 1; 256N.23, subdivisions 2, 6;
256N.24, subdivisions 1, 8, 11, 12, 14; 256N.28, subdivision 6; 256R.02,
subdivisions 4, 17, 18, 19, 29, 42a, 48a; 256R.07, subdivisions 1, 2; 256R.09,
subdivision 2; 256R.10, subdivision 1; 256R.13, subdivision 4; 256R.39; 259.241;
259.35, subdivision 1; 259.37, subdivision 2; 259.53, subdivision 4; 259.75; 259.83,
subdivisions 1, 1a, 3; 259A.75, subdivisions 1, 2, 3, 4, 5; 260.761, subdivision 2;
260C.101, by adding a subdivision; 260C.139, subdivision 3; 260C.171, subdivision
2; 260C.178, subdivision 1; 260C.212, subdivisions 1, 2, by adding a subdivision;
260C.219; 260C.451, subdivision 9; 260C.503, subdivision 2; 260C.515,
subdivisions 3, 4; 260C.605, subdivision 1; 260C.607, subdivision 6; 260C.609;
260C.611; 260C.613, subdivision 6; 260C.615, subdivision 1; 260C.623,
subdivisions 3, 4; 260C.625; 260C.629, subdivision 2; 394.307, subdivision 1;
402A.16, subdivision 3; 462.3593, subdivision 1; 518A.53, subdivision 11;
518A.685; 604A.33, subdivision 1; 609.2231, subdivision 3a; 609.232, subdivisions
3, 11; 626.556, subdivisions 2, 3, 3c, 3e, 4, 7, 10, 10a, 10b, 10d, 10e, 10f, 10m,
11, 11c; 626.5561, subdivision 1; 626.557, subdivisions 3, 3a, 4, 4a, 6, 9, 9b, 9c,
9d, 10, 10b, 12b, 14, 17; 626.5572, subdivisions 2, 3, 4, 6, 8, 9, 16, 17, 20, 21, by
adding a subdivision; 626.558, subdivision 2; Laws 2017, First Special Session
chapter 6, article 1, section 44; proposing coding for new law in Minnesota Statutes,
chapters 245A; 256B; 518A; 609; repealing Minnesota Statutes 2018, sections
62U.15, subdivision 2; 119B.125, subdivision 8; 256.476, subdivisions 1, 2, 3, 4,
5, 6, 8, 9, 10, 11; 256B.057, subdivision 8; 256B.0625, subdivisions 3a, 19a, 19c;
256B.0652, subdivision 6; 256B.0659, subdivisions 1, 2, 3, 3a, 4, 5, 6, 7, 7a, 8, 9,
10, 11, 11a, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29,
30, 31; 256B.0752; 256B.79, subdivision 7; 256I.05, subdivision 3; 256J.751,
subdivision 1; 256L.04, subdivision 13; 256R.08, subdivision 2; 256R.49.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
HOUSING
Section 1.
Minnesota Statutes 2018, section 256I.03, subdivision 8, is amended to read:
Subd. 8.
Supplementary services.
"Supplementary services" means housing support
services provided to individuals in addition to room and board including, but not limited
to, oversight and up to 24-hour supervision, medication reminders, assistance with
transportation, arranging for meetings and appointments, deleted text begin anddeleted text end arranging for medical and
social servicesnew text begin , and services identified in section 256I.03, subdivision 12new text end .
Sec. 2.
Minnesota Statutes 2018, section 256I.03, subdivision 15, is amended to read:
Subd. 15.
Supportive housing.
"Supportive housing" means housing deleted text begin with support
services according to the continuum of care coordinated assessment system established
under Code of Federal Regulations, title 24, section 578.3deleted text end new text begin that is not time-limited and
provides or coordinates services necessary for a resident to maintain housing stabilitynew text end .
Sec. 3.
Minnesota Statutes 2018, section 256I.04, subdivision 1, is amended to read:
Subdivision 1.
Individual eligibility requirements.
An individual is eligible for and
entitled to a housing support payment to be made on the individual's behalf if the agency
has approved the setting where the individual will receive housing support and the individual
meets the requirements in paragraph (a), (b), or (c).
(a) The individual is aged, blind, or is over 18 years of age with a disability 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 housing support in which the individual resides.
(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (4) to (8), and (13), 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 housing support 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 housing support payments if receiving licensed residential crisis stabilization
services under section 256B.0624, subdivision 7.
new text begin
(d) An individual who receives ongoing rental subsidies is not eligible for housing
support payments under paragraph (a) or (b).
new text end
Sec. 4.
Minnesota Statutes 2018, section 256I.04, subdivision 2a, is amended to read:
Subd. 2a.
License required; staffing qualifications.
(a) Except as provided in paragraph
(b), an agency may not enter into an agreement with an establishment to provide housing
support unless:
(1) the establishment is licensed by the Department of Health as a hotel and restaurant;
a board and lodging establishment; a boarding care home before March 1, 1985; or a
supervised living facility, and the service provider for residents of the facility is licensed
under chapter 245A. However, an establishment licensed by the Department of Health to
provide lodging need not also be licensed to provide board if meals are being supplied to
residents under a contract with a food vendor who is licensed by the Department of Health;
(2) the residence is: (i) licensed by the commissioner of human services under Minnesota
Rules, parts 9555.5050 to 9555.6265; (ii) certified by a county human services agency prior
to July 1, 1992, using the standards under Minnesota Rules, parts 9555.5050 to 9555.6265;
(iii) licensed by the commissioner under Minnesota Rules, parts 2960.0010 to 2960.0120,
with a variance under section 245A.04, subdivision 9; or (iv) licensed under section 245D.02,
subdivision 4a, as a community residential setting by the commissioner of human services;
or
(3) the establishment is registered under chapter 144D and provides three meals a day.
(b) The requirements under paragraph (a) do not apply to establishments exempt from
state licensure because they are:
(1) located on Indian reservations and subject to tribal health and safety requirements;
or
(2) deleted text begin a supportive housing establishment that has an approved habitability inspection and
an individual lease agreement and that serves people who have experienced long-term
homelessness and were referred through a coordinated assessment in section 256I.03,
subdivision 15deleted text end new text begin supportive housing establishments where an individual has an approved
habitability inspection and an individual lease agreementnew text end .
(c) Supportive housing establishments new text begin that serve individuals who have experienced
long-term homelessness new text end and emergency shelters must participate in the homeless management
information systemnew text begin and a coordinated assessment system as defined by the commissionernew text end .
(d) Effective July 1, 2016, an agency shall not have an agreement with a provider of
housing support unless all staff members who have direct contact with recipients:
(1) have skills and knowledge acquired through one or more of the following:
(i) a course of study in a health- or human services-related field leading to a bachelor
of arts, bachelor of science, or associate's degree;
(ii) one year of experience with the target population served;
(iii) experience as a mental health certified peer specialist according to section 256B.0615;
or
(iv) meeting the requirements for unlicensed personnel under sections 144A.43 to
144A.483;
(2) hold a current driver's license appropriate to the vehicle driven if transporting
recipients;
(3) complete training on vulnerable adults mandated reporting and child maltreatment
mandated reporting, where applicable; and
(4) complete housing support orientation training offered by the commissioner.
Sec. 5.
Minnesota Statutes 2018, section 256I.04, subdivision 2b, is amended to read:
Subd. 2b.
Housing support agreements.
(a) Agreements between agencies and providers
of housing support must be in writing on a form developed and approved by the commissioner
and must specify the name and address under which the establishment subject to the
agreement does business and under which the establishment, or service provider, if different
from the group residential housing establishment, is licensed by the Department of Health
or the Department of Human Services; the specific license or registration from the
Department of Health or the Department of Human Services held by the provider and the
number of beds subject to that license; the address of the location or locations at which
group residential housing is provided under this agreement; the per diem and monthly rates
that are to be paid from housing support funds for each eligible resident at each location;
the number of beds at each location which are subject to the agreement; whether the license
holder is a not-for-profit corporation under section 501(c)(3) of the Internal Revenue Code;
and a statement that the agreement is subject to the provisions of sections 256I.01 to 256I.06
and subject to any changes to those sections.
(b) Providers are required to verify the following minimum requirements in the
agreement:
(1) current license or registration, including authorization if managing or monitoring
medications;
(2) all staff who have direct contact with recipients meet the staff qualifications;
(3) the provision of housing support;
(4) the provision of supplementary services, if applicable;
(5) reports of adverse events, including recipient death or serious injury; deleted text begin and
deleted text end
(6) submission of residency requirements that could result in recipient evictiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) that the provider complies with the prohibition on limiting or restricting the number
of hours an applicant or recipient is employed, as specified in subdivision 5.
new text end
(c) Agreements may be terminated with or without cause by the commissioner, the
agency, or the provider with two calendar months prior notice. The commissioner may
immediately terminate an agreement under subdivision 2d.
Sec. 6.
Minnesota Statutes 2018, section 256I.04, is amended by adding a subdivision to
read:
new text begin Subd. 2h. new text end
new text begin Required supplementary services. new text end
new text begin
A provider of supplementary services
shall ensure that a recipient has, at a minimum, assistance with services as identified in the
recipient's professional statement of need under section 256I.03, subdivision 12. A provider
of supplementary services shall maintain case notes with the date and description of services
provided to each recipient.
new text end
Sec. 7.
Minnesota Statutes 2018, section 256I.04, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Employment. new text end
new text begin
A provider is prohibited from limiting or restricting the number
of hours an applicant or recipient is employed.
new text end
Sec. 8.
Minnesota Statutes 2018, section 256I.05, subdivision 1c, is amended to read:
Subd. 1c.
Rate increases.
An agency may not increase the rates negotiated for housing
support above those in effect on June 30, 1993, except as provided in paragraphs (a) to (f).
(a) An agency may increase the rates for room and board to the MSA equivalent rate
for those settings whose current rate is below the MSA equivalent rate.
(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total housing support rate for these residents must not exceed the
maximum rate specified in subdivisions 1 and 1a. Agencies must not include nor increase
difficulty of care rates for adults in foster care whose difficulty of care is eligible for funding
by home and community-based waiver programs under title XIX of the Social Security Act.
(c) The room and board rates will be increased each year when the MSA equivalent rate
is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, less
the amount of the increase in the medical assistance personal needs allowance under section
256B.35.
(d) When housing support pays for an individual's room and board, or other costs
necessary to provide room and board, the rate payable to the residence must continue for
up to 18 calendar days per incident that the person is temporarily absent from the residence,
not to exceed 60 days in a calendar year, if the absence or absences deleted text begin have received the prior
approval ofdeleted text end new text begin are reported in advance tonew text end the county agency's social service staff. deleted text begin Prior approvaldeleted text end new text begin
Advance reportingnew text end is not required for emergency absences due to crisis, illness, or injury.
(e) For facilities meeting substantial change criteria within the prior year. Substantial
change criteria exists if the establishment experiences a 25 percent increase or decrease in
the total number of its beds, if the net cost of capital additions or improvements is in excess
of 15 percent of the current market value of the residence, or if the residence physically
moves, or changes its licensure, and incurs a resulting increase in operation and property
costs.
(f) Until June 30, 1994, an agency may increase by up to five percent the total rate paid
for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of health as a boarding care home,
but are not certified for the purposes of the medical assistance program. However, an increase
under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical
assistance reimbursement rate for nursing home resident class A, in the geographic grouping
in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to
9549.0058.
Sec. 9. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2018, section 256I.05, subdivision 3,
new text end
new text begin
is repealed.
new text end
ARTICLE 2
HEALTH CARE
Section 1.
Minnesota Statutes 2018, section 62U.03, is amended to read:
62U.03 PAYMENT RESTRUCTURING; CARE COORDINATION PAYMENTS.
(a) By January 1, 2010, health plan companies shall include health care homes in their
provider networks and by July 1, 2010, shall pay a care coordination fee for their members
who choose to enroll in health care homes certified by the deleted text begin commissioners of health and
human servicesdeleted text end new text begin commissionernew text end under section 256B.0751. Health plan companies shall develop
payment conditions and terms for the care coordination fee for health care homes participating
in their network in a manner that is consistent with the system developed under section
256B.0753. Nothing in this section shall restrict the ability of health plan companies to
selectively contract with health care providers, including health care homes. Health plan
companies may reduce or reallocate payments to other providers to ensure that
implementation of care coordination payments is cost neutral.
(b) By July 1, 2010, the commissioner of management and budget shall implement the
care coordination payments for participants in the state employee group insurance program.
The commissioner of management and budget may reallocate payments within the health
care system in order to ensure that the implementation of this section is cost neutral.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2018, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:
(1) to evaluate the performance of the health care home program as authorized under
deleted text begin sectionsdeleted text end new text begin sectionnew text end 256B.0751, subdivision 6deleted text begin , and 256B.0752, subdivision 2deleted text end ;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patients, payers, or providers;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2018, section 256.01, subdivision 29, is amended to read:
Subd. 29.
State medical review team.
(a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team under sections
256B.055, deleted text begin subdivisiondeleted text end new text begin subdivisions new text end 7, paragraph (b), new text begin and 12; and new text end 256B.057, subdivision 9,
deleted text begin and 256B.055, subdivision 12,deleted text end the commissioner shall review all medical evidence deleted text begin submitted
by county agencies with a referraldeleted text end and seek deleted text begin additionaldeleted text end information from providers, applicants,
and enrollees to support the determination of disability where necessary. Disability shall
be determined according to the rules of title XVI and title XIX of the Social Security Act
and pertinent rules and policies of the Social Security Administration.
(b) Prior to a denial or withdrawal of a requested determination of disability due to
insufficient evidence, the commissioner shall (1) ensure that the missing evidence is necessary
and appropriate to a determination of disability, and (2) assist applicants and enrollees to
obtain the evidence, including, but not limited to, medical examinations and electronic
medical records.
(c) The commissioner shall provide the chairs of the legislative committees with
jurisdiction over health and human services finance and budget the following information
on the activities of the state medical review team by February 1 of each year:
(1) the number of applications to the state medical review team that were denied,
approved, or withdrawn;
(2) the average length of time from receipt of the application to a decision;
(3) the number of appeals, appeal results, and the length of time taken from the date the
person involved requested an appeal for a written decision to be made on each appeal;
(4) for applicants, their age, health coverage at the time of application, hospitalization
history within three months of application, and whether an application for Social Security
or Supplemental Security Income benefits is pending; and
(5) specific information on the medical certification, licensure, or other credentials of
the person or persons performing the medical review determinations and length of time in
that position.
(d) Any appeal made under section 256.045, subdivision 3, of a disability determination
made by the state medical review team must be decided according to the timelines under
section 256.0451, subdivision 22, paragraph (a). If a written decision is not issued within
the timelines under section 256.0451, subdivision 22, paragraph (a), the appeal must be
immediately reviewed by the chief human services judge.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2018, section 256B.04, subdivision 21, is amended to read:
Subd. 21.
Provider enrollment.
(a) If the commissioner or the Centers for Medicare
and Medicaid Services determines that a provider is designated "high-risk," the commissioner
may withhold payment from providers within that category upon initial enrollment for a
90-day period. The withholding for each provider must begin on the date of the first
submission of a claim.
(b) An enrolled provider that is also licensed by the commissioner under chapter 245A,
or is licensed as a home care provider by the Department of Health under chapter 144A and
has a home and community-based services designation on the home care license under
section 144A.484, must designate an individual as the entity's compliance officer. The
compliance officer must:
(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;
(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);
(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;
(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;
(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and
(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.
The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.
(c) The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.
(d) The commissioner shall terminate or deny the enrollment of any individual or entity
if the individual or entity has been terminated from participation in Medicare or under the
Medicaid program or Children's Health Insurance Program of any other state.new text begin The
commissioner may exempt a rehabilitation agency from termination or denial that would
otherwise be required under this paragraph, if the rehabilitation agency:
new text end
new text begin
(1) is unable to retain Medicare certification and enrollment solely due to a lack of billing
to the Medicare program;
new text end
new text begin
(2) meets all other applicable Medicare certification requirements based on an on-site
review completed by the commissioner of health; and
new text end
new text begin
(3) serves primarily a pediatric population.
new text end
(e) As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.
(f) As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.
(g)(1) Upon initial enrollment, reenrollment, and notification of revalidation, all durable
medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.
(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.
(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.
(h) The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph (a) and as
per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in an
amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2018, section 256B.043, subdivision 1, is amended to read:
Subdivision 1.
Alternative and complementary health care.
The commissioner of
human services, through the medical director and in consultation with the Health Services
deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end established under section 256B.0625, subdivision 3c,
as part of the commissioner's ongoing duties, shall consider the potential for improving
quality and obtaining cost savings through greater use of alternative and complementary
treatment methods and clinical practice; shall incorporate these methods into the medical
assistance and MinnesotaCare programs; and shall make related legislative recommendations
as appropriate. The commissioner shall post the recommendations required under this
subdivision on agency websites.
Sec. 6.
Minnesota Statutes 2018, section 256B.056, subdivision 1a, is amended to read:
Subd. 1a.
Income and assets generally.
(a)(1) Unless specifically required by state law
or rule or federal law or regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons whose eligibility category is based
on blindness, disability, or age of 65 or more years, the methodologies for the Supplemental
Security Income program shall be used, except as provided under subdivision 3, paragraph
(a), clause (6).
