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Office of the Revisor of Statutes

HF 1233

2nd Engrossment - 88th Legislature (2013 - 2014) Posted on 04/18/2013 10:21am

KEY: stricken = removed, old language.
underscored = added, new language.
Version List Authors and Status
Pdf Rtf
Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 1.39 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 2.37 2.38 2.39 2.40 2.41 2.42 2.43 2.44 2.45 2.46 2.47 2.48 2.49 2.50 2.51 2.52 2.53 2.54
3.1 3.2 3.3
3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16
3.17
3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16
4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20
5.21 5.22 5.23 5.24 5.25
5.26
5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34 6.1 6.2
6.3
6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15
6.16
6.17 6.18 6.19 6.20 6.21 6.22 6.23
6.24 6.25 6.26
6.27 6.28 6.29 6.30 6.31 6.32 7.1 7.2 7.3
7.4
7.5 7.6 7.7 7.8 7.9
7.10 7.11 7.12
7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26
7.27
7.28 7.29 7.30 7.31 7.32 8.1 8.2
8.3
8.4 8.5 8.6 8.7 8.8
8.9
8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9
9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 9.34 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20
10.21
10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 10.34 10.35 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21
11.22
11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30
11.31
11.32 11.33 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16
12.17
12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 12.33 12.34 13.1 13.2
13.3
13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 13.33 13.34 13.35 14.1 14.2 14.3 14.4 14.5 14.6 14.7
14.8
14.9 14.10 14.11 14.12 14.13 14.14
14.15
14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 15.1 15.2 15.3 15.4 15.5 15.6
15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14
15.15
15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 15.32 15.33 15.34 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 16.33 16.34 16.35 16.36 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 17.34 17.35 17.36 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31
18.32
18.33 18.34 18.35 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16
19.17 19.18
19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30
19.31 19.32 20.1 20.2 20.3 20.4
20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13
20.14 20.15 20.16
20.17 20.18 20.19 20.20 20.21
20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 21.1 21.2
21.3 21.4 21.5
21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14
21.15
21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28
21.29 21.30 21.31 21.32
22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32
22.33
22.34 22.35 23.1 23.2 23.3
23.4
23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18
23.19 23.20 23.21
23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32
24.1 24.2 24.3
24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22
24.23 24.24 24.25
24.26 24.27 24.28 24.29 24.30
24.31
24.32 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 25.33 25.34 25.35 25.36 26.1 26.2
26.3 26.4 26.5
26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15
26.16
26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 26.33 27.1 27.2 27.3
27.4 27.5 27.6
27.7 27.8 27.9 27.10 27.11 27.12 27.13
27.14
27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22
27.23 27.24 27.25
27.26 27.27 27.28 27.29 27.30 27.31 27.32 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19
28.20 28.21 28.22
28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 28.33 28.34 28.35 29.1 29.2 29.3
29.4 29.5 29.6
29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14
29.15 29.16 29.17
29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 29.33 30.1 30.2
30.3
30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13
30.14
30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10
31.11 31.12 31.13
31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34 31.35 32.1 32.2 32.3 32.4 32.5 32.6 32.7
32.8 32.9 32.10
32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 32.33 32.34 32.35
33.1 33.2 33.3
33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25
33.26 33.27 33.28
33.29 33.30 33.31 33.32 33.33 33.34 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32
34.33 34.34 34.35
35.1 35.2 35.3 35.4 35.5 35.6
35.7 35.8 35.9
35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32 35.33 35.34 35.35 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11
36.12 36.13 36.14
36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 36.33 36.34 36.35 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20
37.21
37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 37.32 37.33 37.34 37.35 38.1 38.2 38.3 38.4 38.5 38.6 38.7
38.8 38.9 38.10
38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 38.34 38.35 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23
39.24 39.25 39.26
39.27 39.28 39.29 39.30 39.31 39.32 39.33 39.34 39.35 39.36 39.37 40.1 40.2
40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 40.33 40.34 40.35 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31 41.32 41.33 41.34 41.35 42.1 42.2 42.3 42.4
42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13
42.14 42.15 42.16 42.17 42.18
42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27
42.28 42.29
42.30 42.31 42.32 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27
43.28 43.29 43.30 43.31 43.32 43.33 43.34 43.35 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21
44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31
44.32 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 45.34 45.35 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 46.34 46.35 46.36 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 47.34 47.35 47.36 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 48.34 48.35 48.36 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 49.34 49.35 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 50.33 50.34 50.35 50.36 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 51.35 51.36 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33 52.34 52.35 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10
53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 53.33 53.34
54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 54.32 54.33 54.34 54.35 54.36 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 55.33 55.34 55.35 55.36 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 56.33 56.34 56.35 56.36 57.1 57.2
57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 57.33 57.34 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13
58.14
58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 58.33 58.34 58.35 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23
59.24
59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 59.34 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18
60.19
60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29
60.30
60.31 60.32 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8
61.9 61.10 61.11 61.12 61.13
61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21
61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31
62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9
62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17
62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 62.33 62.34
63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32 63.33 63.34 63.35 63.36 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26
64.27 64.28 64.29 64.30 64.31 64.32 64.33 64.34 64.35 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 65.32 65.33 65.34 65.35 65.36 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 66.34 66.35 66.36 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24
67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 67.33 67.34 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 68.33 68.34 68.35 69.1 69.2 69.3 69.4 69.5 69.6 69.7
69.8
69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19
69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 69.32 69.33 69.34 70.1 70.2
70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 70.32 70.33 70.34 70.35 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 71.32 71.33 71.34 71.35 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10
72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 72.32 72.33 72.34 72.35 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 73.33 73.34 73.35 74.1 74.2 74.3 74.4 74.5 74.6 74.7
74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 74.33 74.34 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15
75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30
75.31 75.32 75.33 75.34 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12
76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 76.33 76.34 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10
77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32
77.33 77.34 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18
78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 78.34 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 79.33 79.34 79.35 79.36 80.1
80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23
80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 80.33 80.34 81.1
81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26
81.27 81.28 81.29 81.30 81.31 81.32 81.33 81.34 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15
82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24
82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32
83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15
83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23
83.24 83.25 83.26 83.27 83.28 83.29 83.30
83.31 83.32 83.33 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32
84.33 84.34 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22
85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33 85.34 85.35 86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 86.33 86.34 86.35 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 87.33 87.34 87.35 87.36 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 88.32 88.33 88.34 88.35 88.36 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 89.33 89.34 89.35 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 90.32 90.33 90.34 90.35 90.36 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 91.33 91.34 91.35 91.36 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 92.32 92.33 92.34 92.35 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 93.33 93.34 93.35 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 94.33 94.34 94.35 94.36 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 95.32 95.33 95.34 95.35 95.36 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 96.32 96.33 96.34 96.35 96.36 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 97.32 97.33 97.34 97.35 97.36 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 98.34 98.35 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 99.33 99.34 99.35 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 100.32 100.33 100.34 100.35 100.36 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 101.34 101.35 101.36 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 102.33 102.34 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 103.32 103.33 103.34 103.35 103.36 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27
104.28 104.29
104.30 104.31 104.32 104.33 104.34 104.35 105.1 105.2 105.3
105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27
105.28
105.29 105.30 105.31 105.32 105.33 105.34 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 106.33 106.34 106.35 106.36 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17
107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 107.33 107.34 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26
108.27 108.28 108.29 108.30 108.31
108.32 108.33 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 109.33 109.34 109.35 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14
110.15 110.16
110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27
110.28 110.29 110.30 110.31 110.32 110.33 110.34 111.1 111.2
111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18
111.19 111.20 111.21 111.22 111.23 111.24 111.25
111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33 112.1 112.2
112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 112.33 112.34 112.35 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 113.34 113.35 113.36 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30 114.31 114.32 114.33 114.34 114.35 114.36 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 115.33 115.34 115.35 115.36 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 116.34 116.35 116.36 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 117.33 117.34 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 118.35 118.36 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32 119.33 119.34 119.35 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 120.34 120.35 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 121.33 121.34 121.35 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 122.33 122.34 122.35 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 123.33 123.34 123.35 123.36 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 124.33 124.34 124.35 124.36 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 125.34 126.1 126.2 126.3 126.4 126.5 126.6 126.7
126.8 126.9
126.10 126.11
126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26
126.27 126.28 126.29 126.30 126.31 126.32 126.33 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29
127.30 127.31 127.32 127.33 127.34 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31
128.32 128.33 128.34 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14
129.15 129.16 129.17 129.18 129.19
129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 129.34 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 130.34 130.35 130.36 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 131.33 131.34 131.35 131.36 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12
132.13 132.14
132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33 132.34 132.35 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 133.34 133.35
133.36
134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9
134.10
134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 134.33 134.34 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8
135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19
135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28
135.29 135.30 135.31 135.32 135.33 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11
136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25
136.26 136.27 136.28 136.29 136.30 136.31 136.32 136.33 136.34 137.1 137.2 137.3 137.4 137.5 137.6 137.7
137.8
137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 137.32 137.33 137.34 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 138.34 138.35 138.36 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 139.34 139.35 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 140.34 140.35 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 141.33 141.34 141.35 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 142.33 142.34 142.35 142.36 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 143.34 143.35
144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17
144.18
144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 144.33 144.34 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12
145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27
145.28 145.29 145.30 145.31 145.32 145.33 145.34
146.1 146.2
146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13
146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33
147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32
147.33 147.34 147.35 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 148.33 148.34 148.35 148.36 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32 149.33
149.34
150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 150.34 150.35
150.36
151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19
151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28
151.29 151.30 151.31 151.32 151.33 151.34 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 152.34 152.35 152.36 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 153.34
153.35 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32 154.33 154.34 154.35 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 155.34 155.35 155.36 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10
156.11
156.12 156.13
156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26
156.27
156.28 156.29 156.30 156.31 156.32 156.33 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14
157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 157.33 157.34 157.35 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 158.33 158.34 158.35 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 159.32 159.33 159.34 159.35 159.36
160.1
160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16
160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 160.34 161.1 161.2
161.3
161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 161.32 161.33 161.34 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 162.32 162.33 162.34 162.35 162.36 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 163.33 163.34 163.35 163.36 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18
164.19
164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 164.33 164.34 164.35 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31
165.32 165.33 165.34 165.35 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 166.33 166.34 166.35 166.36 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 167.34 167.35 167.36 168.1 168.2 168.3 168.4 168.5 168.6 168.7
168.8
168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33 168.34 168.35 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8
169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 169.34
170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9
170.10 170.11 170.12 170.13 170.14 170.15 170.16
170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 170.32 170.33 170.34 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19
171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 171.34 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18
172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 172.34 172.35 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18
173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 173.33 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33
174.34 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 175.33 175.34 175.35 175.36 176.1 176.2 176.3 176.4 176.5
176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 176.34 176.35 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 177.33 177.34 178.1 178.2 178.3
178.4 178.5 178.6 178.7 178.8 178.9
178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22
178.23
178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27
179.28 179.29 179.30 179.31 179.32 179.33 179.34 180.1 180.2
180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27
180.28 180.29 180.30 180.31 180.32 180.33 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22
181.23 181.24
181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 181.33 181.34 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 182.34 182.35 182.36 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 183.33 183.34 183.35 183.36 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13
184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 184.34 184.35 185.1 185.2 185.3 185.4 185.5
185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22
185.23
185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 186.33
186.34 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 187.33 187.34 187.35 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11
188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23
188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 188.32 188.33 188.34 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12
189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 189.33 189.34 190.1 190.2 190.3 190.4
190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 190.33 190.34 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 191.33 191.34 191.35 191.36 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33 192.34 192.35 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 193.34 193.35 193.36 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20
194.21 194.22 194.23 194.24
194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24
195.25
195.26 195.27 195.28 195.29 195.30 195.31 195.32 195.33 195.34 195.35 196.1 196.2 196.3 196.4
196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13
196.14 196.15 196.16 196.17 196.18
196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29
196.30 196.31 196.32 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26
197.27 197.28 197.29 197.30 197.31 197.32 197.33 197.34 197.35 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 198.33 198.34 198.35 198.36 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20
199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 199.33 199.34 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10
200.11
200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32 200.33 200.34 200.35 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 201.33 201.34 201.35 201.36 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16
202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 202.33 202.34 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 203.33 203.34 203.35 203.36 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23
204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 204.33 204.34 204.35 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24
205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32
205.33 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 206.33 206.34
206.35 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25
207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 207.34 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29
208.30
208.31 208.32 208.33 208.34 208.35 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 209.33 209.34 209.35 209.36 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30
210.31 210.32 210.33 210.34 210.35 211.1 211.2 211.3 211.4 211.5 211.6 211.7
211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 211.33 211.34 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8
212.9 212.10 212.11 212.12 212.13 212.14 212.15
212.16 212.17 212.18 212.19 212.20 212.21
212.22
212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33
213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25
213.26 213.27 213.28 213.29 213.30 213.31 213.32 213.33 213.34 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 214.32 214.33 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 215.33 215.34 215.35 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 216.34 216.35 216.36 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 217.33 217.34 217.35 217.36 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22
218.23
218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33
219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 219.32 219.33 219.34 219.35 219.36 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12
220.13 220.14 220.15 220.16 220.17
220.18 220.19 220.20 220.21 220.22
220.23
220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 220.33
221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17
221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 221.33 221.34 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10
222.11 222.12 222.13 222.14 222.15 222.16 222.17
222.18 222.19
222.20 222.21 222.22 222.23 222.24 222.25 222.26
222.27 222.28 222.29 222.30 222.31 222.32 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27
223.28 223.29 223.30 223.31 223.32 223.33 223.34 223.35 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8
224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18
224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28
224.29 224.30 224.31 224.32 224.33 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33 225.34 225.35 225.36 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 226.33 226.34 226.35 226.36 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23
227.24 227.25 227.26 227.27 227.28 227.29
227.30 227.31 227.32 227.33 227.34 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25
228.26 228.27 228.28 228.29 228.30 228.31 228.32 228.33 228.34 228.35 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 229.33 229.34 229.35 229.36 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 230.33
230.34 230.35 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 231.33 231.34 231.35 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 232.32 232.33 232.34 232.35 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 233.33 233.34 233.35 233.36 233.37 233.38 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32 234.33 234.34 234.35 234.36 234.37 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 235.33 235.34 235.35 235.36 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 236.33 236.34 236.35 236.36 236.37 237.1 237.2 237.3 237.4
237.5
237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 237.33 237.34 237.35 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32
238.33 238.34 238.35 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30
239.31 239.32 239.33 239.34 239.35 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 240.33 240.34 240.35 240.36 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 241.32 241.33 241.34 241.35 241.36 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 242.33 242.34 242.35 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 243.32 243.33 243.34 243.35 243.36
244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 244.32 244.33 244.34 244.35 244.36 245.1 245.2 245.3 245.4 245.5 245.6
245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18
245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 245.33 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20
246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 246.34 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 247.34 247.35 247.36 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 248.32 248.33 248.34 248.35 248.36 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 249.32 249.33 249.34 249.35 249.36 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 250.32 250.33 250.34 250.35 250.36 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 251.33 251.34 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 252.33 252.34 252.35 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 253.33 253.34 253.35 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25
254.26
254.27 254.28 254.29 254.30 254.31 254.32 254.33 254.34 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 255.33 255.34 255.35 255.36 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 256.32 256.33 256.34 256.35 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 257.33 257.34 257.35 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 258.33 258.34 258.35 258.36 259.1 259.2
259.3
259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31 259.32 259.33 259.34 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 260.32 260.33 260.34 260.35 260.36 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 261.33 261.34
261.35
262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 262.33 262.34 262.35 262.36 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 263.33 263.34 263.35 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 264.33 264.34 264.35 264.36 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13 265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 265.33 265.34 265.35 265.36 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15
266.16
266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 266.33 266.34 266.35 267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20
267.21
267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 267.33 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 268.32 268.33 268.34 268.35 268.36 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 269.33 269.34 269.35 269.36 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 270.33 270.34 270.35 270.36 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30 271.31 271.32 271.33 271.34
271.35
272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 272.33 272.34 272.35 272.36 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 273.32 273.33 273.34 273.35 273.36 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 274.32 274.33 274.34 275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 275.32 275.33 275.34 275.35 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 276.32 276.33 276.34 276.35 276.36 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11
277.12
277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 277.32 277.33 277.34 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31
278.32
278.33 278.34 279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 279.33 279.34 279.35 279.36 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 280.32 280.33 280.34 280.35 280.36 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15
281.16
281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 281.32 281.33 281.34 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 282.32 282.33 282.34 282.35 282.36 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25
283.26
283.27 283.28 283.29 283.30 283.31 283.32 283.33 283.34 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33 284.34 284.35 284.36 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 285.32 285.33 285.34 285.35 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 286.32 286.33 286.34 286.35 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 287.33 287.34 287.35 287.36 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32 288.33
288.34
288.35 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 289.33 289.34 289.35 289.36 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 290.33 290.34 290.35 290.36 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19
291.20
291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 291.34 291.35 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 292.33 292.34 292.35 292.36 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 293.33 293.34 293.35 294.1 294.2 294.3 294.4 294.5 294.6 294.7
294.8
294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 294.31 294.32 294.33 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 295.32 295.33 295.34 295.35 295.36 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 296.32 296.33 296.34 296.35 296.36
297.1
297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 297.32 297.33 297.34 297.35 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 298.33 298.34 298.35 298.36 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32 299.33
299.34
300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31
300.32
300.33 300.34 300.35 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 301.34 301.35 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 302.33 302.34 302.35 302.36 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21
303.22
303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 303.33 303.34 303.35 304.1 304.2 304.3 304.4 304.5 304.6
304.7
304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 304.32 304.33 304.34 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21
305.22
305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32 305.33 305.34 306.1 306.2
306.3
306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25
306.26
306.27 306.28 306.29 306.30 306.31 306.32 306.33 307.1 307.2 307.3 307.4
307.5
307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31
307.32
308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23
308.24
308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 308.34 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 309.33 309.34 309.35 309.36 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 310.33 310.34 310.35 310.36 311.1 311.2 311.3
311.4
311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 311.32 311.33 311.34 312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 312.32 312.33 312.34 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9
313.10
313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 313.31 313.32 313.33 313.34 313.35 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10
314.11
314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 314.31 314.32 314.33 314.34 314.35 315.1 315.2
315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21
315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 315.32
316.1 316.2 316.3 316.4 316.5 316.6
316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19
316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29
316.30 316.31 316.32 316.33 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17
317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 317.32 317.33 317.34 317.35 318.1 318.2 318.3 318.4 318.5 318.6 318.7
318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 318.33 318.34 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11
319.12 319.13 319.14 319.15 319.16
319.17 319.18
319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 319.33 319.34 320.1 320.2 320.3 320.4 320.5
320.6
320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22
320.23
320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32 320.33 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24
321.25
321.26 321.27 321.28 321.29 321.30 321.31 321.32 321.33 321.34 321.35 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12
322.13
322.14 322.15 322.16
322.17
322.18 322.19 322.20 322.21 322.22
322.23
322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 323.1 323.2 323.3 323.4 323.5
323.6
323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29
323.30
323.31 323.32 323.33 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 324.33 324.34 324.35 324.36 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 325.32 325.33 325.34 325.35 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9
326.10
326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23
326.24
326.25 326.26 326.27 326.28 326.29 326.30 326.31 326.32 326.33 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9
327.10
327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28
327.29
327.30 327.31 327.32 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 328.33 328.34 328.35 328.36 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 329.33 329.34 329.35 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 330.33 330.34 330.35 330.36 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 332.33 332.34 332.35 332.36 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31
333.32
333.33 333.34 333.35 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 334.33 334.34 334.35 334.36 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15
335.16
335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 335.33 335.34 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 336.33 336.34 336.35 336.36 337.1 337.2
337.3
337.4 337.5 337.6
337.7 337.8
337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 337.33 338.1 338.2 338.3 338.4 338.5 338.6 338.7
338.8 338.9 338.10 338.11 338.12 338.13 338.14
338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 338.34 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21
339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 339.34 339.35 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 340.33 340.34 340.35 340.36 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12
341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 341.34 341.35
342.1
342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 342.33 342.34 342.35 343.1 343.2 343.3
343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 343.32 343.33 343.34 343.35 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12
344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 344.33 344.34 344.35 345.1 345.2 345.3 345.4
345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19
345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 345.33 345.34 346.1
346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16
346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 346.32 346.33 346.34 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9
347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 347.32 347.33 347.34 347.35 348.1 348.2 348.3
348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 348.33 348.34 348.35 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 349.33 349.34 349.35 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 350.34 350.35 350.36 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 351.32 351.33 351.34 351.35 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32 352.33 352.34 352.35 352.36 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12
353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 353.33 353.34 353.35 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25
354.26 354.27 354.28 354.29 354.30 354.31 354.32 354.33 354.34 354.35 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 355.32 355.33 355.34 355.35 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31 356.32 356.33 356.34 356.35 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9
357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 357.33 357.34 357.35 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 358.33 358.34 358.35 358.36 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17
359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 359.33 359.34 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11
360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30
360.31
360.32 360.33 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30 361.31 361.32 361.33 361.34 361.35 361.36 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29 362.30 362.31 362.32 362.33 362.34 362.35 362.36 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 363.32
363.33 363.34 363.35 364.1 364.2 364.3
364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22
364.23 364.24
364.25 364.26 364.27 364.28 364.29 364.30 364.31 364.32 364.33 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19
365.20 365.21
365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 365.33 365.34 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 366.33 366.34 366.35 366.36 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10
367.11
367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22
367.23
367.24 367.25 367.26 367.27 367.28
367.29 367.30 367.31
368.1 368.2
368.3
368.4
368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16
368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 368.32 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16
369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 369.32
369.33 370.1 370.2 370.3
370.4
370.5 370.6
370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19
370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 370.32
371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8
371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18 371.19
371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 371.33 371.34 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30 372.31 372.32 372.33 372.34 372.35 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 373.32 373.33 373.34 373.35 373.36 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 374.34 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28 375.29 375.30 375.31 375.32 375.33 375.34 375.35 376.1 376.2 376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32 376.33 376.34 376.35 376.36 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18
377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 377.30 377.31 377.32 377.33 377.34 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 378.32 378.33 378.34 378.35 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 379.31 379.32 379.33 379.34 379.35 379.36 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9
380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30 380.31 380.32 380.33 380.34 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 381.33 381.34 381.35 381.36 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19
382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 382.33 382.34 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 383.32 383.33 383.34 383.35 383.36 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 384.33 384.34 385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 385.32 385.33 385.34 385.35 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 386.31 386.32 386.33 386.34 387.1 387.2 387.3 387.4 387.5 387.6
387.7 387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 387.32 387.33 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 388.31 388.32 388.33 388.34 388.35 388.36 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 389.33 389.34 389.35 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 390.32 390.33 390.34 390.35 390.36 390.37 390.38 390.39 390.40 390.41 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18
391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 391.33 391.34 391.35 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 392.33 392.34 393.1 393.2 393.3 393.4 393.5
393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 393.31 393.32 393.33 393.34 393.35 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 394.33 394.34 394.35 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 395.32 395.33 395.34 395.35 396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 396.33 396.34 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 397.32 397.33 397.34 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 398.33 398.34 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26
399.27 399.28 399.29 399.30 399.31 399.32 399.33 399.34 399.35 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 400.33 400.34 400.35 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 401.33 401.34 401.35 401.36 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 402.33 402.34 402.35 402.36 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 403.31 403.32 403.33 403.34 403.35 403.36 404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8
404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 404.32 404.33 404.34 404.35 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13
405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 405.31 405.32 405.33 405.34 405.35 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13
406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 406.31 406.32 406.33 406.34 406.35 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18
407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 407.32 407.33 407.34 407.35 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 408.32 408.33 408.34 408.35 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19
409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 409.31 409.32 409.33 409.34 409.35 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 410.33 410.34 410.35 410.36 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 411.31 411.32 411.33 411.34 411.35 411.36 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20 412.21 412.22 412.23 412.24 412.25 412.26 412.27 412.28 412.29 412.30 412.31 412.32 412.33 412.34 413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 413.33 413.34 413.35 413.36 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28
414.29 414.30 414.31 414.32 414.33 414.34 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 415.32 415.33 415.34 415.35 415.36 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32 416.33 416.34 416.35 416.36 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 417.32 417.33 417.34 417.35 417.36 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 418.31 418.32 418.33 418.34 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 419.31 419.32 419.33 419.34 419.35 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17
420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 420.33 420.34 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32 421.33 421.34 421.35 421.36 422.1 422.2 422.3 422.4 422.5 422.6
422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 422.32 422.33 422.34 422.35 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 423.32 423.33 423.34 423.35
424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16 424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 424.31 424.32 424.33 424.34 424.35 425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 425.32 425.33 425.34 425.35 425.36 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 426.33 426.34 426.35 426.36 427.1 427.2 427.3 427.4 427.5
427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 427.33 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29
428.30 428.31 428.32 428.33 428.34 428.35 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 429.31 429.32 429.33 429.34
429.35 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12
430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33 430.34 430.35 431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8
431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 431.33 432.1 432.2 432.3
432.4 432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 432.32 432.33 432.34 432.35 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10
433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28 433.29 433.30 433.31 433.32 433.33 433.34
434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 434.32 434.33 434.34 434.35 434.36 435.1 435.2
435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12
435.13 435.14
435.15 435.16
435.17 435.18 435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 435.32 435.33 436.1 436.2
436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 436.33 436.34 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23
437.24 437.25 437.26
437.27 437.28 437.29 437.30 437.31 437.32 437.33 437.34 437.35 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 438.31 438.32 438.33 438.34 438.35 438.36 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22
439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 439.33 439.34 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32 440.33 440.34 440.35 440.36 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9
441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 441.32 441.33 441.34 441.35 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23
442.24 442.25 442.26 442.27 442.28 442.29
442.30 442.31 442.32 443.1 443.2 443.3
443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17
443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31 443.32 443.33 443.34 444.1 444.2
444.3
444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28 444.29
444.30 444.31 444.32 444.33 444.34 445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23
445.24 445.25 445.26 445.27 445.28 445.29
445.30 445.31 445.32 445.33 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22
446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 446.32 446.33 446.34 446.35 447.1 447.2 447.3
447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 447.31 447.32 447.33 447.34 447.35 447.36 447.37 447.38 447.39 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8
448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31 448.32 448.33 448.34 448.35 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 449.33 449.34
449.35 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10
450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 450.31 450.32 450.33 450.34 450.35
451.1
451.2 451.3 451.4 451.5
451.6
451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28 451.29 451.30 451.31 451.32 451.33 451.34 452.1 452.2 452.3 452.4 452.5
452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22
452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 452.32 452.33 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11
453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 453.32 453.33 453.34 453.35 454.1 454.2 454.3 454.4 454.5 454.6 454.7 454.8 454.9 454.10 454.11
454.12
454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28 454.29 454.30 454.31 454.32 454.33
454.34 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15
455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 455.32 455.33 455.34 455.35 456.1 456.2 456.3
456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15
456.16 456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 456.31
456.32 456.33 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 457.32 457.33 457.34 457.35 457.36 458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 458.32 458.33 458.34 458.35 458.36 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12
459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21
459.22 459.23 459.24 459.25 459.26 459.27 459.28
459.29 459.30 459.31 459.32 459.33
460.1 460.2 460.3 460.4
460.5 460.6 460.7 460.8 460.9
460.10 460.11 460.12 460.13
460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21
460.22 460.23 460.24 460.25 460.26
460.27 460.28 460.29 460.30
461.1 461.2 461.3 461.4 461.5
461.6 461.7 461.8
461.9 461.10 461.11 461.12 461.13
461.14 461.15 461.16 461.17 461.18
461.19 461.20 461.21 461.22 461.23 461.24
461.25 461.26 461.27 461.28
461.29 462.1 462.2 462.3 462.4
462.5 462.6 462.7 462.8
462.9 462.10 462.11 462.12
462.13 462.14 462.15 462.16 462.17
462.18 462.19 462.20 462.21 462.22
462.23 462.24 462.25 462.26 462.27 462.28
462.29 462.30 463.1 463.2 463.3 463.4 463.5 463.6
463.7 463.8 463.9 463.10 463.11
463.12 463.13 463.14 463.15 463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 463.31 463.32 463.33 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9
464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 464.31 464.32 464.33 464.34 464.35 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 465.32 465.33 465.34 465.35 465.36 466.1 466.2 466.3 466.4 466.5 466.6
466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28 466.29 466.30 466.31 466.32 466.33 466.34 466.35 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21 467.22
467.23 467.24 467.25 467.26
467.27 467.28 467.29 467.30 467.31
467.32 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13
468.14 468.15 468.16 468.17 468.18
468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26 468.27 468.28 468.29 468.30 468.31 468.32 468.33 468.34 469.1 469.2 469.3 469.4
469.5 469.6 469.7 469.8 469.9 469.10
469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 469.30 469.31 469.32 469.33 469.34 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 470.32 470.33 470.34 470.35 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24 471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 471.33 471.34 471.35 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 472.32 472.33 472.34 472.35 472.36 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23
473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 473.33 473.34 473.35 474.1 474.2
474.3 474.4 474.5 474.6 474.7
474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19
474.20 474.21 474.22 474.23 474.24 474.25
474.26 474.27 474.28 474.29 474.30
474.31 475.1 475.2 475.3 475.4
475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27
475.28 475.29 475.30 475.31 475.32 475.33 475.34 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14
476.15 476.16 476.17 476.18 476.19 476.20
476.21 476.22 476.23 476.24 476.25
476.26 476.27 476.28 476.29 476.30 476.31 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13
477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 477.31 477.32 477.33 477.34 477.35
478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 478.32 478.33 478.34 478.35 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 479.32 479.33 479.34 479.35 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 480.33 480.34 480.35 480.36 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31 481.32 481.33 481.34 481.35 481.36 482.1 482.2 482.3 482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 482.32 482.33 482.34 482.35 483.1 483.2 483.3 483.4 483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 483.29 483.30 483.31 483.32 483.33 483.34 483.35 483.36 484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30 484.31 484.32 484.33 484.34 484.35 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25
485.26 485.27 485.28 485.29 485.30 485.31
485.32 485.33 485.34 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 486.31 486.32 486.33 486.34 486.35 486.36 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12 487.13 487.14 487.15
487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23
487.24 487.25 487.26 487.27 487.28 487.29 487.30 487.31 487.32 487.33 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28
488.29 488.30 488.31 488.32 488.33
488.34 489.1 489.2 489.3 489.4 489.5 489.6
489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23
489.24 489.25 489.26 489.27 489.28 489.29 489.30
489.31 489.32 489.33 490.1 490.2 490.3 490.4
490.5 490.6 490.7 490.8 490.9 490.10
490.11 490.12 490.13 490.14 490.15 490.16 490.17
490.18 490.19
490.20 490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 490.30 490.31 490.32 490.33 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11
491.12 491.13
491.14 491.15
491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26
491.27 491.28 491.29 491.30 491.31 492.1 492.2 492.3 492.4 492.5 492.6 492.7
492.8 492.9 492.10 492.11 492.12 492.13 492.14 492.15 492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 492.33 492.34 492.35 492.36 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27 493.28 493.29 493.30 493.31 493.32 493.33 493.34 493.35 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28 494.29 494.30 494.31 494.32 494.33 494.34 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22 495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 495.32 495.33 495.34 495.35 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28 496.29 496.30 496.31 496.32 496.33 496.34 496.35 497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12 497.13 497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 497.33 497.34 497.35 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 498.33 498.34 498.35 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 499.32 499.33 500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 500.30 500.31 500.32 500.33 500.34 500.35 501.1 501.2 501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16 501.17 501.18 501.19 501.20 501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28 501.29 501.30 501.31 501.32 501.33 501.34 502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9 502.10 502.11 502.12 502.13 502.14 502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27 502.28 502.29 502.30 502.31 502.32 502.33 503.1 503.2 503.3 503.4 503.5 503.6 503.7 503.8 503.9 503.10 503.11 503.12 503.13 503.14 503.15 503.16 503.17 503.18 503.19 503.20 503.21 503.22 503.23 503.24 503.25 503.26 503.27 503.28 503.29 503.30 503.31 503.32 504.1 504.2 504.3 504.4 504.5 504.6 504.7 504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17 504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 504.31 504.32 504.33 504.34 505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12 505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20 505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 505.32 505.33 505.34 506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27 506.28 506.29 506.30 506.31 506.32 506.33 506.34 506.35 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13 507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 507.31 507.32 507.33 507.34 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 508.32 508.33 508.34 509.1 509.2 509.3 509.4 509.5 509.6 509.7 509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20 509.21 509.22 509.23 509.24 509.25 509.26
509.27 509.28 509.29 509.30 509.31 509.32 509.33 510.1 510.2 510.3 510.4 510.5 510.6 510.7 510.8 510.9 510.10 510.11 510.12 510.13 510.14 510.15 510.16 510.17 510.18 510.19 510.20 510.21 510.22 510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30 510.31 510.32 510.33 510.34 510.35 511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15 511.16 511.17 511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26 511.27 511.28 511.29 511.30 511.31 511.32 511.33 511.34 511.35 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10 512.11 512.12 512.13 512.14 512.15 512.16 512.17 512.18 512.19 512.20 512.21 512.22 512.23 512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 512.32 512.33 512.34 512.35 512.36 513.1 513.2 513.3 513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25 513.26 513.27 513.28 513.29 513.30 513.31 513.32 513.33 513.34 513.35 514.1 514.2 514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 514.31 514.32 514.33 514.34 514.35 514.36 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26 515.27 515.28 515.29 515.30 515.31 515.32 515.33 515.34 515.35 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14 516.15 516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24 516.25 516.26 516.27 516.28 516.29 516.30 516.31
516.32 516.33 517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 517.31 517.32 517.33 517.34 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16 518.17 518.18 518.19 518.20 518.21 518.22 518.23 518.24 518.25 518.26 518.27 518.28 518.29 518.30 518.31 518.32 518.33 518.34 518.35 519.1 519.2 519.3 519.4 519.5 519.6 519.7
519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30 519.31 519.32 519.33 520.1 520.2 520.3
520.4
520.5 520.6 520.7
520.8
520.9 520.10 520.11 520.12 520.13 520.14 520.15 520.16 520.17 520.18
520.19 520.20 520.21 520.22 520.23 520.24
520.25 520.26 520.27 520.28 520.29
520.30 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16 521.17 521.18
521.19 521.20 521.21
521.22 521.23 521.24
521.25 521.26
521.27 521.28
521.29 521.30 521.31 521.32 522.1 522.2 522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10
522.11 522.12 522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24 522.25 522.26 522.27 522.28 522.29 522.30 522.31 522.32 522.33 522.34 522.35 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10

A bill for an act
 relating to state government; establishing the health and human services budget;
modifying provisions related to health care, continuing care, human services
licensing, chemical and mental health, managed care organizations, waiver
provider standards, home care, and the Department of Health; redesigning
home and community-based services; establishing payment methodologies
for home and community-based services; adjusting nursing and ICF/DD
facility rates; setting and modifying fees; modifying autism coverage; making
technical changes; requiring studies; requiring reports; appropriating money;
amending Minnesota Statutes 2012, sections 16A.724, subdivisions 2, 3; 16C.10,
subdivision 5; 16C.155, subdivision 1; 62A.65, subdivision 2, by adding a
subdivision; 62J.692, subdivision 4; 62Q.19, subdivision 1; 103I.005, by
adding a subdivision; 103I.521; 119B.13, subdivision 7; 144.051, by adding
subdivisions; 144.0724, subdivisions 4, 6; 144.123, subdivision 1; 144.125,
subdivision 1; 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; 144A.53, subdivision 2; 144D.01, subdivision 4; 145.986; 145C.01,
subdivision 7; 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; 174.30, subdivision 1; 214.40, subdivision 1; 243.166,
subdivisions 4b, 7; 245.4661, subdivisions 5, 6; 245.4682, subdivision 2;
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; 245D.02;
245D.03; 245D.04; 245D.05; 245D.06; 245D.07; 245D.09; 245D.10; 246.18,
subdivision 8, by adding a subdivision; 246.54; 254B.04, subdivision 1; 254B.13;
256.01, subdivisions 2, 24, 34, by adding subdivisions; 256.9657, subdivisions 2,
3a; 256.9685, subdivision 2; 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, 8, 10,
by adding a subdivision; 256B.06, subdivision 4; 256B.0623, subdivision 2;
256B.0625, subdivisions 9, 13e, 19c, 31, 39, 48, 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 subdivisions;
256B.0946; 256B.095; 256B.0951, subdivisions 1, 4; 256B.0952, subdivisions 1,
5; 256B.097, subdivisions 1, 3; 256B.431, subdivision 44; 256B.434, subdivision
4, by adding a subdivision; 256B.437, subdivision 6; 256B.439, subdivisions
1, 2, 3, 4, by adding a subdivision; 256B.441, subdivisions 13, 53; 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.5011, subdivision 2;
256B.5012, by adding subdivisions; 256B.69, subdivisions 5c, 31, by adding a
subdivision; 256B.694; 256B.76, subdivisions 2, 4, by adding a subdivision;
256B.761; 256B.764; 256B.766; 256I.04, subdivision 3; 256I.05, subdivision
1e, by adding a subdivision; 256J.35; 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, by adding subdivisions; 256L.05, subdivisions 1, 2, 3; 256L.06, subdivision
3; 256L.07, subdivisions 1, 2, 3; 256L.09, subdivision 2; 256L.11, subdivision 6;
256L.15, subdivisions 1, 2; 257.0755, subdivision 1; 260B.007, subdivisions 6,
16; 260C.007, subdivisions 6, 31; 471.59, subdivision 1; 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 1, section 3; article 2, section 27; article 10, section 3, subdivision
3, as amended; proposing coding for new law in Minnesota Statutes, chapters
62A; 62D; 144; 144A; 145; 149A; 214; 245; 245A; 245D; 254B; 256; 256B;
256L; repealing Minnesota Statutes 2012, sections 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; 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.14, subdivision 3a; 256B.49, subdivision 16a; 256B.4913, subdivisions 1,
2, 3, 4; 256B.5012, subdivision 13; 256J.24, subdivision 6; 256K.45, subdivision
2; 256L.01, subdivision 4a; 256L.031; 256L.04, subdivisions 1b, 9, 10a;
256L.05, subdivision 3b; 256L.07, subdivisions 5, 8, 9; 256L.11, subdivision 5;
256L.12; 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.

deleted text begin 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. deleted text end new text begin 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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015.
 new text end

Sec. 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, deleted text begin 2,deleted text end 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:


new text begin Subd. 35. new text end

new text begin Federal approval. new text end

new text begin (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 sources:
 new text end

new text begin (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 Minnesota Statutes, section 62V.02;
 new text end

new text begin (2) Medicaid funding; and
new text end

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

new text begin (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:
 new text end

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

new text begin (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;
 new text end

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

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

new text begin (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.
 new text end

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

new text begin (e) The commissioner shall report progress on implementing this subdivision to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance by December 1, 2014.
 new text end

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

Sec. 4.

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


new text begin Subd. 18. new text end

new text begin Caretaker relative. new text end

new text begin "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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 5.

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


new text begin Subd. 19. new text end

new text begin Insurance affordability program. new text end

new text begin "Insurance affordability program"
means one of the following programs:
 new text end

new text begin (1) medical assistance under this chapter;
 new text end

new text begin (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;
 new text end

new text begin (3) MinnesotaCare as defined in chapter 256L; and
 new text end

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 6.

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


Subd. 18.

Applications for medical assistance.

(a) The state agency deleted text begin may take
deleted text end new text begin shall acceptnew text end applications for medical assistance deleted text begin and conduct eligibility determinations for
MinnesotaCare enrolleesdeleted text end new text begin by telephone, via mail, in-person, online via an Internet Web
site, and through other commonly available electronic meansnew text end .

(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.

new text begin (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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 7.

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


Subd. 3a.

Families with children.

deleted text begin Beginning July 1, 2002,deleted text end Medical assistance may
be paid for a person who is a child under the age of deleted text begin 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 agedeleted text end 19; the parent new text begin or
stepparent new text end of a deleted text begin dependentdeleted text end childnew text begin under the age of 19new text end , including a pregnant woman; or a
caretaker relative of a deleted text begin dependentdeleted text end childnew text begin under the age of 19new text end .

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

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 deleted text begin has written verification of a positive pregnancy test from a
physician or licensed registered nurse, whodeleted text end 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. new text begin 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. new text end For
purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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 new text begin less than two years of age and is new text end in a family with countable income that is equal
to or less than the income standard established under section 256B.057, subdivision 1.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

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

new text begin (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
 new text end

deleted text begin (5)deleted text end new text begin (6)new text end not described in another subdivision of this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 11.

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


new text begin Subd. 17. new text end

new text begin Adults who were in foster care at the age of 18. new text end

new text begin 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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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 Minnesotanew text begin ,
new text end in accordance with deleted text begin the rules of the state agencydeleted text end new text begin Code of Federal Regulations, title 42,
section 435.403new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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 deleted text begin whose eligibility is determined under section
256B.057, subdivision 2deleted text end , 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) 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) 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 new text begin certain new text end individuals deleted text begin and familiesdeleted text end .

deleted text begin (a)deleted text end 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.

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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) 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) 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) To be eligible for medical assistance under section 256B.055, subdivision 16, a
childnew text begin age 19 to 20new text end may have an income up to 133 percent of the federal poverty guidelines
for the household size.

new text begin (f) 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.
 new text end

deleted text begin (f)deleted text end new text begin (g)new text end In computing income to determine eligibility of persons under paragraphs (a)
to deleted text begin (e)deleted text end new text begin (f)new text end who are not residents of long-term care facilities, the commissioner shall disregard
increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
For persons eligible under paragraph (a), veteran aid and attendance benefits and Veterans
Administration unusual medical expense payments are considered income to the recipient.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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 deleted text begin families
with childrendeleted text end new text begin parents and caretaker relatives, pregnant women, infants, and children ages
two through 20new text end is the standard specified in subdivision 4new text begin , paragraph (c)new text end .

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 17.

Minnesota Statutes 2012, section 256B.056, is amended by adding a
subdivision to read:


new text begin Subd. 7a. new text end

new text begin Periodic renewal of eligibility. new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (d) Notwithstanding paragraph (a), individuals eligible under subdivision 5 shall be
required to renew eligibility every six months.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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.

new text begin (d) The commissioner shall utilize information obtained through the electronic
service established by the secretary of the United States Department of Health and Human
Services and other available electronic data sources in Code of Federal Regulations, title
42, sections 435.940 to 435.956, to verify eligibility requirements. The commissioner
shall establish standards to define when information obtained electronically is reasonably
compatible with information provided by applicants and enrollees, including use of
self-attestation, to accomplish real-time eligibility determinations and maintain program
integrity.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 19.

