Minnesota Office of the Revisor of Statutes

Accessibility menu

Bills use visual text formatting such as stricken text to denote deleted language, and underlined text to denote new language. For users of the jaws screenreader it is recommended to configure jaws to use the proofreading scheme which will alter the pitch of the reading voice when reading stricken and underlined text. Instructions for configuring your jaws reader are provided by following this link.
If you can not or do not wish to configure your screen reader, deleted language will begin with the phrase "deleted text begin" and be followed by the phrase "deleted text end", new language will begin with the phrase "new text begin" and be followed by "new text end". Skip to text of SF 1034.

Menu

Revisor of Statutes Menu

SF 1034

2nd Engrossment - 88th Legislature (2013 - 2014) Posted on 04/25/2013 08:31am

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

Pdf

Rtf

Version List Authors and Status

Current Version - 2nd Engrossment

A bill for an act
relating to state government; establishing the health and human services budget;
modifying provisions related to health care, continuing care, nursing facility
admission, children and family services, human services licensing, chemical
and mental health, program integrity, managed care organizations, waiver
provider standards, home care, and the Department of Health; redesigning
home and community-based services; establishing community first services and
supports and Northstar Care for Children; providing for fraud investigations
in the child care assistance program; establishing autism early intensive
intervention benefits; creating a human services performance council; making
technical changes; requiring a study; requiring reports; appropriating money;
repealing MinnesotaCare;amending Minnesota Statutes 2012, sections 13.381,
subdivisions 2, 10; 13.411, subdivision 7; 13.461, by adding subdivisions;
16A.724, subdivision 3; 16C.10, subdivision 5; 16C.155, subdivision 1; 62J.692,
subdivisions 1, 3, 4, 5, 7a, 9, by adding a subdivision; 62Q.19, subdivision 1;
103I.005, by adding a subdivision; 103I.521; 119B.05, subdivision 1; 119B.13,
subdivisions 1, 7; 144.051, by adding subdivisions; 144.0724, subdivisions
4, 6; 144.123, subdivision 1; 144.125, subdivision 1; 144.212; 144.213;
144.215, subdivisions 3, 4; 144.216, subdivision 1; 144.217, subdivision 2;
144.218, subdivision 5; 144.225, subdivisions 1, 4, 7, 8; 144.226; 144.966,
subdivisions 2, 3a; 144.98, subdivisions 3, 5, by adding subdivisions; 144.99,
subdivision 4; 144A.351; 144A.43; 144A.44; 144A.45; 144D.01, subdivision 4;
145.906; 145.986; 145A.17, subdivision 1; 145C.01, subdivision 7; 148B.17,
subdivision 2; 148E.065, subdivision 4a; 149A.02, subdivisions 1a, 2, 3, 4, 5,
16, 23, 27, 34, 35, 37, by adding subdivisions; 149A.03; 149A.65, by adding
subdivisions; 149A.70, subdivisions 1, 2, 3, 5; 149A.71, subdivisions 2, 4;
149A.72, subdivisions 3, 9, by adding a subdivision; 149A.73, subdivisions 1,
2, 4; 149A.74; 149A.91, subdivision 9; 149A.93, subdivisions 3, 6; 149A.94;
149A.96, subdivision 9; 151.01, subdivision 27; 151.19, subdivisions 1, 3;
151.26, subdivision 1; 151.37, subdivision 4; 151.47, subdivision 1, by adding
a subdivision; 151.49; 152.126; 174.30, subdivision 1; 214.12, by adding
a subdivision; 214.40, subdivision 1; 243.166, subdivisions 4b, 7; 245.03,
subdivision 1; 245.462, subdivision 20; 245.4661, subdivisions 5, 6; 245.4682,
subdivision 2; 245.4875, subdivision 8; 245.4881, subdivision 1; 245A.02,
subdivisions 1, 9, 10, 14; 245A.03, subdivisions 7, 8, 9; 245A.04, subdivision
13; 245A.042, subdivision 3; 245A.07, subdivisions 2a, 3; 245A.08, subdivision
2a; 245A.10; 245A.11, subdivisions 2a, 7, 7a, 7b, 8; 245A.1435; 245A.144;
245A.1444; 245A.16, subdivision 1; 245A.40, subdivision 5; 245A.50; 245C.04,
by adding a subdivision; 245C.08, subdivision 1; 245C.32, subdivision
2; 245D.02; 245D.03; 245D.04; 245D.05; 245D.06; 245D.07; 245D.09;
245D.10; 246.18, subdivision 8, by adding a subdivision; 252.27, subdivision
2a; 252.291, by adding a subdivision; 253B.10, subdivision 1; 254B.04,
subdivision 1; 254B.13; 256.01, subdivisions 2, 24, 34, by adding subdivisions;
256.82, subdivision 3; 256.9657, subdivision 3; 256.969, subdivisions 3a,
29; 256.975, subdivision 7, by adding subdivisions; 256.9754, subdivision
5, by adding subdivisions; 256B.02, by adding subdivisions; 256B.021, by
adding subdivisions; 256B.04, subdivisions 18, 21, by adding a subdivision;
256B.055, subdivisions 3a, 6, 10, 14, 15, by adding a subdivision; 256B.056,
subdivisions 1, 1c, 3, 4, as amended, 5c, 10, by adding a subdivision; 256B.057,
subdivisions 1, 10, by adding a subdivision; 256B.059, subdivision 1; 256B.06,
subdivision 4; 256B.0623, subdivision 2; 256B.0625, subdivisions 13e, 19c, 31,
39, 48, 56, 58, by adding subdivisions; 256B.0631, subdivision 1; 256B.064,
subdivisions 1a, 1b, 2; 256B.0659, subdivision 21; 256B.0755, subdivision 3;
256B.0756; 256B.0911, subdivisions 1, 1a, 3a, 4d, 6, 7, by adding a subdivision;
256B.0913, subdivision 4, by adding a subdivision; 256B.0915, subdivisions 3a,
5, by adding a subdivision; 256B.0916, by adding a subdivision; 256B.0917,
subdivisions 6, 13, by adding subdivisions; 256B.092, subdivisions 11, 12, by
adding a subdivision; 256B.0943, subdivisions 1, 2, 7, by adding a subdivision;
256B.0946; 256B.095; 256B.0951, subdivisions 1, 4; 256B.0952, subdivisions 1,
5; 256B.0955; 256B.097, subdivisions 1, 3; 256B.196, subdivision 2; 256B.431,
subdivision 44; 256B.434, subdivision 4; 256B.437, subdivision 6; 256B.439,
subdivisions 1, 2, 3, 4, by adding a subdivision; 256B.441, subdivisions 13,
53, 55, 56, 62; 256B.49, subdivisions 11a, 12, 14, 15, by adding subdivisions;
256B.4912, subdivisions 1, 2, 3, 7, by adding subdivisions; 256B.4913,
subdivisions 5, 6, by adding a subdivision; 256B.492; 256B.493, subdivision 2;
256B.501, by adding a subdivision; 256B.5011, subdivision 2; 256B.5012, by
adding subdivisions; 256B.69, subdivisions 5c, 31, by adding a subdivision;
256B.694; 256B.76, subdivisions 1, 2, 4, by adding a subdivision; 256B.761;
256B.764; 256B.766; 256D.44, subdivision 5; 256I.05, subdivision 1e, by
adding a subdivision; 256J.08, subdivision 24; 256J.21, subdivision 3; 256J.24,
subdivisions 5, 5a, 7; 256J.621; 256J.626, subdivision 7; 256K.45; 256L.01,
subdivisions 3a, 5, by adding subdivisions; 256L.02, subdivision 2, by adding
subdivisions; 256L.03, subdivisions 1, 1a, 3, 5, 6, by adding a subdivision;
256L.04, subdivisions 1, 7, 8, 10, 12, by adding subdivisions; 256L.05,
subdivisions 1, 2, 3, 3c; 256L.06, subdivision 3; 256L.07, subdivisions 1, 2, 3;
256L.09, subdivision 2; 256L.11, subdivisions 1, 3; 256L.15, subdivisions 1, 2;
256M.40, subdivision 1; 257.75, subdivision 7; 257.85, subdivision 11; 259A.05,
subdivision 5; 259A.20, subdivision 4; 260B.007, subdivisions 6, 16; 260C.007,
subdivisions 6, 31; 260C.635, subdivision 1; 299C.093; 471.59, subdivision 1;
517.001; 518A.60; 524.5-118, subdivision 1, by adding a subdivision; 524.5-303;
524.5-316; 524.5-403; 524.5-420; 626.556, subdivisions 2, 3, 10d; 626.557,
subdivisions 4, 9, 9a, 9e; 626.5572, subdivision 13; Laws 1998, chapter 407,
article 6, section 116; Laws 2011, First Special Session chapter 9, article 7,
section 39, subdivision 14; Laws 2012, chapter 247, article 1, section 28; article
6, section 4; Laws 2013, chapter 1, sections 1; 6; proposing coding for new law in
Minnesota Statutes, chapters 144; 144A; 145; 149A; 151; 214; 245; 245A; 245D;
254B; 256B; 256J; 256L; proposing coding for new law as Minnesota Statutes,
chapter 245E; repealing Minnesota Statutes 2012, sections 62J.693; 103I.005,
subdivision 20; 144.123, subdivision 2; 144A.46; 144A.461; 149A.025;
149A.20, subdivision 8; 149A.30, subdivision 2; 149A.40, subdivision 8;
149A.45, subdivision 6; 149A.50, subdivision 6; 149A.51, subdivision 7;
149A.52, subdivision 5a; 149A.53, subdivision 9; 151.19, subdivision 2; 151.25;
151.45; 151.47, subdivision 2; 151.48; 245A.655; 245B.01; 245B.02; 245B.03;
245B.031; 245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, 7; 245B.055; 245B.06;
245B.07; 245B.08; 245D.08; 256B.055, subdivisions 3, 5, 10b; 256B.056,
subdivision 5b; 256B.057, subdivisions 1c, 2; 256B.0911, subdivisions 4a, 4b,
4c; 256B.0917, subdivisions 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14; 256B.096,
subdivisions 1, 2, 3, 4; 256B.49, subdivision 16a; 256B.4913, subdivisions 1, 2,
3, 4; 256B.5012, subdivision 13; 256J.24, subdivision 6; 256L.01, subdivisions
3, 4a; 256L.02, subdivision 3; 256L.03, subdivision 4; 256L.031; 256L.04,
subdivisions 1b, 2a, 7a, 9; 256L.07, subdivisions 1, 4, 5, 8, 9; 256L.09,
subdivisions 1, 4, 5, 6, 7; 256L.11, subdivisions 2a, 5, 6; 256L.12, subdivisions
1, 2, 3, 4, 5, 6, 7, 8, 9a, 9b; 256L.17, subdivisions 1, 2, 3, 4, 5; 485.14;
609.093; Laws 2011, First Special Session chapter 9, article 7, section 54, as
amended; Minnesota Rules, parts 4668.0002; 4668.0003; 4668.0005; 4668.0008;
4668.0012; 4668.0016; 4668.0017; 4668.0019; 4668.0030; 4668.0035;
4668.0040; 4668.0050; 4668.0060; 4668.0065; 4668.0070; 4668.0075;
4668.0080; 4668.0100; 4668.0110; 4668.0120; 4668.0130; 4668.0140;
4668.0150; 4668.0160; 4668.0170; 4668.0180; 4668.0190; 4668.0200;
4668.0218; 4668.0220; 4668.0230; 4668.0240; 4668.0800; 4668.0805;
4668.0810; 4668.0815; 4668.0820; 4668.0825; 4668.0830; 4668.0835;
4668.0840; 4668.0845; 4668.0855; 4668.0860; 4668.0865; 4668.0870;
4669.0001; 4669.0010; 4669.0020; 4669.0030; 4669.0040; 4669.0050.

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

ARTICLE 1

AFFORDABLE CARE ACT IMPLEMENTATION; BETTER HEALTH
CARE FOR MORE MINNESOTANS

Section 1.

Minnesota Statutes 2012, section 16A.724, subdivision 3, is amended to read:


Subd. 3.

MinnesotaCare federal receipts.

Receipts received as a result of federal
participation pertaining to administrative costs of the Minnesota health care reform waiver
shall be deposited as nondedicated revenue in the health care access fund. Receipts
received as a result of federal participation pertaining to grants shall be deposited in the
federal fund and shall offset health care access funds for payments to providers.
All federal
funding received by Minnesota for implementation and administration of MinnesotaCare
as a basic health program, as authorized in section 1331 of the Affordable Care Act,
Public Law 111-148, as amended by Public Law 111-152, is dedicated to that program and
shall be deposited into the health care access fund. Federal funding that is received for
implementing and administering MinnesotaCare as a basic health program and deposited in
the fund shall be used only for that program to purchase health care coverage for enrollees
and reduce enrollee premiums and cost-sharing or provide additional enrollee benefits.

EFFECTIVE DATE.

This section is effective January 1, 2015.

Sec. 2.

Minnesota Statutes 2012, section 254B.04, subdivision 1, is amended to read:


Subdivision 1.

Eligibility.

(a) Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, persons eligible for medical assistance benefits under
sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, or who meet
the income standards of section 256B.056, subdivision 4, and persons eligible for general
assistance medical care under section 256D.03, subdivision 3, are entitled to chemical
dependency fund services. State money appropriated for this paragraph must be placed in
a separate account established for this purpose.

Persons with dependent children who are determined to be in need of chemical
dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
local agency to access needed treatment services. Treatment services must be appropriate
for the individual or family, which may include long-term care treatment or treatment in a
facility that allows the dependent children to stay in the treatment facility. The county
shall pay for out-of-home placement costs, if applicable.

(b) A person not entitled to services under paragraph (a), but with family income
that is less than 215 percent of the federal poverty guidelines for the applicable family
size, shall be eligible to receive chemical dependency fund services within the limit
of funds appropriated for this group for the fiscal year. If notified by the state agency
of limited funds, a county must give preferential treatment to persons with dependent
children who are in need of chemical dependency treatment pursuant to an assessment
under section 626.556, subdivision 10, or a case plan under section 260C.201, subdivision
6
, or 260C.212. A county may spend money from its own sources to serve persons under
this paragraph. State money appropriated for this paragraph must be placed in a separate
account established for this purpose.

(c) Persons whose income is between 215 percent and 412 percent of the federal
poverty guidelines for the applicable family size shall be eligible for chemical dependency
services on a sliding fee basis, within the limit of funds appropriated for this group for the
fiscal year. Persons eligible under this paragraph must contribute to the cost of services
according to the sliding fee scale established under subdivision 3. A county may spend
money from its own sources to provide services to persons under this paragraph. State
money appropriated for this paragraph must be placed in a separate account established
for this purpose.

Sec. 3.

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


Subd. 35.

Federal approval.

(a) The commissioner shall seek federal authority
from the U.S. Department of Health and Human Services necessary to operate a health
coverage program for Minnesotans with incomes up to 275 percent of the federal poverty
guidelines (FPG). The proposal shall seek to secure all federal funding available from at
least the following services:

(1) all premium tax credits and cost sharing subsidies available under United States
Code, title 26, section 36B, and United States Code, title 42, section 18071, for individuals
with incomes above 133 percent and at or below 275 percent of the federal poverty
guidelines who would otherwise be enrolled in the Minnesota Insurance Marketplace as
defined in section 62V.02;

(2) Medicaid funding; and

(3) other funding sources identified by the commissioner that support coverage or
care redesign in Minnesota.

(b) Funding received shall be used to design and implement a health coverage
program that creates a single streamlined program and meets the needs of Minnesotans with
incomes up to 275 percent of the federal poverty guidelines. The program must incorporate:

(1) payment reform characteristics included in the health care delivery system and
accountable care organization payment models;

(2) flexibility in benefit set design such that benefits can be targeted to meet enrollee
needs in different income and health status situations and can provide a more seamless
transition from public to private health care coverage;

(3) flexibility in co-payment or premium structures to incent patients to seek
high-quality, low-cost care settings; and

(4) flexibility in premium structures to ease the transition from public to private
health care coverage.

(c) The commissioner shall develop and submit a proposal consistent with the above
criteria and shall seek all federal authority necessary to implement the health coverage
program. In developing the request, the commissioner shall consult with appropriate
stakeholder groups and consumers.

(d) The commissioner is authorized to seek any available waivers or federal
approvals to accomplish the goals under paragraph (b) prior to 2017.

(e) The commissioner shall report to the chairs and ranking minority members of
the legislative committees with jurisdiction over health and human services policy and
financing by January 15, 2015, on the progress of receiving a federal waiver and shall
make recommendations on any legislative changes necessary to accomplish the project
in this subdivision. Any implementation of the waiver that requires a state financial
contribution shall be contingent on legislative action approving the contribution.

(f) The commissioner is authorized to accept and expend federal funds that support
the purposes of this subdivision.

Sec. 4.

Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
to read:


Subd. 18.

Caretaker relative.

"Caretaker relative" means a relative, by blood,
adoption, or marriage, of a child under age 19 with whom the child is living and who
assumes primary responsibility for the child's care.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 5.

Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
to read:


Subd. 19.

Insurance affordability program.

"Insurance affordability program"
means one of the following programs:

(1) medical assistance under this chapter;

(2) a program that provides advance payments of the premium tax credits established
under section 36B of the Internal Revenue Code or cost-sharing reductions established
under section 1402 of the Affordable Care Act;

(3) MinnesotaCare as defined in chapter 256L; and

(4) a Basic Health Plan as defined in section 1331 of the Affordable Care Act.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 6.

Minnesota Statutes 2012, section 256B.04, subdivision 18, is amended to read:


Subd. 18.

Applications for medical assistance.

(a) The state agency may take
shall accept applications for medical assistance and conduct eligibility determinations for
MinnesotaCare enrollees
by telephone, via mail, in-person, online via an Internet Web
site, and through other commonly available electronic means
.

(b) The commissioner of human services shall modify the Minnesota health care
programs application form to add a question asking applicants whether they have ever
served in the United States military.

(c) For each individual who submits an application or whose eligibility is subject to
renewal or whose eligibility is being redetermined pursuant to a change in circumstances,
if the agency determines the individual is not eligible for medical assistance, the agency
shall determine potential eligibility for other insurance affordability programs.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 7.

Minnesota Statutes 2012, section 256B.055, subdivision 3a, is amended to read:


Subd. 3a.

Families with children.

Beginning July 1, 2002, Medical assistance may
be paid for a person who is a child under the age of 18, or age 18 if a full-time student
in a secondary school, or in the equivalent level of vocational or technical training, and
reasonably expected to complete the program before reaching age
19; the parent or
stepparent
of a dependent child under the age of 19, including a pregnant woman; or a
caretaker relative of a dependent child under the age of 19.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 8.

Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:


Subd. 6.

Pregnant women; needy unborn child.

Medical assistance may be paid
for a pregnant woman who has written verification of a positive pregnancy test from a
physician or licensed registered nurse, who
meets the other eligibility criteria of this
section and whose unborn child would be eligible as a needy child under subdivision 10 if
born and living with the woman. In accordance with Code of Federal Regulations, title
42, section 435.956, the commissioner must accept self-attestation of pregnancy unless
the agency has information that is not reasonably compatible with such attestation.
For
purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 9.

Minnesota Statutes 2012, section 256B.055, subdivision 10, is amended to read:


Subd. 10.

Infants.

Medical assistance may be paid for an infant less than one year
of age, whose mother was eligible for and receiving medical assistance at the time of birth
or who is less than two years of age and is in a family with countable income that is equal
to or less than the income standard established under section 256B.057, subdivision 1.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 10.

Minnesota Statutes 2012, section 256B.055, subdivision 15, is amended to read:


Subd. 15.

Adults without children.

Medical assistance may be paid for a person
who is:

(1) at least age 21 and under age 65;

(2) not pregnant;

(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII
of the Social Security Act;

(4) not an adult in a family with children as defined in section 256L.01, subdivision
3a
; and
not otherwise eligible under subdivision 7 as a person who meets the categorical
eligibility requirements of the supplemental security income program;

(5) not enrolled under subdivision 7 as a person who would meet the categorical
eligibility requirements of the supplemental security income program except for excess
income or assets; and

(5) (6) not described in another subdivision of this section.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 11.

Minnesota Statutes 2012, section 256B.055, is amended by adding a
subdivision to read:


Subd. 17.

Adults who were in foster care at the age of 18.

Medical assistance may
be paid for a person under 26 years of age who was in foster care under the commissioner's
responsibility on the date of attaining 18 years of age, and who was enrolled in medical
assistance under the state plan or a waiver of the plan while in foster care, in accordance
with section 2004 of the Affordable Care Act.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 12.

Minnesota Statutes 2012, section 256B.056, subdivision 1, is amended to read:


Subdivision 1.

Residency.

To be eligible for medical assistance, a person must
reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota,
in accordance with the rules of the state agency Code of Federal Regulations, title 42,
section 435.403
.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 13.

Minnesota Statutes 2012, section 256B.056, subdivision 1c, is amended to read:


Subd. 1c.

Families with children income methodology.

(a)(1) [Expired, 1Sp2003
c 14 art 12 s 17]

(2) For applications processed within one calendar month prior to July 1, 2003,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to July 1, 2003, for any months in the six-month budget period before July
1, 2003, and the income standards and methodologies in effect on July 1, 2003, for any
months in the six-month budget period on or after that date. The income standards for
each month shall be added together and compared to the applicant's total countable income
for the six-month budget period to determine eligibility.

(3) For children ages one through 18 whose eligibility is determined under section
256B.057, subdivision 2, the following deductions shall be applied to income counted
toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
16, 1996: $90 work expense, dependent care, and child support paid under court order.
This clause is effective October 1, 2003.

(b) For families with children whose eligibility is determined using the standard
specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
earned income shall be disregarded for up to four months and the following deductions
shall be applied to each individual's income counted toward eligibility as allowed under
the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
under court order.

(c) If the four-month disregard in paragraph (b) has been applied to the wage
earner's income for four months, the disregard shall not be applied again until the wage
earner's income has not been considered in determining medical assistance eligibility for
12 consecutive months.

(d)(b) The commissioner shall adjust the income standards under this section each
July 1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services except that the income standards
shall not go below those in effect on July 1, 2009.

(e) (c) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
organization to or for the benefit of the child with a life-threatening illness must be
disregarded from income.

Sec. 14.

Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:


Subd. 3.

Asset limitations for certain individuals and families.

(a) To be
eligible for medical assistance, a person must not individually own more than $3,000 in
assets, or if a member of a household with two family members, husband and wife, or
parent and child, the household must not own more than $6,000 in assets, plus $200 for
each additional legal dependent. In addition to these maximum amounts, an eligible
individual or family may accrue interest on these amounts, but they must be reduced to the
maximum at the time of an eligibility redetermination. The accumulation of the clothing
and personal needs allowance according to section 256B.35 must also be reduced to the
maximum at the time of the eligibility redetermination. The value of assets that are not
considered in determining eligibility for medical assistance is the value of those assets
excluded under the supplemental security income program for aged, blind, and disabled
persons, with the following exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;

(3) motor vehicles are excluded to the same extent excluded by the supplemental
security income program;

(4) assets designated as burial expenses are excluded to the same extent excluded by
the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;

(5) for a person who no longer qualifies as an employed person with a disability due
to loss of earnings, assets allowed while eligible for medical assistance under section
256B.057, subdivision 9, are not considered for 12 months, beginning with the first month
of ineligibility as an employed person with a disability, to the extent that the person's total
assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph (d);

(6) when a person enrolled in medical assistance under section 256B.057, subdivision
9
, is age 65 or older and has been enrolled during each of the 24 consecutive months
before the person's 65th birthday, the assets owned by the person and the person's spouse
must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d),
when determining eligibility for medical assistance under section 256B.055, subdivision
7
. The income of a spouse of a person enrolled in medical assistance under section
256B.057, subdivision 9, during each of the 24 consecutive months before the person's
65th birthday must be disregarded when determining eligibility for medical assistance
under section 256B.055, subdivision 7. Persons eligible under this clause are not subject to
the provisions in section 256B.059. A person whose 65th birthday occurs in 2012 or 2013
is required to have qualified for medical assistance under section 256B.057, subdivision 9,
prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and

(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.

(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 15.

Minnesota Statutes 2012, section 256B.056, subdivision 4, as amended by
Laws 2013, chapter 1, section 5, 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) To be eligible for medical assistance, families and children may have an income
up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996,
AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16,
1996, shall be increased by three percent.

(c) (b) Effective January 1, 2014, to be eligible for medical assistance, 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.

(d) (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.

(e) (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.

(f) (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 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 section 256B.056, subdivision 7a.

(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.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 16.

Minnesota Statutes 2012, section 256B.056, subdivision 5c, is amended to read:


Subd. 5c.

Excess income standard.

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

(b) The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
family size. Effective July 1, 2002, the excess income standard for this paragraph
shall
equal 75 percent of the federal poverty guidelines.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 17.

Minnesota Statutes 2012, section 256B.056, is amended by adding a
subdivision 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), individuals eligible under subdivision 5 shall be
required to renew eligibility every six months.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 18.

Minnesota Statutes 2012, 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 (d), 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.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 19.

Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:


Subdivision 1.

Infants and pregnant women.

(a)(1) An infant less than one year
two years of age or a pregnant woman who has written verification of a positive pregnancy
test from a physician or licensed registered nurse
is eligible for medical assistance if the
individual's
countable family household income is equal to or less than 275 percent of the
federal poverty guideline for the same family household size or an equivalent standard
when converted using modified adjusted gross income methodology as required under
the Affordable Care Act
. For purposes of this subdivision, "countable family income"
means the amount of income considered available using the methodology of the AFDC
program under the state's AFDC plan as of July 16, 1996, as required by the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public
Law 104-193, except for the earned income disregard and employment deductions.

(2) For applications processed within one calendar month prior to the effective date,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to the effective date for any months in the six-month budget period before
that date and the income standards and methodologies in effect on the effective date for
any months in the six-month budget period on or after that date. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]

(2) For applications processed within one calendar month prior to July 1, 2003,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
2003, and the income standards and methodologies in effect on the expiration date for any
months in the six-month budget period on or after July 1, 2003. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(3) An amount equal to the amount of earned income exceeding 275 percent of
the federal poverty guideline, up to a maximum of the amount by which the combined
total of 185 percent of the federal poverty guideline plus the earned income disregards
and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
pregnant women and infants less than one year of age.

(c) Dependent care and child support paid under court order shall be deducted from
the countable income of pregnant women.

(d) (b) 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.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 20.

Minnesota Statutes 2012, section 256B.057, subdivision 10, is amended to read:


Subd. 10.

Certain persons needing treatment for breast or cervical cancer.

(a)
Medical assistance may be paid for a person who:

(1) has been screened for breast or cervical cancer by the Minnesota breast and
cervical cancer control program, and program funds have been used to pay for the person's
screening;

(2) according to the person's treating health professional, needs treatment, including
diagnostic services necessary to determine the extent and proper course of treatment, for
breast or cervical cancer, including precancerous conditions and early stage cancer;

(3) meets the income eligibility guidelines for the Minnesota breast and cervical
cancer control program;

(4) is under age 65;

(5) is not otherwise eligible for medical assistance under United States Code, title
42, section 1396a(a)(10)(A)(i); and

(6) is not otherwise covered under creditable coverage, as defined under United
States Code, title 42, section 1396a(aa).

(b) Medical assistance provided for an eligible person under this subdivision shall
be limited to services provided during the period that the person receives treatment for
breast or cervical cancer.

(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance
without meeting the eligibility criteria relating to income and assets in section 256B.056,
subdivisions 1a to 5b 5a.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 21.

Minnesota Statutes 2012, section 256B.057, is amended by adding a
subdivision to read:


Subd. 12.

Presumptive eligibility determinations made by qualified hospitals.

The commissioner shall establish a process to qualify hospitals that are participating
providers under the medical assistance program to determine presumptive eligibility for
medical assistance for applicants who may have a basis of eligibility using the modified
adjusted gross income methodology as defined in section 256B.056, subdivision 1a,
paragraph (b), clause (1).

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 22.

Minnesota Statutes 2012, section 256B.059, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) For purposes of this section and sections 256B.058
and 256B.0595, the terms defined in this subdivision have the meanings given them.

(b) "Community spouse" means the spouse of an institutionalized spouse.

(c) "Spousal share" means one-half of the total value of all assets, to the extent that
either the institutionalized spouse or the community spouse had an ownership interest at
the time of the first continuous period of institutionalization.

(d) "Assets otherwise available to the community spouse" means assets individually
or jointly owned by the community spouse, other than assets excluded by subdivision 5,
paragraph (c).

(e) "Community spouse asset allowance" is the value of assets that can be transferred
under subdivision 3.

(f) "Institutionalized spouse" means a person who is:

(1) in a hospital, nursing facility, or intermediate care facility for persons with
developmental disabilities, or receiving home and community-based services under section
256B.0915, 256B.092, or 256B.49 and is expected to remain in the facility or institution
or receive the home and community-based services for at least 30 consecutive days; and

(2) married to a person who is not in a hospital, nursing facility, or intermediate
care facility for persons with developmental disabilities, and is not receiving home and
community-based services under section 256B.0915, 256B.092, or 256B.49.

(g) "For the sole benefit of" means no other individual or entity can benefit in any
way from the assets or income at the time of a transfer or at any time in the future.

(h) "Continuous period of institutionalization" means a 30-consecutive-day period
of time in which a person is expected to stay in a medical or long-term care facility, or
receive home and community-based services that would qualify for coverage under the
elderly waiver (EW) or alternative care (AC) programs
section 256B.0913, 256B.0915,
256B.092, or 256B.49
. For a stay in a facility, the 30-consecutive-day period begins
on the date of entry into a medical or long-term care facility. For receipt of home and
community-based services, the 30-consecutive-day period begins on the date that the
following conditions are met:

(1) the person is receiving services that meet the nursing facility level of care
determined by a long-term care consultation;

(2) the person has received the long-term care consultation within the past 60 days;

(3) the services are paid by the EW program under section 256B.0915 or the AC
program under section
256B.0913, 256B.0915, 256B.092, or 256B.49 or would qualify
for payment under the EW or AC programs those sections if the person were otherwise
eligible for either program, and but for the receipt of such services the person would have
resided in a nursing facility; and

(4) the services are provided by a licensed provider qualified to provide home and
community-based services.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 23.

Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:


Subd. 4.

Citizenship requirements.

(a) Eligibility for medical assistance is limited
to citizens of the United States, qualified noncitizens as defined in this subdivision, and
other persons residing lawfully in the United States. Citizens or nationals of the United
States must cooperate in obtaining satisfactory documentary evidence of citizenship or
nationality according to the requirements of the federal Deficit Reduction Act of 2005,
Public Law 109-171.

(b) "Qualified noncitizen" means a person who meets one of the following
immigration criteria:

(1) admitted for lawful permanent residence according to United States Code, title 8;

(2) admitted to the United States as a refugee according to United States Code,
title 8, section 1157;

(3) granted asylum according to United States Code, title 8, section 1158;

(4) granted withholding of deportation according to United States Code, title 8,
section 1253(h);

(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);

(6) granted conditional entrant status according to United States Code, title 8,
section 1153(a)(7);

(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;

(8) is a child of a noncitizen determined to be a battered noncitizen by the United
States Attorney General according to the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
Public Law 104-200; or

(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.

(c) All qualified noncitizens who were residing in the United States before August
22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance with federal financial participation.