(2) Increases in benefits under title II of the Social Security Act shall not be counted as
income for purposes of this subdivision until July 1 of each year. Effective upon federal
approval, for children eligible under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical assistance is determined
without regard to parental income, child support payments, including any payments made
by an obligor in satisfaction of or in addition to a temporary or permanent order for child
support, and Social Security payments are not counted as income.
(b)(1) The modified adjusted gross income methodology as defined in deleted text begin the Affordable
Care Actdeleted text end new text begin United States Code, title 42, section 1396a(e)(14),new text end shall be used for eligibility
categories based on:
(i) children under age 19 and their parents and relative caretakers as defined in section
256B.055, subdivision 3a;
(ii) children ages 19 to 20 as defined in section 256B.055, subdivision 16;
(iii) pregnant women as defined in section 256B.055, subdivision 6;
(iv) infants as defined in sections 256B.055, subdivision 10, and 256B.057, subdivision
deleted text begin 8deleted text end new text begin 1new text end ; and
(v) adults without children as defined in section 256B.055, subdivision 15.
For these purposes, a "methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.
(2) For individuals whose income eligibility is determined using the modified adjusted
gross income methodology in clause (1)deleted text begin ,deleted text end new text begin :
new text end
new text begin (i) new text end the commissioner shall subtract from the individual's modified adjusted gross income
an amount equivalent to five percent of the federal poverty guidelinesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(ii) the individual's current monthly income and household size is used to determine
eligibility for the 12-month eligibility period. If an individual's income is expected to vary
month to month, eligibility is determined based on the income predicted for the 12-month
eligibility period.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2018, section 256B.056, subdivision 4, is amended to read:
Subd. 4.
Income.
(a) To be eligible for medical assistance, a person eligible under section
256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of the federal
poverty guidelines. Effective January 1, 2000, and each successive January, recipients of
Supplemental Security Income may have an income up to the Supplemental Security Income
standard in effect on that date.
(b) deleted text begin Effective January 1, 2014,deleted text end To be eligible for medical assistancedeleted text begin ,deleted text end under section
256B.055, subdivision 3a, a parent or caretaker relative may have an income up to 133
percent of the federal poverty guidelines for the household size.
(c) To be eligible for medical assistance under section 256B.055, subdivision 15, a
person may have an income up to 133 percent of federal poverty guidelines for the household
size.
(d) To be eligible for medical assistance under section 256B.055, subdivision 16, a child
age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines for
the household size.
(e) To be eligible for medical assistance under section 256B.055, subdivision 3a, a child
under age 19 may have income up to 275 percent of the federal poverty guidelines for the
household size deleted text begin or an equivalent standard when converted using modified adjusted gross
income methodology as required under the Affordable Care Act. Children who are enrolled
in medical assistance as of December 31, 2013, and are determined ineligible for medical
assistance because of the elimination of income disregards under modified adjusted gross
income methodology as defined in subdivision 1a remain eligible for medical assistance
under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law
111-3, until the date of their next regularly scheduled eligibility redetermination as required
in subdivision 7adeleted text end .
(f) In computing income to determine eligibility of persons under paragraphs (a) to (e)
who are not residents of long-term care facilities, the commissioner shall disregard increases
in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. For persons
eligible under paragraph (a), veteran aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2018, section 256B.056, subdivision 7, is amended to read:
Subd. 7.
Period of eligibility.
new text begin (a) new text end Eligibility is available for the month of application
and for three months prior to application if the person was eligible in those prior months.
A redetermination of eligibility must occur every 12 months.
new text begin
(b) For a person eligible for an insurance affordability program who reports a change
that makes the person eligible for medical assistance, eligibility is available for the month
the change was reported and for three months prior to the month the change was reported,
if the person was eligible in those prior months.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2018, section 256B.056, subdivision 7a, is amended to read:
Subd. 7a.
Periodic renewal of eligibility.
(a) The commissioner shall make an annual
redetermination of eligibility based on information contained in the enrollee's case file and
other information available to the agency, including but not limited to information accessed
through an electronic database, without requiring the enrollee to submit any information
when sufficient data is available for the agency to renew eligibility.
(b) If the commissioner cannot renew eligibility in accordance with paragraph (a), the
commissioner must provide the enrollee with a prepopulated renewal form containing
eligibility information available to the agency and permit the enrollee to submit the form
with any corrections or additional information to the agency and sign the renewal form via
any of the modes of submission specified in section 256B.04, subdivision 18.
(c) An enrollee who is terminated for failure to complete the renewal process may
subsequently submit the renewal form and required information within four months after
the date of termination and have coverage reinstated without a lapse, if otherwise eligible
under this chapter.
(d) Notwithstanding paragraph (a), deleted text begin individualsdeleted text end new text begin a person who isnew text end eligible under subdivision
5 shall be deleted text begin required to renew eligibilitydeleted text end new text begin subject to a review of the person's incomenew text end every six
months.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2018, section 256B.056, subdivision 10, is amended to read:
Subd. 10.
Eligibility verification.
(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the 60-day
postpartum period to update their income and asset information and to submit any required
income or asset verification.
(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph deleted text begin (b)deleted text end new text begin (c)new text end , and shall pay for private-sector coverage if this
is determined to be cost-effective.
(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.
(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.
new text begin
(e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to identify unreported accounts as required in section
256.01, subdivision 18f. If a person refuses or revokes the authorization, the commissioner
may determine that the applicant or recipient is ineligible for medical assistance. For purposes
of this paragraph, an authorization to identify unreported accounts meets the requirements
of the Right to Financial Privacy Act, United States Code, title 12, chapter 35, and need not
be furnished to the financial institution.
new text end
new text begin
(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon implementation of Minnesota
Statutes, section 256.01, subdivision 18f. The commissioner of human services shall notify
the revisor of statutes when this section is effective.
new text end
Sec. 11.
Minnesota Statutes 2018, section 256B.0561, subdivision 2, is amended to read:
Subd. 2.
Periodic data matching.
(a) deleted text begin Beginning April 1, 2018,deleted text end The commissioner shall
conduct periodic data matching to identify recipients who, based on available electronic
data, may not meet eligibility criteria for the public health care program in which the recipient
is enrolled. The commissioner shall conduct data matching for medical assistance or
MinnesotaCare recipients at least once during a recipient's 12-month period of eligibility.
(b) If data matching indicates a recipient may no longer qualify for medical assistance
or MinnesotaCare, the commissioner must notify the recipient and allow the recipient no
more than 30 days to confirm the information obtained through the periodic data matching
or provide a reasonable explanation for the discrepancy to the state or county agency directly
responsible for the recipient's case. If a recipient does not respond within the advance notice
period or does not respond with information that demonstrates eligibility or provides a
reasonable explanation for the discrepancy within the 30-day time period, the commissioner
shall terminate the recipient's eligibility in the manner provided for by the laws and
regulations governing the health care program for which the recipient has been identified
as being ineligible.
(c) The commissioner shall not terminate eligibility for a recipient who is cooperating
with the requirements of paragraph (b) and needs additional time to provide information in
response to the notification.
new text begin
(d) A recipient whose eligibility was terminated according to paragraph (b) may be
eligible for medical assistance no earlier than the first day of the month in which the recipient
provides information that demonstrates the recipient's eligibility.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end Any termination of eligibility for benefits under this section may be appealed as
provided for in sections 256.045 to 256.0451, and the laws governing the health care
programs for which eligibility is terminated.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2018, section 256B.057, subdivision 1, is amended to read:
Subdivision 1.
Infants and pregnant women.
(a) An infant less than two years of age
deleted text begin or a pregnant womandeleted text end is eligible for medical assistance if the deleted text begin individual'sdeleted text end new text begin infant'snew text end countable
household income is equal to or less than deleted text begin 275deleted text end new text begin 283new text end percent of the federal poverty guideline
for the same household size deleted text begin or an equivalent standard when converted using modified
adjusted gross income methodology as required under the Affordable Care Actdeleted text end .new text begin Medical
assistance for an uninsured infant younger than two years of age may be paid with federal
funds available under title XXI of the Social Security Act and the state children's health
insurance program, for an infant with countable income above 275 percent and equal to or
less than 283 percent of the federal poverty guideline for the household size.
new text end
new text begin
(b) A pregnant woman is eligible for medical assistance if the woman's countable income
is equal to or less than 278 percent of the federal poverty guideline for the applicable
household size.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end An infant born to a woman who was eligible for and receiving medical assistance
on the date of the child's birth shall continue to be eligible for medical assistance without
redetermination until the child's first birthday.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2018, section 256B.0575, subdivision 2, is amended to read:
Subd. 2.
Reasonable expenses.
For the purposes of subdivision 1, paragraph (a), clause
(9), reasonable expenses are limited to expenses that have not been previously used as a
deduction from income and were not:
(1) for long-term care expenses incurred during a period of ineligibility as defined in
section 256B.0595, subdivision 2;
(2) incurred more than three months before the month of application associated with the
current period of eligibility;
(3) for expenses incurred by a recipient that are duplicative of services that are covered
under chapter 256B; deleted text begin or
deleted text end
(4) nursing facility expenses incurred without a timely assessment as required under
section 256B.0911deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) for private room fees incurred by an assisted living client as defined in section
144G.01, subdivision 3.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 14.
Minnesota Statutes 2018, section 256B.0625, subdivision 1, is amended to read:
Subdivision 1.
Inpatient hospital services.
(a) Medical assistance covers inpatient
hospital servicesnew text begin performed by hospitals holding Medicare certifications for the services
performednew text end . deleted text begin A second medical opinion is required prior to reimbursement for elective surgeries
requiring a second opinion. The commissioner shall publish in the State Register a list of
elective surgeries that require a second medical opinion prior to reimbursement, and the
criteria and standards for deciding whether an elective surgery should require a second
medical opinion. The list and the criteria and standards are not subject to the requirements
of sections 14.001 to 14.69. The commissioner's decision whether a second medical opinion
is required, made in accordance with rules governing that decision, is not subject to
administrative appeal.
deleted text end
(b) When determining medical necessity for inpatient hospital services, the medical
review agent shall follow industry standard medical necessity criteria in determining the
following:
(1) whether a recipient's admission is medically necessary;
(2) whether the inpatient hospital services provided to the recipient were medically
necessary;
(3) whether the recipient's continued stay was or will be medically necessary; and
(4) whether all medically necessary inpatient hospital services were provided to the
recipient.
The medical review agent will determine medical necessity of inpatient hospital services,
including inpatient psychiatric treatment, based on a review of the patient's medical condition
and records, in conjunction with industry standard evidence-based criteria to ensure consistent
and optimal application of medical appropriateness criteria.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2018, section 256B.0625, subdivision 3c, is amended to read:
Subd. 3c.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end .
(a) The commissioner,
after receiving recommendations from professional physician associations, professional
associations representing licensed nonphysician health care professionals, and consumer
groups, shall establish a deleted text begin 13-memberdeleted text end new text begin 14-membernew text end Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end , which consists of deleted text begin 12deleted text end new text begin 13new text end voting members and one nonvoting member. The Health
Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall advise the commissioner regardingnew text begin : (1)new text end
health services pertaining to the administration of health care benefits covered under deleted text begin the
medical assistance and MinnesotaCare programs.deleted text end new text begin Minnesota health care programs (MHCP);
and (2) evidence-based decision making and health care benefit and coverage policies for
Minnesota health care programs. The council shall consider available evidence of quality,
safety, and cost-effectiveness when making recommendations.new text end The Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end shall meet at least quarterly. The Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end shall annually deleted text begin electdeleted text end new text begin selectnew text end a deleted text begin physiciandeleted text end chair from among its
members, who shall work directly with the commissioner's medical directordeleted text begin ,deleted text end to establish
the agenda for each meeting. The Health Services deleted text begin Policy Committee shall alsodeleted text end new text begin Advisory
Council maynew text end recommend criteria for verifying centers of excellence for specific aspects of
medical care where a specific set of combined services, a volume of patients necessary to
maintain a high level of competency, or a specific level of technical capacity is associated
with improved health outcomes.new text begin The Health Services Advisory Council may also recommend
criteria and standards for determining services that require prior authorization or whether
certain providers must obtain prior authorization for their services under section 256B.0625,
subdivision 25.
new text end
(b) The commissioner shall establish a dental deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end to operate under
the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end . The dental deleted text begin subcommitteedeleted text end new text begin
subcouncilnew text end consists of general dentists, dental specialists, safety net providers, dental
hygienists, health plan company and county and public health representatives, health
researchers, consumers, and a designee of the commissioner of health. The dental
deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end shall advise the commissioner regarding:
(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;
(2) any changes to the critical access dental provider program necessary to comply with
program expenditure limits;
(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;
(4) the development of dental delivery models; and
(5) dental services to be added or eliminated from subdivision 9, paragraph (b).
deleted text begin
(c) The Health Services Policy Committee shall study approaches to making provider
reimbursement under the medical assistance and MinnesotaCare programs contingent on
patient participation in a patient-centered decision-making process, and shall evaluate the
impact of these approaches on health care quality, patient satisfaction, and health care costs.
The committee shall present findings and recommendations to the commissioner and the
legislative committees with jurisdiction over health care by January 15, 2010.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end The Health Services deleted text begin Policy Committee shalldeleted text end new text begin Advisory Council maynew text end monitor and
track the practice patterns of deleted text begin physicians providing services to medical assistance and
MinnesotaCare enrolleesdeleted text end new text begin health care providers who serve MHCP recipientsnew text end under
fee-for-service, managed care, and county-based purchasing. The deleted text begin committeedeleted text end new text begin council's
monitoring and trackingnew text end shall focus on services or specialties for which there is a high
variation in utilization new text begin or quality new text end across deleted text begin physiciansdeleted text end new text begin providersnew text end , or which are associated with
high medical costs. The commissioner, based upon the findings of the deleted text begin committeedeleted text end new text begin councilnew text end ,
deleted text begin shall regularlydeleted text end new text begin maynew text end notify deleted text begin physiciansdeleted text end new text begin providersnew text end whose practice patterns indicate new text begin below
average quality or new text end higher than average utilization or costs. Managed care and county-based
purchasing plans shall provide the commissioner with utilization and cost data necessary
to implement this paragraph, and the commissioner shall make deleted text begin thisdeleted text end new text begin thenew text end data available to the
deleted text begin committeedeleted text end new text begin Health Services Advisory Councilnew text end .
deleted text begin
(e) The Health Services Policy Committee shall review caesarean section rates for the
fee-for-service medical assistance population. The committee may develop best practices
policies related to the minimization of caesarean sections, including but not limited to
standards and guidelines for health care providers and health care facilities.
deleted text end
Sec. 16.
Minnesota Statutes 2018, section 256B.0625, subdivision 3d, is amended to read:
Subd. 3d.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end members.
new text begin (a) new text end The
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end consists of:
(1) deleted text begin sevendeleted text end new text begin sixnew text end voting members who are licensed physicians actively engaged in the practice
of medicine in Minnesota, deleted text begin one of whom must be actively engaged in the treatment of persons
with mental illness, anddeleted text end three of whom must represent health plans currently under contract
to serve deleted text begin medical assistancedeleted text end new text begin MHCPnew text end recipients;
(2) two voting members who are new text begin licensed new text end physician specialists actively practicing their
specialty in Minnesota;
(3) two voting members who are nonphysician health care professionals licensed or
registered in their profession and actively engaged in their practice of their profession in
Minnesota;
new text begin
(4) one voting member who is a health care or mental health professional licensed or
registered in their profession, actively engaged in the practice of their profession in
Minnesota, and actively engaged in the treatment of persons with mental illness;
new text end
deleted text begin (4) one consumerdeleted text end new text begin (5) two consumersnew text end who shall serve as deleted text begin adeleted text end voting deleted text begin memberdeleted text end new text begin membersnew text end ; and
deleted text begin (5)deleted text end new text begin (6)new text end the commissioner's medical directornew text begin ,new text end who shall serve as a nonvoting member.
new text begin (b) new text end Members of the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall not be
employed by the deleted text begin Department of Human Servicesdeleted text end new text begin state of Minnesotanew text end , except for the medical
director.new text begin A quorum shall comprise a simple majority of the voting members and vacant
seats must not count toward a quorum.
new text end
Sec. 17.
Minnesota Statutes 2018, section 256B.0625, subdivision 3e, is amended to read:
Subd. 3e.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end terms and
compensation.
deleted text begin Committeedeleted text end Members shall serve staggered three-year terms, with one-third
of the voting members' terms expiring annually. Members may be reappointed by the
commissioner. The commissioner may require more frequent Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end meetings as needed. An honorarium of $200 per meeting and
reimbursement for mileage and parking shall be paid to each deleted text begin committeedeleted text end new text begin councilnew text end member
in attendance except the medical director. The Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end does not expire as provided in section 15.059, subdivision 6.
Sec. 18.
Minnesota Statutes 2018, section 256B.0625, subdivision 27, is amended to read:
Subd. 27.