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


Subdivision 1.

Infants and pregnant women.

(a)deleted text begin (1)deleted text end An infant less than deleted text begin one year
deleted text end new text begin two yearsnew text end of age or a pregnant woman deleted text begin who has written verification of a positive pregnancy
test from a physician or licensed registered nursedeleted text end is eligible for medical assistance ifnew text begin the
individual'snew text end countable deleted text begin familydeleted text end new text begin householdnew text end income is equal to or less than 275 percent of the
federal poverty guideline for the same deleted text begin familydeleted text end new text begin householdnew text end sizenew text begin or an equivalent standard
when converted using modified adjusted gross income methodology as required under
the Affordable Care Actnew text end . deleted text begin 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.
deleted text end

deleted text begin (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.
 deleted text end

deleted text begin (b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]
 deleted text end

deleted text begin (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.
 deleted text end

deleted text begin (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.
 deleted text end

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

deleted text begin (d)deleted text end new text begin (b)new text end An infant born to a woman who was eligible for and receiving medical
assistance on the date of the child's birth shall continue to be eligible for medical assistance
without redetermination until the child's first birthday.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 20.

Minnesota Statutes 2012, section 256B.057, subdivision 8, is amended to read:


Subd. 8.

Children under age two.

Medical assistance may be paid for a child under
two years of age whose countable family income is above 275 percent of the federal poverty
guidelines for the same size family but less than or equal to 280 percent of the federal
poverty guidelines for the same size familynew text begin or an equivalent standard when converted using
modified adjusted gross income methodology as required under the Affordable Care Actnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 21.

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 deleted text begin 5bdeleted text end new text begin 5anew text end .

Sec. 22.

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


new text begin Subd. 12. new text end

new text begin Presumptive eligibility determinations made by qualified hospitals.
 new text end

new text begin 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).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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) deleted text begin Beginning July 1, 2009,deleted text end Pregnant noncitizens who are deleted text begin undocumented,
nonimmigrants, or lawfully present in the United States as defined in Code of Federal
Regulations, title 8, section 103.12,deleted text end new text begin ineligible for federally funded medical assistance
new text end 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.

new text begin (k) Noncitizens who are lawfully present in the United States as defined in Code
of Federal Regulations, title 8, section 103.12, who are not children or pregnant women
as defined in paragraph (d), and who otherwise meet the eligibility requirements of this
chapter, are eligible for medical assistance without federal financial participation. These
individuals must cooperate with the United States Citizenship and Immigration Services to
pursue any applicable immigration status, including citizenship, that would qualify them
for medical assistance with federal financial participation.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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,new text begin county
agencies,new text end and rural clinics to the extent practicable.

new text begin (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: (1) document how other providers
and counties, including county-based purchasing plans, will provide services to persons
attributed to the health care delivery system; (2) document how other providers and
counties, including county-based purchasing plans, participated in developing the
application; (3) provide verification that other providers and counties, including
county-based purchasing plans, support the project and are willing to participate; and (4)
document how it will address applicable local needs, priorities, and public health goals.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section applies to health care delivery system contracts
entered into or renewed on or after July 1, 2013.
 new text end

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 deleted text begin otherdeleted text end county-based purchasing plans, or with other qualified
health plans that have coordination arrangements with counties, to serve persons deleted text begin with
a disability who voluntarily enrolldeleted text end new text begin enrolled in state health care programsnew text end , 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. deleted text begin Nothing in
this paragraph supersedes or modifies the requirements in paragraph (a).
deleted text end

Sec. 26.

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


new text begin Subd. 1b. new text end

new text begin Affordable Care Act. new text end

new text begin "Affordable Care Act" means the federal Patient
Protection and Affordable Care Act, Public Law 111-148, as amended, including the
federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and
any amendments to, and any federal guidance or regulations issued under, these acts.
 new text end

Sec. 27.

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


Subd. 3a.

Family deleted text begin with childrendeleted text end .

(a) deleted text begin "Family with children" means:
deleted text end

deleted text begin (1) parents and their children residing in the same household; or
 deleted text end

deleted text begin (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. deleted text end new text begin "Family" has the meaning given for family and family size as defined
in Code of Federal Regulations, title 26, section 1.36B-1.
 new text end

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

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 28.

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


new text begin Subd. 4b. new text end

new text begin Minnesota Insurance Marketplace. new text end

new text begin "Minnesota Insurance Marketplace"
means the Minnesota Insurance Marketplace as defined in Minnesota Statutes, section
62V.02.
 new text end

Sec. 29.

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


Subd. 5.

Income.

deleted text begin (a)deleted text end "Income" has the meaning given for deleted text begin 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 incomedeleted text end new text begin modified adjusted gross income, as defined in Code of Federal
Regulations, title 26, section 1.36B-1new text end .

deleted text begin (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.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 30.

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


new text begin Subd. 8. new text end

new text begin Participating entity. new text end

new text begin "Participating entity" means a health carrier as
defined in section 62A.011, 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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015.
 new text end

Sec. 31.

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


Subd. 2.

Commissioner's duties.

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 deleted text begin eligible providers
deleted text end new text begin participating entities under contract with the commissionernew text end . The commissioner shall
adopt rules to administer the MinnesotaCare program.new text begin Nothing in this chapter is intended
to violate the requirements of the Affordable Care Act. The commissioner shall not
implement any provision of this chapter if the provision is found to violate the Affordable
Care Act.new text end 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. A toll-free
telephone numbernew text begin and Web sitenew text end must be used to provide information about medical
programs and to promote access to the covered services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014, or upon federal
approval, whichever is later, except that the amendment related to "participating entities"
is effective January 1, 2015. The commissioner of human services shall notify the revisor
when federal approval is obtained.
 new text end

Sec. 32.

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


new text begin Subd. 6. new text end

new text begin Federal approval. new text end

new text begin (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.
 new text end

new text begin (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 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.
 new text end

new text begin (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 become part of the program's base funding for purposes of
future budget forecasts.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 33.

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


new text begin Subd. 7. new text end

new text begin Coordination with Minnesota Insurance Marketplace. new text end

new text begin MinnesotaCare
shall be considered a public health care program for purposes of Minnesota Statutes,
chapter 62V.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

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,new text begin and all essential health benefits required
under section 1302 of the Affordable Care Act,new text end with the exception of deleted text begin inpatient hospital
services,deleted text end 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, new text begin and new text end nursing home or intermediate care facilities servicesdeleted text begin , inpatient
mental health services, and chemical dependency servicesdeleted text end .

(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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 35.

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


Subd. 1a.

deleted text begin Pregnant women anddeleted text end Children; MinnesotaCare health care reform
waiver.

deleted text begin Beginning January 1, 1999,deleted text end Children deleted text begin and pregnant womendeleted text end 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. deleted text begin Pregnant women anddeleted text end Children are exempt from
the provisions of subdivision 5, regarding co-payments. deleted text begin Pregnant women anddeleted text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

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. deleted text begin 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.
deleted text end

(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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 37.

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


new text begin Subd. 4b. new text end

new text begin Loss ratio. new text end

new text begin 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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015.
 new text end

Sec. 38.

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


Subd. 5.

Cost-sharing.

(a) Except as new text begin otherwise new text end provided in deleted text begin paragraphs (b) and (c)
deleted text end new text begin this subdivisionnew text end , 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) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $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) $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) 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 deleted text begin parents and relative caretakers of
deleted text end new text begin families withnew text end children under the age of 21.

(c) Paragraph (a) does not apply to deleted text begin pregnant women anddeleted text end children under the age of 21.

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

deleted text begin (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.
 deleted text end

deleted text begin (f)deleted text end new text begin (e)new text end 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, deleted text begin any charges
submitted towards the $10,000 annual inpatient benefit limit, anddeleted text end 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.

deleted text begin (g)deleted text end new text begin (f)new text end 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), effective January 1, 2011.

deleted text begin (h)deleted text end new text begin (g)new text end 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). 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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

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 deleted text begin prepaid
health plansdeleted text end new text begin participating entities,new text end under contract with the commissioner according to
deleted text begin sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based
purchasing entities under section 256B.692deleted text end new text begin section 256L.121new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015.
 new text end

Sec. 40.

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


Subdivision 1.

Families with children.

deleted text begin (a)deleted text end Families with children with family
incomenew text begin above 133 percent of the federal poverty guidelines andnew text end equal to or less than
deleted text begin 275deleted text end new text begin 200new text end 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.18deleted text begin , including the insurance-related barriers to enrollment under section
256L.07,deleted text end shall apply unless otherwise specified.

deleted text begin (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.
 deleted text end

deleted text begin (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.
 deleted text end

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

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

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 41.

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


new text begin Subd. 1c. new text end

new text begin General requirements. new text end

new text begin 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 treated as 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 health benefit exchange under section 1331 of the Affordable Care Act.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015.
 new text end

Sec. 42.

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


Subd. 7.

Single adults and households with no children.

deleted text begin (a)deleted text end The definition of
eligible persons includes all individuals and deleted text begin householdsdeleted text end new text begin familiesnew text end with no children who
have deleted text begin gross familydeleted text end incomes that are new text begin above 133 percent and new text end equal to or less than 200 percent
of the federal poverty guidelinesnew text begin for the applicable family sizenew text end .

deleted text begin (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.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

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. deleted text begin 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.
deleted text end

(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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 44.

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


Subd. 10.

Citizenship requirements.

new text begin (a) new text end Eligibility for MinnesotaCare is limited to
citizens or nationals of the United Statesdeleted text begin , qualified noncitizens, and other persons residing
deleted text end new text begin andnew text end lawfully deleted text begin in the United Statesdeleted text end new text begin present noncitizensnew text end as defined in Code of Federal
Regulations, title 8, section 103.12. Undocumented noncitizens deleted text begin and nonimmigrants
deleted text end are ineligible for MinnesotaCare. For purposes of this subdivision, deleted text begin a nonimmigrant
is an individual in one or more of the classes listed in United States Code, title 8,
section 1101(a)(15), anddeleted text end 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.

new text begin (b) Eligible persons include individuals who are lawfully present and ineligible for
medical assistance by reason of immigration status, who have family income equal to or
less than 200 percent of the federal poverty guidelines for the applicable family size.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 45.

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


new text begin Subd. 14. new text end

new text begin Coordination with medical assistance. new text end

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

new text begin (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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 46.

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


Subdivision 1.

Application assistance and information availability.

(a)new text begin 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.new text end 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 librariesnew text begin , and at any other locations at which medical
assistance applications must be made availablenew text end . 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
applicationnew text begin through the Minnesota Insurance Marketplacenew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 47.

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 verificationnew text begin through the Minnesota Insurance Marketplacenew text end 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
verificationnew text begin to the extent permitted under the Affordable Care Actnew text end . 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 48.

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. deleted text begin 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.deleted text end The effective date
of coverage for deleted text begin otherdeleted text end 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'snew text begin modified adjustednew text end 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.

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

deleted text begin (d)deleted text end new text begin (c)new text end 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.

deleted text begin (e)deleted text end new text begin (d)new text end 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.

deleted text begin (f)deleted text end new text begin (e)new text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 49.

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. deleted text begin Persons disenrolled for
nonpayment or who voluntarily terminate coverage from the program may not reenroll
until four calendar months have elapsed.deleted text end 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. deleted text begin 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.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 50.

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


Subdivision 1.

General requirements.

deleted text begin (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.
 deleted text end

deleted text begin Parentsdeleted text end new text begin Individualsnew text end enrolled in MinnesotaCare under section 256L.04, subdivision 1new text begin ,
and individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7new text end , whose
income increases above deleted text begin 275deleted text end new text begin 200new text end percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. deleted text begin 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.deleted text end 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.

deleted text begin (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).
 deleted text end

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

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 51.

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


Subd. 2.

Must not have access to employer-subsidizednew text begin minimum essential
new text end coverage.

(a) To be eligible, a family or individual must not have access to subsidized
health coverage deleted text begin 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 eligibledeleted text end new text begin that is affordable and provides minimum value as defined in Code of Federal
Regulations, title 26, section 1.36B-2new text end .

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

deleted text begin (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.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 52.

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


Subd. 3.

Other health coverage.

(a) deleted text begin Families and individuals enrolled in the
MinnesotaCare program must have nodeleted text end new text begin To be eligible, a family must not have minimum
essentialnew text end health coverage deleted text begin while enrolleddeleted text end new text begin , as defined by section 5000A of the Internal
Revenue Codenew text end . deleted text begin 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:
deleted text end

deleted text begin (1) lacks two or more of the following:
 deleted text end

deleted text begin (i) basic hospital insurance;
 deleted text end

deleted text begin (ii) medical-surgical insurance;
 deleted text end

deleted text begin (iii) prescription drug coverage;
 deleted text end

deleted text begin (iv) dental coverage; or
 deleted text end

deleted text begin (v) vision coverage;
 deleted text end

deleted text begin (2) requires a deductible of $100 or more per person per year; or
 deleted text end

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

deleted text begin 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.
 deleted text end

deleted text begin (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.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end 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 havenew text begin minimum essentialnew text end 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.

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

deleted text begin (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.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 53.

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, deleted text begin pregnant women,deleted text end individualsdeleted text begin ,deleted text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 54.

Minnesota Statutes 2012, section 256L.11, subdivision 6, is amended to read:


Subd. 6.

deleted text begin Enrollees 18 or olderdeleted text end new text begin Reimbursement of inpatient hospital servicesnew text end .

Payment by the MinnesotaCare program for inpatient hospital services provided to
MinnesotaCare enrollees eligible under section 256L.04, subdivision 7, or who qualify
under section 256L.04, deleted text begin subdivisionsdeleted text end new text begin subdivisionnew text end 1 deleted text begin and 2, with family gross income that
exceeds 175 percent of the federal poverty guidelines and who are not pregnant, who
are 18 years old or older on the date of admission to the inpatient hospital must be in
accordance with paragraphs (a) and (b). Payment for adults who are not pregnant and are
eligible under section 256L.04, subdivisions 1 and 2, and whose incomes are equal to or
less than 175 percent of the federal poverty guidelines, shall be as provided for under
paragraph (c).deleted text end new text begin , shall be at the medical assistance rate minus any co-payment required
under section 256L.03, subdivision 5. The hospital must not seek payment from the
enrollee in addition to the co-payment. The MinnesotaCare payment plus the co-payment
must be treated as payment in full.
new text end

deleted text begin (a) If the medical assistance rate minus any co-payment required under section
256L.03, subdivision 4, is less than or equal to the amount remaining in the enrollee's
benefit limit under section 256L.03, subdivision 3, payment must be the medical
assistance rate minus any co-payment required under section 256L.03, subdivision 4. The
hospital must not seek payment from the enrollee in addition to the co-payment. The
MinnesotaCare payment plus the co-payment must be treated as payment in full.
 deleted text end

deleted text begin (b) If the medical assistance rate minus any co-payment required under section
256L.03, subdivision 4, is greater than the amount remaining in the enrollee's benefit limit
under section 256L.03, subdivision 3, payment must be the lesser of:
 deleted text end

deleted text begin (1) the amount remaining in the enrollee's benefit limit; or
 deleted text end

deleted text begin (2) charges submitted for the inpatient hospital services less any co-payment
established under section 256L.03, subdivision 4.
 deleted text end

deleted text begin The hospital may seek payment from the enrollee for the amount by which usual and
customary charges exceed the payment under this paragraph. If payment is reduced under
section 256L.03, subdivision 3, paragraph (b), the hospital may not seek payment from the
enrollee for the amount of the reduction.
 deleted text end

deleted text begin (c) For admissions occurring on or after July 1, 2011, for single adults and
households without children who are eligible under section 256L.04, subdivision 7, the
commissioner shall pay hospitals directly, up to the medical assistance payment rate,
for inpatient hospital benefits up to the $10,000 annual inpatient benefit limit, minus
any co-payment required under section 256L.03, subdivision 5. Inpatient services paid
directly by the commissioner under this paragraph do not include chemical dependency
hospital-based and residential treatment.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 55.

new text begin [256L.121] SERVICE DELIVERY.
 new text end

new text begin Subdivision 1. new text end

new text begin Competitive process. new text end

new text begin 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. In rural areas other than metropolitan statistical areas, the commissioner
shall use the medical assistance competitive procurement process under section 256B.69,
subdivisions 1 to 32, under which selection of entities is based on criteria related to
provider network access, coordination of health care with other local services, alignment
with local public health goals, and other factors.
 new text end

new text begin Subd. 2. new text end

new text begin Other requirements for participating entities. new text end

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

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

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

new text begin Subd. 3. new text end

new text begin Coordination with state-administered health programs. new text end

new text begin 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:
 new text end

new text begin (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;
 new text end

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

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

new text begin (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 health benefit exchange 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
 new text end

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 56.

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.

deleted text begin (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.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end 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.

deleted text begin (d)deleted text end new text begin (c)new text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 57.

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 deleted text begin gross individual ordeleted text end 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 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.

deleted text begin (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.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums
according to the premium scale specified in paragraph deleted text begin (d)deleted text end new text begin (c)new text end 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 deleted text begin (d)deleted text end new text begin (c)new text end , "minimum" means a monthly
premium of $4.

deleted text begin (d)deleted text end new text begin (c)new text end The following premium scale is established for individuals and families with
deleted text begin gross familydeleted text end incomes of deleted text begin 275deleted text end new text begin 200new text end 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%
deleted text begin 165-191
deleted text end new text begin 165-200new text end %
 4.6%
deleted text begin 192-219%
 deleted text end 		deleted text begin 5.6%
 deleted text end
deleted text begin 220-248%
 deleted text end 		deleted text begin 6.5%
 deleted text end
deleted text begin 249-275%
 deleted text end 		deleted text begin 7.2%
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin 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.
 new text end

Sec. 58. new text begin DETERMINATION OF FUNDING ADEQUACY.
new text end

new text begin 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 legislature by January 15,
2014, along with recommendations for changes to state revenue for the health care access
fund, if state funding will continue to be required beyond December 31, 2019.
new text end

Sec. 59. new text begin STATE-BASED RISK ADJUSTMENT SYSTEM ASSESSMENT.
new text end

new text begin (a) The commissioners of health, human services, and commerce, and the board of
MNsure, shall study whether Minnesota-based risk adjustment of the individual and small
group insurance market, using either the federal risk adjustment model or a state-based
alternative, can be more cost-effective and perform better than risk adjustment conducted
by federal agencies. The study shall assess the policies, infrastructure, and resources
necessary to satisfy the requirements of Code of Federal Regulations, title 45, section
153, subpart D. The study shall also evaluate the extent to which Minnesota-based risk
adjustment could meet requirements established in Code of Federal Regulations, title
45, section 153.330, including:
 new text end

new text begin (1) explaining the variation in health care costs of a given population;
 new text end

new text begin (2) linking risk factors to daily clinical practices and that which is clinically
meaningful to providers;
 new text end

new text begin (3) encouraging favorable behavior among health care market participants and
discouraging unfavorable behavior;
 new text end

new text begin (4) whether risk adjustment factors are relatively easy for stakeholders to understand
and participate in;
 new text end

new text begin (5) providing stable risk scores over time and across health plan products;
 new text end

new text begin (6) minimizing administrative costs;
 new text end

new text begin (7) accounting for risk selection across metal levels;
 new text end

new text begin (8) aligning each of the elements of the methodology; and
 new text end

new text begin (9) can be conducted at a per-member cost equal to or lower than the projected
cost of the federal risk adjustment model.
 new text end

new text begin (b) In conducting the study, and notwithstanding Minnesota Rules, chapter 4653,
and as part of responsibilities under Minnesota Statutes, section 62U.04, subdivision
4, paragraph (b), the commissioner of health shall collect from health carriers in the
individual and small group health insurance market, beginning on January 1, 2014, and for
service dates in calendar year 2014, all data required for conducting risk adjustment with
standard risk adjusters such as the Adjusted Clinical Groups or the Hierarchical Condition
Category System, including but not limited to:
 new text end

new text begin (1) an indicator identifying the health plan product under which an enrollee is covered;
 new text end

new text begin (2) an indicator identifying whether an enrollee's policy is an individual or small
group market policy;
 new text end

new text begin (3) an indicator identifying, if applicable, the metal level of an enrollee's health plan
product, and whether the policy is a catastrophic policy; and
 new text end

new text begin (4) additional identified demographic data necessary to link individuals' data across
carriers and insurance affordability programs with 95 percent accuracy. The commissioner
shall not collect more than the last four digits of an individual's social security number.
 new text end

new text begin (c) The commissioner of health shall also asses the extent to which data collected
under paragraph (b) and under Minnesota Statutes, section 62U.04, subdivision 4,
paragraph (a), are sufficient for developing and operating a state alternative risk adjustment
methodology consistent with applicable federal rules by evaluating:
 new text end

new text begin (1) if the data submitted are adequately complete, accurate, and timely;
 new text end

new text begin (2) if the data should be further enriched by nontraditional risk adjusters that help
in better explaining variation in health care costs of a given population and account for
risk selection across metal levels;
 new text end

new text begin (3) whether additional data or identifiers have the potential to strengthen a
Minnesota-based risk adjustment approach; and
 new text end

new text begin (4) what if any changes to the technical infrastructure will be necessary to effectively
perform state-based risk adjustment.
 new text end

new text begin For purposes of this paragraph, the commissioner of health shall have the authority to
use identified data to validate and audit a statistically valid sample of data for each
health carrier in the individual and small group market. In conducting the study, the
commissioners shall contract with entities that do not have an economic interest in the
outcome of Minnesota-based risk adjustment but do have demonstrated expertise in
actuarial science or health economics and demonstrated experience with designing and
implementing risk adjustment models.
 new text end

new text begin (d) The commissioner of human services shall evaluate opportunities to maximize
federal funding under section 1331 of the federal Patient and Protection and Affordable
Care Act, Public Law 111-148, and further defined through amendments to the act and
regulations issued under the act. The commissioner of human services shall make
recommendations on risk adjustment strategies to maximize federal funding to the state
of Minnesota.
 new text end

new text begin (e) The commissioners and board of MNsure shall submit to the legislature by March
15, 2014, an interim report with preliminary findings from the assessment conducted in
paragraphs (c) and (d). The interim report shall include legislative recommendations
for any necessary changes to Minnesota Statutes, section 62Q.03. A final report shall
be submitted by the commissioners and board of MNsure to the legislature by October
1, 2015. The final report must include findings from the overall assessment and a
recommendation whether to conduct state-based risk adjustment.
 new text end

new text begin (f) For purposes of this section, the board of MNsure means the board established
under Minnesota Statutes, section 62V.03.
 new text end

Sec. 60. new text begin REQUEST FOR FEDERAL AUTHORITY.
new text end

new text begin The commissioner of human services shall seek authority from the federal Centers
for Medicare and Medicaid Services to allow persons under age 65, participating in
a home and community-based services waiver under section 1915(c) of the Social
Security Act, to continue to disregard spousal income and assets, in place of the spousal
impoverishment provisions under the federal Patient Protection and Affordable Care Act,
Public Law 111-148, section 2404, as amended by the federal Health Care and Education
Reconciliation Act of 2010, Public Law 111-152, and any amendments to, or regulations
and guidance issued under, those acts.
 new text end

Sec. 61. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor shall remove cross-references to the sections repealed in this article
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.
 new text end

Sec. 62. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.031; 256L.04,
subdivisions 1b, 9, and 10a; 256L.05, subdivision 3b; 256L.07, subdivisions 5, 8, and 9;
256L.11, subdivision 5; and 256L.17, subdivisions 1, 2, 3, 4, and 5, new text end new text begin are repealed effective
January 1, 2014.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2012, section 256L.12, new text end new text begin is repealed effective January 1, 2015.
 new text end

new text begin (c) new text end new text begin Minnesota Statutes 2012, sections 256B.055, subdivisions 3, 5, and 10b;
256B.056, subdivision 5b; and 256B.057, subdivisions 1c and 2, new text end new text begin are repealed effective
January 1, 2014.
 new text end

ARTICLE 2

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 deleted text begin 256B.0911, subdivision 4a, by a
county, tribe, or managed care organization under contract with the Department of Human
Servicesdeleted text end new text begin 256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line
or other organization under contract with the Minnesota Board on Agingnew text end ; and

(2) new text begin a nursing facility level of care determination as provided for under section
256B.0911, subdivision 4e, as part of new text end 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 new text begin AND STUDY new text end REQUIRED.

new text begin Subdivision 1. new text end

new text begin Report requirements. new text end

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.

new text begin Subd. 2. new text end

new text begin Critical access study. new text end

new text begin 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.
 new text end

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 new text begin and staff who are
designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
256.01, subdivision 24, new text end 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 deleted text begin (cc)deleted text end new text begin (dd)new text end :

(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.

new text begin (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.
 new text end

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, deleted text begin todeleted text end new text begin who 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 new text end serve as Minnesota's neutral access point for statewide disability information and
assistancenew text begin and must be available during business hours through a statewide toll-free
number and the internetnew text end . 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 choicesnew text begin and link
them to quality profilesnew text end ;

(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; deleted text begin and
deleted text end

(9) serve as the technical assistance and help center for the Web-based tool,
Minnesota's Disability Benefits 101.orgdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (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.
 new text end

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, new text begin 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 new text end must be available during business hours through a statewide
toll-free number and deleted text begin must also be available throughdeleted text end the Internet.new text begin The Minnesota Board
on Aging shall consult with, and when appropriate work through, the area agencies on
aging counties, and other entities that serve aging and disabled populations of all ages,
to provide and maintain the telephone infrastructure and related support for the Aging
and Disability Resource Center partners which agree by memorandum to access the
infrastructure, including the designated providers of the Senior LinkAge Line and the
Disability Linkage Line.
new text end

(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 new text begin and provide for regular updating ofnew text end a comprehensive database that
includes detailed listings in both consumer- and provider-oriented formatsnew text begin that can provide
search results down to the neighborhood levelnew text end ;

(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 new text begin home and
community-based services new text end providers developed by the deleted text begin commissionerdeleted text end new text begin commissionersnew text end of
healthnew text begin and human servicesnew text end ;

new text begin (9) develop an outreach plan to seniors and their caregivers with a particular focus
on establishing a clear presence in places that seniors recognize and:
 new text end

new text begin (i) place a significant emphasis on improved outreach and service to seniors and
their caregivers by establishing annual plans by neighborhood, city, and county, as
necessary, to address the unique needs of geographic areas in the state where there are
dense populations of seniors;
 new text end

new text begin (ii) establish an efficient workforce management approach and assign community
living specialist staff and volunteers to geographic areas as well as aging and disability
resource center sites so that seniors and their caregivers and professionals recognize the
Senior LinkAge Line as the place to call for aging services and information;
new text end

new text begin (iii) recognize the size and complexity of the metropolitan area service system by
working with metropolitan counties to establish a clear partnership with them, including
seeking county advice on the establishment of local aging and disabilities resource center
sites; and
 new text end

new text begin (iv) maintain dashboards with metrics that demonstrate how the service is expanding
and extending or enhancing its outreach efforts in dispersed or hard to reach locations in
varied population centers;
 new text end

deleted text begin (9)deleted text end new text begin (10)new text end 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;

deleted text begin (10)deleted text end new text begin (11)new text end 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;

deleted text begin (11)deleted text end new text begin (12)new text end 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 commissionernew text begin and older adults who request service after consultation
with the Senior LinkAge Line under clause (12)new text end . deleted text begin In order to meet this requirement,deleted text end new text begin 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 withnew text end the commissioner new text begin who
new text end shall provide designated Senior LinkAge Line contact centers with a list of nursing
home residents new text begin that meet the criteria as being new text end 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 assessmentdeleted text begin , review of
risk factors, independent living support consultation, ordeleted text end new text begin and, if appropriate, anew text end 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 deleted text begin appropriatedeleted text end new text begin eligible
new text end for relocation service coordination due to high-risk factors or psychological or physical
disability; and

deleted text begin (12)deleted text end new text begin (13)new text end 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:


new text begin Subd. 7a. new text end

new text begin Preadmission screening activities related to nursing facility
admissions. new text end

new text begin (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).
 new text end

new text begin (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.
 new text end

new text begin (c) The following criteria apply to the preadmission screening:
 new text end

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

new text begin (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
 new text end

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

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

new text begin (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.
 new text end

new text begin (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).
 new text end

new text begin (e) In assessing a person's needs, the screener shall:
 new text end

new text begin (1) use an automated system designated by the commissioner;
 new text end

new text begin (2) consult with care transitions coordinators or physician; and
 new text end

new text begin (3) consider the assessment of the individual's physician.
 new text end

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2013.
 new text end

Sec. 8.

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


new text begin Subd. 7b. new text end

new text begin Exemptions and emergency admissions. new text end

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

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

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

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

new text begin (1) persons described in paragraph (a);
 new text end

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

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

new text begin (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.
 new text end

new text begin (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.
 new text end

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

new text begin (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;
 new text end

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

new text begin (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;
 new text end

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

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

new text begin 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.
 new text end

new text begin (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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2013.
 new text end

Sec. 9.

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


new text begin Subd. 7c. new text end

new text begin Screening requirements. new text end

new text begin (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:
 new text end

new text begin (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;
 new text end

new text begin (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
 new text end

new text begin (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.
 new text end

new text begin (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).
 new text end

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

new text begin (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.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2013.
 new text end

Sec. 10.

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


new text begin Subd. 7d. new text end

new text begin Payment for preadmission screening. new text end

new text begin 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).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2013.
 new text end

Sec. 11.

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


new text begin Subd. 3a. new text end

new text begin Priority for other grants. new text end

new text begin 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 part of the 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 under subdivision 3
when distributing transportation-related funds to create transportation options for older
adults unless that preference conflicts with existing state or federal guidance related to
grant awards by the Department of Transportation.
 new text end

Sec. 12.

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


new text begin Subd. 3b. new text end

new text begin State waivers. new text end

new text begin 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.
 new text end

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 occurringnew text begin or areas with service needs identified by section
144A.351new text end . 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:


new text begin Subd. 4a. new text end

new text begin Evaluation. new text end

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

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

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

new text begin (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.
 new text end

Sec. 15.

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


new text begin Subd. 6. new text end

new text begin Work, empower, and encourage independence. new text end

new text begin 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.
 new text end

Sec. 16.

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


new text begin Subd. 7. new text end

new text begin Housing stabilization. new text end

new text begin 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.
 new text end

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 new text begin subdivision 4d, new text end section 256.975, deleted text begin subdivisiondeleted text end new text begin subdivisionsnew text end 7new text begin to 7cnew text end , 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;

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

deleted text begin (7)deleted text end new text begin (6)new text end 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 deleted text begin 4a, paragraph (d)deleted text end new text begin 4enew text end , 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;

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

deleted text begin (9)deleted text end new text begin (8)new text end providing access to assistance to transition people back to community settings
after institutional admission; and

deleted text begin (10)deleted text end new text begin (9)new text end 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 256.01new text begin , subdivision 24,new text end 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 new text begin section 256.975, new text end subdivision deleted text begin 4a, paragraph (c)deleted text end new text begin 7a, paragraph (d)new text end .

(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 new text begin conducted by long-term
care options counselors according to section 256.975, subdivisions 7a to 7c, and section
256.01, subdivision 24, new text end if the person selects nursing facility placementnew text begin . 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 commissionernew text end ;

(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 deleted text begin 4a,
paragraph (d)deleted text end new text begin 4enew text end , 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 deleted text begin 65deleted text end new text begin 60new text end 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 deleted text begin 65deleted text end new text begin 60new text end years of age who are admitted to a new text begin Medicaid-certified
new text end nursing facility deleted text begin from a hospitaldeleted text end must be screened prior to admission deleted text begin as outlined in
subdivisions 4a through 4cdeleted text end new text begin 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 24new text end .

(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.

deleted text begin (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.
 deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end 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.

deleted text begin (f)deleted text end new text begin (e)new text end 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.

deleted text begin (g)deleted text end new text begin (f)new text end In the event that an individual under deleted text begin 65deleted text end new text begin 60new text end years of age is admitted to a
nursing facility on an emergency basis, the deleted text begin countydeleted text end new text begin Disability Linkage Linenew text end 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.

deleted text begin (h)deleted text end new text begin (g)new text end 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.

deleted text begin (i)deleted text end new text begin (h)new text end 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.

deleted text begin (j)deleted text end new text begin (i)new text end 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.

new text begin (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).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective October 1, 2013.
 new text end

Sec. 21.

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


new text begin Subd. 4e. new text end

new text begin Determination of institutional level of care. new text end

new text begin 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.
 new text end

Sec. 22.

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 new text begin section 256.975, new text end subdivisions deleted text begin 4a, 4b, and 4cdeleted text end new text begin 7a to 7cnew text end . The nursing
facility must include unreimbursed resident days in the nursing facility resident day totals
reported to the commissioner.

Sec. 23.

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 deleted text begin 4a, paragraph (d)deleted text end new text begin 4enew text end , 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. 24.

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


new text begin Subd. 17. new text end

new text begin Essential community supports grants. new text end

new text begin (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.
 new text end

new text begin (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:
 new text end

new text begin (1) is age 65 or older;
 new text end

new text begin (2) is not eligible for medical assistance;
 new text end

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

new text begin (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;
 new text end

new text begin (5) has a community support plan; and
 new text end

new text begin (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:
 new text end

new text begin (i) caregiver support;
 new text end

new text begin (ii) homemaker support;
 new text end

new text begin (iii) chores; or
 new text end

new text begin (iv) a personal emergency response device or system.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

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

new text begin (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;
 new text end

new text begin (2) meets one of the following criteria:
 new text end

new text begin (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
 new text end

new text begin (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;
 new text end

new text begin (3) is not eligible for personal care attendant services; and
 new text end

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

new text begin 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.
 new text end

new text begin (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.
 new text end

Sec. 25.

Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to
read:


Subd. 3a.

Elderly waiver cost limits.

(a) The monthly limit for the cost of
waivered services to an individual elderly waiver client except for individuals described in
deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (b)new text begin and (d)new text end shall be the weighted average monthly nursing facility
rate of the case mix resident class to which the elderly waiver client would be assigned
under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance
needs allowance as described in subdivision 1d, paragraph (a), until the first day of the
state fiscal year in which the resident assessment system as described in section 256B.438
for nursing home rate determination is implemented. Effective on the first day of the state
fiscal year in which the resident assessment system as described in section 256B.438 for
nursing home rate determination is implemented and the first day of each subsequent state
fiscal year, the monthly limit for the cost of waivered services to an individual elderly
waiver client shall be the rate of the case mix resident class to which the waiver client
would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on
the last day of the previous state fiscal year, adjusted by any legislatively adopted home
and community-based services percentage rate adjustment.

(b) The monthly limit for the cost of waivered services to an individual elderly
waiver client assigned to a case mix classification A under paragraph (a) with:

(1) no dependencies in activities of daily living; or

(2) 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

shall be $1,750 per month effective on July 1, 2011, 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 paragraph (a).

(c) If extended medical supplies and equipment or environmental modifications are
or will be purchased for an elderly waiver client, the costs may be prorated for up to
12 consecutive months beginning with the month of purchase. If the monthly cost of a
recipient's waivered services exceeds the monthly limit established in paragraph (a) or
(b), the annual cost of all waivered services shall be determined. In this event, the annual
cost of all waivered services shall not exceed 12 times the monthly limit of waivered
services as described in paragraph (a) or (b).

new text begin (d) Effective July 1, 2013, the monthly cost limit of waiver services, including
any necessary home care services described in section 256B.0651, subdivision 2, for
individuals who meet the criteria as ventilator-dependent given in section 256B.0651,
subdivision 1, paragraph (g), shall be the average of the monthly medical assistance
amount established for home care services as described in section 256B.0652, subdivision
7, and the annual average contracted amount established by the commissioner for nursing
facility services for ventilator-dependent individuals. This monthly limit shall be increased
annually as described in paragraph (a).
 new text end

Sec. 26.

Minnesota Statutes 2012, section 256B.0915, is amended by adding a
subdivision to read:


new text begin Subd. 3j. new text end

new text begin Individual community living support. new text end

new text begin Upon federal approval, there
is established a new service called individual community living support (ICLS) that is
available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor
have any interest in the recipient's housing. ICLS must be delivered in a single-family
home or apartment where the service recipient or their family owns or rents, as
demonstrated by a lease agreement, and maintains control over the individual unit. Case
managers or care coordinators must develop individual ICLS plans in consultation with
the client using a tool developed by the commissioner. The commissioner shall establish
payment rates and mechanisms to align payments with the type and amount of service
provided, assure statewide uniformity for payment rates, and assure cost-effectiveness.
Licensing standards for ICLS shall be reviewed jointly by the Departments of Health and
Human Services to avoid conflict with provider regulatory standards pursuant to section
144A.43 and chapter 245D.
new text end

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 deleted text begin 4a, paragraph (d)deleted text end new text begin 4enew text end , 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:


new text begin Subd. 1a. new text end

new text begin Home and community-based services for older adults. new text end

new text begin (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:
 new text end

new text begin (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;
 new text end

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

new text begin (3) support the informal caregivers of older adults;
 new text end

new text begin (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;
 new text end

new text begin (5) ensure cost-effective use of financial and human resources;
 new text end

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

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

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

new text begin (9) strengthen programs that use volunteers.
 new text end

new text begin (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.
 new text end

Sec. 29.

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


new text begin Subd. 1b. new text end

new text begin Definitions. new text end

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

new text begin (b) "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.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

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

Sec. 30.

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


new text begin Subd. 1c. new text end

new text begin Eldercare development partnerships. new text end

new text begin 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:
 new text end

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

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

new text begin (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;
 new text end

new text begin (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;
 new text end

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

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

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 deleted text begin up to 36deleted text end projects to expand the deleted text begin respite care network in the state and to
support caregivers in their responsibilities for care. The purpose of each project shall
be todeleted text end new text begin 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 shallnew text end :

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

(2) coordinate assignment of respite deleted text begin workersdeleted text end new text begin care servicesnew text end to deleted text begin clients and care
receivers and assure the health and safety of the client; anddeleted text end new text begin caregivers of older adults;
new text end

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

new text begin (3) assure the health and safety of the older adults;
 new text end

new text begin (4) identify at-risk caregivers;
 new text end

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

new text begin (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.
 new text end

deleted text begin (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.
 deleted text end

deleted text begin (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.
 deleted text end

deleted text begin (d) The commissioner shall select grantees based on the following criteriadeleted text end new text begin (b)
Projects must clearly describenew text end :

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

deleted text begin (2) the ability of the proposal to clearly describe how the projectdeleted text end new text begin (1) how theynew text end will
achieve deleted text begin thedeleted text end new text begin theirnew text end purpose deleted text begin defined in paragraph (b)deleted text end ;

deleted text begin (3) the ability of the proposal to reach underserved populations;
 deleted text end

deleted text begin (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;
 deleted text end

deleted text begin (5) the ability of the proposal to clearly describedeleted text end new text begin (2)new text end the process for recruiting,
training, and retraining volunteers; and

deleted text begin (6) the inclusion in the proposal of thedeleted text end new text begin (3) theirnew text end plan to promote the project in the
new text begin designated new text end community, including outreach to persons needing the services.

deleted text begin (e)deleted text end new text begin (c)new text end 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) deleted text begin traindeleted text end new text begin provide information, training, and education tonew text end caregivers;

deleted text begin (4) ensure the development of support groups for caregivers;
 deleted text end

deleted text begin (5)deleted text end new text begin (4)new text end advertise the availability of the caregiver support and respite care project; and

deleted text begin (6)deleted text end new text begin (5)new text end purchase equipment to maintain a system of assigning workers to clients.

deleted text begin (f)deleted text end new text begin (d)new text end 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:


new text begin Subd. 7a. new text end

new text begin Core home and community-based services. new text end

new text begin 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:
 new text end

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

new text begin (2) have a specific, clearly defined geographic service area;
 new text end

new text begin (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;
 new text end

new text begin (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;
 new text end

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

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

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

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

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 occurringnew text begin or to areas with service
needs identified under section 144A.351new text end . deleted text begin The commissioner shall consider grants for:
deleted text end

deleted text begin (1) caregiver support and respite care projects under subdivision 6;
 deleted text end

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

deleted text begin (3) services identified as needed for community transition.
 deleted text end

Sec. 34.

Minnesota Statutes 2012, section 256B.092, is amended by adding a
subdivision to read:


new text begin Subd. 14. new text end

new text begin Reduce avoidable behavioral crisis emergency room, psychiatric
inpatient hospitalizations, and commitments to institutions. new text end

new text begin (a) Persons receiving
home and community-based services authorized under this section who have had two
or more admissions within a calendar year to an emergency room, psychiatric unit,
or institution must receive consultation from a mental health professional as defined in
section 245.462, subdivision 18, or a behavioral professional as defined in the home and
community-based services state plan within 30 days of discharge. The mental health
professional or behavioral professional must:
 new text end

new text begin (1) conduct a functional assessment of the crisis incident as defined in section
245D.02, subdivision 11, which led to the hospitalization with the goal of developing
proactive strategies as well as necessary reactive strategies to reduce the likelihood of
future avoidable hospitalizations due to a behavioral crisis;
 new text end

new text begin (2) use the results of the functional assessment to amend the coordinated service and
support plan set forth in section 245D.02, subdivision 4b, to address the potential need
for additional staff training, increased staffing, access to crisis mobility services, mental
health services, use of technology, and crisis stabilization services in section 256B.0624,
subdivision 7; and
new text end

new text begin (3) identify the need for additional consultation, testing, and mental health crisis
intervention team services as defined in section 245D.02, subdivision 20, psychotropic
medication use and monitoring under section 245D.051, as well as the frequency and
duration of ongoing consultation.
new text end

new text begin (b) For the purposes of this subdivision, "institution" includes, but is not limited to,
the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.
 new text end

Sec. 35.

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 deleted text begin adeleted text end quality deleted text begin profile systemdeleted text end new text begin profilesnew text end for nursing facilities and,
beginning not later than July 1, deleted text begin 2004deleted text end new text begin 2014new text end , 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 deleted text begin systemdeleted text end new text begin quality profiles new text end must be developed
deleted text begin and implemented to the extent possible without the collection of significant amounts of
new data. To the extent possible, the systemdeleted text end new text begin using existing data sets maintained by the
commissioners of health and human services to the extent possible. The profiles new text end must
incorporate or be coordinated with information on quality maintained by area agencies on
aging, long-term care trade associations,new text begin the ombudsman offices, counties, tribes, health
plans,new text end and other entitiesnew text begin and the long-term care database maintained under section 256.975,
subdivision 7new text end . The deleted text begin systemdeleted text end new text begin profilesnew text end 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 deleted text begin systemdeleted text end new text begin profilesnew text end 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. 36.