(d) Beginning December 1, 1996, qualified noncitizens who entered the United
States on or after August 22, 1996, and who otherwise meet the eligibility requirements
of this chapter are eligible for medical assistance with federal participation for five years
if they meet one of the following criteria:

(1) refugees admitted to the United States according to United States Code, title 8,
section 1157;

(2) persons granted asylum according to United States Code, title 8, section 1158;

(3) persons granted withholding of deportation according to United States Code,
title 8, section 1253(h);

(4) veterans of the United States armed forces with an honorable discharge for
a reason other than noncitizen status, their spouses and unmarried minor dependent
children; or

(5) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.

Beginning July 1, 2010, children and pregnant women who are noncitizens
described in paragraph (b) or who are lawfully present in the United States as defined
in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
eligibility requirements of this chapter, are eligible for medical assistance with federal
financial participation as provided by the federal Children's Health Insurance Program
Reauthorization Act of 2009, Public Law 111-3.

(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
Code, title 8, section 1101(a)(15).

(f) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of
this chapter, if such care and services are necessary for the treatment of an emergency
medical condition.

(g) For purposes of this subdivision, the term "emergency medical condition" means
a medical condition that meets the requirements of United States Code, title 42, section
1396b(v).

(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
of an emergency medical condition are limited to the following:

(i) services delivered in an emergency room or by an ambulance service licensed
under chapter 144E that are directly related to the treatment of an emergency medical
condition;

(ii) services delivered in an inpatient hospital setting following admission from an
emergency room or clinic for an acute emergency condition; and

(iii) follow-up services that are directly related to the original service provided
to treat the emergency medical condition and are covered by the global payment made
to the provider.

(2) Services for the treatment of emergency medical conditions do not include:

(i) services delivered in an emergency room or inpatient setting to treat a
nonemergency condition;

(ii) organ transplants, stem cell transplants, and related care;

(iii) services for routine prenatal care;

(iv) continuing care, including long-term care, nursing facility services, home health
care, adult day care, day training, or supportive living services;

(v) elective surgery;

(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
part of an emergency room visit;

(vii) preventative health care and family planning services;

(viii) dialysis;

(ix) chemotherapy or therapeutic radiation services;

(x) rehabilitation services;

(xi) physical, occupational, or speech therapy;

(xii) transportation services;

(xiii) case management;

(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;

(xv) dental services;

(xvi) hospice care;

(xvii) audiology services and hearing aids;

(xviii) podiatry services;

(xix) chiropractic services;

(xx) immunizations;

(xxi) vision services and eyeglasses;

(xxii) waiver services;

(xxiii) individualized education programs; or

(xxiv) chemical dependency treatment.

(i) Beginning July 1, 2009, Pregnant noncitizens who are undocumented,
nonimmigrants, or lawfully present in the United States as defined in Code of Federal
Regulations, title 8, section 103.12,
ineligible for federally funded medical assistance
because of immigration status
are not covered by a group health plan or health insurance
coverage according to Code of Federal Regulations, title 42, section 457.310, and who
otherwise meet the eligibility requirements of this chapter, are eligible for medical
assistance through the period of pregnancy, including labor and delivery, and 60 days
postpartum, to the extent federal funds are available under title XXI of the Social Security
Act, and the state children's health insurance program.

(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
services from a nonprofit center established to serve victims of torture and are otherwise
ineligible for medical assistance under this chapter are eligible for medical assistance
without federal financial participation. These individuals are eligible only for the period
during which they are receiving services from the center. Individuals eligible under this
paragraph shall not be required to participate in prepaid medical assistance.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 24.

Minnesota Statutes 2012, section 256B.0755, subdivision 3, is amended to read:


Subd. 3.

Accountability.

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

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

(c) A health care delivery system must demonstrate how its services will be
coordinated with other services affecting its attributed patients' health, quality of care, and
cost of care that are provided by other providers and county agencies in the local service
area. The health care delivery system must document how other providers and counties,
including county-based purchasing plans, will provide services to attributed patients of
the health care delivery system, and how it will address applicable local needs, priorities,
and public health goals. As part of this documentation, the health care delivery system
must describe the involvement of local providers and counties, including county-based
purchasing plans, in developing the application to participate in the demonstration project.

EFFECTIVE DATE.

This section is effective July 1, 2013, and applies to health
care delivery system contracts entered into on or after that date.

Sec. 25.

Minnesota Statutes 2012, section 256B.694, is amended to read:


256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
CONTRACT.

(a) MS 2010 [Expired, 2008 c 364 s 10]

(b) The commissioner shall consider, and may approve, contracting on a
single-health plan basis with other county-based purchasing plans, or with other qualified
health plans that have coordination arrangements with counties, to serve persons with a
disability who voluntarily enroll
enrolled in state public health care programs, in order
to promote better coordination or integration of health care services, social services and
other community-based services, provided that all requirements applicable to health plan
purchasing, including those in section 256B.69, subdivision 23, are satisfied. Nothing in
this paragraph supersedes or modifies the requirements in paragraph (a).

Sec. 26.

Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
to read:


Subd. 1b.

Affordable Care Act.

"Affordable Care Act" means Public Law 111-148,
as amended by the federal Health Care and Education Reconciliation Act of 2010, Public
Law 111-152, and any amendments to, or regulations or guidance issued under, those acts.

Sec. 27.

Minnesota Statutes 2012, section 256L.01, subdivision 3a, is amended to read:


Subd. 3a.

Family with children.

(a) "Family with children" means:

(1) parents and their children residing in the same household; or

(2) grandparents, foster parents, relative caretakers as defined in the medical
assistance program, or legal guardians; and their wards who are children residing in the
same household.
"Family" has the meaning given for family and family size as defined
in Code of Federal Regulations, title 26, section 1.36B-1.

(b) The term includes children who are temporarily absent from the household in
settings such as schools, camps, or parenting time with noncustodial parents.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 28.

Minnesota Statutes 2012, section 256L.01, subdivision 5, is amended to read:


Subd. 5.

Income.

(a) "Income" has the meaning given for earned and unearned
income for families and children in the medical assistance program, according to the
state's aid to families with dependent children plan in effect as of July 16, 1996. The
definition does not include medical assistance income methodologies and deeming
requirements. The earned income of full-time and part-time students under age 19 is
not counted as income. Public assistance payments and supplemental security income
are not excluded income
modified adjusted gross income, as defined in Code of Federal
Regulations, title 26, section 1.36B-1
.

(b) For purposes of this subdivision, and unless otherwise specified in this section,
the commissioner shall use reasonable methods to calculate gross earned and unearned
income including, but not limited to, projecting income based on income received within
the past 30 days, the last 90 days, or the last 12 months.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 29.

Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
to read:


Subd. 6.

Minnesota Insurance Marketplace.

"Minnesota Insurance Marketplace"
means the Minnesota Insurance Marketplace as defined in section 62V.02.

Sec. 30.

Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
to read:


Subd. 7.

Participating entity.

"Participating entity" means a health carrier as
defined in section 62A.01, subdivision 2; a county-based purchasing plan established
under section 256B.692; an accountable care organization or other entity operating a
health care delivery systems demonstration project authorized under section 256B.0755;
an entity operating a county integrated health care delivery network pilot project
authorized under section 256B.0756; or a network of health care providers established to
offer services under MinnesotaCare.

EFFECTIVE DATE.

This section is effective January 1, 2015.

Sec. 31.

Minnesota Statutes 2012, section 256L.02, subdivision 2, is amended to read:


Subd. 2.

Commissioner's duties.

(a) The commissioner shall establish an office
for the state administration of this plan. The plan shall be used to provide covered health
services for eligible persons. Payment for these services shall be made to all eligible
providers
participating entities under contract with the commissioner. The commissioner
shall adopt rules to administer the MinnesotaCare program. The commissioner shall
establish marketing efforts to encourage potentially eligible persons to receive information
about the program and about other medical care programs administered or supervised by
the Department of Human Services.

(b) A toll-free telephone number and Web site must be used to provide information
about medical programs and to promote access to the covered services.

EFFECTIVE DATE.

Paragraph (a) is effective January 1, 2015. Paragraph (b) is
effective January 1, 2014.

Sec. 32.

Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
to read:


Subd. 6.

Federal approval.

(a) The commissioner of human services shall seek
federal approval to implement the MinnesotaCare program under this chapter as a basic
health program. In any agreement with the Centers for Medicare and Medicaid Services
to operate MinnesotaCare as a basic health program, the commissioner shall seek to
include procedures to ensure that federal funding is predictable, stable, and sufficient
to sustain ongoing operation of MinnesotaCare. These procedures must address issues
related to the timing of federal payments, payment reconciliation, enrollee risk adjustment,
and minimization of state financial risk. The commissioner shall consult with the
commissioner of management and budget, when developing the proposal for establishing
MinnesotaCare as a basic health program to be submitted to the Centers for Medicare
and Medicaid Services.

(b) The commissioner of human services, in consultation with the commissioner
of management and budget, shall work with the Centers for Medicare and Medicaid
Services to establish a process for reconciliation and adjustment of federal payments that
balances state and federal liability over time. The commissioner of human services shall
request that the United States secretary of health and human services hold the state, and
enrollees, harmless in the reconciliation process for the first three years, to allow the state
to develop a statistically valid methodology for predicting enrollment trends and their
net effect on federal payments.

(c) The commissioner of human services, through December 31, 2015, may modify
the MinnesotaCare program as specified in this chapter, if it is necessary to enhance
health benefits, expand provider access, or reduce cost-sharing and premiums in order
to comply with the terms and conditions of federal approval as a basic health program.
The commissioner may not reduce benefits, impose greater limits on access to providers,
or increase cost-sharing and premiums by enrollees under the authority granted by this
paragraph. If the commissioner modifies the terms and requirements for MinnesotaCare
under this paragraph, the commissioner shall provide the legislature with notice of
implementation of the modifications at least ten working days before notifying enrollees
and participating entities. The costs of any changes to the program necessary to comply
with federal approval shall not become part of the program's base funding for purposes of
future budget forecasts.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 33.

Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
to read:


Subd. 7.

Coordination with Minnesota Insurance Marketplace.

MinnesotaCare
shall be considered a public health care program for purposes of chapter 62V.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 34.

Minnesota Statutes 2012, 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 inpatient hospital
services,
special education services, private duty 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, and nursing home or intermediate care facilities services, inpatient
mental health services, and chemical dependency 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.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 35.

Minnesota Statutes 2012, section 256L.03, subdivision 1a, is amended to read:


Subd. 1a.

Pregnant women and Children; MinnesotaCare health care reform
waiver.

Beginning January 1, 1999, Children and pregnant women are eligible for coverage
of all services that are eligible for reimbursement under the medical assistance program
according to chapter 256B, except that abortion services under MinnesotaCare shall be
limited as provided under subdivision 1. Pregnant women and Children are exempt from
the provisions of subdivision 5, regarding co-payments. Pregnant women and Children
who are lawfully residing in the United States but who are not "qualified noncitizens" under
title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
Public Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage
of all services provided under the medical assistance program according to chapter 256B.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 36.

Minnesota Statutes 2012, section 256L.03, subdivision 3, is amended to read:


Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
2
, with family gross income that exceeds 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of $10,000.

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3
, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 37.

Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision
to read:


Subd. 4a.

Loss ratio.

Health coverage provided through the MinnesotaCare
program must have a medical loss ratio of at least 85 percent, as defined using the loss
ratio methodology described in section 1001 of the Affordable Care Act.

EFFECTIVE DATE.

This section is effective January 1, 2015.

Sec. 38.

Minnesota Statutes 2012, section 256L.03, subdivision 5, is amended to read:


Subd. 5.

Cost-sharing.

(a) Except as otherwise provided in paragraphs (b) and (c)
this subdivision, the MinnesotaCare benefit plan shall include the following cost-sharing
requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;

(2) (1) $3 per prescription for adult enrollees;

(3) (2) $25 for eyeglasses for adult enrollees;

(4) (3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means
an episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist;

(5) (4) $6 for nonemergency visits to a hospital-based emergency room for services
provided through December 31, 2010, and $3.50 effective January 1, 2011; and

(6) (5) a family deductible equal to the maximum amount allowed under Code of
Federal Regulations, title 42, part 447.54.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21.

(c) (b) Paragraph (a) does not apply to pregnant women and children under the
age of 21.

(d) (c) Paragraph (a), clause (4) (3), does not apply to mental health services.

(e) Adult enrollees with family gross income that exceeds 200 percent of the federal
poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
and who are not pregnant shall be financially responsible for the coinsurance amount, if
applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.

(f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
or changes from one prepaid health plan to another during a calendar year, any charges
submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
expenses incurred by the enrollee for inpatient services, that were submitted or incurred
prior to enrollment, or prior to the change in health plans, shall be disregarded.

(g) (d) MinnesotaCare reimbursements to fee-for-service providers and payments to
managed care plans or county-based purchasing plans shall not be increased as a result of
the reduction of the co-payments in paragraph (a), clause (5) (4), effective January 1, 2011.

(h) (e) The commissioner, through the contracting process under section 256L.12,
may allow managed care plans and county-based purchasing plans to waive the family
deductible under paragraph (a), clause (6) (5). The value of the family deductible shall not
be included in the capitation payment to managed care plans and county-based purchasing
plans. Managed care plans and county-based purchasing plans shall certify annually to the
commissioner the dollar value of the family deductible.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 39.

Minnesota Statutes 2012, section 256L.03, subdivision 6, is amended to read:


Subd. 6.

Lien.

When the state agency provides, pays for, or becomes liable for
covered health services, the agency shall have a lien for the cost of the covered health
services upon any and all causes of action accruing to the enrollee, or to the enrollee's
legal representatives, as a result of the occurrence that necessitated the payment for the
covered health services. All liens under this section shall be subject to the provisions
of section 256.015. For purposes of this subdivision, "state agency" includes prepaid
health plans
participating entities, under contract with the commissioner according to
sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based
purchasing entities under section 256B.692
section 256L.121.

EFFECTIVE DATE.

This section is effective January 1, 2015.

Sec. 40.

Minnesota Statutes 2012, section 256L.04, subdivision 1, is amended to read:


Subdivision 1.

Families with children.

(a) Families with children with family
income above 133 percent of the federal poverty guidelines and equal to or less than
275 200 percent of the federal poverty guidelines for the applicable family size shall be
eligible for MinnesotaCare according to this section. All other provisions of sections
256L.01 to 256L.18, including the insurance-related barriers to enrollment under section
256L.07,
shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) Parents are not eligible for MinnesotaCare if their gross income exceeds $57,500.

(e) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
8
, are exempt from the eligibility requirements of this subdivision.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 41.

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


Subd. 1c.

General requirements.

To be eligible for coverage under MinnesotaCare,
a person must meet the eligibility requirements of this section. A person eligible for
MinnesotaCare shall not be considered a qualified individual under section 1312 of the
Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered
through the Minnesota Insurance Marketplace under chapter 62V.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 42.

Minnesota Statutes 2012, section 256L.04, subdivision 7, is amended to read:


Subd. 7.

Single adults and households with no children.

(a) The definition of
eligible persons includes all individuals and households families with no children who
have gross family incomes that are above 133 percent and equal to or less than 200 percent
of the federal poverty guidelines for the applicable family size.

(b) Effective July 1, 2009, the definition of eligible persons includes all individuals
and households with no children who have gross family incomes that are equal to or less
than 250 percent of the federal poverty guidelines.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 43.

Minnesota Statutes 2012, section 256L.04, subdivision 8, is amended to read:


Subd. 8.

Applicants potentially eligible for medical assistance.

(a) Individuals
who receive supplemental security income or retirement, survivors, or disability benefits
due to a disability, or other disability-based pension, who qualify under subdivision 7, but
who are potentially eligible for medical assistance without a spenddown shall be allowed
to enroll in MinnesotaCare for a period of 60 days, so long as the applicant meets all other
conditions of eligibility. The commissioner shall identify and refer the applications of
such individuals to their county social service agency. The county and the commissioner
shall cooperate to ensure that the individuals obtain medical assistance coverage for any
months for which they are eligible.

(b) The enrollee must cooperate with the county social service agency in determining
medical assistance eligibility within the 60-day enrollment period. Enrollees who do not
cooperate with medical assistance within the 60-day enrollment period shall be disenrolled
from the plan within one calendar month. Persons disenrolled for nonapplication for
medical assistance may not reenroll until they have obtained a medical assistance
eligibility determination. Persons disenrolled for noncooperation with medical assistance
may not reenroll until they have cooperated with the county agency and have obtained a
medical assistance eligibility determination.

(c) Beginning January 1, 2000, Counties that choose to become MinnesotaCare
enrollment sites shall consider MinnesotaCare applications to also be applications for
medical assistance. Applicants who are potentially eligible for medical assistance, except
for those described in paragraph (a), may choose to enroll in either MinnesotaCare or
medical assistance.

(d) The commissioner shall redetermine provider payments made under
MinnesotaCare to the appropriate medical assistance payments for those enrollees who
subsequently become eligible for medical assistance.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 44.

Minnesota Statutes 2012, section 256L.04, subdivision 10, is amended to read:


Subd. 10.

Citizenship requirements.

(a) Eligibility for MinnesotaCare is limited to
citizens or nationals of the United States, qualified noncitizens, and other persons residing
lawfully in the United States present noncitizens as defined in Code of Federal Regulations,
title 8, section 103.12. Undocumented noncitizens and nonimmigrants are ineligible for
MinnesotaCare. For purposes of this subdivision, a nonimmigrant is an individual in one
or more of the classes listed in United States Code, title 8, section 1101(a)(15), and
an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the United States Citizenship and Immigration Services.
Families with children who are citizens or nationals of the United States must cooperate in
obtaining satisfactory documentary evidence of citizenship or nationality according to the
requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171.

(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are lawfully present and ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal
poverty guidelines.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 45.

Minnesota Statutes 2012, section 256L.04, subdivision 12, is amended to read:


Subd. 12.

Persons in detention.

Beginning January 1, 1999, An applicant or
enrollee
residing in a correctional or detention facility is not eligible for MinnesotaCare,
unless the applicant or enrollee is awaiting disposition of charges
. An enrollee residing in
a correctional or detention facility is not eligible at renewal of eligibility under section
256L.05, subdivision 3a.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 46.

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


Subd. 14.

Coordination with medical assistance.

(a) Individuals eligible for
medical assistance under chapter 256B are not eligible for MinnesotaCare under this
section.

(b) The commissioner shall coordinate eligibility and coverage to ensure that
individuals transitioning between medical assistance and MinnesotaCare have seamless
eligibility and access to health care services.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 47.

Minnesota Statutes 2012, section 256L.05, subdivision 1, is amended to read:


Subdivision 1.

Application assistance and information availability.

(a) Applicants
may submit applications online, in person, by mail, or by phone in accordance with the
Affordable Care Act, and by any other means by which medical assistance applications
may be submitted. Applicants may submit applications through the Minnesota Insurance
Marketplace or through the MinnesotaCare program.
Applications and application
assistance must be made available at provider offices, local human services agencies,
school districts, public and private elementary schools in which 25 percent or more of
the students receive free or reduced price lunches, community health offices, Women,
Infants and Children (WIC) program sites, Head Start program sites, public housing
councils, crisis nurseries, child care centers, early childhood education and preschool
program sites, legal aid offices, and libraries, and at any other locations at which medical
assistance applications must be made available
. These sites may accept applications and
forward the forms to the commissioner or local county human services agencies that
choose to participate as an enrollment site. Otherwise, applicants may apply directly to the
commissioner or to participating local county human services agencies.

(b) Application assistance must be available for applicants choosing to file an online
application through the Minnesota Insurance Marketplace.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 48.

Minnesota Statutes 2012, section 256L.05, subdivision 2, is amended to read:


Subd. 2.

Commissioner's duties.

The commissioner or county agency shall use
electronic verification through the Minnesota Insurance Marketplace as the primary
method of income verification. If there is a discrepancy between reported income
and electronically verified income, an individual may be required to submit additional
verification to the extent permitted under the Affordable Care Act. In addition, the
commissioner shall perform random audits to verify reported income and eligibility. The
commissioner may execute data sharing arrangements with the Department of Revenue
and any other governmental agency in order to perform income verification related to
eligibility and premium payment under the MinnesotaCare program.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 49.

Minnesota Statutes 2012, section 256L.05, subdivision 3, is amended to read:


Subd. 3.

Effective date of coverage.

(a) The effective date of coverage is the
first day of the month following the month in which eligibility is approved and the first
premium payment has been received. As provided in section 256B.057, coverage for
newborns is automatic from the date of birth and must be coordinated with other health
coverage. The effective date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the month of placement.
The effective date
of coverage for other new members added to the family is the first day of the month
following the month in which the change is reported. All eligibility criteria must be met
by the family at the time the new family member is added. The income of the new family
member is included with the family's modified adjusted gross income and the adjusted
premium begins in the month the new family member is added.

(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.

(c) Benefits are not available until the day following discharge if an enrollee is
hospitalized on the first day of coverage.

(d) (c) Notwithstanding any other law to the contrary, benefits under sections
256L.01 to 256L.18 are secondary to a plan of insurance or benefit program under which
an eligible person may have coverage and the commissioner shall use cost avoidance
techniques to ensure coordination of any other health coverage for eligible persons. The
commissioner shall identify eligible persons who may have coverage or benefits under
other plans of insurance or who become eligible for medical assistance.

(e) (d) The effective date of coverage for individuals or families who are exempt
from paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first
day of the month following the month in which verification of American Indian status
is received or eligibility is approved, whichever is later.

(f) (e) The effective date of coverage for children eligible under section 256L.07,
subdivision 8, is the first day of the month following the date of termination from foster
care or release from a juvenile residential correctional facility.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 50.

Minnesota Statutes 2012, section 256L.05, subdivision 3c, is amended to read:


Subd. 3c.

Retroactive coverage.

Notwithstanding subdivision 3, the effective
date of coverage shall be the first day of the month following termination from medical
assistance for families and individuals who are eligible for MinnesotaCare and who
submitted a written request for retroactive MinnesotaCare coverage with a completed
application within 30 days of the mailing of notification of termination from medical
assistance. The applicant must provide all required verifications within 30 days of the
written request for verification. For retroactive coverage, premiums must be paid in full
for any retroactive month, current month, and next month within 30 days of the premium
billing. General assistance medical care recipients may qualify for retroactive coverage
under this subdivision at six-month renewal.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 51.

Minnesota Statutes 2012, section 256L.06, subdivision 3, is amended to read:


Subd. 3.

Commissioner's duties and payment.

(a) Premiums are dedicated to the
commissioner for MinnesotaCare.

(b) The commissioner shall develop and implement procedures to: (1) require
enrollees to report changes in income; (2) adjust sliding scale premium payments, based
upon both increases and decreases in enrollee income, at the time the change in income
is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
premiums. Failure to pay includes payment with a dishonored check, a returned automatic
bank withdrawal, or a refused credit card or debit card payment. The commissioner may
demand a guaranteed form of payment, including a cashier's check or a money order, as
the only means to replace a dishonored, returned, or refused payment.

(c) Premiums are calculated on a calendar month basis and may be paid on a
monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
commissioner of the premium amount required. The commissioner shall inform applicants
and enrollees of these premium payment options. Premium payment is required before
enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
received before noon are credited the same day. Premium payments received after noon
are credited on the next working day.

(d) Nonpayment of the premium will result in disenrollment from the plan effective
for the calendar month for which the premium was due. Persons disenrolled for
nonpayment or who voluntarily terminate coverage from the program may not reenroll
until four calendar months have elapsed.
Persons disenrolled for nonpayment who pay
all past due premiums as well as current premiums due, including premiums due for the
period of disenrollment, within 20 days of disenrollment, shall be reenrolled retroactively
to the first day of disenrollment. Persons disenrolled for nonpayment or who voluntarily
terminate coverage from the program may not reenroll for four calendar months unless
the person demonstrates good cause for nonpayment. Good cause does not exist if a
person chooses to pay other family expenses instead of the premium. The commissioner
shall define good cause in rule.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 52.

Minnesota Statutes 2012, section 256L.07, subdivision 1, is amended to read:


Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 200 percent of the federal poverty guidelines are eligible without meeting the
requirements of subdivision 2 and the four-month requirement in subdivision 3, as long as
they maintain continuous coverage in the MinnesotaCare program or medical assistance.

Parents Families and individuals enrolled in MinnesotaCare under section 256L.04,
subdivision 1
, whose income increases above 275 200 percent of the federal poverty
guidelines, are no longer eligible for the program and shall be disenrolled by the
commissioner. Beginning January 1, 2008, Individuals enrolled in MinnesotaCare under
section 256L.04, subdivision 7, whose income increases above 200 percent of the federal
poverty guidelines or 250 percent of the federal poverty guidelines on or after July 1,
2009, are no longer eligible for the program and shall be disenrolled by the commissioner.
For persons disenrolled under this subdivision, MinnesotaCare coverage terminates the
last day of the calendar month following the month in which the commissioner determines
that the income of a family or individual exceeds program income limits.

(b) Children may remain enrolled in MinnesotaCare if their gross family income as
defined in section 256L.01, subdivision 4, is greater than 275 percent of federal poverty
guidelines. The premium for children remaining eligible under this paragraph shall be the
maximum premium determined under section 256L.15, subdivision 2, paragraph (b).

(c) Notwithstanding paragraph (a), parents are not eligible for MinnesotaCare if
gross household income exceeds $57,500 for the 12-month period of eligibility.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 53.

Minnesota Statutes 2012, section 256L.07, subdivision 2, is amended to read:


Subd. 2.

Must not have access to employer-subsidized minimum essential
coverage.

(a) To be eligible, a family or individual must not have access to subsidized
health coverage through an employer and must not have had access to employer-subsidized
coverage through a current employer for 18 months prior to application or reapplication.
A family or individual whose employer-subsidized coverage is lost due to an employer
terminating health care coverage as an employee benefit during the previous 18 months is
not eligible
that is affordable and provides minimum value as defined in Code of Federal
Regulations, title 26, section 1.36B-2
.

(b) This subdivision does not apply to a family or individual who was enrolled
in MinnesotaCare within six months or less of reapplication and
who no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
employee benefit. This subdivision does not apply to children with family gross incomes
that are equal to or less than 200 percent of federal poverty guidelines.

(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent. The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 54.

Minnesota Statutes 2012, section 256L.07, subdivision 3, is amended to read:


Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no
To be eligible, a family or individual must not have
minimum essential
health coverage while enrolled, as defined by section 5000A of the
Internal Revenue Code
. Children with family gross incomes equal to or greater than 200
percent of federal poverty guidelines, and adults, must have had no health coverage for
at least four months prior to application and renewal. Children enrolled in the original
children's health plan and children in families with income equal to or less than 200
percent of the federal poverty guidelines, who have other health insurance, are eligible if
the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) Coverage purchased as provided under section 256L.031, subdivision 2, medical
assistance, and the Civilian Health and Medical Program of the Uniformed Service,
CHAMPUS, or other coverage provided under United States Code, title 10, subtitle A,
part II, chapter 55, are not considered insurance or health coverage for purposes of the
four-month requirement described in this subdivision.

(c) (b) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered
to have minimum essential health coverage. An applicant or enrollee who is entitled to
premium-free Medicare Part A may not refuse to apply for or enroll in Medicare coverage
to establish eligibility for MinnesotaCare.

(d) Applicants who were recipients of medical assistance within one month of
application must meet the provisions of this subdivision and subdivision 2.

(e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 55.

Minnesota Statutes 2012, section 256L.09, subdivision 2, is amended to read:


Subd. 2.

Residency requirement.

To be eligible for health coverage under the
MinnesotaCare program, pregnant women, individuals, and families with children must
meet the residency requirements as provided by Code of Federal Regulations, title 42,
section 435.403, except that the provisions of section 256B.056, subdivision 1, shall apply
upon receipt of federal approval
.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 56.

Minnesota Statutes 2012, section 256L.11, subdivision 1, is amended to read:


Subdivision 1.

Medical assistance rate to be used.

(a) Payment to providers
under sections 256L.01 to 256L.11 this chapter shall be at the same rates and conditions
established for medical assistance, except as provided in subdivisions 2 to 6 this section.

(b) Effective for services provided on or after July 1, 2009, total payments for basic
care services shall be reduced by three percent, in accordance with section 256B.766.
Payments made to managed care and county-based purchasing plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.

(c) Effective for services provided on or after July 1, 2009, payment rates for
physician and professional services shall be reduced as described under section 256B.76,
subdivision 1, paragraph (c). Payments made to managed care and county-based
purchasing plans shall be reduced for services provided on or after October 1, 2009,
to reflect this reduction.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 57.

Minnesota Statutes 2012, section 256L.11, subdivision 3, is amended to read:


Subd. 3.

Inpatient hospital services.

Inpatient hospital services provided under
section 256L.03, subdivision 3, shall be paid for as provided in subdivisions 4 to 6 at the
medical assistance rate
.

EFFECTIVE DATE.

This section is effective January 1, 2014.

Sec. 58.

[256L.121] SERVICE DELIVERY.

Subdivision 1.

Competitive process.

The commissioner of human services shall
establish a competitive process for entering into contracts with participating entities for
the offering of standard health plans through MinnesotaCare. Coverage through standard
health plans must be available to enrollees beginning January 1, 2015. Each standard health
plan must cover the health services listed in, and meet the requirements of, section 256L.03.
The competitive process must meet the requirements of section 1331 of the Affordable
Care Act and be designed to ensure enrollee access to high-quality health care coverage
options. The commissioner, to the extent feasible, shall seek to ensure that enrollees have
a choice of coverage from more than one participating entity within a geographic area.

Subd. 2.

Other requirements for participating entities.

The commissioner shall
require participating entities, as a condition of contract, to document to the commissioner:

(1) the provision of culturally and linguistically appropriate services, including
marketing materials, to MinnesotaCare enrollees; and

(2) the inclusion in provider networks of providers designated as essential
community providers under section 62Q.19.

Subd. 3.

Coordination with state-administered health programs.

The
commissioner shall coordinate the administration of the MinnesotaCare program with
medical assistance to maximize efficiency and improve the continuity of care. This
includes, but is not limited to:

(1) establishing geographic areas for MinnesotaCare that are consistent with the
geographic areas of the medical assistance program, within which participating entities
may offer health plans;

(2) requiring, as a condition of participation in MinnesotaCare, participating entities
to also participate in the medical assistance program;

(3) complying with sections 256B.69, subdivision 3a; 256B.692, subdivision 1; and
256B.694 when contracting with MinnesotaCare participating entities;

(4) providing MinnesotaCare enrollees, to the extent possible, with the option to
remain in the same health plan and provider network, if they later become eligible for
medical assistance or coverage through the Minnesota Insurance Marketplace and if, in
the case of becoming eligible for medical assistance, the enrollee's MinnesotaCare health
plan is also a medical assistance health plan in the enrollee's county of residence; and

(5) establishing requirements and criteria for selection that ensure that covered
health care services will be coordinated with local public health, social services, long-term
care services, mental health services, and other local services affecting enrollees' health,
access, and quality of care.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 59.

Minnesota Statutes 2012, section 256L.15, subdivision 1, is amended to read:


Subdivision 1.

Premium determination.

(a) Families with children and individuals
shall pay a premium determined according to subdivision 2.