Organ and tissue transplants.
deleted text begin All organ transplants must be performed at
transplant centers meeting united network for organ sharing criteria or at Medicare-approved
organ transplant centers.deleted text end new text begin Organ and tissue transplants are a covered service. new text end Stem cell or
bone marrow transplant centers must meet the standards established by the Foundation for
the Accreditation of Hematopoietic Cell Therapy.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
Minnesota Statutes 2018, section 256B.0625, subdivision 53, is amended to read:
Subd. 53.
Centers of excellence.
For complex medical procedures with a high degree
of variation in outcomes, for which the Medicare program requires facilities providing the
services to meet certain criteria as a condition of coverage, the commissioner may develop
centers of excellence facility criteria in consultation with the Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end under subdivision 3c. The criteria must reflect facility traits
that have been linked to superior patient safety and outcomes for the procedures in question,
and must be based on the best available empirical evidence. For medical assistance recipients
enrolled on a fee-for-service basis, the commissioner may make coverage for these procedures
conditional upon the facility providing the services meeting the specified criteria. Only
facilities meeting the criteria may be reimbursed for the procedures in question.
Sec. 20.
Minnesota Statutes 2018, section 256B.0638, subdivision 3, is amended to read:
Subd. 3.
Opioid prescribing work group.
(a) The commissioner of human services, in
consultation with the commissioner of health, shall appoint the following voting members
to an opioid prescribing work group:
(1) two consumer members who have been impacted by an opioid abuse disorder or
opioid dependence disorder, either personally or with family members;
(2) one member who is a licensed physician actively practicing in Minnesota and
registered as a practitioner with the DEA;
(3) one member who is a licensed pharmacist actively practicing in Minnesota and
registered as a practitioner with the DEA;
(4) one member who is a licensed nurse practitioner actively practicing in Minnesota
and registered as a practitioner with the DEA;
(5) one member who is a licensed dentist actively practicing in Minnesota and registered
as a practitioner with the DEA;
(6) two members who are nonphysician licensed health care professionals actively
engaged in the practice of their profession in Minnesota, and their practice includes treating
pain;
(7) one member who is a mental health professional who is licensed or registered in a
mental health profession, who is actively engaged in the practice of that profession in
Minnesota, and whose practice includes treating patients with chemical dependency or
substance abuse;
(8) one member who is a medical examiner for a Minnesota county;
(9) one member of the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end established
under section 256B.0625, subdivisions 3c to 3e;
(10) one member who is a medical director of a health plan company doing business in
Minnesota;
(11) one member who is a pharmacy director of a health plan company doing business
in Minnesota; and
(12) one member representing Minnesota law enforcement.
(b) In addition, the work group shall include the following nonvoting members:
(1) the medical director for the medical assistance program;
(2) a member representing the Department of Human Services pharmacy unit; and
(3) the medical director for the Department of Labor and Industry.
(c) An honorarium of $200 per meeting and reimbursement for mileage and parking
shall be paid to each voting member in attendance.
Sec. 21.
Minnesota Statutes 2018, section 256B.0751, is amended to read:
256B.0751 HEALTH CARE HOMES.
Subdivision 1.
Definitions.
(a) For purposes of deleted text begin sectionsdeleted text end new text begin sectionnew text end 256B.0751 deleted text begin to 256B.0753deleted text end ,
the following definitions apply.
(b) "Commissioner" means the commissioner of deleted text begin human servicesdeleted text end new text begin healthnew text end .
deleted text begin
(c) "Commissioners" means the commissioner of human services and the commissioner
of health, acting jointly.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end "Health plan company" has the meaning provided in section 62Q.01, subdivision
4.
deleted text begin (e)deleted text end new text begin (d)new text end "Personal clinician" means a physician licensed under chapter 147, a physician
assistant licensed and practicing under chapter 147A, or an advanced practice nurse licensed
and registered to practice under chapter 148.
deleted text begin
(f) "State health care program" means the medical assistance and MinnesotaCare
programs.
deleted text end
Subd. 2.
Development and implementation of standards.
(a) deleted text begin By July 1, 2009,deleted text end The
deleted text begin commissionersdeleted text end new text begin commissionernew text end of health deleted text begin and human servicesdeleted text end shall develop and implement
standards of certification for health care homes deleted text begin for state health care programsdeleted text end . In developing
these standards, the deleted text begin commissionersdeleted text end new text begin commissionernew text end shall consider existing standards developed
by national independent accrediting and medical home organizations. The standards
developed by the deleted text begin commissionersdeleted text end new text begin commissionernew text end must meet the following criteria:
(1) emphasize, enhance, and encourage the use of primary care, and include the use of
primary care physicians, advanced practice nurses, and physician assistants as personal
clinicians;
(2) focus on delivering high-quality, efficient, and effective health care services;
(3) encourage patient-centered care, including active participation by the patient and
family or a legal guardian, or a health care agent as defined in chapter 145C, as appropriate
in decision making and care plan development, and providing care that is appropriate to the
patient's race, ethnicity, and language;
(4) provide patients with a consistent, ongoing contact with a personal clinician or team
of clinical professionals to ensure continuous and appropriate care for the patient's condition;
(5) ensure that health care homes develop and maintain appropriate comprehensive care
plans for their patients with complex or chronic conditions, including an assessment of
health risks and chronic conditions;
(6) enable and encourage utilization of a range of qualified health care professionals,
including dedicated care coordinators, in a manner that enables providers to practice to the
fullest extent of their license;
(7) focus initially on patients who have or are at risk of developing chronic health
conditions;
(8) incorporate measures of quality, resource use, cost of care, and patient experience;
(9) ensure the use of health information technology and systematic follow-up, including
the use of patient registries; and
(10) encourage the use of scientifically based health care, patient decision-making aids
that provide patients with information about treatment options and their associated benefits,
risks, costs, and comparative outcomes, and other clinical decision support tools.
(b) In developing these standards, the deleted text begin commissionersdeleted text end new text begin commissionernew text end shall consult with
national and local organizations working on health care home models, physicians, relevant
state agencies, health plan companies, hospitals, other providers, patients, and patient
advocates. deleted text begin The commissioners may satisfy this requirement by continuing the provider
directed care coordination advisory committee.
deleted text end
(c) For the purposes of developing and implementing these standards, the deleted text begin commissionersdeleted text end new text begin
commissionernew text end may use the expedited rulemaking process under section 14.389.
Subd. 3.
Requirements for clinicians certified as health care homes.
(a) A personal
clinician or a primary care clinic may be certified as a health care home. If a primary care
clinic is certified, all of the primary care clinic's clinicians must meet the criteria of a health
care home. In order to be certified as a health care home, a clinician or clinic must meet the
standards set by the deleted text begin commissionersdeleted text end new text begin commissionernew text end in accordance with this section.
Certification as a health care home is voluntary. In order to maintain their status as health
care homes, clinicians or clinics must renew their certification every three years.
(b) Clinicians or clinics certified as health care homes must offer their health care home
services to all their patients with complex or chronic health conditions who are interested
in participation.
(c) Health care homes must participate in the health care home collaborative established
under subdivision 5.
Subd. 4.
Alternative models and waivers of requirements.
(a) Nothing in this section
shall preclude the continued development of existing medical or health care home projects
currently operating or under development by the commissioner of human services or preclude
the commissioner new text begin of human services new text end from establishing alternative models and payment
mechanisms for persons who are enrolled in integrated Medicare and Medicaid programs
under section 256B.69, subdivisions 23 and 28, are enrolled in managed care long-term
care programs under section 256B.69, subdivision 6b, are dually eligible for Medicare and
medical assistance, are in the waiting period for Medicare, or who have other primary
coverage.
(b) The commissioner deleted text begin of healthdeleted text end shall waive health care home certification requirements
if an applicant demonstrates that compliance with a certification requirement will create a
major financial hardship or is not feasible, and the applicant establishes an alternative way
to accomplish the objectives of the certification requirement.
Subd. 5.
Health care home collaborative.
deleted text begin By July 1, 2009,deleted text end The deleted text begin commissionersdeleted text end new text begin
commissionernew text end shall establish a health care home collaborative to provide an opportunity for
health care homes and state agencies to exchange information related to quality improvement
and best practices.
Subd. 6.
Evaluation and continued development.
(a) For continued certification under
this section, health care homes must meet process, outcome, and quality standards as
developed and specified by the deleted text begin commissionersdeleted text end new text begin commissionernew text end . The deleted text begin commissionersdeleted text end new text begin
commissionernew text end shall collect data from health care homes necessary for monitoring compliance
with certification standards and for evaluating the impact of health care homes on health
care quality, cost, and outcomes.
(b) The deleted text begin commissionersdeleted text end new text begin commissionernew text end may contract with a private entity to perform an
evaluation of the effectiveness of health care homes. Data collected under this subdivision
is classified as nonpublic data under chapter 13.
Subd. 7.
Outreach.
deleted text begin Beginning July 1, 2009,deleted text end The commissioner new text begin of human services new text end shall
encourage state health care program enrollees who have a complex or chronic condition to
select a primary care clinic with clinicians who have been certified as health care homes.
Subd. 8.
Coordination with local services.
The health care home and the county shall
coordinate care and services provided to patients enrolled with a health care home who have
complex medical needs or a disability, and who need and are eligible for additional local
services administered by counties, including but not limited to waivered services, mental
health services, social services, public health services, transportation, and housing. The
coordination of care and services must be as provided in the plan established by the patient
and new text begin the new text end health care home.
Subd. 9.
Pediatric care coordination.
The commissioner new text begin of human services new text end shall
implement a pediatric care coordination service for children with high-cost medical or
high-cost psychiatric conditions who are at risk of recurrent hospitalization or emergency
room use for acute, chronic, or psychiatric illness, who receive medical assistance services.
Care coordination services must be targeted to children not already receiving care
coordination through another service and may include but are not limited to the provision
of health care home services to children admitted to hospitals that do not currently provide
care coordination. Care coordination services must be provided by care coordinators who
are directly linked to provider teams in the care delivery setting, but who may be part of a
community care team shared by multiple primary care providers or practices. For purposes
of this subdivision, the commissioner new text begin of human services new text end shall, to the extent possible, use
the existing health care home certification and payment structure established under this
section and section 256B.0753.
Subd. 10.
Health care homes advisory committee.
(a) The deleted text begin commissioners of health
and human servicesdeleted text end new text begin commissionernew text end shall establish a health care homes advisory committee
to advise the deleted text begin commissionersdeleted text end new text begin commissionernew text end on the ongoing statewide implementation of the
health care homes program authorized in this section.
(b) The deleted text begin commissionersdeleted text end new text begin commissionernew text end shall establish an advisory committee that includes
representatives of the health care professions such as primary care providers; mental health
providers; nursing and care coordinators; certified health care home clinics with statewide
representation; health plan companies; state agencies; employers; academic researchers;
consumers; and organizations that work to improve health care quality in Minnesota. At
least 25 percent of the committee members must be consumers or patients in health care
homes. The deleted text begin commissionersdeleted text end new text begin commissionernew text end , in making appointments to the committee, shall
ensure geographic representation of all regions of the state.
(c) The advisory committee shall advise the deleted text begin commissionersdeleted text end new text begin commissionernew text end on ongoing
implementation of the health care homes program, including, but not limited to, the following
activities:
(1) implementation of certified health care homes across the state on performance
management and implementation of benchmarking;
(2) implementation of modifications to the health care homes program based on results
of the legislatively mandated health care homes evaluation;
(3) statewide solutions for engagement of employers and commercial payers;
(4) potential modifications of the health care homes rules or statutes;
(5) consumer engagement, including patient and family-centered care, patient activation
in health care, and shared decision making;
(6) oversight for health care homes subject matter task forces or workgroups; and
(7) other related issues as requested by the deleted text begin commissionersdeleted text end new text begin commissionernew text end .
(d) The advisory committee shall have the ability to establish subcommittees on specific
topics. The advisory committee is governed by section 15.059. Notwithstanding section
15.059, the advisory committee does not expire.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 22.
Minnesota Statutes 2018, section 256B.0753, subdivision 1, is amended to read:
Subdivision 1.
Development.
The commissioner of human services, in coordination
with the commissioner of health, shall develop a payment system that provides per-person
care coordination payments to health care homes certified under section 256B.0751 for
providing care coordination services and directly managing on-site or employing care
coordinators. The care coordination payments under this section are in addition to the quality
incentive payments in section 256B.0754, subdivision 1. The care coordination payment
system must vary the fees paid by thresholds of care complexity, with the highest fees being
paid for care provided to individuals requiring the most intensive care coordination. In
developing the criteria for care coordination payments, the commissioner shall consider the
feasibility of including the additional time and resources needed by patients with limited
English-language skills, cultural differences, or other barriers to health care. The
commissioner may determine a schedule for phasing in care coordination fees such that the
fees will be applied first to individuals who have, or are at risk of developing, complex or
chronic health conditions. deleted text begin Development of the payment system must be completed by
January 1, 2010.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 23.
Minnesota Statutes 2018, section 256B.0753, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Definitions. new text end
new text begin
For the purposes of this section, the definitions in section
256B.0751, subdivision 1, apply.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24.
Minnesota Statutes 2018, 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 deleted text begin 2016deleted text end new text begin 2017new text end , 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 25.
Minnesota Statutes 2018, section 256L.03, subdivision 1, is amended to read:
Subdivision 1.
Covered health services.
(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation
services, personal care assistance and case management services, new text begin behavioral health home
services, new text end and nursing home or intermediate care facilities services.
(b) No public funds shall be used for coverage of abortion under MinnesotaCare except
where the life of the female would be endangered or substantial and irreversible impairment
of a major bodily function would result if the fetus were carried to term; or where the
pregnancy is the result of rape or incest.
(c) Covered health services shall be expanded as provided in this section.
(d) For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.
Sec. 26.
Minnesota Statutes 2018, section 256L.15, subdivision 1, is amended to read:
Subdivision 1.
Premium determination for MinnesotaCare.
(a) Families with children
and individuals shall pay a premium determined according to subdivision 2.
(b) Members of the military and their families who meet the eligibility criteria for
MinnesotaCare upon eligibility approval made within 24 months following the end of the
member's tour of active duty shall have their premiums paid by the commissioner. The
effective date of coverage for an individual or family who meets the criteria of this paragraph
shall be the first day of the month following the month in which eligibility is approved. This
exemption applies for 12 months.
(c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and their
families shall have their premiums waived by the commissioner in accordance with section
5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5. An
individual must indicate status as an American Indian, as defined under Code of Federal
Regulations, title 42, section 447.50, to qualify for the waiver of premiums. The
commissioner shall accept attestation of an individual's status as an American Indian as
verification until the United States Department of Health and Human Services approves an
electronic data source for this purpose.
deleted text begin
(d) For premiums effective August 1, 2015, and after, the commissioner, after consulting
with the chairs and ranking minority members of the legislative committees with jurisdiction
over human services, shall increase premiums under subdivision 2 for recipients based on
June 2015 program enrollment. Premium increases shall be sufficient to increase projected
revenue to the fund described in section 16A.724 by at least $27,800,000 for the biennium
ending June 30, 2017. The commissioner shall publish the revised premium scale on the
Department of Human Services website and in the State Register no later than June 15,
2015. The revised premium scale applies to all premiums on or after August 1, 2015, in
place of the scale under subdivision 2.
deleted text end
deleted text begin
(e) By July 1, 2015, the commissioner shall provide the chairs and ranking minority
members of the legislative committees with jurisdiction over human services the revised
premium scale effective August 1, 2015, and statutory language to codify the revised
premium schedule.
deleted text end
deleted text begin
(f) Premium changes authorized under paragraph (d) must only apply to enrollees not
otherwise excluded from paying premiums under state or federal law. Premium changes
authorized under paragraph (d) must satisfy the requirements for premiums for the Basic
Health Program under title 42 of Code of Federal Regulations, section 600.505.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall renumber the provisions of Minnesota Statutes listed in
column A to the references listed in column B.
new text end
|
new text begin
Column A new text end |
new text begin
Column B new text end |
|
|
new text begin
256B.0751, subd. 1 new text end |
new text begin
62U.03, subd. 2 new text end |
|
|
new text begin
256B.0751, subd. 2 new text end |
new text begin
62U.03, subd. 3 new text end |
|
|
new text begin
256B.0751, subd. 3 new text end |
new text begin
62U.03, subd. 4 new text end |
|
|
new text begin
256B.0751, subd. 4 new text end |
new text begin
62U.03, subd. 5 new text end |
|
|
new text begin
256B.0751, subd. 5 new text end |
new text begin
62U.03, subd. 6 new text end |
|
|
new text begin
256B.0751, subd. 6 new text end |
new text begin
62U.03, subd. 7 new text end |
|
|
new text begin
256B.0751, subd. 7 new text end |
new text begin
62U.03, subd. 8 new text end |
|
|
new text begin
256B.0751, subd. 8 new text end |
new text begin
62U.03, subd. 9 new text end |
|
|
new text begin
256B.0751, subd. 9 new text end |
new text begin
62U.03, subd. 10 new text end |
|
|
new text begin
256B.0751, subd. 10 new text end |
new text begin
62U.03, subd. 11 new text end |
new text begin
(b) The revisor of statutes shall change the applicable references to Minnesota Statutes,
section 256B.0751, to section 62U.03. The revisor shall make necessary cross-reference
changes in Minnesota Statutes consistent with the renumbering. The revisor shall also make
technical and other necessary changes to sentence structure to preserve the meaning of the
text.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2018, sections 62U.15, subdivision 2; 256B.057, subdivision 8;
256B.0625, subdivision 3a; 256B.0752; 256B.79, subdivision 7; and 256L.04, subdivision
13,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 3
CHEMICAL AND MENTAL HEALTH
Section 1.