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 deleted text begin currentdeleted text end state and federal requirements.

Sec. 37.

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


Subd. 3.

Consumer surveysnew text begin of nursing facilities residentsnew text end .

Following
identification of the quality measurement tool, the commissioners shall conduct surveys
of long-term care service consumers new text begin of nursing facilities new text end 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 deleted text begin servicedeleted text end new text begin nursing facilitiesnew text end providers.

Sec. 38.

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


new text begin Subd. 3a. new text end

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

new text begin 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 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.
 new text end

Sec. 39.

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


Subd. 4.

Dissemination of quality profiles.

By July 1, deleted text begin 2003deleted text end new text begin 2014new text end , the
commissioners shall implement a deleted text begin systemdeleted text end new text begin public awareness effortnew text end to disseminate the quality
profiles deleted text begin developed from consumer surveys using the quality measurement tooldeleted text end . Profiles
may be disseminated deleted text begin todeleted text end new text begin throughnew text end the Senior LinkAge Linenew text begin and Disability Linkage Linenew text end and
to consumers, providers, and purchasers of long-term care services deleted text begin through all feasible
printed and electronic outlets. The commissioners may conduct a public awareness
campaign to inform potential users regarding profile contents and potential usesdeleted text end .

Sec. 40.

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.0911new text begin , subdivision
4e,new text end 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. 41.

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 deleted text begin 4a, paragraph
(d)deleted text end new text begin 4enew text end , 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. 42.

Minnesota Statutes 2012, section 256B.49, is amended by adding a
subdivision to read:


new text begin Subd. 25. new text end

new text begin Reduce avoidable behavioral crisis emergency room, psychiatric
inpatient hospitalizations, and commitments to institutions. new text end

new text begin (a) Persons receiving
home and community-based services authorized under this section who have two or more
admissions within a calendar year to an emergency room, psychiatric unit, or institution
must receive consultation from a mental health professional as defined in section 245.462,
subdivision 18, or a behavioral professional as defined in the home and community-based
services state plan within 30 days of discharge. The mental health professional or
behavioral professional must:
 new text end

new text begin (1) conduct a functional assessment of the crisis incident as defined in section
245D.02, subdivision 11, which led to the hospitalization with the goal of developing
proactive strategies as well as necessary reactive strategies to reduce the likelihood of
future avoidable hospitalizations due to a behavioral crisis;
 new text end

new text begin (2) use the results of the functional assessment to amend the coordinated service and
support plan in section 245D.02, subdivision 4b, to address the potential need for additional
staff training, increased staffing, access to crisis mobility services, mental health services,
use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and
 new text end

new text begin (3) identify the need for additional consultation, testing, mental health crisis
intervention team services as defined in section 245D.02, subdivision 20, psychotropic
medication use and monitoring under section 245D.051, as well as the frequency and
duration of ongoing consultation.
new text end

new text begin (b) For the purposes of this subdivision, "institution" includes, but is not limited to,
the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.
 new text end

Sec. 43.

new text begin [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Basis and scope. new text end

new text begin (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)."
 new text end

new text begin (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.
 new text end

new text begin (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 complete the task or
supervision and cueing to complete 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.
 new text end

new text begin (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.
 new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

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

new text begin (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.
 new text end

new text begin (d) "Behavior" means a category to determine the home care rating and is based on the
criteria in section 256B.0659. "Level I behavior" means physical aggression towards self,
others, or destruction of property that requires the immediate response of another person.
 new text end

new text begin (e) "Complex health-related needs" means a category to determine the home care
rating and is based on the criteria in section 256B.0659.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

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

new text begin (i) "Dependency" in activities of daily living means a person requires assistance to
begin and complete one or more of the activities of daily living.
 new text end

new text begin (j) "Financial management services contractor or vendor" means a qualified
organization having a written contract with the department to provide services necessary
to use the flexible spending 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.
 new text end

new text begin (k) "Flexible spending 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.
 new text end

new text begin (l) "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.
 new text end

new text begin (m) "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.
 new text end

new text begin (n) "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.
 new text end

new text begin (o) "Medication assistance" means providing verbal or visual reminders to take
regularly scheduled medication and includes any of the following supports:
 new text end

new text begin (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;
 new text end

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

new text begin (3) providing verbal or visual reminders to perform regularly scheduled medications.
 new text end

new text begin (p) "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:
 new text end

new text begin (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;
 new text end

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

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

new text begin (q) "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:
 new text end

new text begin (1) include people chosen by the participant;
 new text end

new text begin (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;
 new text end

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

new text begin (4) reflect cultural considerations of the participant;
 new text end

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

new text begin (6) offers choices to the participant regarding the services and supports they receive
and from whom;
 new text end

new text begin (7) include a method for the participant to request updates to the plan; and
 new text end

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

new text begin (r) "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.
 new text end

new text begin (s) "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:
 new text end

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

new text begin (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
 new text end

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

new text begin (t) "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.
 new text end

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

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin (a) CFSS is available to a person who meets one of the
following:
 new text end

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

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

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

new text begin (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.
 new text end

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

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

new text begin (2) is not a recipient under the family support grant under section 252.32;
 new text end

new text begin (3) lives in the person's own apartment or home including a family foster care setting
licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
noncertified boarding care or boarding and lodging establishments under chapter 157;
unless transitioning into the community from an institution; and
 new text end

new text begin (4) has not been excluded or disenrolled from the flexible spending model.
new text end

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

new text begin (1) when a participant has been restricted by the Minnesota restricted recipient
program, the participant may be excluded for a specified time period;
 new text end

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

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

new text begin (d) A participant may appeal in writing to the department to contest the department's
decision under paragraph (c), clause (3), to remove or exclude the participant from the
flexible spending model.
 new text end

new text begin Subd. 4. new text end

new text begin Eligibility for other services. new text end

new text begin 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.
 new text end

new text begin Subd. 5. new text end

new text begin Assessment requirements. new text end

new text begin (a) The assessment of functional need must:
 new text end

new text begin (1) be conducted by a certified assessor according to the criteria established in
section 256B.0911;
 new text end

new text begin (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
 new text end

new text begin (3) be completed using the format established by the commissioner.
 new text end

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

new text begin (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.
 new text end

new text begin Subd. 6. new text end

new text begin Community first services and support service delivery plan. new text end

new text begin (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.
 new text end

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

new text begin (c) The CFSS service delivery plan must be person-centered and:
 new text end

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

new text begin (2) reflect the setting in which the participant resides that is chosen by the participant;
 new text end

new text begin (3) reflect the participant's strengths and preferences;
 new text end

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

new text begin (5) include individually identified goals and desired outcomes;
 new text end

new text begin (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;
 new text end

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

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

new text begin (9) be understandable to the participant and the individuals providing support;
 new text end

new text begin (10) identify the individual or entity responsible for monitoring the plan;
 new text end

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

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

new text begin (13) prevent the provision of unnecessary or inappropriate care.
 new text end

new text begin (d) The total units of agency-provider services or the budget allocation amount for
the flexible spending 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.
 new text end

new text begin Subd. 7. new text end

new text begin Community first services and supports; covered services. new text end

new text begin Services
and supports covered under CFSS include:
 new text end

new text begin (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;
 new text end

new text begin (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;
 new text end

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

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

new text begin (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; and
 new text end

new text begin (iii) fit within the annual limit of the participant's approved service allocation
or budget;
 new text end

new text begin (4) observation and redirection for episodes where there is a need for redirection
due to participant behaviors or intervention needed due to a participant's symptoms. An
assessment of behaviors must meet the criteria in this clause. 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:
 new text end

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

new text begin (ii) increased vulnerability due to cognitive deficits or socially inappropriate
behavior; or
 new text end

new text begin (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;
 new text end

new text begin (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;
 new text end

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

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

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

new text begin (iii) bedding;
 new text end

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

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

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

new text begin (7) services by a support specialist defined under subdivision 2 that are chosen
by the participant.
 new text end

new text begin Subd. 8. new text end

new text begin Determination of CFSS service methodology. new text end

new text begin (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 within 30 days after receiving
a complete request.
 new text end

new text begin (b) The amount of CFSS authorized must be based on the recipient's home
care rating. 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:
 new text end

new text begin (1) the total number of dependencies of activities of daily living as defined in
subdivision 2;
 new text end

new text begin (2) the presence of complex health-related needs as defined in subdivision 2; and
 new text end

new text begin (3) the presence of Level I behavior as defined in subdivision 2.
 new text end

new text begin (c) For purposes meeting the criteria in paragraph (b), the methodology to determine
the total minutes 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. Each
home care rating has a base number of minutes assigned. Additional minutes are added
through the assessment and identification of the following:
 new text end

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

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

new text begin (3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.
 new text end

new text begin Subd. 9. new text end

new text begin Noncovered services. new text end

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

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

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

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

new text begin (4) supplant natural unpaid supports that are provided voluntarily to the participant
and are selected by the participant in lieu of a support worker and appropriately meeting
the participant's needs;
 new text end

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

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

new text begin (b) Additional services, goods, or supports that are not covered include:
 new text end

new text begin (1) those that are not for the direct benefit of the participant;
 new text end

new text begin (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;
 new text end

new text begin (3) insurance, except for insurance costs related to employee coverage;
 new text end

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

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

new text begin (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;
 new text end

new text begin (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;
 new text end

new text begin (8) medical supplies and equipment;
 new text end

new text begin (9) environmental modifications, except as specified in subdivision 7;
 new text end

new text begin (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;
 new text end

new text begin (11) experimental treatments;
 new text end

new text begin (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;
 new text end

new text begin (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;
 new text end

new text begin (14) vacation expenses other than the cost of direct services;
 new text end

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

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

new text begin Subd. 10. new text end

new text begin Provider qualifications and general requirements. new text end

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

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

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

new text begin (3) demonstrate compliance with law and policies of CFSS as determined by the
commissioner;
 new text end

new text begin (4) comply with background study requirements under chapter 245C;
 new text end

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

new text begin (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;
 new text end

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

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

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

new text begin (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;
 new text end

new text begin (11) report suspected neglect and abuse to the common entry point according to
sections 256B.0651 and 626.557; and
 new text end

new text begin (12) provide the participant with a copy of the service-related rights under
subdivision 19 at the start of services and supports.
 new text end

new text begin (b) The commissioner shall develop policies and procedures designed to ensure
program integrity and fiscal accountability for goods and services provided in this section.
 new text end

new text begin Subd. 11. new text end

new text begin Agency-provider model. new text end

new text begin (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.
 new text end

new text begin (b) The agency-provider shall allow the participant to retain the ability 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 service delivery plan.
 new text end

new text begin (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
agency-provider services or the budget allocation amount for the flexible spending model
flexibly does not increase the total amount of services and supports authorized for a
participant or included in the participant's service delivery plan.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (f) The agency-provider model must be used by individuals who have been restricted
by the Minnesota restricted recipient program.
 new text end

new text begin Subd. 12. new text end

new text begin Requirements for initial enrollment of CFSS provider agencies. new text end

new text begin (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:
 new text end

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

new text begin (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;
 new text end

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

new text begin (4) proof of workers' compensation insurance coverage;
 new text end

new text begin (5) proof of liability insurance;
 new text end

new text begin (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;
 new text end

new text begin (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;
 new text end

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

new text begin (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;
 new text end

new text begin (ii) the CFSS provider agency's template for the CFSS care plan; and
 new text end

new text begin (iii) the CFSS provider agency's template for the written agreement in subdivision
21 for recipients using the CFSS choice option, if applicable;
 new text end

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

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

new text begin (11) documentation of the agency's marketing practices;
 new text end

new text begin (12) disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;
 new text end

new text begin (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
 new text end

new text begin (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.
 new text end

new text begin (b) CFSS provider agencies shall provide the information specified in paragraph
(a) to the commissioner.
 new text end

new text begin (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.
 new text end

new text begin Subd. 13. new text end

new text begin Flexible spending model. new text end

new text begin (a) Under the flexible spending 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:
 new text end

new text begin (1) participants directly employ support workers;
 new text end

new text begin (2) participants may use a budget allocation to obtain supports and goods as defined
in subdivision 7; and
 new text end

new text begin (3) from the financial management services (FMS) contractor the participant may
choose a range of support assistance services relating to:
 new text end

new text begin (i) planning, budgeting, and management of services and support;
 new text end

new text begin (ii) the participant's employment, training, supervision, and evaluation of workers;
 new text end

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

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

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

new text begin (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:
 new text end

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

new text begin (2) assistance with the development of the service delivery plan and flexible
spending model as requested by the participant;
 new text end

new text begin (3) billing and making payments for flexible spending model expenditures;
 new text end

new text begin (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;
 new text end

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

new text begin (6) other duties established in the contract with the department.
 new text end

new text begin (d) A participant who requests to purchase goods and supports along with support
worker services under the agency-provider model must use flexible spending 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.
 new text end

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

new text begin (1) not limit or restrict the participant's choice of service or support providers or
service delivery models as authorized by the commissioner;
 new text end

new text begin (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;
 new text end

new text begin (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;
 new text end

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

new text begin (5) assume fiscal accountability for state funds designated for the program; and
 new text end

new text begin (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.
 new text end

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

new text begin (1) establish rates and payment methodology for the FMS contractor;
 new text end

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

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

new text begin (g) Participants who are disenrolled from the model shall be transferred to the
agency-provider model.
 new text end

new text begin Subd. 14. new text end

new text begin Participant's responsibilities under flexible spending model. new text end

new text begin (a) A
participant using the flexible spending model must use a 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.
 new text end

new text begin (b) When the participant, participant's representative, or legal representative chooses
to be the employer of the support worker, they are responsible for recruiting, interviewing,
hiring, training, scheduling, supervising, and discharging direct support workers.
 new text end

new text begin (c) In addition to the employer responsibilities in paragraph (b), the participant,
participant's representative, or legal representative is responsible for:
 new text end

new text begin (1) tracking the services provided and all expenditures for goods or other supports;
 new text end

new text begin (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;
 new text end

new text begin (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;
 new text end

new text begin (4) notifying the FMS contractor of any changes in the employment status of each
participant support worker; and
 new text end

new text begin (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.
 new text end

new text begin Subd. 15. new text end

new text begin Documentation of support services provided. new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (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:
 new text end

new text begin (1) full name of the support worker and individual provider number;
 new text end

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

new text begin (3) full name of the participant;
 new text end

new text begin (4) consecutive dates, including month, day, and year, and arrival and departure
times with a.m. or p.m. notations;
 new text end

new text begin (5) signatures of the participant or the participant's representative;
 new text end

new text begin (6) personal signature of the support worker;
 new text end

new text begin (7) any shared care provided, if applicable;
 new text end

new text begin (8) a statement that it is a federal crime to provide false information on CFSS
billings for medical assistance payments; and
 new text end

new text begin (9) dates and location of recipient stays in a hospital, care facility, or incarceration.
 new text end

new text begin Subd. 16. new text end

new text begin Support workers requirements. new text end

new text begin (a) Support workers shall:
 new text end

new text begin (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:
 new text end

new text begin (i) the support worker is not disqualified under section 245C.14; or
 new text end

new text begin (ii) is disqualified, but the support worker has received a set-aside of the
disqualification under section 245C.22;
 new text end

new text begin (2) have the ability to effectively communicate with the participant or the
participant's representative;
 new text end

new text begin (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;
 new text end

new text begin (4) not be a participant of CFSS;
 new text end

new text begin (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;
 new text end

new text begin (6) complete training and orientation on the participant's individual needs; and
 new text end

new text begin (7) maintain the privacy and confidentiality of the participant, and not independently
determine the medication dose or time for medications for the participant.
 new text end

new text begin (b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
 new text end

new text begin (1) lacks the skills, knowledge, or ability to adequately or safely perform the
required work;
 new text end

new text begin (2) fails to provide the authorized services required by the participant employer;
 new text end

new text begin (3) has been intoxicated by alcohol or drugs while providing authorized services to
the participant or while in the participant's home;
 new text end

new text begin (4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
 new text end

new text begin (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.
 new text end

new text begin (c) A support worker may appeal in writing to the commissioner to contest the
decision to terminate the support worker's provider enrollment and provider number.
 new text end

new text begin Subd. 17. new text end

new text begin Support specialist requirements and payments. new text end

new text begin The commissioner
shall develop qualifications, scope of functions, and payment rates and service limits for a
support specialist that may provide additional or specialized assistance necessary to plan,
implement, arrange, augment, or evaluate services and supports.
 new text end

new text begin Subd. 18. new text end

new text begin Service unit and budget allocation requirements. new text end

new text begin (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 by section
256B.0652, subdivision 6. The unit rate established by the commissioner is used with
assessed units to determine the maximum available CFSS allocation.
 new text end

new text begin (b) For the flexible spending model, services and supports are authorized under
a budget limit.
 new text end

new text begin (c) The maximum available CFSS participant budget allocation shall be established
by multiplying the number of units authorized under subdivision 8 by the payment rate
established by the commissioner.
 new text end

new text begin Subd. 19. new text end

new text begin Support system. new text end

new text begin (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.
 new text end

new text begin (b) The commissioner shall provide assistance with the development of risk
management agreements.
 new text end

new text begin Subd. 20. new text end

new text begin Service-related rights. new text end

new text begin 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. A participant who appeals a reduction in
previously authorized CFSS services may continue previously authorized services pending
an appeal under section 256.045. The commissioner must ensure that the participant
has a copy of the most recent service delivery plan that contains a detailed explanation
of which areas of covered CFSS are reduced, and provide notice of the amount of the
budget reduction, and the reasons for the reduction in the participant's notice of denial,
termination, or reduction.
 new text end

new text begin Subd. 21. new text end

new text begin Development and Implementation Council. new text end

new text begin 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.
 new text end

new text begin Subd. 22. new text end

new text begin Quality assurance and risk management system. new text end

new text begin (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.
 new text end

new text begin (b) The commissioner shall provide ongoing technical assistance and resource and
educational materials for CFSS participants.
 new text end

new text begin (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.
 new text end

new text begin Subd. 23. new text end

new text begin Commissioner's access. new text end

new text begin 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.
 new text end

new text begin Subd. 24. new text end

new text begin CFSS agency-providers; background studies. new text end

new text begin CFSS agency-providers
enrolled to provide personal care assistance services under the medical assistance program
shall comply with the following:
 new text end

new text begin (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:
 new text end

new text begin (i) the organization has not initiated background studies on owners managing
employees; or
 new text end

new text begin (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;
 new text end

new text begin (2) a background study must be initiated and completed for all support specialists; and
 new text end

new text begin (3) a background study must be initiated and completed for all support workers.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval. The
commissioner of human services shall notify the revisor of statutes when this occurs.
 new text end

Sec. 44.

Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
to read:


new text begin Subd. 1o. new text end

new text begin Supplementary service rate; exemptions. new text end

new text begin 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).
 new text end

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. new text begin The common entry
point may accept electronic reports submitted through a Web-based reporting system
established by the commissioner. new text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2014.
 new text end

Sec. 46.

Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:


Subd. 9.

Common entry point designation.

(a) deleted text begin Each county board shall designate
a common entry point for reports of suspected maltreatment. Two or more county boards
may jointly designate a singledeleted text end new text begin The commissioner of human services shall establish a
new text end common entry pointnew text begin effective July 1, 2014new text end . The common entry point is the unit responsible
for receiving the report of suspected maltreatment under this section.

(b) The common entry point must be available 24 hours per day to take calls from
reporters of suspected maltreatment. The common entry point shall use a standard intake
form that includes:

(1) the time and date of the report;

(2) 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.new text begin 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.
new text end

new text begin (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.
 new text end

new text begin (i) a common entry point must be operated in a manner that enables the
commissioner of human services to:
 new text end

new text begin (1) track critical steps in the reporting, evaluation, referral, response, disposition,
and investigative process to ensure compliance with all requirements for all reports;
 new text end

new text begin (2) maintain data to facilitate the production of aggregate statistical reports for
monitoring patterns of abuse, neglect, or exploitation;
 new text end

new text begin (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;
 new text end

new text begin (4) set standards, priorities, and policies to maximize the efficiency and effectiveness
of the common entry point; and
 new text end

new text begin (5) track and manage consumer complaints related to the common entry point.
 new text end

new text begin (j) The commissioners of human services and health shall collaborate on the
creation of a system for referring reports to the lead investigative agencies. This system
shall enable the commissioner of human services to track critical steps in the reporting,
evaluation, referral, response, disposition, investigation, notification, determination, and
appeal processes.
 new text end

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.

new text begin (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.
 new text end

deleted text begin (b)deleted text end new text begin (c)new text end 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.

deleted text begin (c)deleted text end new text begin (d)new text end 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.

deleted text begin (d)deleted text end new text begin (e)new text end 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.

deleted text begin (e)deleted text end new text begin (f)new text end 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. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, sections 245A.655; and 256B.0917, subdivisions 1, 2,
3, 4, 5, 7, 8, 9, 10, 11, 12, and 14, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2012, section 256B.0911, subdivisions 4a, 4b, and 4c, new text end new text begin are
repealed effective October 1, 2013.
 new text end

Sec. 49. new text begin EFFECTIVE DATE; CONTINGENT SYSTEMS MODERNIZATION
APPROPRIATION.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) Unless otherwise indicated, "commissioner" means the commissioner of human
services.
 new text end

new text begin (c) "Contingent systems modernization appropriation" refers to the appropriation in
article 15, section 2.
 new text end

new text begin (d) "Department" means the Department of Human Services.
 new text end

new text begin (e) "Plan" means the plan that outlines how the provisions in this article, and the
contingent appropriation for systems modernization, are implemented once federal action
on Reform 2020 has occurred.
 new text end

new text begin (f) Unless otherwise indicated, "Reform 2020" means the commissioner's request
for any necessary federal approval of provisions in this article that modify or provide
new medical assistance services, or that otherwise modify the federal role in the state's
long-term care system.
 new text end

new text begin Subd. 2. new text end

new text begin Intent; effective dates generally. new text end

new text begin (a) Because the changes contained in
this article generate savings that are contingent on federal approval of Reform 2020,
the legislature has also made an appropriation for systems modernization contingent on
federal approval of Reform 2020. The purpose of this section is to outline how this article
and the contingent systems modernization appropriation in article 15 are implemented if
Reform 2020 is fully, partially, or incrementally approved or denied.
 new text end

new text begin (b) In order for sections 1 to 48 of this article to be effective, the commissioner must
follow the provisions of subdivisions 3 and 4, as applicable, notwithstanding any other
effective dates for those sections.
 new text end

new text begin Subd. 3. new text end

new text begin Federal approval. new text end

new text begin (a) The implementation of this article is contingent
on federal approval.
 new text end

new text begin (b) Upon full or partial approval of the waiver application, the commissioner shall
develop a plan for implementing the provisions in this article that received federal
approval as well as any that do not require federal approval. The plan must:
 new text end

new text begin (1) include fiscal estimates for the 2014-2015 and 2016-2017 biennia;
 new text end

new text begin (2) include the contingent systems modernization appropriation, which cannot
exceed $16,992,000 for the biennium ending June 30, 2015; and
 new text end

new text begin (3) include spending estimates that, with federal administrative reimbursement, do
not exceed the department's net general fund appropriations for the 2014-2015 biennium.
 new text end

new text begin (c) Upon approval by the commissioner of management and budget, the department
may implement the plan.
 new text end

new text begin (d) The commissioner may follow this plan and implement parts of Reform 2020
consistent with federal law if federal approval is denied, received incrementally, or
significantly delayed.
 new text end

new text begin (e) The commissioner must notify the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services funding of the
plan. The plan must be made publicly available online.
 new text end

new text begin Subd. 4. new text end

new text begin Disbursement; implementation. new text end

new text begin The commissioner of management and
budget shall disburse the appropriations in article 15, section 2, to the commissioner to
allow for implementation of the approved plan and make necessary adjustments in the
accounting system to reflect any modified funding levels. Notwithstanding Minnesota
Statutes, section 16A.11, subdivision 3, paragraph (b), these fiscal estimates must be
considered in establishing the appropriation base for the biennium ending June 30, 2017.
The commissioner of management and budget shall reflect the modified funding levels in
the first fund balance following the approval of the plan.
 new text end

ARTICLE 3

HOME AND COMMUNITY-BASED SERVICES DISABILITY RATE SETTING

Section 1.

Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to
read:


Subd. 2.

Payment methodologies.

(a) The commissioner shall establishnew text begin , as defined
under section 256B.4914,new text end statewide payment methodologies that meet federal waiver
requirements for home and community-based waiver services for individuals with
disabilities. The payment methodologies must abide by the principles of transparency
and equitability across the state. The methodologies must involve a uniform process of
structuring rates for each service and must promote quality and participant choice.

(b) As of January 1, 2012, counties shall not implement changes to established
processes for rate-setting methodologies for individuals using components of or data
from research rates.

Sec. 2.

Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:


Subd. 3.

Payment requirements.

The payment methodologies established under
this section shall accommodate:

(1) supervision costs;

(2) deleted text begin staffing patternsdeleted text end new text begin staff compensationnew text end ;

new text begin (3) staffing and supervisory patterns;
 new text end

deleted text begin (3)deleted text end new text begin (4)new text end program-related expenses;

deleted text begin (4)deleted text end new text begin (5)new text end general and administrative expenses; and

deleted text begin (5)deleted text end new text begin (6)new text end consideration of recipient intensity.

Sec. 3.

Minnesota Statutes 2012, section 256B.4913, is amended by adding a
subdivision to read:


new text begin Subd. 4a. new text end

new text begin Rate stabilization adjustment. new text end

new text begin (a) The commissioner of human services
shall adjust individual reimbursement rates by no more than 1.0 percent per year effective
January 1, 2016. Rates determined under section 256B.4914 must be adjusted so that
the unit rate varies no more than 1.0 percent per year from the rate effective December
1 of the prior calendar year. This adjustment is made annually for three calendar years
from the date of implementation.
 new text end

new text begin (b) Rate stabilization adjustment applies to services that are authorized in a
recipient's service plan prior to January 1, 2016.
 new text end

new text begin (c) Exemptions shall be made only when there is a significant change in the
recipient's assessed needs which results in a service authorization change. Exemption
adjustments shall be limited to the difference in the authorized framework rate specific to
change in assessed need. Exemptions shall be managed within lead agencies' budgets per
existing allocation procedures.
 new text end

new text begin (d) This subdivision expires January 1, 2019.
 new text end

Sec. 4.

Minnesota Statutes 2012, section 256B.4913, subdivision 5, is amended to read:


Subd. 5.

Stakeholder consultation.

The commissioner shall continue consultation
on regular intervals with the existing stakeholder group established as part of the
rate-setting methodology processnew text begin and others,new text end to gather input, concerns, and data, deleted text begin and
exchange ideas for the legislative proposals fordeleted text end new text begin to assist in the full implementation of
new text end the new rate payment system andnew text begin tonew text end make pertinent information available to the public
through the department's Web site.

Sec. 5.

Minnesota Statutes 2012, section 256B.4913, subdivision 6, is amended to read:


Subd. 6.

Implementation.

new text begin (a) new text end The commissioner deleted text begin maydeleted text end new text begin shallnew text end implement changes
deleted text begin no sooner thandeleted text end new text begin onnew text end January 1, 2014, to payment rates for individuals receiving home and
community-based waivered services after the enactment of legislation that establishes
specific payment methodology frameworks, processes for rate calculations, and specific
values to populate the deleted text begin payment methodology frameworksdeleted text end new text begin disability waiver rates systemnew text end .

new text begin (b) On January 1, 2014, all new service authorizations must use the disability waiver
rates system. Beginning January 1, 2014, all renewing individual service plans must use the
disability waiver rates system as reassessment and reauthorization occurs. By December
31, 2014, data for all recipients must be entered into the disability waiver rates system.
 new text end

Sec. 6.

new text begin [256B.4914] HOME AND COMMUNITY-BASED SERVICES WAIVERS;
RATE SETTING.
 new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin The payment methodologies in this section apply to
home and community-based services waivers under sections 256B.092 and 256B.49. This
section does not change existing waiver policies and procedures.
 new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

new text begin (b) "Commissioner" means the commissioner of human services.
 new text end

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

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

new text begin (e) "Disability Waiver Rates System" means a statewide system which establishes
rates that are based on uniform processes and captures the individualized nature of waiver
services and recipient needs.
 new text end

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

new text begin (g) "Median" means the amount that divides distribution into two equal groups, half
above the median and half below the median.
 new text end

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

new text begin (i) "Rates management system" means a web-based software application that uses
a framework and component values, as determined by the commissioner, to establish
service rates.
 new text end

new text begin (j) "Recipient" means a person receiving home and community-based services
funded under any of the disability waivers.
 new text end

new text begin Subd. 3. new text end

new text begin Applicable services. new text end

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

new text begin (1) 24-hour customized living;
 new text end

new text begin (2) adult day care;
 new text end

new text begin (3) adult day care bath;
 new text end

new text begin (4) behavioral programming;
 new text end

new text begin (5) companion services;
 new text end

new text begin (6) customized living;
 new text end

new text begin (7) day training and habilitation;
 new text end

new text begin (8) housing access coordination;
 new text end

new text begin (9) independent living skills;
 new text end

new text begin (10) in-home family support;
 new text end

new text begin (11) night supervision;
 new text end

new text begin (12) personal support;
 new text end

new text begin (13) prevocational services;
 new text end

new text begin (14) residential care services;
 new text end

new text begin (15) residential support services;
 new text end

new text begin (16) respite services;
 new text end

new text begin (17) structured day services;
 new text end

new text begin (18) supported employment services;
 new text end

new text begin (19) supported living services;
 new text end

new text begin (20) transportation services; and
 new text end

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

new text begin Subd. 4. new text end

new text begin Data collection for rate determination. new text end

new text begin (a) Rates for all applicable home
and community-based waivered services, including rate exceptions under subdivision 12
are set via the rates management system.
 new text end

new text begin (b) Only data and information in the rates management system may be used to
calculate an individual's rate.
 new text end

new text begin (c) Service providers, with information from the community support plan, shall enter
values and information needed to calculate an individual's rate into the rates management
system. These values and information include:
 new text end

new text begin (1) shared staffing hours;
 new text end

new text begin (2) individual staffing hours;
 new text end

new text begin (3) staffing ratios;
 new text end

new text begin (4) information to document variable levels of service qualification for variable
levels of reimbursement in each framework;
 new text end

new text begin (5) shared or individualized arrangements for unit-based services, including the
staffing ratio; and
 new text end

new text begin (6) number of trips and miles for transportation services.
 new text end

new text begin (d) Updates to individual data shall include:
 new text end

new text begin (1) data for each individual that is updated annually when renewing service plans; and
 new text end

new text begin (2) requests by individuals or lead agencies to update a rate whenever there is a
change in an individual's service needs, with accompanying documentation.
 new text end

new text begin (e) Lead agencies shall review and approve values to calculate the final payment rate
for each individual. Lead agencies must notify the individual and the service provider
of the final agreed upon values and rate. If a value used was mistakenly or erroneously
entered and used to calculate a rate, a provider may petition lead agencies to correct it.
Lead agencies must respond to these requests.
 new text end

new text begin Subd. 5. new text end

new text begin Base wage index and standard component values. new text end

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

new text begin (1) for residential direct care basic staff, 50 percent of the median wage for personal
and home health aide (SOC code 39-9021); 30 percent of the median wage for nursing
aide (SOC code 31-1012); and 20 percent of the median wage for social and human
services aide (SOC code 21-1093);
 new text end

new text begin (2) for residential direct care intensive staff, 20 percent of the median wage for home
health aide (SOC code 31-1011); 20 percent of the median wage for personal and home
health aide (SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code
21-1012); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
 new text end

new text begin (3) for day services, 20 percent of the median wage for nursing aide (SOC Code
31-1012); 20 percent of the median wage for psychiatric technician (SOC Code 29-2053);
and 60 percent of the median wage for social and human services code (SOC Code
21-1093);
 new text end

new text begin (4) for residential asleep overnight staff, the wage will be $7.66 per hour, except
in a family foster care setting the wage is $2.80 per hour;
 new text end

new text begin (5) for behavior program analyst staff: 100 percent of the median wage for mental
health counselors (SOC code 21-1014);
 new text end

new text begin (6) for behavior program professional staff: 100 percent of the median wage for
clinical counseling and school psychologist (SOC code 19-3031);
 new text end

new text begin (7) for behavior program specialist staff: 100 percent of the median wage for
psychiatric technicians (SOC code 29-2053);
 new text end

new text begin (8) for supportive living services staff: 20 percent of the median wage for nursing
aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 60 percent of the median wage for social and human services aide
(SOC code 21-1093);
 new text end

new text begin (9) for housing access coordination staff: 50 percent of the median wage for
community and social services specialist (SOC code 21-1099); and 50 percent of the
median wage for social and human services aide (SOC code 21-1093);
 new text end

new text begin (10) for in-home family support staff: 20 percent of the median wage for nursing
aide (SOC code 31-1012); 30 percent of community social service specialist (SOC code
21-1099); 40 percent of the median wage for social and human services aide (SOC code
21-1093); and 10 percent of the median wage for psychiatric technician (SOC code
29-2053);
 new text end

new text begin (11) for independent living skills staff: 40 percent of the median wage for
community social service specialist (SOC code 21-1099); 50 percent of the median wage
for social and human services aide (SOC code 21-1093); and 10 percent of the median
wage for psychiatric technician (SOC code 29-2053);
 new text end

new text begin (12) for supported employment staff: 20 percent of the median wage for nursing
aide (SOC code 31-1012); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 60 percent of the median wage for social and human services aide
(SOC code 21-1093);
 new text end

new text begin (13) for adult companion staff: 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing aides,
orderlies, and attendants (SOC code 31-1012);
 new text end

new text begin (14) for night supervision staff: 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing aide (SOC code 31-1012);
20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 20
percent of the median wage for social and human services aide (SOC code 21-1093);
 new text end

new text begin (15) for respite staff: 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing aides, orderlies, and
attendants (SOC code 31-1012);
 new text end

new text begin (16) for personal support staff: 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
aides, orderlies, and attendants (SOC code 31-1012); and
 new text end

new text begin (17) for supervisory staff: the basic wage is $17.43 per hour with exception of the
supervisor of behavior analyst and behavior specialists which shall be $30.75 per hour.
 new text end

new text begin (b) Component values for residential support services, excluding family foster
care, are:
 new text end

new text begin (1) supervisory span of control ratio: 11 percent;
 new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (4) general administrative support ratio: 13.25 percent;
 new text end

new text begin (5) program-related expense ratio: 1.3 percent; and
 new text end

new text begin (6) absence and utilization factor ratio: 3.9 percent.
 new text end

new text begin (c) Component values for family foster care are:
 new text end

new text begin (1) supervisory span of control ratio: 11 percent;
 new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (4) general administrative support ratio: 3.3 percent; and
 new text end

new text begin (5) program-related expense ratio: 1.3 percent.
 new text end

new text begin (d) Component values for day services for all services are:
 new text end

new text begin (1) supervisory span of control ratio: 11 percent;
 new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (4) program plan support ratio: 5.6 percent;
 new text end

new text begin (5) client programming and support ratio: 10 percent;
 new text end

new text begin (6) general administrative support ratio: 13.25 percent;
 new text end

new text begin (7) program-related expense ratio: 1.8 percent; and
 new text end

new text begin (8) absence and utilization factor ratio: 3.9 percent.
 new text end

new text begin (e) Component values for unit-based with program services are:
 new text end

new text begin (1) supervisory span of control ratio: 11 percent;
 new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
new text end

new text begin (4) program plan supports ratio: 3.1 percent;
 new text end

new text begin (5) client programming and support ratio: 8.6 percent;
 new text end

new text begin (6) general administrative support ratio: 13.25 percent;
 new text end

new text begin (7) program-related expense ratio: 6.1 percent; and
 new text end

new text begin (8) absence and utilization factor ratio: 3.9 percent.
 new text end