(b) Pregnant women and children under age two are exempt from the provisions
of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
for failure to pay premiums. For pregnant women, this exemption continues until the
first day of the month following the 60th day postpartum. Women who remain enrolled
during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
disenrolled on the first of the month following the 60th day postpartum for the penalty
period that otherwise applies under section 256L.06, unless they begin paying premiums.

(c) (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.

(d) (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 document status as an American Indian, as defined under Code of
Federal Regulations, title 42, section 447.50, to qualify for the waiver of premiums.

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 60.

Minnesota Statutes 2012, section 256L.15, subdivision 2, is amended to read:


Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay to
obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
on the enrollee's monthly gross individual or family income. The sliding fee scale must
contain separate tables based on enrollment of one, two, or three or more persons. Until
June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
individual or family income for individuals or families with incomes below the limits for
the medical assistance program for families and children in effect on January 1, 1999, and
proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
8.8 percent.
These percentages are matched to evenly spaced income steps ranging from
the medical assistance income limit for families and children in effect on January 1, 1999,
to 275 200 percent of the federal poverty guidelines for the applicable family size, up to a
family size of five. The sliding fee scale for a family of five must be used for families of
more than five. The sliding fee scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income after enrollment, premiums
shall be adjusted at the time the change in income is reported.

(b) Children in families whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

(c) Beginning July 1, 2009, (b) MinnesotaCare enrollees shall pay premiums
according to the premium scale specified in paragraph (d) (c), with the exception that
children in families with income at or below 200 percent of the federal poverty guidelines
shall pay no premiums. For purposes of paragraph (d) (c), "minimum" means a monthly
premium of $4.

(d) the following premium scale is established for individuals and families with
gross family incomes of 275 percent of the federal poverty guidelines or less:

Federal Poverty Guideline Range
Percent of Average Gross Monthly Income
0-45%
minimum
46-54%
$4 or 1.1% of family income, whichever is
greater
55-81%
1.6%
82-109%
2.2%
110-136%
2.9%
137-164%
3.6%
165-191%
4.6%
192-219%
5.6%
220-248%
6.5%
249-275%
7.2%

(c) Effective January 1, 2014, the following premium scale is established for
individuals and families with incomes of 200 percent of federal poverty guidelines or less:

Federal Poverty Guideline Range
Percent of Average Income
0-45%
minimum
46-54%
$4 or .25% of family income, whichever is
greater
55-81%
.5%
82-109%
1.0%
110-136%
1.5%
137-164%
2.0%
165-191%
2.5%
192-200%
3.0%

EFFECTIVE DATE.

This section is effective January 1, 2014, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 61.

Laws 2013, chapter 1, section 1, the effective date, is amended to read:


EFFECTIVE DATE.

This section is effective January 1, 2014 July 1, 2013.

Sec. 62. DETERMINATION OF FUNDING ADEQUACY FOR
MINNESOTACARE.

The commissioners of revenue and management and budget, in consultation with
the commissioner of human services, shall conduct an assessment of health care taxes,
including the gross premiums tax, the provider tax, and Medicaid surcharges, and their
relationship to the long-term solvency of the health care access fund, as part of the state
revenue and expenditure forecast in November 2013. The commissioners shall determine
the amount of state funding that will be required after December 31, 2019, in addition
to the federal payments made available under section 1331 of the Affordable Care Act,
for the MinnesotaCare program. The commissioners shall evaluate the stability and
likelihood of long-term federal funding for the MinnesotaCare program under section
1331. The commissioners shall report the results of this assessment to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services, finances, and taxes by January 15, 2014, along with recommendations for
changes to state revenue for the health care access fund, if state funding continues to
be required beyond December 31, 2019.

Sec. 63. REVISOR'S INSTRUCTION.

The revisor shall remove cross-references to the sections repealed in this act
wherever they appear in Minnesota Statutes and Minnesota Rules and make changes
necessary to correct the punctuation, grammar, or structure of the remaining text and
preserve its meaning.

Sec. 64. REPEALER.

(a) Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.02, subdivision
3; 256L.031; 256L.04, subdivisions 1b, 7a, and 9; and 256L.11, subdivisions 2a, 5, and
6,
are repealed, effective January 1, 2014.

(b) Minnesota Statutes 2012, sections 256L.01, subdivision 3; 256L.03, subdivision
4; 256L.04, subdivision 2a; 256L.07, subdivisions 1, 4, 5, 8, and 9; 256L.09, subdivisions
1, 4, 5, 6, and 7; 256L.12, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9a, and 9b; and 256L.17,
subdivisions 1, 2, 3, 4, and 5,
are repealed effective January 1, 2015.

(c) Minnesota Statutes 2012, sections 256B.055, subdivisions 3, 5, and 10b;
256B.056, subdivision 5b; and 256B.057, subdivisions 1c and 2,
are repealed.

ARTICLE 2

CONTINGENT REFORM 2020; REDESIGNING HOME AND
COMMUNITY-BASED SERVICES

Section 1.

Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:


Subd. 4.

Resident assessment schedule.

(a) A facility must conduct and
electronically submit to the commissioner of health case mix assessments that conform
with the assessment schedule defined by Code of Federal Regulations, title 42, section
483.20, and published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
Instrument User's Manual, version 3.0, and subsequent updates when issued by the
Centers for Medicare and Medicaid Services. The commissioner of health may substitute
successor manuals or question and answer documents published by the United States
Department of Health and Human Services, Centers for Medicare and Medicaid Services,
to replace or supplement the current version of the manual or document.

(b) The assessments used to determine a case mix classification for reimbursement
include the following:

(1) a new admission assessment must be completed by day 14 following admission;

(2) an annual assessment which must have an assessment reference date (ARD)
within 366 days of the ARD of the last comprehensive assessment;

(3) a significant change assessment must be completed within 14 days of the
identification of a significant change; and

(4) all quarterly assessments must have an assessment reference date (ARD) within
92 days of the ARD of the previous assessment.

(c) In addition to the assessments listed in paragraph (b), the assessments used to
determine nursing facility level of care include the following:

(1) preadmission screening completed under section 256B.0911, subdivision 4a, by a
county, tribe, or managed care organization under contract with the Department of Human
Services
256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line
or other organization under contract with the Minnesota Board on Aging
; and

(2) a nursing facility level of care determination as provided for under section
256B.0911, subdivision 4e, as part of
a face-to-face long-term care consultation assessment
completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
managed care organization under contract with the Department of Human Services.

Sec. 2.

Minnesota Statutes 2012, section 144A.351, is amended to read:


144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS:
REPORT AND STUDY REQUIRED.

Subdivision 1.

Report requirements.

The commissioners of health and human
services, with the cooperation of counties and in consultation with stakeholders, including
persons who need or are using long-term care services and supports, lead agencies,
regional entities, senior, disability, and mental health organization representatives, service
providers, and community members shall prepare a report to the legislature by August 15,
2013, and biennially thereafter, regarding the status of the full range of long-term care
services and supports for the elderly and children and adults with disabilities and mental
illnesses in Minnesota. The report shall address:

(1) demographics and need for long-term care services and supports in Minnesota;

(2) summary of county and regional reports on long-term care gaps, surpluses,
imbalances, and corrective action plans;

(3) status of long-term care services and related mental health services, housing
options, and supports by county and region including:

(i) changes in availability of the range of long-term care services and housing options;

(ii) access problems, including access to the least restrictive and most integrated
services and settings, regarding long-term care services; and

(iii) comparative measures of long-term care services availability, including serving
people in their home areas near family, and changes over time; and

(4) recommendations regarding goals for the future of long-term care services and
supports, policy and fiscal changes, and resource development and transition needs.

Subd. 2.

Critical access study.

The commissioner shall conduct a onetime study to
assess local capacity and availability of home and community-based services for older
adults, people with disabilities, and people with mental illnesses. The study must assess
critical access at the community level and identify potential strategies to build home and
community-based service capacity in critical access areas. The report shall be submitted
to the legislature no later than August 15, 2015.

Sec. 3.

Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:


Subd. 4a.

City, county, and state social workers.

(a) Beginning July 1, 2016, the
licensure of city, county, and state agency social workers is voluntary, except an individual
who is newly employed by a city or state agency after July 1, 2016, must be licensed
if the individual who provides social work services, as those services are defined in
section 148E.010, subdivision 11, paragraph (b), is presented to the public by any title
incorporating the words "social work" or "social worker."

(b) City, county, and state agencies employing social workers and staff who are
designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
256.01, subdivision 24,
are not required to employ licensed social workers.

Sec. 4.

Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:


Subd. 2.

Specific powers.

Subject to the provisions of section 241.021, subdivision
2
, the commissioner of human services shall carry out the specific duties in paragraphs (a)
through (cc) (dd):

(a) Administer and supervise all forms of public assistance provided for by state law
and other welfare activities or services as are vested in the commissioner. Administration
and supervision of human services activities or services includes, but is not limited to,
assuring timely and accurate distribution of benefits, completeness of service, and quality
program management. In addition to administering and supervising human services
activities vested by law in the department, the commissioner shall have the authority to:

(1) require county agency participation in training and technical assistance programs
to promote compliance with statutes, rules, federal laws, regulations, and policies
governing human services;

(2) monitor, on an ongoing basis, the performance of county agencies in the
operation and administration of human services, enforce compliance with statutes, rules,
federal laws, regulations, and policies governing welfare services and promote excellence
of administration and program operation;

(3) develop a quality control program or other monitoring program to review county
performance and accuracy of benefit determinations;

(4) require county agencies to make an adjustment to the public assistance benefits
issued to any individual consistent with federal law and regulation and state law and rule
and to issue or recover benefits as appropriate;

(5) delay or deny payment of all or part of the state and federal share of benefits and
administrative reimbursement according to the procedures set forth in section 256.017;

(6) make contracts with and grants to public and private agencies and organizations,
both profit and nonprofit, and individuals, using appropriated funds; and

(7) enter into contractual agreements with federally recognized Indian tribes with
a reservation in Minnesota to the extent necessary for the tribe to operate a federally
approved family assistance program or any other program under the supervision of the
commissioner. The commissioner shall consult with the affected county or counties in
the contractual agreement negotiations, if the county or counties wish to be included,
in order to avoid the duplication of county and tribal assistance program services. The
commissioner may establish necessary accounts for the purposes of receiving and
disbursing funds as necessary for the operation of the programs.

(b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
regulation, and policy necessary to county agency administration of the programs.

(c) Administer and supervise all child welfare activities; promote the enforcement of
laws protecting disabled, dependent, neglected and delinquent children, and children born
to mothers who were not married to the children's fathers at the times of the conception
nor at the births of the children; license and supervise child-caring and child-placing
agencies and institutions; supervise the care of children in boarding and foster homes or
in private institutions; and generally perform all functions relating to the field of child
welfare now vested in the State Board of Control.

(d) Administer and supervise all noninstitutional service to disabled persons,
including those who are visually impaired, hearing impaired, or physically impaired
or otherwise disabled. The commissioner may provide and contract for the care and
treatment of qualified indigent children in facilities other than those located and available
at state hospitals when it is not feasible to provide the service in state hospitals.

(e) Assist and actively cooperate with other departments, agencies and institutions,
local, state, and federal, by performing services in conformity with the purposes of Laws
1939, chapter 431.

(f) Act as the agent of and cooperate with the federal government in matters of
mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
431, including the administration of any federal funds granted to the state to aid in the
performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
and including the promulgation of rules making uniformly available medical care benefits
to all recipients of public assistance, at such times as the federal government increases its
participation in assistance expenditures for medical care to recipients of public assistance,
the cost thereof to be borne in the same proportion as are grants of aid to said recipients.

(g) Establish and maintain any administrative units reasonably necessary for the
performance of administrative functions common to all divisions of the department.

(h) Act as designated guardian of both the estate and the person of all the wards of
the state of Minnesota, whether by operation of law or by an order of court, without any
further act or proceeding whatever, except as to persons committed as developmentally
disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
recognized by the Secretary of the Interior whose interests would be best served by
adoptive placement, the commissioner may contract with a licensed child-placing agency
or a Minnesota tribal social services agency to provide adoption services. A contract
with a licensed child-placing agency must be designed to supplement existing county
efforts and may not replace existing county programs or tribal social services, unless the
replacement is agreed to by the county board and the appropriate exclusive bargaining
representative, tribal governing body, or the commissioner has evidence that child
placements of the county continue to be substantially below that of other counties. Funds
encumbered and obligated under an agreement for a specific child shall remain available
until the terms of the agreement are fulfilled or the agreement is terminated.

(i) Act as coordinating referral and informational center on requests for service for
newly arrived immigrants coming to Minnesota.

(j) The specific enumeration of powers and duties as hereinabove set forth shall in no
way be construed to be a limitation upon the general transfer of powers herein contained.

(k) Establish county, regional, or statewide schedules of maximum fees and charges
which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
nursing home care and medicine and medical supplies under all programs of medical
care provided by the state and for congregate living care under the income maintenance
programs.

(l) Have the authority to conduct and administer experimental projects to test methods
and procedures of administering assistance and services to recipients or potential recipients
of public welfare. To carry out such experimental projects, it is further provided that the
commissioner of human services is authorized to waive the enforcement of existing specific
statutory program requirements, rules, and standards in one or more counties. The order
establishing the waiver shall provide alternative methods and procedures of administration,
shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and
in no event shall the duration of a project exceed four years. It is further provided that no
order establishing an experimental project as authorized by the provisions of this section
shall become effective until the following conditions have been met:

(1) the secretary of health and human services of the United States has agreed, for
the same project, to waive state plan requirements relative to statewide uniformity; and

(2) a comprehensive plan, including estimated project costs, shall be approved by
the Legislative Advisory Commission and filed with the commissioner of administration.

(m) According to federal requirements, establish procedures to be followed by
local welfare boards in creating citizen advisory committees, including procedures for
selection of committee members.

(n) Allocate federal fiscal disallowances or sanctions which are based on quality
control error rates for the aid to families with dependent children program formerly
codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
following manner:

(1) one-half of the total amount of the disallowance shall be borne by the county
boards responsible for administering the programs. For the medical assistance and the
AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
shared by each county board in the same proportion as that county's expenditures for the
sanctioned program are to the total of all counties' expenditures for the AFDC program
formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
food stamp program, sanctions shall be shared by each county board, with 50 percent of
the sanction being distributed to each county in the same proportion as that county's
administrative costs for food stamps are to the total of all food stamp administrative costs
for all counties, and 50 percent of the sanctions being distributed to each county in the
same proportion as that county's value of food stamp benefits issued are to the total of
all benefits issued for all counties. Each county shall pay its share of the disallowance
to the state of Minnesota. When a county fails to pay the amount due hereunder, the
commissioner may deduct the amount from reimbursement otherwise due the county, or
the attorney general, upon the request of the commissioner, may institute civil action
to recover the amount due; and

(2) notwithstanding the provisions of clause (1), if the disallowance results from
knowing noncompliance by one or more counties with a specific program instruction, and
that knowing noncompliance is a matter of official county board record, the commissioner
may require payment or recover from the county or counties, in the manner prescribed in
clause (1), an amount equal to the portion of the total disallowance which resulted from the
noncompliance, and may distribute the balance of the disallowance according to clause (1).

(o) Develop and implement special projects that maximize reimbursements and
result in the recovery of money to the state. For the purpose of recovering state money,
the commissioner may enter into contracts with third parties. Any recoveries that result
from projects or contracts entered into under this paragraph shall be deposited in the
state treasury and credited to a special account until the balance in the account reaches
$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
transferred and credited to the general fund. All money in the account is appropriated to
the commissioner for the purposes of this paragraph.

(p) Have the authority to make direct payments to facilities providing shelter
to women and their children according to section 256D.05, subdivision 3. Upon
the written request of a shelter facility that has been denied payments under section
256D.05, subdivision 3, the commissioner shall review all relevant evidence and make
a determination within 30 days of the request for review regarding issuance of direct
payments to the shelter facility. Failure to act within 30 days shall be considered a
determination not to issue direct payments.

(q) Have the authority to establish and enforce the following county reporting
requirements:

(1) the commissioner shall establish fiscal and statistical reporting requirements
necessary to account for the expenditure of funds allocated to counties for human
services programs. When establishing financial and statistical reporting requirements, the
commissioner shall evaluate all reports, in consultation with the counties, to determine if
the reports can be simplified or the number of reports can be reduced;

(2) the county board shall submit monthly or quarterly reports to the department
as required by the commissioner. Monthly reports are due no later than 15 working days
after the end of the month. Quarterly reports are due no later than 30 calendar days after
the end of the quarter, unless the commissioner determines that the deadline must be
shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
or risking a loss of federal funding. Only reports that are complete, legible, and in the
required format shall be accepted by the commissioner;

(3) if the required reports are not received by the deadlines established in clause (2),
the commissioner may delay payments and withhold funds from the county board until
the next reporting period. When the report is needed to account for the use of federal
funds and the late report results in a reduction in federal funding, the commissioner shall
withhold from the county boards with late reports an amount equal to the reduction in
federal funding until full federal funding is received;

(4) a county board that submits reports that are late, illegible, incomplete, or not
in the required format for two out of three consecutive reporting periods is considered
noncompliant. When a county board is found to be noncompliant, the commissioner
shall notify the county board of the reason the county board is considered noncompliant
and request that the county board develop a corrective action plan stating how the
county board plans to correct the problem. The corrective action plan must be submitted
to the commissioner within 45 days after the date the county board received notice
of noncompliance;

(5) the final deadline for fiscal reports or amendments to fiscal reports is one year
after the date the report was originally due. If the commissioner does not receive a report
by the final deadline, the county board forfeits the funding associated with the report for
that reporting period and the county board must repay any funds associated with the
report received for that reporting period;

(6) the commissioner may not delay payments, withhold funds, or require repayment
under clause (3) or (5) if the county demonstrates that the commissioner failed to
provide appropriate forms, guidelines, and technical assistance to enable the county to
comply with the requirements. If the county board disagrees with an action taken by the
commissioner under clause (3) or (5), the county board may appeal the action according
to sections 14.57 to 14.69; and

(7) counties subject to withholding of funds under clause (3) or forfeiture or
repayment of funds under clause (5) shall not reduce or withhold benefits or services to
clients to cover costs incurred due to actions taken by the commissioner under clause
(3) or (5).

(r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
federal fiscal disallowances or sanctions are based on a statewide random sample in direct
proportion to each county's claim for that period.

(s) Be responsible for ensuring the detection, prevention, investigation, and
resolution of fraudulent activities or behavior by applicants, recipients, and other
participants in the human services programs administered by the department.

(t) Require county agencies to identify overpayments, establish claims, and utilize
all available and cost-beneficial methodologies to collect and recover these overpayments
in the human services programs administered by the department.

(u) Have the authority to administer a drug rebate program for drugs purchased
pursuant to the prescription drug program established under section 256.955 after the
beneficiary's satisfaction of any deductible established in the program. The commissioner
shall require a rebate agreement from all manufacturers of covered drugs as defined in
section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
or after July 1, 2002, must include rebates for individuals covered under the prescription
drug program who are under 65 years of age. For each drug, the amount of the rebate shall
be equal to the rebate as defined for purposes of the federal rebate program in United
States Code, title 42, section 1396r-8. The manufacturers must provide full payment
within 30 days of receipt of the state invoice for the rebate within the terms and conditions
used for the federal rebate program established pursuant to section 1927 of title XIX of
the Social Security Act. The manufacturers must provide the commissioner with any
information necessary to verify the rebate determined per drug. The rebate program shall
utilize the terms and conditions used for the federal rebate program established pursuant to
section 1927 of title XIX of the Social Security Act.

(v) Have the authority to administer the federal drug rebate program for drugs
purchased under the medical assistance program as allowed by section 1927 of title XIX
of the Social Security Act and according to the terms and conditions of section 1927.
Rebates shall be collected for all drugs that have been dispensed or administered in an
outpatient setting and that are from manufacturers who have signed a rebate agreement
with the United States Department of Health and Human Services.

(w) Have the authority to administer a supplemental drug rebate program for drugs
purchased under the medical assistance program. The commissioner may enter into
supplemental rebate contracts with pharmaceutical manufacturers and may require prior
authorization for drugs that are from manufacturers that have not signed a supplemental
rebate contract. Prior authorization of drugs shall be subject to the provisions of section
256B.0625, subdivision 13.

(x) Operate the department's communication systems account established in Laws
1993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
communication costs necessary for the operation of the programs the commissioner
supervises. A communications account may also be established for each regional
treatment center which operates communications systems. Each account must be used
to manage shared communication costs necessary for the operations of the programs the
commissioner supervises. The commissioner may distribute the costs of operating and
maintaining communication systems to participants in a manner that reflects actual usage.
Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
other costs as determined by the commissioner. Nonprofit organizations and state, county,
and local government agencies involved in the operation of programs the commissioner
supervises may participate in the use of the department's communications technology and
share in the cost of operation. The commissioner may accept on behalf of the state any
gift, bequest, devise or personal property of any kind, or money tendered to the state for
any lawful purpose pertaining to the communication activities of the department. Any
money received for this purpose must be deposited in the department's communication
systems accounts. Money collected by the commissioner for the use of communication
systems must be deposited in the state communication systems account and is appropriated
to the commissioner for purposes of this section.

(y) Receive any federal matching money that is made available through the medical
assistance program for the consumer satisfaction survey. Any federal money received for
the survey is appropriated to the commissioner for this purpose. The commissioner may
expend the federal money received for the consumer satisfaction survey in either year of
the biennium.

(z) Designate community information and referral call centers and incorporate
cost reimbursement claims from the designated community information and referral
call centers into the federal cost reimbursement claiming processes of the department
according to federal law, rule, and regulations. Existing information and referral centers
provided by Greater Twin Cities United Way or existing call centers for which Greater
Twin Cities United Way has legal authority to represent, shall be included in these
designations upon review by the commissioner and assurance that these services are
accredited and in compliance with national standards. Any reimbursement is appropriated
to the commissioner and all designated information and referral centers shall receive
payments according to normal department schedules established by the commissioner
upon final approval of allocation methodologies from the United States Department of
Health and Human Services Division of Cost Allocation or other appropriate authorities.

(aa) Develop recommended standards for foster care homes that address the
components of specialized therapeutic services to be provided by foster care homes with
those services.

(bb) Authorize the method of payment to or from the department as part of the
human services programs administered by the department. This authorization includes the
receipt or disbursement of funds held by the department in a fiduciary capacity as part of
the human services programs administered by the department.

(cc) Have the authority to administer a drug rebate program for drugs purchased for
persons eligible for general assistance medical care under section 256D.03, subdivision 3.
For manufacturers that agree to participate in the general assistance medical care rebate
program, the commissioner shall enter into a rebate agreement for covered drugs as
defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
United States Code, title 42, section 1396r-8. The manufacturers must provide payment
within the terms and conditions used for the federal rebate program established under
section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
the terms and conditions used for the federal rebate program established under section
1927 of title XIX of the Social Security Act.

Effective January 1, 2006, drug coverage under general assistance medical care shall
be limited to those prescription drugs that:

(1) are covered under the medical assistance program as described in section
256B.0625, subdivisions 13 and 13d; and

(2) are provided by manufacturers that have fully executed general assistance
medical care rebate agreements with the commissioner and comply with such agreements.
Prescription drug coverage under general assistance medical care shall conform to
coverage under the medical assistance program according to section 256B.0625,
subdivisions 13 to 13g
.

The rebate revenues collected under the drug rebate program are deposited in the
general fund.

(dd) Designate the agencies that operate the Senior LinkAge Line under section
256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state
of Minnesota Aging and the Disability Resource Centers under United States Code, title
42, section 3001, the Older Americans Act Amendments of 2006, and incorporate cost
reimbursement claims from the designated centers into the federal cost reimbursement
claiming processes of the department according to federal law, rule, and regulations. Any
reimbursement must be appropriated to the commissioner and all Aging and Disability
Resource Center designated agencies shall receive payments of grant funding that supports
the activity and generates the federal financial participation according to Board on Aging
administrative granting mechanisms.

Sec. 5.

Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:


Subd. 24.

Disability Linkage Line.

The commissioner shall establish the Disability
Linkage Line, to which shall serve people with disabilities as the designated Aging and
Disability Resource Center under United States Code, title 42, section 3001, the Older
Americans Act Amendments of 2006, in partnership with the Senior LinkAge Line and
shall
serve as Minnesota's neutral access point for statewide disability information and
assistance and must be available during business hours through a statewide toll-free
number and the Internet
. The Disability Linkage Line shall:

(1) deliver information and assistance based on national and state standards;

(2) provide information about state and federal eligibility requirements, benefits,
and service options;

(3) provide benefits and options counseling;

(4) make referrals to appropriate support entities;

(5) educate people on their options so they can make well-informed choices and link
them to quality profiles
;

(6) help support the timely resolution of service access and benefit issues;

(7) inform people of their long-term community services and supports;

(8) provide necessary resources and supports that can lead to employment and
increased economic stability of people with disabilities; and

(9) serve as the technical assistance and help center for the Web-based tool,
Minnesota's Disability Benefits 101.org.; and

(10) provide preadmission screening for individuals under 60 years of age using
the procedures as defined in section 256.975, subdivisions 7a to 7c, and 256B.0911,
subdivision 4d.

Sec. 6.

Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:


Subd. 7.

Consumer information and assistance and long-term care options
counseling; Senior LinkAge Line.

(a) The Minnesota Board on Aging shall operate a
statewide service to aid older Minnesotans and their families in making informed choices
about long-term care options and health care benefits. Language services to persons
with limited English language skills may be made available. The service, known as
Senior LinkAge Line, shall serve older adults as the designated Aging and Disability
Resource Center under United States Code, title 42, section 3001, the Older Americans
Act Amendments of 2006, in partnership with the Disability LinkAge Line under section
256.01, subdivision 24, and
must be available during business hours through a statewide
toll-free number and must also be available through the Internet. The Minnesota Board
on Aging shall consult with, and when appropriate work through, the area agencies on
aging to provide and maintain the telephone infrastructure and related support for the
Aging and Disability Resource Center partners that agree by memorandum to access the
infrastructure, including the designated providers of the Senior LinkAge Line and the
Disability Linkage Line.

(b) The service must provide long-term care options counseling by assisting older
adults, caregivers, and providers in accessing information and options counseling about
choices in long-term care services that are purchased through private providers or available
through public options. The service must:

(1) develop a comprehensive database that includes detailed listings in both
consumer- and provider-oriented formats;

(2) make the database accessible on the Internet and through other telecommunication
and media-related tools;

(3) link callers to interactive long-term care screening tools and make these tools
available through the Internet by integrating the tools with the database;

(4) develop community education materials with a focus on planning for long-term
care and evaluating independent living, housing, and service options;

(5) conduct an outreach campaign to assist older adults and their caregivers in
finding information on the Internet and through other means of communication;

(6) implement a messaging system for overflow callers and respond to these callers
by the next business day;

(7) link callers with county human services and other providers to receive more
in-depth assistance and consultation related to long-term care options;

(8) link callers with quality profiles for nursing facilities and other home and
community-based services
providers developed by the commissioner commissioners of
health and human services;

(9) incorporate information about the availability of housing options, as well as
registered housing with services and consumer rights within the MinnesotaHelp.info
network long-term care database to facilitate consumer comparison of services and costs
among housing with services establishments and with other in-home services and to
support financial self-sufficiency as long as possible. Housing with services establishments
and their arranged home care providers shall provide information that will facilitate price
comparisons, including delineation of charges for rent and for services available. The
commissioners of health and human services shall align the data elements required by
section 144G.06, the Uniform Consumer Information Guide, and this section to provide
consumers standardized information and ease of comparison of long-term care options.
The commissioner of human services shall provide the data to the Minnesota Board on
Aging for inclusion in the MinnesotaHelp.info network long-term care database;

(10) provide long-term care options counseling. Long-term care options counselors
shall:

(i) for individuals not eligible for case management under a public program or public
funding source, provide interactive decision support under which consumers, family
members, or other helpers are supported in their deliberations to determine appropriate
long-term care choices in the context of the consumer's needs, preferences, values, and
individual circumstances, including implementing a community support plan;

(ii) provide Web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care basics,
issues to be considered, and the range of options available in the community;

(iii) provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for the more
distant future; and

(iv) provide expertise in benefits and financing options for long-term care, including
Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
private pay options, and ways to access low or no-cost services or benefits through
volunteer-based or charitable programs;

(11) using risk management and support planning protocols, provide long-term care
options counseling to current residents of nursing homes deemed appropriate for discharge
by the commissioner and older adults who request service after consultation with the
Senior LinkAge Line under clause (12)
. In order to meet this requirement, The Senior
LinkAge Line shall also receive referrals from the residents or staff of nursing homes. The
Senior LinkAge Line shall identify and contact residents deemed appropriate for discharge
by developing targeting criteria in consultation with
the commissioner who shall provide
designated Senior LinkAge Line contact centers with a list of nursing home residents that
meet the criteria as being
appropriate for discharge planning via a secure Web portal.
Senior LinkAge Line shall provide these residents, if they indicate a preference to
receive long-term care options counseling, with initial assessment, review of risk factors,
independent living support consultation, or
and, if appropriate, a referral to:

(i) long-term care consultation services under section 256B.0911;

(ii) designated care coordinators of contracted entities under section 256B.035 for
persons who are enrolled in a managed care plan; or

(iii) the long-term care consultation team for those who are appropriate eligible
for relocation service coordination due to high-risk factors or psychological or physical
disability; and

(12) develop referral protocols and processes that will assist certified health care
homes and hospitals to identify at-risk older adults and determine when to refer these
individuals to the Senior LinkAge Line for long-term care options counseling under this
section. The commissioner is directed to work with the commissioner of health to develop
protocols that would comply with the health care home designation criteria and protocols
available at the time of hospital discharge. The commissioner shall keep a record of the
number of people who choose long-term care options counseling as a result of this section.

Sec. 7.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7a.

Preadmission screening activities related to nursing facility
admissions.

(a) All individuals seeking admission to Medicaid certified nursing facilities,
including certified boarding care facilities, must be screened prior to admission regardless
of income, assets, or funding sources for nursing facility care, except as described in
subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the
need for nursing facility level of care as described in section 256B.0911, subdivision
4e, and to complete activities required under federal law related to mental illness and
developmental disability as outlined in paragraph (b).

(b) A person who has a diagnosis or possible diagnosis of mental illness or
developmental disability must receive a preadmission screening before admission
regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify
the need for further evaluation and specialized services, unless the admission prior to
screening is authorized by the local mental health authority or the local developmental
disabilities case manager, or unless authorized by the county agency according to Public
Law 101-508.

(c) The following criteria apply to the preadmission screening:

(1) requests for preadmission screenings must be submitted via an online form
developed by the commissioner;

(2) the Senior LinkAge Line must use forms and criteria developed by the
commissioner to identify persons who require referral for further evaluation and
determination of the need for specialized services; and

(3) the evaluation and determination of the need for specialized services must be
done by:

(i) a qualified independent mental health professional, for persons with a primary or
secondary diagnosis of a serious mental illness; or

(ii) a qualified developmental disability professional, for persons with a primary or
secondary diagnosis of developmental disability. For purposes of this requirement, a
qualified developmental disability professional must meet the standards for a qualified
developmental disability professional under Code of Federal Regulations, title 42, section
483.430.

(d) The local county mental health authority or the state developmental disability
authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
nursing facility if the individual does not meet the nursing facility level of care criteria or
needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
purposes of this section, "specialized services" for a person with developmental disability
means active treatment as that term is defined under Code of Federal Regulations, title
42, section 483.440(a)(1).