Minnesota Statutes 2018, section 245G.01, subdivision 8, is amended to read:
Subd. 8.
Client.
"Client" means an individual accepted by a license holder for assessment
or treatment of a substance use disorder. An individual remains a client until the license
holder no longer provides or intends to provide the individual with treatment service.new text begin Client
also includes the meaning of patient under section 144.651, subdivision 2.
new text end
Sec. 2.
Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:
new text begin Subd. 10a. new text end
new text begin Day of service initiation. new text end
new text begin
"Day of service initiation" means the day the
license holder begins the provision of a treatment service identified in section 245G.07.
new text end
Sec. 3.
Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:
new text begin Subd. 20a. new text end
new text begin Person-centered. new text end
new text begin
"Person-centered" means a client actively participates in
the client's treatment planning of services. This includes a client making meaningful and
informed choices about the client's own goals, objectives, and the services the client receives
in collaboration with the client's identified natural supports.
new text end
Sec. 4.
Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:
new text begin Subd. 20b. new text end
new text begin Staff or staff member. new text end
new text begin
"Staff" or "staff member" means an individual who
works under the direction of the license holder regardless of the individual's employment
status including but not limited to an intern, consultant, individual who works part time, or
individual who does not provide direct care services.
new text end
Sec. 5.
Minnesota Statutes 2018, section 245G.01, subdivision 21, is amended to read:
Subd. 21.
Student intern.
"Student intern" means an individual who is new text begin enrolled in a
program specializing in alcohol and drug counseling or mental health counseling at an
accredited educational institution and is new text end authorized by a licensing board to provide services
under supervision of a licensed professional.
Sec. 6.
Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:
new text begin Subd. 28. new text end
new text begin Treatment week. new text end
new text begin
"Treatment week" means the seven-day period that the
program identified in the program's policy and procedure manual as the day of the week
that the treatment program week starts and ends for the purpose of identifying the nature
and number of treatment services an individual receives weekly.
new text end
Sec. 7.
Minnesota Statutes 2018, section 245G.01, is amended by adding a subdivision to
read:
new text begin Subd. 29. new text end
new text begin Volunteer. new text end
new text begin
"Volunteer" means an individual who, under the direction of the
license holder, provides services or an activity to a client without compensation.
new text end
Sec. 8.
Minnesota Statutes 2018, section 245G.04, is amended to read:
245G.04 deleted text begin INITIAL SERVICES PLANdeleted text end new text begin SERVICE INITIATIONnew text end .
new text begin Subdivision 1. new text end
new text begin Initial services plan. new text end
deleted text begin (a)deleted text end The license holder must complete an initial
services plan deleted text begin ondeleted text end new text begin within 24 hours ofnew text end the day of service initiation. The plan must new text begin be
person-centered and client-specific, new text end address the client's immediate health and safety concerns,
new text begin and new text end identify the new text begin treatment new text end needsnew text begin of the clientnew text end to be addressed deleted text begin in the first treatment session,
and make treatment suggestions for the clientdeleted text end during the time between deleted text begin intakedeleted text end new text begin the day of
service initiationnew text end and deleted text begin completiondeleted text end new text begin developmentnew text end of the individual treatment plan.
new text begin Subd. 2. new text end
new text begin Vulnerable adult status. new text end
deleted text begin (b) The initial services plan must include a
determination ofdeleted text end new text begin (a) Within 24 hours of the day of service initiation, a nonresidential program
must determine new text end whether a client is a vulnerable adult as defined in section 626.5572,
subdivision 21. An adult client of a residential program is a vulnerable adult.
new text begin (b)new text end An individual abuse prevention plan, according to sections 245A.65, subdivision 2,
paragraph (b), and 626.557, subdivision 14, paragraph (b), is required for a client who meets
the definition of vulnerable adult.
Sec. 9.
Minnesota Statutes 2018, section 245G.05, is amended to read:
245G.05 COMPREHENSIVE ASSESSMENT AND ASSESSMENT SUMMARY.
Subdivision 1.
Comprehensive assessment.
(a) A comprehensive assessment of the
client's substance use disorder must be administered face-to-face by an alcohol and drug
counselor within three calendar days deleted text begin afterdeleted text end new text begin from the day ofnew text end service initiation for a residential
program or deleted text begin during the initial session for all other programsdeleted text end new text begin within three sessions of the day
of service initiation for a client in a nonresidential programnew text end . If the comprehensive assessment
is not completed deleted text begin during the initial session,deleted text end new text begin within the required time frame, new text end the deleted text begin client-centereddeleted text end new text begin
person-centerednew text end reason for the delaynew text begin and the planned completion datenew text end must be documented
in the client's file deleted text begin and the planned completion datedeleted text end . new text begin The comprehensive assessment is
complete upon a qualified staff member's dated signature. new text end If the client received a
comprehensive assessment that authorized the treatment service, an alcohol and drug
counselor new text begin may use the comprehensive assessment for requirements of this subdivision but
new text end must new text begin document a new text end review deleted text begin thedeleted text end new text begin of the comprehensive new text end assessmentnew text begin and update the comprehensive
assessment as necessarynew text end to deleted text begin determinedeleted text end new text begin ensurenew text end compliance with this subdivisiondeleted text begin , includingdeleted text end new text begin
withinnew text end applicable timelines. deleted text begin If available, the alcohol and drug counselor may use current
information provided by a referring agency or other source as a supplement. Information
gathered more than 45 days before the date of admission is not considered current.deleted text end The
comprehensive assessment must include sufficient information to complete the assessment
summary according to subdivision 2 and the individual treatment plan according to section
245G.06. The comprehensive assessment must include information about the client's needs
that relate to substance use and personal strengths that support recovery, including:
(1) age, sex, cultural background, sexual orientation, living situation, economic status,
and level of education;
(2) new text begin a description of the new text end circumstances new text begin on the day new text end of service initiation;
(3) new text begin a list of new text end previous attempts at treatment for substance misuse or substance use disorder,
compulsive gambling, or mental illness;
(4) new text begin a list of new text end substance use history including amounts and types of substances used,
frequency and duration of use, periods of abstinence, and circumstances of relapse, if any.
For each substance used within the previous 30 days, the information must include the date
of the most recent use and new text begin address the absence or presence of new text end previous withdrawal symptoms;
(5) specific problem behaviors exhibited by the client when under the influence of
substances;
(6) deleted text begin family statusdeleted text end new text begin the client's desire for family involvement in the treatment programnew text end ,
family historynew text begin of substance use and misusenew text end , deleted text begin includingdeleted text end history or presence of physical or
sexual abuse, new text begin and new text end level of family supportdeleted text begin , and substance misuse or substance use disorder
of a family member or significant otherdeleted text end ;
(7) physical new text begin and medical new text end concerns or diagnoses, deleted text begin the severity of the concerns, anddeleted text end new text begin current
medical treatment needed or being received related to the diagnoses, andnew text end whether the
concerns deleted text begin are being addressed by adeleted text end new text begin need to be referred to an appropriatenew text end health care
professional;
(8) mental health history deleted text begin and psychiatric statusdeleted text end , including symptomsdeleted text begin , disability,deleted text end new text begin and the
effect on the client's ability to function;new text end current new text begin mental health new text end treatment deleted text begin supports,deleted text end new text begin ;new text end and
psychotropic medication needed to maintain stabilitydeleted text begin ;deleted text end new text begin .new text end The assessment must utilize screening
tools approved by the commissioner pursuant to section 245.4863 to identify whether the
client screens positive for co-occurring disorders;
(9) arrests and legal interventions related to substance use;
(10) new text begin a description of how the client's use affected the client's new text end ability to function
appropriately in work and educational settings;
(11) ability to understand written treatment materials, including rules and the client's
rights;
(12) new text begin a description of any new text end risk-taking behavior, including behavior that puts the client at
risk of exposure to blood-borne or sexually transmitted diseases;
(13) social network in relation to expected support for recovery deleted text begin anddeleted text end new text begin ;
new text end
new text begin (14)new text end leisure time activities that are associated with substance use;
deleted text begin (14)deleted text end new text begin (15)new text end whether the client is pregnant and, if so, the health of the unborn child and the
client's current involvement in prenatal care;
deleted text begin (15)deleted text end new text begin (16)new text end whether the client recognizes deleted text begin problemsdeleted text end new text begin needsnew text end related to substance use and is
willing to follow treatment recommendations; and
deleted text begin (16) collateraldeleted text end new text begin (17)new text end informationnew text begin from a collateral contact may be included, but is not
requirednew text end . deleted text begin If the assessor gathered sufficient information from the referral source or the client
to apply the criteria in Minnesota Rules, parts 9530.6620 and 9530.6622, a collateral contact
is not required.
deleted text end
(b) If the client is identified as having opioid use disorder or seeking treatment for opioid
use disorder, the program must provide educational information to the client concerning:
(1) risks for opioid use disorder and dependence;
(2) treatment options, including the use of a medication for opioid use disorder;
(3) the risk of and recognizing opioid overdose; and
(4) the use, availability, and administration of naloxone to respond to opioid overdose.
(c) The commissioner shall develop educational materials that are supported by research
and updated periodically. The license holder must use the educational materials that are
approved by the commissioner to comply with this requirement.
(d) If the comprehensive assessment is completed to authorize treatment service for the
client, at the earliest opportunity during the assessment interview the assessor shall determine
if:
(1) the client is in severe withdrawal and likely to be a danger to self or others;
(2) the client has severe medical problems that require immediate attention; or
(3) the client has severe emotional or behavioral symptoms that place the client or others
at risk of harm.
If one or more of the conditions in clauses (1) to (3) are present, the assessor must end the
assessment interview and follow the procedures in the program's medical services plan
under section 245G.08, subdivision 2, to help the client obtain the appropriate services. The
assessment interview may resume when the condition is resolved.
Subd. 2.
Assessment summary.
(a) An alcohol and drug counselor must complete an
assessment summary within three calendar days deleted text begin afterdeleted text end new text begin from the day ofnew text end service initiation for
a residential program and within three sessions deleted text begin for all other programsdeleted text end new text begin from the day of service
initiation for a client in a nonresidential programnew text end .new text begin The comprehensive assessment summary
is complete upon a qualified staff member's dated signature.new text end If the comprehensive assessment
is used to authorize the treatment service, the alcohol and drug counselor must prepare an
assessment summary on the same date the comprehensive assessment is completed. If the
comprehensive assessment and assessment summary are to authorize treatment services,
the assessor must determine appropriate services for the client using the dimensions in
Minnesota Rules, part 9530.6622, and document the recommendations.
(b) An assessment summary must include:
(1) a risk description according to section 245G.05 for each dimension listed in paragraph
(c);
(2) a narrative summary supporting the risk descriptions; and
(3) a determination of whether the client has a substance use disorder.
(c) An assessment summary must contain information relevant to treatment service
planning and recorded in the dimensions in clauses (1) to (6). The license holder must
consider:
(1) Dimension 1, acute intoxication/withdrawal potential; the client's ability to cope with
withdrawal symptoms and current state of intoxication;
(2) Dimension 2, biomedical conditions and complications; the degree to which any
physical disorder of the client would interfere with treatment for substance use, and the
client's ability to tolerate any related discomfort. The license holder must determine the
impact of continued deleted text begin chemicaldeleted text end new text begin substancenew text end use on the unborn child, if the client is pregnant;
(3) Dimension 3, emotional, behavioral, and cognitive conditions and complications;
the degree to which any condition or complication is likely to interfere with treatment for
substance use or with functioning in significant life areas and the likelihood of harm to self
or others;
(4) Dimension 4, readiness for change; the support necessary to keep the client involved
in treatment service;
(5) Dimension 5, relapse, continued use, and continued problem potential; the degree
to which the client recognizes relapse issues and has the skills to prevent relapse of either
substance use or mental health problems; and
(6) Dimension 6, recovery environment; whether the areas of the client's life are
supportive of or antagonistic to treatment participation and recovery.
Sec. 10.
Minnesota Statutes 2018, section 245G.06, subdivision 1, is amended to read:
Subdivision 1.
General.
Each client must have deleted text begin andeleted text end new text begin a person-centerednew text end individual treatment
plan developed by an alcohol and drug counselor within deleted text begin sevendeleted text end new text begin tennew text end days new text begin from the day new text end of
service initiation for a residential program and within deleted text begin threedeleted text end new text begin fivenew text end sessions for deleted text begin all other
programsdeleted text end new text begin from the day of service initiation for a client in a nonresidential program. Opioid
treatment programs must complete the individual treatment plan within 21 days from the
day of service initiationnew text end . deleted text begin The client must have active, direct involvement in selecting the
anticipated outcomes of the treatment process and developing the treatment plan.deleted text end The
individual treatment plan must be signed by the client and the alcohol and drug counselor
and document the client's involvement in the development of the plan. deleted text begin The plan may be a
continuation of the initial services plan required in section 245G.04.deleted text end new text begin The individual treatment
plan is developed upon the qualified staff member's dated signature.new text end Treatment planning
must include ongoing assessment of client needs. An individual treatment plan must be
updated based on new information gathered about the client's conditionnew text begin , the client's level
of participation,new text end and on whether methods identified have the intended effect. A change to
the plan must be signed by the client and the alcohol and drug counselor. deleted text begin The plan must
provide for the involvement of the client's family and people selected by the client as
important to the success of treatment at the earliest opportunity, consistent with the client's
treatment needs and written consent.deleted text end new text begin If the client chooses to have family or others involved
in treatment, the client's individual treatment plan must include goals and methods identifying
how the family or others will be involved in the client's treatment.
new text end
Sec. 11.
Minnesota Statutes 2018, section 245G.06, subdivision 2, is amended to read:
Subd. 2.
Plan contents.
An individual treatment plan must be recorded in the six
dimensions listed in section 245G.05, subdivision 2, paragraph (c), must address each issue
identified in the assessment summary, prioritized according to the client's needs and focus,
and must include:
(1) specific new text begin goals and new text end methods to address each identified neednew text begin in the comprehensive
assessment summarynew text end , including amount, frequency, and anticipated duration of treatment
service. The methods must be appropriate to the client's language, reading skills, cultural
background, and strengths;
(2) resources to refer the client to when the client's needs are to be addressed concurrently
by another providernew text begin and identification of whether the client has an assessed need of peer
support services and, if available, how peer support services are made available to the client
with an assessed neednew text end ; and
(3) goals the client must reach to complete treatment and terminate services.
Sec. 12.
Minnesota Statutes 2018, section 245G.06, subdivision 4, is amended to read:
Subd. 4.
Service discharge summary.
(a) An alcohol and drug counselor must write a
new text begin service new text end discharge summary for each client. The new text begin service discharge new text end summary must be
completed within five days of the client's service termination deleted text begin or within five days from the
client's or program's decision to terminate services, whichever is earlier.deleted text end new text begin The client's file
must include verification that the client was provided a copy of the client's service discharge
summary. If the program is unable to provide a copy of the client's service discharge summary
directly to the client, the program must document the reason.
new text end
(b) The service discharge summary must be recorded in the six dimensions listed in
section 245G.05, subdivision 2, paragraph (c), and include the following information:
(1) the client's issues, strengths, and needs while participating in treatment, including
services provided;
(2) the client's progress toward achieving each goal identified in the individual treatment
plan;
(3) a risk description according to section 245G.05; deleted text begin and
deleted text end
(4) the reasons for and circumstances of service termination. If a program discharges a
client at staff request, the reason for discharge and the procedure followed for the decision
to discharge must be documented and comply with the deleted text begin program's policies on staff-initiated
client discharge. If a client is discharged at staff request, the program must give the client
crisis and other referrals appropriate for the client's needs and offer assistance to the client
to access the services.deleted text end new text begin requirements in section 245G.14, subdivision 3, clause (3);
new text end
deleted text begin
(c) For a client who successfully completes treatment, the summary must also include:
deleted text end
deleted text begin (1)deleted text end new text begin (5) new text end the client's living arrangements at service termination;
deleted text begin (2)deleted text end new text begin (6) new text end continuing care recommendations, including transitions between more or less
intense services, or more frequent to less frequent services, and referrals made with specific
attention to continuity of care for mental health, as needed;new text begin and
new text end
deleted text begin (3)deleted text end new text begin (7) new text end service termination diagnosisdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) the client's prognosis.
deleted text end
Sec. 13.
Minnesota Statutes 2018, section 245G.07, is amended to read:
245G.07 TREATMENT SERVICE.
Subdivision 1.
Treatment service.
(a) A deleted text begin license holderdeleted text end new text begin licensed residential treatment
program new text end must deleted text begin offerdeleted text end new text begin provide new text end the deleted text begin followingdeleted text end treatment servicesnew text begin in clauses (1) to (5) to each
clientnew text end , unless clinically inappropriate and the justifying clinical rationale is documenteddeleted text begin :deleted text end new text begin .