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

new text begin (1) supervisory span of control ratio: 11 percent;
 new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (4) program plan support ratio: 3.1 percent;
 new text end

new text begin (5) client programming and support ratio: 8.6 percent;
 new text end

new text begin (6) general administrative support ratio: 13.25 percent;
 new text end

new text begin (7) program-related expense ratio: 6.1 percent; and
 new text end

new text begin (8) absence and utilization factor ratio: 3.9 percent.
 new text end

new text begin (g) Component values for unit-based services without programming for respite are:
 new text end

new text begin (1) supervisory span of control ratio: 11 percent;
 new text end

new text begin (2) employee vacation, sick, and training allowance ratio: 8.71 percent;
 new text end

new text begin (3) employee-related cost ratio: 23.6 percent;
 new text end

new text begin (4) general administrative support ratio: 13.25 percent;
 new text end

new text begin (5) program-related expense ratio: 6.1 percent; and
 new text end

new text begin (6) absence and utilization factor ratio: 3.9 percent.
 new text end

new text begin (h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of
Labor Statistics available on December 31, 2016. The commissioner shall publish these
updated values and load them into the rate management system. This adjustment shall
occur every five years. For adjustments in 2021 and beyond, the commissioner shall use
the data available on December 31 of the calendar year five years prior.
 new text end

new text begin (i) On July 1, 2017, the commissioner shall update the framework components in
paragraph (c) for changes in the Consumer Price Index. The commissioner must adjust
these values higher or lower by the percentage change in the Consumer Price Index-All
Items (United States city average) (CPI-U) from January 1, 2014, to January 1, 2017. The
commissioner shall publish these updated values and load them into the rate management
system. This adjustment shall occur every five years. For adjustments in 2021 and
beyond, the commissioner shall use the data available on January 1 of the calendar year
four years prior and January 1 of the current calendar year.
 new text end

new text begin Subd. 6. new text end

new text begin Payments for residential support services. new text end

new text begin (a) Payments for residential
support services, as defined in sections 256B.092, subdivision 11, and 256B.49 subdivision
22, must be calculated as follows:
 new text end

new text begin (1) determine the number of units of service to meet a recipient's needs;
 new text end

new text begin (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
national and Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5. This is defined as the direct care rate;
 new text end

new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
 new text end

new text begin (4) multiply the number of residential services direct staff hours by the appropriate
staff wage in subdivision 5, paragraph (a), or the customized direct care rate;
 new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
 new text end

new text begin (6) combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (2). This is defined as the direct staffing cost;
 new text end

new text begin (7) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
 new text end

new text begin (8) for client programming and supports, the commissioner shall add $2,179; and
 new text end

new text begin (9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport per year.
 new text end

new text begin (b) The total rate shall be calculated using the following steps:
 new text end

new text begin (1) subtotal paragraph (a), clauses (7) to (9);
 new text end

new text begin (2) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization ratio; and
 new text end

new text begin (3) divide the result of clause (1) by one minus the result of clause (2). This is
the total payment amount.
 new text end

new text begin Subd. 7. new text end

new text begin Payments for day programs. new text end

new text begin Payments for services with day programs
including adult day care, day treatment and habilitation, prevocational services, and
structured day services must be calculated as follows:
 new text end

new text begin (1) determine the number of units of service to meet a recipient's needs;
 new text end

new text begin (2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
 new text end

new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
 new text end

new text begin (4) multiply the number of day program direct staff hours by the appropriate staff
wage in subdivision 5, paragraph (a), or the customized direct care rate;
 new text end

new text begin (5) multiply the number of day program direct staff hours by the product of the
supervision span of control ratio in subdivision 5, paragraph (d), clause (1), and the
appropriate supervision wage in subdivision 5, paragraph (a), clause (17);
 new text end

new text begin (6) combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d),
clause (2). This is defined as the direct staffing rate;
 new text end

new text begin (7) for program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in subdivision 5, paragraph (d), clause (4);
 new text end

new text begin (8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (3);
 new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (5);
 new text end

new text begin (10) for program facility costs, add $8.30 per week with consideration of staffing
ratios to meet individual needs;
 new text end

new text begin (11) for adult day bath services, add $7.01 per 15 minute unit;
 new text end

new text begin (12) this is the subtotal rate;
 new text end

new text begin (13) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
 new text end

new text begin (14) divide the result of clause (12) by one minus the result of clause (13). This is
the total payment amount;
 new text end

new text begin (15) for transportation provided as part of day training and habilitation for an
individual who does not require a lift, add:
 new text end

new text begin (i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle
without a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared
ride in a vehicle with a lift;
 new text end

new text begin (ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle
without a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared
ride in a vehicle with a lift;
 new text end

new text begin (iii) $25.75 for a trip between 21and 50 miles for a nonshared ride in a vehicle
without a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared
ride in a vehicle with a lift; or
 new text end

new text begin (iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a
lift, $16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a
vehicle with a lift;
 new text end

new text begin (16) for transportation provide as part of day training and habilitation for an
individual who does require a lift, add:
 new text end

new text begin (i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with
a lift, and $15.05 for a shared ride in a vehicle with a lift;
 new text end

new text begin (ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
 new text end

new text begin (iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with
a lift, and $58.76 for a shared ride in a vehicle with a lift; or
 new text end

new text begin (iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a
lift, and $80.93 for a shared ride in a vehicle with a lift.
 new text end

new text begin Subd. 8. new text end

new text begin Payments for unit-based services with programming. new text end

new text begin Payments for
unit-based services with programming, including behavior programming, housing access
coordination, in-home family support, independent living skills training, hourly supported
living services, and supported employment provided to an individual outside of any day or
residential service plan must be calculated as follows, unless the services are authorized
separately under subdivision 6 or 7:
 new text end

new text begin (1) determine the number of units of service to meet a recipient's needs;
 new text end

new text begin (2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision 5;
 new text end

new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
 new text end

new text begin (4) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5, paragraph (a), or the customized direct care rate;
 new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
 new text end

new text begin (6) combine the results of clauses (4) and (5), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e),
clause (2). This is defined as the direct staffing rate;
 new text end

new text begin (7) for program plan support, multiply the result of clause (6) by one plus the
program plan supports ratio in subdivision 5, paragraph (e), clause (4);
 new text end

new text begin (8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
 new text end

new text begin (9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
 new text end

new text begin (10) this is the subtotal rate;
 new text end

new text begin (11) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio; and
 new text end

new text begin (12) divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount.
 new text end

new text begin Subd. 9. new text end

new text begin Payments for unit-based services without programming. new text end

new text begin Payments
for unit-based without program services including night supervision, personal support,
respite, and companion care provided to an individual outside of any day or residential
service plan must be calculated as follows unless the services are authorized separately
under subdivision 6 or 7:
 new text end

new text begin (1) for all services except respite, determine the number of units of service to meet
a recipient's needs;
 new text end

new text begin (2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
 new text end

new text begin (3) for a recipient requiring customization for deaf or hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct care rate;
 new text end

new text begin (4) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5 or the customized direct care rate;
 new text end

new text begin (5) multiply the number of direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (f), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
 new text end

new text begin (6) combine the results of clauses (4) and (5) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in, subdivision 5, paragraph (f),
clause (2). This is defined as the direct staffing rate;
 new text end

new text begin (7) for program plan support, multiply the result of clause (6) by one plus the
program plan support ratio in subdivision 5, paragraph (f), clause (4);
 new text end

new text begin (8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (f), clause (3);
 new text end

new text begin (9) For client programming and supports, multiply the result of clause (8) by one
plus the client programming and support ratio in subdivision 5, paragraph (f), clause (5);
 new text end

new text begin (10) this is the subtotal rate;
 new text end

new text begin (11) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio;
 new text end

new text begin (12) divide the result of clause (10) by one minus the result of clause (11). This is
the total payment amount;
 new text end

new text begin (13) for respite services, determine the number of daily units of service to meet an
individual's needs;
 new text end

new text begin (14) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
 new text end

new text begin (15) for a recipient requiring deaf or hard-of-hearing customization under
subdivision 12, add the customization rate provided in subdivision 12 to the result of
clause (14). This is defined as the customized direct care rate;
 new text end

new text begin (16) multiply the number of direct staff hours by the appropriate staff wage in
subdivision 5, paragraph (a);
 new text end

new text begin (17) multiply the number of direct staff hours by the product of the supervisory span
of control ratio in subdivision 5, paragraph (g), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (17);
 new text end

new text begin (18) combine the results of clauses (16) and (17) and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (g),
clause (2). This is defined as the direct staffing rate;
 new text end

new text begin (19) for employee-related expenses, multiply the result of clause (18) by one plus
the employee-related cost ratio in subdivision 5, paragraph (g), clause (3).
 new text end

new text begin (20) this is the subtotal rate;
 new text end

new text begin (21) sum the standard general and administrative rate, the program-related expense
ratio, and the absence and utilization factor ratio; and
 new text end

new text begin (22) divide the result of clause (20) by one minus the result of clause (21). This is
the total payment amount.
 new text end

new text begin Subd. 10. new text end

new text begin Updating payment values and additional information. new text end

new text begin (a) The
commissioner shall develop and implement uniform procedures to refine terms and update
or adjust values used to calculate payment rates in this section. For calendar year 2014,
the commissioner shall use the values, terms, and procedures provided in this section.
 new text end

new text begin (b) The commissioner shall work with stakeholders to assess efficacy of values
and payment rates. The commissioner shall report back to the legislature with proposed
changes for component values and recommendations for revisions on the schedule
provided in paragraphs (c) and (d).
 new text end

new text begin (c) The commissioner shall work with stakeholders to continue refining a
subset of component values, which are to be referred to as interim values, and report
recommendations to the legislature by February 15, 2014. Interim component values are:
transportation rates for day training and habilitation; transportation for adult day, structured
day, and prevocational services; geographic difference factor; day program facility rate;
services where monitoring technology replaces staff time; shared services for independent
living skills training; and supported employment and billing for indirect services.
 new text end

new text begin (d) The commissioner shall report and make recommendations to the legislature on:
February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
2021, reports shall be provided on a four-year cycle.
 new text end

new text begin (e) The commissioner shall provide a public notice via list serve in October of each
year beginning October 1, 2014. The notice shall contain information detailing legislatively
approved changes in: calculation values including derived wage rates and related employee
and administrative factors; services utilization; county and tribal allocation changes
and; information on adjustments to be made to calculation values and timing of those
adjustments. Information in this notice shall be effective January 1 of the following year.
 new text end

new text begin Subd. 11. new text end

new text begin Payment implementation. new text end

new text begin Upon implementation of the payment
methodologies under this section, those payment rates supersede rates established in county
contracts for recipients receiving waiver services under sections 256B.092 or 256B.49.
 new text end

new text begin Subd. 12. new text end

new text begin Customization of rates for individuals. new text end

new text begin (a) For persons determined to
have higher needs based on being deaf or hard-of-hearing, the direct care costs must be
increased by an adjustment factor prior to calculating the rate under subdivisions 6, 7, 8,
and 9. The customization rate with respect to deaf or hard-of-hearing persons shall be
$2.50 per hour for waiver recipients who meet the respective criteria as determined by
the commissioner.
new text end

new text begin (b) For the purposes of this section, "Deaf or Hard of Hearing" means:
 new text end

new text begin (1)(i) the person has a developmental disability and an assessment score which
indicates a hearing impairment that is severe or that the person has no useful hearing;
 new text end

new text begin (ii) the person has a developmental disability and an expressive communications
score that indicates the person uses single signs or gestures, uses an augmentative
communication aid, or does not have functional communication, or the person's expressive
communications are unknown; and
 new text end

new text begin (iii) the person has a developmental disability and a communication score which
indicates the person comprehends signs, gestures, and modeling prompts or does not
comprehend verbal, visual, or gestural communication or that the person's receptive
communications score is unknown; or
 new text end

new text begin (2)(i) the person receives long-term care services and has an assessment score which
indicates they hear only very loud sounds, have no useful hearing, or a determination
cannot be made; and
 new text end

new text begin (ii) the person receives long-term care services and has an assessment which
indicates the person communicates needs with sign language, symbol board, written
messages, gestures or an interpreter; communicates with inappropriate content; makes
garbled sounds or displays echolalia; or does not communicate needs.
 new text end

new text begin Subd. 13. new text end

new text begin Transportation. new text end

new text begin The commissioner shall require that the purchase
of transportation services be cost-effective and be limited to market rates where the
transportation mode is generally available and accessible.
 new text end

new text begin Subd. 14. new text end

new text begin Exceptions. new text end

new text begin (a) In a format prescribed by the commissioner, lead
agencies must identify individuals with exceptional needs that cannot be met under the
disability waiver rate system. The commissioner shall use that information to evaluate
and, if necessary, approve an alternative payment rate for those individuals.
 new text end

new text begin (b) Lead agencies must submit exception requests to the state.
 new text end

new text begin (c) An application for a rate exception may be submitted for the following criteria:
 new text end

new text begin (1) an individual has service needs that cannot be met through additional units
of service; or
 new text end

new text begin (2) an individual's rate determined under subdivisions 6, 7, 8, and 9 results in an
individual being discharged.
 new text end

new text begin (d) Exception requests must include the following information:
 new text end

new text begin (1) the service needs required by each individual that are not accounted for in
subdivisions 6, 7, 8, and 9;
 new text end

new text begin (2) the service rate requested and the difference from the rate determined in
subdivisions 6, 7, 8, and 9;
 new text end

new text begin (3) a basis for the underlying costs used for the rate exception and any accompanying
documentation;
 new text end

new text begin (4) the duration of the rate exception; and
 new text end

new text begin (5) any contingencies for approval.
 new text end

new text begin (e) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.
 new text end

new text begin (f) Individual disability waiver recipients may request that a lead agency submit an
exception request. A lead agency that denies such a request shall notify the individual
waiver recipient of its decision and the reasons for denying the request in writing no later
than 30 days after the individual's request has been made.
 new text end

new text begin (g) The commissioner shall determine whether to approve or deny an exception
request no more than 30 days after receiving the request. If the commissioner denies the
request, the commissioner shall notify the lead agency and the individual disability waiver
recipient in writing of the reasons for the denial.
 new text end

new text begin (h) The individual disability waiver recipient may appeal any denial of an exception
request by either the lead agency or the commissioner, pursuant to sections 256.045 and
256.0451. When the denial of an exception request results in the proposed demission of a
waiver recipient from a residential or day habilitation program, the commissioner shall
issue a temporary stay of demission, when requested by the disability waiver recipient,
consistent with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c).
The temporary stay shall remain in effect until the lead agency can provide an informed
choice of appropriate, alternative services to the disability waiver.
 new text end

new text begin (i) Providers may petition lead agencies to update values that were entered
incorrectly or erroneously into the rate management system, based on past service level
discussions and determination in subdivision 4, without applying for a rate exception.
 new text end

new text begin Subd. 15. new text end

new text begin County or tribal allocations. new text end

new text begin (a) Upon implementation of the Disability
Waiver Rates Management System on January 1, 2014, the commissioner shall establish
a method of tracking and reporting the fiscal impact of the Disability Waiver Rates
Management System on individual lead agencies.
 new text end

new text begin (b) Beginning January 1, 2014, and continuing through full implementation on
December 31, 2017, the commissioner shall make annual adjustments to lead agencies'
home and community-based waivered service budget allocations to adjust for rate
differences and the resulting impact on county allocations upon implementation of the
disability waiver rates system.
 new text end

new text begin Subd. 16. new text end

new text begin Budget neutrality adjustment. new text end

new text begin The commissioner shall calculate the
total spending for all home and community-based waiver services under the payments as
defined in subdivisions 6, 7, 8, and 9 for all recipients as of July 1, 2013, and compare it to
spending for services defined for subdivisions 6, 7, 8, and 9 under current law. If spending
for services in one particular subdivision differs, there will be a percentage adjustment
to increase or decrease individual rates for the services defined in each subdivision so
aggregate spending matches projections under current law.
 new text end

new text begin Subd. 17. new text end

new text begin Implementation. new text end

new text begin (a) On January 1, 2014, the commissioner shall fully
implement the calculation of rates for waivered services under sections 256B.092 and
256B.49, without additional legislative approval.
 new text end

new text begin (b) The commissioner shall phase in the application of rates determined in
subdivisions 6 to 9 for two years.
 new text end

new text begin (c) The commissioner shall preserve rates in effect on December 31, 2013, for
the two-year period.
 new text end

new text begin (d) The commissioner shall calculate and measure the difference in cost per
individual using the historical rate and the rates under subdivisions 6 to 9, for all
individuals enrolled as of December 31, 2013. This measurement shall occur statewide,
and for individuals in every county.
 new text end

new text begin The commissioner shall provide the results of this analysis, by county for calendar
year 2014, to the legislative committees with jurisdiction over health and human services
finance by February 15, 2015.
 new text end

new text begin (e) The commissioner shall calculate the average rate per unit for each service by
county. For individuals enrolled after January 1, 2014, individuals will receive the higher
of the rate produced under subdivisions 6 to 9, or the by-county average rate.
 new text end

new text begin (f) On January 1, 2016, the rates determined in subdivisions 6 to 9 shall be applied.
 new text end

Sec. 7. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2012, section 256B.4913, subdivisions 1, 2, 3, and 4, new text end new text begin are repealed.
 new text end

ARTICLE 4

STRENGTHENING CHEMICAL AND MENTAL HEALTH SERVICES

Section 1.

Minnesota Statutes 2012, section 245.4661, subdivision 5, is amended to read:


Subd. 5.

Planning for pilot projects.

new text begin (a) new text end Each local plan for a pilot projectnew text begin , with
the exception of the placement of a Minnesota specialty treatment facility as defined in
paragraph (c),new text end 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.

new text begin (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.
 new text end

new text begin (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).
 new text end

Sec. 2.

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; deleted text begin and
deleted text end

(5) regional treatment center resources consistent with section 246.0136, subdivision
1deleted text begin .deleted text end new text begin ; and
new text end

new text begin (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.
 new text end

(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. 3.

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 deleted text begin and children'sdeleted text end mental health grants under sections
245.4661deleted text begin , 245.4889,deleted text end and 256E.12.

(c) This appropriation is not authorized to be expended after December 31, 2010,
unless approved by the legislature.

Sec. 4.

Minnesota Statutes 2012, section 246.18, subdivision 8, is amended to read:


Subd. 8.

State-operated services account.

new text begin (a) new text end 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.

new text begin (b) Funds deposited in the state-operated services account are available to the
commissioner of human services for the purposes of:
 new text end

new text begin (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;
new text end

new text begin (2) grants to providers participating in mental health specialty treatment services
under section 245.4661; and
 new text end

new text begin (3) to fund the operation of the Intensive Residential Treatment Service program in
Willmar.
 new text end

Sec. 5.

Minnesota Statutes 2012, section 246.18, is amended by adding a subdivision
to read:


new text begin Subd. 9. new text end

new text begin Transfers. new text end

new text begin 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.
 new text end

Sec. 6.

Minnesota Statutes 2012, section 254B.13, is amended to read:


254B.13 PILOT PROJECTS; CHEMICAL HEALTH CARE.

Subdivision 1.

Authorization for new text begin navigator new text end pilot projects.

The commissioner may
approve and implement new text begin navigator new text end 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 new text begin navigator new text end pilot projects shall continue to work in partnership
to refine and implement the new text begin navigator new text end pilot projects initiated under Laws 2009, chapter
79, article 7, section 26.

(b) The commissioner and counties participating in the new text begin navigator new text end pilot projects shall
complete the planning phase deleted text begin by June 30, 2010,deleted text end and, if approved by the commissioner for
implementation, enter into agreements governing the operation of the new text begin navigator new text end pilot
projects deleted text begin with implementation scheduled no earlier than July 1, 2010deleted text end .

new text begin Subd. 2a. new text end

new text begin Eligibility for navigator pilot program. new text end

new text begin (a) To be considered for
participation in a navigator pilot program, an individual must:
 new text end

new text begin (1) be a resident of a county with an approved navigator program;
 new text end

new text begin (2) be eligible for consolidated chemical dependency treatment fund services;
 new text end

new text begin (3) be a voluntary participant in the navigator program;
 new text end

new text begin (4) satisfy one of the following items:
 new text end

new text begin (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
 new text end

new text begin (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
 new text end

new text begin (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.
 new text end

new text begin (b) New eligibility criteria may be added as mutually agreed upon by the
commissioner and participating navigator programs.
 new text end

Subd. 3.

Program evaluation.

The commissioner shall evaluate new text begin navigator new text end 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 new text begin navigator new text end pilot projects must be
based on outcome evaluation criteria negotiated with the new text begin navigator new text end pilot projects prior
to implementation.

Subd. 4.

Notice of new text begin navigator new text end project discontinuation.

Each county's participation
in the new text begin navigator new text end 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. deleted text begin 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.
deleted text end

Subd. 5.

Duties of commissioner.

(a) Notwithstanding any other provisions in
this chapter, the commissioner may authorize new text begin navigator new text end pilot projects to use chemical
dependency treatment funds to pay for nontreatment new text begin navigator new text end 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 new text begin navigator new text end 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 new text begin navigator
new text end pilot services provided by or through the new text begin navigator new text end pilot projects must not be greater than
the chemical dependency treatment fund expected share of forecasted expenditures in the
absence of the new text begin navigator new text end 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 thenew text begin navigatornew text end pilot projects.

deleted text begin (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.
 deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end The commissioner may waive administrative rule requirements that are
incompatible with the implementation of the new text begin navigator new text end pilot project, except that any
chemical dependency treatment funded under this section must continue to be provided
by a licensed treatment provider.

deleted text begin (f)deleted text end new text begin (e)new text end The commissioner shall not approve or enter into any agreement related to
new text begin navigator new text end pilot projects authorized under this section that puts current or future federal
funding at risk.

new text begin (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.
 new text end

Subd. 6.

Duties of county board.

The county board, or other county entity that
is approved to administer a new text begin navigator new text end pilot project, shall:

(1) administer the new text begin navigator new text end pilot project in a manner consistent with the objectives
described in subdivision 2 and the planning process in subdivision 5;

(2) ensure that no one is denied chemical dependency treatment services for which
they would otherwise be eligible under section 254A.03, subdivision 3; and

(3) provide the commissioner with timely and pertinent information as negotiated in
agreements governing operation of the new text begin navigator new text end pilot projects.

new text begin Subd. 7. new text end

new text begin Managed care. new text end

new text begin An individual who is eligible for the navigator pilot
program under subdivision 2a is excluded from mandatory enrollment in managed care
until these services are included in the health plan's benefit set.
 new text end

new text begin Subd. 8. new text end

new text begin Authorization for continuation of navigator pilots. new text end

new text begin The navigator pilot
projects implemented pursuant to subdivision 1 are authorized to continue operation after
July 1, 2013, under existing agreements governing operation of the pilot projects.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to subdivisions 1 to 6 and 8 are effective
August 1, 2013. Subdivision 7 is effective July 1, 2013.
 new text end

Sec. 7.

new text begin [254B.14] CONTINUUM OF CARE PILOT PROJECTS; CHEMICAL
HEALTH CARE.
 new text end

new text begin Subdivision 1. new text end

new text begin Authorization for continuum of care pilot projects. new text end

new text begin The
commissioner shall establish chemical dependency continuum of care pilot projects to
begin implementing the measures developed with stakeholder input and identified in the
report completed pursuant to Laws 2012, chapter 247, article 5, section 8. The pilot
projects are intended to improve the effectiveness and efficiency of the service continuum
for chemically dependent individuals in Minnesota while reducing duplication of efforts
and promoting scientifically supported practices.
 new text end

new text begin Subd. 2. new text end

new text begin Program implementation. new text end

new text begin (a) The commissioner, in coordination with
representatives of the Minnesota Association of County Social Service Administrators
and the Minnesota Inter-County Association, shall develop a process for identifying and
selecting interested counties and providers for participation in the continuum of care pilot
projects. There will be three pilot projects; one representing the northern region, one for
the metro region, and one for the southern region. The selection process of counties and
providers must include consideration of population size, geographic distribution, cultural
and racial demographics, and provider accessibility. The commissioner shall identify
counties and providers that are selected for participation in the continuum of care pilot
projects no later than September 30, 2013.
 new text end

new text begin (b) The commissioner and entities participating in the continuum of care pilot
projects shall enter into agreements governing the operation of the continuum of care pilot
projects. The agreements shall identify pilot project outcomes and include timelines for
implementation and beginning operation of the pilot projects.
 new text end

new text begin (c) Entities that are currently participating in the navigator pilot project are
eligible to participate in the continuum of care pilot project subsequent to or instead of
participating in the navigator pilot project.
 new text end

new text begin (d) The commissioner may waive administrative rule requirements that are
incompatible with implementation of the continuum of care pilot projects.
 new text end

new text begin (e) Notwithstanding section 254A.19, the commissioner may designate noncounty
entities to complete chemical use assessments and placement authorizations required
under section 254A.19 and Minnesota Rules, parts 9530.6600 to 9530.6655. Section
254A.19, subdivision 3, is applicable to the continuum of care pilot projects at the
discretion of the commissioner.
 new text end

new text begin Subd. 3. new text end

new text begin Program design. new text end

new text begin (a) The operation of the pilot projects shall include:
 new text end

new text begin (1) new services that are responsive to the chronic nature of substance use disorder;
 new text end

new text begin (2) telehealth services, when appropriate to address barriers to services;
 new text end

new text begin (3) services that assure integration with the mental health delivery system when
appropriate;
 new text end

new text begin (4) services that address the needs of diverse populations; and
 new text end

new text begin (5) an assessment and access process that permits clients to present directly to a
service provider for a substance use disorder assessment and authorization of services.
 new text end

new text begin (b) Prior to implementation of the continuum of care pilot projects, a utilization
review process must be developed and agreed to by the commissioner, participating
counties, and providers. The utilization review process shall be described in the
agreements governing operation of the continuum of care pilot projects.
 new text end

new text begin Subd. 4. new text end

new text begin Notice of project discontinuation. new text end

new text begin Each entity's participation in the
continuum of care pilot project may be discontinued for any reason by the county or the
commissioner after 30 days' written notice to the entity.
 new text end

new text begin Subd. 5. new text end

new text begin Duties of commissioner. new text end

new text begin (a) Notwithstanding any other provisions in this
chapter, the commissioner may authorize chemical dependency treatment funds to pay for
nontreatment services arranged by continuum of care pilot projects. Individuals who are
currently accessing Rule 31 treatment services are eligible for concurrent participation in
the continuum of care pilot projects.
 new text end

new text begin (b) County expenditures for continuum of care pilot project services shall not
be greater than their expected share of forecasted expenditures in the absence of the
continuum of care pilot projects.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2013.
 new text end

Sec. 8.

new text begin [256.478] HOME AND COMMUNITY-BASED SERVICES
TRANSITIONS GRANTS.
 new text end

new text begin (a) The commissioner shall make available home and community-based services
transition grants to serve individuals who do not meet eligibility criteria for the medical
assistance program under section 256B.056 or 256B.057, but who otherwise meet the
criteria under section 256B.092, subdivision 13, or 256B.49, subdivision 24.
 new text end

new text begin (b) For the purposes of this section, the commissioner has the authority to transfer
funds between the medical assistance account and the home and community-based
services transitions grants account.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2015.
 new text end

Sec. 9.

Minnesota Statutes 2012, section 256B.0623, subdivision 2, is amended to read:


Subd. 2.

Definitions.

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

(a) "Adult rehabilitative mental health services" means mental health services
which are rehabilitative and enable the recipient to develop and enhance psychiatric
stability, social competencies, personal and emotional adjustment, deleted text begin anddeleted text end independent livingnew text begin ,
parenting skills,new text end and community skills, when these abilities are impaired by the symptoms
of mental illness. Adult rehabilitative mental health services are also appropriate when
provided to enable a recipient to retain stability and functioning, if the recipient would
be at risk of significant functional decompensation or more restrictive service settings
without these services.

(1) Adult rehabilitative mental health services instruct, assist, and support the
recipient in areas such as: interpersonal communication skills, community resource
utilization and integration skills, crisis assistance, relapse prevention skills, health care
directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking
and nutrition skills, transportation skills, medication education and monitoring, mental
illness symptom management skills, household management skills, employment-related
skills,new text begin parenting skills,new text end and transition to community living services.

(2) These services shall be provided to the recipient on a one-to-one basis in the
recipient's home or another community setting or in groups.

(b) "Medication education services" means services provided individually or in
groups which focus on educating the recipient about mental illness and symptoms; the role
and effects of medications in treating symptoms of mental illness; and the side effects of
medications. Medication education is coordinated with medication management services
and does not duplicate it. Medication education services are provided by physicians,
pharmacists, physician's assistants, or registered nurses.

(c) "Transition to community living services" means services which maintain
continuity of contact between the rehabilitation services provider and the recipient and
which facilitate discharge from a hospital, residential treatment program under Minnesota
Rules, chapter 9505, board and lodging facility, or nursing home. Transition to community
living services are not intended to provide other areas of adult rehabilitative mental health
services.

Sec. 10.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 35c. new text end

new text begin School-linked mental health services. new text end

new text begin Medical assistance covers mental
health services provided in a school as part of a school-linked mental health program by
an individual who is licensed by the Board of Behavioral Health and Therapy, Board of
Marriage and Family Therapy, Board of Psychology, or Board of Social Work, and who also
meets the definition of a mental health practitioner under section 245.462, subdivision 17,
or 245.4871, subdivision 26. For purposes of this subdivision, an individual who meets the
definition of mental health practitioner under section 245.462, subdivision 17, or 245.4871,
subdivision 26, is not limited to having less than 4,000 hours of post-master's experience.
The mental health practitioner must be supervised by a licensed mental health professional.
 new text end

Sec. 11.

Minnesota Statutes 2012, section 256B.0625, subdivision 48, is amended to
read:


Subd. 48.

Psychiatric consultation to primary care practitioners.

deleted text begin Effective
January 1, 2006,deleted text end Medical assistance covers consultation provided by a psychiatrist new text begin or
psychologist new text end via telephone, e-mail, facsimile, or other means of communication to primary
care practitioners, including pediatricians. The need for consultation and the receipt of the
consultation must be documented in the patient record maintained by the primary care
practitioner. If the patient consents, and subject to federal limitations and data privacy
provisions, the consultation may be provided without the patient present.

Sec. 12.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 61. new text end

new text begin Family psychoeducation services. new text end

new text begin Effective July 1, 2013, or upon
federal approval, whichever is later, medical assistance covers family psychoeducation
services provided to a child up to age 21 with a diagnosed mental health condition when
identified in the child's individual treatment plan and provided by a licensed mental health
professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a
clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who
has determined it medically necessary to involve family members in the child's care. For
the purposes of this subdivision, "family psychoeducation services" means information
or demonstration provided to an individual or family as part of an individual, family,
multifamily group, or peer group session to explain, educate, and support the child and
family in understanding a child's symptoms of mental illness, the impact on the child's
development, and needed components of treatment and skill development so that the
individual, family, or group can help the child to prevent relapse, prevent the acquisition
of comorbid disorders, and to achieve optimal mental health and long-term resilience.
 new text end

Sec. 13.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 62. new text end

new text begin Mental health clinical care consultation. new text end

new text begin Effective July 1, 2013, or upon
federal approval, whichever is later, medical assistance covers clinical care consultation
for a person up to age 21 who is diagnosed with a complex mental health condition or a
mental health condition that co-occurs with other complex and chronic conditions, when
described in the person's individual treatment plan and provided by a licensed mental
health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A. For
the purposes of this subdivision, "clinical care consultation" means communication from a
treating mental health professional to other providers not under the clinical supervision of
the treating mental health professional who are working with the same client to inform,
inquire, and instruct regarding the client's symptoms; strategies for effective engagement,
care, and intervention needs; and treatment expectations across service settings; and to
direct and coordinate clinical service components provided to the client and family.
 new text end

Sec. 14.

Minnesota Statutes 2012, section 256B.092, is amended by adding a
subdivision to read:


new text begin Subd. 13. new text end

new text begin Waiver allocations for transition populations. new text end

new text begin (a) The commissioner
shall make available additional waiver allocations and additional necessary resources
to assure timely discharges from the Anoka Metro Regional Treatment Center and the
Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
 new text end

new text begin (1) are otherwise eligible for the developmental disabilities waiver under this section;
 new text end

new text begin (2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
the Minnesota Security Hospital;
 new text end

new text begin (3) whose discharge would be significantly delayed without the available waiver
allocation; and
 new text end

new text begin (4) who have met treatment objectives and no longer meet hospital level of care.
 new text end

new text begin (b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.
 new text end

new text begin (c) Any corporate foster care home developed under this subdivision must be
considered an exception under section 245A.03, subdivision 7, paragraph (a).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2015.
 new text end

Sec. 15.

Minnesota Statutes 2012, section 256B.0946, is amended to read:


256B.0946 new text begin INTENSIVE new text end TREATMENTnew text begin INnew text end FOSTER CARE.

Subdivision 1.

new text begin Required new text end covered servicenew text begin componentsnew text end .

(a) Effective deleted text begin July 1, 2006,
deleted text end new text begin upon enactmentnew text end and subject to federal approval, medical assistance covers medically
necessary new text begin intensive treatment new text end services described under paragraph (b) that are provided
by a provider entity eligible under subdivision 3 to a client eligible under subdivision 2
who is placed in a deleted text begin treatmentdeleted text end foster home licensed under Minnesota Rules, parts 2960.3000
to 2960.3340.

(b) new text begin Intensive treatment new text end services to children with deleted text begin severe emotional disturbancedeleted text end new text begin mental
illnessnew text end residing in deleted text begin treatmentdeleted text end foster deleted text begin caredeleted text end new text begin familynew text end settings deleted text begin must meet the relevant standards
for mental health services under sections 245.487 to 245.4889. In addition,deleted text end new text begin that comprise
new text end specific new text begin required new text end service componentsnew text begin provided in clauses (1) to (5), arenew text end reimbursed by
medical assistance deleted text begin mustdeleted text end new text begin when theynew text end meet the following standards:

deleted text begin (1) case management service component must meet the standards in Minnesota
Rules, parts 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10;
 deleted text end

new text begin (1) psychotherapy provided by a mental health professional as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota
Rules, part 9505.0371, subpart 5, item C;
 new text end

(2) deleted text begin psychotherapy,deleted text end crisis assistancedeleted text begin , and skills training components must meet the
deleted text end new text begin provided according tonew text end standards for children's therapeutic services and supports in section
256B.0943; deleted text begin and
deleted text end

(3)new text begin individualnew text end familynew text begin , and groupnew text end psychoeducation services deleted text begin under supervision ofdeleted text end new text begin ,
defined in subdivision 1a, paragraph (q), provided bynew text end a mental health professionaldeleted text begin .deleted text end new text begin or a
clinical trainee;
new text end

new text begin (4) clinical care consultation, as defined in subdivision 1a, and provided by a mental
health professional or a clinical trainee; and
 new text end

new text begin (5) service delivery payment requirements as provided under subdivision 4.
 new text end

new text begin Subd. 1a. new text end

new text begin Definitions. new text end

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

new text begin (a) "Clinical care consultation" means communication from a treating clinician to
other providers working with the same client to inform, inquire, and instruct regarding
the client's symptoms, strategies for effective engagement, care and intervention needs,
and treatment expectations across service settings, including but not limited to the client's
school, social services, day care, probation, home, primary care, medication prescribers,
disabilities services, and other mental health providers and to direct and coordinate clinical
service components provided to the client and family.
 new text end

new text begin (b) "Clinical supervision" means the documented time a clinical supervisor and
supervisee spend together to discuss the supervisee's work, to review individual client
cases, and for the supervisee's professional development. It includes the documented
oversight and supervision responsibility for planning, implementation, and evaluation of
services for a client's mental health treatment.
 new text end

new text begin (c) "Clinical supervisor" means the mental health professional who is responsible
for clinical supervision.
 new text end

new text begin (d) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371,
subpart 5, item C;
 new text end

new text begin (e) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a,
including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis, but does not include actual crisis intervention.
 new text end

new text begin (f) "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370,
subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.
 new text end

new text begin (g) "Culture" means the distinct ways of living and understanding the world that
are used by a group of people and are transmitted from one generation to another or
adopted by an individual.
 new text end

new text begin (h) "Diagnostic assessment" has the meaning given in Minnesota Rules, part
9505.0370, subpart 11.
 new text end

new text begin (i) "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.
 new text end

new text begin (j) "Foster care" has the meaning given in section 260C.007, subdivision 18.
 new text end

new text begin (k) "Foster family setting" means the foster home in which the license holder resides.
 new text end

new text begin (l) "Individual treatment plan" has the meaning given in Minnesota Rules, part
9505.0370, subpart 15.
 new text end

new text begin (m) "Mental health practitioner" has the meaning given in Minnesota Rules, part
9505.0370, subpart 17.
 new text end

new text begin (n) "Mental health professional" has the meaning given in Minnesota Rules, part
9505.0370, subpart 18.
 new text end

new text begin (o) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370,
subpart 20.
 new text end

new text begin (p) "Parent" has the meaning given in section 260C.007, subdivision 25.
 new text end

new text begin (q) "Psychoeducation services" means information or demonstration provided to
an individual, family, or group to explain, educate, and support the individual, family, or
group in understanding a child's symptoms of mental illness, the impact on the child's
development, and needed components of treatment and skill development so that the
individual, family, or group can help the child to prevent relapse, prevent the acquisition
of comorbid disorders, and to achieve optimal mental health and long-term resilience.
 new text end

new text begin (r) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370,
subpart 27.
 new text end

new text begin (s) "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with
the child, a parent, the child unless the team lead or parent deem it clinically inappropriate,
and at least two of the following: an individualized education program case manager;
probation agent; children's mental health case manager; child welfare worker, including
adoption or guardianship worker; primary care provider; foster parent; and any other
member of the child's service team.
 new text end

Subd. 2.

Determination of client eligibility.

deleted text begin A client's eligibility to receive
treatment foster care under this section shall be determined bydeleted text end new text begin An eligible recipient is an
individual, from birth through age 20, who is currently placed in a foster home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3340, and has receivednew text end a diagnostic
assessmentdeleted text begin ,deleted text end new text begin andnew text end an evaluation of level of care needed, deleted text begin and development of an individual
treatment plan,deleted text end as defined in paragraphs (a) deleted text begin to (c)deleted text end new text begin and (b)new text end .

(a) The diagnostic assessment must:

(1) new text begin meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and new text end be
conducted by a deleted text begin psychiatrist, licensed psychologist, or licensed independent clinical social
worker that isdeleted text end new text begin mental health professional or a clinical trainee;
new text end

new text begin (2) determine whether or not a child meets the criteria for mental illness, as defined
in Minnesota Rules, part 9505.0370, subpart 20;
 new text end

new text begin (3) document that intensive treatment services are medically necessary within a
foster family setting to ameliorate identified symptoms and functional impairments;
 new text end

new text begin (4) be new text end performed within 180 days deleted text begin prior todeleted text end new text begin beforenew text end the start of service;new text begin and
new text end

deleted text begin (2) include current diagnoses on all five axes of the client's current mental health
status;
 deleted text end

deleted text begin (3) determine whether or not a child meets the criteria for severe emotional
disturbance in section 245.4871, subdivision 6, or for serious and persistent mental illness
in section 245.462, subdivision 20; and
 deleted text end

deleted text begin (4) be completed annually until age 18. For individuals between age 18 and 21,
unless a client's mental health condition has changed markedly since the client's most
recent diagnostic assessment, annual updating is necessary. For the purpose of this section,
"updating" means a written summary, including current diagnoses on all five axes, by a
mental health professional of the client's current mental status and service needs.
 deleted text end

new text begin (5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
 new text end

(b) The evaluation of level of care must be conducted by the placing county deleted text begin with
an instrumentdeleted text end new text begin , tribe, or case manager in conjunction with the diagnostic assessment as
described by Minnesota Rules, part 9505.0372, subpart 1, item B, using a validated tool
new text end approved by the commissioner of human servicesnew text begin and not subject to the rulemaking
process, consistent with section 245.4885, subdivision 1, paragraph (d), the result of which
evaluation demonstrates that the child requires intensive intervention without 24-hour
medical monitoringnew text end . The commissioner shall update the list of approved level of care
deleted text begin instrumentsdeleted text end new text begin toolsnew text end annuallynew text begin and publish on the department's Web sitenew text end .

deleted text begin (c) The individual treatment plan must be:
 deleted text end

deleted text begin (1) based on the information in the client's diagnostic assessment;
 deleted text end

deleted text begin (2) developed through a child-centered, family driven planning process that identifies
service needs and individualized, planned, and culturally appropriate interventions that
contain specific measurable treatment goals and objectives for the client and treatment
strategies for the client's family and foster family;
 deleted text end

deleted text begin (3) reviewed at least once every 90 days and revised; and
 deleted text end

deleted text begin (4) signed by the client or, if appropriate, by the client's parent or other person
authorized by statute to consent to mental health services for the client.
 deleted text end

Subd. 3.

Eligible new text begin mental health services new text end providers.

new text begin (a) Eligible providers for
intensive children's mental health services in a foster family setting must be certified
by the state and have a service provision contract with a county board or a reservation
tribal council and must be able to demonstrate the ability to provide all of the services
required in this section.
 new text end

new text begin (b) new text end For purposes of this section, a provider agency must deleted text begin have an individual
placement agreement for each recipient and must be a licensed child placing agency, under
Minnesota Rules, parts 9543.0010 to 9543.0150, and eitherdeleted text end new text begin benew text end :

(1) a deleted text begin countydeleted text end new text begin county-operated entity certified by the statenew text end ;

(2) an Indian Health Services facility operated by a tribe or tribal organization under
funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or

(3) a noncounty entity deleted text begin under contract with a county boarddeleted text end .

new text begin (c) Certified providers that do not meet the service delivery standards required in
this section shall be subject to a decertification process.
 new text end

new text begin (d) For the purposes of this section, all services delivered to a client must be
provided by a mental health professional or a clinical trainee.
 new text end

Subd. 4.

deleted text begin Eligible provider responsibilitiesdeleted text end new text begin Service delivery payment
requirementsnew text end .

(a) To be deleted text begin andeleted text end eligible deleted text begin providerdeleted text end new text begin for paymentnew text end under this section, a provider
must develop new text begin and practice new text end written policies and procedures for deleted text begin treatment foster care services
deleted text end new text begin intensive treatment in foster care,new text end consistent with subdivision 1, paragraph (b), deleted text begin clauses (1),
(2), and (3)deleted text end new text begin and comply with the following requirements in paragraphs (b) to (n)new text end .

deleted text begin (b) In delivering services under this section, a treatment foster care provider must
ensure that staff caseload size reasonably enables the provider to play an active role in
service planning, monitoring, delivering, and reviewing for discharge planning to meet
the needs of the client, the client's foster family, and the birth family, as specified in each
client's individual treatment plan.
 deleted text end

new text begin (b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.
 new text end

new text begin (c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within
30 days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
 new text end

new text begin (d) Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received and this information must be reviewed and incorporated into
the diagnostic assessment and team consultation and treatment planning review process.
 new text end

new text begin (e) Each client receiving treatment must be assessed for a trauma history and
the client's treatment plan must document how the results of the assessment will be
incorporated into treatment.
 new text end

new text begin (f) Each client receiving treatment services must have an individual treatment plan
that is reviewed, evaluated, and signed every 90 days using the team consultation and
treatment planning process, as defined in subdivision 1a, paragraph (s).
 new text end

new text begin (g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided
in accordance with the client's individual treatment plan.
 new text end

new text begin (h) Each client must have a crisis assistance plan within ten days of initiating
services and must have access to clinical phone support 24 hours per day, seven days per
week, during the course of treatment, and the crisis plan must demonstrate coordination
with the local or regional mobile crisis intervention team.
 new text end

new text begin (i) Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week, unless reduced units of service are specified on
the treatment plan as part of transition or on a discharge plan to another service or level of
care. Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
 new text end

new text begin (j) Location of service delivery must be in the client's home, day care setting,
school, or other community-based setting that is specified on the client's individualized
treatment plan.
 new text end

new text begin (k) Treatment must be developmentally and culturally appropriate for the client.
 new text end

new text begin (l) Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis, and members of the service team must be
aware of the medication regimen and potential side effects.
 new text end

new text begin (m) Parents, siblings, foster parents, and members of the child's permanency plan
must be involved in treatment and service delivery unless otherwise noted in the treatment
plan.
 new text end

new text begin (n) Transition planning for the child must be conducted starting with the first
treatment plan and must be addressed throughout treatment to support the child's
permanency plan and postdischarge mental health service needs.
 new text end

Subd. 5.

Service authorization.

The commissioner will administer authorizations
for services under this section in compliance with section 256B.0625, subdivision 25.

Subd. 6.

Excluded services.

(a) Services in clauses (1) to deleted text begin (4)deleted text end new text begin (7)new text end are not new text begin covered
under this section and are not new text end eligible new text begin for medical assistance payment new text end as components of
new text begin intensive new text end treatment new text begin in new text end foster care servicesnew text begin , but may be billed separatelynew text end :

deleted text begin (1) treatment foster care services provided in violation of medical assistance policy
in Minnesota Rules, part 9505.0220;
 deleted text end

deleted text begin (2) service components of children's therapeutic services and supports
simultaneously provided by more than one treatment foster care provider;
 deleted text end

deleted text begin (3) home and community-based waiver services; and
 deleted text end

deleted text begin (4) treatment foster care services provided to a child without a level of care
determination according to section 245.4885, subdivision 1.
 deleted text end

new text begin (1) inpatient psychiatric hospital treatment;
 new text end

new text begin (2) mental health targeted case management;
 new text end

new text begin (3) partial hospitalization;
 new text end

new text begin (4) medication management;
 new text end

new text begin (5) children's mental health day treatment services;
 new text end

new text begin (6) crisis response services under section 256B.0944; and
 new text end

new text begin (7) transportation.
 new text end

(b) Children receiving new text begin intensive new text end treatment new text begin in new text end foster care services are not eligible for
medical assistance reimbursement for the following services while receiving new text begin intensive
new text end treatment new text begin in new text end foster care:

deleted text begin (1) mental health case management services under section 256B.0625, subdivision
20; and
 deleted text end

deleted text begin (2)deleted text end new text begin (1)new text end psychotherapy and deleted text begin skilldeleted text end new text begin skillsnew text end training components of children's therapeutic
services and supports under section 256B.0625, subdivision 35bdeleted text begin .deleted text end new text begin ;
new text end

new text begin (2) mental health behavioral aide services as defined in section 256B.0943,
subdivision 1, paragraph (m);
 new text end

new text begin (3) home and community-based waiver services;
 new text end

new text begin (4) mental health residential treatment; and
 new text end

new text begin (5) room and board costs as defined in section 256I.03, subdivision 6.
 new text end

new text begin Subd. 7. new text end

new text begin Medical assistance payment and rate setting. new text end

new text begin The commissioner shall
establish a single daily per-client encounter rate for intensive treatment in foster care
services. The rate must be constructed to cover only eligible services delivered to an
eligible recipient by an eligible provider, as prescribed in subdivision 1, paragraph (b).
 new text end

Sec. 16.

Minnesota Statutes 2012, section 256B.49, is amended by adding a
subdivision to read:


new text begin Subd. 24. new text end

new text begin Waiver allocations for transition populations. new text end

new text begin (a) The commissioner
shall make available additional waiver allocations and additional necessary resources
to assure timely discharges from the Anoka Metro Regional Treatment Center and the
Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
 new text end

new text begin (1) are otherwise eligible for the brain injury, community alternatives for disabled
individuals, or community alternative care waivers under this section;
 new text end

new text begin (2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
the Minnesota Security Hospital;
 new text end

new text begin (3) whose discharge would be significantly delayed without the available waiver
allocation; and
 new text end

new text begin (4) who have met treatment objectives and no longer meet hospital level of care.
 new text end

new text begin (b) Additional waiver allocations under this subdivision must meet cost-effectiveness
requirements of the federal approved waiver plan.
 new text end

new text begin (c) Any corporate foster care home developed under this subdivision must be
considered an exception under section 245A.03, subdivision 7, paragraph (a).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2015.
 new text end

Sec. 17.

Minnesota Statutes 2012, section 256B.761, is amended to read:


256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.

(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day
treatment services, home-based mental health services, and family community support
services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
50th percentile of 1999 charges.

(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
1993, with at least 33 percent of the clients receiving rehabilitation services in the most
recent calendar year who are medical assistance recipients, will be increased by 38 percent,
when those services are provided within the comprehensive outpatient rehabilitation
facility and provided to residents of nursing facilities owned by the entity.