(e) In assessing a person's needs, the screener shall:

(1) use an automated system designated by the commissioner;

(2) consult with care transitions coordinators or physician; and

(3) consider the assessment of the individual's physician.

Other personnel may be included in the level of care determination as deemed
necessary by the screener.

EFFECTIVE DATE.

This section is effective October 1, 2013.

Sec. 8.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7b.

Exemptions and emergency admissions.

(a) Exemptions from the federal
screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:

(1) a person who, having entered an acute care facility from a certified nursing
facility, is returning to a certified nursing facility; or

(2) a person transferring from one certified nursing facility in Minnesota to another
certified nursing facility in Minnesota.

(b) Persons who are exempt from preadmission screening for purposes of level of
care determination include:

(1) persons described in paragraph (a);

(2) an individual who has a contractual right to have nursing facility care paid for
indefinitely by the Veterans' Administration;

(3) an individual enrolled in a demonstration project under section 256B.69,
subdivision 8, at the time of application to a nursing facility; and

(4) an individual currently being served under the alternative care program or under
a home and community-based services waiver authorized under section 1915(c) of the
federal Social Security Act.

(c) Persons admitted to a Medicaid-certified nursing facility from the community
on an emergency basis as described in paragraph (d) or from an acute care facility on a
nonworking day must be screened the first working day after admission.

(d) Emergency admission to a nursing facility prior to screening is permitted when
all of the following conditions are met:

(1) a person is admitted from the community to a certified nursing or certified
boarding care facility during Senior LinkAge Line nonworking hours for ages 60 and
older and Disability Linkage Line nonworking hours for under age 60;

(2) a physician has determined that delaying admission until preadmission screening
is completed would adversely affect the person's health and safety;

(3) there is a recent precipitating event that precludes the client from living safely in
the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
inability to continue to provide care;

(4) the attending physician has authorized the emergency placement and has
documented the reason that the emergency placement is recommended; and

(5) the Senior LinkAge Line or Disability Linkage Line is contacted on the first
working day following the emergency admission.

Transfer of a patient from an acute care hospital to a nursing facility is not considered
an emergency except for a person who has received hospital services in the following
situations: hospital admission for observation, care in an emergency room without hospital
admission, or following hospital 24-hour bed care and from whom admission is being
sought on a nonworking day.

(e) A nursing facility must provide written information to all persons admitted
regarding the person's right to request and receive long-term care consultation services as
defined in section 256B.0911, subdivision 1a. The information must be provided prior to
the person's discharge from the facility and in a format specified by the commissioner.

EFFECTIVE DATE.

This section is effective October 1, 2013.

Sec. 9.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7c.

Screening requirements.

(a) A person may be screened for nursing
facility admission by telephone or in a face-to-face screening interview. The Senior
LinkAge Line shall identify each individual's needs using the following categories:

(1) the person needs no face-to-face long-term care consultation assessment
completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
managed care organization under contract with the Department of Human Services to
determine the need for nursing facility level of care based on information obtained from
other health care professionals;

(2) the person needs an immediate face-to-face long-term care consultation
assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county,
tribe, or managed care organization under contract with the Department of Human
Services to determine the need for nursing facility level of care and complete activities
required under subdivision 7a; or

(3) the person may be exempt from screening requirements as outlined in subdivision
7b, but will need transitional assistance after admission or in-person follow-along after
a return home.

(b) Individuals between the ages of 60 and 64 who are admitted to nursing facilities
with only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission as described in
section 256B.0911, subdivision 4d, paragraph (c).

(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
facility must be screened prior to admission.

(d) Screenings provided by the Senior LinkAge Line must include processes
to identify persons who may require transition assistance described in subdivision 7,
paragraph (b), clause (12), and section 256B.0911, subdivision 3b.

EFFECTIVE DATE.

This section is effective October 1, 2013.

Sec. 10.

Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
to read:


Subd. 7d.

Payment for preadmission screening.

Funding for preadmission
screening shall be provided to the Minnesota Board on Aging for the population 60
years of age and older by the Department of Human Services to cover screener salaries
and expenses to provide the services described in subdivisions 7a to 7c. The Minnesota
Board on Aging shall employ, or contract with other agencies to employ, within the limits
of available funding, sufficient personnel to provide preadmission screening and level of
care determination services and shall seek to maximize federal funding for the service as
provided under section 256.01, subdivision 2, paragraph (dd).

EFFECTIVE DATE.

This section is effective October 1, 2013.

Sec. 11.

Minnesota Statutes 2012, section 256.9754, is amended by adding a
subdivision to read:


Subd. 3a.

Priority for other grants.

The commissioner of health shall give
priority to a grantee selected under subdivision 3 when awarding technology-related
grants, if the grantee is using technology as a part of a proposal, unless that priority
conflicts with existing state or federal guidance related to grant awards by the Department
of Health. The commissioner of transportation shall give priority to a grantee selected
under subdivision 3 when distributing transportation-related funds to create transportation
options for older adults.

Sec. 12.

Minnesota Statutes 2012, section 256.9754, is amended by adding a
subdivision to read:


Subd. 3b.

State waivers.

The commissioner of health may waive applicable state
laws and rules on a time-limited basis if the commissioner of health determines that a
participating grantee requires a waiver in order to achieve demonstration project goals.

Sec. 13.

Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:


Subd. 5.

Grant preference.

The commissioner of human services shall give
preference when awarding grants under this section to areas where nursing facility
closures have occurred or are occurring or areas with service needs identified by section
144A.351
. The commissioner may award grants to the extent grant funds are available
and to the extent applications are approved by the commissioner. Denial of approval of an
application in one year does not preclude submission of an application in a subsequent
year. The maximum grant amount is limited to $750,000.

Sec. 14.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:


Subd. 4a.

Evaluation.

The commissioner shall evaluate the projects contained in
subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:

(1) an impact assessment focusing on program outcomes, especially those
experienced directly by the person receiving services;

(2) study samples drawn from the population of interest for each project; and

(3) a time series analysis to examine aggregate trends in average monthly
utilization, expenditures, and other outcomes in the targeted populations before and after
implementation of the initiatives.

Sec. 15.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:


Subd. 6.

Work, empower, and encourage independence.

As provided under
subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a
demonstration project to provide navigation, employment supports, and benefits planning
services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014.
This demonstration shall promote economic stability, increase independence, and reduce
applications for disability benefits while providing a positive impact on the health and
future of participants.

Sec. 16.

Minnesota Statutes 2012, section 256B.021, is amended by adding a
subdivision to read:


Subd. 7.

Housing stabilization.

As provided under subdivision 4, paragraph (e),
upon federal approval, the commissioner shall establish a demonstration project to provide
service coordination, outreach, in-reach, tenancy support, and community living assistance
to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This
demonstration shall promote housing stability, reduce costly medical interventions, and
increase opportunities for independent community living.

Sec. 17.

Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:


Subdivision 1.

Purpose and goal.

(a) The purpose of long-term care consultation
services is to assist persons with long-term or chronic care needs in making care
decisions and selecting support and service options that meet their needs and reflect
their preferences. The availability of, and access to, information and other types of
assistance, including assessment and support planning, is also intended to prevent or delay
institutional placements and to provide access to transition assistance after admission.
Further, the goal of these services is to contain costs associated with unnecessary
institutional admissions. Long-term consultation services must be available to any person
regardless of public program eligibility. The commissioner of human services shall seek
to maximize use of available federal and state funds and establish the broadest program
possible within the funding available.

(b) These services must be coordinated with long-term care options counseling
provided under subdivision 4d, section 256.975, subdivision subdivisions 7 to 7c, and
section 256.01, subdivision 24. The lead agency providing long-term care consultation
services shall encourage the use of volunteers from families, religious organizations, social
clubs, and similar civic and service organizations to provide community-based services.

Sec. 18.

Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to
read:


Subd. 1a.

Definitions.

For purposes of this section, the following definitions apply:

(a) Until additional requirements apply under paragraph (b), "long-term care
consultation services" means:

(1) intake for and access to assistance in identifying services needed to maintain an
individual in the most inclusive environment;

(2) providing recommendations for and referrals to cost-effective community
services that are available to the individual;

(3) development of an individual's person-centered community support plan;

(4) providing information regarding eligibility for Minnesota health care programs;

(5) face-to-face long-term care consultation assessments, which may be completed
in a hospital, nursing facility, intermediate care facility for persons with developmental
disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
residence;

(6) federally mandated preadmission screening activities described under
subdivisions 4a and 4b;

(7) (6) determination of home and community-based waiver and other service
eligibility as required under sections 256B.0913, 256B.0915, and 256B.49, including level
of care determination for individuals who need an institutional level of care as determined
under section 256B.0911, subdivision 4a, paragraph (d) 4e, based on assessment and
community support plan development, appropriate referrals to obtain necessary diagnostic
information, and including an eligibility determination for consumer-directed community
supports;

(8) (7) providing recommendations for institutional placement when there are no
cost-effective community services available;

(9) (8) providing access to assistance to transition people back to community settings
after institutional admission; and

(10) (9) providing information about competitive employment, with or without
supports, for school-age youth and working-age adults and referrals to the Disability
Linkage Line and Disability Benefits 101 to ensure that an informed choice about
competitive employment can be made. For the purposes of this subdivision, "competitive
employment" means work in the competitive labor market that is performed on a full-time
or part-time basis in an integrated setting, and for which an individual is compensated at or
above the minimum wage, but not less than the customary wage and level of benefits paid
by the employer for the same or similar work performed by individuals without disabilities.

(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
2c, and 3a, "long-term care consultation services" also means:

(1) service eligibility determination for state plan home care services identified in:

(i) section 256B.0625, subdivisions 7, 19a, and 19c;

(ii) section 256B.0657; or

(iii) consumer support grants under section 256.476;

(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
determination of eligibility for case management services available under sections
256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part
9525.0016;

(3) determination of institutional level of care, home and community-based service
waiver, and other service eligibility as required under section 256B.092, determination
of eligibility for family support grants under section 252.32, semi-independent living
services under section 252.275, and day training and habilitation services under section
256B.092; and

(4) obtaining necessary diagnostic information to determine eligibility under clauses
(2) and (3).

(c) "Long-term care options counseling" means the services provided by the linkage
lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and
also includes telephone assistance and follow up once a long-term care consultation
assessment has been completed.

(d) "Minnesota health care programs" means the medical assistance program under
chapter 256B and the alternative care program under section 256B.0913.

(e) "Lead agencies" means counties administering or tribes and health plans under
contract with the commissioner to administer long-term care consultation assessment and
support planning services.

Sec. 19.

Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
read:


Subd. 3a.

Assessment and support planning.

(a) Persons requesting assessment,
services planning, or other assistance intended to support community-based living,
including persons who need assessment in order to determine waiver or alternative care
program eligibility, must be visited by a long-term care consultation team within 20
calendar days after the date on which an assessment was requested or recommended.
Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
applies to an assessment of a person requesting personal care assistance services and
private duty nursing. The commissioner shall provide at least a 90-day notice to lead
agencies prior to the effective date of this requirement. Face-to-face assessments must be
conducted according to paragraphs (b) to (i).

(b) The lead agency may utilize a team of either the social worker or public health
nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
use certified assessors to conduct the assessment. The consultation team members must
confer regarding the most appropriate care for each individual screened or assessed. For
a person with complex health care needs, a public health or registered nurse from the
team must be consulted.

(c) The assessment must be comprehensive and include a person-centered assessment
of the health, psychological, functional, environmental, and social needs of referred
individuals and provide information necessary to develop a community support plan that
meets the consumers needs, using an assessment form provided by the commissioner.

(d) The assessment must be conducted in a face-to-face interview with the person
being assessed and the person's legal representative, and other individuals as requested by
the person, who can provide information on the needs, strengths, and preferences of the
person necessary to develop a community support plan that ensures the person's health and
safety, but who is not a provider of service or has any financial interest in the provision
of services. For persons who are to be assessed for elderly waiver customized living
services under section 256B.0915, with the permission of the person being assessed or
the person's designated or legal representative, the client's current or proposed provider
of services may submit a copy of the provider's nursing assessment or written report
outlining its recommendations regarding the client's care needs. The person conducting
the assessment will notify the provider of the date by which this information is to be
submitted. This information shall be provided to the person conducting the assessment
prior to the assessment.

(e) If the person chooses to use community-based services, the person or the person's
legal representative must be provided with a written community support plan within 40
calendar days of the assessment visit, regardless of whether the individual is eligible for
Minnesota health care programs. The written community support plan must include:

(1) a summary of assessed needs as defined in paragraphs (c) and (d);

(2) the individual's options and choices to meet identified needs, including all
available options for case management services and providers;

(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;

(4) referral information; and

(5) informal caregiver supports, if applicable.

For a person determined eligible for state plan home care under subdivision 1a,
paragraph (b), clause (1), the person or person's representative must also receive a copy of
the home care service plan developed by the certified assessor.

(f) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying
community support, the person must be transferred or referred to long-term care options
counseling services available under sections 256.975, subdivision 7, and 256.01,
subdivision 24, for telephone assistance and follow up.

(g) The person has the right to make the final decision between institutional
placement and community placement after the recommendations have been provided,
except as provided in section 256.975, subdivision 4a, paragraph (c) 7a, paragraph (d).

(h) The lead agency must give the person receiving assessment or support planning,
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:

(1) written recommendations for community-based services and consumer-directed
options;

(2) documentation that the most cost-effective alternatives available were offered to
the individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;

(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to sections 256.975, subdivisions 7a to 7c, and 256.01,
subdivision 24,
if the person selects nursing facility placement. If the individual selects
nursing facility placement, the lead agency shall forward information needed to complete
the level of care determinations and screening for developmental disability and mental
illness collected during the assessment to the long-term care options counselor using forms
provided by the commissioner
;

(4) the role of long-term care consultation assessment and support planning in
eligibility determination for waiver and alternative care programs, and state plan home
care, case management, and other services as defined in subdivision 1a, paragraphs (a),
clause (7), and (b);

(5) information about Minnesota health care programs;

(6) the person's freedom to accept or reject the recommendations of the team;

(7) the person's right to confidentiality under the Minnesota Government Data
Practices Act, chapter 13;

(8) the certified assessor's decision regarding the person's need for institutional level
of care as determined under criteria established in section 256B.0911, subdivision 4a,
paragraph (d)
4e, and the certified assessor's decision regarding eligibility for all services
and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and

(9) the person's right to appeal the certified assessor's decision regarding eligibility
for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
(b), and incorporating the decision regarding the need for institutional level of care or the
lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3.

(i) Face-to-face assessment completed as part of eligibility determination for
the alternative care, elderly waiver, community alternatives for disabled individuals,
community alternative care, and brain injury waiver programs under sections 256B.0913,
256B.0915, and 256B.49 is valid to establish service eligibility for no more than 60
calendar days after the date of assessment.

(j) The effective eligibility start date for programs in paragraph (i) can never be
prior to the date of assessment. If an assessment was completed more than 60 days
before the effective waiver or alternative care program eligibility start date, assessment
and support plan information must be updated in a face-to-face visit and documented in
the department's Medicaid Management Information System (MMIS). Notwithstanding
retroactive medical assistance coverage of state plan services, the effective date of
eligibility for programs included in paragraph (i) cannot be prior to the date the most
recent updated assessment is completed.

Sec. 20.

Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
read:


Subd. 4d.

Preadmission screening of individuals under 65 60 years of age.

(a)
It is the policy of the state of Minnesota to ensure that individuals with disabilities or
chronic illness are served in the most integrated setting appropriate to their needs and have
the necessary information to make informed choices about home and community-based
service options.

(b) Individuals under 65 60 years of age who are admitted to a Medicaid-certified
nursing facility from a hospital must be screened prior to admission as outlined in
subdivisions 4a through 4c
according to the requirements outlined in section 256.975,
subdivisions 7a to 7c. This shall be provided by the Disability Linkage Line as required
under section 256.01, subdivision 24
.

(c) Individuals under 65 years of age who are admitted to nursing facilities with
only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission.

(d) Individuals under 65 years of age who are admitted to a nursing facility
without preadmission screening according to the exemption described in subdivision 4b,
paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
a face-to-face assessment within 40 days of admission.

(e) (d) At the face-to-face assessment, the long-term care consultation team member
or county case manager must perform the activities required under subdivision 3b.

(f) (e) For individuals under 21 years of age, a screening interview which
recommends nursing facility admission must be face-to-face and approved by the
commissioner before the individual is admitted to the nursing facility.

(g) (f) In the event that an individual under 65 60 years of age is admitted to a
nursing facility on an emergency basis, the county Disability Linkage Line must be
notified of the admission on the next working day, and a face-to-face assessment as
described in paragraph (c) must be conducted within 40 calendar days of admission.

(h) (g) At the face-to-face assessment, the long-term care consultation team member
or the case manager must present information about home and community-based options,
including consumer-directed options, so the individual can make informed choices. If the
individual chooses home and community-based services, the long-term care consultation
team member or case manager must complete a written relocation plan within 20 working
days of the visit. The plan shall describe the services needed to move out of the facility
and a time line for the move which is designed to ensure a smooth transition to the
individual's home and community.

(i) (h) An individual under 65 years of age residing in a nursing facility shall receive
a face-to-face assessment at least every 12 months to review the person's service choices
and available alternatives unless the individual indicates, in writing, that annual visits are
not desired. In this case, the individual must receive a face-to-face assessment at least
once every 36 months for the same purposes.

(j) (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay
county agencies directly for face-to-face assessments for individuals under 65 years of age
who are being considered for placement or residing in a nursing facility.

(j) Funding for preadmission screening shall be provided to the Disability Linkage
Line for the under 60 population by the Department of Human Services to cover screener
salaries and expenses to provide the services described in subdivisions 7a to 7c. The
Disability Linkage Line shall employ, or contract with other agencies to employ, within
the limits of available funding, sufficient personnel to provide preadmission screening and
level of care determination services and shall seek to maximize federal funding for the
service as provided under section 256.01, subdivision 2, paragraph (dd).

EFFECTIVE DATE.

This section is effective October 1, 2013.

Sec. 21.

Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
read:


Subd. 4d.

Preadmission screening of individuals under 65 years of age.

(a)
It is the policy of the state of Minnesota to ensure that individuals with disabilities or
chronic illness are served in the most integrated setting appropriate to their needs and have
the necessary information to make informed choices about home and community-based
service options.

(b) Individuals under 65 years of age who are admitted to a nursing facility from a
hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.

(c) Individuals under 65 years of age who are admitted to nursing facilities with
only a telephone screening must receive a face-to-face assessment from the long-term
care consultation team member of the county in which the facility is located or from the
recipient's county case manager within 40 calendar days of admission.

(d) Individuals under 65 years of age who are admitted to a nursing facility
without preadmission screening according to the exemption described in subdivision 4b,
paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
a face-to-face assessment within 40 days of admission.

(e) At the face-to-face assessment, the long-term care consultation team member or
county case manager must perform the activities required under subdivision 3b.

(f) For individuals under 21 years of age, a screening interview which recommends
nursing facility admission must be face-to-face and approved by the commissioner before
the individual is admitted to the nursing facility.

(g) In the event that an individual under 65 years of age is admitted to a nursing
facility on an emergency basis, the county must be notified of the admission on the
next working day, and a face-to-face assessment as described in paragraph (c) must be
conducted within 40 calendar days of admission.

(h) At the face-to-face assessment, the long-term care consultation team member or
the case manager must present information about home and community-based options,
including consumer-directed options, so the individual can make informed choices. If the
individual chooses home and community-based services, the long-term care consultation
team member or case manager must complete a written relocation plan within 20 working
days of the visit. The plan shall describe the services needed to move out of the facility
and a time line for the move which is designed to ensure a smooth transition to the
individual's home and community.

(i) An individual under 65 years of age residing in a nursing facility shall receive a
face-to-face assessment at least every 12 months to review the person's service choices
and available alternatives unless the individual indicates, in writing, that annual visits are
not desired. In this case, the individual must receive a face-to-face assessment at least
once every 36 months for the same purposes.

(j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
county agencies directly for face-to-face assessments for individuals under 65 years of age
who are being considered for placement or residing in a nursing facility. Until September
30, 2013, payments for individuals under 65 years of age shall be made as described
in this subdivision.

Sec. 22.

Minnesota Statutes 2012, section 256B.0911, is amended by adding a
subdivision to read:


Subd. 4e.

Determination of institutional level of care.

The determination of the
need for nursing facility, hospital, and intermediate care facility levels of care must be
made according to criteria developed by the commissioner, and in section 256B.092,
using forms developed by the commissioner. Effective January 1, 2014, for individuals
age 21 and older, the determination of need for nursing facility level of care shall be
based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the
determination of the need for nursing facility level of care must be made according to
criteria developed by the commissioner until criteria in section 144.0724, subdivision 11,
becomes effective on or after October 1, 2019.

Sec. 23.

Minnesota Statutes 2012, section 256B.0911, subdivision 6, is amended to read:


Subd. 6.

Payment for long-term care consultation services.

(a) Until September
30, 2013, payment for long-term care consultation face-to-face assessment shall be made
as described in this subdivision.

(b) The total payment for each county must be paid monthly by certified nursing
facilities in the county. The monthly amount to be paid by each nursing facility for each
fiscal year must be determined by dividing the county's annual allocation for long-term
care consultation services by 12 to determine the monthly payment and allocating the
monthly payment to each nursing facility based on the number of licensed beds in the
nursing facility. Payments to counties in which there is no certified nursing facility must be
made by increasing the payment rate of the two facilities located nearest to the county seat.

(b) (c) The commissioner shall include the total annual payment determined under
paragraph (a) for each nursing facility reimbursed under section 256B.431, 256B.434,
or 256B.441.

(c) (d) In the event of the layaway, delicensure and decertification, or removal
from layaway of 25 percent or more of the beds in a facility, the commissioner may
adjust the per diem payment amount in paragraph (b) (c) and may adjust the monthly
payment amount in paragraph (a) (b). The effective date of an adjustment made under this
paragraph shall be on or after the first day of the month following the effective date of the
layaway, delicensure and decertification, or removal from layaway.

(d) (e) Payments for long-term care consultation services are available to the county
or counties to cover staff salaries and expenses to provide the services described in
subdivision 1a. The county shall employ, or contract with other agencies to employ,
within the limits of available funding, sufficient personnel to provide long-term care
consultation services while meeting the state's long-term care outcomes and objectives as
defined in subdivision 1. The county shall be accountable for meeting local objectives
as approved by the commissioner in the biennial home and community-based services
quality assurance plan on a form provided by the commissioner.

(e) (f) Notwithstanding section 256B.0641, overpayments attributable to payment
of the screening costs under the medical assistance program may not be recovered from
a facility.

(f) (g) The commissioner of human services shall amend the Minnesota medical
assistance plan to include reimbursement for the local consultation teams.

(g) (h) Until the alternative payment methodology in paragraph (h) (i) is implemented,
the county may bill, as case management services, assessments, support planning, and
follow-along provided to persons determined to be eligible for case management under
Minnesota health care programs. No individual or family member shall be charged for an
initial assessment or initial support plan development provided under subdivision 3a or 3b.

(h) (i) The commissioner shall develop an alternative payment methodology,
effective on October 1, 2013,
for long-term care consultation services that includes
the funding available under this subdivision, and for assessments authorized under
sections 256B.092 and 256B.0659. In developing the new payment methodology, the
commissioner shall consider the maximization of other funding sources, including federal
administrative reimbursement through federal financial participation funding, for all
long-term care consultation and preadmission screening activity. The alternative payment
methodology shall include the use of the appropriate time studies and the state financing
of nonfederal share as part of the state's medical assistance program.

Sec. 24.

Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:


Subd. 7.

Reimbursement for certified nursing facilities.

(a) Medical assistance
reimbursement for nursing facilities shall be authorized for a medical assistance recipient
only if a preadmission screening has been conducted prior to admission or the county has
authorized an exemption. Medical assistance reimbursement for nursing facilities shall
not be provided for any recipient who the local screener has determined does not meet the
level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
mental illness is approved by the local mental health authority or an admission for a
recipient with developmental disability is approved by the state developmental disability
authority.

(b) The nursing facility must not bill a person who is not a medical assistance
recipient for resident days that preceded the date of completion of screening activities
as required under section 256.975, subdivisions 4a, 4b, and 4c 7a to 7c. The nursing
facility must include unreimbursed resident days in the nursing facility resident day totals
reported to the commissioner.

Sec. 25.

Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:


Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a) Funding for services under the alternative care program is available to persons who
meet the following criteria:

(1) the person has been determined by a community assessment under section
256B.0911 to be a person who would require the level of care provided in a nursing
facility, as determined under section 256B.0911, subdivision 4a, paragraph (d) 4e, but for
the provision of services under the alternative care program;

(2) the person is age 65 or older;

(3) the person would be eligible for medical assistance within 135 days of admission
to a nursing facility;

(4) the person is not ineligible for the payment of long-term care services by the
medical assistance program due to an asset transfer penalty under section 256B.0595 or
equity interest in the home exceeding $500,000 as stated in section 256B.056;

(5) the person needs long-term care services that are not funded through other
state or federal funding, or other health insurance or other third-party insurance such as
long-term care insurance;

(6) except for individuals described in clause (7), the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
does not prohibit the alternative care client from payment for additional services, but in no
case may the cost of additional services purchased under this section exceed the difference
between the client's monthly service limit defined under section 256B.0915, subdivision
3
, and the alternative care program monthly service limit defined in this paragraph. If
care-related supplies and equipment or environmental modifications and adaptations are or
will be purchased for an alternative care services recipient, the costs may be prorated on a
monthly basis for up to 12 consecutive months beginning with the month of purchase.
If the monthly cost of a recipient's other alternative care services exceeds the monthly
limit established in this paragraph, the annual cost of the alternative care services shall be
determined. In this event, the annual cost of alternative care services shall not exceed 12
times the monthly limit described in this paragraph;

(7) for individuals assigned a case mix classification A as described under section
256B.0915, subdivision 3a, paragraph (a), with (i) no dependencies in activities of daily
living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating
when the dependency score in eating is three or greater as determined by an assessment
performed under section 256B.0911, the monthly cost of alternative care services funded
by the program cannot exceed $593 per month for all new participants enrolled in
the program on or after July 1, 2011. This monthly limit shall be applied to all other
participants who meet this criteria at reassessment. This monthly limit shall be increased
annually as described in section 256B.0915, subdivision 3a, paragraph (a). This monthly
limit does not prohibit the alternative care client from payment for additional services, but
in no case may the cost of additional services purchased exceed the difference between the
client's monthly service limit defined in this clause and the limit described in clause (6)
for case mix classification A; and

(8) the person is making timely payments of the assessed monthly fee.

A person is ineligible if payment of the fee is over 60 days past due, unless the person
agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee payments.

The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(b) Alternative care funding under this subdivision is not available for a person who
is a medical assistance recipient or who would be eligible for medical assistance without a
spenddown or waiver obligation. A person whose initial application for medical assistance
and the elderly waiver program is being processed may be served under the alternative care
program for a period up to 60 days. If the individual is found to be eligible for medical
assistance, medical assistance must be billed for services payable under the federally
approved elderly waiver plan and delivered from the date the individual was found eligible
for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
care funds may not be used to pay for any service the cost of which: (i) is payable by
medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to
pay a medical assistance income spenddown for a person who is eligible to participate in the
federally approved elderly waiver program under the special income standard provision.

(c) Alternative care funding is not available for a person who resides in a licensed
nursing home, certified boarding care home, hospital, or intermediate care facility, except
for case management services which are provided in support of the discharge planning
process for a nursing home resident or certified boarding care home resident to assist with
a relocation process to a community-based setting.

(d) Alternative care funding is not available for a person whose income is greater
than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
year for which alternative care eligibility is determined, who would be eligible for the
elderly waiver with a waiver obligation.

Sec. 26.

Minnesota Statutes 2012, section 256B.0913, is amended by adding a
subdivision to read:


Subd. 17.

Essential community supports grants.

(a) Notwithstanding subdivisions
1 to 14, the purpose of the essential community supports grant program is to provide
targeted services to persons age 65 and older who need essential community support, but
whose needs do not meet the level of care required for nursing facility placement under
section 144.0724, subdivision 11.

(b) Essential community supports grants are available not to exceed $400 per person
per month. Essential community supports service grants may be used as authorized within
an authorization period not to exceed 12 months. Grants must be available to a person who:

(1) is age 65 or older;

(2) is not eligible for medical assistance;

(3) would otherwise be financially eligible for the alternative care program under
subdivision 4;

(4) has received a community assessment under section 256B.0911, subdivision 3a
or 3b, and does not require the level of care provided in a nursing facility;

(5) has a community support plan; and

(6) has been determined by a community assessment under section 256B.0911,
subdivision 3a or 3b, to be a person who would require provision of at least one of the
following services, as defined in the approved elderly waiver plan, in order to maintain
their community residence:

(i) caregiver support;

(ii) homemaker support;

(iii) chores; or

(iv) a personal emergency response device or system.

(c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination, not to exceed $600 in a 12-month authorization
period, as part of their community support plan.

(d) A person who has been determined to be eligible for an essential community
supports grant must be reassessed at least annually and continue to meet the criteria in
paragraph (b) to remain eligible for an essential community supports grant.

(e) The commissioner is authorized to use federal matching funds for essential
community supports as necessary and to meet demand for essential community supports
grants as outlined in paragraphs (f) and (g), and that amount of federal funds is
appropriated to the commissioner for this purpose.

(f) Upon federal approval and following a reasonable implementation period
determined by the commissioner, essential community supports are available to an
individual who:

(1) is receiving nursing facility services or home and community-based long-term
services and supports under section 256B.0915 or 256B.49 on the effective date of
implementation of the revised nursing facility level of care under section 144.0724,
subdivision 11;

(2) meets one of the following criteria:

(i) due to the implementation of the revised nursing facility level of care, loses
eligibility for continuing medical assistance payment of nursing facility services at the
first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or
after the effective date of the revised nursing facility level of care criteria under section
144.0724, subdivision 11; or

(ii) due to the implementation of the revised nursing facility level of care, loses
eligibility for continuing medical assistance payment of home and community-based
long-term services and supports under section 256B.0915 or 256B.49 at the first
reassessment required under those sections that occurs on or after the effective date of
implementation of the revised nursing facility level of care under section 144.0724,
subdivision 11;

(3) is not eligible for personal care attendant services; and

(4) has an assessed need for one or more of the supportive services offered under
essential community supports.

Individuals eligible under this paragraph includes individuals who continue to be
eligible for medical assistance state plan benefits and those who are not or are no longer
financially eligible for medical assistance.

(g) Upon federal approval and following a reasonable implementation period
determined by the commissioner, the services available through essential community
supports include the services and grants provided in paragraphs (b) and (c), home-delivered
meals, and community living assistance as defined by the commissioner. These services
are available to all eligible recipients including those outlined in paragraphs (b) and (f).
Recipients are eligible if they have a need for any of these services and meet all other
eligibility criteria.

Sec. 27.

Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:


Subd. 5.

Assessments and reassessments for waiver clients.

(a) Each client
shall receive an initial assessment of strengths, informal supports, and need for services
in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
client served under the elderly waiver must be conducted at least every 12 months and at
other times when the case manager determines that there has been significant change in
the client's functioning. This may include instances where the client is discharged from
the hospital. There must be a determination that the client requires nursing facility level
of care as defined in section 256B.0911, subdivision 4a, paragraph (d) 4e, at initial and
subsequent assessments to initiate and maintain participation in the waiver program.