A nonresidential treatment program must offer all treatment services in clauses (1) to (5)
and document in the individual treatment plan the specific services for which a client has
an assessed need and the plan to provide the services:
new text end
(1) individual and group counseling to help the client identify and address needs related
to substance use and develop strategies to avoid harmful substance use after discharge and
to help the client obtain the services necessary to establish a lifestyle free of the harmful
effects of substance use disorderdeleted text begin ;deleted text end new text begin . Notwithstanding subdivision 3, individual and group
counseling services must be provided by an individual who meets the staff qualifications
of an alcohol and drug counselor in section 245G.11, subdivision 5;
new text end
(2) client education strategies to avoid inappropriate substance use and health problems
related to substance use and the necessary lifestyle changes to regain and maintain health.
Client education must include information on tuberculosis education on a form approved
by the commissioner, the human immunodeficiency virus according to section 245A.19,
other sexually transmitted diseases, drug and alcohol use during pregnancy, and hepatitis.
A licensed alcohol and drug counselor must be present during an educational group;
(3) a service to help the client integrate gains made during treatment into daily living
and to reduce the client's reliance on a staff member for support;
(4) a service to address issues related to co-occurring disorders, including client education
on symptoms of mental illness, the possibility of comorbidity, and the need for continued
medication compliance while recovering from substance use disorder. A group must address
co-occurring disorders, as needed. When treatment for mental health problems is indicated,
the treatment must be integrated into the client's individual treatment plan;new text begin and
new text end
deleted text begin
(5) on July 1, 2018, or upon federal approval, whichever is later, peer recovery support
services provided one-to-one by an individual in recovery. Peer support services include
education, advocacy, mentoring through self-disclosure of personal recovery experiences,
attending recovery and other support groups with a client, accompanying the client to
appointments that support recovery, assistance accessing resources to obtain housing,
employment, education, and advocacy services, and nonclinical recovery support to assist
the transition from treatment into the recovery community; and
deleted text end
deleted text begin (6) on July 1, 2018, or upon federal approval, whichever is later, caredeleted text end new text begin (5) treatmentnew text end
coordination provided new text begin one-to-one new text end by an individual who meets the staff qualifications in
section 245G.11, subdivision 7new text begin , or an alcohol and drug counselor under section 245G.11,
subdivision 5new text end . deleted text begin Caredeleted text end new text begin Treatmentnew text end coordination services include:
(i) assistance in coordination with significant others to help in the treatment planning
process whenever possible;
(ii) assistance in coordination with and follow up for medical services as identified in
the treatment plan;
(iii) facilitation of referrals to substance use disorder services as indicated by a client's
medical provider, comprehensive assessment, or treatment plan;
(iv) facilitation of referrals to mental health services as identified by a client's
comprehensive assessment or treatment plan;
(v) assistance with referrals to economic assistance, social services, housing resources,
and prenatal care according to the client's needs;
(vi) life skills advocacy and support accessing treatment follow-up, disease management,
and education services, including referral and linkages to long-term services and supports
as needed; and
(vii) documentation of the provision of deleted text begin caredeleted text end new text begin treatmentnew text end coordination services in the client's
file.
(b) A treatment service provided to a client must be provided according to the individual
treatment plan and must consider cultural differences and special needs of a client.
Subd. 2.
Additional treatment service.
A license holder may provide or arrange the
following additional treatment service as a part of the client's individual treatment plan:
(1) relationship counseling provided by a qualified professional to help the client identify
the impact of the client's substance use disorder on others and to help the client and persons
in the client's support structure identify and change behaviors that contribute to the client's
substance use disorder;
(2) therapeutic recreation to allow the client to participate in recreational activities
without the use of mood-altering chemicals and to plan and select leisure activities that do
not involve the inappropriate use of chemicals;
(3) stress management and physical well-being to help the client reach and maintain an
appropriate level of health, physical fitness, and well-being;
(4) living skills development to help the client learn basic skills necessary for independent
living;
(5) employment or educational services to help the client become financially independent;
(6) socialization skills development to help the client live and interact with others in a
positive and productive manner; deleted text begin and
deleted text end
(7) room, board, and supervision at the treatment site to provide the client with a safe
and appropriate environment to gain and practice new skillsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) peer recovery support services provided one-to-one by an individual in recovery.
Peer support services include education; advocacy; mentoring through self-disclosure of
personal recovery experiences; attending recovery and other support groups with a client;
accompanying the client to appointments that support recovery; assistance accessing resources
to obtain housing, employment, education, and advocacy services; and nonclinical recovery
support to assist the transition from treatment into the recovery community.
new text end
Subd. 3.
Counselors.
A treatment service, including therapeutic recreation, must be
provided by an alcohol and drug counselor according to section 245G.11, unless the
individual providing the service is specifically qualified according to the accepted credential
required to provide the service. deleted text begin Therapeutic recreation does not include planned leisure
activities.deleted text end new text begin The commissioner shall maintain a current list of professionals qualified to provide
treatment services, notwithstanding the staff qualification requirements in section 245G.11,
subdivision 4.
new text end
Subd. 4.
Location of service provision.
The license holder may provide services at any
of the license holder's licensed locations or at another suitable location including a school,
government building, medical or behavioral health facility, or social service organization,
upon notification and approval of the commissioner. If services are provided off site from
the licensed site, the reason for the provision of services remotely must be documented.new text begin
The license holder may provide additional services under subdivision 2, clauses (2) to (5),
off-site if the license holder includes a policy and procedure detailing the off-site location
as a part of the treatment service description and the program abuse prevention plan.
new text end
Sec. 14.
Minnesota Statutes 2018, section 245G.08, subdivision 3, is amended to read:
Subd. 3.
Standing order protocol.
A license holder that maintains a supply of naloxone
available for emergency treatment of opioid overdose must have a written standing order
protocol by a physician who is licensed under chapter 147, that permits the license holder
to maintain a supply of naloxone on sitedeleted text begin , anddeleted text end new text begin . A license holdernew text end must require staff to undergo
deleted text begin specificdeleted text end training in deleted text begin administration of naloxonedeleted text end new text begin the specific mode of administration used at
the program, which may include intranasal administration, intramuscular injection, or bothnew text end .
Sec. 15.
Minnesota Statutes 2018, section 245G.10, subdivision 4, is amended to read:
Subd. 4.
Staff requirement.
It is the responsibility of the license holder to determine
an acceptable group size based on each client's needs except that treatment services provided
in a group shall not exceed 16 clients. deleted text begin A counselor in an opioid treatment program must not
supervise more than 50 clients.deleted text end The license holder must maintain a record that documents
compliance with this subdivision.
Sec. 16.
Minnesota Statutes 2018, section 245G.11, subdivision 7, is amended to read:
Subd. 7.
deleted text begin Caredeleted text end new text begin Treatmentnew text end coordination provider qualifications.
(a) deleted text begin Caredeleted text end new text begin Treatmentnew text end
coordination must be provided by qualified staff. An individual is qualified to provide deleted text begin caredeleted text end new text begin
treatmentnew text end coordination if the individualdeleted text begin :deleted text end new text begin meets the qualifications of an alcohol and drug
counselor under subdivision 5. An individual who does not meet the qualifications of an
alcohol and drug counselor under subdivision 5 is qualified to provide treatment coordination
if the individual:
new text end
(1) is skilled in the process of identifying and assessing a wide range of client needs;
(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;
(3) has successfully completed 30 hours of classroom instruction on deleted text begin caredeleted text end new text begin treatmentnew text end
coordination for an individual with substance use disorder;
(4) has either:
(i) a bachelor's degree in one of the behavioral sciences or related fields; or
(ii) current certification as an alcohol and drug counselor, level I, by the Upper Midwest
Indian Council on Addictive Disorders; and
(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.
(b) A deleted text begin caredeleted text end new text begin treatmentnew text end coordinator must receive at least one hour of supervision regarding
individual service delivery from an alcohol and drug counselor weekly.
Sec. 17.
Minnesota Statutes 2018, section 245G.11, subdivision 8, is amended to read:
Subd. 8.
Recovery peer qualifications.
A recovery peer must:
(1) have a high school diploma or its equivalent;
(2) have a minimum of one year in recovery from substance use disorder;
(3) hold a current credential from deleted text begin a certification body approved by the commissioner
that demonstratesdeleted text end new text begin the Minnesota Certification Board, the Upper Midwest Indian Council
on Addictive Disorders, or the National Association for Alcoholism and Drug Abuse
Counselors. An individual may also receive a credential from a tribal nation when providing
peer recovery support services in a tribally licensed program. The credential must demonstratenew text end
skills and training in the domains of ethics and boundaries, advocacy, mentoring and
education, and recovery and wellness support; and
(4) receive ongoing supervision in areas specific to the domains of the recovery peer's
role by an alcohol and drug counselor deleted text begin or an individual with a certification approved by the
commissionerdeleted text end .
Sec. 18.
Minnesota Statutes 2018, section 245G.12, is amended to read:
245G.12 PROVIDER POLICIES AND PROCEDURES.
A license holder must develop a written policies and procedures manual, indexed
according to section 245A.04, subdivision 14, paragraph (c), that provides staff members
immediate access to all policies and procedures and provides a client and other authorized
parties access to all policies and procedures. The manual must contain the following
materials:
(1) assessment and treatment planning policies, including screening for mental health
concerns and treatment objectives related to the client's identified mental health concerns
in the client's treatment plan;
(2) policies and procedures regarding HIV according to section 245A.19;
(3) the license holder's methods and resources to provide information on tuberculosis
and tuberculosis screening to each client and to report a known tuberculosis infection
according to section 144.4804;
(4) personnel policies according to section 245G.13;
(5) policies and procedures that protect a client's rights according to section 245G.15;
(6) a medical services plan according to section 245G.08;
(7) emergency procedures according to section 245G.16;
(8) policies and procedures for maintaining client records according to section 245G.09;
(9) procedures for reporting the maltreatment of minors according to section 626.556,
and vulnerable adults according to sections 245A.65, 626.557, and 626.5572;
(10) a description of treatment services, including the amount and type of services
providednew text begin and the program's treatment weeknew text end ;
(11) the methods used to achieve desired client outcomes;
(12) the hours of operation; and
(13) the target population served.
Sec. 19.
Minnesota Statutes 2018, section 245G.13, subdivision 1, is amended to read:
Subdivision 1.
Personnel policy requirements.
A license holder must have written
personnel policies that are available to each staff member. The personnel policies must:
(1) ensure that staff member retention, promotion, job assignment, or pay are not affected
by a good faith communication between a staff member and the department, the Department
of Health, the ombudsman for mental health and developmental disabilities, law enforcement,
or a local agency for the investigation of a complaint regarding a client's rights, health, or
safety;
(2) contain a job description for each staff member position specifying responsibilities,
degree of authority to execute job responsibilities, and qualification requirements;
(3) provide for a job performance evaluation based on standards of job performance
conducted on a regular and continuing basis, including a written annual review;
(4) describe behavior that constitutes grounds for disciplinary action, suspension, or
dismissal, including policies that address staff member problematic substance use and the
requirements of section 245G.11, subdivision 1, policies prohibiting personal involvement
with a client in violation of chapter 604, and policies prohibiting client abuse described in
sections 245A.65, 626.556, 626.557, and 626.5572;
(5) identify how the program will identify whether behaviors or incidents are problematic
substance use, including a description of how the facility must address:
(i) receiving treatment for substance use within the period specified for the position in
the staff qualification requirements, including medication-assisted treatment;
(ii) substance use that negatively impacts the staff member's job performance;
(iii) deleted text begin chemicaldeleted text end new text begin substancenew text end use that affects the credibility of treatment services with a client,
referral source, or other member of the community;
(iv) symptoms of intoxication or withdrawal on the job; and
(v) the circumstances under which an individual who participates in monitoring by the
health professional services program for a substance use or mental health disorder is able
to provide services to the program's clients;
(6) include a chart or description of the organizational structure indicating lines of
authority and responsibilities;
(7) include orientation within 24 working hours of starting for each new staff member
based on a written plan that, at a minimum, must provide training related to the staff member's
specific job responsibilities, policies and procedures, client confidentiality, HIV minimum
standards, and client needs; and
(8) include policies outlining the license holder's response to a staff member with a
behavior problem that interferes with the provision of treatment service.
Sec. 20.
Minnesota Statutes 2018, section 245G.15, subdivision 1, is amended to read:
Subdivision 1.
Explanation.
A client has the rights identified in sections 144.651,
148F.165, and 253B.03, as applicable. The license holder must give each client deleted text begin atdeleted text end new text begin on the
day ofnew text end service initiation a written statement of the client's rights and responsibilities. A staff
member must review the statement with a client at that time.
Sec. 21.
Minnesota Statutes 2018, section 245G.15, subdivision 2, is amended to read:
Subd. 2.
Grievance procedure.
deleted text begin Atdeleted text end new text begin On the day ofnew text end service initiation, the license holder
must explain the grievance procedure to the client or the client's representative. The grievance
procedure must be posted in a place visible to clients, and made available upon a client's or
former client's request. The grievance procedure must require that:
(1) a staff member helps the client develop and process a grievance;
(2) current telephone numbers and addresses of the Department of Human Services,
Licensing Division; the Office of Ombudsman for Mental Health and Developmental
Disabilities; the Department of Health Office of Health Facilities Complaints; and the Board
of Behavioral Health and Therapy, when applicable, be made available to a client; and
(3) a license holder responds to the client's grievance within three days of a staff member's
receipt of the grievance, and the client may bring the grievance to the highest level of
authority in the program if not resolved by another staff member.
Sec. 22.
Minnesota Statutes 2018, section 245G.18, subdivision 3, is amended to read:
Subd. 3.
Staff ratios.
deleted text begin At least 25 percent of a counselor's scheduled work hours must
be allocated to indirect services, including documentation of client services, coordination
of services with others, treatment team meetings, and other duties.deleted text end A counseling group
consisting entirely of adolescents must not exceed 16 adolescents. It is the responsibility of
the license holder to determine an acceptable group size based on the needs of the clients.
Sec. 23.
Minnesota Statutes 2018, section 245G.18, subdivision 5, is amended to read:
Subd. 5.
Program requirements.
In addition to the requirements specified in the client's
treatment plan under section 245G.06, programs serving an adolescent must include:
(1) coordination with the school system to address the client's academic needs;
(2) when appropriate, a plan that addresses the client's leisure activities without deleted text begin chemicaldeleted text end new text begin
substancenew text end use; and
(3) a plan that addresses family involvement in the adolescent's treatment.
Sec. 24.
Minnesota Statutes 2018, section 245G.22, subdivision 1, is amended to read:
Subdivision 1.
Additional requirements.
(a) An opioid treatment program licensed
under this chapter must alsonew text begin : (1)new text end comply with the requirements of this section and Code of
Federal Regulations, title 42, part 8deleted text begin . When federal guidance or interpretations are issued on
federal standards or requirements also required under this section, the federal guidance or
interpretations shall apply.deleted text end new text begin ; (2) be registered as a narcotic treatment program with the Drug
Enforcement Administration; (3) be accredited through an accreditation body approved by
the Division of Pharmacologic Therapy of the Center for Substance Abuse Treatment; (4)
be certified through the Division of Pharmacologic Therapy of the Center for Substance
Abuse Treatment; and (5) hold a license from the Minnesota Board of Pharmacy or equivalent
agency.
new text end
(b) Where a standard in this section differs from a standard in an otherwise applicable
administrative rule or statute, the standard of this section applies.
Sec. 25.
Minnesota Statutes 2018, section 245G.22, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given them.
(b) "Diversion" means the use of a medication for the treatment of opioid addiction being
diverted from intended use of the medication.
(c) "Guest dose" means administration of a medication used for the treatment of opioid
addiction to a person who is not a client of the program that is administering or dispensing
the medication.
(d) "Medical director" means a deleted text begin physiciandeleted text end new text begin practitionernew text end licensed to practice medicine in
the jurisdiction that the opioid treatment program is located who assumes responsibility for
administering all medical services performed by the program, either by performing the
services directly or by delegating specific responsibility to deleted text begin (1) authorized program physicians;
(2) advanced practice registered nurses, when approved by variance by the State Opioid
Treatment Authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration; or (3) health care professionals functioning under the
medical director's direct supervisiondeleted text end new text begin a practitioner of the opioid treatment programnew text end .
(e) "Medication used for the treatment of opioid use disorder" means a medication
approved by the Food and Drug Administration for the treatment of opioid use disorder.
(f) "Minnesota health care programs" has the meaning given in section 256B.0636.
(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations,
title 42, section 8.12, and includes programs licensed under this chapter.
(h) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605,
subpart 21a.
new text begin
(i) "Practitioner" means a staff member holding a current, unrestricted license to practice
medicine issued by the Board of Medical Practice or nursing issued by the Board of Nursing
and is currently registered with the Drug Enforcement Administration to order or dispense
controlled substances in Schedules II to V under the Controlled Substances Act, United
States Code, title 21, part B, section 821. Practitioner includes an advanced practice registered
nurse and physician assistant if the staff member receives a variance by the state opioid
treatment authority under section 254A.03 and the federal Substance Abuse and Mental
Health Services Administration.
new text end
deleted text begin (i)deleted text end new text begin (j)new text end "Unsupervised use" means the use of a medication for the treatment of opioid use
disorder dispensed for use by a client outside of the program setting.