(c) The commissioner shall establish three levels of payment for mental health
diagnostic assessment, based on three levels of complexity. The aggregate payment under
the tiered rates must not exceed the projected aggregate payments for mental health
diagnostic assessment under the previous single rate. The new rate structure is effective
January 1, 2011, or upon federal approval, whichever is later.

new text begin (d) In addition to rate increases otherwise provided, the commissioner may
restructure coverage policy and rates to improve access to adult rehabilitative mental
health services under section 256B.0623 and related mental health support services under
section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and
2016, the projected state share of increased costs due to this paragraph is transferred
from adult mental health grants under sections 245.4661 and 256E.12. The transfer for
fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments
made to managed care plans and county-based purchasing plans under sections 256B.69,
256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.
 new text end

Sec. 18. new text begin STATE ASSISTANCE TO COUNTIES; TRANSITIONS FOR HIGH
NEEDS POPULATIONS.
new text end

new text begin (a) Effective immediately, the commissioner of human services shall work with
counties that request assistance to assure timely discharge from Anoka Metro Regional
Treatment Center and the Minnesota Security Hospital for individuals who are ready
for discharge but for whom the county may not have provider resources or appropriate
placement available. Special consideration must be given to uninsured individuals who are
not eligible for medical assistance and who may need continued treatment, and individuals
with complex needs and other factors that hinder county efforts to place the individual in a
safe, affordable setting.
new text end

new text begin (b) The commissioner shall assure that, given Olmstead court directives and the
role family and friends play in treatment progress, metropolitan area residents are asked
whether they wished to be placed in an Intensive Residential Treatment Service program
at Willmar or Cambridge or to be placed in a location more accessible to family, friends,
and health providers.
 new text end

Sec. 19. new text begin INSTRUCTIONS TO THE COMMISSIONER.
new text end

new text begin In consultation with labor organizations, the commissioner of human services shall
develop clear and consistent standards for state-operated services programs to:
 new text end

new text begin (1) address direct service staffing shortages;
 new text end

new text begin (2) identify and help resolve workplace safety issues; and
 new text end

new text begin (3) elevate the use and visibility of performance measures and objectives related to
overtime use.
 new text end

ARTICLE 5

DEPARTMENT OF HUMAN SERVICES PROGRAM INTEGRITY

Section 1.

Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:


Subd. 7.

Use of data.

new text begin (a) new text end Except as otherwise provided in subdivision 7a or sections
244.052 and 299C.093, the data provided under this section is private data on individuals
under section 13.02, subdivision 12.

new text begin (b) new text end The data may be used only deleted text begin fordeleted text end new text begin by law enforcement and corrections agencies for
new text end law enforcement and corrections purposes.

new text begin (c) The commissioner of human services is authorized to have access to the data for:
 new text end

new text begin (1)new text end state-operated services, as defined in section 246.014, deleted text begin are also authorized to
have access to the datadeleted text end for the purposes described in section 246.13, subdivision 2,
paragraph (b)new text begin ; and
new text end

new text begin (2) purposes of completing background studies under chapter 245Cnew text end .

Sec. 2.

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


new text begin Subd. 4a. new text end

new text begin Agency background studies. new text end

new text begin (a) The commissioner shall develop
and implement an electronic process for the regular transfer of new criminal history
information that is added to the Minnesota court information system. The commissioner's
system must include for review only information that relates to individuals who have been
the subject of a background study under this chapter that remain affiliated with the agency
that initiated the background study. For purposes of this paragraph, an individual remains
affiliated with an agency that initiated the background study until the agency informs the
commissioner that the individual is no longer affiliated. When any individual no longer
affiliated according to this paragraph returns to a position requiring a background study
under this chapter, the agency with whom the individual is again affiliated shall initiate
a new background study regardless of the length of time the individual was no longer
affiliated with the agency.
 new text end

new text begin (b) The commissioner shall develop and implement an online system for agencies that
initiate background studies under this chapter to access and maintain records of background
studies initiated by that agency. The system must show all active background study subjects
affiliated with that agency and the status of each individual's background study. Each
agency that initiates background studies must use this system to notify the commissioner
of discontinued affiliation for purposes of the processes required under paragraph (a).
 new text end

Sec. 3.

Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:


Subdivision 1.

Background studies conducted by Department of Human
Services.

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

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

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

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

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

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

(6) for a background study related to a child foster care application for licensure or
adoptions, the commissioner shall also review:

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

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

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

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

Sec. 4.

Minnesota Statutes 2012, section 256B.04, subdivision 21, is amended to read:


Subd. 21.

Provider enrollment.

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

(b) An enrolled provider that is also licensed by the commissioner under chapter
245A must designate an individual as the entity's compliance officer. The compliance
officer must:

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

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

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

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

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

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

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

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

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

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

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

new text begin (g) As a condition of enrollment, all durable medical equipment, prosthetics,
orthotics, and supplies (DMEPOS) suppliers operating in Minnesota are required to name
the Department of Human Services, in addition to the Centers for Medicare and Medicaid
Services, as an obligee on all surety performance bonds required pursuant to section
4312(a) of the Balanced Budget Act of 1997, Public Law 105-33, amending Social
Security Act, section 1834(a). The performance bond must also allow for recovery of
costs and fees in pursuing a claim on the bond.
 new text end

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

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


new text begin Subd. 22. new text end

new text begin Application fee. new text end

new text begin (a) The commissioner must collect and retain federally
required nonrefundable application fees to pay for provider screening activities in
accordance with Code of Federal Regulations, title 42, section 455, subpart E. The
enrollment application must be made under the procedures specified by the commissioner,
in the form specified by the commissioner, and accompanied by an application fee
described in paragraph (b), or a request for a hardship exception as described in the
specified procedures. Application fees must be deposited in the provider screening account
in the special revenue fund. Amounts in the provider screening account are appropriated
to the commissioner for costs associated with the provider screening activities required
in Code of Federal Regulations, title 42, section 455, subpart E. The commissioner
shall conduct screening activities as required by Code of Federal Regulations, title 42,
section 455, subpart E, and as otherwise provided by law, to include database checks,
unannounced pre- and postenrollment site visits, fingerprinting, and criminal background
studies. The commissioner must revalidate all providers under this subdivision at least
once every five years.
 new text end

new text begin (b) The application fee under this subdivision is $532 for the calendar year 2013.
For calendar year 2014 and subsequent years, the fee:
 new text end

new text begin (1) is adjusted by the percentage change to the consumer price index for all urban
consumers, United States city average, for the 12-month period ending with June of the
previous year. The resulting fee must be announced in the Federal Register;
 new text end

new text begin (2) is effective from January 1 to December 31 of a calendar year;
 new text end

new text begin (3) is required on the submission of an initial application, an application to establish
a new practice location, an application for re-enrollment when the provider is not enrolled
at the time of application of re-enrollment, or at revalidation when required by federal
regulation; and
 new text end

new text begin (4) must be in the amount in effect for the calendar year during which the application
for enrollment, new practice location, or re-enrollment is being submitted.
 new text end

new text begin (c) The application fee under this subdivision cannot be charged to:
 new text end

new text begin (1) providers who are enrolled in Medicare or who provide documentation of
payment of the fee to, and enrollment with, another state;
 new text end

new text begin (2) providers who are enrolled but are required to submit new applications for
purposes of re-enrollment; or
 new text end

new text begin (3) a provider who enrolls as an individual.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 6.

Minnesota Statutes 2012, section 256B.064, subdivision 1a, is amended to read:


Subd. 1a.

Grounds for sanctions against vendors.

The commissioner may
impose sanctions against a vendor of medical care for any of the following: (1) fraud,
theft, or abuse in connection with the provision of medical care to recipients of public
assistance; (2) a pattern of presentment of false or duplicate claims or claims for services
not medically necessary; (3) a pattern of making false statements of material facts for
the purpose of obtaining greater compensation than that to which the vendor is legally
entitled; (4) suspension or termination as a Medicare vendor; (5) refusal to grant the state
agency access during regular business hours to examine all records necessary to disclose
the extent of services provided to program recipients and appropriateness of claims for
payment; (6) failure to repay an overpayment new text begin or a fine new text end finally established under this
section; deleted text begin anddeleted text end (7) new text begin failure to correct errors in the maintenance of health service or financial
records for which a fine was imposed or after issuance of a warning by the commissioner;
and (8) new text end any reason for which a vendor could be excluded from participation in the
Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act.
The determination of services not medically necessary may be made by the commissioner
in consultation with a peer advisory task force appointed by the commissioner on the
recommendation of appropriate professional organizations. The task force expires as
provided in section 15.059, subdivision 5.

Sec. 7.

Minnesota Statutes 2012, section 256B.064, subdivision 1b, is amended to read:


Subd. 1b.

Sanctions available.

The commissioner may impose the following
sanctions for the conduct described in subdivision 1a: suspension or withholding of
payments to a vendor and suspending or terminating participation in the programnew text begin , or
imposition of a fine under subdivision 2, paragraph (f). When imposing sanctions under
this section, the commissioner shall consider the nature, chronicity, or severity of the
conduct and the effect of the conduct on the health and safety of persons served by the
vendornew text end . Regardless of imposition of sanctions, the commissioner may make a referral
to the appropriate state licensing board.

Sec. 8.

Minnesota Statutes 2012, section 256B.064, subdivision 2, is amended to read:


Subd. 2.

Imposition of monetary recovery and sanctions.

(a) The commissioner
shall determine any monetary amounts to be recovered and sanctions to be imposed upon
a vendor of medical care under this section. Except as provided in paragraphs (b) and
(d), neither a monetary recovery nor a sanction will be imposed by the commissioner
without prior notice and an opportunity for a hearing, according to chapter 14, on the
commissioner's proposed action, provided that the commissioner may suspend or reduce
payment to a vendor of medical care, except a nursing home or convalescent care facility,
after notice and prior to the hearing if in the commissioner's opinion that action is
necessary to protect the public welfare and the interests of the program.

(b) Except when the commissioner finds good cause not to suspend payments under
Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
withhold or reduce payments to a vendor of medical care without providing advance
notice of such withholding or reduction if either of the following occurs:

(1) the vendor is convicted of a crime involving the conduct described in subdivision
1a; or

(2) the commissioner determines there is a credible allegation of fraud for which an
investigation is pending under the program. A credible allegation of fraud is an allegation
which has been verified by the state, from any source, including but not limited to:

(i) fraud hotline complaints;

(ii) claims data mining; and

(iii) patterns identified through provider audits, civil false claims cases, and law
enforcement investigations.

Allegations are considered to be credible when they have an indicia of reliability
and the state agency has reviewed all allegations, facts, and evidence carefully and acts
judiciously on a case-by-case basis.

(c) The commissioner must send notice of the withholding or reduction of payments
under paragraph (b) within five days of taking such action unless requested in writing by a
law enforcement agency to temporarily withhold the notice. The notice must:

(1) state that payments are being withheld according to paragraph (b);

(2) set forth the general allegations as to the nature of the withholding action, but
need not disclose any specific information concerning an ongoing investigation;

(3) except in the case of a conviction for conduct described in subdivision 1a, state
that the withholding is for a temporary period and cite the circumstances under which
withholding will be terminated;

(4) identify the types of claims to which the withholding applies; and

(5) inform the vendor of the right to submit written evidence for consideration by
the commissioner.

The withholding or reduction of payments will not continue after the commissioner
determines there is insufficient evidence of fraud by the vendor, or after legal proceedings
relating to the alleged fraud are completed, unless the commissioner has sent notice of
intention to impose monetary recovery or sanctions under paragraph (a).

(d) The commissioner shall suspend or terminate a vendor's participation in the
program without providing advance notice and an opportunity for a hearing when the
suspension or termination is required because of the vendor's exclusion from participation
in Medicare. Within five days of taking such action, the commissioner must send notice of
the suspension or termination. The notice must:

(1) state that suspension or termination is the result of the vendor's exclusion from
Medicare;

(2) identify the effective date of the suspension or termination; and

(3) inform the vendor of the need to be reinstated to Medicare before reapplying
for participation in the program.

(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or
sanction is to be imposed, a vendor may request a contested case, as defined in section
14.02, subdivision 3, by filing with the commissioner a written request of appeal. The
appeal request must be received by the commissioner no later than 30 days after the date
the notification of monetary recovery or sanction was mailed to the vendor. The appeal
request must specify:

(1) each disputed item, the reason for the dispute, and an estimate of the dollar
amount involved for each disputed item;

(2) the computation that the vendor believes is correct;

(3) the authority in statute or rule upon which the vendor relies for each disputed item;

(4) the name and address of the person or entity with whom contacts may be made
regarding the appeal; and

(5) other information required by the commissioner.

new text begin (f) The commissioner may order a vendor to forfeit a fine for failure to fully
document services according to standards in this chapter and Minnesota Rules, chapter
9505. Fines may be assessed when the commissioner has no evidence that services were
not provided and services are partially documented in the health service or financial
record, but specific required components of documentation are missing. The fine for
incomplete documentation shall equal 20 percent of the amount paid on the claims for
reimbursement submitted by the vendor, or up to $5,000, whichever is less.
 new text end

new text begin (g) The vendor shall pay the fine assessed on or before the payment date specified. If
the vendor fails to pay the fine, the commissioner may withhold or reduce payments and
recover the amount of the fine. A timely appeal shall stay payment of the fine until the
commissioner issues a final order.
 new text end

Sec. 9.

Minnesota Statutes 2012, section 256B.0659, subdivision 21, is amended to read:


Subd. 21.

Requirements for initial enrollment of personal care assistance
provider agencies.

(a) All personal care assistance provider agencies must provide, at the
time of enrollment as a personal care assistance provider agency in a format determined
by the commissioner, information and documentation that includes, but is not limited to,
the following:

(1) the personal care assistance provider agency's current contact information
including address, telephone number, and e-mail address;

(2) proof of surety bond coverage in the amount of deleted text begin $50,000deleted text end new text begin $100,000new text end or ten percent
of the provider's payments from Medicaid in the previous year, whichever is deleted text begin lessdeleted text end new text begin more.
The performance bond must be in a form approved by the commissioner, must be renewed
annually, and must allow for recovery of costs and fees in pursuing a claim on the bondnew text end ;

(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 personal care assistance provider agency's organization
identifying the names of 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 personal care assistance 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 personal care assistance provider agency uses in
the course of daily business including, but not limited to:

(i) a copy of the personal care assistance provider agency's time sheet if the time
sheet varies from the standard time sheet for personal care assistance services approved
by the commissioner, and a letter requesting approval of the personal care assistance
provider agency's nonstandard time sheet;

(ii) the personal care assistance provider agency's template for the personal care
assistance care plan; and

(iii) the personal care assistance provider agency's template for the written
agreement in subdivision 20 for recipients using the personal care assistance choice
option, if applicable;

(9) a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;

(10) documentation that the personal care assistance 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 personal care assistance services
for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
personal care assistance choice option and 72.5 percent of revenue from other personal
care assistance providers. The revenue generated by the qualified professional and the
reasonable costs associated with the qualified professional shall not be used in making
this calculation; and

(14) effective May 15, 2010, 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 personal care
assistance recipient or for another personal care assistance 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) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider
agency enrolls as a vendor or upon request from the commissioner. The commissioner
shall collect the information specified in paragraph (a) from all personal care assistance
providers beginning July 1, 2009.

(c) All personal care assistance 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 before enrollment of the agency as a provider.
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 personal care assistance 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. By September 1, 2010, the required training must
be available with meaningful access according to title VI of the Civil Rights Act and
federal regulations adopted under that law or any guidance from the United States Health
and Human Services Department. The required training must be available online or by
electronic remote connection. The required training must provide for competency testing.
Personal care assistance provider agency billing staff shall complete training about
personal care assistance program financial management. This training is effective July 1,
2009. Any personal care assistance provider agency enrolled before that date shall, if it
has not already, complete the provider training within 18 months of July 1, 2009. 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. Personal care assistance provider agencies certified for participation in Medicare
as home health agencies are exempt from the training required in this subdivision. When
available, Medicare-certified home health agency owners, supervisors, or managers must
successfully complete the competency test.

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 6

HEALTH CARE

Section 1.

Minnesota Statutes 2012, section 256.9657, subdivision 2, is amended to read:


Subd. 2.

Hospital surcharge.

(a) Effective October 1, 1992, each Minnesota
hospital except facilities of the federal Indian Health Service and regional treatment
centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net
patient revenues excluding net Medicare revenues reported by that provider to the health
care cost information system according to the schedule in subdivision 4.

(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 1.56
percent.

(c) new text begin Effective July 1, 2013, the surcharge under paragraph (b) is increased to 2.68
percent for all nongovernment-owned hospitals.
new text end

new text begin (d) new text end Notwithstanding the Medicare cost finding and allowable cost principles, the
hospital surcharge is not an allowable cost for purposes of rate setting under sections
256.9685 to 256.9695.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
 new text end

Sec. 2.

Minnesota Statutes 2012, section 256.9685, subdivision 2, is amended to read:


Subd. 2.

Federal requirements.

new text begin (a) new text end If it is determined that a provision of this
section or section 256.9686, 256.969, or 256.9695 conflicts with existing or future
requirements of the United States government with respect to federal financial participation
in medical assistance, the federal requirements prevail. The commissioner may, deleted text begin in the
aggregate,deleted text end prospectively new text begin and retrospectively, new text end reduce payment rates new text begin and payments new text end to avoid
reduced federal financial participation resulting from rates new text begin and payments determined by
the commissioner new text end that are in excess of the Medicare new text begin upper payment new text end limitations.

new text begin (b) For rates and payments determined by the commissioner to be in excess of the
Medicare upper payment limits for the nongovernment-owned limit category, rates and
payments shall be reduced to the limits according to clauses (1) to (4):
 new text end

new text begin (1) rates and payments under section 256.969, subdivision 3a, paragraph (j), shall be
reduced proportionately;
 new text end

new text begin (2) if rates and payments remain above the limit, medical education payments under
section 62J.692, subdivision 8, shall be the first reduction for the government-owned
limit category;
 new text end

new text begin (3) if rates and payments remain above the limit, rates and payments not included
under clause (1) shall be reduced in total; and
new text end

new text begin (4) the state share of payments under clauses (1) and (2) shall be returned to the
hospital.
 new text end

Sec. 3.

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


Subd. 3a.

Payments.

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

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

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

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

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

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

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

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

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

new text begin (j) In order to offset the rateable reductions provided for in this subdivision, the total
payment rate for medical assistance admissions for nongovernment-owned hospitals
occurring on or after July 1, 2013, made to Minnesota hospitals for inpatient services
before third-party liability and spenddown, shall be increased by 30 percent from the
current statutory rates. The commissioner shall not adjust rates paid to a prepaid health
plan under contract with the commissioner to reflect payments provided in this paragraph.
The commissioner shall adjust rates and payments in excess of the Medicare upper limits
on payments according to section 256.9685, subdivision 2.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
 new text end

Sec. 4.

Minnesota Statutes 2012, section 256.969, subdivision 29, is amended to read:


Subd. 29.

Reimbursement for the fee increase for the early hearing detection
and intervention program.

new text begin (a) new text end For admissions occurring on or after July 1, 2010,
payment rates shall be adjusted to include the increase to the fee that is effective on July 1,
2010, for the early hearing detection and intervention program recipients under section
144.125, subdivision 1, that is paid by the hospital for public program recipients. This
payment increase shall be in effect until the increase is fully recognized in the base year
cost under subdivision 2b. This payment shall be included in payments to contracted
managed care organizations.

new text begin (b) For admissions occurring on or after July 1, 2013, payment rates shall be
adjusted to include the increase to the fee that is effective July 1, 2013, for the early
hearing detection and intervention program recipients under section 144.125, subdivision
1, that is paid by the hospital for public program recipients. This payment increase shall
be in effect until the increase is fully recognized in the base year cost under subdivision
2b. This payment shall be included in payments to contracted managed care organizations.
 new text end

Sec. 5.

Minnesota Statutes 2012, section 256B.055, subdivision 14, is amended to read:


Subd. 14.

Persons detained by law.

(a) Medical assistance may be paid for an
inmate of a correctional facility who is conditionally released as authorized under section
241.26, 244.065, or 631.425, if the individual does not require the security of a public
detention facility and is housed in a halfway house or community correction center, or
under house arrest and monitored by electronic surveillance in a residence approved
by the commissioner of corrections, and if the individual meets the other eligibility
requirements of this chapter.

(b) An individual who is enrolled in medical assistance, and who is charged with a
crime and incarcerated for less than 12 months shall be suspended from eligibility at the
time of incarceration until the individual is released. Upon release, medical assistance
eligibility is reinstated without reapplication using a reinstatement process and form, if the
individual is otherwise eligible.

(c) An individual, regardless of age, who is considered an inmate of a public
institution as defined in Code of Federal Regulations, title 42, section 435.1010, new text begin and
who meets the eligibility requirements in section 256B.056, new text end is not eligible for medical
assistancenew text begin , except for covered services received while an inpatient in a medical institution
as defined in the Code of Federal Regulations, title 42, section 435.1010. Security issues
related to the inpatient treatment of an inmate are the responsibility of the entity with
jurisdiction over the inmate.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 6.

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;

deleted text begin (viii) dialysis;
 deleted text end

deleted text begin (ix) chemotherapy or therapeutic radiation services;
 deleted text end

deleted text begin (x)deleted text end new text begin (viii)new text end rehabilitation services;

deleted text begin (xi)deleted text end new text begin (ix)new text end physical, occupational, or speech therapy;

deleted text begin (xii)deleted text end new text begin (x)new text end transportation services;

deleted text begin (xiii)deleted text end new text begin (xi)new text end case management;

deleted text begin (xiv)deleted text end new text begin (xii)new text end prosthetics, orthotics, durable medical equipment, or medical supplies;

deleted text begin (xv)deleted text end new text begin (xiii)new text end dental services;

deleted text begin (xvi)deleted text end new text begin (xiv)new text end hospice care;

deleted text begin (xvii)deleted text end new text begin (xv)new text end audiology services and hearing aids;

deleted text begin (xviii)deleted text end new text begin (xvi)new text end podiatry services;

deleted text begin (xix)deleted text end new text begin (xvii)new text end chiropractic services;

deleted text begin (xx)deleted text end new text begin (xviii)new text end immunizations;

deleted text begin (xxi)deleted text end new text begin (xix)new text end vision services and eyeglasses;

deleted text begin (xxii)deleted text end new text begin (xx)new text end waiver services;

deleted text begin (xxiii)deleted text end new text begin (xxi)new text end individualized education programs; or

deleted text begin (xxiv)deleted text end new text begin (xxii)new text end 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, 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.

new text begin (k) Notwithstanding paragraph (h), clause (2), the following services are covered as
emergency medical conditions under paragraph (f) except where coverage is prohibited
under federal law:
 new text end

new text begin (1) dialysis services provided in a hospital or freestanding dialysis facility; and
 new text end

new text begin (2) surgery and the administration of chemotherapy, radiation, and related services
necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission
and requires surgery, chemotherapy, or radiation treatment.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
 new text end

Sec. 7.

Minnesota Statutes 2012, section 256B.0625, subdivision 9, is amended to read:


Subd. 9.

Dental services.

(a) Medical assistance covers dental services.

(b) Medical assistance dental coverage for nonpregnant adults is limited to the
following services:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, limited to one per year;

(3) limited exams;

(4) bitewing x-rays, limited to one per year;

(5) periapical x-rays;

(6) panoramic x-rays, limited to one every five years except (1) when medically
necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
or (2) once every two years for patients who cannot cooperate for intraoral film due to
a developmental disability or medical condition that does not allow for intraoral film
placement;

(7) prophylaxis, limited to one per year;

(8) application of fluoride varnish, limited to one per year;

(9) posterior fillings, all at the amalgam rate;

(10) anterior fillings;

(11) endodontics, limited to root canals on the anterior and premolars only;

(12) removable prostheses, each dental arch limited to one every six years;

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
abscesses;

(14) palliative treatment and sedative fillings for relief of pain; and

(15) full-mouth debridement, limited to one every five years.

(c) In addition to the services specified in paragraph (b), medical assistance
covers the following services for adults, if provided in an outpatient hospital setting or
freestanding ambulatory surgical center as part of outpatient dental surgery:

(1) periodontics, limited to periodontal scaling and root planing once every two years;

(2) general anesthesia; and

(3) full-mouth survey once every five years.

(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants are covered once every five years per permanent molar for
children only;

(3) application of fluoride varnish is covered once every six months; and

(4) orthodontia is eligible for coverage for children only.

new text begin (e) In addition to the services specified in paragraphs (b) and (c), medical assistance
covers the following services for adults:
 new text end

new text begin (1) house calls or extended care facility calls for on-site delivery of covered services;
 new text end

new text begin (2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
 new text end

new text begin (3) oral or IV sedation, if the covered dental service cannot be performed safely
without it or would otherwise require the service to be performed under general anesthesia
in a hospital or surgical center; and
 new text end

new text begin (4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
 new text end

Sec. 8.

Minnesota Statutes 2012, section 256B.0625, subdivision 13e, is amended to
read:


Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment
shall be the lower of the actual acquisition costs of the drugs or the maximum allowable
cost by the commissioner plus the fixed dispensing fee; or the usual and customary price
charged to the public. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any provider/insurer agreement or contract for submitted
charges to medical assistance programs. The net submitted charge may not be greater
than the patient liability for the service. The pharmacy dispensing fee shall be $3.65,
except that the dispensing fee for intravenous solutions which must be compounded by
the pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and
$30 per bag for total parenteral nutritional products dispensed in one liter quantities,
or $44 per bag for total parenteral nutritional products dispensed in quantities greater
than one liter. Actual acquisition cost includes quantity and other special discounts
except time and cash discounts. The actual acquisition cost of a drug shall be estimated
by the commissioner at wholesale acquisition cost plus four percent for independently
owned pharmacies located in a designated rural area within Minnesota, and at wholesale
acquisition cost plus two percent for all other pharmacies. A pharmacy is "independently
owned" if it is one of four or fewer pharmacies under the same ownership nationally.
A "designated rural area" means an area defined as a small rural area or isolated rural
area according to the four-category classification of the Rural Urban Commuting Area
system developed for the United States Health Resources and Services Administration.
new text begin The actual acquisition cost of a drug acquired through the federal 340B Drug Pricing
Program shall be estimated by the commissioner at wholesale acquisition cost minus 44
percent. new text end Wholesale acquisition cost is defined as the manufacturer's list price for a drug or
biological to wholesalers or direct purchasers in the United States, not including prompt
pay or other discounts, rebates, or reductions in price, for the most recent month for which
information is available, as reported in wholesale price guides or other publications of
drug or biological pricing data. The maximum allowable cost of a multisource drug may
be set by the commissioner and it shall be comparable to, but no higher than, the maximum
amount paid by other third-party payors in this state who have maximum allowable cost
programs. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.

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

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

(d) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider deleted text begin ordeleted text end new text begin ,new text end 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Actnew text begin , the specialty pharmacy rate, or the maximum allowable cost
set by the commissionernew text end . If average sales price is unavailable, the amount of payment
must be lower of the usual and customary cost submitted by the provider deleted text begin ordeleted text end new text begin ,new text end the wholesale
acquisition costnew text begin , the specialty pharmacy rate, or the maximum allowable cost set by the
commissioner. The commissioner shall discount the payment rate for drugs obtained
through the federal 340B Drug Pricing Program by 33 percent. The payment for drugs
administered in an outpatient setting shall be made to the administering facility or
practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
outpatient setting is not eligible for direct reimbursementnew text end .

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

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 9.

Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to read:


Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall
be made for wheelchairs and wheelchair accessories for recipients who are residents
of intermediate care facilities for the developmentally disabled. Reimbursement for
wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
conditions and limitations as coverage for recipients who do not reside in institutions. A
wheelchair purchased outside of the facility's payment rate is the property of the recipient.
The commissioner may set reimbursement rates for specified categories of medical
supplies at levels below the Medicare payment rate.

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.

(c) When necessary to ensure access to durable medical equipment, prosthetics,
orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
enrollment requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic,
orthotic, or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or
similar durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with
the Medicare program's supplier and quality standards and the vendor serves primarily
pediatric patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical
condition or is generally used primarily for a medical purpose.

new text begin (e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
must be locked in order to prevent use not related to communication.
 new text end

Sec. 10.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 31b. new text end

new text begin Preferred diabetic testing supply program. new text end

new text begin (a) The commissioner
shall adopt and implement a point of sale preferred diabetic testing supply program by
January 1, 2014. Medical assistance coverage for diabetic testing supplies shall conform
to the limitations established under the program. The commissioner may enter into a
contract with a vendor for the purpose of participating in a preferred diabetic testing
supply list and supplemental rebate program. The commissioner shall ensure that any
contract meets all federal requirements and maximizes federal financial participation. The
commissioner shall maintain an accurate and up-to-date list on the agency Web site.
 new text end

new text begin (b) The commissioner may add to, delete from, and otherwise modify the preferred
diabetic testing supply program drug list after consulting with the Drug Formulary
Committee and appropriate medial specialists and providing public notice and the
opportunity for public comment.
 new text end

new text begin (c) The commissioner shall adopt and administer the preferred diabetic testing
supply program as part of the administration of the diabetic testing supply rebate program.
Reimbursement for diabetic testing supplies not on the preferred diabetic testing supply
list may be subject to prior authorization.
 new text end

new text begin (d) All claims for diabetic testing supplies in categories on the preferred diabetic
testing supply list must be submitted by enrolled pharmacy providers using the most
current National Council of Prescription Drug Providers electronic claims standard.
 new text end

new text begin (e) For purposes of this subdivision, "preferred diabetic testing supply list" means a
list of diabetic testing supplies selected by the commissioner, for which prior authorization
is not required.
 new text end

new text begin (f) The commissioner shall seek any federal waivers or approvals necessary to
implement this subdivision.
 new text end

Sec. 11.

Minnesota Statutes 2012, section 256B.0625, subdivision 39, is amended to
read:


Subd. 39.

Childhood immunizations.

Providers who administer pediatric vaccines
within the scope of their licensure, and who are enrolled as a medical assistance provider,
must enroll in the pediatric vaccine administration program established by section 13631
of the Omnibus Budget Reconciliation Act of 1993. Medical assistance shall pay deleted text begin an
$8.50 fee per dosedeleted text end for administration of the vaccine to children eligible for medical
assistance. Medical assistance does not pay for vaccines that are available at no cost from
the pediatric vaccine administration program.

Sec. 12.

Minnesota Statutes 2012, section 256B.0625, subdivision 58, is amended to
read:


Subd. 58.

Early and periodic screening, diagnosis, and treatment services.

Medical assistance covers early and periodic screening, diagnosis, and treatment services
(EPSDT). The payment amount for a complete EPSDT screening new text begin shall not include charges
for vaccines that are available at no cost to the provider and new text end shall not exceed the rate
established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.

Sec. 13.

Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to read:


Subdivision 1.

Cost-sharing.

(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011:

(1) $3 per nonpreventive visit, except as provided in paragraph (b). 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;

(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
this co-payment shall be increased to $20 upon federal approval;

(3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness;

(4) effective January 1, 2012, a family deductible equal to the maximum amount
allowed under Code of Federal Regulations, title 42, part 447.54; and

(5) for individuals identified by the commissioner with income at or below 100
percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
percent of family income. For purposes of this paragraph, family income is the total
earned and unearned income of the individual and the individual's spouse, if the spouse is
enrolled in medical assistance and also subject to the five percent limit on cost-sharing.

(b) Recipients of medical assistance are responsible for all co-payments and
deductibles in this subdivision.

(c) Notwithstanding paragraph (b), the commissioner, through the contracting
process under sections 256B.69 and 256B.692, may allow managed care plans and
county-based purchasing plans to waive the family deductible under paragraph (a),
clause (4). 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.

(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
the family deductible described under paragraph (a), clause (4), from individuals and
allow long-term care and waivered service providers to assume responsibility for payment.

new text begin (e) Notwithstanding paragraph (b), the commissioner, through the contracting
process under section 256B.0756 shall allow the pilot program in Hennepin County to
waive co-payments. The value of the co-payments shall not be included in the capitation
amount to the managed care organization.
 new text end

Sec. 14.

Minnesota Statutes 2012, section 256B.0756, is amended to read:


256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.

(a) The commissioner, upon federal approval of a new waiver request or amendment
of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey
County, or both, to test alternative and innovative integrated health care delivery networks.

(b) Individuals eligible for the pilot program shall be individuals who are eligible for
medical assistance under section 256B.055deleted text begin , subdivision 15,deleted text end and who reside in Hennepin
County or Ramsey County. new text begin The commissioner may identify individuals to be enrolled in
the Hennepin County pilot program based on zip code in Hennepin County or whether the
individuals would benefit from an integrated health care delivery network.
new text end

(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
health care delivery network in their county of residence. The integrated health care
delivery network in Hennepin County shall be a network, such as an accountable care
organization or a community-based collaborative care network, created by or including
Hennepin County Medical Center. The integrated health care delivery network in Ramsey
County shall be a network, such as an accountable care organization or community-based
collaborative care network, created by or including Regions Hospital.

deleted text begin (d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for
Hennepin County and 3,500 enrollees for Ramsey County.
 deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end In developing a payment system for the pilot programs, the commissioner
shall establish a total cost of care for the recipients enrolled in the pilot programs that
equals the cost of care that would otherwise be spent for these enrollees in the prepaid
medical assistance program.

deleted text begin (f) Counties may transfer funds necessary to support the nonfederal share of
payments for integrated health care delivery networks in their county. Such transfers per
county shall not exceed 15 percent of the expected expenses for county enrollees.
 deleted text end

deleted text begin (g)deleted text end new text begin (e)new text end The commissioner shall apply to the federal government for, or as appropriate,
cooperate with counties, providers, or other entities that are applying for any applicable
grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
111-152, that would further the purposes of or assist in the creation of an integrated health
care delivery network for the purposes of this subdivision, including, but not limited to, a
global payment demonstration or the community-based collaborative care network grants.

Sec. 15.

Minnesota Statutes 2012, section 256B.69, subdivision 5c, is amended to read:


Subd. 5c.

Medical education and research fund.

(a) The commissioner of human
services shall transfer each year to the medical education and research fund established
under section 62J.692, an amount specified in this subdivision. The commissioner shall
calculate the following:

(1) an amount equal to the reduction in the prepaid medical assistance payments as
specified in this clause. Until January 1, 2002, the county medical assistance capitation
base rate prior to plan specific adjustments and after the regional rate adjustments under
subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
January 1, 2002, the county medical assistance capitation base rate prior to plan specific
adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
facility and elderly waiver payments and demonstration project payments operating
under subdivision 23 are excluded from this reduction. The amount calculated under
this clause shall not be adjusted for periods already paid due to subsequent changes to
the capitation payments;

(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
section;

(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
paid under this section; and

(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
under this section.

(b) This subdivision shall be effective upon approval of a federal waiver which
allows federal financial participation in the medical education and research fund. The
amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount
transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under
paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally
reduce the amount specified under paragraph (a), clause (1).

(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
shall transfer $21,714,000 each fiscal year to the medical education and research fund.

(d) Beginning September 1, 2011, of the amount in paragraph (a), following the
transfer under paragraph (c), the commissioner shall transfer to the medical education
research fund $23,936,000 in fiscal years 2012 and 2013 and deleted text begin $36,744,000deleted text end new text begin $49,552,000new text end in
fiscal year 2014 and thereafter.

Sec. 16.

Minnesota Statutes 2012, section 256B.69, subdivision 31, is amended to read:


Subd. 31.

Payment reduction.

(a) Beginning September 1, 2011, the commissioner
shall reduce payments and limit future rate increases paid to managed care plans and
county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved
on a statewide aggregate basis by program. The commissioner may use competitive
bidding, payment reductions, or other reductions to achieve the reductions and limits
in this subdivision.

(b) Beginning September 1, 2011, the commissioner shall reduce payments to
managed care plans and county-based purchasing plans as follows:

(1) 2.0 percent for medical assistance elderly basic care. This shall not apply
to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
services;

(2) 2.82 percent for medical assistance families and children;

(3) 10.1 percent for medical assistance adults without children; and

(4) 6.0 percent for MinnesotaCare families and children.

(c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed
care plans and county-based purchasing plans for calendar year 2012 to a percentage of
the rates in effect on August 31, 2011, as follows:

(1) 98 percent for medical assistance elderly basic care. This shall not apply to
Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
services;

(2) 97.18 percent for medical assistance families and children;

(3) 89.9 percent for medical assistance adults without children; and

(4) 94 percent for MinnesotaCare families and children.

(d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit
the maximum annual trend increases to rates paid to managed care plans and county-based
purchasing plans as follows:

(1) 7.5 percent for medical assistance elderly basic care. This shall not apply
to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
services;

(2) 5.0 percent for medical assistance special needs basic care;

(3) 2.0 percent for medical assistance families and children;

(4) 3.0 percent for medical assistance adults without children;

(5) 3.0 percent for MinnesotaCare families and children; and

(6) 3.0 percent for MinnesotaCare adults without children.

(e) The commissioner may limit trend increases to less than the maximum.
Beginning deleted text begin Julydeleted text end new text begin Januarynew text end 1, 2014, the commissioner shall limit the maximum annual trend
increases to rates paid to managed care plans and county-based purchasing plans as
follows for calendar years 2014 and 2015:

(1) deleted text begin 7.5deleted text end new text begin 3.25new text end percent for medical assistance elderly basic care. This shall not apply
to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
services;

(2) deleted text begin 5.0deleted text end new text begin 2.5new text end percent for medical assistance special needs basic care;

(3) 2.0 percent for medical assistance families and children;

(4) 3.0 percent for medical assistance adults without children;

(5) 3.0 percent for MinnesotaCare families and children; and

(6) deleted text begin 4.0deleted text end new text begin 3.0new text end percent for MinnesotaCare adults without children.

The commissioner may limit trend increases to less than the maximum.

Sec. 17.

Minnesota Statutes 2012, section 256B.76, subdivision 2, is amended to read:


Subd. 2.

Dental reimbursement.

(a) Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
percent above the rate in effect on June 30, 1992; and

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases.

(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.

(c) Effective for services rendered on or after January 1, 2000, payment rates for
dental services shall be increased by three percent over the rates in effect on December
31, 1999.

(d) Effective for services provided on or after January 1, 2002, payment for
diagnostic examinations and dental x-rays provided to children under age 21 shall be the
lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.

(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
2000, for managed care.

(f) Effective for dental services rendered on or after October 1, 2010, by a
state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
on the Medicare principles of reimbursement. This payment shall be effective for services
rendered on or after January 1, 2011, to recipients enrolled in managed care plans or
county-based purchasing plans.

(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics
in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal
year, a supplemental state payment equal to the difference between the total payments
in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated
services for the operation of the dental clinics.

(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).

(i) Effective for services rendered on or after September 1, 2011, through June 30,
2013, payment rates for dental services shall be reduced by three percent. This reduction
does not apply to state-operated dental clinics in paragraph (f).

new text begin (j) Effective for services rendered on or after January 1, 2014, payment rates for
dental services shall be increased by five percent from the rates in effect on December
31, 2013. This increase does not apply to state-operated dental clinics in paragraph (f),
federally qualified health centers, rural health centers, and Indian health services. Effective
January 1, 2014, payments made to managed care plans and county-based purchasing
plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
described in this paragraph.
 new text end

Sec. 18.

Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:


Subd. 4.

Critical access dental providers.

(a) Effective for dental services
rendered on or after January 1, 2002, the commissioner shall increase reimbursements
to dentists and dental clinics deemed by the commissioner to be critical access dental
providers. For dental services rendered on or after July 1, 2007, the commissioner shall
increase reimbursement by 30 percent above the reimbursement rate that would otherwise
be paid to the critical access dental provider. The commissioner shall pay the managed
care plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.

(b) The commissioner shall designate the following dentists and dental clinics as
critical access dental providers:

(1) nonprofit community clinics that:

(i) have nonprofit status in accordance with chapter 317A;

(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);

(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;

(iv) have professional staff familiar with the cultural background of the clinic's
patients;

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

(vi) do not restrict access or services because of a patient's financial limitations
or public assistance status; and

(vii) have free care available as needed;

(2) federally qualified health centers, rural health clinics, and public health clinics;

(3) new text begin city or new text end county owned and operated hospital-based dental clinics;

(4) a dental clinic deleted text begin or dental groupdeleted text end new text begin that is part of a dental groupnew text end owned and operated
by a nonprofit corporation in accordance with chapter 317A with more than 10,000 new text begin dental
groupnew text end patient encounters per year with patients who are uninsured or covered by medical
assistancedeleted text begin , general assistance medical care,deleted text end or MinnesotaCarenew text begin , if more than 50 percent
of the individual dental clinic's patient encounters per year are with patients who are
uninsured or covered by medical assistance or MinnesotaCarenew text end ; deleted text begin and
deleted text end

(5) a dental clinic owned and operated by the University of Minnesota or the
Minnesota State Colleges and Universities systemdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (6) private practicing dentists if:
 new text end

new text begin (i) the dentist's office is located within a health professional shortage area as defined
under Code of Federal Regulations, title 42, part 5, and United States Code, title 42,
section 254E;
 new text end

new text begin (ii) more than 50 percent of the dentist's patient encounters per year are with patients
who are uninsured or covered by medical assistance or MinnesotaCare;
 new text end

new text begin (iii) the dentist does not restrict access or services because of a patient's financial
limitations or public assistance status; and
 new text end

new text begin (iv) the level of service provided by the dentist is critical to maintaining adequate
levels of patient access within the service area in which the dentist operates.
 new text end

(c) The commissioner may designate a dentist or dental clinic as a critical access
dental provider if the dentist or dental clinic is willing to provide care to patients covered
by medical assistance, general assistance medical care, or MinnesotaCare at a level which
significantly increases access to dental care in the service area.

(d) A designated critical access clinic shall receive the reimbursement rate specified
in paragraph (a) for dental services provided off site at a private dental office if the
following requirements are met:

(1) the designated critical access dental clinic is located within a health professional
shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
States Code, title 42, section 254E, and is located outside the seven-county metropolitan
area;

(2) the designated critical access dental clinic is not able to provide the service
and refers the patient to the off-site dentist;

(3) the service, if provided at the critical access dental clinic, would be reimbursed
at the critical access reimbursement rate;

(4) the dentist and allied dental professionals providing the services off site are
licensed and in good standing under chapter 150A;

(5) the dentist providing the services is enrolled as a medical assistance provider;

(6) the critical access dental clinic submits the claim for services provided off site
and receives the payment for the services; and

(7) the critical access dental clinic maintains dental records for each claim submitted
under this paragraph, including the name of the dentist, the off-site location, and the
license number of the dentist and allied dental professionals providing the services.