(b) Regardless of other assessments identified in section 144.0724, subdivision
4, as appropriate to determine nursing facility level of care for purposes of medical
assistance payment for nursing facility services, only face-to-face assessments conducted
according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
level of care determination will be accepted for purposes of initial and ongoing access to
waiver service payment.

Sec. 28.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 1a.

Home and community-based services for older adults.

(a) The purpose
of projects selected by the commissioner of human services under this section is to
make strategic changes in the long-term services and supports system for older adults
including statewide capacity for local service development and technical assistance, and
statewide availability of home and community-based services for older adult services,
caregiver support and respite care services, and other supports in the state of Minnesota.
These projects are intended to create incentives for new and expanded home and
community-based services in Minnesota in order to:

(1) reach older adults early in the progression of their need for long-term services
and supports, providing them with low-cost, high-impact services that will prevent or
delay the use of more costly services;

(2) support older adults to live in the most integrated, least restrictive community
setting;

(3) support the informal caregivers of older adults;

(4) develop and implement strategies to integrate long-term services and supports
with health care services, in order to improve the quality of care and enhance the quality
of life of older adults and their informal caregivers;

(5) ensure cost-effective use of financial and human resources;

(6) build community-based approaches and community commitment to delivering
long-term services and supports for older adults in their own homes;

(7) achieve a broad awareness and use of lower-cost in-home services as an
alternative to nursing homes and other residential services;

(8) strengthen and develop additional home and community-based services and
alternatives to nursing homes and other residential services; and

(9) strengthen programs that use volunteers.

(b) The services provided by these projects are available to older adults who are
eligible for medical assistance and the elderly waiver under section 256B.0915, the
alternative care program under section 256B.0913, or essential community supports grant
under subdivision 14, paragraph (b), and to persons who have their own funds to pay for
services.

Sec. 29.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 1b.

Definitions.

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

(b) "Community" means a town; township; city; or targeted neighborhood within a
city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.

(c) "Core home and community-based services provider" means a Faith in Action,
Living at Home Block Nurse, Congregational Nurse, or similar community-based
program governed by a board, the majority of whose members reside within the program's
service area, that organizes and uses volunteers and paid staff to deliver nonmedical
services intended to assist older adults to identify and manage risks and to maintain their
community living and integration in the community.

(d) "Eldercare development partnership" means a team of representatives of county
social service and public health agencies, the area agency on aging, local nursing home
providers, local home care providers, and other appropriate home and community-based
providers in the area agency's planning and service area.

(e) "Long-term services and supports" means any service available under the
elderly waiver program or alternative care grant programs, nursing facility services,
transportation services, caregiver support and respite care services, and other home and
community-based services identified as necessary either to maintain lifestyle choices for
older adults or to support them to remain in their own home.

(f) "Older adult" refers to an individual who is 65 years of age or older.

Sec. 30.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 1c.

Eldercare development partnerships.

The commissioner of human
services shall select and contract with eldercare development partnerships sufficient to
provide statewide availability of service development and technical assistance using a
request for proposals process. Eldercare development partnerships shall:

(1) develop a local long-term services and supports strategy consistent with state
goals and objectives;

(2) identify and use existing local skills, knowledge, and relationships, and build
on these assets;

(3) coordinate planning for funds to provide services to older adults, including funds
received under Title III of the Older Americans Act, Title XX of the Social Security Act,
and the Local Public Health Act;

(4) target service development and technical assistance where nursing facility
closures have occurred or are occurring or in areas where service needs have been
identified through activities under section 144A.351;

(5) provide sufficient staff for development and technical support in its designated
area; and

(6) designate a single public or nonprofit member of the eldercare development
partnerships to apply grant funding and manage the project.

Sec. 31.

Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:


Subd. 6.

Caregiver support and respite care projects.

(a) The commissioner
shall establish up to 36 projects to expand the respite care network in the state and to
support caregivers in their responsibilities for care. The purpose of each project shall
be to
availability of caregiver support and respite care services for family and other
caregivers. The commissioner shall use a request for proposals to select nonprofit entities
to administer the projects. Projects shall
:

(1) establish a local coordinated network of volunteer and paid respite workers;

(2) coordinate assignment of respite workers care services to clients and care
receivers and assure the health and safety of the client; and
caregivers of older adults;

(3) provide training for caregivers and ensure that support groups are available
in the community.

(b) The caregiver support and respite care funds shall be available to the four to six
local long-term care strategy projects designated in subdivisions 1 to 5.

(c) The commissioner shall publish a notice in the State Register to solicit proposals
from public or private nonprofit agencies for the projects not included in the four to six
local long-term care strategy projects defined in subdivision 2. A county agency may,
alone or in combination with other county agencies, apply for caregiver support and
respite care project funds. A public or nonprofit agency within a designated SAIL project
area may apply for project funds if the agency has a letter of agreement with the county
or counties in which services will be developed, stating the intention of the county or
counties to coordinate their activities with the agency requesting a grant.

(d) The commissioner shall select grantees based on the following criteria:

(1) the ability of the proposal to demonstrate need in the area served, as evidenced
by a community needs assessment or other demographic data;

(2) the ability of the proposal to clearly describe how the project

(3) assure the health and safety of the older adults;

(4) identify at-risk caregivers;

(5) provide information, education, and training for caregivers in the designated
community; and

(6) demonstrate the need in the proposed service area particularly where nursing
facility closures have occurred or are occurring or areas with service needs identified
by section 144A.351. Preference must be given for projects that reach underserved
populations.

(b) Projects must clearly describe:

(1) how they will achieve the their purpose defined in paragraph (b);

(3) the ability of the proposal to reach underserved populations;

(4) the ability of the proposal to demonstrate community commitment to the project,
as evidenced by letters of support and cooperation as well as formation of a community
task force;

(5) the ability of the proposal to clearly describe (2) the process for recruiting,
training, and retraining volunteers; and

(6) the inclusion in the proposal of the (3) a plan to promote the project in the
designated community, including outreach to persons needing the services.

(e) (c) Funds for all projects under this subdivision may be used to:

(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
care services and assign workers to clients;

(2) recruit and train volunteer providers;

(3) train provide information, training, and education to caregivers;

(4) ensure the development of support groups for caregivers;

(5) (4) advertise the availability of the caregiver support and respite care project; and

(6) (5) purchase equipment to maintain a system of assigning workers to clients.

(f) (d) Project funds may not be used to supplant existing funding sources.

Sec. 32.

Minnesota Statutes 2012, section 256B.0917, is amended by adding a
subdivision to read:


Subd. 7a.

Core home and community-based services.

The commissioner shall
select and contract with core home and community-based services providers for projects
to provide services and supports to older adults both with and without family and other
informal caregivers using a request for proposals process. Projects must:

(1) have a credible, public, or private nonprofit sponsor providing ongoing financial
support;

(2) have a specific, clearly defined geographic service area;

(3) use a practice framework designed to identify high-risk older adults and help them
take action to better manage their chronic conditions and maintain their community living;

(4) have a team approach to coordination and care, ensuring that the older adult
participants, their families, and the formal and informal providers are all part of planning
and providing services;

(5) provide information, support services, homemaking services, counseling, and
training for the older adults and family caregivers;

(6) encourage service area or neighborhood residents and local organizations to
collaborate in meeting the needs of older adults in their geographic service areas;

(7) recruit, train, and direct the use of volunteers to provide informal services and
other appropriate support to older adults and their caregivers; and

(8) provide coordination and management of formal and informal services to older
adults and their families using less expensive alternatives.

Sec. 33.

Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to
read:


Subd. 13.

Community service grants.

The commissioner shall award contracts
for grants to public and private nonprofit agencies to establish services that strengthen
a community's ability to provide a system of home and community-based services
for elderly persons. The commissioner shall use a request for proposal process. The
commissioner shall give preference when awarding grants under this section to areas
where nursing facility closures have occurred or are occurring or to areas with service
needs identified under section 144A.351
. The commissioner shall consider grants for:

(1) caregiver support and respite care projects under subdivision 6;

(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and

(3) services identified as needed for community transition.

Sec. 34.

Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:


Subdivision 1.

Development and implementation of quality profiles.

(a) The
commissioner of human services, in cooperation with the commissioner of health,
shall develop and implement a quality profile system profiles for nursing facilities and,
beginning not later than July 1, 2004 2014, other providers of long-term care services,
except when the quality profile system would duplicate requirements under section
256B.5011, 256B.5012, or 256B.5013. The system quality profiles must be developed
and implemented to the extent possible without the collection of significant amounts of
new data. To the extent possible, the system
using existing data sets maintained by the
commissioners of health and human services to the extent possible. The profiles
must
incorporate or be coordinated with information on quality maintained by area agencies on
aging, long-term care trade associations, the ombudsman offices, counties, tribes, health
plans,
and other entities and the long-term care database maintained under section 256.975,
subdivision 7
. The system profiles must be designed to provide information on quality to:

(1) consumers and their families to facilitate informed choices of service providers;

(2) providers to enable them to measure the results of their quality improvement
efforts and compare quality achievements with other service providers; and

(3) public and private purchasers of long-term care services to enable them to
purchase high-quality care.

(b) The system profiles must be developed in consultation with the long-term care
task force, area agencies on aging, and representatives of consumers, providers, and labor
unions. Within the limits of available appropriations, the commissioners may employ
consultants to assist with this project.

Sec. 35.

Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:


Subd. 2.

Quality measurement tools.

The commissioners shall identify and apply
existing quality measurement tools to:

(1) emphasize quality of care and its relationship to quality of life; and

(2) address the needs of various users of long-term care services, including, but not
limited to, short-stay residents, persons with behavioral problems, persons with dementia,
and persons who are members of minority groups.

The tools must be identified and applied, to the extent possible, without requiring
providers to supply information beyond current state and federal requirements.

Sec. 36.

Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:


Subd. 3.

Consumer surveys of nursing facilities residents.

Following
identification of the quality measurement tool, the commissioners shall conduct surveys
of long-term care service consumers of nursing facilities to develop quality profiles
of providers. To the extent possible, surveys must be conducted face-to-face by state
employees or contractors. At the discretion of the commissioners, surveys may be
conducted by telephone or by provider staff. Surveys must be conducted periodically to
update quality profiles of individual service nursing facilities providers.

Sec. 37.

Minnesota Statutes 2012, section 256B.439, is amended by adding a
subdivision to read:


Subd. 3a.

Home and community-based services report card in cooperation with
the commissioner of health.

The profiles developed for home and community-based
services providers under this section shall be incorporated into a report card and
maintained by the Minnesota Board on Aging pursuant to section 256.975, subdivision
7, paragraph (b), clause (2), as data becomes available. The commissioner, in
cooperation with the commissioner of health, shall use consumer choice, quality of life,
care approaches, and cost or flexible purchasing categories to organize the consumer
information in the profiles. The final categories used shall include consumer input and
survey data to the extent that it is available through the state agencies. The commissioner
shall develop and disseminate the qualify profiles for a limited number of provider types
initially, and develop quality profiles for additional provider types as measurement tools
are developed and data becomes available. This includes providers of services to older
adults and people with disabilities, regardless of payor source.

Sec. 38.

Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:


Subd. 4.

Dissemination of quality profiles.

By July 1, 2003 2014, the
commissioners shall implement a system public awareness effort to disseminate the quality
profiles developed from consumer surveys using the quality measurement tool. Profiles
may be disseminated to through the Senior LinkAge Line and Disability Linkage Line and
to consumers, providers, and purchasers of long-term care services through all feasible
printed and electronic outlets. The commissioners may conduct a public awareness
campaign to inform potential users regarding profile contents and potential uses
.

Sec. 39.

Minnesota Statutes 2012, section 256B.441, subdivision 13, is amended to read:


Subd. 13.

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; until September 30, 2013, long-term care consultation fees under
section 256B.0911, subdivision 6; family advisory council fee under section 144A.33;
scholarships under section 256B.431, subdivision 36; planned closure rate adjustments
under section 256B.437; or single bed room incentives under section 256B.431,
subdivision 42
; property taxes and property insurance; and PERA.

Sec. 40.

Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:


Subd. 53.

Calculation of payment rate for external fixed costs.

The commissioner
shall calculate a payment rate for external fixed costs.

(a) For a facility licensed as a nursing home, the portion related to section 256.9657
shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
result of its number of nursing home beds divided by its total number of licensed beds.

(b) The portion related to the licensure fee under section 144.122, paragraph (d),
shall be the amount of the fee divided by actual resident days.

(c) The portion related to scholarships shall be determined under section 256B.431,
subdivision 36.

(d) Until September 30, 2013, the portion related to long-term care consultation shall
be determined according to section 256B.0911, subdivision 6.

(e) The portion related to development and education of resident and family advisory
councils under section 144A.33 shall be $5 divided by 365.

(f) The portion related to planned closure rate adjustments shall be as determined
under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.
Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
be included in the payment rate for external fixed costs beginning October 1, 2016.
Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
longer be included in the payment rate for external fixed costs beginning on October 1 of
the first year not less than two years after their effective date.

(g) The portions related to property insurance, real estate taxes, special assessments,
and payments made in lieu of real estate taxes directly identified or allocated to the nursing
facility shall be the actual amounts divided by actual resident days.

(h) The portion related to the Public Employees Retirement Association shall be
actual costs divided by resident days.

(i) The single bed room incentives shall be as determined under section 256B.431,
subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
no longer be included in the payment rate for external fixed costs beginning October 1,
2016. Single bed room incentives that take effect on or after October 1, 2014, shall no
longer be included in the payment rate for external fixed costs beginning on October 1 of
the first year not less than two years after their effective date.

(j) The payment rate for external fixed costs shall be the sum of the amounts in
paragraphs (a) to (i).

Sec. 41.

Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:


Subd. 12.

Informed choice.

Persons who are determined likely to require the level
of care provided in a nursing facility as determined under section 256B.0911, subdivision
4e,
or a hospital shall be informed of the home and community-based support alternatives
to the provision of inpatient hospital services or nursing facility services. Each person
must be given the choice of either institutional or home and community-based services
using the provisions described in section 256B.77, subdivision 2, paragraph (p).

Sec. 42.

Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:


Subd. 14.

Assessment and reassessment.

(a) Assessments and reassessments
shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
With the permission of the recipient or the recipient's designated legal representative,
the recipient's current provider of services may submit a written report outlining their
recommendations regarding the recipient's care needs prepared by a direct service
employee with at least 20 hours of service to that client. The person conducting the
assessment or reassessment must notify the provider of the date by which this information
is to be submitted. This information shall be provided to the person conducting the
assessment and the person or the person's legal representative and must be considered
prior to the finalization of the assessment or reassessment.

(b) There must be a determination that the client requires a hospital level of care or a
nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
(d)
4e, at initial and subsequent assessments to initiate and maintain participation in the
waiver program.

(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
appropriate to determine nursing facility level of care for purposes of medical assistance
payment for nursing facility services, only face-to-face assessments conducted according
to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
determination or a nursing facility level of care determination must be accepted for
purposes of initial and ongoing access to waiver services payment.

(d) Recipients who are found eligible for home and community-based services under
this section before their 65th birthday may remain eligible for these services after their
65th birthday if they continue to meet all other eligibility factors.

(e) The commissioner shall develop criteria to identify recipients whose level of
functioning is reasonably expected to improve and reassess these recipients to establish
a baseline assessment. Recipients who meet these criteria must have a comprehensive
transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
reassessed every six months until there has been no significant change in the recipient's
functioning for at least 12 months. After there has been no significant change in the
recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
informal support systems, and need for services shall be conducted at least every 12
months and at other times when there has been a significant change in the recipient's
functioning. Counties, case managers, and service providers are responsible for
conducting these reassessments and shall complete the reassessments out of existing funds.

Sec. 43.

[256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.

Subdivision 1.

Basis and scope.

(a) Upon federal approval, the commissioner
shall establish a medical assistance state plan option for the provision of home and
community-based personal assistance service and supports called "community first
services and supports (CFSS)."

(b) CFSS is a participant-controlled method of selecting and providing services
and supports that allows the participant maximum control of the services and supports.
Participants may choose the degree to which they direct and manage their supports by
choosing to have a significant and meaningful role in the management of services and
supports including by directly employing support workers with the necessary supports
to perform that function.

(c) CFSS is available statewide to eligible individuals to assist with accomplishing
activities of daily living (ADLs), instrumental activities of daily living (IADLs), and
health-related procedures and tasks through hands-on assistance to accomplish the task
or constant supervision and cueing to accomplish the task; and to assist with acquiring,
maintaining, and enhancing the skills necessary to accomplish ADLs, IADLs, and
health-related procedures and tasks. CFSS allows payment for certain supports and goods
such as environmental modifications and technology that are intended to replace or
decrease the need for human assistance.

(d) Upon federal approval, CFSS will replace the personal care assistance program
under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.

Subd. 2.

Definitions.

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

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

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

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

(1) Level I behavior;

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

(3) increased need for assistance for recipients who are verbally aggressive or
resistive to care so that time needed to perform activities of daily living is increased.

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

(1) tube feedings requiring:

(i) a gastrojejunostomy tube; or

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

(2) wounds described as:

(i) stage III or stage IV;

(ii) multiple wounds;

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

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

(3) parenteral therapy described as:

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

(ii) total parenteral nutrition (TPN) daily;

(4) respiratory interventions, including:

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

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

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

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

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

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

(5) insertion and maintenance of catheter, including:

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

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

(iii) bladder irrigations;

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

(7) neurological intervention, including:

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

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

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

(f) "Community first services and supports" or "CFSS" means the assistance and
supports program under this section needed for accomplishing activities of daily living,
instrumental activities of daily living, and health-related tasks through hands-on assistance
to complete the task or supervision and cueing to complete the task, or the purchase of
goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for
human assistance.

(g) "Community first services and supports service delivery plan" or "service delivery
plan" means a written summary of the services and supports, that is based on the community
support plan identified in section 256B.0911 and coordinated services and support plan
and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
by the participant to meet the assessed needs, using a person-centered planning process.

(h) "Critical activities of daily living" means transferring, mobility, eating, and
toileting.

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

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

(k) "Financial management services contractor or vendor" means a qualified
organization having a written contract with the department to provide services necessary to
use the budget model under subdivision 13, that include but are not limited to: participant
education and technical assistance; CFSS service delivery planning and budgeting; billing,
making payments, and monitoring of spending; and assisting the participant in fulfilling
employer-related requirements in accordance with Section 3504 of the IRS code and
the IRS Revenue Procedure 70-6.

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

(m) "Health-related procedures and tasks" means procedures and tasks related to
the specific needs of an individual that can be delegated or assigned by a state-licensed
healthcare or behavioral health professional and performed by a support worker.

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

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

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

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

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

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

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

(1) being available while care is provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;

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

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

(r) "Person-centered planning process" means a process that is driven by the
participant for discovering and planning services and supports that ensures the participant
makes informed choices and decisions. The person-centered planning process must:

(1) include people chosen by the participant;

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

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

(4) reflect cultural considerations of the participant;

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

(6) offer choices to the participant regarding the services and supports they receive
and from whom;

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

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

(s) "Shared services" means the provision of CFSS services by the same CFSS
support worker to two or three participants who voluntarily enter into an agreement to
receive services at the same time and in the same setting by the same provider.

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

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

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

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

(u) "Support worker" means an employee of the agency provider or of the participant
who has direct contact with the participant and provides services as specified within the
participant's service delivery plan.

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

Subd. 3.

Eligibility.

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

(1) is a recipient of medical assistance as determined under section 256B.055,
256B.056, or 256B.057, subdivisions 5 and 9;

(2) is a recipient of the alternative care program under section 256B.0913;

(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
or 256B.49; or

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

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

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

(2) is not a recipient under the family support grant under section 252.32;

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

Subd. 4.

Eligibility for other services.

Selection of CFSS by a participant must not
restrict access to other medically necessary care and services furnished under the state
plan medical assistance benefit or other services available through alternative care.

Subd. 5.

Assessment requirements.

(a) The assessment of functional need must:

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

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

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

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

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

(d) The lead agency assessor may request a temporary authorization for CFSS
services. Authorization for a temporary level of CFSS services is limited to the time
specified by the commissioner, but shall not exceed 45 days. The level of services
authorized under this provision shall have no bearing on a future authorization.

Subd. 6.

Community first services and support service delivery plan.

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

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

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

(1) specify the agency-provider or financial management services contractor selected
by the participant;

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

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

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

(5) include individually identified goals and desired outcomes;

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

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

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

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

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

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

(12) be distributed to the participant and other people involved in the plan; and

(13) prevent the provision of unnecessary or inappropriate care.

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

Subd. 7.

Community first services and supports; covered services.

Services
and supports covered under CFSS include:

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

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

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

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

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

(4) observation and redirection for behavior or symptoms where there is a need for
assistance. A recipient qualifies as having a need for assistance due to behaviors if the
recipient's behavior requires assistance at least four times per week and shows one or
more of the following behaviors:

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

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

(iii) increased need for assistance for recipients who are verbally aggressive or
resistive to care so that time needed to perform activities of daily living is increased;

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

(6) transition costs, including:

(i) deposits for rent and utilities;

(ii) first month's rent and utilities;

(iii) bedding;

(iv) basic kitchen supplies;

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

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

(7) services by a support specialist defined under subdivision 2 that are chosen
by the participant.

Subd. 8.

Determination of CFSS service methodology.

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

(b) The amount of CFSS authorized must be based on the recipient's home care
rating described in subdivision 8, paragraphs (d) and (e), and any additional service units
for which the person qualifies as described in subdivision 8, paragraph (f).

(c) The home care rating shall be determined by the commissioner or the
commissioner's designee based on information submitted to the commissioner identifying
the following for a recipient:

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

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

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

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

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

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

(ii) Q home care rating requires Level 1 behavior and one to three dependencies in
ADLs and qualifies one for six service units;

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

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

(v) T home care rating requires four to six dependencies in ADLs and Level 1
behavior and qualifies one for 11 service units;

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

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

(viii) W home care rating requires seven to eight dependencies in ADLs and Level 1
behavior and qualifies one for 20 service units;

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

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

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

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

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

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

Subd. 9.

Noncovered services.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(8) medical supplies and equipment;

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

(10) expenses for travel, lodging, or meals related to training the participant, the
participant's representative, legal representative, or paid or unpaid caregivers that exceed
$500 in a 12-month period;

(11) experimental treatments;

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

(13) membership dues or costs, except when the service is necessary and appropriate
to treat a physical condition or to improve or maintain the participant's physical condition.
The condition must be identified in the participant's CFSS plan and monitored by a
physician enrolled in a Minnesota health care program;

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

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

(16) tickets and related costs to attend sporting or other recreational or entertainment
events.

Subd. 10.

Provider qualifications and general requirements.

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

(1) enroll as a medical assistance Minnesota health care programs provider and meet
all applicable provider standards;

(2) comply with medical assistance provider enrollment requirements;

(3) demonstrate compliance with law and policies of CFSS as determined by the
commissioner;

(4) comply with background study requirements under chapter 245C;

(5) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers and support specialists;

(6) not engage in any agency-initiated direct contact or marketing in person, by
telephone, or other electronic means to potential participants, guardians, family member,
or participants' representatives;

(7) pay support workers and support specialists based upon actual hours of services
provided;

(8) withhold and pay all applicable federal and state payroll taxes;

(9) make arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

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

(11) report maltreatment as required under sections 626.556 and 626.557; and

(12) provide the participant with a copy of the service-related rights under
subdivision 19 at the start of services and supports.

(b) The commissioner shall develop policies and procedures designed to ensure
program integrity and fiscal accountability for goods and services provided in this section
in consultation with the implementation council described in subdivision 21.

Subd. 11.

Agency-provider model.

(a) The agency-provider model is limited to
the services provided by support workers and support specialists who are employed by
an agency-provider that is licensed according to chapter 245A or meets other criteria
established by the commissioner, including required training.

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

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

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

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

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

Subd. 12.

Requirements for initial enrollment of CFSS provider agencies.

(a)
All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider
agency in a format determined by the commissioner, information and documentation that
includes, but is not limited to, the following:

(1) the CFSS provider agency's current contact information including address,
telephone number, and e-mail address;

(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous year, whichever is less;

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

(4) proof of workers' compensation insurance coverage;

(5) proof of liability insurance;

(6) a description of the CFSS provider agency's organization identifying the names
or all owners, managing employees, staff, board of directors, and the affiliations of the
directors, owners, or staff to other service providers;

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

(8) copies of all other forms the CFSS provider agency uses in the course of daily
business including, but not limited to:

(i) a copy of the CFSS provider agency's time sheet if the time sheet varies from
the standard time sheet for CFSS services approved by the commissioner, and a letter
requesting approval of the CFSS provider agency's nonstandard time sheet;

(ii) the CFSS provider agency's template for the CFSS care plan; and

(iii) the CFSS provider agency's template for the written agreement in subdivision
21 for recipients using the CFSS choice option, if applicable;

(9) a list of all training and classes that the CFSS provider agency requires of its
staff providing CFSS services;

(10) documentation that the CFSS provider agency and staff have successfully
completed all the training required by this section;

(11) documentation of the agency's marketing practices;

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

(13) documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for CFSS services for employee personal
care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The
revenue generated by the support specialist and the reasonable costs associated with the
support specialist shall not be used in making this calculation; and

(14) documentation that the agency does not burden recipients' free exercise of their
right to choose service providers by requiring personal care assistants to sign an agreement
not to work with any particular CFSS recipient or for another CFSS provider agency after
leaving the agency and that the agency is not taking action on any such agreements or
requirements regardless of the date signed.

(b) CFSS provider agencies shall provide to the commissioner the information
specified in paragraph (a).

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

Subd. 13.

Budget model.

(a) Under the budget model participants can exercise
more responsibility and control over the services and supports described and budgeted
within the CFSS service delivery plan. Under this model, participants may use their
budget allocation to:

(1) directly employ support workers;

(2) obtain supports and goods as defined in subdivision 7; and

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

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

(ii) the employment, training, supervision, and evaluation of workers by the
participant;

(iii) acquisition and payment for supports and goods; and

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

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

(c) The FMS contractor shall not provide CFSS services and supports under the
agency-provider service model. The FMS contractor shall provide service functions as
determined by the commissioner that include but are not limited to:

(1) information and consultation about CFSS;

(2) assistance with the development of the service delivery plan and budget model
as requested by the participant;

(3) billing and making payments for budget model expenditures;

(4) assisting participants in fulfilling employer-related requirements according to
Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability,
regulation 137036-08, which includes assistance with filing and paying payroll taxes, and
obtaining worker compensation coverage;

(5) data recording and reporting of participant spending; and

(6) other duties established in the contract with the department.

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

(e) The FMS contractor shall:

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

(2) provide the participant and the targeted case manager, if applicable, with a
monthly written summary of the spending for services and supports that were billed
against the spending budget;

(3) be knowledgeable of state and federal employment regulations under the Fair
Labor Standards Act of 1938, and comply with the requirements under the Internal
Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax
Liability for vendor or fiscal employer agent, and any requirements necessary to process
employer and employee deductions, provide appropriate and timely submission of
employer tax liabilities, and maintain documentation to support medical assistance claims;

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

(5) assume fiscal accountability for state funds designated for the program; and

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

(f) The commissioner of human services shall:

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

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

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

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

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

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

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

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

Subd. 14.

Participant's responsibilities under budget model.

(a) A participant
using the budget model must use an FMS contractor or vendor that is under contract with
the department. Upon a determination of eligibility and completion of the assessment and
community support plan, the participant shall choose a FMS contractor from a list of
eligible vendors maintained by the department.

(b) When the participant, participant's representative, or legal representative chooses
to be the employer of the support worker, they are responsible for the hiring and supervision
of the support worker, including, but not limited to, recruiting, interviewing, training, and
discharging the support worker consistent with federal and state laws and regulations.

(c) In addition to the employer responsibilities in paragraph (b), the participant,
participant's representative, or legal representative is responsible for:

(1) tracking the services provided and all expenditures for goods or other supports;

(2) preparing and submitting time sheets, signed by both the participant and support
worker, to the FMS contractor on a regular basis and in a timely manner according to
the FMS contractor's procedures;

(3) notifying the FMS contractor within ten days of any changes in circumstances
affecting the CFSS service plan or in the participant's place of residence including, but
not limited to, any hospitalization of the participant or change in the participant's address,
telephone number, or employment;

(4) notifying the FMS contractor of any changes in the employment status of each
participant support worker; and

(5) reporting any problems resulting from the quality of services rendered by the
support worker to the FMS contractor. If the participant is unable to resolve any problems
resulting from the quality of service rendered by the support worker with the assistance of
the FMS contractor, the participant shall report the situation to the department.

Subd. 15.

Documentation of support services provided.

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

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

(c) The time sheet must be on a form approved by the commissioner documenting
time the support worker provides services in the home. The following criteria must be
included in the time sheet:

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

(2) provider name and telephone numbers, if an agency-provider is responsible for
delivery services under the written service plan;

(3) full name of the participant;

(4) consecutive dates, including month, day, and year, and arrival and departure
times with a.m. or p.m. notations;

(5) signatures of the participant or the participant's representative;

(6) personal signature of the support worker;

(7) any shared care provided, if applicable;

(8) a statement that it is a federal crime to provide false information on CFSS
billings for medical assistance payments; and

(9) dates and location of recipient stays in a hospital, care facility, or incarceration.

Subd. 16.

Support workers requirements.

(a) Support workers shall:

(1) enroll with the department as a support worker after a background study under
chapter 245C has been completed and the support worker has received a notice from the
commissioner that:

(i) the support worker is not disqualified under section 245C.14; or

(ii) is disqualified, but the support worker has received a set-aside of the
disqualification under section 245C.22;

(2) have the ability to effectively communicate with the participant or the
participant's representative;

(3) have the skills and ability to provide the services and supports according to the
person's CFSS service delivery plan and respond appropriately to the participant's needs;

(4) not be a participant of CFSS, unless the support services provided by the support
worker differ from those provided to the support worker;

(5) complete the basic standardized training as determined by the commissioner
before completing enrollment. The training must be available in languages other than
English and to those who need accommodations due to disabilities. Support worker
training must include successful completion of the following training components: basic
first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
and responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance
to participants;

(6) complete training and orientation on the participant's individual needs; and

(7) maintain the privacy and confidentiality of the participant, and not independently
determine the medication dose or time for medications for the participant.

(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:

(1) lacks the skills, knowledge, or ability to adequately or safely perform the
required work;

(2) fails to provide the authorized services required by the participant employer;

(3) has been intoxicated by alcohol or drugs while providing authorized services to
the participant or while in the participant's home;

(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or

(5) has been excluded as a provider by the commissioner of human services, or the
United States Department of Health and Human Services, Office of Inspector General,
from participation in Medicaid, Medicare, or any other federal health care program.

(c) A support worker may appeal in writing to the commissioner to contest the
decision to terminate the support worker's provider enrollment and provider number.

Subd. 17.

Support specialist requirements and payments.

The commissioner
shall develop qualifications, scope of functions, and payment rates and service limits for a
support specialist that may provide additional or specialized assistance necessary to plan,
implement, arrange, augment, or evaluate services and supports.

Subd. 18.

Service unit and budget allocation requirements and limits.