Sec. 26.
Minnesota Statutes 2018, section 245G.22, subdivision 3, is amended to read:
Subd. 3.
Medication orders.
Before the program may administer or dispense a medication
used for the treatment of opioid use disorder:
(1) a client-specific order must be received from an appropriately credentialed deleted text begin physiciandeleted text end new text begin
practitionernew text end who is enrolled as a Minnesota health care programs provider and meets all
applicable provider standards;
(2) the signed order must be documented in the client's record; and
(3) if the deleted text begin physiciandeleted text end new text begin practitionernew text end that issued the order is not able to sign the order when
issued, the unsigned order must be entered in the client record at the time it was received,
and the deleted text begin physiciandeleted text end new text begin practitionernew text end must review the documentation and sign the order in the
client's record within 72 hours of the medication being ordered. The license holder must
report to the commissioner any medication error that endangers a client's health, as
determined by the medical director.
Sec. 27.
Minnesota Statutes 2018, section 245G.22, subdivision 4, is amended to read:
Subd. 4.
High dose requirements.
A client being administered or dispensed a dose
beyond that set forth in subdivision 6, paragraph (a), deleted text begin clause (1),deleted text end that exceeds 150 milligrams
of methadone or 24 milligrams of buprenorphine daily, and for each subsequent increase,
must meet face-to-face with a prescribing deleted text begin physiciandeleted text end new text begin practitionernew text end . The meeting must occur
before the administration or dispensing of the increased medication dose.
Sec. 28.
Minnesota Statutes 2018, section 245G.22, subdivision 6, is amended to read:
Subd. 6.
Criteria for unsupervised use.
(a) To limit the potential for diversion of
medication used for the treatment of opioid use disorder to the illicit market, medication
dispensed to a client for unsupervised use shall be subject to the deleted text begin followingdeleted text end requirementsdeleted text begin :deleted text end new text begin
of this subdivision.
new text end
deleted text begin (1)deleted text end Any client in an opioid treatment program may receive a single unsupervised use
dose for a day that the clinic is closed for business, including Sundays and state and federal
holidaysdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(2) other treatment program decisions on dispensing medications used for the treatment
of opioid use disorder to a client for unsupervised use shall be determined by the medical
director.
deleted text end
(b) deleted text begin In determining whether a client may be permitted unsupervised use of medications,
a physiciandeleted text end new text begin A practitionernew text end with authority to prescribe must deleted text begin considerdeleted text end new text begin review and documentnew text end
the criteria in deleted text begin thisdeleted text end paragraphdeleted text begin . The criteria in this paragraph must also be considereddeleted text end new text begin (c)new text end when
determining whether dispensing medication for a client's unsupervised use is appropriate
to new text begin implement, new text end increasenew text begin ,new text end or deleted text begin todeleted text end extend the amount of time between visits to the program. The
criteria are:
(1) absence of recent abuse of drugs including but not limited to opioids, non-narcotics,
and alcohol;
(2) regularity of program attendance;
(3) absence of serious behavioral problems at the program;
(4) absence of known recent criminal activity such as drug dealing;
(5) stability of the client's home environment and social relationships;
(6) length of time in comprehensive maintenance treatment;
(7) reasonable assurance that unsupervised use medication will be safely stored within
the client's home; and
(8) whether the rehabilitative benefit the client derived from decreasing the frequency
of program attendance outweighs the potential risks of diversion or unsupervised use.
(c) The determination, including the basis of the determination must be documented in
the client's medical record.
Sec. 29.
Minnesota Statutes 2018, section 245G.22, subdivision 7, is amended to read:
Subd. 7.
Restrictions for unsupervised use of methadone hydrochloride.
(a) If a
deleted text begin physician with authority to prescribedeleted text end new text begin medical director or prescribing practitioner assesses
andnew text end determines that a client meets the criteria in subdivision 6 and may be dispensed a
medication used for the treatment of opioid addiction, the restrictions in this subdivision
must be followed when the medication to be dispensed is methadone hydrochloride.new text begin The
results of the assessment must be contained in the client file.
new text end
(b) During the first 90 days of treatment, the unsupervised use medication supply must
be limited to a maximum of a single dose each week and the client shall ingest all other
doses under direct supervision.
(c) In the second 90 days of treatment, the unsupervised use medication supply must be
limited to two doses per week.
(d) In the third 90 days of treatment, the unsupervised use medication supply must not
exceed three doses per week.
(e) In the remaining months of the first year, a client may be given a maximum six-day
unsupervised use medication supply.
(f) After one year of continuous treatment, a client may be given a maximum two-week
unsupervised use medication supply.
(g) After two years of continuous treatment, a client may be given a maximum one-month
unsupervised use medication supply, but must make monthly visits to the program.
Sec. 30.
Minnesota Statutes 2018, section 245G.22, subdivision 15, is amended to read:
Subd. 15.
Nonmedication treatment services; documentation.
(a) The program must
offer at least 50 consecutive minutes of individual or group therapy treatment services as
defined in section 245G.07, subdivision 1, paragraph (a), clause (1), per week, for the first
ten weeks following admission, and at least 50 consecutive minutes per month thereafter.
As clinically appropriate, the program may offer these services cumulatively and not
consecutively in increments of no less than 15 minutes over the required time period, and
for a total of 60 minutes of treatment services over the time period, and must document the
reason for providing services cumulatively in the client's record. The program may offer
additional levels of service when deemed clinically necessary.
(b) Notwithstanding the requirements of comprehensive assessments in section 245G.05,
the assessment must be completed within 21 days new text begin from the day new text end of service initiation.
(c) Notwithstanding the requirements of individual treatment plans set forth in section
245G.06:
(1) treatment plan contents for a maintenance client are not required to include goals
the client must reach to complete treatment and have services terminated;
(2) treatment plans for a client in a taper or detox status must include goals the client
must reach to complete treatment and have services terminated;
(3) for the initial ten weeks after admission for all new admissions, readmissions, and
transfers, deleted text begin progress notesdeleted text end new text begin a weekly treatment plan reviewnew text end must be deleted text begin entered in a client's file at
least weekly and be recorded in each of the six dimensions upon the development of the
treatment plan and thereafterdeleted text end new text begin documented upon the completion of the treatment plan. Prior
to the completion of the treatment plan, all services must be documented according to section
245G.06, subdivision 3new text end . Subsequently, the counselor must document deleted text begin progressdeleted text end new text begin treatment
plan reviewsnew text end in the six dimensions at least once monthlynew text begin after the initial ten weeksnew text end or, when
clinical need warrants, more frequentlydeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) upon the development of the treatment plan and thereafter, treatment plan reviews
must occur weekly, or after each treatment service, whichever is less frequent, for the first
ten weeks after the treatment plan is developed. Following the first ten weeks of treatment
plan reviews, reviews may occur monthly, unless the client's needs warrant more frequent
revisions or documentation.
deleted text end
Sec. 31.
Minnesota Statutes 2018, section 245G.22, subdivision 16, is amended to read:
Subd. 16.
Prescription monitoring program.
(a) The program must develop and
maintain a policy and procedure that requires the ongoing monitoring of the data from the
prescription monitoring program (PMP) for each client. The policy and procedure must
include how the program meets the requirements in paragraph (b).
(b) deleted text begin Ifdeleted text end new text begin Whennew text end a medication used for the treatment of substance use disorder is administered
or dispensed to a client, the license holder deleted text begin shall bedeleted text end new text begin isnew text end subject to the following requirements:
(1) upon admission to deleted text begin a methadone clinic outpatientdeleted text end new text begin an opioidnew text end treatment program, a
client must be notified in writing that the commissioner of human services and the medical
director must monitor the PMP to review the prescribed controlled drugs a client received;
(2) the medical director or the medical director's delegate must review the data from the
PMP described in section 152.126 before the client is ordered any controlled substance, as
defined under section 152.126, subdivision 1, paragraph (c), including medications used
for the treatment of opioid addiction, and the medical director's or the medical director's
delegate's subsequent reviews of the PMP data must occur at least every 90 days;
(3) a copy of the PMP data reviewed must be maintained in the client's filenew text begin along with
the licensed practitioner's decision for frequency of ongoing PMP checksnew text end ;
(4) when the PMP data contains a recent history of multiple prescribers or multiple
prescriptions for controlled substances, the physician's review of the data and subsequent
actions must be documented in the client's file within 72 hours and must contain the medical
director's determination of whether or not the prescriptions place the client at risk of harm
and the actions to be taken in response to the PMP findings. The provider must conduct
subsequent reviews of the PMP on a monthly basis; and
(5) if at any time the deleted text begin medical directordeleted text end new text begin licensed practitionernew text end believes the use of the
controlled substances places the client at risk of harm, the program must seek the client's
consent to discuss the client's opioid treatment with other prescribers and must seek the
client's consent for the other prescriber to disclose to the opioid treatment program's medical
director the client's condition that formed the basis of the other prescriptions. If the
information is not obtained within seven days, the medical director must document whether
or not changes to the client's medication dose or number of unsupervised use doses are
necessary until the information is obtained.
(c) The commissioner shall collaborate with the Minnesota Board of Pharmacy to develop
and implement an electronic system for the commissioner to routinely access the PMP data
to determine whether any client enrolled in an opioid addiction treatment program licensed
according to this section was prescribed or dispensed a controlled substance in addition to
that administered or dispensed by the opioid addiction treatment program. When the
commissioner determines there have been multiple prescribers or multiple prescriptions of
controlled substances for a client, the commissioner shall:
(1) inform the medical director of the opioid treatment program only that the
commissioner determined the existence of multiple prescribers or multiple prescriptions of
controlled substances; and
(2) direct the medical director of the opioid treatment program to access the data directly,
review the effect of the multiple prescribers or multiple prescriptions, and document the
review.
(d) If determined necessary, the commissioner shall seek a federal waiver of, or exception
to, any applicable provision of Code of Federal Regulations, title 42, section 2.34 (c), before
implementing this subdivision.
Sec. 32.
Minnesota Statutes 2018, section 245G.22, subdivision 17, is amended to read:
Subd. 17.
Policies and procedures.
(a) A license holder must develop and maintain the
policies and procedures required in this subdivision.
(b) For a program that is not open every day of the year, the license holder must maintain
a policy and procedure that deleted text begin permits a client to receive a singledeleted text end new text begin covers requirements under
section 245G.22, subdivisions 6 and 7.new text end Unsupervised use of medication used for the treatment
of opioid use disorder for days that the program is closed for business, includingdeleted text begin ,deleted text end but not
limited todeleted text begin ,deleted text end Sundays and state and federal holidays deleted text begin as required under subdivision 6, paragraph
(a), clause (1)deleted text end new text begin , must meet the requirements under section 245G.22, subdivisions 6 and 7new text end .
(c) The license holder must maintain a policy and procedure that includes specific
measures to reduce the possibility of diversion. The policy and procedure must:
(1) specifically identify and define the responsibilities of the medical and administrative
staff for performing diversion control measures; and
(2) include a process for contacting no less than five percent of clients who have
unsupervised use of medication, excluding clients approved solely under subdivision 6,
paragraph (a), deleted text begin clause (1),deleted text end to require clients to physically return to the program each month.
The system must require clients to return to the program within a stipulated time frame and
turn in all unused medication containers related to opioid use disorder treatment. The license
holder must document all related contacts on a central log and the outcome of the contact
for each client in the client's record.new text begin The medical director must be informed of each outcome
that results in a situation in which a possible diversion issue was identified.
new text end
(d) Medication used for the treatment of opioid use disorder must be ordered,
administered, and dispensed according to applicable state and federal regulations and the
standards set by applicable accreditation entities. If a medication order requires assessment
by the person administering or dispensing the medication to determine the amount to be
administered or dispensed, the assessment must be completed by an individual whose
professional scope of practice permits an assessment. For the purposes of enforcement of
this paragraph, the commissioner has the authority to monitor the person administering or
dispensing the medication for compliance with state and federal regulations and the relevant
standards of the license holder's accreditation agency and may issue licensing actions
according to sections 245A.05, 245A.06, and 245A.07, based on the commissioner's
determination of noncompliance.
new text begin
(e) A counselor in an opioid treatment program must not supervise more than 50 clients.
new text end
Sec. 33.
Minnesota Statutes 2018, section 245G.22, subdivision 19, is amended to read:
Subd. 19.
Placing authorities.
A program must provide certain notification and
client-specific updates to placing authorities for a client who is enrolled in Minnesota health
care programs. At the request of the placing authority, the program must provide
client-specific updates, including but not limited to informing the placing authority of
positive drug deleted text begin screeningsdeleted text end new text begin testingsnew text end and changes in medications used for the treatment of opioid
use disorder ordered for the client.
Sec. 34.
Minnesota Statutes 2018, section 254B.04, is amended by adding a subdivision
to read:
new text begin Subd. 2c. new text end
new text begin
Eligibility to receive peer recovery support and treatment service
coordination.
new text end
new text begin
Notwithstanding Minnesota Rules, part 9530.6620, subpart 6, a placing
authority may authorize peer recovery support and treatment service coordination for a
person who scores a severity of one or more in dimension 4, 5, or 6, under Minnesota Rules,
part 9530.6622. Authorization for peer recovery support and treatment service coordination
under this subdivision does not need to be provided in conjunction with treatment services
under Minnesota Rules, part 9530.6622, subpart 4, 5, or 6.
new text end
Sec. 35.
Minnesota Statutes 2018, 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
substance use disorder treatment, extended care, transitional residence, or outpatient treatment
services, and are licensed by tribal government are eligible vendors.
(b) On July 1, 2018, or upon federal approval, whichever is later, a licensed professional
in private practice who meets the requirements of section 245G.11, subdivisions 1 and 4,
is an eligible vendor of a comprehensive assessment and assessment summary provided
according to section 245G.05, and treatment services provided according to sections 245G.06
and 245G.07, subdivision 1, paragraphs (a), clauses (1) to deleted text begin (5)deleted text end new text begin (4)new text end , and (b); and subdivision
2.
(c) On July 1, 2018, or upon federal approval, whichever is later, a county is an eligible
vendor for a comprehensive assessment and assessment summary when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 4, and
completed according to the requirements of section 245G.05. A county is an eligible vendor
of care coordination services when provided by an individual who meets the staffing
credentials of section 245G.11, subdivisions 1 and 7, and provided according to the
requirements of section 245G.07, subdivision 1, new text begin paragraph (a), new text end clause deleted text begin (7)deleted text end new text begin (5)new text end .
(d) On July 1, 2018, or upon federal approval, whichever is later, a recovery community
organization that meets certification requirements identified by the commissioner is an
eligible vendor of peer support services.
(e) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.
Sec. 36.
Minnesota Statutes 2018, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) deleted text begin on July 1, 2018, or upon federal approval, whichever is later,deleted text end comprehensive
assessments provided according to sections 245.4863, paragraph (a), and 245G.05deleted text begin , and
Minnesota Rules, part 9530.6422deleted text end ;
(3) deleted text begin on July 1, 2018, or upon federal approval, whichever is later,deleted text end care coordination
services provided according to section 245G.07, subdivision 1, paragraph (a), clause deleted text begin (6)deleted text end new text begin
(5)new text end ;
(4) deleted text begin on July 1, 2018, or upon federal approval, whichever is later,deleted text end peer recovery support
services provided according to section 245G.07, subdivision deleted text begin 1, paragraph (a)deleted text end new text begin 2new text end , clause deleted text begin (5)deleted text end new text begin
(8)new text end ;
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 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;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 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
(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 section 245G.19, subdivision 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 section 245G.20;
(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 section 245G.19.
(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. 37.
Minnesota Statutes 2018, section 256B.0941, subdivision 1, is amended to read:
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 deleted text begin by the state's
medical review agentdeleted text end 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.
Sec. 38.
Minnesota Statutes 2018, section 256B.0941, subdivision 3, is amended to read:
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 deleted text begin must
be billed by the facility on a separate claim, and the facility shall be responsible for payment
to the providerdeleted text end new text begin may be billed by either the facility or the licensed professionalnew text end . These services
must be included in the individual plan of care and are subject to prior authorization deleted text begin by the
state's medical review agentdeleted text end .
(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.
ARTICLE 4
CONTINUING CARE FOR OLDER ADULTS
Section 1.
Minnesota Statutes 2018, section 245A.07, subdivision 3, is amended to read:
Subd. 3.
License suspension, revocation, or fine.
(a) The commissioner may suspend
or revoke a license, or impose a fine if:
(1) a license holder fails to comply fully with applicable laws or rules;
(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
a disqualification which has not been set aside under section 245C.22;
(3) a license holder knowingly withholds relevant information from or gives false or
misleading information to the commissioner in connection with an application for a license,
in connection with the background study status of an individual, during an investigation,
or regarding compliance with applicable laws or rules; or
(4) after July 1, 2012, and upon request by the commissioner, a license holder fails to
submit the information required of an applicant under section 245A.04, subdivision 1,
paragraph (f) or (g).