Sec. 19.

Minnesota Statutes 2012, section 256B.76, is amended by adding a
subdivision to read:


new text begin Subd. 7. new text end

new text begin Payment for certain primary care services and immunization
administration. new text end

new text begin Payment for certain primary care services and immunization
administration services rendered on or after January 1, 2013, through December 31, 2014,
shall be made in accordance with section 1902(a)(13) of the Social Security Act.
 new text end

Sec. 20.

Minnesota Statutes 2012, section 256B.764, is amended to read:


256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.

new text begin (a) new text end Effective for services rendered on or after July 1, 2007, payment rates for family
planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
when these services are provided by a community clinic as defined in section 145.9268,
subdivision 1.

new text begin (b) Effective for services rendered on or after July 1, 2013, payment rates for
family planning services shall be increased by 20 percent over the rates in effect June
30, 2013, when these services are provided by a community clinic as defined in section
145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care
and county-based purchasing plans to reflect this increase, and shall require plans to pass
on the full amount of the rate increase to eligible community clinics, in the form of higher
payment rates for family planning services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
 new text end

Sec. 21.

Minnesota Statutes 2012, section 256B.766, is amended to read:


256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

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

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

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

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

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

new text begin (f) For services provided on or after July 1, 2013, fee-for-service payments made
to pediatric hospitals as referenced in the Social Security Act, section 1886(d)(1)(B)(iii)
and nonstate government hospitals located in cities of the first class for the provision of
outpatient basic care services to persons under age 21 shall be increased by one percent,
subject to an aggregate spending limit under this paragraph of $450,000 for the biennium
ending June 30, 2015.
 new text end

Sec. 22. new text begin PAYMENT FOR MULTIPLE SERVICES PROVIDED ON THE SAME
DAY.
new text end

new text begin The commissioner of human services shall report by December 15, 2013, to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance on the costs and savings to the medical
assistance program of allowing medical assistance payment, including supplemental
payments, for mental health services or dental services provided to a patient by a federally
qualified health center, federally qualified health care center look-alike, or a rural health
clinic on the same day as other covered health services furnished by the same provider.
 new text end

Sec. 23. new text begin DENTAL ADMINISTRATION AND REIMBURSEMENT REPORT.
new text end

new text begin (a) The commissioner of human services shall study the feasibility of a single
administrator for all dental services provided under medical assistance and MinnesotaCare.
Dental services shall include services provided through the prepaid medical assistance
program and the fee-for-service system administered by the Department of Human
Services. The commissioner's study shall address and include recommendations on:
new text end

new text begin (1) possible administrative savings under a single administrator;
new text end

new text begin (2) current reimbursement levels and alternative reimbursement that could target
funding to assure greater access to dental services;
new text end

new text begin (3) flexible scheduling and the coordination of referrals to encourage greater
participation from private dental practitioners and clinics;
new text end

new text begin (4) approaches to reduce emergency room visits; and
new text end

new text begin (5) the use of a streamlined information system to provide information on patient
eligibility and restrictions on benefits.
 new text end

new text begin (b) The commissioner shall also make recommendations on service delivery and
reimbursement methods, including the continuation or modification of critical access dental
provider payments under sections 256B.76, subdivision 4, and 256L.11, subdivision 7.
 new text end

new text begin (c) In conducting the study, the commissioner shall consult with dental providers
currently providing services to enrollees of Minnesota health care programs, including
those receiving enhanced payments through critical access dental provider payments,
private practice dentists, safety net clinics, and the University of Minnesota Dental School.
 new text end

new text begin (d) The commissioner shall submit a report and recommendations relating to dental
administration and reimbursement to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services policy and finance
by December 15, 2013.
 new text end

Sec. 24. new text begin REQUEST FOR INFORMATION; EMERGENCY MEDICAL
ASSISTANCE.
new text end

new text begin (a) The commissioner of human services shall issue a request for information (RFI)
to identify and develop options for a program to provide emergency medical assistance
recipients with coverage for medically necessary services not eligible for federal financial
participation. The RFI must focus on providing coverage for nonemergent services
for recipients who have two or more chronic conditions and have had two or more
hospitalizations covered by emergency medical assistance in a one-year period.
 new text end

new text begin (b) The RFI must be issued by August 1, 2013, and require respondents to submit
information to the commissioner by November 1, 2013. The RFI must request information
on:
 new text end

new text begin (1) services necessary to reduce emergency department and inpatient hospital use for
emergency medical assistance recipients;
 new text end

new text begin (2) methods of service delivery that promote efficiency and cost-effectiveness, and
provide statewide access;
 new text end

new text begin (3) funding options for the services to be covered under the program;
 new text end

new text begin (4) coordination of service delivery and funding with services covered under
emergency medical assistance;
 new text end

new text begin (5) options for program administration; and
 new text end

new text begin (6) methods to evaluate the program, including evaluation of cost-effectiveness and
health outcomes for those emergency medical assistance recipients eligible for coverage
of additional services under the program.
 new text end

new text begin (c) The commissioner shall make information submitted in response to the RFI
available on the agency Web site. The commissioner, based on the responses to the RFI,
shall submit recommendations on providing emergency medical assistance recipients
with coverage for nonemergent services, as described in paragraph (a), to the chairs and
ranking minority members of the legislative committees with jurisdiction over health and
human services policy and finance by January 15, 2014.
 new text end

ARTICLE 7

CONTINUING CARE

Section 1.

Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:


Subd. 7.

Licensing moratorium.

(a) The commissioner shall not issue an
initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
2960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
9555.6265, under this chapter for a physical location that will not be the primary residence
of the license holder for the entire period of licensure. If a license is issued during this
moratorium, and the license holder changes the license holder's primary residence away
from the physical location of the foster care license, the commissioner shall revoke the
license according to section 245A.07. Exceptions to the moratorium include:

(1) foster care settings that are required to be registered under chapter 144D;

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
and determined to be needed by the commissioner under paragraph (b);

(3) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or
restructuring of state-operated services that limits the capacity of state-operated facilities;

(4) new foster care licenses determined to be needed by the commissioner under
paragraph (b) for persons requiring hospital level care; or

(5) new foster care licenses determined to be needed by the commissioner for the
transition of people from personal care assistance to the home and community-based
services.

(b) The commissioner shall determine the need for newly licensed foster care homes
as defined under this subdivision. As part of the determination, the commissioner shall
consider the availability of foster care capacity in the area in which the licensee seeks to
operate, and the recommendation of the local county board. The determination by the
commissioner must be final. A determination of need is not required for a change in
ownership at the same address.

deleted text begin (c) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011. This study shall
include, but is not limited to the following:
 deleted text end

deleted text begin (1) the overall capacity and utilization of foster care beds where the physical location
is not the primary residence of the license holder prior to and after implementation
of the moratorium;
 deleted text end

deleted text begin (2) the overall capacity and utilization of foster care beds where the physical
location is the primary residence of the license holder prior to and after implementation
of the moratorium; and
 deleted text end

deleted text begin (3) the number of licensed and occupied ICF/MR beds prior to and after
implementation of the moratorium.
 deleted text end

deleted text begin (d)deleted text end new text begin (c)new text end When a foster care recipient moves out of a foster home that is not the
primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), the county shall immediately inform the Department of Human Services
Licensing Division. The department shall decrease the statewide licensed capacity for
foster care settings where the physical location is not the primary residence of the license
holder, if the voluntary changes described in paragraph deleted text begin (f)deleted text end new text begin (e)new text end are not sufficient to meet the
savings required by reductions in licensed bed capacity under Laws 2011, First Special
Session chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide
long-term care residential services capacity within budgetary limits. Implementation of
the statewide licensed capacity reduction shall begin on July 1, 2013. The commissioner
shall delicense up to 128 beds by June 30, 2014, using the needs determination process.
Under this paragraph, the commissioner has the authority to reduce unused licensed
capacity of a current foster care program to accomplish the consolidation or closure of
settings. A decreased licensed capacity according to this paragraph is not subject to appeal
under this chapter.

deleted text begin (e)deleted text end new text begin (d)new text end Residential settings that would otherwise be subject to the decreased license
capacity established in paragraph deleted text begin (d)deleted text end new text begin (c)new text end shall be exempt under the following circumstances:

(1) until August 1, 2013, the license holder's beds occupied by residents whose
primary diagnosis is mental illness and the license holder is:

(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
health services (ARMHS) as defined in section 256B.0623;

(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
9520.0870;

(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
9520.0870; or

(iv) a provider of intensive residential treatment services (IRTS) licensed under
Minnesota Rules, parts 9520.0500 to 9520.0670; or

(2) the license holder is certified under the requirements in subdivision 6a.

deleted text begin (f)deleted text end new text begin (e)new text end A resource need determination process, managed at the state level, using the
available reports required by section 144A.351, and other data and information shall
be used to determine where the reduced capacity required under paragraph deleted text begin (d)deleted text end new text begin (c)new text end will
be implemented. The commissioner shall consult with the stakeholders described in
section 144A.351, and employ a variety of methods to improve the state's capacity to
meet long-term care service needs within budgetary limits, including seeking proposals
from service providers or lead agencies to change service type, capacity, or location to
improve services, increase the independence of residents, and better meet needs identified
by the long-term care services reports and statewide data and information. By February
1 of deleted text begin eachdeleted text end new text begin 2013 and August 1 of 2014 and each followingnew text end year, the commissioner shall
provide information and data on the overall capacity of licensed long-term care services,
actions taken under this subdivision to manage statewide long-term care services and
supports resources, and any recommendations for change to the legislative committees
with jurisdiction over health and human services budget.

deleted text begin (g)deleted text end new text begin (f)new text end At the time of application and reapplication for licensure, the applicant and the
license holder that are subject to the moratorium or an exclusion established in paragraph
(a) are required to inform the commissioner whether the physical location where the foster
care will be provided is or will be the primary residence of the license holder for the entire
period of licensure. If the primary residence of the applicant or license holder changes, the
applicant or license holder must notify the commissioner immediately. The commissioner
shall print on the foster care license certificate whether or not the physical location is the
primary residence of the license holder.

deleted text begin (h)deleted text end new text begin (g)new text end License holders of foster care homes identified under paragraph deleted text begin (g)deleted text end new text begin (f)new text end that
are not the primary residence of the license holder and that also provide services in the
foster care home that are covered by a federally approved home and community-based
services waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must
inform the human services licensing division that the license holder provides or intends to
provide these waiver-funded services. These license holders must be considered registered
under section 256B.092, subdivision 11, paragraph (c), and this registration status must
be identified on their license certificates.

Sec. 2.

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


new text begin Subd. 35. new text end

new text begin Commissioner must annually report certain prepaid medical
assistance plan data. new text end

new text begin (a) The commissioner of human services and the commissioner
of education may share private or nonpublic data to allow the commissioners to analyze
the screening, diagnosis, and treatment of children with autism spectrum disorder and
other developmental conditions. The commissioners may share the individual-level data
necessary to:
 new text end

new text begin (1) measure the prevalence of autism spectrum disorder and other developmental
conditions;
new text end

new text begin (2) analyze the effectiveness of existing policies and procedures in the early
identification of children with autism spectrum disorder and other developmental
conditions;
 new text end

new text begin (3) assess the effectiveness of screening, diagnosis, and treatment to allow children
with autism spectrum disorder and other developmental conditions to meet developmental
and social-emotional milestones;
 new text end

new text begin (4) identify and address disparities in screening, diagnosis, and treatment related
to the native language or race and ethnicity of the child;
 new text end

new text begin (5) measure the effectiveness of public health care programs in addressing the medical
needs of children with autism spectrum disorder and other developmental conditions; and
new text end

new text begin (6) determine the capacity of educational systems and health care systems to meet
the needs of children with autism spectrum disorder and other developmental conditions.
 new text end

new text begin (b) The commissioner of human services shall use the data shared with the
commissioner of education under this subdivision to improve public health care program
performance in early screening, diagnosis, and treatment for children once data are
available and shall report on the results and any summary data, as defined in section 13.02,
subdivision 19, on the department's public Web site by September 30 each year.
 new text end

Sec. 3.

Minnesota Statutes 2012, section 256.9657, subdivision 3a, is amended to read:


Subd. 3a.

deleted text begin ICF/MRdeleted text end new text begin ICF/DDnew text end license surcharge.

new text begin (a) new text end Effective July 1, 2003, each
non-state-operated facility as defined under section 256B.501, subdivision 1, shall pay
to the commissioner an annual surcharge according to the schedule in subdivision 4,
paragraph (d). The annual surcharge shall be $1,040 per licensed bed. If the number of
licensed beds is reduced, the surcharge shall be based on the number of remaining licensed
beds the second month following the receipt of timely notice by the commissioner of
human services that beds have been delicensed. The facility must notify the commissioner
of health in writing when beds are delicensed. The commissioner of health must notify
the commissioner of human services within ten working days after receiving written
notification. If the notification is received by the commissioner of human services by
the 15th of the month, the invoice for the second following month must be reduced to
recognize the delicensing of beds. The commissioner may reduce, and may subsequently
restore, the surcharge under this subdivision based on the commissioner's determination of
a permissible surcharge.

new text begin (b) Effective July 1, 2013, the surcharge under paragraph (a) is increased to$3,679
per licensed bed.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
 new text end

Sec. 4.

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.new text begin Until September
30, 2013, payments for individuals under 65 years of age shall be made as described
in this subdivision.
new text end

Sec. 5.

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


Subd. 6.

Payment for long-term care consultation services.

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

new text begin (b) new text end 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.

deleted text begin (b)deleted text end new text begin (c)new text end 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.

deleted text begin (c)deleted text end new text begin (d)new text end 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 deleted text begin (b)deleted text end new text begin (c)new text end and may adjust the monthly payment
amount in paragraph (a). 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.

deleted text begin (d)deleted text end new text begin (e)new text end 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.

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

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

deleted text begin (g)deleted text end new text begin (h)new text end Until the alternative payment methodology in paragraph deleted text begin (h)deleted text end new text begin (i)new text end 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.

deleted text begin (h)deleted text end new text begin (i)new text end The commissioner shall develop an alternative payment methodologynew text begin ,
effective on October 1, 2013,new text end for long-term care consultation services that includes
the funding available under this subdivision, and new text begin for assessments authorized under
new text end sections 256B.092 and 256B.0659. In developing the new payment methodology, the
commissioner shall consider the maximization of other funding sources, including federal
new text begin administrative reimbursement through federal financial participation new text end funding, for all
long-term care consultation deleted text begin and preadmission screeningdeleted text end activity.new text begin 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.
new text end

Sec. 6.

Minnesota Statutes 2012, section 256B.0916, is amended by adding a
subdivision to read:


new text begin Subd. 11. new text end

new text begin Excess spending. new text end

new text begin County and tribal agencies are responsible for spending
in excess of the allocation made by the commissioner. In the event a county or tribal
agency spends in excess of the allocation made by the commissioner for a given allocation
period, they must submit a corrective action plan to the commissioner. The plan must state
the actions the agency will take to correct their overspending for the year following the
period when the overspending occurred. Failure to correct overspending shall result in
recoupment of spending in excess of the allocation. Nothing in this subdivision shall be
construed as reducing the county's responsibility to offer and make available feasible
home and community-based options to eligible waiver recipients within the resources
allocated to them for that purpose.
 new text end

Sec. 7.

Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:


Subd. 11.

Residential support services.

(a) Upon federal approval, there is
established a new service called residential support that is available on the community
alternative care, community alternatives for disabled individuals, developmental
disabilities, and brain injury waivers. Existing waiver service descriptions must be
modified to the extent necessary to ensure there is no duplication between other services.
Residential support services must be provided by vendors licensed as a community
residential setting as defined in section 245A.11, subdivision 8.

(b) Residential support services must meet the following criteria:

(1) providers of residential support services must own or control the residential site;

(2) the residential site must not be the primary residence of the license holder;

(3) the residential site must have a designated program supervisor responsible for
program oversight, development, and implementation of policies and procedures;

(4) the provider of residential support services must provide supervision, training,
and assistance as described in the person's coordinated service and support plan; and

(5) the provider of residential support services must meet the requirements of
licensure and additional requirements of the person's coordinated service and support plan.

(c) Providers of residential support services that meet the definition in paragraph
(a) must be registered using a process determined by the commissioner beginning July
1, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
2960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
9555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
7, paragraph deleted text begin (g)deleted text end new text begin (f)new text end , are considered registered under this section.

Sec. 8.

Minnesota Statutes 2012, section 256B.092, subdivision 12, is amended to read:


Subd. 12.

Waivered services statewide priorities.

(a) The commissioner shall
establish statewide priorities for individuals on the waiting list for developmental
disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must
include, but are not limited to, individuals who continue to have a need for waiver services
after they have maximized the use of state plan services and other funding resources,
including natural supports, prior to accessing waiver services, and who meet at least one
of the following criteria:

(1) have unstable living situations due to the age, incapacity, or sudden loss of
the primary caregivers;

(2) are moving from an institution due to bed closures;

(3) experience a sudden closure of their current living arrangement;

(4) require protection from confirmed abuse, neglect, or exploitation;

(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or

(6) meet other priorities established by the department.

(b) When allocating resources to lead agencies, the commissioner must take into
consideration the number of individuals waiting who meet statewide priorities and the
lead agencies' current use of waiver funds and existing service options.new text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary
base level reserve amount for each county, group of counties, and tribe.
new text end

deleted text begin (c) The commissioner shall evaluate the impact of the use of statewide priorities and
provide recommendations to the legislature on whether to continue the use of statewide
priorities in the November 1, 2011, annual report required by the commissioner in sections
256B.0916, subdivision 7, and 256B.49, subdivision 21.
 deleted text end

Sec. 9.

new text begin [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
 new text end

new text begin Subdivision 1. new text end

new text begin Purpose. new text end

new text begin This section creates a new benefit available under the
medical assistance state plan when federal approval consistent with the provisions in
subdivision 11 is obtained for a 1915(i) waiver pursuant to the Affordable Care Act, section
2402(c), amending United States Code, title 42, section 1396n(i)(1), or other option to
provide early intensive intervention to a child with an autism spectrum disorder diagnosis.
This benefit must provide coverage for diagnosis, multidisciplinary assessment, ongoing
progress evaluation, and medically necessary treatment of autism spectrum disorder.
 new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

new text begin (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
 new text end

new text begin (c) "Child" means a person under the age of seven, or for two years at any age under
age 18 if the person was not diagnosed with autism spectrum disorder before age five, or a
person under age 18 pursuant to subdivision 12.
 new text end

new text begin (d) "Commissioner" means the commissioner of human services, unless otherwise
specified.
 new text end

new text begin (e) "Early intensive intervention benefit" means autism treatment options based in
behavioral and developmental science, which may include modalities such as applied
behavior analysis, developmental treatment approaches, and naturalistic and parent
training models.
 new text end

new text begin (f) "Generalizable goals" means results or gains that are observed during a variety
of activities with different people, such as providers, family members, other adults, and
children, and in different environments including, but not limited to, clinics, homes,
schools, and the community.
 new text end

new text begin Subd. 3. new text end

new text begin Initial eligibility. new text end

new text begin This benefit is available to a child enrolled in medical
assistance who:
 new text end

new text begin (1) has an autism spectrum disorder diagnosis;
 new text end

new text begin (2) has had a diagnostic assessment described in subdivision 5, which recommends
early intensive intervention services;
new text end

new text begin (3) meets the criteria for medically necessary autism early intensive intervention
services; and
 new text end

new text begin (4) declines to enroll in the state services described in section 252.27.
 new text end

new text begin Subd. 4. new text end

new text begin Diagnosis. new text end

new text begin (a) A diagnosis must:
 new text end

new text begin (1) be based upon current DSM criteria including direct observations of the child
and reports from parents or primary caregivers;
 new text end

new text begin (2) be completed by a professional who has expertise and training in autism spectrum
disorder and child development and who is a licensed physician, nurse practitioner, or
a licensed mental health professional until the commissioner's assessment required in
subdivision 8, clause (7), shows there are adequate professionals to avoid access problems
or delays in diagnosis for young children if two professionals are required for a diagnosis
pursuant to clause (3); and
 new text end

new text begin (3) be completed by both a medical and mental health professional who have expertise
and training in autism spectrum disorder and child development when the assessment in
subdivision 8, clause (7), demonstrates that there are sufficient professionals available.
 new text end

new text begin (b) Additional diagnostic assessment information including from special education
evaluations and licensed school personnel, and from professionals licensed in the fields of
medicine, speech and language, psychology, occupational therapy, and physical therapy
may be considered.
 new text end

new text begin Subd. 5. new text end

new text begin Diagnostic assessment. new text end

new text begin The following information and assessments must
be performed, reviewed, and relied upon for the eligibility determination, treatment and
services recommendations, and treatment plan development for the child:
 new text end

new text begin (1) an assessment of the child's developmental skills, functional behavior, needs,
and capacities based on direct observation of the child which must be administered by
a licensed mental health professional and may also include observations from family
members, licensed school personnel, child care providers, or other caregivers, as well as
any medical or assessment information from other licensed professionals such as the
child's physician, rehabilitation therapists, or mental health professionals; and
 new text end

new text begin (2) an assessment of parental or caregiver capacity to participate in therapy including
the type and level of parental or caregiver involvement and training recommended.
 new text end

new text begin Subd. 6. new text end

new text begin Treatment plan. new text end

new text begin (a) Each child's treatment plan must be:
 new text end

new text begin (1) based on the diagnostic assessment information specified in subdivisions 4 and 5;
 new text end

new text begin (2) coordinated with medically necessary occupational, physical, and speech and
language therapies, special education, and other services the child and family are receiving;
 new text end

new text begin (3) family-centered;
 new text end

new text begin (4) culturally sensitive; and
 new text end

new text begin (5) individualized based on the child's developmental status and the child's and
family's identified needs.
 new text end

new text begin (b) The treatment plan must specify the:
 new text end

new text begin (1) child's goals which are developmentally appropriate, functional, and
generalizable;
 new text end

new text begin (2) treatment modality;
 new text end

new text begin (3) treatment intensity;
 new text end

new text begin (4) setting; and
 new text end

new text begin (5) level and type of parental or caregiver involvement.
 new text end

new text begin (c) The treatment must be supervised by a professional with expertise and training in
autism and child development who is a licensed physician, nurse practitioner, or mental
health professional.
 new text end

new text begin (d) The treatment plan must be submitted to the commissioner for approval in a
manner determined by the commissioner for this purpose.
 new text end

new text begin (e) Services authorized must be consistent with the child's approved treatment plan.
 new text end

new text begin Subd. 7. new text end

new text begin Ongoing eligibility. new text end

new text begin (a) An independent progress evaluation conducted
by a licensed mental health professional with expertise and training in autism spectrum
disorder and child development must be completed after each six months of treatment,
or more frequently as determined by the commissioner, to determine if progress is being
made toward achieving generalizable gains and meeting functional goals contained in
the treatment plan.
 new text end

new text begin (b) The progress evaluation must include:
 new text end

new text begin (1) the treating provider's report;
 new text end

new text begin (2) parental or caregiver input;
 new text end

new text begin (3) an independent observation of the child which can be performed by the child's
licensed special education staff;
 new text end

new text begin (4) any treatment plan modifications; and
 new text end

new text begin (5) recommendations for continued treatment services.
 new text end

new text begin (c) Progress evaluations must be submitted to the commissioner in a manner
determined by the commissioner for this purpose.
 new text end

new text begin (d) A child who continues to achieve generalizable gains and treatment goals as
specified in the treatment plan is eligible to continue receiving this benefit.
new text end

new text begin (e) A child's treatment shall continue during the progress evaluation and during an
appeal if continuation of services pending appeal have been requested pursuant to section
256.045, subdivision 10.
 new text end

new text begin Subd. 8. new text end

new text begin Refining the benefit with stakeholders. new text end

new text begin The commissioner must develop
the implementation details of the benefit in consultation with stakeholders and consider
recommendations from the Health Services Advisory Council, the Department of Human
Services Autism Spectrum Disorder Advisory Council, the Legislative Autism Spectrum
Disorder Task Force, and the Interagency Task Force of the Departments of Health,
Education, and Human Services. The commissioner must release these details for a 30-day
public comment period prior to submission to the federal government for approval. The
implementation details include, but are not limited to, the following components:
 new text end

new text begin (1) a definition of the qualifications, standards, and roles of the treatment team,
including recommendations after stakeholder consultation on whether board-certified
behavior analysts and other types of professionals trained in autism spectrum disorder and
child development should be added as mental health or other professionals for treatment
supervision or other function under medical assistance;
 new text end

new text begin (2) development of initial, uniform parameters for comprehensive multidisciplinary
diagnostic assessment information and progress evaluation standards;
 new text end

new text begin (3) the design of an effective and consistent process for assessing parent and
caregiver capacity to participate in the child's early intervention treatment and methods of
involving the parents in the treatment of the child;
 new text end

new text begin (4) formulation of a collaborative process in which professionals have opportunities
to collectively inform the comprehensive, multidisciplinary diagnostic assessment and
progress evaluation processes and standards to support quality improvement of early
intensive intervention services;
 new text end

new text begin (5) coordination of this benefit and its interaction with other services provided by the
Departments of Human Services, Health, and Education;
 new text end

new text begin (6) evaluation, on an ongoing basis, of research regarding the program and treatment
modalities provided to children under this benefit; and
 new text end

new text begin (7) determination of the availability of licensed medical and mental health
professionals with expertise and training in autism spectrum disorder throughout the state
in order to assess whether there are sufficient professionals to require involvement of
both a medical and mental health professional to provide access and prevent delay in the
diagnosis and treatment of young children so as to implement subdivision 4, paragraph
(a), and to ensure treatment is effective, timely, and accessible.
 new text end

new text begin Subd. 9. new text end

new text begin Revision of treatment options. new text end

new text begin (a) The commissioner may revise covered
treatment options as needed based on outcome data and other evidence.
 new text end

new text begin (b) Before the changes become effective, the commissioner must provide public
notice of the changes, the reasons for the change, and a 30-day public comment period
to those who request notice through an electronic list accessible to the public on the
department's Web site.
 new text end

new text begin Subd. 10. new text end

new text begin Coordination between agencies. new text end

new text begin The commissioners of human services
and education must develop the capacity to coordinate services and information including
diagnostic, functional, developmental, medical, and educational assessments; service
delivery; and progress evaluations across health and education sectors.
 new text end

new text begin Subd. 11. new text end

new text begin Federal approval of the autism benefit. new text end

new text begin The provisions of subdivision 9
shall apply to state plan services under Title XIX of the Social Security Act when federal
approval is granted under a 1915(i) waiver or other authority which allows children
eligible for medical assistance through the TEFRA option under section 256B.055,
subdivision 12, to qualify and includes children eligible for medical assistance in families
over 150 percent of the federal poverty guidelines.
 new text end

new text begin Subd. 12. new text end

new text begin Local school districts option to continue treatment. new text end

new text begin (a) A local school
district may contract with the commissioner of human services to pay the state share of
the benefits described under this section to continue this treatment as part of the special
education services offered to all students in the district diagnosed with an autism spectrum
disorder.
 new text end

new text begin (b) A local school district may utilize third-party billing to seek reimbursement
for the district for any services paid by the district under this section for which private
insurance coverage was available to the child.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin The autism benefit under subdivisions 1 to 7, 9, and 12, is
effective upon federal approval for the benefit under a 1915(i) waiver or other federal
authority needed to meet the requirements of subdivision 11, but no earlier than March 1,
2014. Subdivisions 8, 10, and 11 are effective July 1, 2013.
 new text end

Sec. 10.

Minnesota Statutes 2012, section 256B.095, is amended to read:


256B.095 QUALITY ASSURANCE SYSTEM ESTABLISHED.

(a) Effective July 1, 1998, a quality assurance system for persons with developmental
disabilities, which includes an alternative quality assurance licensing system for programs,
is established in Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice,
Steele, Wabasha, and Winona Counties for the purpose of improving the quality of
services provided to persons with developmental disabilities. A county, at its option, may
choose to have all programs for persons with developmental disabilities located within
the county licensed under chapter 245A using standards determined under the alternative
quality assurance licensing system or may continue regulation of these programs under the
licensing system operated by the commissioner. deleted text begin The project expires on June 30, 2014.
deleted text end

(b) Effective July 1, 2003, a county not listed in paragraph (a) may apply to
participate in the quality assurance system established under paragraph (a). The
commission established under section 256B.0951 may, at its option, allow additional
counties to participate in the system.

(c) Effective July 1, 2003, any county or group of counties not listed in paragraph (a)
may establish a quality assurance system under this section. A new system established
under this section shall have the same rights and duties as the system established
under paragraph (a). A new system shall be governed by a commission under section
256B.0951. The commissioner shall appoint the initial commission members based
on recommendations from advocates, families, service providers, and counties in the
geographic area included in the new system. Counties that choose to participate in a
new system shall have the duties assigned under section 256B.0952. The new system
shall establish a quality assurance process under section 256B.0953. The provisions of
section 256B.0954 shall apply to a new system established under this paragraph. The
commissioner shall delegate authority to a new system established under this paragraph
according to section 256B.0955.

(d) Effective July 1, 2007, the quality assurance system may be expanded to include
programs for persons with disabilities and older adults.

new text begin (e) Effective July 1, 2013, a provider of service located in a county listed in
paragraph (a) that is a non-opted-in county may opt-in to the quality assurance system
provided the county where services are provided indicates its agreement with a county
with a delegation agreement with the Department of Human Services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
 new text end

Sec. 11.

Minnesota Statutes 2012, section 256B.0951, subdivision 1, is amended to read:


Subdivision 1.

Membership.

The Quality Assurance Commission is established.
The commission consists of at least 14 but not more than 21 members as follows: at
least three but not more than five members representing advocacy organizations; at
least three but not more than five members representing consumers, families, and their
legal representatives; at least three but not more than five members representing service
providers; at least three but not more than five members representing counties; and the
commissioner of human services or the commissioner's designee. The first commission
shall establish membership guidelines for the transition and recruitment of membership for
the commission's ongoing existence. Members of the commission who do not receive a
salary or wages from an employer for time spent on commission duties may receive a per
diem payment when performing commission duties and functions. All members may be
reimbursed for expenses related to commission activities. deleted text begin Notwithstanding the provisions
of section 15.059, subdivision 5, the commission expires on June 30, 2014.
deleted text end

Sec. 12.

Minnesota Statutes 2012, section 256B.0951, subdivision 4, is amended to read:


Subd. 4.

Commission's authority to recommend variances of licensing
standards.

The commission may recommend to the commissioners of human services
and health variances from the standards governing licensure of programs for persons with
deleted text begin developmentaldeleted text end disabilities in order to improve the quality of services by implementing
an alternative deleted text begin developmentaldeleted text end disabilities licensing system if the commission determines
that the alternative licensing system does not adversely affect the health or safety of
persons being served by the licensed program nor compromise the qualifications of staff
to provide services.

Sec. 13.

Minnesota Statutes 2012, section 256B.0952, subdivision 1, is amended to read:


Subdivision 1.

Notification.

Counties new text begin or providers new text end shall give notice to the
commission and commissioners of human services and health of intent to join the
alternative quality assurance licensing system. A county new text begin or provider new text end choosing to participate
in the alternative quality assurance licensing system commits to participate for three years.

Sec. 14.

Minnesota Statutes 2012, section 256B.0952, subdivision 5, is amended to read:


Subd. 5.

Quality assurance teams.

Quality assurance teams shall be comprised
of county staff; providers; consumers, families, and their legal representatives; members
of advocacy organizations; and other involved community members. Team members
must satisfactorily complete the training program approved by the commission and must
demonstrate performance-based competency. Team members are not considered to be
county employees for purposes of workers' compensation, unemployment insurance, or
state retirement laws solely on the basis of participation on a quality assurance team. deleted text begin The
county may paydeleted text end A per diem new text begin may be paid new text end to team members for time spent on alternative
quality assurance process matters. All team members may be reimbursed for expenses
related to their participation in the alternative process.

Sec. 15.

Minnesota Statutes 2012, section 256B.097, subdivision 1, is amended to read:


Subdivision 1.

Scope.

(a) In order to improve the quality of services provided to
Minnesotans with disabilities and to meet the requirements of the federally approved home
and community-based waivers under section 1915c of the Social Security Act, a State
Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving
disability services is enacted. This system is a partnership between the Department of
Human Services and the State Quality Council established under subdivision 3.

(b) This system is a result of the recommendations from the Department of Human
Services' licensing and alternative quality assurance study mandated under Laws 2005,
First Special Session chapter 4, article 7, section 57, and presented to the legislature
in February 2007.

(c) The disability services eligible under this section include:

(1) the home and community-based services waiver programs for persons with
developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
including brain injuries and services for those who qualify for nursing facility level of care
or hospital facility level of carenew text begin and any other services licensed under chapter 245Dnew text end ;

(2) home care services under section 256B.0651;

(3) family support grants under section 252.32;

(4) consumer support grants under section 256.476;

(5) semi-independent living services under section 252.275; and

(6) services provided through an intermediate care facility for the developmentally
disabled.

(d) For purposes of this section, the following definitions apply:

(1) "commissioner" means the commissioner of human services;

(2) "council" means the State Quality Council under subdivision 3;

(3) "Quality Assurance Commission" means the commission under section
256B.0951; and

(4) "system" means the State Quality Assurance, Quality Improvement and
Licensing System under this section.

Sec. 16.

Minnesota Statutes 2012, section 256B.097, subdivision 3, is amended to read:


Subd. 3.

State Quality Council.

(a) There is hereby created a State Quality
Council which must define regional quality councils, and carry out a community-based,
person-directed quality review component, and a comprehensive system for effective
incident reporting, investigation, analysis, and follow-up.

(b) By August 1, 2011, the commissioner of human services shall appoint the
members of the initial State Quality Council. Members shall include representatives
from the following groups:

(1) disability service recipients and their family members;

(2) during the first deleted text begin twodeleted text end new text begin fournew text end years of the State Quality Council, there must be at least
three members from the Region 10 stakeholders. As regional quality councils are formed
under subdivision 4, each regional quality council shall appoint one member;

(3) disability service providers;

(4) disability advocacy groups; and

(5) county human services agencies and staff from the Department of Human
Services and Ombudsman for Mental Health and Developmental Disabilities.

(c) Members of the council who do not receive a salary or wages from an employer
for time spent on council duties may receive a per diem payment when performing council
duties and functions.

(d) The State Quality Council shall:

(1) assist the Department of Human Services in fulfilling federally mandated
obligations by monitoring disability service quality and quality assurance and
improvement practices in Minnesota;

(2) establish state quality improvement priorities with methods for achieving results
and provide an annual report to the legislative committees with jurisdiction over policy
and funding of disability services on the outcomes, improvement priorities, and activities
undertaken by the commission during the previous state fiscal year;

(3) identify issues pertaining to financial and personal risk that impede Minnesotans
with disabilities from optimizing choice of community-based services; and

(4) recommend to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services and civil law by January 15, deleted text begin 2013
deleted text end new text begin 2014new text end , statutory and rule changes related to the findings under clause (3) that promote
individualized service and housing choices balanced with appropriate individualized
protection.

(e) The State Quality Council, in partnership with the commissioner, shall:

(1) approve and direct implementation of the community-based, person-directed
system established in this section;

(2) recommend an appropriate method of funding this system, and determine the
feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;

(3) approve measurable outcomes in the areas of health and safety, consumer
evaluation, education and training, providers, and systems;

(4) establish variable licensure periods not to exceed three years based on outcomes
achieved; and

(5) in cooperation with the Quality Assurance Commission, design a transition plan
for licensed providers from Region 10 into the alternative licensing system deleted text begin by July 1, 2013deleted text end .

(f) The State Quality Council shall notify the commissioner of human services that a
facility, program, or service has been reviewed by quality assurance team members under
subdivision 4, paragraph (b), clause (13), and qualifies for a license.

(g) The State Quality Council, in partnership with the commissioner, shall establish
an ongoing review process for the system. The review shall take into account the
comprehensive nature of the system which is designed to evaluate the broad spectrum of
licensed and unlicensed entities that provide services to persons with disabilities. The
review shall address efficiencies and effectiveness of the system.

(h) The State Quality Council may recommend to the commissioner certain
variances from the standards governing licensure of programs for persons with disabilities
in order to improve the quality of services so long as the recommended variances do
not adversely affect the health or safety of persons being served or compromise the
qualifications of staff to provide services.

(i) The safety standards, rights, or procedural protections referenced under
subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make
recommendations to the commissioner or to the legislature in the report required under
paragraph (c) regarding alternatives or modifications to the safety standards, rights, or
procedural protections referenced under subdivision 2, paragraph (c).

(j) The State Quality Council may hire staff to perform the duties assigned in this
subdivision.

Sec. 17.

Minnesota Statutes 2012, section 256B.431, subdivision 44, is amended to read:


Subd. 44.

Property rate deleted text begin increasedeleted text end new text begin increasesnew text end for deleted text begin a facility in Bloomington effective
November 1, 2010deleted text end new text begin certain nursing facilitiesnew text end .

new text begin (a) new text end Notwithstanding any other law to the
contrary, money available for moratorium projects under section 144A.073, subdivision
11, shall be used, effective November 1, 2010, to fund an approved moratorium exception
project for a nursing facility in Bloomington licensed for 137 beds as of November 1,
2010, up to a total property rate adjustment of $19.33.

new text begin (b) Effective June 1, 2012, any nursing facility in McLeod County licensed for 110
beds shall have its replacement-cost-new limit under subdivision 17e adjusted to allow
$1,129,463 of a completed construction project to increase the property payment rate.
Notwithstanding any other law to the contrary, money available under section 144A.073,
subdivision 11, after the completion of the moratorium exception approval process in 2013
under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to the
medical assistance budget for the increase in the replacement-cost-new limit.
 new text end

new text begin (c) Effective July 1, 2013, or later, any boarding care facility in Hennepin
County licensed for 100 beds shall be allowed to receive a property rate adjustment
for a construction project that takes action to come into compliance with Minnesota
Department of Labor and Industry elevator upgrade requirements, with costs below the
minimum threshold under subdivision 16. Only costs related to the construction project
that brings the facility into compliance with the elevator requirements shall be allowed.
Notwithstanding any other law to the contrary, money available under section 144A.073,
subdivision 11, after the completion of the moratorium exception approval process in
2013 under section 144A.073, subdivision 3, shall be used to reduce the fiscal impact to
the medical assistance program.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (b) is effective retroactively from June 1, 2012.
 new text end

Sec. 18.

Minnesota Statutes 2012, section 256B.434, subdivision 4, is amended to read:


Subd. 4.

Alternate rates for nursing facilities.

(a) For nursing facilities which
have their payment rates determined under this section rather than section 256B.431, the
commissioner shall establish a rate under this subdivision. The nursing facility must enter
into a written contract with the commissioner.

(b) A nursing facility's case mix payment rate for the first rate year of a facility's
contract under this section is the payment rate the facility would have received under
section 256B.431.

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

(d) The commissioner shall develop additional incentive-based payments of up to
five percent above a facility's operating payment rate for achieving outcomes specified
in a contract. The commissioner may solicit contract amendments and implement those
which, on a competitive basis, best meet the state's policy objectives. The commissioner
shall limit the amount of any incentive payment and the number of contract amendments
under this paragraph to operate the incentive payments within funds appropriated for this
purpose. The contract amendments may specify various levels of payment for various
levels of performance. Incentive payments to facilities under this paragraph may be in the
form of time-limited rate adjustments or onetime supplemental payments. In establishing
the specified outcomes and related criteria, the commissioner shall consider the following
state policy objectives:

(1) successful diversion or discharge of residents to the residents' prior home or other
community-based alternatives;

(2) adoption of new technology to improve quality or efficiency;

(3) improved quality as measured in the Nursing Home Report Card;

(4) reduced acute care costs; and

(5) any additional outcomes proposed by a nursing facility that the commissioner
finds desirable.

(e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
take action to come into compliance with existing or pending requirements of the life
safety code provisions or federal regulations governing sprinkler systems must receive
reimbursement for the costs associated with compliance if all of the following conditions
are met:

(1) the expenses associated with compliance occurred on or after January 1, 2005,
and before December 31, 2008;

(2) the costs were not otherwise reimbursed under subdivision 4f or section
144A.071 or 144A.073; and

(3) the total allowable costs reported under this paragraph are less than the minimum
threshold established under section 256B.431, subdivision 15, paragraph (e), and
subdivision 16.

The commissioner shall use money appropriated for this purpose to provide to qualifying
nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
2008. Nursing facilities that have spent money or anticipate the need to spend money
to satisfy the most recent life safety code requirements by (1) installing a sprinkler
system or (2) replacing all or portions of an existing sprinkler system may submit to the
commissioner by June 30, 2007, on a form provided by the commissioner the actual
costs of a completed project or the estimated costs, based on a project bid, of a planned
project. The commissioner shall calculate a rate adjustment equal to the allowable
costs of the project divided by the resident days reported for the report year ending
September 30, 2006. If the costs from all projects exceed the appropriation for this
purpose, the commissioner shall allocate the money appropriated on a pro rata basis to the
qualifying facilities by reducing the rate adjustment determined for each facility by an
equal percentage. Facilities that used estimated costs when requesting the rate adjustment
shall report to the commissioner by January 31, 2009, on the use of this money on a
form provided by the commissioner. If the nursing facility fails to provide the report, the
commissioner shall recoup the money paid to the facility for this purpose. If the facility
reports expenditures allowable under this subdivision that are less than the amount received
in the facility's annualized rate adjustment, the commissioner shall recoup the difference.

Sec. 19.