(a) For the
agency-provider model, services will be authorized in units of service. The total service
unit amount must be established based upon the assessed need for CFSS services, and must
not exceed the maximum number of units available as determined under subdivision 8.

(b) For the budget model, the budget allocation allowed for services and supports
is established by multiplying the number of units authorized under subdivision 8 by the
payment rate established by the commissioner.

Subd. 19.

Support system.

(a) The commissioner shall provide information,
consultation, training, and assistance to ensure the participant is able to manage the
services and supports and budgets, if applicable. This support shall include individual
consultation on how to select and employ workers, manage responsibilities under CFSS,
and evaluate personal outcomes.

(b) The commissioner shall provide assistance with the development of risk
management agreements.

Subd. 20.

Service-related rights.

(a) Participants must be provided with adequate
information, counseling, training, and assistance, as needed, to ensure that the participant
is able to choose and manage services, models, and budgets. This support shall include
information regarding:

(1) person-centered planning;

(2) the range and scope of individual choices;

(3) the process for changing plans, services and budgets;

(4) the grievance process;

(5) individual rights;

(6) identifying and assessing appropriate services;

(7) risks and responsibilities; and

(8) risk management.

(b) The commissioner must ensure that the participant has a copy of the most recent
community support plan and service delivery plan.

(c) A participant who appeals a reduction in previously authorized CFSS services
may continue previously authorized services pending an appeal in accordance with section
256.045.

(d) If the units of service or budget allocation for CFSS are reduced, denied, or
terminated, the commissioner must provide notice of the reasons for the reduction in the
participant's notice of denial, termination, or reduction.

(e) If all or part of a service delivery plan is denied approval, the commissioner must
provide a notice that describes the basis of the denial.

Subd. 21.

Development and Implementation Council.

The commissioner
shall establish a Development and Implementation Council of which the majority of
members are individuals with disabilities, elderly individuals, and their representatives.
The commissioner shall consult and collaborate with the council when developing and
implementing this section for at least the first five years of operation. The commissioner,
in consultation with the council, shall provide recommendations on how to improve the
quality and integrity of CFSS, reduce the paper documentation required in subdivisions
10, 12, and 15, make use of electronic means of documentation and online reporting in
order to reduce administrative costs and improve training to the legislative chairs of the
health and human services policy and finance committees by February 1, 2014.

Subd. 22.

Quality assurance and risk management system.

(a) The commissioner
shall establish quality assurance and risk management measures for use in developing and
implementing CFSS, including those that (1) recognize the roles and responsibilities of
those involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and
budgets based upon a recipient's resources and capabilities. Risk management measures
must include background studies, and backup and emergency plans, including disaster
planning.

(b) The commissioner shall provide ongoing technical assistance and resource and
educational materials for CFSS participants.

(c) Performance assessment measures, such as a participant's satisfaction with the
services and supports, and ongoing monitoring of health and well-being shall be identified
in consultation with the council established in subdivision 21.

(d) Data reporting requirements will be developed in consultation with the council
established in subdivision 21.

Subd. 23.

Commissioner's access.

When the commissioner is investigating a
possible overpayment of Medicaid funds, the commissioner must be given immediate
access without prior notice to the agency provider or FMS contractor's office during
regular business hours and to documentation and records related to services provided and
submission of claims for services provided. Denying the commissioner access to records
is cause for immediate suspension of payment and terminating the agency provider's
enrollment according to section 256B.064 or terminating the FMS contract.

Subd. 24.

CFSS agency-providers; background studies.

CFSS agency-providers
enrolled to provide personal care assistance services under the medical assistance program
shall comply with the following:

(1) owners who have a five percent interest or more and all managing employees
are subject to a background study as provided in chapter 245C. This applies to currently
enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
agency-provider. "Managing employee" has the same meaning as Code of Federal
Regulations, title 42, section 455. An organization is barred from enrollment if:

(i) the organization has not initiated background studies on owners managing
employees; or

(ii) the organization has initiated background studies on owners and managing
employees, but the commissioner has sent the organization a notice that an owner or
managing employee of the organization has been disqualified under section 245C.14, and
the owner or managing employee has not received a set-aside of the disqualification
under section 245C.22;

(2) a background study must be initiated and completed for all support specialists; and

(3) a background study must be initiated and completed for all support workers.

EFFECTIVE DATE.

This section is effective upon federal approval but no earlier
than January 1, 2014. The service will begin 90 days after federal approval or January 1,
2014, whichever is later. The commissioner of human services shall notify the revisor of
statutes when this occurs.

Sec. 44.

Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
to read:


Subd. 1o.

Supplementary service rate; exemptions.

A county agency shall not
negotiate a supplementary service rate under this section for any individual that has been
determined to be eligible for Housing Stability Services as approved by the Centers
for Medicare and Medicaid Services, and who resides in an establishment voluntarily
registered under section 144D.025, as a supportive housing establishment or participates
in the Minnesota supportive housing demonstration program under section 256I.04,
subdivision 3, paragraph (a), clause (4).

Sec. 45.

Minnesota Statutes 2012, 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. 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. 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 facility 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.

EFFECTIVE DATE.

This section is effective July 1, 2014.

Sec. 46.

Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:


Subd. 9.

Common entry point designation.

(a) Each county board shall designate
a common entry point for reports of suspected maltreatment. Two or more county boards
may jointly designate a single
The commissioner of human services shall establish a
common entry point effective July 1, 2014. 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) the name, address, and telephone number of the person reporting;

(3) the time, date, and location of the incident;

(4) the names of the persons involved, including but not limited to, perpetrators,
alleged victims, and witnesses;

(5) whether there was a risk of imminent danger to the alleged victim;

(6) a description of the suspected maltreatment;

(7) the disability, if any, of the alleged victim;

(8) the relationship of the alleged perpetrator to the alleged victim;

(9) whether a facility was involved and, if so, which agency licenses the facility;

(10) any action taken by the common entry point;

(11) whether law enforcement has been notified;

(12) whether the reporter wishes to receive notification of the initial and final
reports; and

(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.

(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 and
immediately identify and locate prior reports of abuse, neglect, or exploitation.

(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.

Sec. 47.

Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:


Subd. 9e.

Education requirements.

(a) The commissioners of health, human
services, and public safety shall cooperate in the development of a joint program for
education of lead investigative agency investigators in the appropriate techniques for
investigation of complaints of maltreatment. This program must be developed by July
1, 1996. The program must include but need not be limited to the following areas: (1)
information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
conclusions based on evidence; (5) interviewing skills, including specialized training to
interview people with unique needs; (6) report writing; (7) coordination and referral
to other necessary agencies such as law enforcement and judicial agencies; (8) human
relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
systems and the appropriate methods for interviewing relatives in the course of the
assessment or investigation; (10) the protective social services that are available to protect
alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
which lead investigative agency investigators and law enforcement workers cooperate in
conducting assessments and investigations in order to avoid duplication of efforts; and
(12) data practices laws and procedures, including provisions for sharing data.

(b) The commissioner of human services shall conduct an outreach campaign to
promote the common entry point for reporting vulnerable adult maltreatment. This
campaign shall use the Internet and other means of communication.

(b) (c) The commissioners of health, human services, and public safety shall offer at
least annual education to others on the requirements of this section, on how this section is
implemented, and investigation techniques.

(c) (d) The commissioner of human services, in coordination with the commissioner
of public safety shall provide training for the common entry point staff as required in this
subdivision and the program courses described in this subdivision, at least four times
per year. At a minimum, the training shall be held twice annually in the seven-county
metropolitan area and twice annually outside the seven-county metropolitan area. The
commissioners shall give priority in the program areas cited in paragraph (a) to persons
currently performing assessments and investigations pursuant to this section.

(d) (e) The commissioner of public safety shall notify in writing law enforcement
personnel of any new requirements under this section. The commissioner of public
safety shall conduct regional training for law enforcement personnel regarding their
responsibility under this section.

(e) (f) Each lead investigative agency investigator must complete the education
program specified by this subdivision within the first 12 months of work as a lead
investigative agency investigator.

A lead investigative agency investigator employed when these requirements take
effect must complete the program within the first year after training is available or as soon
as training is available.

All lead investigative agency investigators having responsibility for investigation
duties under this section must receive a minimum of eight hours of continuing education
or in-service training each year specific to their duties under this section.

Sec. 48. FEDERAL APPROVAL.

This article is contingent on federal approval.

Sec. 49. REPEALER.

(a) Minnesota Statutes 2012, sections 245A.655; and 256B.0917, subdivisions 1, 2,
3, 4, 5, 7, 8, 9, 10, 11, 12, and 14,
are repealed.

(b) Minnesota Statutes 2012, section 256B.0911, subdivisions 4a, 4b, and 4c, are
repealed effective October 1, 2013.

ARTICLE 3

SAFE AND HEALTHY DEVELOPMENT OF CHILDREN,
YOUTH, AND FAMILIES

Section 1.

Minnesota Statutes 2012, section 119B.05, subdivision 1, is amended to read:


Subdivision 1.

Eligible participants.

Families eligible for child care assistance
under the MFIP child care program are:

(1) MFIP participants who are employed or in job search and meet the requirements
of section 119B.10;

(2) persons who are members of transition year families under section 119B.011,
subdivision 20
, and meet the requirements of section 119B.10;

(3) families who are participating in employment orientation or job search, or
other employment or training activities that are included in an approved employability
development plan under section 256J.95;

(4) MFIP families who are participating in work job search, job support,
employment, or training activities as required in their employment plan, or in appeals,
hearings, assessments, or orientations according to chapter 256J;

(5) MFIP families who are participating in social services activities under chapter
256J or mental health treatment as required in their employment plan approved according
to chapter 256J;

(6) families who are participating in services or activities that are included in an
approved family stabilization plan under section 256J.575;

(7) MFIP child-only cases under section 256J.88, for up to 20 hours of child care
per child per week under the following conditions: (i) child care will be authorized if the
child's primary caregiver is receiving SSI for a disability related to depression or other
serious mental illness; and (ii) child care will only be authorized for children five years
of age or younger. The child's authorized care under this clause is not conditional based
on the primary caregiver participating in an authorized activity under section 119B.07 or
119B.11. Medical appointments, treatment, or therapy are considered authorized activities
for participants in this category;

(8) families who are participating in programs as required in tribal contracts under
section 119B.02, subdivision 2, or 256.01, subdivision 2; and

(8) (9) families who are participating in the transition year extension under section
119B.011, subdivision 20a.

Sec. 2.

Minnesota Statutes 2012, section 119B.13, subdivision 1, is amended to read:


Subdivision 1.

Subsidy restrictions.

(a) Beginning October 31, 2011 July 1, 2014,
the maximum rate paid for child care assistance in any county or multicounty region under
the child care fund shall be the rate for like-care arrangements in the county effective July
1, 2006 2012, decreased increased by 2.5 two percent.

(b) Biennially, beginning in 2012, the commissioner shall survey rates charged
by child care providers in Minnesota to determine the 75th percentile for like-care
arrangements in counties. When the commissioner determines that, using the
commissioner's established protocol, the number of providers responding to the survey is
too small to determine the 75th percentile rate for like-care arrangements in a county or
multicounty region, the commissioner may establish the 75th percentile maximum rate
based on like-care arrangements in a county, region, or category that the commissioner
deems to be similar.

(c) A rate which includes a special needs rate paid under subdivision 3 or under a
school readiness service agreement paid under section 119B.231, may be in excess of the
maximum rate allowed under this subdivision.

(d) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care
on an hourly, full-day, and weekly basis, including special needs and disability care. The
maximum payment to a provider for one day of care must not exceed the daily rate. The
maximum payment to a provider for one week of care must not exceed the weekly rate.

(e) Child care providers receiving reimbursement under this chapter must not be
paid activity fees or an additional amount above the maximum rates for care provided
during nonstandard hours for families receiving assistance.

(f) When the provider charge is greater than the maximum provider rate allowed,
the parent is responsible for payment of the difference in the rates in addition to any
family co-payment fee.

(g) All maximum provider rates changes shall be implemented on the Monday
following the effective date of the maximum provider rate.

Sec. 3.

Minnesota Statutes 2012, section 119B.13, subdivision 7, is amended to read:


Subd. 7.

Absent days.

(a) Licensed child care providers and license-exempt centers
must not be reimbursed for more than ten 25 full-day absent days per child, excluding
holidays, in a fiscal year, or for more than ten consecutive full-day absent days. Legal
nonlicensed family child care providers must not be reimbursed for absent days. If a child
attends for part of the time authorized to be in care in a day, but is absent for part of the
time authorized to be in care in that same day, the absent time must be reimbursed but the
time must not count toward the ten 25 absent day days limit. Child care providers must
only be reimbursed for absent days if the provider has a written policy for child absences
and charges all other families in care for similar absences.

(b) Notwithstanding paragraph (a), children in families may exceed the ten 25 absent
days limit if at least one parent: (1) is under the age of 21; (2) does not have a high school
or general equivalency diploma; and (3) is a student in a school district or another similar
program that provides or arranges for child care, parenting support, social services, career
and employment supports, and academic support to achieve high school graduation, upon
request of the program and approval of the county. If a child attends part of an authorized
day, payment to the provider must be for the full amount of care authorized for that day.

(c) Child care providers must be reimbursed for up to ten federal or state holidays or
designated holidays per year when the provider charges all families for these days and the
holiday or designated holiday falls on a day when the child is authorized to be in attendance.
Parents may substitute other cultural or religious holidays for the ten recognized state and
federal holidays. Holidays do not count toward the ten 25 absent day days limit.

(d) A family or child care provider must not be assessed an overpayment for an
absent day payment unless (1) there was an error in the amount of care authorized for the
family, (2) all of the allowed full-day absent payments for the child have been paid, or (3)
the family or provider did not timely report a change as required under law.

(e) The provider and family shall receive notification of the number of absent days
used upon initial provider authorization for a family and ongoing notification of the
number of absent days used as of the date of the notification.

Sec. 4.

Minnesota Statutes 2012, section 245A.07, subdivision 2a, is amended to read:


Subd. 2a.

Immediate suspension expedited hearing.

(a) Within five working days
of receipt of the license holder's timely appeal, the commissioner shall request assignment
of an administrative law judge. The request must include a proposed date, time, and place
of a hearing. A hearing must be conducted by an administrative law judge within 30
calendar days of the request for assignment, unless an extension is requested by either
party and granted by the administrative law judge for good cause. The commissioner shall
issue a notice of hearing by certified mail or personal service at least ten working days
before the hearing. The scope of the hearing shall be limited solely to the issue of whether
the temporary immediate suspension should remain in effect pending the commissioner's
final order under section 245A.08, regarding a licensing sanction issued under subdivision
3 following the immediate suspension. The burden of proof in expedited hearings under
this subdivision shall be limited to the commissioner's demonstration that reasonable
cause exists to believe that the license holder's actions or failure to comply with applicable
law or rule poses, or if the actions of other individuals or conditions in the program
poses an imminent risk of harm to the health, safety, or rights of persons served by the
program. "Reasonable cause" means there exist specific articulable facts or circumstances
which provide the commissioner with a reasonable suspicion that there is an imminent
risk of harm to the health, safety, or rights of persons served by the program. When the
commissioner has determined there is reasonable cause to order the temporary immediate
suspension of a license based on a violation of safe sleep requirements, as defined in
section 245A.1435, the commissioner is not required to demonstrate that an infant died or
was injured as a result of the safe sleep violations.

(b) The administrative law judge shall issue findings of fact, conclusions, and a
recommendation within ten working days from the date of hearing. The parties shall have
ten calendar days to submit exceptions to the administrative law judge's report. The
record shall close at the end of the ten-day period for submission of exceptions. The
commissioner's final order shall be issued within ten working days from the close of the
record. Within 90 calendar days after a final order affirming an immediate suspension, the
commissioner shall make a determination regarding whether a final licensing sanction
shall be issued under subdivision 3. The license holder shall continue to be prohibited
from operation of the program during this 90-day period.

(c) When the final order under paragraph (b) affirms an immediate suspension, and a
final licensing sanction is issued under subdivision 3 and the license holder appeals that
sanction, the license holder continues to be prohibited from operation of the program
pending a final commissioner's order under section 245A.08, subdivision 5, regarding the
final licensing sanction.

Sec. 5.

Minnesota Statutes 2012, section 245A.1435, is amended to read:


245A.1435 REDUCTION OF RISK OF SUDDEN UNEXPECTED INFANT
DEATH SYNDROME IN LICENSED PROGRAMS.

(a) When a license holder is placing an infant to sleep, the license holder must
place the infant on the infant's back, unless the license holder has documentation from
the infant's parent physician directing an alternative sleeping position for the infant. The
parent physician directive must be on a form approved by the commissioner and must
include a statement that the parent or legal guardian has read the information provided by
the Minnesota Sudden Infant Death Center, related to the risk of SIDS and the importance
of placing an infant or child on its back to sleep to reduce the risk of SIDS.
remain on file
at the licensed location. An infant who independently rolls onto its stomach after being
placed to sleep on its back may be allowed to remain sleeping on its stomach if the infant
is at least six months of age or the license holder has a signed statement from the parent
indicating that the infant regularly rolls over at home.

(b) The license holder must place the infant in a crib directly on a firm mattress with
a fitted crib sheet that fits tightly on the mattress and overlaps the mattress so it cannot be
dislodged by pulling on the corner of the sheet. The license holder must not place pillows,
quilts, comforters, sheepskin, pillow-like stuffed toys, or other soft products in the crib
with the infant
The license holder must place the infant in a crib directly on a firm mattress
with a fitted sheet that is appropriate to the mattress size, that fits tightly on the mattress,
and overlaps the underside of the mattress so it cannot be dislodged by pulling on the corner
of the sheet with reasonable effort. The license holder must not place anything in the crib
with the infant except for the infant's pacifier
. The requirements of this section apply to
license holders serving infants up to and including 12 months younger than one year of age.
Licensed child care providers must meet the crib requirements under section 245A.146.

(c) If an infant falls asleep before being placed in a crib, the license holder must
move the infant to a crib as soon as practicable, and must keep the infant within sight of
the license holder until the infant is placed in a crib. When an infant falls asleep while
being held, the license holder must consider the supervision needs of other children in
care when determining how long to hold the infant before placing the infant in a crib to
sleep. The sleeping infant must not be in a position where the airway may be blocked or
with anything covering the infant's face.

(d) Placing a swaddled infant down to sleep in a licensed setting is not recommended
for an infant of any age and is prohibited for any infant who has begun to roll over
independently. However, with the written consent of a parent or guardian according to this
paragraph, a license holder may place the infant who has not yet begun to roll over on its
own down to sleep in a one-piece sleeper equipped with an attached system that fastens
securely only across the upper torso, with no constriction of the hips or legs, to create a
swaddle. Prior to any use of swaddling for sleep by a provider licensed under this chapter,
the license holder must obtain informed written consent for the use of swaddling from the
parent or guardian of the infant on a form provided by the commissioner and prepared in
partnership with the Minnesota Sudden Infant Death Center.

Sec. 6.

Minnesota Statutes 2012, section 245A.144, is amended to read:


245A.144 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
DEATH AND SHAKEN BABY SYNDROME ABUSIVE HEAD TRAUMA FOR
CHILD FOSTER CARE PROVIDERS.

(a) Licensed child foster care providers that care for infants or children through five
years of age must document that before staff persons and caregivers assist in the care
of infants or children through five years of age, they are instructed on the standards in
section 245A.1435 and receive training on reducing the risk of sudden unexpected infant
death syndrome and shaken baby syndrome for abusive head trauma from shaking infants
and young children. This section does not apply to emergency relative placement under
section 245A.035. The training on reducing the risk of sudden unexpected infant death
syndrome and shaken baby syndrome abusive head trauma may be provided as:

(1) orientation training to child foster care providers, who care for infants or children
through five years of age, under Minnesota Rules, part 2960.3070, subpart 1; or

(2) in-service training to child foster care providers, who care for infants or children
through five years of age, under Minnesota Rules, part 2960.3070, subpart 2.

(b) Training required under this section must be at least one hour in length and must
be completed at least once every five years. At a minimum, the training must address
the risk factors related to sudden unexpected infant death syndrome and shaken baby
syndrome
abusive head trauma, means of reducing the risk of sudden unexpected infant
death syndrome and shaken baby syndrome abusive head trauma, and license holder
communication with parents regarding reducing the risk of sudden unexpected infant
death syndrome and shaken baby syndrome abusive head trauma.

(c) Training for child foster care providers must be approved by the county or
private licensing agency that is responsible for monitoring the child foster care provider
under section 245A.16. The approved training fulfills, in part, training required under
Minnesota Rules, part 2960.3070.

Sec. 7.

Minnesota Statutes 2012, section 245A.1444, is amended to read:


245A.1444 TRAINING ON RISK OF SUDDEN UNEXPECTED INFANT
DEATH SYNDROME AND SHAKEN BABY SYNDROME ABUSIVE HEAD
TRAUMA
BY OTHER PROGRAMS.

A licensed chemical dependency treatment program that serves clients with infants
or children through five years of age, who sleep at the program and a licensed children's
residential facility that serves infants or children through five years of age, must document
that before program staff persons or volunteers assist in the care of infants or children
through five years of age, they are instructed on the standards in section 245A.1435 and
receive training on reducing the risk of sudden unexpected infant death syndrome and
shaken baby syndrome abusive head trauma from shaking infants and young children. The
training conducted under this section may be used to fulfill training requirements under
Minnesota Rules, parts 2960.0100, subpart 3; and 9530.6490, subpart 4, item B.

This section does not apply to child care centers or family child care programs
governed by sections 245A.40 and 245A.50.

Sec. 8.

[245A.1446] FAMILY CHILD CARE DIAPERING AREA
DISINFECTION.

Notwithstanding Minnesota Rules, part 9502.0435, a family child care provider may
disinfect the diaper changing surface with either a solution of at least two teaspoons
of chlorine bleach to one quart of water or with a surface disinfectant that meets the
following criteria:

(1) the manufacturer's label or instructions state that the product is registered with
the United States Environmental Protection Agency;

(2) the manufacturer's label or instructions state that the disinfectant is effective
against Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa;

(3) the manufacturer's label or instructions state that the disinfectant is effective with
a ten minute or less contact time;

(4) the disinfectant is clearly labeled by the manufacturer with directions for mixing
and use;

(5) the disinfectant is used only in accordance with the manufacturer's directions; and

(6) the product does not include triclosan or derivatives of triclosan.

Sec. 9.

[245A.147] FAMILY CHILD CARE INFANT SLEEP SUPERVISION
REQUIREMENTS.

Subdivision 1.

In-person checks on infants.

(a) License holders that serve infants
are encouraged to monitor sleeping infants by conducting in-person checks on each infant
in their care every 30 minutes.

(b) Upon enrollment of an infant in a family child care program, the license holder is
encouraged to conduct in-person checks on the sleeping infant every 15 minutes, during
the first four months of care.

(c) When an infant has an upper respiratory infection, the license holder is
encouraged to conduct in-person checks on the sleeping infant every 15 minutes
throughout the hours of sleep.

Subd. 2.

Use of audio or visual monitoring devices.

In addition to conducting
the in-person checks encouraged under subdivision 1, license holders serving infants are
encouraged to use and maintain an audio or visual monitoring device to monitor each
sleeping infant in care during all hours of sleep.

Sec. 10.

[245A.152] CHILD CARE LICENSE HOLDER INSURANCE.

(a) A license holder must provide a written notice to all parents or guardians of all
children to be accepted for care prior to admission stating whether the license holder has
liability insurance. This notice may be incorporated into and provided on the admission
form used by the license holder.

(b) If the license holder has liability insurance:

(1) the license holder shall inform parents in writing that a current certificate of
coverage for insurance is available for inspection to all parents or guardians of children
receiving services and to all parents seeking services from the family child care program;

(2) the notice must provide the parent or guardian with the date of expiration or
next renewal of the policy; and

(3) upon the expiration date of the policy, the license holder must provide a new
written notice indicating whether the insurance policy has lapsed or whether the license
holder has renewed the policy.

If the policy was renewed, the license holder must provide the new expiration date of the
policy in writing to the parents or guardians.

(c) If the license holder does not have liability insurance, the license holder must
provide an annual notice on a form developed and made available by the commissioner,
to the parents or guardians of children in care indicating that the license holder does not
carry liability insurance.

(d) The license holder must notify all parents and guardians in writing immediately
of any change in insurance status.

(e) The license holder must make available upon request the certificate of liability
insurance to the parents of children in care, to the commissioner, and to county licensing
agents.

(f) The license holder must document, with the signature of the parent or guardian,
that the parent or guardian received the notices required by this section.

Sec. 11.

Minnesota Statutes 2012, section 245A.40, subdivision 5, is amended to read:


Subd. 5.

Sudden unexpected infant death syndrome and shaken baby syndrome
abusive head trauma training.

(a) License holders must document that before staff
persons and volunteers care for infants, they are instructed on the standards in section
245A.1435 and receive training on reducing the risk of sudden unexpected infant death
syndrome. In addition, license holders must document that before staff persons care for
infants or children under school age, they receive training on the risk of shaken baby
syndrome
abusive head trauma from shaking infants and young children. The training
in this subdivision may be provided as orientation training under subdivision 1 and
in-service training under subdivision 7.

(b) Sudden unexpected infant death syndrome reduction training required under
this subdivision must be at least one-half hour in length and must be completed at least
once every five years year. At a minimum, the training must address the risk factors
related to sudden unexpected infant death syndrome, means of reducing the risk of sudden
unexpected infant death syndrome in child care, and license holder communication with
parents regarding reducing the risk of sudden unexpected infant death syndrome.

(c) Shaken baby syndrome Abusive head trauma training under this subdivision
must be at least one-half hour in length and must be completed at least once every five
years
year. At a minimum, the training must address the risk factors related to shaken
baby syndrome for
shaking infants and young children, means to reduce the risk of shaken
baby syndrome
abusive head trauma in child care, and license holder communication with
parents regarding reducing the risk of shaken baby syndrome abusive head trauma.

(d) The commissioner shall make available for viewing a video presentation on the
dangers associated with shaking infants and young children. The video presentation must
be part of the orientation and annual in-service training of licensed child care center
staff persons caring for children under school age. The commissioner shall provide to
child care providers and interested individuals, at cost, copies of a video approved by the
commissioner of health under section 144.574 on the dangers associated with shaking
infants and young children.

Sec. 12.

Minnesota Statutes 2012, section 245A.50, is amended to read:


245A.50 FAMILY CHILD CARE TRAINING REQUIREMENTS.

Subdivision 1.

Initial training.

(a) License holders, caregivers, and substitutes must
comply with the training requirements in this section.

(b) Helpers who assist with care on a regular basis must complete six hours of
training within one year after the date of initial employment.

Subd. 2.

Child growth and development and behavior guidance training.

(a) For
purposes of family and group family child care, the license holder and each adult caregiver
who provides care in the licensed setting for more than 30 days in any 12-month period
shall complete and document at least two four hours of child growth and development
and behavior guidance training within the first year of prior to initial licensure, and before
caring for children
. For purposes of this subdivision, "child growth and development
training" means training in understanding how children acquire language and develop
physically, cognitively, emotionally, and socially. "Behavior guidance training" means
training in the understanding of the functions of child behavior and strategies for managing
challenging situations. Child growth and development and behavior guidance training
must be repeated annually. Training curriculum shall be developed or approved by the
commissioner of human services by January 1, 2014.

(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if
they:

(1) have taken a three-credit course on early childhood development within the
past five years;

(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;

(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood
educator, a kindergarten to grade 6 teacher with a prekindergarten specialty, an early
childhood special education teacher, or an elementary teacher with a kindergarten
endorsement; or

(4) have received a baccalaureate degree with a Montessori certificate within the
past five years.

Subd. 3.

First aid.

(a) When children are present in a family child care home
governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least one staff person
must be present in the home who has been trained in first aid. The first aid training must
have been provided by an individual approved to provide first aid instruction. First aid
training may be less than eight hours and persons qualified to provide first aid training
include individuals approved as first aid instructors. First aid training must be repeated
every two years.

(b) A family child care provider is exempt from the first aid training requirements
under this subdivision related to any substitute caregiver who provides less than 30 hours
of care during any 12-month period.

(c) Video training reviewed and approved by the county licensing agency satisfies
the training requirement of this subdivision.

Subd. 4.

Cardiopulmonary resuscitation.

(a) When children are present in a family
child care home governed by Minnesota Rules, parts 9502.0315 to 9502.0445, at least
one staff person must be present in the home who has been trained in cardiopulmonary
resuscitation (CPR) and in the treatment of obstructed airways that includes CPR
techniques for infants and children
. The CPR training must have been provided by an
individual approved to provide CPR instruction, must be repeated at least once every three
two years, and must be documented in the staff person's records.

(b) A family child care provider is exempt from the CPR training requirement in
this subdivision related to any substitute caregiver who provides less than 30 hours of
care during any 12-month period.

(c) Video training reviewed and approved by the county licensing agency satisfies
the training requirement of this subdivision.
Persons providing CPR training must use
CPR training that has been developed:

(1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or

(2) using nationally recognized, evidence-based guidelines for CPR training and
incorporates psychomotor skills to support the instruction.

Subd. 5.

Sudden unexpected infant death syndrome and shaken baby syndrome
abusive head trauma training.

(a) License holders must document that before staff
persons, caregivers, and helpers assist in the care of infants, they are instructed on the
standards in section 245A.1435 and receive training on reducing the risk of sudden
unexpected infant death syndrome. In addition, license holders must document that before
staff persons, caregivers, and helpers assist in the care of infants and children under
school age, they receive training on reducing the risk of shaken baby syndrome abusive
head trauma from shaking infants and young children
. The training in this subdivision
may be provided as initial training under subdivision 1 or ongoing annual training under
subdivision 7.

(b) Sudden unexpected infant death syndrome reduction training required under this
subdivision must be at least one-half hour in length and must be completed in person
at least once every five years two years. On the years when the license holder is not
receiving the in-person training on sudden unexpected infant death reduction, the license
holder must receive sudden unexpected infant death reduction training through a video
of no more than one hour in length developed or approved by the commissioner.
At a
minimum, the training must address the risk factors related to sudden unexpected infant
death syndrome, means of reducing the risk of sudden unexpected infant death syndrome
in child care, and license holder communication with parents regarding reducing the risk
of sudden unexpected infant death syndrome.

(c) Shaken baby syndrome Abusive head trauma training required under this
subdivision must be at least one-half hour in length and must be completed at least once
every five years year. At a minimum, the training must address the risk factors related
to shaken baby syndrome shaking infants and young children, means of reducing the
risk of shaken baby syndrome abusive head trauma in child care, and license holder
communication with parents regarding reducing the risk of shaken baby syndrome abusive
head trauma
.

(d) Training for family and group family child care providers must be developed
by the commissioner in conjunction with the Minnesota Sudden Infant Death Center
and
approved by the county licensing agency by the Minnesota Center for Professional
Development
.

(e) The commissioner shall make available for viewing by all licensed child care
providers a video presentation on the dangers associated with shaking infants and young
children. The video presentation shall be part of the initial and ongoing annual training of
licensed child care providers, caregivers, and helpers caring for children under school age.
The commissioner shall provide to child care providers and interested individuals, at cost,
copies of a video approved by the commissioner of health under section 144.574 on the
dangers associated with shaking infants and young children.

Subd. 6.

Child passenger restraint systems; training requirement.

(a) A license
holder must comply with all seat belt and child passenger restraint system requirements
under section 169.685.