A license holder who has had a license suspended, revoked, or has been ordered to pay
a fine must be given notice of the action by certified mail or personal service. If mailed, the
notice must be mailed to the address shown on the application or the last known address of
the license holder. The notice must state in plain language the reasons the license was
suspended or revoked, or a fine was ordered.
(b) If the license was suspended or revoked, the notice must inform the license holder
of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
the commissioner within ten calendar days after the license holder receives notice that the
license has been suspended or revoked. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received the
order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits a
timely appeal of an order suspending or revoking a license, the license holder may continue
to operate the program as provided in section 245A.04, subdivision 7, paragraphs (g) and
(h), until the commissioner issues a final order on the suspension or revocation.
(c)(1) If the license holder was ordered to pay a fine, the notice must inform the license
holder of the responsibility for payment of fines and the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal of an
order to pay a fine must be made in writing by certified mail or personal service. If mailed,
the appeal must be postmarked and sent to the commissioner within ten calendar days after
the license holder receives notice that the fine has been ordered. If a request is made by
personal service, it must be received by the commissioner within ten calendar days after
the license holder received the order.
(2) The license holder shall 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. If the license holder
receives state funds, the state, county, or municipal agencies or departments responsible for
administering the funds shall withhold payments and recover any payments made while the
license is suspended for failure to pay a fine. A timely appeal shall stay payment of the fine
until the commissioner issues a final order.
(3) A license holder shall promptly notify the commissioner of human services, in writing,
when a violation specified in the order to forfeit a fine is corrected. If upon reinspection the
commissioner determines that a violation has not been corrected as indicated by the order
to forfeit a fine, the commissioner may issue a second fine. The commissioner shall notify
the license holder by certified mail or personal service that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.
(4) Fines shall be assessed as follows:
(i) the license holder shall forfeit $1,000 for each determination of maltreatment of a
child under section 626.556 or the maltreatment of a vulnerable adult under section 626.557
for which the license holder is determined responsible for the maltreatment under section
626.556, subdivision 10e, paragraph (i), or 626.557, subdivision 9c, paragraph deleted text begin (c)deleted text end new text begin (f)new text end ;
(ii) if the commissioner determines that a determination of maltreatment for which the
license holder is responsible is the result of maltreatment that meets the definition of serious
maltreatment as defined in section 245C.02, subdivision 18, the license holder shall forfeit
$5,000;
(iii) for a program that operates out of the license holder's home and a program licensed
under Minnesota Rules, parts 9502.0300 to deleted text begin 9502.0495deleted text end new text begin 9502.0445new text end , the fine assessed against
the license holder shall not exceed $1,000 for each determination of maltreatment;
(iv) the license holder shall forfeit $200 for each occurrence of a violation of law or rule
governing matters of health, safety, or supervision, including but not limited to the provision
of adequate staff-to-child or adult ratios, and failure to comply with background study
requirements under chapter 245C; and
(v) the license holder shall forfeit $100 for each occurrence of a violation of law or rule
other than those subject to a $5,000, $1,000, or $200 fine in items (i) to (iv).
For purposes of this section, "occurrence" means each violation identified in the
commissioner's fine order. Fines assessed against a license holder that holds a license to
provide home and community-based services, as identified in section 245D.03, subdivision
1, and a community residential setting or day services facility license under chapter 245D
where the services are provided, may be assessed against both licenses for the same
occurrence, but the combined amount of the fines shall not exceed the amount specified in
this clause for that occurrence.
(5) 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 will be personally liable for payment. In the case of a corporation, each
controlling individual is personally and jointly liable for payment.
(d) Except for background study violations involving the failure to comply with an order
to immediately remove an individual or an order to provide continuous, direct supervision,
the commissioner shall not issue a fine under paragraph (c) relating to a background study
violation to a license holder who self-corrects a background study violation before the
commissioner discovers the violation. A license holder who has previously exercised the
provisions of this paragraph to avoid a fine for a background study violation may not avoid
a fine for a subsequent background study violation unless at least 365 days have passed
since the license holder self-corrected the earlier background study violation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 2.
Minnesota Statutes 2018, section 245C.08, subdivision 1, is amended to read:
Subdivision 1.
Background studies conducted by Department of Human Services.
(a)
For a background study conducted by the Department of Human Services, the commissioner
shall review:
(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph deleted text begin (j)deleted text end new text begin (n)new text end ;
(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;
(3) information from juvenile courts as required in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;
(5) except as provided in clause (6), information received as a result of submission of
fingerprints for a national criminal history record check, as defined in section 245C.02,
subdivision 13c, when the commissioner has reasonable cause for a national criminal history
record check as defined under section 245C.02, subdivision 15a, or as required under section
144.057, subdivision 1, clause (2);
(6) for a background study related to a child foster care application for licensure, a
transfer of permanent legal and physical custody of a child under sections 260C.503 to
260C.515, or adoptions, and for a background study required for family child care, certified
license-exempt child care, child care centers, and legal nonlicensed child care authorized
under chapter 119B, the commissioner shall also review:
(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years; and
(ii) when the background study subject is 18 years of age or older, or a minor under
section 245C.05, subdivision 5a, paragraph (c), information received following submission
of fingerprints for a national criminal history record check; and
(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B, the background study shall also include, to the extent practicable, a name
and date-of-birth search of the National Sex Offender Public website.
(b) Notwithstanding expungement by a court, the commissioner may consider information
obtained under paragraph (a), clauses (3) and (4), unless the commissioner received notice
of the petition for expungement and the court order for expungement is directed specifically
to the commissioner.
(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.
(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.
(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 3.
Minnesota Statutes 2018, section 256.021, subdivision 2, is amended to read:
Subd. 2.
Review procedure.
(a) If a vulnerable adult or an interested person acting on
behalf of the vulnerable adult requests a review under this section, the panel shall review
the request at its next quarterly meeting. If the next quarterly meeting is within deleted text begin tendeleted text end new text begin 30
calendarnew text end days of the panel's receipt of the request for review, the review may be delayed
until the next subsequent meeting. The panel shall review the request and the investigation
memorandum and may review any other data on the investigation maintained by the lead
investigative agency that are pertinent and necessary to its review of the final disposition.
If more than one person requests a review under this section with respect to the same final
disposition, the review panel shall combine the requests into one review. The panel shall
submit its written request for the case file and other documentation relevant to the review
to the supervisor of the investigator conducting the investigation under review.
(b) Within 30 days of the review under this section, the panel shall notify the director
or manager of the lead investigative agency and the vulnerable adult or interested person
who requested the review as to whether the panel concurs with the final disposition or
whether the lead investigative agency must reconsider the final disposition. If the panel
determines that the lead investigative agency must reconsider the final disposition, the panel
must make specific recommendations to the director or manager of the lead investigative
agency. The recommendation must include an explanation of the factors that form the basis
of the recommendation to reconsider the final disposition and must specifically identify the
disputed facts, the disputed application of maltreatment definitions, the disputed application
of responsibility for maltreatment, and the disputed weighing of evidence, whichever apply.
Within 30 days the lead investigative agency shall conduct a review and report back to the
panel with its determination and the specific rationale for its final disposition. At a minimum,
the specific rationale must include a detailed response to each of the factors identified by
the panel that formed the basis for the recommendations of the panel.
(c) Upon receiving the report of reconsideration from the lead investigative agency, the
panel shall communicate the decision in writing to the vulnerable adult or interested person
acting on behalf of the vulnerable adult who requested the review. The panel shall include
the specific rationale provided by the lead investigative agency as part of the communication.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 4.
Minnesota Statutes 2018, 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,new text begin purchasing and inventory employees,new text end and associated fringe benefits and payroll
taxes, fees, contracts, or purchases related to business office functions, licenses, 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 except insurance that is a fringe benefit under subdivision 22, personnel
recruitment, legal services, accounting services, management or business consultants, data
processing, information technology, website, central or home office costs, business meetings
and seminars, postage, fees for professional organizations, subscriptions, security services,new text begin
nonpromotionalnew text end advertising, board of directors fees, working capital interest expense, bad
debts, 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 5.
Minnesota Statutes 2018, 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 anew text begin Minnesota registerednew text end
supplemental nursing services agencynew text begin up to the maximum allowable charges under section
144A.74, excluding associated lodging and travel costsnew text end ; 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,new text begin personal
hygienenew text end soap, medication cups, diapers, deleted text begin plastic waste bags,deleted text end sanitary products, new text begin disposable
new text end thermometers, hypodermic needles and syringes, clinical reagents or similar diagnostic
agents, drugs deleted text begin that are not paiddeleted text end new text begin payablenew text end on a separate fee schedule by the medical assistance
program or any other payer, and deleted text begin technology relateddeleted text end new text begin clinical software costs specificnew text end 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 6.
Minnesota Statutes 2018, section 256R.02, subdivision 18, is amended to read:
Subd. 18.
Employer health insurance costs.
"Employer health insurance costs" means
premium expenses for group coveragedeleted text begin ;deleted text end new text begin andnew text end actual expenses incurred for self-insured plans,
including deleted text begin reinsurance;deleted text end new text begin actual claims paid, stop loss premiums, plan fees,new text end and employer
contributions to employee health reimbursement and health savings accounts. new text begin Actual costs
of self-insurance plans must not include any allowance for future funding unless the plan
meets the Medicare requirements for reporting on a premium basis when the Medicare
regulations define the actual costs. new text end Premium and expense costs and contributions are
allowable for (1) all employees and (2) the spouse and dependents of those employees who
are employed on average at least 30 hours per week.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 7.
Minnesota Statutes 2018, 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, new text begin special new text end 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; deleted text begin rate adjustments for
compensation-related costs for minimum wage changes under section 256R.49 provided
on or after January 1, 2018;deleted text end and Public Employees Retirement Association employer costs.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 8.
Minnesota Statutes 2018, section 256R.02, subdivision 29, is amended to read:
Subd. 29.
Maintenance and plant operations costs.
"Maintenance and plant operations
costs" means the costs for the salaries and wages of the maintenance supervisor, engineers,
heating-plant employees, and other maintenance employees and associated fringe benefits
and payroll taxes. It also includes identifiable costs for maintenance and operation of the
building and grounds, including, but not limited to, fuel, electricity,new text begin plastic waste bags,new text end
medical waste and garbage removal, water, sewer, supplies, tools, deleted text begin anddeleted text end repairsnew text begin , and equipment
that is not required to be included in the property allowancenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 9.
Minnesota Statutes 2018, section 256R.02, subdivision 42a, is amended to read:
Subd. 42a.
Real estate taxes.
"Real estate taxes" means the real estate tax liability shown
on the annual property tax deleted text begin statementdeleted text end new text begin statementsnew text end of the nursing facility for the reporting
period. The term does not include personnel costs or fees for late payment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 10.
Minnesota Statutes 2018, section 256R.02, subdivision 48a, is amended to read:
Subd. 48a.
Special assessments.
"Special assessments" means the actual special
assessments and related interest paid during the reporting periodnew text begin that are involuntary costsnew text end .
The term does not include personnel costs deleted text begin ordeleted text end new text begin ,new text end fees for late paymentnew text begin , or special assessments
for projects that are reimbursed in the property allowancenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 11.
Minnesota Statutes 2018, 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, 6, and 7; 256R.08, subdivisions 1 deleted text begin todeleted text end new text begin andnew text end 3; and 256R.09, subdivisions 3 and
4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 12.
Minnesota Statutes 2018, section 256R.07, subdivision 2, is amended to read:
Subd. 2.
Documentation of compensation.
Compensation for personal services,
regardless of whether treated as identifiable costs or costs that are not identifiable, must be
documented on payroll records. Payrolls must be supported by time and attendance or
equivalent records for individual employees. Salaries and wages of employees which are
allocated to more than one cost category must be supported by time distribution records.
deleted text begin The method used must produce a proportional distribution of actual time spent, or an accurate
estimate of time spent performing assigned duties. The nursing facility that chooses to
estimate time spent must use a statistically valid method. The compensation must reflect
an amount proportionate to a full-time basis if the services are rendered on less than a
full-time basis.deleted text end new text begin Salary allocations are allowable using the Medicare approved allocation
basis and methodology only if the salary costs cannot be directly determined including when
employees provide shared services to noncovered operations.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 13.
Minnesota Statutes 2018, section 256R.09, subdivision 2, is amended to read:
Subd. 2.
Reporting of statistical and cost information.
All nursing facilities shall
provide information annually to the commissioner on a form and in a manner determined
by the commissioner. The commissioner may separately require facilities to submit in a
manner specified by the commissioner documentation of statistical and cost information
included in the report to ensure accuracy in establishing payment rates and to perform audit
and appeal review functions under this chapter. The commissioner may also require nursing
facilities to provide statistical and cost information for a subset of the items in the annual
report on a semiannual basis. Nursing facilities shall report only costs directly related to the
operation of the nursing facility. The facility shall not include costs which are separately
deleted text begin reimburseddeleted text end new text begin reimbursablenew text end by residents, medical assistance, or other payors. Allocations of
costs from central, affiliated, or corporate office and related organization transactions shall
be reported according to sections 256R.07, subdivision 3, and 256R.12, subdivisions 1 to
7. The commissioner shall not grant facilities extensions to the filing deadline.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 14.
Minnesota Statutes 2018, section 256R.10, subdivision 1, is amended to read:
Subdivision 1.
General cost principles.
Only costs determined to be allowable shall be
used to compute the total payment rate for nursing facilities participating in the medical
assistance program. To be considered an allowable cost for rate-setting purposes, a cost
must satisfy the following criteria:
(1) the cost is ordinary, necessary, and related to resident care;
(2) the cost is what a prudent and cost-conscious business person would pay for the
specific good or service in the open market in an arm's-length transaction;
(3) the cost is for goods or services actually provided in the nursing facility;
(4)new text begin incurred costs that are not salary or wage costs must be paid within 180 days of the
end of the reporting period to be allowable costs of the reporting period;
new text end
new text begin (5)new text end the cost effects of transactions that have the effect of circumventing this chapter are
not allowable under the principle that the substance of the transaction shall prevail over
form; and
deleted text begin (5)deleted text end new text begin (6)new text end costs that are incurred due to management inefficiency, unnecessary care or
facilities, agreements not to compete, or activities not commonly accepted in the nursing
facility care field are not allowable.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 15.
Minnesota Statutes 2018, 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, 6, and 7; 256R.08, subdivisions 1 deleted text begin todeleted text end new text begin andnew text end 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 16.
Minnesota Statutes 2018, section 256R.39, is amended to read:
256R.39 QUALITY IMPROVEMENT INCENTIVE PROGRAM.
The commissioner shall develop a quality improvement incentive program in consultation
with stakeholders. The annual funding pool available for quality improvement incentive
payments shall be equal to 0.8 percent of all operating payments, not including any rate
components resulting from equitable cost-sharing for publicly owned nursing facility program
participation under section 256R.48, critical access nursing facility program participation
under section 256R.47, or performance-based incentive payment program participation
under section 256R.38. deleted text begin For the period from October 1, 2015, to December 31, 2016, rate
adjustments provided under this section shall be effective for 15 months. Beginning January
1, 2017,deleted text end Annual rate adjustments provided under this section shall be effective for one rate
year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 17.
Minnesota Statutes 2018, section 626.557, subdivision 3, is amended to read:
Subd. 3.
Timing of report.
(a) A mandated reporter who has reason to believe that a
vulnerable adult is being or has been maltreated, or who has knowledge that a vulnerable
adult has sustained a physical injury which is not reasonably explained shall immediately
report the information to the common entry point. If an individual is a vulnerable adult
solely because the individual deleted text begin is admitted to a facilitydeleted text end new text begin receives licensed servicesnew text end , a mandated
reporter is not required to report suspected maltreatment of the individual that occurred
prior to deleted text begin admissiondeleted text end new text begin receiving licensed servicesnew text end , unless:
(1) the individual deleted text begin was admitted to the facilitydeleted text end new text begin received licensed services new text end from another
deleted text begin facilitydeleted text end new text begin licensed provider new text end and the reporter has reason to believe the vulnerable adult was
maltreated deleted text begin in the previous facilitydeleted text end new text begin during the time period in which the vulnerable adult
received licensed servicesnew text end ; or
(2) the reporter knows or has reason to believe that the individual is a vulnerable adult
as defined in section 626.5572, subdivision 21, paragraph (a), clause (4).
(b) A person not required to report under the provisions of this section may voluntarily
report as described above.
(c) Nothing in this section requires a report of known or suspected maltreatment, if the
reporter knows or has reason to know that a report has been made to the common entry
point.
(d) Nothing in this section shall preclude a reporter from also reporting to a law
enforcement agency.
(e) A mandated reporter who knows or has reason to believe that an error under section
626.5572, subdivision 17, paragraph (c), clause (5), occurred must make a report under this
subdivision. If the reporter or deleted text begin a facilitydeleted text end new text begin licensed providernew text end , at any time believes that an
investigation by a lead investigative agency will determine or should determine that the
reported error was not neglect according to the criteria under section 626.5572, subdivision
17, paragraph (c), clause (5), the reporter or deleted text begin facilitydeleted text end new text begin licensed providernew text end may provide to the
common entry point or directly to the lead investigative agency information explaining how
the event meets the criteria under section 626.5572, subdivision 17, paragraph (c), clause
(5). The lead investigative agency shall consider this information when making an initial
disposition of the report under subdivision 9c.