Minnesota Statutes 2012, section 256B.434, is amended by adding a
subdivision to read:


new text begin Subd. 19a. new text end

new text begin Nursing facility rate adjustments beginning October 1, 2013. new text end

new text begin (a)
For the rate year beginning October 1, 2013, the commissioner shall make available to
each nursing facility reimbursed under this section a three percent operating payment
rate increase.
 new text end

new text begin (b) Seventy-five percent of the money resulting from the rate adjustment under
paragraph (a) must be used for increases in compensation-related costs for employees
directly employed by the nursing facility on or after the effective date of the rate
adjustment, except:
 new text end

new text begin (1) the administrator;
 new text end

new text begin (2) persons employed in the central office of a corporation that has an ownership
interest in the nursing facility or exercises control over the nursing facility; and
 new text end

new text begin (3) persons paid by the nursing facility under a management contract.
 new text end

new text begin (c) The commissioner shall allow as compensation-related costs all costs for:
 new text end

new text begin (1) wages and salaries;
new text end

new text begin (2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
compensation;
 new text end

new text begin (3) the employer's share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, and pensions; and
 new text end

new text begin (4) other benefits provided and workforce needs including the recruiting and training
of employees, subject to the approval of the commissioner.
 new text end

new text begin (d) The portion of the rate adjustment under paragraph (a) that is not subject to the
requirements of paragraph (b) shall be provided to nursing facilities effective October 1.
Nursing facilities may apply for the portion of the rate adjustment under paragraph (a)
that is subject to the requirements in paragraph (b). The application must be submitted
to the commissioner within six months of the effective date of the rate adjustment, and
the nursing facility must provide additional information required by the commissioner
within nine months of the effective date of the rate adjustment. The commissioner must
respond to all applications within three weeks of receipt. The commissioner may waive
the deadlines in this paragraph under extraordinary circumstances, to be determined at the
sole discretion of the commissioner. The application must contain:
 new text end

new text begin (1) an estimate of the amounts of money that must be used as specified in paragraph
(b);
 new text end

new text begin (2) a detailed distribution plan specifying the allowable compensation-related and
wage increases the nursing facility will implement to use the funds available in clause (1);
 new text end

new text begin (3) a description of how the nursing facility will notify eligible employees of
the contents of the approved application, which must provide for giving each eligible
employee a copy of the approved application, excluding the information required in clause
(1), or posting a copy of the approved application, excluding the information required in
clause (1), for a period of at least six weeks in an area of the nursing facility to which all
eligible employees have access; and
 new text end

new text begin (4) instructions for employees who believe they have not received the
compensation-related or wage increases specified in clause (2), as approved by the
commissioner, and which must include a mailing address, e-mail address, and the
telephone number that may be used by the employee to contact the commissioner or the
commissioner's representative.
 new text end

new text begin (e) For the October 1, 2013, rate increase, the commissioner shall ensure that cost
increases in distribution plans under paragraph (d), clause (2), that may be included in
approved applications, comply with the following requirements:
 new text end

new text begin (1) a portion of the costs resulting from tenure-related wage or salary increases
may be considered to be allowable wage increases, according to formulas that the
commissioner shall provide, where employee retention is above the average statewide
rate of retention of direct care employees;
 new text end

new text begin (2) the annualized amount of increases in costs for the employer's share of health
and dental insurance, life insurance, disability insurance, and workers' compensation
shall be allowable compensation-related increases if they are effective on or after April
1, 2013, and prior to April 1, 2014; and
 new text end

new text begin (3) for nursing facilities in which employees are represented by an exclusive
bargaining representative, the commissioner shall approve the application only upon
receipt of a letter of acceptance of the distribution plan, in regard to members of the
bargaining unit, signed by the exclusive bargaining agent and dated after May 25, 2013.
Upon receipt of the letter of acceptance, the commissioner shall deem all requirements of
this provision as having been met in regard to the members of the bargaining unit.
 new text end

new text begin (f) The commissioner shall review applications received under paragraph (e) and
shall provide the portion of the rate adjustment under paragraph (b) if the requirements
of this statute have been met. The rate adjustment shall be effective October 1.
Notwithstanding paragraph (a), if the approved application distributes less money than is
available, the amount of the rate adjustment shall be reduced so that the amount of money
made available is equal to the amount to be distributed.
 new text end

new text begin (g) The increase in this subdivision shall be applied as a total percentage to
operating rates effective September 30, 2013, except that they shall not increase any
performance-based incentive payments under section 256B.434, subdivision 4, paragraph
(d), awarded prior to the effective date of the rate adjustment. Facilities receiving equitable
cost-sharing for publicly owned nursing facilities program rate adjustments under section
256B.441, subdivision 55a, must have rate increases under this paragraph computed based
on rates in effect before the increases given under section 256B.441, subdivision 55a.
 new text end

Sec. 20.

Minnesota Statutes 2012, section 256B.437, subdivision 6, is amended to read:


Subd. 6.

Planned closure rate adjustment.

(a) The commissioner of human
services shall calculate the amount of the planned closure rate adjustment available under
subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):

(1) the amount available is the net reduction of nursing facility beds multiplied
by $2,080;

(2) the total number of beds in the nursing facility or facilities receiving the planned
closure rate adjustment must be identified;

(3) capacity days are determined by multiplying the number determined under
clause (2) by 365; and

(4) the planned closure rate adjustment is the amount available in clause (1), divided
by capacity days determined under clause (3).

(b) A planned closure rate adjustment under this section is effective on the first day
of the month following completion of closure of the facility designated for closure in
the application and becomes part of the nursing facility's deleted text begin total operatingdeleted text end new text begin external fixed
new text end payment rate.

(c) Applicants may use the planned closure rate adjustment to allow for a property
payment for a new nursing facility or an addition to an existing nursing facility or as
an deleted text begin operating paymentdeleted text end new text begin external fixednew text end rate adjustment. Applications approved under this
subdivision are exempt from other requirements for moratorium exceptions under section
144A.073, subdivisions 2 and 3.

(d) Upon the request of a closing facility, the commissioner must allow the facility a
closure rate adjustment as provided under section 144A.161, subdivision 10.

(e) A facility that has received a planned closure rate adjustment may reassign it
to another facility that is under the same ownership at any time within three years of its
effective date. The amount of the adjustment shall be computed according to paragraph (a).

(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
the commissioner shall recalculate planned closure rate adjustments for facilities that
delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
bed dollar amount. The recalculated planned closure rate adjustment shall be effective
from the date the per bed dollar amount is increased.

(g) For planned closures approved after June 30, 2009, the commissioner of human
services shall calculate the amount of the planned closure rate adjustment available under
subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).

(h) deleted text begin Beginningdeleted text end new text begin Betweennew text end July 16, 2011, new text begin and June 30, 2013, new text end the commissioner shall deleted text begin no
longerdeleted text end new text begin notnew text end accept applications for planned closure rate adjustments under subdivision 3.

Sec. 21.

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; new text begin until September 30, 2013, new text end 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. 22.

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) new text begin Until September 30, 2013, new text end 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. 23.

Minnesota Statutes 2012, section 256B.49, subdivision 11a, is amended to read:


Subd. 11a.

Waivered services statewide priorities.

(a) The commissioner shall
establish statewide priorities for individuals on the waiting list for community alternative
care, community alternatives for disabled individuals, and brain injury waiver services,
as of January 1, 2010. The statewide priorities must include, but are not limited to,
individuals who continue to have a need for waiver services after they have maximized the
use of state plan services and other funding resources, including natural supports, prior to
accessing waiver services, and who meet at least one of the following criteria:

(1) have unstable living situations due to the age, incapacity, or sudden loss of
the primary caregivers;

(2) are moving from an institution due to bed closures;

(3) experience a sudden closure of their current living arrangement;

(4) require protection from confirmed abuse, neglect, or exploitation;

(5) experience a sudden change in need that can no longer be met through state plan
services or other funding resources alone; or

(6) meet other priorities established by the department.

(b) When allocating resources to lead agencies, the commissioner must take into
consideration the number of individuals waiting who meet statewide priorities and the
lead agencies' current use of waiver funds and existing service options.new text begin The commissioner
has the authority to transfer funds between counties, groups of counties, and tribes to
accommodate statewide priorities and resource needs while accounting for a necessary
base level reserve amount for each county, group of counties, and tribe.
new text end

deleted text begin (c) The commissioner shall evaluate the impact of the use of statewide priorities and
provide recommendations to the legislature on whether to continue the use of statewide
priorities in the November 1, 2011, annual report required by the commissioner in sections
256B.0916, subdivision 7, and 256B.49, subdivision 21.
 deleted text end

Sec. 24.

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), 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. new text begin Upon federal approval, if the recipient is able to have
the recipient's needs met through alternative services in a less restrictive setting, the
case manager shall help the recipient develop a plan to transition to an appropriate less
restrictive setting. new text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 25.

Minnesota Statutes 2012, section 256B.49, subdivision 15, is amended to read:


Subd. 15.

Coordinated service and support plan; comprehensive transitional
service plan; maintenance service plan.

(a) Each recipient of home and community-based
waivered services shall be provided a copy of the written coordinated service and support
plan which meets the requirements in section 256B.092, subdivision 1b.

(b) In developing the comprehensive transitional service plan, the individual
receiving services, the case manager, and the guardian, if applicable, will identify the
transitional service plan fundamental service outcome and anticipated timeline to achieve
this outcome. Within the first 20 days following a recipient's request for an assessment or
reassessment, the transitional service planning team must be identified. A team leader must
be identified who will be responsible for assigning responsibility and communicating with
team members to ensure implementation of the transition plan and ongoing assessment and
communication process. The team leader should be an individual, such as the case manager
or guardian, who has the opportunity to follow the recipient to the next level of service.

Within ten days following an assessment, a comprehensive transitional service plan
must be developed incorporating elements of a comprehensive functional assessment and
including short-term measurable outcomes and timelines for achievement of and reporting
on these outcomes. Functional milestones must also be identified and reported according
to the timelines agreed upon by the transitional service planning team. In addition, the
comprehensive transitional service plan must identify additional supports that may assist
in the achievement of the fundamental service outcome such as the development of greater
natural community support, increased collaboration among agencies, and technological
supports.

The timelines for reporting on functional milestones will prompt a reassessment of
services provided, the units of services, rates, and appropriate service providers. It is
the responsibility of the transitional service planning team leader to review functional
milestone reporting to determine if the milestones are consistent with observable skills
and that milestone achievement prompts any needed changes to the comprehensive
transitional service plan.

For those whose fundamental transitional service outcome involves the need to
procure housing, a plan for the recipient to seek the resources necessary to secure the least
restrictive housing possible should be incorporated into the plan, including employment
and public supports such as housing access and shelter needy funding.

(c) Counties and other agencies responsible for funding community placement and
ongoing community supportive services are responsible for the implementation of the
comprehensive transitional service plans. Oversight responsibilities include both ensuring
effective transitional service delivery and efficient utilization of funding resources.

(d) Following one year of transitional services, the transitional services planning team
will make a determination as to whether or not the individual receiving services requires
the current level of continuous and consistent support in order to maintain the recipient's
current level of functioning. Recipients who are determined to have not had a significant
change in functioning for 12 months must move from a transitional to a maintenance
service plan. Recipients on a maintenance service plan must be reassessed to determine if
the recipient would benefit from a transitional service plan at least every 12 months and at
other times when there has been a significant change in the recipient's functioning. This
assessment should consider any changes to technological or natural community supports.

(e) When a county is evaluating denials, reductions, or terminations of home and
community-based services under section 256B.49 for an individual, the case manager
shall offer to meet with the individual or the individual's guardian in order to discuss
the prioritization of service needs within the coordinated service and support plan,
comprehensive transitional service plan, or maintenance service plan. The reduction in
the authorized services for an individual due to changes in funding for waivered services
may not exceed the amount needed to ensure medically necessary services to meet the
individual's health, safety, and welfare.

(f) At the time of reassessment, local agency case managers shall assess each recipient
of community alternatives for disabled individuals or brain injury waivered services
currently residing in a licensed adult foster home that is not the primary residence of the
license holder, or in which the license holder is not the primary caregiver, to determine if
that recipient could appropriately be served in a community-living setting. If appropriate
for the recipient, the case manager shall offer the recipient, through a person-centered
planning process, the option to receive alternative housing and service options. In the
event that the recipient chooses to transfer from the adult foster home, the vacated bed
shall not be filled with another recipient of waiver services and group residential housing
and the licensed capacity shall be reduced accordingly, unless the savings required by the
licensed bed closure reductions under Laws 2011, First Special Session chapter 9, article 7,
sections 1 and 40, paragraph (f), for foster care settings where the physical location is not
the primary residence of the license holder are met through voluntary changes described
in section 245A.03, subdivision 7, paragraph deleted text begin (f)deleted text end new text begin (e)new text end , or as provided under paragraph (a),
clauses (3) and (4). If the adult foster home becomes no longer viable due to these transfers,
the county agency, with the assistance of the department, shall facilitate a consolidation of
settings or closure. This reassessment process shall be completed by July 1, 2013.

Sec. 26.

Minnesota Statutes 2012, section 256B.49, is amended by adding a
subdivision to read:


new text begin Subd. 25. new text end

new text begin Excess allocations. new text end

new text begin County and tribal agencies will be responsible for
authorizations in excess of the allocation made by the commissioner. In the event a county
or tribal agency authorizes in excess of the allocation made by the commissioner for a
given allocation period, they must submit a corrective action plan to the commissioner.
The plan must state the actions the agency will take to correct their over-authorization for
the year following the period when the over-authorization occurred. Failure to correct
over-authorizations shall result in recoupment of authorizations in excess of the allocation.
Nothing in this subdivision shall be construed as reducing the county's responsibility to
offer and make available feasible home and community-based options to eligible waiver
recipients within the resources allocated to them for that purpose.
 new text end

Sec. 27.

Minnesota Statutes 2012, section 256B.492, is amended to read:


256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
WITH DISABILITIES.

(a) Individuals receiving services under a home and community-based waiver under
section 256B.092 or 256B.49 may receive services in the following settings:

(1) an individual's own home or family home;

(2) a licensed adult foster care setting of up to five people; and

(3) community living settings as defined in section 256B.49, subdivision 23, where
individuals with disabilities may reside in all of the units in a building of four or fewer
units, and no more than the greater of four or 25 percent of the units in a multifamily
building of more than four unitsnew text begin , unless required by the Housing Opportunities for Persons
with AIDS programnew text end .

(b) The settings in paragraph (a) must not:

(1) be located in a building that is a publicly or privately operated facility that
provides institutional treatment or custodial care;

(2) be located in a building on the grounds of or adjacent to a public or private
institution;

(3) be a housing complex designed expressly around an individual's diagnosis or
disabilitynew text begin , unless required by the Housing Opportunities for Persons with AIDS programnew text end ;

(4) be segregated based on a disability, either physically or because of setting
characteristics, from the larger community; and

(5) have the qualities of an institution which include, but are not limited to:
regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
agreed to and documented in the person's individual service plan shall not result in a
residence having the qualities of an institution as long as the restrictions for the person are
not imposed upon others in the same residence and are the least restrictive alternative,
imposed for the shortest possible time to meet the person's needs.

(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
individuals receive services under a home and community-based waiver as of July 1,
2012, and the setting does not meet the criteria of this section.

(d) Notwithstanding paragraph (c), a program in Hennepin County established as
part of a Hennepin County demonstration project is qualified for the exception allowed
under paragraph (c).

(e) The commissioner shall submit an amendment to the waiver plan no later than
December 31, 2012.

Sec. 28.

Minnesota Statutes 2012, section 256B.493, subdivision 2, is amended to read:


Subd. 2.

Planned closure process needs determination.

The commissioner shall
announce and implement a program for planned closure of adult foster care homes. Planned
closure shall be the preferred method for achieving necessary budgetary savings required by
the licensed bed closure budget reduction in section 245A.03, subdivision 7, paragraph deleted text begin (d)
deleted text end new text begin (c)new text end . If additional closures are required to achieve the necessary savings, the commissioner
shall use the process and priorities in section 245A.03, subdivision 7, paragraph deleted text begin (d)deleted text end new text begin (c)new text end .

Sec. 29.

Minnesota Statutes 2012, section 256B.5012, is amended by adding a
subdivision to read:


new text begin Subd. 14. new text end

new text begin Rate increase effective June 1, 2013. new text end

new text begin For rate periods beginning on or
after June 1, 2013, the commissioner shall increase the total operating payment rate for
each facility reimbursed under this section by $7.81 per day. The increase shall not be
subject to any annual percentage increase.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2013.
 new text end

Sec. 30.

Minnesota Statutes 2012, section 256B.5012, is amended by adding a
subdivision to read:


new text begin Subd. 15. new text end

new text begin ICF/DD rate increases effective July 1, 2013. new text end

new text begin (a) Notwithstanding
subdivision 12, for each facility reimbursed under this section, for the rate period
beginning July 1, 2013, the commissioner shall increase operating payments equal to two
percent of the operating payment rates in effect on June 30, 2013.
 new text end

new text begin (b) For each facility, the commissioner shall apply the rate increase based on
occupied beds, using the percentage specified in this subdivision multiplied by the total
payment rate, including the variable rate, but excluding the property-related payment
rate in effect on the preceding date. The total rate increase shall include the adjustment
provided in section 256B.501, subdivision 12.
 new text end

Sec. 31.

Minnesota Statutes 2012, section 256B.69, is amended by adding a
subdivision to read:


new text begin Subd. 32a. new text end

new text begin Initiatives to improve early screening, diagnosis, and treatment of
children with autism spectrum disorder and other developmental conditions. new text end

new text begin (a) The
commissioner shall require managed care plans and county-based purchasing plans, as
a condition of contract, to implement strategies that facilitate access for young children
between the ages of one and three years to periodic developmental and social-emotional
screenings, as recommended by the Minnesota Interagency Developmental Screening
Task Force, and that those children who do not meet milestones are provided access to
appropriate evaluation and assessment, including treatment recommendations, expected to
improve the child's functioning, with the goal of meeting milestones by age five.
 new text end

new text begin (b) The managed care plans must report the following data annually:
 new text end

new text begin (1) the number of children who received a diagnostic assessment;
 new text end

new text begin (2) the total number of children ages one to six with a diagnosis of autism spectrum
disorder who received treatments;
 new text end

new text begin (3) the number of children identified under clause (2) reported by each 12-month
age group beginning with age one and ending with age six;
 new text end

new text begin (4) the types of treatments provided to children identified under clause (2) listed by
billing code, including the number of units billed for each child;
 new text end

new text begin (5) barriers to providing screening, diagnosis, and treatment of young children
between the ages of one and three years and any strategies implemented to address
those barriers; and
 new text end

new text begin (6) recommendations on how to measure and report on the effectiveness of the
strategies implemented to facilitate access for young children to provide developmental
and social-emotional screening, diagnosis, and treatment.
 new text end

Sec. 32.

Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision
3, as amended by Laws 2012, chapter 247, article 4, section 43, is amended to read:


Subd. 3.

Forecasted Programs

The amounts that may be spent from this
appropriation for each purpose are as follows:

(a) MFIP/DWP Grants
Appropriations by Fund
General
 84,680,000
 91,978,000
Federal TANF
 84,425,000
 75,417,000
(b) MFIP Child Care Assistance Grants
 55,456,000
 30,923,000
(c) General Assistance Grants
 49,192,000
 46,938,000

General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart
from parents or a legal guardian at $203.
The commissioner may reduce this amount
according to Laws 1997, chapter 85, article
3, section 54.

Emergency General Assistance. The
amount appropriated for emergency general
assistance funds is limited to no more than
$6,689,812 in fiscal year 2012 and $6,729,812
in fiscal year 2013. Funds to counties shall
be allocated by the commissioner using the
allocation method specified in Minnesota
Statutes, section 256D.06.

(d) Minnesota Supplemental Aid Grants
 38,095,000
 39,120,000
(e) Group Residential Housing Grants
 121,080,000
 129,238,000
(f) MinnesotaCare Grants
 295,046,000
 317,272,000

This appropriation is from the health care
access fund.

(g) Medical Assistance Grants
 4,501,582,000
 4,437,282,000

Managed Care Incentive Payments. The
commissioner shall not make managed care
incentive payments for expanding preventive
services during fiscal years beginning July 1,
2011, and July 1, 2012.

Reduction of Rates for Congregate
Living for Individuals with Lower Needs.
Beginning October 1, 2011, lead agencies
must reduce rates in effect on January 1, 2011,
by ten percent for individuals with lower
needs living in foster care settings where the
license holder does not share the residence
with recipients on the CADI and DD waivers
and customized living settings for CADI.
Lead agencies shall consult with providers to
review individual service plans and identify
changes or modifications to reduce the
utilization of services while maintaining the
health and safety of the individual receiving
services. Lead agencies must adjust contracts
within 60 days of the effective date. If
federal waiver approval is obtained under
the long-term care realignment waiver
application submitted on February 13,
2012, and federal financial participation is
authorized for the alternative care program,
the commissioner shall adjust this payment
rate reduction from ten to five percent for
services rendered on or after July 1, 2012, or
the first day of the month following federal
approval, whichever is later.new text begin Effective
August 1, 2013, this provision does not apply
to individuals whose primary diagnosis is
mental illness and who are living in foster
care settings where the license holder is
also (1) a provider of assertive community
treatment (ACT) or adult rehabilitative
mental health services (ARMHS) as defined
in Minnesota Statutes, section 256B.0623;
(2) a mental health center or mental health
clinic certified under Minnesota Rules, parts
9520.0750 to 9520.0870; or (3) a provider
of intensive residential treatment services
(IRTS) licensed under Minnesota Rules,
parts 9520.0500 to 9520.0670.
new text end

Reduction of Lead Agency Waiver
Allocations to Implement Rate Reductions
for Congregate Living for Individuals
with Lower Needs. Beginning October 1,
2011, the commissioner shall reduce lead
agency waiver allocations to implement the
reduction of rates for individuals with lower
needs living in foster care settings where the
license holder does not share the residence
with recipients on the CADI and DD waivers
and customized living settings for CADI.

Reduce customized living and 24-hour
customized living component rates.
Effective July 1, 2011, the commissioner
shall reduce elderly waiver customized living
and 24-hour customized living component
service spending by five percent through
reductions in component rates and service
rate limits. The commissioner shall adjust
the elderly waiver capitation payment
rates for managed care organizations paid
under Minnesota Statutes, section 256B.69,
subdivisions 6a and 23, to reflect reductions
in component spending for customized living
services and 24-hour customized living
services under Minnesota Statutes, section
256B.0915, subdivisions 3e and 3h, for the
contract period beginning January 1, 2012.
To implement the reduction specified in
this provision, capitation rates paid by the
commissioner to managed care organizations
under Minnesota Statutes, section 256B.69,
shall reflect a ten percent reduction for the
specified services for the period January 1,
2012, to June 30, 2012, and a five percent
reduction for those services on or after July
1, 2012.

Limit Growth in the Developmental
Disability Waiver. The commissioner
shall limit growth in the developmental
disability waiver to six diversion allocations
per month beginning July 1, 2011, through
June 30, 2013, and 15 diversion allocations
per month beginning July 1, 2013, through
June 30, 2015. Waiver allocations shall
be targeted to individuals who meet the
priorities for accessing waiver services
identified in Minnesota Statutes, 256B.092,
subdivision 12. The limits do not include
conversions from intermediate care facilities
for persons with developmental disabilities.
Notwithstanding any contrary provisions in
this article, this paragraph expires June 30,
2015.

Limit Growth in the Community
Alternatives for Disabled Individuals
Waiver. The commissioner shall limit
growth in the community alternatives for
disabled individuals waiver to 60 allocations
per month beginning July 1, 2011, through
June 30, 2013, and 85 allocations per
month beginning July 1, 2013, through
June 30, 2015. Waiver allocations must
be targeted to individuals who meet the
priorities for accessing waiver services
identified in Minnesota Statutes, section
256B.49, subdivision 11a. The limits include
conversions and diversions, unless the
commissioner has approved a plan to convert
funding due to the closure or downsizing
of a residential facility or nursing facility
to serve directly affected individuals on
the community alternatives for disabled
individuals waiver. Notwithstanding any
contrary provisions in this article, this
paragraph expires June 30, 2015.

Personal Care Assistance Relative
Care. The commissioner shall adjust the
capitation payment rates for managed care
organizations paid under Minnesota Statutes,
section 256B.69, to reflect the rate reductions
for personal care assistance provided by
a relative pursuant to Minnesota Statutes,
section 256B.0659, subdivision 11. This rate
reduction is effective July 1, 2013.

(h) Alternative Care Grants
 46,421,000
 46,035,000

Alternative Care Transfer. Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but shall be transferred to the
medical assistance account.

(i) Chemical Dependency Entitlement Grants
 94,675,000
 93,298,000

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2013.
 new text end

Sec. 33. new text begin RECOMMENDATIONS FOR CONCENTRATION LIMITS ON HOME
AND COMMUNITY-BASED SETTINGS.
new text end

new text begin The commissioner of human services shall consult with the Minnesota Olmstead
subcabinet, advocates, providers, and city representatives to develop recommendations
on concentration limits on home and community-based settings, as defined in
Minnesota Statutes, section 256B.492, as well as any other exceptions to the definition.
The recommendations must be consistent with Minnesota's Olmstead plan. The
recommendations and proposed legislation must be submitted to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance by February 1, 2014.
 new text end

Sec. 34. new text begin PROVIDER RATE AND GRANT INCREASES EFFECTIVE JULY
1, 2013.
new text end

new text begin (a) The commissioner of human services shall increase reimbursement rates, grants,
allocations, individual limits, and rate limits, as applicable, by two percent for the rate
period beginning July 1, 2013, for services rendered on or after those dates. County or
tribal contracts for services specified in this section must be amended to pass through
these rate increases within 60 days of the effective date.
 new text end

new text begin (b) The rate changes described in this section must be provided to:
 new text end

new text begin (1) home and community-based waivered services for persons with developmental
disabilities or related conditions, including consumer-directed community supports, under
Minnesota Statutes, section 256B.501;
 new text end

new text begin (2) waivered services under community alternatives for disabled individuals,
including consumer-directed community supports, under Minnesota Statutes, section
256B.49;
 new text end

new text begin (3) community alternative care waivered services, including consumer-directed
community supports, under Minnesota Statutes, section 256B.49;
 new text end

new text begin (4) traumatic brain injury waivered services, including consumer-directed
community supports, under Minnesota Statutes, section 256B.49;
 new text end

new text begin (5) home and community-based waivered services for the elderly under Minnesota
Statutes, section 256B.0915;
 new text end

new text begin (6) nursing services and home health services under Minnesota Statutes, section
256B.0625, subdivision 6a;
 new text end

new text begin (7) personal care services and qualified professional supervision of personal care
services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
 new text end

new text begin (8) private duty nursing services under Minnesota Statutes, section 256B.0625,
subdivision 7;
 new text end

new text begin (9) day training and habilitation services for adults with developmental disabilities
or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
additional cost of rate adjustments on day training and habilitation services, provided as a
social service, under Minnesota Statutes, section 256M.60;
 new text end

new text begin (10) alternative care services under Minnesota Statutes, section 256B.0913;
 new text end

new text begin (11) living skills training programs for persons with intractable epilepsy who need
assistance in the transition to independent living under Laws 1988, chapter 689;
 new text end

new text begin (12) semi-independent living services (SILS) under Minnesota Statutes, section
252.275, including SILS funding under county social services grants formerly funded
under Minnesota Statutes, chapter 256I;
 new text end

new text begin (13) consumer support grants under Minnesota Statutes, section 256.476;
 new text end

new text begin (14) family support grants under Minnesota Statutes, section 252.32;
 new text end

new text begin (15) housing access grants under Minnesota Statutes, section 256B.0658;
 new text end

new text begin (16) self-advocacy grants under Laws 2009, chapter 101; and
 new text end

new text begin (17) technology grants under Laws 2009, chapter 79.
 new text end

new text begin (c) A managed care plan receiving state payments for the services in this section
must include these increases in their payments to providers. To implement the rate increase
in this section, capitation rates paid by the commissioner to managed care organizations
under Minnesota Statutes, section 256B.69, shall reflect a two percent increase for the
specified services for the period beginning July 1, 2013.
 new text end

new text begin (d) Counties shall increase the budget for each recipient of consumer-directed
community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).
 new text end

Sec. 35. new text begin TRAINING OF AUTISM SERVICE PROVIDERS.
new text end

new text begin The commissioners of health and human services shall ensure that the departments'
autism-related service providers receive training in culturally appropriate approaches to
serving the Somali, Latino, Hmong, and Indigenous American Indian communities, and
other cultural groups experiencing a disproportionate incidence of autism.
 new text end

Sec. 36. new text begin DIRECTION TO COMMISSIONER.
new text end

new text begin By January 1, 2014, the commissioner of human services shall apply to the federal
Centers for Medicare and Medicaid Services for a waiver or other authority to provide
applied behavioral analysis services to children with autism spectrum disorder and related
conditions under the medical assistance program.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 37. new text begin RECOMMENDATIONS ON RAISING THE ASSET LIMITS FOR
SENIORS AND PERSONS WITH DISABILITIES.
new text end

new text begin The commissioner of human services shall consult with interested stakeholders to
develop recommendations to increase the asset limit a reasonable amount considering
changes since the limit was established for (1) individuals who are not homeowners and (2)
homeowners eligible for medical assistance due to disability or age who are not residing in
a nursing facility, intermediate care facility for persons with developmental disabilities,
or other institution whose costs for room and board are covered by medical assistance or
state funds. The recommendations must be provided to the legislative committees with
jurisdiction over health and human services policy and finance by February 1, 2014.
 new text end

Sec. 38. new text begin NURSING HOME LEVEL OF CARE REPORT.
new text end

new text begin (a) The commissioner of human services shall report on the impact of the nursing
facility level of care to be implemented January 1, 2014, including the following:
 new text end

new text begin (1) the number of individuals who lose eligibility for home and community-based
services waivers under Minnesota Statutes, sections 256B.0915 and 256B.49, and
alternative care under Minnesota Statutes, section 256B.0913;
 new text end

new text begin (2) the number of individuals who lose eligibility for medical assistance; and
 new text end

new text begin (3) for individuals reported under clauses (1) and (2), and to the extent possible:
 new text end

new text begin (i) their living situation before and after nursing facility level of care implementation;
and
 new text end

new text begin (ii) the programs or services they received before and after nursing facility level of
care implementation, including, but not limited to, personal care assistant services and
essential community supports.
 new text end

new text begin (b) The commissioner of human services shall report to the chairs of the legislative
committees with jurisdiction over health and human services policy and finance with the
information required under paragraph (a). A preliminary report shall be submitted on
October 1, 2014, and a final report shall be submitted February 15, 2015.
 new text end

Sec. 39. new text begin HOME AND COMMUNITY-BASED SERVICES REPORT CARD.
new text end

new text begin (a) The commissioner of human services shall work with existing advisory groups
to develop recommendations for a home and community-based services report card.
The advisory committee shall consider the requirements from the Minnesota Consumer
Information Guide under Minnesota Statutes, section 144G.06, as a base for development
of a home and community-based services report card to compare the housing options
available to consumers. Other items to be considered by the advisory committee in
developing recommendations include:
 new text end

new text begin (1) defining the goal of the report card;
 new text end

new text begin (2) measuring outcomes, consumer information, and options for pay for performance;
 new text end

new text begin (3) developing separate measures for programs for the elderly population and for
persons with disabilities;
 new text end

new text begin (4) identifying sources of information that are standardized and contain sufficient
data;
 new text end

new text begin (5) identifying the financial support needed to create and publicize the housing
information guide, and ongoing funding for data collection and staffing to monitor,
report, and analyze data;
 new text end

new text begin (6) recognizing that home and community-based services settings exist with
significant variations as to size, settings, and services available;
 new text end

new text begin (7) ensuring that consumer choice and consumer information is retained and valued;
and
 new text end

new text begin (8) considering the applicability of these measures on providers based on payer
source, size, and population served.
 new text end

new text begin (b) The workgroup shall discuss whether additional funding, resources, or research
is needed. The workgroup shall report recommendations to the legislative committees
with jurisdiction over health and human services policy and finance by August 1, 2014.
The report card shall be available on July 1, 2015.
 new text end

Sec. 40. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, sections 256B.14, subdivision 3a; and 256B.5012,
subdivision 13; new text end new text begin and new text end new text begin Laws 2011, First Special Session chapter 9, article 7, section 54, as
amended by Laws 2012, chapter 247, article 4, section 42, and Laws 2012, chapter 298,
section 3, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2012, section 256B.096, subdivisions 1, 2, 3, and 4, new text end new text begin are
repealed.
 new text end

ARTICLE 8

WAIVER PROVIDER STANDARDS

Section 1.

Minnesota Statutes 2012, section 145C.01, subdivision 7, is amended to read:


Subd. 7.

Health care facility.

"Health care facility" means a hospital or other entity
licensed under sections 144.50 to 144.58, a nursing home licensed to serve adults under
section 144A.02, a home care provider licensed under sections 144A.43 to 144A.47,
an adult foster care provider licensed under chapter 245A and Minnesota Rules, parts
9555.5105 to 9555.6265,new text begin a community residential setting licensed under chapter 245D,new text end or
a hospice provider licensed under sections 144A.75 to 144A.755.

Sec. 2.

Minnesota Statutes 2012, section 243.166, subdivision 4b, is amended to read:


Subd. 4b.

Health care facility; notice of status.

(a) For the purposes of this
subdivision, "health care facility" means a facility:

(1) licensed by the commissioner of health as a hospital, boarding care home or
supervised living facility under sections 144.50 to 144.58, or a nursing home under
chapter 144A;

(2) registered by the commissioner of health as a housing with services establishment
as defined in section 144D.01; or

(3) licensed by the commissioner of human services as a residential facility under
chapter 245A to provide adult foster care, adult mental health treatment, chemical
dependency treatment to adults, or residential services to persons with deleted text begin developmental
deleted text end disabilities.

(b) Prior to admission to a health care facility, a person required to register under
this section shall disclose to:

(1) the health care facility employee processing the admission the person's status
as a registered predatory offender under this section; and

(2) the person's corrections agent, or if the person does not have an assigned
corrections agent, the law enforcement authority with whom the person is currently
required to register, that inpatient admission will occur.

(c) A law enforcement authority or corrections agent who receives notice under
paragraph (b) or who knows that a person required to register under this section is
planning to be admitted and receive, or has been admitted and is receiving health care
at a health care facility shall notify the administrator of the facility and deliver a fact
sheet to the administrator containing the following information: (1) name and physical
description of the offender; (2) the offender's conviction history, including the dates of
conviction; (3) the risk level classification assigned to the offender under section 244.052,
if any; and (4) the profile of likely victims.

(d) Except for a hospital licensed under sections 144.50 to 144.58, if a health care
facility receives a fact sheet under paragraph (c) that includes a risk level classification for
the offender, and if the facility admits the offender, the facility shall distribute the fact
sheet to all residents at the facility. If the facility determines that distribution to a resident
is not appropriate given the resident's medical, emotional, or mental status, the facility
shall distribute the fact sheet to the patient's next of kin or emergency contact.

Sec. 3.

new text begin [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY
MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
 new text end

new text begin Subdivision 1. new text end

new text begin Rules. new text end

new text begin The commissioner of human services shall, within 24 months
of enactment of this section, adopt rules governing the use of positive support strategies,
safety interventions, and emergency use of manual restraint in facilities and services
licensed under chapter 245D.
 new text end

new text begin Subd. 2. new text end

new text begin Data collection. new text end

new text begin (a) The commissioner shall, with stakeholder input,
develop data collection elements specific to incidents on the use of controlled procedures
with persons receiving services from providers regulated under Minnesota Rules, parts
9525.2700 to 9525.2810, and incidents involving persons receiving services from
providers identified to be licensed under chapter 245D effective January 1, 2014. Providers
shall report the data in a format and at a frequency provided by the commissioner of
human services.
 new text end

new text begin (b) Beginning July 1, 2013, providers regulated under Minnesota Rules, parts
9525.2700 to 9525.2810, shall submit data regarding the use of all controlled procedures
in a format and at a frequency provided by the commissioner.
 new text end

Sec. 4.

Minnesota Statutes 2012, section 245A.02, subdivision 10, is amended to read:


Subd. 10.

Nonresidential program.

"Nonresidential program" means care,
supervision, rehabilitation, training or habilitation of a person provided outside the
person's own home and provided for fewer than 24 hours a day, including adult day
care programs; and chemical dependency or chemical abuse programs that are located
in a nursing home or hospital and receive public funds for providing chemical abuse or
chemical dependency treatment services under chapter 254B. Nonresidential programs
include home and community-based services deleted text begin and semi-independent living servicesdeleted text end for
persons with deleted text begin developmentaldeleted text end disabilitiesnew text begin or persons age 65 and oldernew text end that are provided in
or outside of a person's own homenew text begin under chapter 245Dnew text end .

Sec. 5.

Minnesota Statutes 2012, section 245A.02, subdivision 14, is amended to read:


Subd. 14.

Residential program.

"Residential program" means a program
that provides 24-hour-a-day care, supervision, food, lodging, rehabilitation, training,
education, habilitation, or treatment outside a person's own home, including a program
in an intermediate care facility for four or more persons with developmental disabilities;
and chemical dependency or chemical abuse programs that are located in a hospital
or nursing home and receive public funds for providing chemical abuse or chemical
dependency treatment services under chapter 254B. Residential programs include home
and community-based services for persons with deleted text begin developmentaldeleted text end disabilitiesnew text begin or persons age
65 and oldernew text end that are provided in or outside of a person's own homenew text begin under chapter 245Dnew text end .

Sec. 6.

Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:


Subd. 7.

Licensing moratorium.

(a) The commissioner shall not issue an initial
license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340,
or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under
this chapter for a physical location that will not be the primary residence of the license
holder for the entire period of licensure. If a license is issued during this moratorium, and
the license holder changes the license holder's primary residence away from the physical
location of the foster care license, the commissioner shall revoke the license according
to section 245A.07. new text begin The commissioner shall not issue an initial license for a community
residential setting licensed under chapter 245D. new text end Exceptions to the moratorium include:

(1) foster care settings that are required to be registered under chapter 144D;

(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,new text begin or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013,new text end and determined to be needed by the commissioner under paragraph (b);

(3) new foster care licensesnew text begin or community residential setting licensesnew text end determined to
be needed by the commissioner under paragraph (b) for the closure of a nursing facility,
ICF/MR, or regional treatment center, or restructuring of state-operated services that
limits the capacity of state-operated facilities;

(4) new foster care licensesnew text begin or community residential setting licensesnew text end determined
to be needed by the commissioner under paragraph (b) for persons requiring hospital
level care; or

(5) new foster care licensesnew text begin or community residential setting licensesnew text end determined to
be needed by the commissioner for the transition of people from personal care assistance
to the home and community-based services.

(b) The commissioner shall determine the need for newly licensed foster care
homesnew text begin or community residential settingsnew text end as defined under this subdivision. As part of the
determination, the commissioner shall consider the availability of foster care capacity in
the area in which the licensee seeks to operate, and the recommendation of the local
county board. The determination by the commissioner must be final. A determination of
need is not required for a change in ownership at the same address.

(c) The commissioner shall study the effects of the license moratorium under this
subdivision and shall report back to the legislature by January 15, 2011. This study shall
include, but is not limited to the following:

(1) the overall capacity and utilization of foster care beds where the physical location
is not the primary residence of the license holder prior to and after implementation
of the moratorium;

(2) the overall capacity and utilization of foster care beds where the physical
location is the primary residence of the license holder prior to and after implementation
of the moratorium; and

(3) the number of licensed and occupied ICF/MR beds prior to and after
implementation of the moratorium.

(d) When a deleted text begin foster care recipientdeleted text end new text begin resident served by the programnew text end moves out of a
foster home that is not the primary residence of the license holder according to section
256B.49, subdivision 15, paragraph (f)new text begin , or the community residential settingnew text end , the county
shall immediately inform the Department of Human Services Licensing Division.
The department shall decrease the statewide licensed capacity for foster care settings
where the physical location is not the primary residence of the license holdernew text begin , or for
community residential settingsnew text end , if the voluntary changes described in paragraph (f) are
not sufficient to meet the savings required by reductions in licensed bed capacity under
Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f),
and maintain statewide long-term care residential services capacity within budgetary
limits. Implementation of the statewide licensed capacity reduction shall begin on July
1, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the
needs determination process. Under this paragraph, the commissioner has the authority
to reduce unused licensed capacity of a current foster care programnew text begin , or the community
residential settings,new text end to accomplish the consolidation or closure of settings. A decreased
licensed capacity according to this paragraph is not subject to appeal under this chapter.

(e) Residential settings that would otherwise be subject to the decreased license
capacity established in paragraph (d) shall be exempt under the following circumstances:

(1) until August 1, 2013, the license holder's beds occupied by residents whose
primary diagnosis is mental illness and the license holder is:

(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
health services (ARMHS) as defined in section 256B.0623;

(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
9520.0870;

(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
9520.0870; or

(iv) a provider of intensive residential treatment services (IRTS) licensed under
Minnesota Rules, parts 9520.0500 to 9520.0670; or

(2) the license holder is certified under the requirements in subdivision 6anew text begin or section
245D.33new text end .

(f) A resource need determination process, managed at the state level, using the
available reports required by section 144A.351, and other data and information shall
be used to determine where the reduced capacity required under paragraph (d) will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet
long-term care service needs within budgetary limits, including seeking proposals from
service providers or lead agencies to change service type, capacity, or location to improve
services, increase the independence of residents, and better meet needs identified by the
long-term care services reports and statewide data and information. By February 1 of each
year, the commissioner shall provide information and data on the overall capacity of
licensed long-term care services, actions taken under this subdivision to manage statewide
long-term care services and supports resources, and any recommendations for change to
the legislative committees with jurisdiction over health and human services budget.

(g) At the time of application and reapplication for licensure, the applicant and the
license holder that are subject to the moratorium or an exclusion established in paragraph
(a) are required to inform the commissioner whether the physical location where the foster
care will be provided is or will be the primary residence of the license holder for the entire
period of licensure. If the primary residence of the applicant or license holder changes, the
applicant or license holder must notify the commissioner immediately. The commissioner
shall print on the foster care license certificate whether or not the physical location is the
primary residence of the license holder.

(h) License holders of foster care homes identified under paragraph (g) that are not
the primary residence of the license holder and that also provide services in the foster care
home that are covered by a federally approved home and community-based services
waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must inform the
human services licensing division that the license holder provides or intends to provide
these waiver-funded services. deleted text begin These license holders must be considered registered under
deleted text end deleted text begin section 256B.092, subdivision 11, paragraph (c), and this registration status must be
identified on their license certificates.
deleted text end

Sec. 7.

Minnesota Statutes 2012, section 245A.03, subdivision 8, is amended to read:


Subd. 8.

Excluded providers seeking licensure.

Nothing in this section shall
prohibit a program that is excluded from licensure under subdivision 2, paragraph
(a), clause deleted text begin (28)deleted text end new text begin (26)new text end , from seeking licensure. The commissioner shall ensure that any
application received from such an excluded provider is processed in the same manner as
all other applications for child care center licensure.

Sec. 8.

Minnesota Statutes 2012, section 245A.042, subdivision 3, is amended to read:


Subd. 3.

Implementation.

(a) The commissioner shall implement the
responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
only within the limits of available appropriations or other administrative cost recovery
methodology.