(b) Family and group family child care programs licensed by the Department of
Human Services that serve a child or children under nine years of age must document
training that fulfills the requirements in this subdivision.

(1) Before a license holder, staff person, caregiver, or helper transports a child or
children under age nine in a motor vehicle, the person placing the child or children in a
passenger restraint must satisfactorily complete training on the proper use and installation
of child restraint systems in motor vehicles. Training completed under this subdivision may
be used to meet initial training under subdivision 1 or ongoing training under subdivision 7.

(2) Training required under this subdivision must be at least one hour in length,
completed at initial training, and repeated at least once every five years. At a minimum,
the training must address the proper use of child restraint systems based on the child's
size, weight, and age, and the proper installation of a car seat or booster seat in the motor
vehicle used by the license holder to transport the child or children.

(3) Training under this subdivision must be provided by individuals who are certified
and approved by the Department of Public Safety, Office of Traffic Safety. License holders
may obtain a list of certified and approved trainers through the Department of Public
Safety Web site or by contacting the agency.

(c) Child care providers that only transport school-age children as defined in section
245A.02, subdivision 19, paragraph (f), in child care buses as defined in section 169.448,
subdivision 1, paragraph (e), are exempt from this subdivision.

Subd. 7.

Training requirements for family and group family child care.

For
purposes of family and group family child care, the license holder and each primary
caregiver must complete eight 16 hours of ongoing training each year. For purposes
of this subdivision, a primary caregiver is an adult caregiver who provides services in
the licensed setting for more than 30 days in any 12-month period. Repeat of topical
training requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
requirement. Additional
ongoing training subjects to meet the annual 16-hour training
requirement
must be selected from the following areas:

(1) "child growth and development training" has the meaning given in under
subdivision 2, paragraph (a);

(2) "learning environment and curriculum" includes, including training in
establishing an environment and providing activities that provide learning experiences to
meet each child's needs, capabilities, and interests;

(3) "assessment and planning for individual needs" includes, including training in
observing and assessing what children know and can do in order to provide curriculum
and instruction that addresses their developmental and learning needs, including children
with special needs and bilingual children or children for whom English is not their
primary language;

(4) "interactions with children" includes, including training in establishing
supportive relationships with children, guiding them as individuals and as part of a group;

(5) "families and communities" includes, including training in working
collaboratively with families and agencies or organizations to meet children's needs and to
encourage the community's involvement;

(6) "health, safety, and nutrition" includes, including training in establishing and
maintaining an environment that ensures children's health, safety, and nourishment,
including child abuse, maltreatment, prevention, and reporting; home and fire safety; child
injury prevention; communicable disease prevention and control; first aid; and CPR; and

(7) "program planning and evaluation" includes, including training in establishing,
implementing, evaluating, and enhancing program operations.; and

(8) behavior guidance, including training in the understanding of the functions of
child behavior and strategies for managing behavior.

Subd. 8.

Other required training requirements.

(a) The training required of
family and group family child care providers and staff must include training in the cultural
dynamics of early childhood development and child care. The cultural dynamics and
disabilities training and skills development of child care providers must be designed to
achieve outcomes for providers of child care that include, but are not limited to:

(1) an understanding and support of the importance of culture and differences in
ability in children's identity development;

(2) understanding the importance of awareness of cultural differences and
similarities in working with children and their families;

(3) understanding and support of the needs of families and children with differences
in ability;

(4) developing skills to help children develop unbiased attitudes about cultural
differences and differences in ability;

(5) developing skills in culturally appropriate caregiving; and

(6) developing skills in appropriate caregiving for children of different abilities.

The commissioner shall approve the curriculum for cultural dynamics and disability
training.

(b) The provider must meet the training requirement in section 245A.14, subdivision
11
, paragraph (a), clause (4), to be eligible to allow a child cared for at the family child
care or group family child care home to use the swimming pool located at the home.

Subd. 9.

Supervising for safety; training requirement.

Effective July 1, 2014,
all family child care license holders and each adult caregiver who provides care in the
licensed family child care home for more than 30 days in any 12-month period shall
complete and document at least six hours approved training on supervising for safety
prior to initial licensure, and before caring for children. At least two hours of training
on supervising for safety must be repeated annually. For purposes of this subdivision,
"supervising for safety" includes supervision basics, supervision outdoors, equipment and
materials, illness, injuries, and disaster preparedness. The commissioner shall develop
the supervising for safety curriculum by January 1, 2014.

Subd. 10.

Approved training.

(a) County licensing staff must accept training
approved by the Minnesota Center for Professional Development, including:

(1) face-to-face or classroom training;

(2) online training; and

(3) relationship-based professional development, such as mentoring, coaching,
and consulting.

(b) New and increased training requirements under this section must not be imposed
on providers until the commissioner establishes statewide accessibility to the required
provider training.

Sec. 13.

Minnesota Statutes 2012, section 252.27, subdivision 2a, is amended to read:


Subd. 2a.

Contribution amount.

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

(b) For households with adjusted gross income equal to or greater than 100 percent
of federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:

(1) if the adjusted gross income is equal to or greater than 100 percent of federal
poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
contribution is $4 per month;

(2) if the adjusted gross income is equal to or greater than 175 percent of federal
poverty guidelines and less than or equal to 545 percent of federal poverty guidelines,
the parental contribution shall be determined using a sliding fee scale established by the
commissioner of human services which begins at one percent of adjusted gross income
at 175 percent of federal poverty guidelines and increases to 7.5 percent of adjusted
gross income for those with adjusted gross income up to 545 percent of federal poverty
guidelines;

(3) if the adjusted gross income is greater than 545 percent of federal poverty
guidelines and less than 675 percent of federal poverty guidelines, the parental
contribution shall be 7.5 percent of adjusted gross income;

(4) if the adjusted gross income is equal to or greater than 675 percent of federal
poverty guidelines and less than 975 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 7.5 percent of adjusted gross income at 675 percent of
federal poverty guidelines and increases to ten percent of adjusted gross income for those
with adjusted gross income up to 975 percent of federal poverty guidelines; and

(5) if the adjusted gross income is equal to or greater than 975 percent of federal
poverty guidelines, the parental contribution shall be 12.5 percent of adjusted gross income.

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

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

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

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

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

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

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

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

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

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

(2) the insurer denied insurance;

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

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

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

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

(j) Notwithstanding paragraph (b), for the period from July 1, 2010, to June 30,
2015, the parental contribution shall be computed by applying the following contribution
schedule to the adjusted gross income of the natural or adoptive parents:

(1) if the adjusted gross income is equal to or greater than 100 percent of federal
poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
contribution is $4 per month;

(2) if the adjusted gross income is equal to or greater than 175 percent of federal
poverty guidelines and less than or equal to 525 percent of federal poverty guidelines,
the parental contribution shall be determined using a sliding fee scale established by the
commissioner of human services which begins at one percent of adjusted gross income
at 175 percent of federal poverty guidelines and increases to eight percent of adjusted
gross income for those with adjusted gross income up to 525 percent of federal poverty
guidelines;

(3) if the adjusted gross income is greater than 525 percent of federal poverty
guidelines and less than 675 percent of federal poverty guidelines, the parental
contribution shall be 9.5 percent of adjusted gross income;

(4) if the adjusted gross income is equal to or greater than 675 percent of federal
poverty guidelines and less than 900 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 9.5 percent of adjusted gross income at 675 percent of
federal poverty guidelines and increases to 12 percent of adjusted gross income for those
with adjusted gross income up to 900 percent of federal poverty guidelines; and

(5) if the adjusted gross income is equal to or greater than 900 percent of federal
poverty guidelines, the parental contribution shall be 13.5 percent of adjusted gross
income. If the child lives with the parent, the annual adjusted gross income is reduced by
$2,400 prior to calculating the parental contribution. If the child resides in an institution
specified in section 256B.35, the parent is responsible for the personal needs allowance
specified under that section in addition to the parental contribution determined under this
section. The parental contribution is reduced by any amount required to be paid directly to
the child pursuant to a court order, but only if actually paid.

Sec. 14.

Minnesota Statutes 2012, section 256.82, subdivision 3, is amended to read:


Subd. 3.

Setting foster care standard rates.

The commissioner shall annually
establish minimum standard maintenance rates for foster care maintenance and difficulty
of care payments for all children in foster care. Any increase in rates shall in no case
exceed three percent per annum. The foster care rates in effect on January 1, 2013, shall
remain in effect until December 13, 2015.

Sec. 15.

Minnesota Statutes 2012, section 256J.08, subdivision 24, is amended to read:


Subd. 24.

Disregard.

"Disregard" means earned income that is not counted when
determining initial eligibility
in the initial income test in section 256J.21, subdivision 3,
or income that is not counted when determining ongoing eligibility and calculating the
amount of the assistance payment for participants. The commissioner shall determine
the amount of the
disregard according to section 256J.24, subdivision 10 for ongoing
eligibility shall be 50 percent of gross earned income
.

EFFECTIVE DATE.

This section is effective October 1, 2013, or upon approval
from the United States Department of Agriculture, whichever is later.

Sec. 16.

Minnesota Statutes 2012, section 256J.21, subdivision 3, is amended to read:


Subd. 3.

Initial income test.

The county agency shall determine initial eligibility
by considering all earned and unearned income that is not excluded under subdivision 2.
To be eligible for MFIP, the assistance unit's countable income minus the disregards in
paragraphs (a) and (b) must be below the transitional standard of assistance family wage
level
according to section 256J.24 for that size assistance unit.

(a) The initial eligibility determination must disregard the following items:

(1) the employment disregard is 18 percent of the gross earned income whether or
not the member is working full time or part time;

(2) dependent care costs must be deducted from gross earned income for the actual
amount paid for dependent care up to a maximum of $200 per month for each child less
than two years of age, and $175 per month for each child two years of age and older under
this chapter and chapter 119B;

(3) all payments made according to a court order for spousal support or the support
of children not living in the assistance unit's household shall be disregarded from the
income of the person with the legal obligation to pay support, provided that, if there has
been a change in the financial circumstances of the person with the legal obligation to pay
support since the support order was entered, the person with the legal obligation to pay
support has petitioned for a modification of the support order; and

(4) an allocation for the unmet need of an ineligible spouse or an ineligible child
under the age of 21 for whom the caregiver is financially responsible and who lives with
the caregiver according to section 256J.36.

(b) Notwithstanding paragraph (a), when determining initial eligibility for applicant
units when at least one member has received MFIP in this state within four months of
the most recent application for MFIP, apply the disregard as defined in section 256J.08,
subdivision 24
, for all unit members.

After initial eligibility is established, the assistance payment calculation is based on
the monthly income test.

EFFECTIVE DATE.

This section is effective October 1, 2013, or upon approval
from the United States Department of Agriculture, whichever is later.

Sec. 17.

Minnesota Statutes 2012, section 256J.24, subdivision 5, is amended to read:


Subd. 5.

MFIP transitional standard.

The MFIP transitional standard is based
on the number of persons in the assistance unit eligible for both food and cash assistance
unless the restrictions in subdivision 6 on the birth of a child apply. The amount of the
transitional standard is published annually by the Department of Human Services.

EFFECTIVE DATE.

This section is effective July 1, 2014.

Sec. 18.

Minnesota Statutes 2012, section 256J.24, subdivision 5a, is amended to read:


Subd. 5a.

Food portion of Adjustments to the MFIP transitional standard.

(a)
Effective October 1, 2015,
the commissioner shall adjust the MFIP transitional standard as
needed to reflect a onetime increase in the cash portion of 16 percent.

(b) When any adjustments are made in the Supplemental Nutrition Assistance
Program, the commissioner shall adjust
the food portion of the MFIP transitional standard
as needed to reflect adjustments to the Supplemental Nutrition Assistance Program. The
commissioner shall publish the transitional standard including a breakdown of the cash
and food portions for an assistance unit of sizes one to ten in the State Register whenever
an adjustment is made.

Sec. 19.

Minnesota Statutes 2012, section 256J.24, subdivision 7, is amended to read:


Subd. 7.

Family wage level.

The family wage level is 110 percent of the transitional
standard under subdivision 5 or 6, when applicable, and is the standard used when there is
earned income in the assistance unit. As specified in section 256J.21
. If there is earned
income in the assistance unit
, earned income is subtracted from the family wage level to
determine the amount of the assistance payment, as specified in section 256J.21. The
assistance payment may not exceed the transitional standard under subdivision 5 or 6,
or the shared household standard under subdivision 9, whichever is applicable, for the
assistance unit.

EFFECTIVE DATE.

This section is effective October 1, 2013, or upon approval
from the United States Department of Agriculture, whichever is later.

Sec. 20.

Minnesota Statutes 2012, section 256J.621, is amended to read:


256J.621 WORK PARTICIPATION CASH BENEFITS.

Subdivision 1.

Program characteristics.

(a) Effective October 1, 2009, upon
exiting the diversionary work program (DWP) or upon terminating the Minnesota family
investment program with earnings, a participant who is employed may be eligible for work
participation cash benefits of $25 per month to assist in meeting the family's basic needs
as the participant continues to move toward self-sufficiency.

(b) To be eligible for work participation cash benefits, the participant shall not
receive MFIP or diversionary work program assistance during the month and the
participant or participants must meet the following work requirements:

(1) if the participant is a single caregiver and has a child under six years of age, the
participant must be employed at least 87 hours per month;

(2) if the participant is a single caregiver and does not have a child under six years of
age, the participant must be employed at least 130 hours per month; or

(3) if the household is a two-parent family, at least one of the parents must be
employed 130 hours per month.

Whenever a participant exits the diversionary work program or is terminated from
MFIP and meets the other criteria in this section, work participation cash benefits are
available for up to 24 consecutive months.

(c) Expenditures on the program are maintenance of effort state funds under
a separate state program for participants under paragraph (b), clauses (1) and (2).
Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort
funds. Months in which a participant receives work participation cash benefits under this
section do not count toward the participant's MFIP 60-month time limit.

Subd. 2.

Program suspension.

(a) Effective December 1, 2013, the work
participation cash benefits program shall be suspended.

(b) The commissioner of human services may reinstate the work participation cash
benefits program if the United States Department of Human Services determines that the
state of Minnesota did not meet the federal TANF work participation rate and sends a
notice of penalty to reduce Minnesota's federal TANF block grant authorized under title I
of Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996, and under Public Law 109-171, the Deficit Reduction Act of 2005.

(c) The commissioner shall notify the chairs and ranking minority members of the
legislative committees with jurisdiction over human services policy and finance of the
potential penalty and the commissioner's plans to reinstate the work participation cash
benefit program within 30 days of the date the commissioner receives notification that
the state failed to meet the federal work participation rate.

Sec. 21.

Minnesota Statutes 2012, section 256J.626, subdivision 7, is amended to read:


Subd. 7.

Performance base funds.

(a) For the purpose of this section, the following
terms have the meanings given.

(1) "Caseload Reduction Credit" (CRC) means the measure of how much Minnesota
TANF and separate state program caseload has fallen relative to federal fiscal year 2005
based on caseload data from October 1 to September 30.

(2) "TANF participation rate target" means a 50 percent participation rate reduced by
the CRC for the previous year.

(b) (a) For calendar year 2010 2016 and yearly thereafter, each county and tribe will
must be allocated 95 percent of their initial calendar year allocation. Allocations for
counties and tribes will must be allocated additional funds adjusted based on performance
as follows:

(1) a county or tribe that achieves the TANF participation rate target or a five
percentage point improvement over the previous year's TANF participation rate under
section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive months for
the most recent year for which the measurements are available, will receive an additional
allocation equal to 2.5 percent of its initial allocation;

(2) (1) a county or tribe that performs within or above its range of expected
performance on the annualized three-year self-support index under section 256J.751,
subdivision 2
, clause (6), will must receive an additional allocation equal to 2.5 five
percent of its initial allocation; and

(3) a county or tribe that does not achieve the TANF participation rate target or
a five percentage point improvement over the previous year's TANF participation rate
under section 256J.751, subdivision 2, clause (7), as averaged across 12 consecutive
months for the most recent year for which the measurements are available, will not
receive an additional 2.5 percent of its initial allocation until after negotiating a multiyear
improvement plan with the commissioner; or

(4) (2) a county or tribe that does not perform within or above performs below its
range of expected performance on the annualized three-year self-support index under
section 256J.751, subdivision 2, clause (6), will not receive an additional allocation equal
to 2.5 percent of its initial allocation until after negotiating
for a single year, may receive
an additional allocation of up to five percent of its initial allocation. A county or tribe that
continues to perform below its range of expected performance for two consecutive years
must negotiate
a multiyear improvement plan with the commissioner. If no improvement
is shown by the end of the multiyear plan, the commissioner may decrease the county's or
tribe's performance-based funds by up to five percent. The decrease must remain in effect
until the county or tribe performs within or above its range of expected performance
.

(c) (b) For calendar year 2009 2016 and yearly thereafter, performance-based funds
for a federally approved tribal TANF program in which the state and tribe have in place a
contract under section 256.01, addressing consolidated funding, will must be allocated
as follows:

(1) a tribe that achieves the participation rate approved in its federal TANF plan
using the average of 12 consecutive months for the most recent year for which the
measurements are available, will receive an additional allocation equal to 2.5 percent of
its initial allocation; and

(2) (1) a tribe that performs within or above its range of expected performance on the
annualized three-year self-support index under section 256J.751, subdivision 2, clause (6),
will must receive an additional allocation equal to 2.5 percent of its initial allocation; or

(3) a tribe that does not achieve the participation rate approved in its federal TANF
plan using the average of 12 consecutive months for the most recent year for which the
measurements are available, will not receive an additional allocation equal to 2.5 percent
of its initial allocation until after negotiating a multiyear improvement plan with the
commissioner; or

(4) (2) a tribe that does not perform within or above performs below its range of
expected performance on the annualized three-year self-support index under section
256J.751, subdivision 2, clause (6), will not receive an additional allocation equal to 2.5
percent until after negotiating
for a single year may receive an additional allocation of up
to five percent of its initial allocation. A county or tribe that continues to perform below
its range of expected performance for two consecutive years must negotiate
a multiyear
improvement plan with the commissioner. If no improvement is shown by the end of the
multiyear plan, the commissioner may decrease the tribe's performance-based funds by
up to five percent. The decrease must remain in effect until the tribe performs within or
above its range of expected performance
.

(d) (c) Funds remaining unallocated after the performance-based allocations in
paragraph paragraphs (a) and (b) are available to the commissioner for innovation projects
under subdivision 5.

(1) (d) If available funds are insufficient to meet county and tribal allocations under
paragraph paragraphs (a) and (b), the commissioner may make available for allocation
funds that are unobligated and available from the innovation projects through the end of
the current biennium
shall proportionally prorate funds to counties and tribes that qualify
for an additional allocation under paragraphs (a), clause (1), and (b), clause (1)
.

(2) If after the application of clause (1) funds remain insufficient to meet county and
tribal allocations under paragraph (b), the commissioner must proportionally reduce the
allocation of each county and tribe with respect to their maximum allocation available
under paragraph (b).

Sec. 22.

[256J.78] TANF DEMONSTRATION PROJECTS OR WAIVER FROM
FEDERAL RULES AND REGULATIONS.

Subdivision 1.

Duties of the commissioner.

The commissioner of human services
may pursue TANF demonstration projects or waivers of TANF requirements from the
United States Department of Health and Human Services as needed to allow the state to
build a more results-oriented Minnesota Family Investment Program to better meet the
needs of Minnesota families.

Subd. 2.

Purpose.

The purpose of the TANF demonstration projects or waivers is to:

(1) replace the federal TANF process measure and its complex administrative
requirements with state-developed outcomes measures that track adult employment and
exits from MFIP cash assistance;

(2) simplify programmatic and administrative requirements; and

(3) make other policy or programmatic changes that improve the performance of the
program and the outcomes for participants.

Subd. 3.

Report to legislature.

The commissioner shall report to the members of
the legislative committees having jurisdiction over human services issues by March 1,
2014, regarding the progress of this waiver or demonstration project.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 23.

Minnesota Statutes 2012, section 256K.45, is amended to read:


256K.45 RUNAWAY AND HOMELESS YOUTH ACT.

Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this
section.

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

(c) "Homeless youth" means a person 21 years of age or younger who is
unaccompanied by a parent or guardian and is without shelter where appropriate care and
supervision are available, whose parent or legal guardian is unable or unwilling to provide
shelter and care, or who lacks a fixed, regular, and adequate nighttime residence. The
following are not fixed, regular, or adequate nighttime residences:

(1) a supervised publicly or privately operated shelter designed to provide temporary
living accommodations;

(2) an institution or a publicly or privately operated shelter designed to provide
temporary living accommodations;

(3) transitional housing;

(4) a temporary placement with a peer, friend, or family member that has not offered
permanent residence, a residential lease, or temporary lodging for more than 30 days; or

(5) a public or private place not designed for, nor ordinarily used as, a regular
sleeping accommodation for human beings.

Homeless youth does not include persons incarcerated or otherwise detained under
federal or state law.

(d) "Youth at risk of homelessness" means a person 21 years of age or younger
whose status or circumstances indicate a significant danger of experiencing homelessness
in the near future. Status or circumstances that indicate a significant danger may include:
(1) youth exiting out-of-home placements; (2) youth who previously were homeless; (3)
youth whose parents or primary caregivers are or were previously homeless; (4) youth
who are exposed to abuse and neglect in their homes; (5) youth who experience conflict
with parents due to chemical or alcohol dependency, mental health disabilities, or other
disabilities; and (6) runaways.

(e) "Runaway" means an unmarried child under the age of 18 years who is absent
from the home of a parent or guardian or other lawful placement without the consent of
the parent, guardian, or lawful custodian.

Subd. 2.

Homeless and runaway youth report.

The commissioner shall develop a
report for homeless youth, youth at risk of homelessness, and runaways. The report shall
include coordination of services as defined under subdivisions 3 to 5 prepare a biennial
report, beginning in February 2015, which provides meaningful information to the
legislative committees having jurisdiction over the issue of homeless youth, that includes,
but is not limited to: (1) a list of the areas of the state with the greatest need for services
and housing for homeless youth, and the level and nature of the needs identified; (2) details
about grants made; (3) the distribution of funds throughout the state based on population
need; (4) follow-up information, if available, on the status of homeless youth and whether
they have stable housing two years after services are provided; and (5) any other outcomes
for populations served to determine the effectiveness of the programs and use of funding
.

Subd. 3.

Street and community outreach and drop-in program.

Youth drop-in
centers must provide walk-in access to crisis intervention and ongoing supportive services
including one-to-one case management services on a self-referral basis. Street and
community outreach programs must locate, contact, and provide information, referrals,
and services to homeless youth, youth at risk of homelessness, and runaways. Information,
referrals, and services provided may include, but are not limited to:

(1) family reunification services;

(2) conflict resolution or mediation counseling;

(3) assistance in obtaining temporary emergency shelter;

(4) assistance in obtaining food, clothing, medical care, or mental health counseling;

(5) counseling regarding violence, prostitution, substance abuse, sexually transmitted
diseases, and pregnancy;

(6) referrals to other agencies that provide support services to homeless youth,
youth at risk of homelessness, and runaways;

(7) assistance with education, employment, and independent living skills;

(8) aftercare services;

(9) specialized services for highly vulnerable runaways and homeless youth,
including teen parents, emotionally disturbed and mentally ill youth, and sexually
exploited youth; and

(10) homelessness prevention.

Subd. 4.

Emergency shelter program.

(a) Emergency shelter programs must
provide homeless youth and runaways with referral and walk-in access to emergency,
short-term residential care. The program shall provide homeless youth and runaways with
safe, dignified shelter, including private shower facilities, beds, and at least one meal each
day; and shall assist a runaway and homeless youth with reunification with the family or
legal guardian when required or appropriate.

(b) The services provided at emergency shelters may include, but are not limited to:

(1) family reunification services;

(2) individual, family, and group counseling;

(3) assistance obtaining clothing;

(4) access to medical and dental care and mental health counseling;

(5) education and employment services;

(6) recreational activities;

(7) advocacy and referral services;

(8) independent living skills training;

(9) aftercare and follow-up services;

(10) transportation; and

(11) homelessness prevention.

Subd. 5.

Supportive housing and transitional living programs.

Transitional
living programs must help homeless youth and youth at risk of homelessness to find and
maintain safe, dignified housing. The program may also provide rental assistance and
related supportive services, or refer youth to other organizations or agencies that provide
such services. Services provided may include, but are not limited to:

(1) educational assessment and referrals to educational programs;

(2) career planning, employment, work skill training, and independent living skills
training;

(3) job placement;

(4) budgeting and money management;

(5) assistance in securing housing appropriate to needs and income;

(6) counseling regarding violence, prostitution, substance abuse, sexually transmitted
diseases, and pregnancy;

(7) referral for medical services or chemical dependency treatment;

(8) parenting skills;

(9) self-sufficiency support services or life skill training;

(10) aftercare and follow-up services; and

(11) homelessness prevention.

Subd. 6.

Funding.

Any Funds appropriated for this section may be expended on
programs described under subdivisions 3 to 5, technical assistance, and capacity building.
Up to four percent of funds appropriated may be used for the purpose of monitoring and
evaluating runaway and homeless youth programs receiving funding under this section.
Funding shall be directed to meet the greatest need, with a significant share of the funding
focused on homeless youth providers in greater Minnesota
to meet the greatest need
on a statewide basis
.

Sec. 24.

Minnesota Statutes 2012, section 256M.40, subdivision 1, is amended to read:


Subdivision 1.

Formula.

The commissioner shall allocate state funds appropriated
under this chapter to each county board on a calendar year basis in an amount determined
according to the formula in paragraphs (a) to (e).

(a) For calendar years 2011 and 2012, the commissioner shall allocate available
funds to each county in proportion to that county's share in calendar year 2010.

(b) For calendar year 2013 and each calendar year thereafter, the commissioner shall
allocate available funds to each county as follows:

(1) 75 percent must be distributed on the basis of the county share in calendar year
2012;

(2) five percent must be distributed on the basis of the number of persons residing in
the county as determined by the most recent data of the state demographer;

(3) ten percent must be distributed on the basis of the number of vulnerable children
that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, and in
the county as determined by the most recent data of the commissioner; and

(4) ten percent must be distributed on the basis of the number of vulnerable adults
that are subjects of reports under section 626.557 in the county as determined by the most
recent data of the commissioner.

(c) For calendar year 2014, the commissioner shall allocate available funds to each
county as follows:

(1) 50 percent must be distributed on the basis of the county share in calendar year
2012;

(2) Ten percent must be distributed on the basis of the number of persons residing in
the county as determined by the most recent data of the state demographer;

(3) 20 percent must be distributed on the basis of the number of vulnerable children
that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the
county as determined by the most recent data of the commissioner; and

(4) 20 percent must be distributed on the basis of the number of vulnerable adults
that are subjects of reports under section 626.557 in the county as determined by the
most recent data of the commissioner
The commissioner is precluded from changing the
formula under this subdivision or recommending a change to the legislature without
public review and input
.

(d) For calendar year 2015, the commissioner shall allocate available funds to each
county as follows:

(1) 25 percent must be distributed on the basis of the county share in calendar year
2012;

(2) 15 percent must be distributed on the basis of the number of persons residing in
the county as determined by the most recent data of the state demographer;

(3) 30 percent must be distributed on the basis of the number of vulnerable children
that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the
county as determined by the most recent data of the commissioner; and

(4) 30 percent must be distributed on the basis of the number of vulnerable adults
that are subjects of reports under section 626.557 in the county as determined by the most
recent data of the commissioner.

(e) For calendar year 2016 and each calendar year thereafter, the commissioner shall
allocate available funds to each county as follows:

(1) 20 percent must be distributed on the basis of the number of persons residing in
the county as determined by the most recent data of the state demographer;

(2) 40 percent must be distributed on the basis of the number of vulnerable children
that are subjects of reports under chapter 260C and sections 626.556 and 626.5561, in the
county as determined by the most recent data of the commissioner; and

(3) 40 percent must be distributed on the basis of the number of vulnerable adults
that are subjects of reports under section 626.557 in the county as determined by the most
recent data of the commissioner.

Sec. 25.

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


Subd. 11.

Financial considerations.

(a) Payment of relative custody assistance
under a relative custody assistance agreement is subject to the availability of state funds
and payments may be reduced or suspended on order of the commissioner if insufficient
funds are available
Beginning July 1, 2013, relative custody assistance shall be a forecasted
program, and the commissioner, with the approval of the commissioner of management
and budget, may transfer unencumbered appropriation balances within fiscal years of
each biennium to other forecasted programs of the Department of Human Services. The
commissioner shall inform the chairs and ranking minority members of the senate Health
and Human Services Finance Division and the house of representatives Health and Human
Services Finance Committee quarterly about transfers made under this provision
.

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

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

Sec. 26.

Minnesota Statutes 2012, section 259A.05, subdivision 5, is amended to read:


Subd. 5.

Transfer of funds.

The commissioner of human services may transfer
funds into the adoption assistance account when a deficit in the adoption assistance
program occurs
Beginning July 1, 2013, adoption assistance shall be a forecasted program
and the commissioner, with the approval of the commissioner of management and budget,
may transfer unencumbered appropriation balances within fiscal years of each biennium to
other forecasted programs of the Department of Human Services. The commissioner shall
inform the chairs and ranking minority members of the senate Health and Human Services
Finance Division and the house of representatives Health and Human Services Finance
Committee quarterly about transfers made under this provision
.

Sec. 27.

Minnesota Statutes 2012, section 259A.20, subdivision 4, is amended to read:


Subd. 4.

Reimbursement for special nonmedical expenses.

(a) Reimbursement
for special nonmedical expenses is available to children, except those eligible for adoption
assistance based on being an at-risk child.

(b) Reimbursements under this paragraph shall be made only after the adoptive
parent documents that the requested service was denied by the local social service agency,
community agencies, the local school district, the local public health department, the
parent's insurance provider, or the child's program. The denial must be for an eligible
service or qualified item under the program requirements of the applicable agency or
organization.

(c) Reimbursements must be previously authorized, adhere to the requirements and
procedures prescribed by the commissioner, and be limited to:

(1) child care for a child age 12 and younger, or for a child age 13 or 14 who has a
documented disability that requires special instruction for and services by the child care
provider. Child care reimbursements may be made if all available adult caregivers are
employed, unemployed due to a disability as defined in section 259A.01, subdivision 14,
or attending educational or vocational training programs. Documentation from a qualified
expert that is dated within the last 12 months must be provided to verify the disability
. If a
parent is attending an educational or vocational training program, child care reimbursement
is limited to no more than the time necessary to complete the credit requirements for an
associate or baccalaureate degree as determined by the educational institution. Child
care reimbursement is not limited for an adoptive parent completing basic or remedial
education programs needed to prepare for postsecondary education or employment;

(2) respite care provided for the relief of the child's parent up to 504 hours of respite
care annually;

(3) camping up to 14 days per state fiscal year for a child to attend a special needs
camp. The camp must be accredited by the American Camp Association as a special needs
camp in order to be eligible for camp reimbursement;

(4) postadoption counseling to promote the child's integration into the adoptive
family that is provided by the placing agency during the first year following the date of the
adoption decree. Reimbursement is limited to 12 sessions of postadoption counseling;

(5) family counseling that is required to meet the child's special needs.
Reimbursement is limited to the prorated portion of the counseling fees allotted to the
family when the adoptive parent's health insurance or Medicaid pays for the child's
counseling but does not cover counseling for the rest of the family members;

(6) home modifications to accommodate the child's special needs upon which
eligibility for adoption assistance was approved. Reimbursement is limited to once every
five years per child;

(7) vehicle modifications to accommodate the child's special needs upon which
eligibility for adoption assistance was approved. Reimbursement is limited to once every
five years per family; and

(8) burial expenses up to $1,000, if the special needs, upon which eligibility for
adoption assistance was approved, resulted in the death of the child.