Sec. 18.
Minnesota Statutes 2018, section 626.557, subdivision 3a, is amended to read:
Subd. 3a.
Report not required.
The following events are not required to be reported
under this section:
(1) A circumstance where federal law specifically prohibits a person from disclosing
patient identifying information in connection with a report of suspected maltreatment, unless
the vulnerable adult, or the vulnerable adult's guardian, conservator, or legal representative,
has consented to disclosure in a manner which conforms to federal requirements. deleted text begin Facilitiesdeleted text end new text begin
Licensed providersnew text end whose patients or residents are covered by such a federal law shall seek
consent to the disclosure of suspected maltreatment from each patient or resident, or a
guardian, conservator, or legal representative, upon the patient's or resident's deleted text begin admission to
the facilitydeleted text end new text begin receipt of licensed servicesnew text end . Persons who are prohibited by federal law from
reporting an incident of suspected maltreatment shall immediately seek consent to make a
report.
(2) Verbal or physical aggression occurring between patients, residents, or clients of a
deleted text begin facilitydeleted text end new text begin licensed providernew text end , or self-abusive behavior by these persons does not constitute
abuse unless the behavior causes serious harm. The deleted text begin operator of the facility or a designeedeleted text end new text begin
licensed providernew text end shall record incidents of aggression and self-abusive behavior to facilitate
review by licensing agencies and county and local welfare agencies.
(3) Accidents as defined in section 626.5572, subdivision 3.
(4) Events deleted text begin occurring in a facilitydeleted text end that result from deleted text begin an individual'sdeleted text end new text begin a licensed provider's
new text end error in the provision of therapeutic conduct to a vulnerable adult, as provided in section
626.5572, subdivision 17, paragraph (c), clause (4).
(5) Nothing in this section shall be construed to require a report of financial exploitation,
as defined in section 626.5572, subdivision 9, solely on the basis of the transfer of money
or property by gift or as compensation for services rendered.
Sec. 19.
Minnesota Statutes 2018, section 626.557, subdivision 4, is amended to read:
Subd. 4.
Reporting.
(a) Except as provided in paragraph (b), a mandated reporter shall
immediately make an oral report to the common entry point. deleted text begin The common entry point may
accept electronic reports submitted through a web-based reporting system established by
the commissioner. Use of a telecommunications device for the deaf or other similar device
shall be considered an oral report. The common entry point may not require written reports.deleted text end
To the extent possible, the report must be of sufficient content to identify the vulnerable
adult, the caregiver, the nature and extent of the suspected maltreatment, any evidence of
previous maltreatment, the name and address of the reporter, the time, date, and location of
the incident, and any other information that the reporter believes might be helpful in
investigating the suspected maltreatment. A mandated reporter may disclose not public data,
as defined in section 13.02, and medical records under sections 144.291 to 144.298, to the
extent necessary to comply with this subdivision.
(b) A boarding care home that is licensed under sections 144.50 to 144.58 and certified
under Title 19 of the Social Security Act, a nursing home that is licensed under section
144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a hospital
that is licensed under sections 144.50 to 144.58 and has swing beds certified under Code
of Federal Regulations, title 42, section 482.66, may submit a report electronically to the
common entry point instead of submitting an oral report. The report may be a duplicate of
the initial report the deleted text begin facilitydeleted text end new text begin licensed providernew text end submits electronically to the commissioner
of health to comply with the reporting requirements under Code of Federal Regulations,
title 42, section 483.13. The commissioner of health may modify these reporting requirements
to include items required under paragraph (a) that are not currently included in the electronic
reporting form.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 20.
Minnesota Statutes 2018, section 626.557, subdivision 4a, is amended to read:
Subd. 4a.
Internal reporting of maltreatment.
(a) Each deleted text begin facilitydeleted text end new text begin licensed providernew text end shall
establish and enforce an ongoing written procedure in compliance with applicable licensing
rules to ensure that all cases of suspected maltreatment are reported. If a deleted text begin facilitydeleted text end new text begin licensed
providernew text end has an internal reporting procedure, a mandated reporter may meet the reporting
requirements of this section by reporting internally. However, the deleted text begin facilitydeleted text end new text begin licensed providernew text end
remains responsible for complying with the immediate reporting requirements of this section.
(b) A deleted text begin facilitydeleted text end new text begin licensed providernew text end with an internal reporting procedure that receives an
internal report by a mandated reporter shall give the mandated reporter a written notice
stating whether the deleted text begin facilitydeleted text end new text begin licensed providernew text end has reported the incident to the common entry
point. The written notice must be provided within two working days and in a manner that
protects the confidentiality of the reporter.
(c) The written response to the mandated reporter shall note that if the mandated reporter
is not satisfied with the action taken by the deleted text begin facilitydeleted text end new text begin licensed providernew text end on whether to report
the incident to the common entry point, then the mandated reporter may report externally.
(d) A deleted text begin facilitydeleted text end new text begin licensed providernew text end may not prohibit a mandated reporter from reporting
externally, and a deleted text begin facilitydeleted text end new text begin licensed providernew text end is prohibited from retaliating against a mandated
reporter who reports an incident to the common entry point in good faith. The written notice
by the deleted text begin facilitydeleted text end new text begin licensed providernew text end must inform the mandated reporter of this protection from
retaliatory measures by the deleted text begin facilitydeleted text end new text begin licensed providernew text end against the mandated reporter for
reporting externally.
Sec. 21.
Minnesota Statutes 2018, section 626.557, subdivision 6, is amended to read:
Subd. 6.
Falsified reports.
A person or deleted text begin facilitydeleted text end new text begin licensed providernew text end who intentionally
makes a false report under the provisions of this section shall be liable in a civil suit for any
actual damages suffered by the reported deleted text begin facilitydeleted text end new text begin licensed providernew text end , person or persons and
for punitive damages up to $10,000 and attorney fees.
Sec. 22.
Minnesota Statutes 2018, section 626.557, subdivision 9, is amended to read:
Subd. 9.
Common entry point designation.
(a) deleted text begin Each county board shall designate a
common entry point for reports of suspected maltreatment, for use until the commissioner
of human services establishes a common entry point. Two or more county boards may
jointly designate a single common entry point.deleted text end The commissioner of human services shall
establish a common entry point deleted text begin effective July 1, 2015deleted text end . The common entry point is the unit
responsible for receiving the report of suspected maltreatment under this section.
(b) The common entry point must be available 24 hours per day to take calls from
reporters of suspected maltreatment. The common entry point shall use a standard intake
form that includes:
(1) the time and date of the report;
(2) new text begin the name, relationship, and identifying and contact information for the alleged victim
and alleged perpetrator;
new text end
new text begin (3) new text end the name, deleted text begin address, and telephone number of the person reporting;deleted text end new text begin relationship, and
contact information for the:
new text end
new text begin
(i) reporter;
new text end
new text begin
(ii) initial reporter, witnesses, and persons who may have knowledge about the
maltreatment; and
new text end
new text begin
(iii) alleged victim's legal surrogate and persons who may provide support to the alleged
victim;
new text end
new text begin
(4) the basis of vulnerability for the alleged victim;
new text end
deleted text begin (3)deleted text end new text begin (5)new text end the time, date, and location of the incident;
deleted text begin
(4) the names of the persons involved, including but not limited to, perpetrators, alleged
victims, and witnesses;
deleted text end
deleted text begin (5) whether there was a risk of imminent dangerdeleted text end new text begin (6) the immediate safety risknew text end to the
alleged victim;
deleted text begin (6)deleted text end new text begin (7)new text end a description of the suspected maltreatment;
deleted text begin
(7) the disability, if any, of the alleged victim;
deleted text end
deleted text begin
(8) the relationship of the alleged perpetrator to the alleged victim;
deleted text end
new text begin
(8) the impact of the suspected maltreatment on the alleged victim;
new text end
(9) whether a deleted text begin facilitydeleted text end new text begin licensed providernew text end was involved and, if so, which agency licenses
the deleted text begin facilitydeleted text end new text begin licensed providernew text end ;
new text begin
(10) the actions taken to protect the alleged victim;
new text end
deleted text begin (10) any action takendeleted text end new text begin (11) the required notifications and referrals madenew text end by the common
entry point;new text begin and
new text end
deleted text begin
(11) whether law enforcement has been notified;
deleted text end
(12) whether the reporter wishes to receive notification of the deleted text begin initial and final reports;
anddeleted text end new text begin disposition.
new text end
deleted text begin
(13) if the report is from a facility with an internal reporting procedure, the name, mailing
address, and telephone number of the person who initiated the report internally.
deleted text end
(c) The common entry point is not required to complete each item on the form prior to
dispatching the report to the appropriate lead investigative agency.
(d) The common entry point shall immediately report to a law enforcement agency any
incident in which there is reason to believe a crime has been committed.
(e) If a report is initially made to a law enforcement agency or a lead investigative agency,
those agencies shall take the report on the appropriate common entry point intake forms
and immediately forward a copy to the common entry point.
(f) The common entry point staff must receive training on how to screen and dispatch
reports efficiently and in accordance with this section.
(g) The commissioner of human services shall maintain a centralized database for the
collection of common entry point data, lead investigative agency data including maltreatment
report disposition, and appeals data. The common entry point shall have access to the
centralized database and must log the reports into the database deleted text begin and immediately identify
and locate prior reports of abuse, neglect, or exploitationdeleted text end .
(h) When appropriate, the common entry point staff must refer calls that do not allege
the abuse, neglect, or exploitation of a vulnerable adult to other organizations that might
resolve the reporter's concerns.
(i) A common entry point must be operated in a manner that enables the commissioner
of human services to:
(1) track critical steps in the reporting, evaluation, referral, response, disposition, and
investigative process to ensure compliance with all requirements for all reports;
(2) maintain data to facilitate the production of aggregate statistical reports for monitoring
patterns of abuse, neglect, or exploitation;
(3) serve as a resource for the evaluation, management, and planning of preventative
and remedial services for vulnerable adults who have been subject to abuse, neglect, or
exploitation;
(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
of the common entry point; and
(5) track and manage consumer complaints related to the common entry point.
(j) The commissioners of human services and health shall collaborate on the creation of
a system for referring reports to the lead investigative agencies. This system shall enable
the commissioner of human services to track critical steps in the reporting, evaluation,
referral, response, disposition, investigation, notification, determination, and appeal processes.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2019.
new text end
Sec. 23.
Minnesota Statutes 2018, section 626.557, subdivision 9b, is amended to read:
Subd. 9b.
Response to reports.
Law enforcement is the primary agency to conduct
investigations of any incident in which there is reason to believe a crime has been committed.
Law enforcement shall initiate a response immediately. If the common entry point notified
a county agency for emergency adult protective services, law enforcement shall cooperate
with that county agency when both agencies are involved and shall exchange data to the
extent authorized in subdivision 12b, paragraph (g). County adult protection shall initiate
a response immediately. Each lead investigative agency shall complete the investigative
process for reports within its jurisdiction. A lead investigative agency, county, adult protective
agency, licensed deleted text begin facilitydeleted text end new text begin providernew text end , or law enforcement agency shall cooperate with other
agencies in the provision of protective services, coordinating its investigations, and assisting
another agency within the limits of its resources and expertise and shall exchange data to
the extent authorized in subdivision 12b, paragraph (g). The lead investigative agency shall
obtain the results of any investigation conducted by law enforcement officials. The lead
investigative agency has the right to enter deleted text begin facilitiesdeleted text end new text begin licensed provider premisesnew text end and inspect
and copy records as part of investigations. The lead investigative agency has access to not
public data, as defined in section 13.02, and medical records under sections 144.291 to
144.298, that are maintained by deleted text begin facilitiesdeleted text end new text begin licensed providersnew text end to the extent necessary to
conduct its investigation. Each lead investigative agency shall develop guidelines for
prioritizing reports for investigation.
Sec. 24.
Minnesota Statutes 2018, section 626.557, subdivision 9c, is amended to read:
Subd. 9c.
Lead investigative agency; notifications, dispositions, determinations.
(a)
Upon request of the reporter, the lead investigative agency shall notify the reporter that it
has received the report, and provide information on the initial disposition of the report within
five business days of receipt of the report, provided that the notification will not endanger
the vulnerable adult or hamper the investigation.
(b) new text begin In making the initial disposition, the lead investigative agency may consider previous
reports of suspected maltreatment and may request and consider public information, records
maintained by a lead investigative agency or licensed providers, and information from any
other person who may have knowledge regarding the alleged maltreatment.
new text end
new text begin
(c) Unless the lead investigative agency knows the information would endanger the
well-being of the vulnerable adult, during the investigation period the lead investigative
agency shall inform the vulnerable adult of the maltreatment allegation, investigation
guidelines, time frame, and evidence standards used for determinations. The lead investigative
agency must also provide the information to the vulnerable adult's guardian or health care
agent if the allegation is applicable to the guardian or health care agent.
new text end
new text begin
(d) During the investigation and in the provision of adult protective services, the lead
investigative agency may coordinate with entities identified under section 626.557,
subdivision 12b, paragraph (g), and the primary support person to safeguard the welfare
and prevent further maltreatment of the vulnerable adult. The lead investigative agency
must request and consider the vulnerable adult's choice of a primary support person.
new text end
new text begin (e) new text end Upon conclusion of every investigation it conducts, the lead investigative agency
shall make a final disposition as defined in section 626.5572, subdivision 8.
deleted text begin (c)deleted text end new text begin (f)new text end When determining whether the deleted text begin facilitydeleted text end new text begin licensed providernew text end or individual is the
responsible party for substantiated maltreatment or whether both the deleted text begin facilitydeleted text end new text begin licensed providernew text end
and deleted text begin thedeleted text end individual are responsible for substantiated maltreatment, the lead investigative
agency shall consider at least the following mitigating factors:
(1) whether the actions of the deleted text begin facilitydeleted text end new text begin licensed providernew text end or deleted text begin thedeleted text end individual deleted text begin caregiversdeleted text end new text begin
caregivernew text end were in accordance with, and followed the terms of, an erroneous physician order,
prescription, resident care plan, or directive. This is not a mitigating factor when the deleted text begin facilitydeleted text end new text begin
licensed providernew text end ornew text begin individualnew text end caregiver is responsible for the issuance of the erroneous
order, prescription, plan, or directive or knows or should have known of the errors and took
no reasonable measures to correct the defect before administering care;
(2) the comparative responsibility between the deleted text begin facility, other caregivers,deleted text end new text begin licensed provider
or individual caregivernew text end and requirements placed upon the employee, including but not limited
to, the deleted text begin facility'sdeleted text end new text begin licensed provider'snew text end compliance with related regulatory standards and factors
such as the adequacy of deleted text begin facilitydeleted text end new text begin licensed provider'snew text end policies and procedures, the adequacy
of deleted text begin facilitydeleted text end new text begin the licensed provider'snew text end training, the adequacy of an individual's participation in
the training, the adequacy of caregiver supervision, the adequacy of deleted text begin facilitydeleted text end new text begin the licensed
provider'snew text end staffing levels, and a consideration of the scope of the individual employee's
authority; and
(3) whether the deleted text begin facilitydeleted text end new text begin licensed provider, employee,new text end or individual followed professional
standards in exercising professional judgment.
deleted text begin (d)deleted text end new text begin (g)new text end When substantiated maltreatment is determined to have been committed by an
individual who is also the deleted text begin facilitydeleted text end license holder, both the individual and the deleted text begin facilitydeleted text end new text begin licensed
providernew text end must be determined responsible for the maltreatment, and both the background
study disqualification standards under section 245C.15, subdivision 4, and the licensing
actions under section 245A.06 or 245A.07 apply.
deleted text begin (e)deleted text end new text begin (h)new text end The lead investigative agency shall complete its final disposition within 60
calendar daysnew text begin from the date of the initial disposition for the reportnew text end . If the lead investigative
agency is unable to complete its final disposition within 60 calendar days, the lead
investigative agency shall notify the following persons provided that the notification will
not endanger the vulnerable adult or hamper the investigation: (1) the vulnerable adult or
the vulnerable adult's guardian or health care agent, when known, if the lead investigative
agency knows them to be aware of the investigation; and (2) the deleted text begin facilitydeleted text end new text begin licensed providernew text end ,
where applicable. The notice shall contain the reason for the delay and the projected
completion date. If the lead investigative agency is unable to complete its final disposition
by a subsequent projected completion date, the lead investigative agency shall again notify
the vulnerable adult or the vulnerable adult's guardian or health care agent, when known if
the lead investigative agency knows them to be aware of the investigation, and the deleted text begin facilitydeleted text end new text begin
licensed providernew text end , where applicable, of the reason for the delay and the revised projected
completion date provided that the notification will not endanger the vulnerable adult or
hamper the investigation. The lead investigative agency must notify the health care agent
of the vulnerable adult only if the health care agent's authority to make health care decisions
for the vulnerable adult is currently effective under section 145C.06 and not suspended
under section 524.5-310 and the investigation relates to a duty assigned to the health care