(d) The adoptive parent shall submit statements for expenses incurred between July
1 and June 30 of a given fiscal year to the state adoption assistance unit within 60 days
after the end of the fiscal year in order for reimbursement to occur.

Sec. 28.

Minnesota Statutes 2012, section 260B.007, subdivision 6, is amended to read:


Subd. 6.

Delinquent child.

(a) Except as otherwise provided in paragraphs (b)
and (c), "delinquent child" means a child:

(1) who has violated any state or local law, except as provided in section 260B.225,
subdivision 1
, and except for juvenile offenders as described in subdivisions 16 to 18;

(2) who has violated a federal law or a law of another state and whose case has been
referred to the juvenile court if the violation would be an act of delinquency if committed
in this state or a crime or offense if committed by an adult;

(3) who has escaped from confinement to a state juvenile correctional facility after
being committed to the custody of the commissioner of corrections; or

(4) who has escaped from confinement to a local juvenile correctional facility after
being committed to the facility by the court.

(b) The term delinquent child does not include a child alleged to have committed
murder in the first degree after becoming 16 years of age, but the term delinquent child
does include a child alleged to have committed attempted murder in the first degree.

(c) The term delinquent child does not include a child under the age of 16 years
alleged to have engaged in conduct which would, if committed by an adult, violate any
federal, state, or local law relating to being hired, offering to be hired, or agreeing to be
hired by another individual to engage in sexual penetration or sexual conduct.

EFFECTIVE DATE.

This section is effective August 1, 2014, and applies to
offenses committed on or after that date.

Sec. 29.

Minnesota Statutes 2012, section 260B.007, subdivision 16, is amended to read:


Subd. 16.

Juvenile petty offender; juvenile petty offense.

(a) "Juvenile petty
offense" includes a juvenile alcohol offense, a juvenile controlled substance offense,
a violation of section 609.685, or a violation of a local ordinance, which by its terms
prohibits conduct by a child under the age of 18 years which would be lawful conduct if
committed by an adult.

(b) Except as otherwise provided in paragraph (c), "juvenile petty offense" also
includes an offense that would be a misdemeanor if committed by an adult.

(c) "Juvenile petty offense" does not include any of the following:

(1) a misdemeanor-level violation of section 518B.01, 588.20, 609.224, 609.2242,
609.324, subdivision 2 or 3, 609.5632, 609.576, 609.66, 609.746, 609.748, 609.79,
or 617.23;

(2) a major traffic offense or an adult court traffic offense, as described in section
260B.225;

(3) a misdemeanor-level offense committed by a child whom the juvenile court
previously has found to have committed a misdemeanor, gross misdemeanor, or felony
offense; or

(4) a misdemeanor-level offense committed by a child whom the juvenile court
has found to have committed a misdemeanor-level juvenile petty offense on two or
more prior occasions, unless the county attorney designates the child on the petition
as a juvenile petty offender notwithstanding this prior record. As used in this clause,
"misdemeanor-level juvenile petty offense" includes a misdemeanor-level offense that
would have been a juvenile petty offense if it had been committed on or after July 1, 1995.

(d) A child who commits a juvenile petty offense is a "juvenile petty offender." The
term juvenile petty offender does not include a child under the age of 16 years alleged
to have violated any law relating to being hired, offering to be hired, or agreeing to be
hired by another individual to engage in sexual penetration or sexual conduct which, if
committed by an adult, would be a misdemeanor.

EFFECTIVE DATE.

This section is effective August 1, 2014, and applies to
offenses committed on or after that date.

Sec. 30.

Minnesota Statutes 2012, section 260C.007, subdivision 6, is amended to read:


Subd. 6.

Child in need of protection or services.

"Child in need of protection or
services" means a child who is in need of protection or services because the child:

(1) is abandoned or without parent, guardian, or custodian;

(2)(i) has been a victim of physical or sexual abuse as defined in section 626.556,
subdivision 2, (ii) resides with or has resided with a victim of child abuse as defined in
subdivision 5 or domestic child abuse as defined in subdivision 13, (iii) resides with or
would reside with a perpetrator of domestic child abuse as defined in subdivision 13 or
child abuse as defined in subdivision 5 or 13, or (iv) is a victim of emotional maltreatment
as defined in subdivision 15;

(3) is without necessary food, clothing, shelter, education, or other required care
for the child's physical or mental health or morals because the child's parent, guardian,
or custodian is unable or unwilling to provide that care;

(4) is without the special care made necessary by a physical, mental, or emotional
condition because the child's parent, guardian, or custodian is unable or unwilling to
provide that care;

(5) is medically neglected, which includes, but is not limited to, the withholding of
medically indicated treatment from a disabled infant with a life-threatening condition. The
term "withholding of medically indicated treatment" means the failure to respond to the
infant's life-threatening conditions by providing treatment, including appropriate nutrition,
hydration, and medication which, in the treating physician's or physicians' reasonable
medical judgment, will be most likely to be effective in ameliorating or correcting all
conditions, except that the term does not include the failure to provide treatment other
than appropriate nutrition, hydration, or medication to an infant when, in the treating
physician's or physicians' reasonable medical judgment:

(i) the infant is chronically and irreversibly comatose;

(ii) the provision of the treatment would merely prolong dying, not be effective in
ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be
futile in terms of the survival of the infant; or

(iii) the provision of the treatment would be virtually futile in terms of the survival
of the infant and the treatment itself under the circumstances would be inhumane;

(6) is one whose parent, guardian, or other custodian for good cause desires to be
relieved of the child's care and custody, including a child who entered foster care under a
voluntary placement agreement between the parent and the responsible social services
agency under section 260C.227;

(7) has been placed for adoption or care in violation of law;

(8) is without proper parental care because of the emotional, mental, or physical
disability, or state of immaturity of the child's parent, guardian, or other custodian;

(9) is one whose behavior, condition, or environment is such as to be injurious or
dangerous to the child or others. An injurious or dangerous environment may include, but
is not limited to, the exposure of a child to criminal activity in the child's home;

(10) is experiencing growth delays, which may be referred to as failure to thrive, that
have been diagnosed by a physician and are due to parental neglect;

(11) has engaged in prostitution as defined in section 609.321, subdivision 9 is a
sexually exploited youth
;

(12) has committed a delinquent act or a juvenile petty offense before becoming
ten years old;

(13) is a runaway;

(14) is a habitual truant;

(15) has been found incompetent to proceed or has been found not guilty by reason
of mental illness or mental deficiency in connection with a delinquency proceeding, a
certification under section 260B.125, an extended jurisdiction juvenile prosecution, or a
proceeding involving a juvenile petty offense; or

(16) has a parent whose parental rights to one or more other children were
involuntarily terminated or whose custodial rights to another child have been involuntarily
transferred to a relative and there is a case plan prepared by the responsible social services
agency documenting a compelling reason why filing the termination of parental rights
petition under section 260C.301, subdivision 3, is not in the best interests of the child; or.

(17) is a sexually exploited youth.

EFFECTIVE DATE.

This section is effective August 1, 2014.

Sec. 31.

Minnesota Statutes 2012, section 260C.007, subdivision 31, is amended to read:


Subd. 31.

Sexually exploited youth.

"Sexually exploited youth" means an
individual who:

(1) is alleged to have engaged in conduct which would, if committed by an adult,
violate any federal, state, or local law relating to being hired, offering to be hired, or
agreeing to be hired by another individual to engage in sexual penetration or sexual conduct;

(2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
609.3451, 609.3453, 609.352, 617.246, or 617.247;

(3) is a victim of a crime described in United States Code, title 18, section 2260;
2421; 2422; 2423; 2425; 2425A; or 2256; or

(4) is a sex trafficking victim as defined in section 609.321, subdivision 7b.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 32.

Minnesota Statutes 2012, section 518A.60, is amended to read:


518A.60 COLLECTION; ARREARS ONLY.

(a) Remedies available for the collection and enforcement of support in this chapter
and chapters 256, 257, 518, and 518C also apply to cases in which the child or children
for whom support is owed are emancipated and the obligor owes past support or has an
accumulated arrearage as of the date of the youngest child's emancipation. Child support
arrearages under this section include arrearages for child support, medical support, child
care, pregnancy and birth expenses, and unreimbursed medical expenses as defined in
section 518A.41, subdivision 1, paragraph (h).

(b) This section applies retroactively to any support arrearage that accrued on or
before June 3, 1997, and to all arrearages accruing after June 3, 1997.

(c) Past support or pregnancy and confinement expenses ordered for which the
obligor has specific court ordered terms for repayment may not be enforced using
drivers' and occupational or professional license suspension, credit bureau reporting, and
additional income withholding under section 518A.53, subdivision 10, paragraph (a),
unless the obligor fails to comply with the terms of the court order for repayment.

(d) If an arrearage exists at the time a support order would otherwise terminate
and section 518A.53, subdivision 10, paragraph (c), does not apply to this section, the
arrearage shall be repaid in an amount equal to the current support order until all arrears
have been paid in full, absent a court order to the contrary.

(e) If an arrearage exists according to a support order which fails to establish a
monthly support obligation in a specific dollar amount, the public authority, if it provides
child support services, or the obligee, may establish a payment agreement which shall
equal what the obligor would pay for current support after application of section 518A.34,
plus an additional 20 percent of the current support obligation, until all arrears have been
paid in full. If the obligor fails to enter into or comply with a payment agreement, the
public authority, if it provides child support services, or the obligee, may move the district
court or child support magistrate, if section 484.702 applies, for an order establishing
repayment terms.

(f) If there is no longer a current support order because all of the children of the
order are emancipated, the public authority may discontinue child support services and
close its case under title IV-D of the Social Security Act if:

(1) the arrearage is under $500; or

(2) the arrearage is considered unenforceable by the public authority because there
have been no collections for three years, and all administrative and legal remedies have
been attempted or are determined by the public authority to be ineffective because the
obligor is unable to pay, the obligor has no known income or assets, and there is no
reasonable prospect that the obligor will be able to pay in the foreseeable future.

(g) At least 60 calendar days before the discontinuation of services under paragraph
(f), the public authority must mail a written notice to the obligee and obligor at the
obligee's and obligor's last known addresses that the public authority intends to close the
child support enforcement case and explaining each party's rights. Seven calendar days
after the first notice is mailed, the public authority must mail a second notice under this
paragraph to the obligee.

(h) The case must be kept open if the obligee responds before case closure and
provides information that could reasonably lead to collection of arrears. If the case is
closed, the obligee may later request that the case be reopened by completing a new
application for services, if there is a change in circumstances that could reasonably lead to
the collection of arrears.

Sec. 33.

Laws 1998, chapter 407, article 6, section 116, is amended to read:


Sec. 116. EBT TRANSACTION COSTS; APPROVAL FROM LEGISLATURE.

The commissioner of human services shall request and receive approval from the
legislature before adjusting the payment to
discontinue the state subsidy to retailers for
electronic benefit transfer transaction costs Supplemental Nutrition Assistance Program
transactions when the federal government discontinues the federal subsidy to the same
.

Sec. 34. DIRECTION TO COMMISSIONERS; INCOME AND ASSET
EXCLUSION.

(a) The commissioner of human services shall not count conditional cash transfers
made to families participating in a family independence demonstration as income or
assets for purposes of determining or redetermining eligibility for child care assistance
programs under Minnesota Statutes, chapter 119B; general assistance under Minnesota
Statutes, chapter 256D; group residential housing under Minnesota Statutes, chapter 256I;
the Minnesota family investment program, work benefit program, or diversionary work
program under Minnesota Statutes, chapter 256J, during the duration of the demonstration.

(b) The commissioner of human services shall not count conditional cash transfers
made to families participating in a family independence demonstration as income or assets
for purposes of determining or redetermining eligibility for medical assistance under
Minnesota Statutes, chapter 256B, and MinnesotaCare under Minnesota Statutes, chapter
256L, except that for enrollees subject to a modified adjusted gross income calculation to
determine eligibility, the conditional cash transfer payments shall be counted as income if
they are included on the enrollee's federal tax return as income, or if the payments can be
taken into account in the month of receipt as a lump sum payment.

(c) The commissioner of the Minnesota Housing Finance Agency shall not count
conditional cash transfers made to families participating in a family independence
demonstration as income or assets for purposes of determining or redetermining eligibility
for housing assistance programs under Minnesota Statutes, section 462A.201, during
the duration of the demonstration.

(d) For the purposes of this section:

(1) "conditional cash transfer" means a payment made to a participant in a family
independence demonstration by a sponsoring organization to incent, support, or facilitate
participation; and

(2) "family independence demonstration" means an initiative sponsored or
cosponsored by a governmental or nongovernmental organization, the goal of which is
to facilitate individualized goal-setting and peer support for cohorts of no more than 12
families each toward the development of financial and nonfinancial assets that enable the
participating families to achieve financial independence.

(e) The citizens league shall provide a report to the legislative committees having
jurisdiction over human services issues by July 1, 2016, informing the legislature on the
progress and outcomes of the demonstration under this section.

Sec. 35. UNIFORM BENEFITS FOR CHILDREN IN FOSTER CARE,
PERMANENT RELATIVE CARE, AND ADOPTION ASSISTANCE.

Using available resources, the commissioner of human services, in consultation with
representatives of the judicial branch, county human services, and tribes participating in
the American Indian child welfare initiative under Minnesota Statutes, section 256.01,
subdivision 14b, together with other appropriate stakeholders, which might include
communities of color; youth in foster care or those who have aged out of care; kinship
caregivers, foster parents, adoptive parents, foster and adoptive agencies; guardians ad
litem; and experts in permanency, adoption, child development, and the effects of trauma,
and the use of medical assistance home and community-based waivers for persons with
disabilities, shall analyze benefits and services available to children in family foster care
under Minnesota Rules, parts 9560.0650 to 9560.0656, relative custody assistance under
Minnesota Statutes, section 257.85, and adoption assistance under Minnesota Statutes,
chapter 259A. The goal of the analysis is to establish a uniform set of benefits available
to children in foster care, permanent relative care, and adoption so that the benefits
can follow the child rather than being tied to the child's legal status. Included in the
analysis is possible accessing of federal title IV-E through guardianship assistance. The
commissioner shall report findings and conclusions to the chairs and ranking minority
members of the legislative committees and divisions with jurisdiction over health and
human services policy and finance by January 15, 2014, and include draft legislation
establishing uniform benefits.

Sec. 36. REPEALER.

(a) Minnesota Statutes 2012, section 256J.24, subdivision 6, is repealed effective
July 1, 2014.

(b) Minnesota Statutes 2012, section 609.093, is repealed effective the day following
final enactment.

ARTICLE 4

STRENGTHENING CHEMICAL AND MENTAL HEALTH SERVICES

Section 1.

Minnesota Statutes 2012, section 245.462, subdivision 20, is amended to read:


Subd. 20.

Mental illness.

(a) "Mental illness" means an organic disorder of the brain
or a clinically significant disorder of thought, mood, perception, orientation, memory, or
behavior that is detailed in a diagnostic codes list published by the commissioner, and that
seriously limits a person's capacity to function in primary aspects of daily living such as
personal relations, living arrangements, work, and recreation.

(b) An "adult with acute mental illness" means an adult who has a mental illness that
is serious enough to require prompt intervention.

(c) For purposes of case management and community support services, a "person
with serious and persistent mental illness" means an adult who has a mental illness and
meets at least one of the following criteria:

(1) the adult has undergone two or more episodes of inpatient care for a mental
illness within the preceding 24 months;

(2) the adult has experienced a continuous psychiatric hospitalization or residential
treatment exceeding six months' duration within the preceding 12 months;

(3) the adult has been treated by a crisis team two or more times within the preceding
24 months;

(4) the adult:

(i) has a diagnosis of schizophrenia, bipolar disorder, major depression,
schizoaffective disorder, or borderline personality disorder;

(ii) indicates a significant impairment in functioning; and

(iii) has a written opinion from a mental health professional, in the last three years,
stating that the adult is reasonably likely to have future episodes requiring inpatient or
residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
management or community support services are provided;

(5) the adult has, in the last three years, been committed by a court as a person who is
mentally ill under chapter 253B, or the adult's commitment has been stayed or continued; or

(6) the adult (i) was eligible under clauses (1) to (5), but the specified time period
has expired or the adult was eligible as a child under section 245.4871, subdivision 6; and
(ii) has a written opinion from a mental health professional, in the last three years, stating
that the adult is reasonably likely to have future episodes requiring inpatient or residential
treatment, of a frequency described in clause (1) or (2), unless ongoing case management
or community support services are provided; or

(7) the adult was eligible as a child under section 245.4871, subdivision 6, and is
age 21 or younger
.

Sec. 2.

Minnesota Statutes 2012, section 245.4661, subdivision 5, is amended to read:


Subd. 5.

Planning for pilot projects.

(a) Each local plan for a pilot project, with
the exception of the placement of a Minnesota specialty treatment facility as defined in
paragraph (c),
must be developed under the direction of the county board, or multiple
county boards acting jointly, as the local mental health authority. The planning process
for each pilot shall include, but not be limited to, mental health consumers, families,
advocates, local mental health advisory councils, local and state providers, representatives
of state and local public employee bargaining units, and the department of human services.
As part of the planning process, the county board or boards shall designate a managing
entity responsible for receipt of funds and management of the pilot project.

(b) For Minnesota specialty treatment facilities, the commissioner shall issue a
request for proposal for regions in which a need has been identified for services.

(c) For purposes of this section, Minnesota specialty treatment facility is defined as
an intensive rehabilitative mental health service under section 256B.0622, subdivision 2,
paragraph (b).

Sec. 3.

Minnesota Statutes 2012, section 245.4661, subdivision 6, is amended to read:


Subd. 6.

Duties of commissioner.

(a) For purposes of the pilot projects, the
commissioner shall facilitate integration of funds or other resources as needed and
requested by each project. These resources may include:

(1) residential services funds administered under Minnesota Rules, parts 9535.2000
to 9535.3000, in an amount to be determined by mutual agreement between the project's
managing entity and the commissioner of human services after an examination of the
county's historical utilization of facilities located both within and outside of the county
and licensed under Minnesota Rules, parts 9520.0500 to 9520.0690;

(2) community support services funds administered under Minnesota Rules, parts
9535.1700 to 9535.1760;

(3) other mental health special project funds;

(4) medical assistance, general assistance medical care, MinnesotaCare and group
residential housing if requested by the project's managing entity, and if the commissioner
determines this would be consistent with the state's overall health care reform efforts; and

(5) regional treatment center resources consistent with section 246.0136, subdivision
1
.; and

(6) funds transferred from section 246.18, subdivision 8, for grants to providers to
participate in mental health specialty treatment services, awarded to providers through
a request for proposal process.

(b) The commissioner shall consider the following criteria in awarding start-up and
implementation grants for the pilot projects:

(1) the ability of the proposed projects to accomplish the objectives described in
subdivision 2;

(2) the size of the target population to be served; and

(3) geographical distribution.

(c) The commissioner shall review overall status of the projects initiatives at least
every two years and recommend any legislative changes needed by January 15 of each
odd-numbered year.

(d) The commissioner may waive administrative rule requirements which are
incompatible with the implementation of the pilot project.

(e) The commissioner may exempt the participating counties from fiscal sanctions
for noncompliance with requirements in laws and rules which are incompatible with the
implementation of the pilot project.

(f) The commissioner may award grants to an entity designated by a county board or
group of county boards to pay for start-up and implementation costs of the pilot project.

Sec. 4.

Minnesota Statutes 2012, section 245.4682, subdivision 2, is amended to read:


Subd. 2.

General provisions.

(a) In the design and implementation of reforms to
the mental health system, the commissioner shall:

(1) consult with consumers, families, counties, tribes, advocates, providers, and
other stakeholders;

(2) bring to the legislature, and the State Advisory Council on Mental Health, by
January 15, 2008, recommendations for legislation to update the role of counties and to
clarify the case management roles, functions, and decision-making authority of health
plans and counties, and to clarify county retention of the responsibility for the delivery of
social services as required under subdivision 3, paragraph (a);

(3) withhold implementation of any recommended changes in case management
roles, functions, and decision-making authority until after the release of the report due
January 15, 2008;

(4) ensure continuity of care for persons affected by these reforms including
ensuring client choice of provider by requiring broad provider networks and developing
mechanisms to facilitate a smooth transition of service responsibilities;

(5) provide accountability for the efficient and effective use of public and private
resources in achieving positive outcomes for consumers;

(6) ensure client access to applicable protections and appeals; and

(7) make budget transfers necessary to implement the reallocation of services and
client responsibilities between counties and health care programs that do not increase the
state and county costs and efficiently allocate state funds.

(b) When making transfers under paragraph (a) necessary to implement movement
of responsibility for clients and services between counties and health care programs,
the commissioner, in consultation with counties, shall ensure that any transfer of state
grants to health care programs, including the value of case management transfer grants
under section 256B.0625, subdivision 20, does not exceed the value of the services being
transferred for the latest 12-month period for which data is available. The commissioner
may make quarterly adjustments based on the availability of additional data during the
first four quarters after the transfers first occur. If case management transfer grants under
section 256B.0625, subdivision 20, are repealed and the value, based on the last year prior
to repeal, exceeds the value of the services being transferred, the difference becomes an
ongoing part of each county's adult and children's mental health grants under sections
245.4661, 245.4889, and 256E.12.

(c) This appropriation is not authorized to be expended after December 31, 2010,
unless approved by the legislature.

Sec. 5.

Minnesota Statutes 2012, section 245.4875, subdivision 8, is amended to read:


Subd. 8.

Transition services.

The county board may continue to provide mental
health services as defined in sections 245.487 to 245.4889 to persons over 18 years of
age, but under 21 years of age, if the person was receiving case management or family
community support services prior to age 18, and if one of the following conditions is met:

(1) the person is receiving special education services through the local school
district; or

(2) it is in the best interest of the person to continue services defined in sections
245.487 to 245.4889; or

(3) the person is requesting services and the services are medically necessary.

Sec. 6.

Minnesota Statutes 2012, section 245.4881, subdivision 1, is amended to read:


Subdivision 1.

Availability of case management services.

(a) The county board
shall provide case management services for each child with severe emotional disturbance
who is a resident of the county and the child's family who request or consent to the services.
Case management services may be continued must be offered to be provided for a child with
a serious emotional disturbance who is over the age of 18 consistent with section 245.4875,
subdivision 8
, or the child's legal representative, provided the child's service needs can be
met within the children's service system. Before discontinuing case management services
under this subdivision for children between the ages of 17 and 21, a transition plan
must be developed. The transition plan must be developed with the child and, with the
consent of a child age 18 or over, the child's parent, guardian, or legal representative. The
transition plan should include plans for health insurance, housing, education, employment,
and treatment
. Staffing ratios must be sufficient to serve the needs of the clients. The case
manager must meet the requirements in section 245.4871, subdivision 4.

(b) Except as permitted by law and the commissioner under demonstration projects,
case management services provided to children with severe emotional disturbance eligible
for medical assistance must be billed to the medical assistance program under sections
256B.02, subdivision 8, and 256B.0625.

(c) Case management services are eligible for reimbursement under the medical
assistance program. Costs of mentoring, supervision, and continuing education may be
included in the reimbursement rate methodology used for case management services under
the medical assistance program.

Sec. 7.

Minnesota Statutes 2012, section 246.18, subdivision 8, is amended to read:


Subd. 8.

State-operated services account.

(a) The state-operated services account is
established in the special revenue fund. Revenue generated by new state-operated services
listed under this section established after July 1, 2010, that are not enterprise activities must
be deposited into the state-operated services account, unless otherwise specified in law:

(1) intensive residential treatment services;

(2) foster care services; and

(3) psychiatric extensive recovery treatment services.

(b) Funds deposited in the state-operated services account are available to the
commissioner of human services for the purposes of:

(1) providing services needed to transition individuals from institutional settings
within state-operated services to the community when those services have no other
adequate funding source;

(2) grants to providers participating in mental health specialty treatment services
under section 245.4661; and

(3) to fund the operation of the Intensive Residential Treatment Service program in
Willmar.

Sec. 8.

Minnesota Statutes 2012, section 246.18, is amended by adding a subdivision
to read:


Subd. 9.

Transfers.

The commissioner may transfer state mental health grant funds
to the account in subdivision 8 for noncovered allowable costs of a provider certified and
licensed under section 256B.0622 and operating under section 246.014.

Sec. 9.

Minnesota Statutes 2012, section 253B.10, subdivision 1, is amended to read:


Subdivision 1.

Administrative requirements.

(a) When a person is committed,
the court shall issue a warrant or an order committing the patient to the custody of the
head of the treatment facility. The warrant or order shall state that the patient meets the
statutory criteria for civil commitment.

(b) The commissioner shall prioritize patients being admitted from jail or a
correctional institution who are:

(1) ordered confined in a state hospital for an examination under Minnesota Rules of
Criminal Procedure, rules 20.01, subdivision 4, paragraph (a), and 20.02, subdivision 2;

(2) under civil commitment for competency treatment and continuing supervision
under Minnesota Rules of Criminal Procedure, rule 20.01, subdivision 7;

(3) found not guilty by reason of mental illness under Minnesota Rules of Criminal
Procedure, rule 20.02, subdivision 8, and under civil commitment or are ordered to be
detained in a state hospital or other facility pending completion of the civil commitment
proceedings; or

(4) committed under this chapter to the commissioner after dismissal of the patient's
criminal charges.

Patients described in this paragraph must be admitted to a service operated by the
commissioner within 48 hours. The commitment must be ordered by the court as provided
in section 253B.09, subdivision 1, paragraph (c).

(c) Upon the arrival of a patient at the designated treatment facility, the head of the
facility shall retain the duplicate of the warrant and endorse receipt upon the original
warrant or acknowledge receipt of the order. The endorsed receipt or acknowledgment
must be filed in the court of commitment. After arrival, the patient shall be under the
control and custody of the head of the treatment facility.

(d) Copies of the petition for commitment, the court's findings of fact and
conclusions of law, the court order committing the patient, the report of the examiners,
and the prepetition report shall be provided promptly to the treatment facility.

Sec. 10.

Minnesota Statutes 2012, section 254B.13, is amended to read:


254B.13 PILOT PROJECTS; CHEMICAL HEALTH CARE.

Subdivision 1.

Authorization for navigator pilot projects.

The commissioner may
approve and implement navigator pilot projects developed under the planning process
required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and
enhance coordination of the delivery of chemical health services required under section
254B.03.

Subd. 2.

Program design and implementation.

(a) The commissioner and
counties participating in the navigator pilot projects shall continue to work in partnership
to refine and implement the navigator pilot projects initiated under Laws 2009, chapter
79, article 7, section 26.

(b) The commissioner and counties participating in the navigator pilot projects shall
complete the planning phase by June 30, 2010, and, if approved by the commissioner for
implementation, enter into agreements governing the operation of the navigator pilot
projects with implementation scheduled no earlier than July 1, 2010.

Subd. 2a.

Eligibility for navigator pilot program.

(a) To be considered for
participation in a navigator pilot program, an individual must:

(1) be a resident of a county with an approved navigator program;

(2) be eligible for consolidated chemical dependency treatment fund services;

(3) be a voluntary participant in the navigator program;

(4) satisfy one of the following items:

(i) have at least one severity rating of three or above in dimension four, five, or six in
a comprehensive assessment under Minnesota Rules, part 9530.6422; or

(ii) have at least one severity rating of two or above in dimension four, five, or six in
a comprehensive assessment under Minnesota Rules, part 9530.6422, and be currently
participating in a Rule 31 treatment program under Minnesota Rules, parts 9530.6405 to
9530.6505, or be within 60 days following discharge after participation in a Rule 31
treatment program; and

(5) have had at least two treatment episodes in the past two years, not limited
to episodes reimbursed by the consolidated chemical dependency treatment funds. An
admission to an emergency room, a detoxification program, or a hospital may be substituted
for one treatment episode if it resulted from the individual's substance use disorder.

(b) New eligibility criteria may be added as mutually agreed upon by the
commissioner and participating navigator programs.

Subd. 3.

Program evaluation.

The commissioner shall evaluate navigator pilot
projects under this section and report the results of the evaluation to the chairs and
ranking minority members of the legislative committees with jurisdiction over chemical
health issues by January 15, 2014. Evaluation of the navigator pilot projects must be
based on outcome evaluation criteria negotiated with the navigator pilot projects prior
to implementation.

Subd. 4.

Notice of navigator pilot project discontinuation.

Each county's
participation in the navigator pilot project may be discontinued for any reason by the county
or the commissioner of human services after 30 days' written notice to the other party.
Any unspent funds held for the exiting county's pro rata share in the special revenue fund
under the authority in subdivision 5, paragraph (d), shall be transferred to the consolidated
chemical dependency treatment fund following discontinuation of the pilot project.

Subd. 5.

Duties of commissioner.

(a) Notwithstanding any other provisions in
this chapter, the commissioner may authorize navigator pilot projects to use chemical
dependency treatment funds to pay for nontreatment navigator pilot services:

(1) in addition to those authorized under section 254B.03, subdivision 2, paragraph
(a); and

(2) by vendors in addition to those authorized under section 254B.05 when not
providing chemical dependency treatment services.

(b) For purposes of this section, "nontreatment navigator pilot services" include
navigator services, peer support, family engagement and support, housing support, rent
subsidies, supported employment, and independent living skills.

(c) State expenditures for chemical dependency services and nontreatment navigator
pilot services provided by or through the navigator pilot projects must not be greater than
the chemical dependency treatment fund expected share of forecasted expenditures in the
absence of the navigator pilot projects. The commissioner may restructure the schedule of
payments between the state and participating counties under the local agency share and
division of cost provisions under section 254B.03, subdivisions 3 and 4, as necessary to
facilitate the operation of the navigator pilot projects.

(d) To the extent that state fiscal year expenditures within a pilot project are less
than the expected share of forecasted expenditures in the absence of the pilot projects,
the commissioner shall deposit the unexpended funds in a separate account within the
consolidated chemical dependency treatment fund, and make these funds available for
expenditure by the pilot projects the following year. To the extent that treatment and
nontreatment pilot services expenditures within the pilot project exceed the amount
expected in the absence of the pilot projects, the pilot project county or counties are
responsible for the portion of nontreatment pilot services expenditures in excess of the
otherwise expected share of forecasted expenditures.

(e) (d) The commissioner may waive administrative rule requirements that are
incompatible with the implementation of the navigator pilot project, except that any
chemical dependency treatment funded under this section must continue to be provided
by a licensed treatment provider.

(f) (e) The commissioner shall not approve or enter into any agreement related to
navigator pilot projects authorized under this section that puts current or future federal
funding at risk.

(f) The commissioner shall provide participating navigator pilot projects with
transactional data, reports, provider data, and other data generated by county activity to
assess and measure outcomes. This information must be transmitted or made available in
an acceptable form to participating navigator pilot projects at least once every six months
or within a reasonable time following the commissioner's receipt of information from the
counties needed to comply with this paragraph.
</