(b) The licensure of home and community-based services according to this section
shall be implemented January 1, 2014. License applications shall be received and
processed on a phased-in schedule as determined by the commissioner beginning July
1, 2013. Licenses will be issued thereafter upon the commissioner's determination that
the application is complete according to section 245A.04.

(c) Within the limits of available appropriations or other administrative cost recovery
methodology, implementation of compliance monitoring must be phased in after January
1, 2014.

(1) Applicants who do not currently hold a license issued under deleted text begin thisdeleted text end chapternew text begin 245B
new text end must receive an initial compliance monitoring visit after 12 months of the effective date of
the initial license for the purpose of providing technical assistance on how to achieve and
maintain compliance with the applicable law or rules governing the provision of home and
community-based services under chapter 245D. If during the review the commissioner
finds that the license holder has failed to achieve compliance with an applicable law or
rule and this failure does not imminently endanger the health, safety, or rights of the
persons served by the program, the commissioner may issue a licensing review report with
recommendations for achieving and maintaining compliance.

(2) Applicants who do currently hold a license issued under this chapter must receive
a compliance monitoring visit after 24 months of the effective date of the initial license.

(d) Nothing in this subdivision shall be construed to limit the commissioner's
authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
or deleted text begin makedeleted text end new text begin issuenew text end correction orders and make a license conditional for failure to comply with
applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
of the violation of law or rule and the effect of the violation on the health, safety, or
rights of persons served by the program.

Sec. 9.

Minnesota Statutes 2012, section 245A.08, subdivision 2a, is amended to read:


Subd. 2a.

Consolidated contested case hearings.

(a) When a denial of a license
under section 245A.05 or a licensing sanction under section 245A.07, subdivision 3, is
based on a disqualification for which reconsideration was requested and which was not
set aside under section 245C.22, the scope of the contested case hearing shall include the
disqualification and the licensing sanction or denial of a license, unless otherwise specified
in this subdivision. When the licensing sanction or denial of a license is based on a
determination of maltreatment under section 626.556 or 626.557, or a disqualification for
serious or recurring maltreatment which was not set aside, the scope of the contested case
hearing shall include the maltreatment determination, disqualification, and the licensing
sanction or denial of a license, unless otherwise specified in this subdivision. In such
cases, a fair hearing under section 256.045 shall not be conducted as provided for in
sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d.

(b) Except for family child care and child foster care, reconsideration of a
maltreatment determination under sections 626.556, subdivision 10i, and 626.557,
subdivision 9d, and reconsideration of a disqualification under section 245C.22, shall
not be conducted when:

(1) a denial of a license under section 245A.05, or a licensing sanction under section
245A.07, is based on a determination that the license holder is responsible for maltreatment
or the disqualification of a license holder is based on serious or recurring maltreatment;

(2) the denial of a license or licensing sanction is issued at the same time as the
maltreatment determination or disqualification; and

(3) the license holder appeals the maltreatment determination or disqualification,
and denial of a license or licensing sanction. In these cases, a fair hearing shall not be
conducted under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision
9d. The scope of the contested case hearing must include the maltreatment determination,
disqualification, and denial of a license or licensing sanction.

Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
determination or disqualification, but does not appeal the denial of a license or a licensing
sanction, reconsideration of the maltreatment determination shall be conducted under
sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
disqualification shall be conducted under section 245C.22. In such cases, a fair hearing
shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
626.557, subdivision 9d.

(c) In consolidated contested case hearings regarding sanctions issued in family child
care, child foster care, family adult day services, deleted text begin anddeleted text end adult foster care,new text begin and community
residential settings,new text end the county attorney shall defend the commissioner's orders in
accordance with section 245A.16, subdivision 4.

(d) The commissioner's final order under subdivision 5 is the final agency action
on the issue of maltreatment and disqualification, including for purposes of subsequent
background studies under chapter 245C and is the only administrative appeal of the final
agency determination, specifically, including a challenge to the accuracy and completeness
of data under section 13.04.

(e) When consolidated hearings under this subdivision involve a licensing sanction
based on a previous maltreatment determination for which the commissioner has issued
a final order in an appeal of that determination under section 256.045, or the individual
failed to exercise the right to appeal the previous maltreatment determination under
section 626.556, subdivision 10i, or 626.557, subdivision 9d, the commissioner's order is
conclusive on the issue of maltreatment. In such cases, the scope of the administrative
law judge's review shall be limited to the disqualification and the licensing sanction or
denial of a license. In the case of a denial of a license or a licensing sanction issued to
a facility based on a maltreatment determination regarding an individual who is not the
license holder or a household member, the scope of the administrative law judge's review
includes the maltreatment determination.

(f) The hearings of all parties may be consolidated into a single contested case
hearing upon consent of all parties and the administrative law judge, if:

(1) a maltreatment determination or disqualification, which was not set aside under
section 245C.22, is the basis for a denial of a license under section 245A.05 or a licensing
sanction under section 245A.07;

(2) the disqualified subject is an individual other than the license holder and upon
whom a background study must be conducted under section 245C.03; and

(3) the individual has a hearing right under section 245C.27.

(g) When a denial of a license under section 245A.05 or a licensing sanction under
section 245A.07 is based on a disqualification for which reconsideration was requested
and was not set aside under section 245C.22, and the individual otherwise has no hearing
right under section 245C.27, the scope of the administrative law judge's review shall
include the denial or sanction and a determination whether the disqualification should
be set aside, unless section 245C.24 prohibits the set-aside of the disqualification. In
determining whether the disqualification should be set aside, the administrative law judge
shall consider the factors under section 245C.22, subdivision 4, to determine whether the
individual poses a risk of harm to any person receiving services from the license holder.

(h) Notwithstanding section 245C.30, subdivision 5, when a licensing sanction
under section 245A.07 is based on the termination of a variance under section 245C.30,
subdivision 4, the scope of the administrative law judge's review shall include the sanction
and a determination whether the disqualification should be set aside, unless section
245C.24 prohibits the set-aside of the disqualification. In determining whether the
disqualification should be set aside, the administrative law judge shall consider the factors
under section 245C.22, subdivision 4, to determine whether the individual poses a risk of
harm to any person receiving services from the license holder.

Sec. 10.

Minnesota Statutes 2012, section 245A.10, is amended to read:


245A.10 FEES.

Subdivision 1.

Application or license fee required, programs exempt from fee.

(a) Unless exempt under paragraph (b), the commissioner shall charge a fee for evaluation
of applications and inspection of programs which are licensed under this chapter.

(b) Except as provided under subdivision 2, no application or license fee shall be
charged for child foster care, adult foster care, deleted text begin ordeleted text end family and group family child carenew text begin , or
a community residential settingnew text end .

Subd. 2.

County fees for background studies and licensing inspections.

(a) For
purposes of family and group family child care licensing under this chapter, a county
agency may charge a fee to an applicant or license holder to recover the actual cost of
background studies, but in any case not to exceed $100 annually. A county agency may
also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
license or $100 for a two-year license.

(b) A county agency may charge a fee to a legal nonlicensed child care provider or
applicant for authorization to recover the actual cost of background studies completed
under section 119B.125, but in any case not to exceed $100 annually.

(c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):

(1) in cases of financial hardship;

(2) if the county has a shortage of providers in the county's area;

(3) for new providers; or

(4) for providers who have attained at least 16 hours of training before seeking
initial licensure.

(d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
an installment basis for up to one year. If the provider is receiving child care assistance
payments from the state, the provider may have the fees under paragraph (a) or (b)
deducted from the child care assistance payments for up to one year and the state shall
reimburse the county for the county fees collected in this manner.

(e) For purposes of adult foster care and child foster care licensingnew text begin , and licensing
the physical plant of a community residential setting,new text end under this chapter, a county agency
may charge a fee to a corporate applicant or corporate license holder to recover the actual
cost of licensing inspections, not to exceed $500 annually.

(f) Counties may elect to reduce or waive the fees in paragraph (e) under the
following circumstances:

(1) in cases of financial hardship;

(2) if the county has a shortage of providers in the county's area; or

(3) for new providers.

Subd. 3.

Application fee for initial license or certification.

(a) For fees required
under subdivision 1, an applicant for an initial license or certification issued by the
commissioner shall submit a $500 application fee with each new application required
under this subdivision. new text begin An applicant for an initial day services facility license under
chapter 245D shall submit a $250 application fee with each new application. new text end The
application fee shall not be prorated, is nonrefundable, and is in lieu of the annual license
or certification fee that expires on December 31. The commissioner shall not process an
application until the application fee is paid.

(b) Except as provided in clauses (1) to deleted text begin (4)deleted text end new text begin (3)new text end , an applicant shall apply for a license
to provide services at a specific location.

(1) deleted text begin For a license to provide residential-based habilitation services to persons with
developmental disabilities under chapter 245B, an applicant shall submit an application
for each county in which the services will be provided. Upon licensure, the license
holder may provide services to persons in that county plus no more than three persons
at any one time in each of up to ten additional counties. A license holder in one county
may not provide services under the home and community-based waiver for persons with
developmental disabilities to more than three people in a second county without holding
a separate license for that second county. Applicants or licensees providing services
under this clause to not more than three persons remain subject to the inspection fees
established in section 245A.10, subdivision 2, for each location. The license issued by
the commissioner must state the name of each additional county where services are being
provided to persons with developmental disabilities. A license holder must notify the
commissioner before making any changes that would alter the license information listed
under section 245A.04, subdivision 7, paragraph (a), including any additional counties
where persons with developmental disabilities are being served.deleted text end new text begin For a license to provide
home and community-based services to persons with disabilities or age 65 and older under
chapter 245D, an applicant shall submit an application to provide services statewide.
new text end

(2) deleted text begin For a license to provide supported employment, crisis respite, or
semi-independent living services to persons with developmental disabilities under chapter
245B, an applicant shall submit a single application to provide services statewide.
deleted text end

deleted text begin (3)deleted text end For a license to provide independent living assistance for youth under section
245A.22, an applicant shall submit a single application to provide services statewide.

deleted text begin (4)deleted text end new text begin (3)new text end For a license for a private agency to provide foster care or adoption services
under Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single
application to provide services statewide.

new text begin (c) The initial application fee charged under this subdivision does not include the
temporary license surcharge under section 16E.22.
 new text end

Subd. 4.

License or certification fee for certain programs.

(a) Child care centers
shall pay an annual nonrefundable license fee based on the following schedule:

Licensed Capacity
 Child Care CenterLicense Fee
1 to 24 persons
 $200
25 to 49 persons
 $300
50 to 74 persons
 $400
75 to 99 persons
 $500
100 to 124 persons
 $600
125 to 149 persons
 $700
150 to 174 persons
 $800
175 to 199 persons
 $900
200 to 224 persons
 $1,000
225 or more persons
 $1,100

deleted text begin (b) A day training and habilitation program serving persons with developmental
disabilities or related conditions shall pay an annual nonrefundable license fee based on
the following schedule:
 deleted text end

deleted text begin Licensed Capacity
 deleted text end 		deleted text begin License Fee
 deleted text end
deleted text begin 1 to 24 persons
 deleted text end 		deleted text begin $800
 deleted text end
deleted text begin 25 to 49 persons
 deleted text end 		deleted text begin $1,000
 deleted text end
deleted text begin 50 to 74 persons
 deleted text end 		deleted text begin $1,200
 deleted text end
deleted text begin 75 to 99 persons
 deleted text end 		deleted text begin $1,400
 deleted text end
deleted text begin 100 to 124 persons
 deleted text end 		deleted text begin $1,600
 deleted text end
deleted text begin 125 to 149 persons
 deleted text end 		deleted text begin $1,800
 deleted text end
deleted text begin 150 or more persons
 deleted text end 		deleted text begin $2,000
 deleted text end

deleted text begin Except as provided in paragraph (c), when a day training and habilitation program
serves more than 50 percent of the same persons in two or more locations in a community,
the day training and habilitation program shall pay a license fee based on the licensed
capacity of the largest facility and the other facility or facilities shall be charged a license
fee based on a licensed capacity of a residential program serving one to 24 persons.
 deleted text end

deleted text begin (c) When a day training and habilitation program serving persons with developmental
disabilities or related conditions seeks a single license allowed under section 245B.07,
subdivision 12, clause (2) or (3), the licensing fee must be based on the combined licensed
capacity for each location.
 deleted text end

deleted text begin (d) A program licensed to provide supported employment services to persons
with developmental disabilities under chapter 245B shall pay an annual nonrefundable
license fee of $650.
 deleted text end

deleted text begin (e) A program licensed to provide crisis respite services to persons with
developmental disabilities under chapter 245B shall pay an annual nonrefundable license
fee of $700.
 deleted text end

deleted text begin (f) A program licensed to provide semi-independent living services to persons
with developmental disabilities under chapter 245B shall pay an annual nonrefundable
license fee of $700.
 deleted text end

deleted text begin (g) A program licensed to provide residential-based habilitation services under the
home and community-based waiver for persons with developmental disabilities shall pay
an annual license fee that includes a base rate of $690 plus $60 times the number of clients
served on the first day of July of the current license year.
 deleted text end

deleted text begin (h) A residential program certified by the Department of Health as an intermediate
care facility for persons with developmental disabilities (ICF/MR) and a noncertified
residential program licensed to provide health or rehabilitative services for persons
with developmental disabilities shall pay an annual nonrefundable license fee based on
the following schedule:
 deleted text end

deleted text begin Licensed Capacity
 deleted text end 		deleted text begin License Fee
 deleted text end
deleted text begin 1 to 24 persons
 deleted text end 		deleted text begin $535
 deleted text end
deleted text begin 25 to 49 persons
 deleted text end 		deleted text begin $735
 deleted text end
deleted text begin 50 or more persons
 deleted text end 		deleted text begin $935
 deleted text end

new text begin (b) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age
65 and older, shall pay an annual nonrefundable license fee that includes a base rate of
$2,250, plus $92 times the number of persons served, on average, greater than 40 hours per
week for the month of June of the current license year for programs serving ten or more
persons. The fee is limited to a maximum of 200 persons, regardless of the actual number
of persons served. Programs serving nine or fewer persons pay only half of the base rate.
 new text end

new text begin (c) A facility licensed under chapter 245D to provide day services shall pay an
annual nonrefundable license fee of $100.
 new text end

deleted text begin (i)deleted text end new text begin (d)new text end A chemical dependency treatment program licensed under Minnesota Rules,
parts 9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an
annual nonrefundable license fee based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $600
25 to 49 persons
 $800
50 to 74 persons
 $1,000
75 to 99 persons
 $1,200
100 or more persons
 $1,400

deleted text begin (j)deleted text end new text begin (e)new text end A chemical dependency program licensed under Minnesota Rules, parts
9530.6510 to 9530.6590, to provide detoxification services shall pay an annual
nonrefundable license fee based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $760
25 to 49 persons
 $960
50 or more persons
 $1,160

deleted text begin (k)deleted text end new text begin (f)new text end Except for child foster care, a residential facility licensed under Minnesota
Rules, chapter 2960, to serve children shall pay an annual nonrefundable license fee
based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $1,000
25 to 49 persons
 $1,100
50 to 74 persons
 $1,200
75 to 99 persons
 $1,300
100 or more persons
 $1,400

deleted text begin (l)deleted text end new text begin (g)new text end A residential facility licensed under Minnesota Rules, parts 9520.0500 to
9520.0670, to serve persons with mental illness shall pay an annual nonrefundable license
fee based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $2,525
25 or more persons
 $2,725

deleted text begin (m)deleted text end new text begin (h)new text end A residential facility licensed under Minnesota Rules, parts 9570.2000 to
9570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable
license fee based on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $450
25 to 49 persons
 $650
50 to 74 persons
 $850
75 to 99 persons
 $1,050
100 or more persons
 $1,250

deleted text begin (n)deleted text end new text begin (i)new text end A program licensed to provide independent living assistance for youth under
section 245A.22 shall pay an annual nonrefundable license fee of $1,500.

deleted text begin (o)deleted text end new text begin (j)new text end A private agency licensed to provide foster care and adoption services under
Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable
license fee of $875.

deleted text begin (p)deleted text end new text begin (k)new text end A program licensed as an adult day care center licensed under Minnesota
Rules, parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based
on the following schedule:

Licensed Capacity
 License Fee
1 to 24 persons
 $500
25 to 49 persons
 $700
50 to 74 persons
 $900
75 to 99 persons
 $1,100
100 or more persons
 $1,300

deleted text begin (q)deleted text end new text begin (l)new text end A program licensed to provide treatment services to persons with sexual
psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts
9515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.

deleted text begin (r)deleted text end new text begin (m)new text end A mental health center or mental health clinic requesting certification for
purposes of insurance and subscriber contract reimbursement under Minnesota Rules,
parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,550 per year. If the
mental health center or mental health clinic provides services at a primary location with
satellite facilities, the satellite facilities shall be certified with the primary location without
an additional charge.

Subd. 6.

License not issued until license or certification fee is paid.

The
commissioner shall not issue a license or certification until the license or certification fee
is paid. The commissioner shall send a bill for the license or certification fee to the billing
address identified by the license holder. If the license holder does not submit the license or
certification fee payment by the due date, the commissioner shall send the license holder
a past due notice. If the license holder fails to pay the license or certification fee by the
due date on the past due notice, the commissioner shall send a final notice to the license
holder informing the license holder that the program license will expire on December 31
unless the license fee is paid before December 31. If a license expires, the program is no
longer licensed and, unless exempt from licensure under section 245A.03, subdivision 2,
must not operate after the expiration date. After a license expires, if the former license
holder wishes to provide licensed services, the former license holder must submit a new
license application and application fee under subdivision 3.

Subd. 7.

Human services licensing fees to recover expenditures.

Notwithstanding
section 16A.1285, subdivision 2, related to activities for which the commissioner charges
a fee, the commissioner must plan to fully recover direct expenditures for licensing
activities under this chapter over a five-year period. The commissioner may have
anticipated expenditures in excess of anticipated revenues in a biennium by using surplus
revenues accumulated in previous bienniums.

Subd. 8.

Deposit of license fees.

A human services licensing account is created in
the state government special revenue fund. Fees collected under subdivisions 3 and 4 must
be deposited in the human services licensing account and are annually appropriated to the
commissioner for licensing activities authorized under this chapter.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2013.
 new text end

Sec. 11.

Minnesota Statutes 2012, section 245A.11, subdivision 2a, is amended to read:


Subd. 2a.

Adult foster carenew text begin and community residential settingnew text end license capacity.

(a) The commissioner shall issue adult foster carenew text begin and community residential setting
new text end licenses with a maximum licensed capacity of four beds, including nonstaff roomers and
boarders, except that the commissioner may issue a license with a capacity of five beds,
including roomers and boarders, according to paragraphs (b) to (f).

(b) deleted text begin An adult foster caredeleted text end new text begin Thenew text end license holder may have a maximum license capacity
of five if all persons in care are age 55 or over and do not have a serious and persistent
mental illness or a developmental disability.

(c) The commissioner may grant variances to paragraph (b) to allow a deleted text begin foster care
providerdeleted text end new text begin facilitynew text end with a licensed capacity of five persons to admit an individual under the
age of 55 if the variance complies with section 245A.04, subdivision 9, and approval of
the variance is recommended by the county in which the licensed deleted text begin foster care provider
deleted text end new text begin facilitynew text end is located.

(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
bed for emergency crisis services for a person with serious and persistent mental illness
or a developmental disability, regardless of age, if the variance complies with section
245A.04, subdivision 9, and approval of the variance is recommended by the county in
which the licensed deleted text begin foster care providerdeleted text end new text begin facilitynew text end is located.

(e) The commissioner may grant a variance to paragraph (b) to allow for the use of a
fifth bed for respite services, as defined in section 245A.02, for persons with disabilities,
regardless of age, if the variance complies with sections 245A.03, subdivision 7, and
245A.04, subdivision 9, and approval of the variance is recommended by the county in
which the licensed deleted text begin foster care providerdeleted text end new text begin facilitynew text end is deleted text begin licenseddeleted text end new text begin locatednew text end . Respite care may be
provided under the following conditions:

(1) staffing ratios cannot be reduced below the approved level for the individuals
being served in the home on a permanent basis;

(2) no more than two different individuals can be accepted for respite services in
any calendar month and the total respite days may not exceed 120 days per program in
any calendar year;

(3) the person receiving respite services must have his or her own bedroom, which
could be used for alternative purposes when not used as a respite bedroom, and cannot be
the room of another person who lives in the deleted text begin foster care homedeleted text end new text begin facilitynew text end ; and

(4) individuals living in the deleted text begin foster care homedeleted text end new text begin facilitynew text end must be notified when the
variance is approved. The provider must give 60 days' notice in writing to the residents
and their legal representatives prior to accepting the first respite placement. Notice must
be given to residents at least two days prior to service initiation, or as soon as the license
holder is able if they receive notice of the need for respite less than two days prior to
initiation, each time a respite client will be served, unless the requirement for this notice is
waived by the resident or legal guardian.

(f) The commissioner may issue an adult foster carenew text begin or community residential setting
new text end license with a capacity of five adults if the fifth bed does not increase the overall statewide
capacity of licensed adult foster carenew text begin or community residential settingnew text end beds in homes that
are not the primary residence of the license holder, as identified in a plan submitted to the
commissioner by the county, when the capacity is recommended by the county licensing
agency of the county in which the facility is located and if the recommendation verifies that:

(1) the facility meets the physical environment requirements in the adult foster
care licensing rule;

(2) the five-bed living arrangement is specified for each resident in the resident's:

(i) individualized plan of care;

(ii) individual service plan under section 256B.092, subdivision 1b, if required; or

(iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required;

(3) the license holder obtains written and signed informed consent from each
resident or resident's legal representative documenting the resident's informed choice
to remain living in the home and that the resident's refusal to consent would not have
resulted in service termination; and

(4) the facility was licensed for adult foster care before March 1, 2011.

(g) The commissioner shall not issue a new adult foster care license under paragraph
(f) after June 30, 2016. The commissioner shall allow a facility with an adult foster care
license issued under paragraph (f) before June 30, 2016, to continue with a capacity of five
adults if the license holder continues to comply with the requirements in paragraph (f).

Sec. 12.

Minnesota Statutes 2012, section 245A.11, subdivision 7, is amended to read:


Subd. 7.

Adult foster care; variance for alternate overnight supervision.

(a) The
commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts
requiring a caregiver to be present in an adult foster care home during normal sleeping
hours to allow for alternative methods of overnight supervision. The commissioner may
grant the variance if the local county licensing agency recommends the variance and the
county recommendation includes documentation verifying that:

(1) the county has approved the license holder's plan for alternative methods of
providing overnight supervision and determined the plan protects the residents' health,
safety, and rights;

(2) the license holder has obtained written and signed informed consent from
each resident or each resident's legal representative documenting the resident's or legal
representative's agreement with the alternative method of overnight supervision; and

(3) the alternative method of providing overnight supervision, which may include
the use of technology, is specified for each resident in the resident's: (i) individualized
plan of care; (ii) individual service plan under section 256B.092, subdivision 1b, if
required; or (iii) individual resident placement agreement under Minnesota Rules, part
9555.5105, subpart 19, if required.

(b) To be eligible for a variance under paragraph (a), the adult foster care license
holder must not have had a conditional license issued under section 245A.06, or any
other licensing sanction issued under section 245A.07 during the prior 24 months based
on failure to provide adequate supervision, health care services, or resident safety in
the adult foster care home.

(c) A license holder requesting a variance under this subdivision to utilize
technology as a component of a plan for alternative overnight supervision may request
the commissioner's review in the absence of a county recommendation. Upon receipt of
such a request from a license holder, the commissioner shall review the variance request
with the county.

new text begin (d) A variance granted by the commissioner according to this subdivision before
January 1, 2014, to a license holder for an adult foster care home must transfer with the
license when the license converts to a community residential setting license under chapter
245D. The terms and conditions of the variance remain in effect as approved at the time
the variance was granted.
 new text end

Sec. 13.

Minnesota Statutes 2012, section 245A.11, subdivision 7a, is amended to read:


Subd. 7a.

Alternate overnight supervision technology; adult foster care deleted text begin license
deleted text end new text begin and community residential setting licensesnew text end .

(a) The commissioner may grant an
applicant or license holder an adult foster carenew text begin or community residential settingnew text end license
for a residence that does not have a caregiver in the residence during normal sleeping
hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B,new text begin or section
245D.02, subdivision 33b,new text end but uses monitoring technology to alert the license holder
when an incident occurs that may jeopardize the health, safety, or rights of a foster
care recipient. The applicant or license holder must comply with all other requirements
under Minnesota Rules, parts 9555.5105 to 9555.6265,new text begin or applicable requirements under
chapter 245D,new text end and the requirements under this subdivision. The license printed by the
commissioner must state in bold and large font:

(1) that the facility is under electronic monitoring; and

(2) the telephone number of the county's common entry point for making reports of
suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.

(b) Applications for a license under this section must be submitted directly to
the Department of Human Services licensing division. The licensing division must
immediately notify the deleted text begin host county and lead county contract agency and the hostdeleted text end county
licensing agency. The licensing division must collaborate with the county licensing
agency in the review of the application and the licensing of the program.

(c) Before a license is issued by the commissioner, and for the duration of the
license, the applicant or license holder must establish, maintain, and document the
implementation of written policies and procedures addressing the requirements in
paragraphs (d) through (f).

(d) The applicant or license holder must have policies and procedures that:

(1) establish characteristics of target populations that will be admitted into the home,
and characteristics of populations that will not be accepted into the home;

(2) explain the discharge process when a deleted text begin foster care recipientdeleted text end new text begin resident served by the
programnew text end requires overnight supervision or other services that cannot be provided by the
license holder due to the limited hours that the license holder is on site;

(3) describe the types of events to which the program will respond with a physical
presence when those events occur in the home during time when staff are not on site, and
how the license holder's response plan meets the requirements in paragraph (e), clause
(1) or (2);

(4) establish a process for documenting a review of the implementation and
effectiveness of the response protocol for the response required under paragraph (e),
clause (1) or (2). The documentation must include:

(i) a description of the triggering incident;

(ii) the date and time of the triggering incident;

(iii) the time of the response or responses under paragraph (e), clause (1) or (2);

(iv) whether the response met the resident's needs;

(v) whether the existing policies and response protocols were followed; and

(vi) whether the existing policies and protocols are adequate or need modification.

When no physical presence response is completed for a three-month period, the
license holder's written policies and procedures must require a physical presence response
drill to be conducted for which the effectiveness of the response protocol under paragraph
(e), clause (1) or (2), will be reviewed and documented as required under this clause; and

(5) establish that emergency and nonemergency phone numbers are posted in a
prominent location in a common area of the home where they can be easily observed by a
person responding to an incident who is not otherwise affiliated with the home.

(e) The license holder must document and include in the license application which
response alternative under clause (1) or (2) is in place for responding to situations that
present a serious risk to the health, safety, or rights of deleted text begin people receiving foster care services
in the homedeleted text end new text begin residents served by the programnew text end :

(1) response alternative (1) requires only the technology to provide an electronic
notification or alert to the license holder that an event is underway that requires a response.
Under this alternative, no more than ten minutes will pass before the license holder will be
physically present on site to respond to the situation; or

(2) response alternative (2) requires the electronic notification and alert system under
alternative (1), but more than ten minutes may pass before the license holder is present on
site to respond to the situation. Under alternative (2), all of the following conditions are met:

(i) the license holder has a written description of the interactive technological
applications that will assist the license holder in communicating with and assessing the
needs related to the care, health, and safety of the foster care recipients. This interactive
technology must permit the license holder to remotely assess the well being of the deleted text begin foster
care recipientdeleted text end new text begin resident served by the programnew text end without requiring the initiation of the
foster care recipient. Requiring the foster care recipient to initiate a telephone call does
not meet this requirement;

(ii) the license holder documents how the remote license holder is qualified and
capable of meeting the needs of the foster care recipients and assessing foster care
recipients' needs under item (i) during the absence of the license holder on site;

(iii) the license holder maintains written procedures to dispatch emergency response
personnel to the site in the event of an identified emergency; and

(iv) each deleted text begin foster care recipient'sdeleted text end new text begin resident'snew text end individualized plan of care, deleted text begin individual
service plandeleted text end new text begin coordinated service and support plannew text end under deleted text begin sectiondeleted text end new text begin sections 256B.0913,
subdivision 8; 256B.0915, subdivision 6; new text end 256B.092, subdivision 1bnew text begin ; and 256B.49,
subdivision 15new text end , if required, or individual resident placement agreement under Minnesota
Rules, part 9555.5105, subpart 19, if required, identifies the maximum response time,
which may be greater than ten minutes, for the license holder to be on site for that deleted text begin foster
care recipientdeleted text end new text begin residentnew text end .

(f) Each deleted text begin foster care recipient'sdeleted text end new text begin resident'snew text end placement agreement, individual service
agreement, and plan must clearly state that the adult foster carenew text begin or community residential
settingnew text end license category is a program without the presence of a caregiver in the residence
during normal sleeping hours; the protocols in place for responding to situations that
present a serious risk to the health, safety, or rights of deleted text begin foster care recipientsdeleted text end new text begin residents
served by the programnew text end under paragraph (e), clause (1) or (2); and a signed informed
consent from each deleted text begin foster care recipientdeleted text end new text begin resident served by the programnew text end or the person's
legal representative documenting the person's or legal representative's agreement with
placement in the program. If electronic monitoring technology is used in the home, the
informed consent form must also explain the following:

(1) how any electronic monitoring is incorporated into the alternative supervision
system;

(2) the backup system for any electronic monitoring in times of electrical outages or
other equipment malfunctions;

(3) how the caregiversnew text begin or direct support staffnew text end are trained on the use of the technology;

(4) the event types and license holder response times established under paragraph (e);

(5) how the license holder protects deleted text begin the foster care recipient'sdeleted text end new text begin each resident'snew text end privacy
related to electronic monitoring and related to any electronically recorded data generated
by the monitoring system. A deleted text begin foster care recipientdeleted text end new text begin resident served by the programnew text end may
not be removed from a program under this subdivision for failure to consent to electronic
monitoring. The consent form must explain where and how the electronically recorded
data is stored, with whom it will be shared, and how long it is retained; and

(6) the risks and benefits of the alternative overnight supervision system.

The written explanations under clauses (1) to (6) may be accomplished through
cross-references to other policies and procedures as long as they are explained to the
person giving consent, and the person giving consent is offered a copy.

(g) Nothing in this section requires the applicant or license holder to develop or
maintain separate or duplicative policies, procedures, documentation, consent forms, or
individual plans that may be required for other licensing standards, if the requirements of
this section are incorporated into those documents.

(h) The commissioner may grant variances to the requirements of this section
according to section 245A.04, subdivision 9.

(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
under section 245A.2, subdivision 9, and additionally includes all staff, volunteers, and
contractors affiliated with the license holder.

(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to
remotely determine what action the license holder needs to take to protect the well-being
of the foster care recipient.

(k) The commissioner shall evaluate license applications using the requirements
in paragraphs (d) to (f). The commissioner shall provide detailed application forms,
including a checklist of criteria needed for approval.

(l) To be eligible for a license under paragraph (a), the adult foster carenew text begin or community
residential settingnew text end license holder must not have had a conditional license issued under
section 245A.06 or any licensing sanction under section 245A.07 during the prior 24
months based on failure to provide adequate supervision, health care services, or resident
safety in the adult foster care homenew text begin or community residential settingnew text end .

(m) The commissioner shall review an application for an alternative overnight
supervision license within 60 days of receipt of the application. When the commissioner
receives an application that is incomplete because the applicant failed to submit required
documents or that is substantially deficient because the documents submitted do not meet
licensing requirements, the commissioner shall provide the applicant written notice
that the application is incomplete or substantially deficient. In the written notice to the
applicant, the commissioner shall identify documents that are missing or deficient and
give the applicant 45 days to resubmit a second application that is substantially complete.
An applicant's failure to submit a substantially complete application after receiving
notice from the commissioner is a basis for license denial under section 245A.05. The
commissioner shall complete subsequent review within 30 days.

(n) Once the application is considered complete under paragraph (m), the
commissioner will approve or deny an application for an alternative overnight supervision
license within 60 days.

(o) For the purposes of this subdivision, "supervision" means:

(1) oversight by a caregivernew text begin or direct support staffnew text end as specified in the individual
resident's place agreementnew text begin or coordinated service and support plannew text end and awareness of the
resident's needs and activities; and

(2) the presence of a caregivernew text begin or direct support staffnew text end in a residence during normal
sleeping hours, unless a determination has been made and documented in the individual's
new text begin coordinated service andnew text end support plan that the individual does not require the presence of a
caregivernew text begin or direct support staffnew text end during normal sleeping hours.

Sec. 14.

Minnesota Statutes 2012, section 245A.11, subdivision 7b, is amended to read:


Subd. 7b.

Adult foster care data privacy and security.

(a) An adult foster care
new text begin or community residential settingnew text end license holder who creates, collects, records, maintains,
stores, or discloses any individually identifiable recipient data, whether in an electronic
or any other format, must comply with the privacy and security provisions of applicable
privacy laws and regulations, including:

(1) the federal Health Insurance Portability and Accountability Act of 1996
(HIPAA), Public Law 104-1; and the HIPAA Privacy Rule, Code of Federal Regulations,
title 45, part 160, and subparts A and E of part 164; and

(2) the Minnesota Government Data Practices Act as codified in chapter 13.

(b) For purposes of licensure, the license holder shall be monitored for compliance
with the following data privacy and security provisions:

(1) the license holder must control access to data on deleted text begin foster care recipientsdeleted text end new text begin residents
served by the programnew text end according to the definitions of public and private data on individuals
under section 13.02; classification of the data on individuals as private under section
13.46, subdivision 2; and control over the collection, storage, use, access, protection,
and contracting related to data according to section 13.05, in which the license holder is
assigned the duties of a government entity;

(2) the license holder must provide each deleted text begin foster care recipientdeleted text end new text begin resident served by
the programnew text end with a notice that meets the requirements under section 13.04, in which
the license holder is assigned the duties of the government entity, and that meets the
requirements of Code of Federal Regulations, title 45, part 164.52. The notice shall
describe the purpose for collection of the data, and to whom and why it may be disclosed
pursuant to law. The notice must inform the deleted text begin recipientdeleted text end new text begin individualnew text end that the license holder
uses electronic monitoring and, if applicable, that recording technology is used;

(3) the license holder must not install monitoring cameras in bathrooms;

(4) electronic monitoring cameras must not be concealed from the deleted text begin foster care
recipientsdeleted text end new text begin residents served by the programnew text end ; and

(5) electronic video and audio recordings of deleted text begin foster care recipientsdeleted text end new text begin residents served
by the programnew text end shall be stored by the license holder for five days unless: (i) a deleted text begin foster care
recipientdeleted text end new text begin resident served by the programnew text end or legal representative requests that the recording
be held longer based on a specific report of alleged maltreatment; or (ii) the recording
captures an incident or event of alleged maltreatment under section 626.556 or 626.557 or
a crime under chapter 609. When requested by a deleted text begin recipientdeleted text end new text begin resident served by the program
new text end or when a recording captures an incident or event of alleged maltreatment or a crime, the
license holder must maintain the recording in a secured area for no longer than 30 days
to give the investigating agency an opportunity to make a copy of the recording. The
investigating agency will maintain the electronic video or audio recordings as required in
section 626.557, subdivision 12b.

(c) The commissioner shall develop, and make available to license holders and
county licensing workers, a checklist of the data privacy provisions to be monitored
for purposes of licensure.

Sec. 15.

Minnesota Statutes 2012, section 245A.11, subdivision 8, is amended to read:


Subd. 8.

Community residential setting license.

(a) The commissioner shall
establish provider standards for residential support services that integrate service standards
and the residential setting under one license. The commissioner shall propose statutory
language and an implementation plan for licensing requirements for residential support
services to the legislature by January 15, 2012, as a component of the quality outcome
standards recommendations required by Laws 2010, chapter 352, article 1, section 24.

(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
for services in settings licensed as adult foster care under Minnesota Rules, parts 9555.5105
to 9555.6265deleted text begin , or child foster care under Minnesota Rules, parts 2960.3000 to 2960.3340deleted text end ;
and meeting the provisions of deleted text begin section 256B.092, subdivision 11, paragraph (b)deleted text end new text begin section
245D.02, subdivision 4anew text end , must be required to obtain a community residential setting license.

Sec. 16.

Minnesota Statutes 2012, section 245A.16, subdivision 1, is amended to read:


Subdivision 1.

Delegation of authority to agencies.

(a) County agencies and
private agencies that have been designated or licensed by the commissioner to perform
licensing functions and activities under section 245A.04 and background studies for family
child care under chapter 245C; to recommend denial of applicants under section 245A.05;
to issue correction orders, to issue variances, and recommend a conditional license under
section 245A.06, or to recommend suspending or revoking a license or issuing a fine under
section 245A.07, shall comply with rules and directives of the commissioner governing
those functions and with this section. The following variances are excluded from the
delegation of variance authority and may be issued only by the commissioner:

(1) dual licensure of family child care and child foster care, dual licensure of child
and adult foster care, and adult foster care and family child care;

(2) adult foster care maximum capacity;

(3) adult foster care minimum age requirement;

(4) child foster care maximum age requirement;

(5) variances regarding disqualified individuals except that county agencies may
issue variances under section 245C.30 regarding disqualified individuals when the county
is responsible for conducting a consolidated reconsideration according to sections 245C.25
and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
and a disqualification based on serious or recurring maltreatment; deleted text begin and
deleted text end

(6) the required presence of a caregiver in the adult foster care residence during
normal sleeping hoursnew text begin ; and
new text end

new text begin (7) variances for community residential setting licenses under chapter 245Dnew text end .

Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency
must not grant a license holder a variance to exceed the maximum allowable family child
care license capacity of 14 children.

(b) County agencies must report information about disqualification reconsiderations
under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
prescribed by the commissioner.

(c) For family day care programs, the commissioner may authorize licensing reviews
every two years after a licensee has had at least one annual review.

(d) For family adult day services programs, the commissioner may authorize
licensing reviews every two years after a licensee has had at least one annual review.

(e) A license issued under this section may be issued for up to two years.

Sec. 17.

Minnesota Statutes 2012, section 245D.02, is amended to read:


245D.02 DEFINITIONS.

Subdivision 1.

Scope.

The terms used in this chapter have the meanings given
them in this section.

Subd. 2.

Annual and annually.

"Annual" and "annually" have the meaning given
in section 245A.02, subdivision 2b.

new text begin Subd. 2a. new text end

new text begin Authorized representative. new text end

new text begin "Authorized representative" means a parent,
family member, advocate, or other adult authorized by the person or the person's legal
representative, to serve as a representative in connection with the provision of services
licensed under this chapter. This authorization must be in writing or by another method
that clearly indicates the person's free choice. The authorized representative must have no
financial interest in the provision of any services included in the person's service delivery
plan and must be capable of providing the support necessary to assist the person in the use
of home and community-based services licensed under this chapter.
 new text end

Subd. 3.

Case manager.

"Case manager" means the individual designated
to provide waiver case management services, care coordination, or long-term care
consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
or successor provisions.

new text begin Subd. 3a. new text end

new text begin Certification. new text end

new text begin "Certification" means the commissioner's written
authorization for a license holder to provide specialized services based on certification
standards in section 245D.33. The term certification and its derivatives have the same
meaning and may be substituted for the term licensure and its derivatives in this chapter
and chapter 245A.
 new text end

Subd. 4.

Commissioner.

"Commissioner" means the commissioner of the
Department of Human Services or the commissioner's designated representative.

new text begin Subd. 4a. new text end

new text begin Community residential setting. new text end

new text begin "Community residential setting" means
a residential program as identified in section 245A.11, subdivision 8, where residential
supports and services identified in section 245D.03, subdivision 1, paragraph (c), clause
(3), items (i) and (ii), are provided and the license holder is the owner, lessor, or tenant
of the facility licensed according to this chapter, and the license holder does not reside
in the facility.
 new text end

new text begin Subd. 4b. new text end

new text begin Coordinated service and support plan. new text end

new text begin "Coordinated service and support
plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915, subdivision
6; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor provisions.
 new text end

new text begin Subd. 4c. new text end

new text begin Coordinated service and support plan addendum. new text end

new text begin "Coordinated
service and support plan addendum" means the documentation that this chapter requires
of the license holder for each person receiving services.
 new text end

new text begin Subd. 4d. new text end

new text begin Corporate foster care. new text end

new text begin "Corporate foster care" means a child foster
residence setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340,
or an adult foster care home licensed according to Minnesota Rules, parts 9555.5105 to
9555.6265, where the license holder does not live in the home.
 new text end

new text begin Subd. 4e. new text end

new text begin Cultural competence or culturally competent. new text end

new text begin "Cultural competence"
or "culturally competent" means the ability and the will to respond to the unique needs of
a person that arise from the person's culture and the ability to use the person's culture as a
resource or tool to assist with the intervention and help meet the person's needs.
 new text end

new text begin Subd. 4f. new text end

new text begin Day services facility. new text end

new text begin "Day services facility" means a facility licensed
according to this chapter at which persons receive day services licensed under this chapter
from the license holder's direct support staff for a cumulative total of more than 30 days
within any 12-month period and the license holder is the owner, lessor, or tenant of the
facility.
 new text end

Subd. 5.

Department.

"Department" means the Department of Human Services.

Subd. 6.

Direct contact.

"Direct contact" has the meaning given in section 245C.02,
subdivision 11, and is used interchangeably with the term "direct new text begin support new text end service."

new text begin Subd. 6a. new text end

new text begin Direct support staff or staff. new text end

new text begin "Direct support staff" or "staff" means
employees of the license holder who have direct contact with persons served by the
program and includes temporary staff or subcontractors, regardless of employer, providing
program services for hire under the control of the license holder who have direct contact
with persons served by the program.
 new text end

Subd. 7.

Drug.

"Drug" has the meaning given in section 151.01, subdivision 5.

Subd. 8.

Emergency.

"Emergency" means any event that affects the ordinary
daily operation of the program including, but not limited to, fires, severe weather, natural
disasters, power failures, or other events that threaten the immediate health and safety of
a person receiving services and that require calling 911, emergency evacuation, moving
to an emergency shelter, or temporary closure or relocation of the program to another
facility or service sitenew text begin for more than 24 hoursnew text end .

new text begin Subd. 8a. new text end

new text begin Emergency use of manual restraint. new text end

new text begin "Emergency use of manual
restraint" means using a manual restraint when a person poses an imminent risk of
physical harm to self or others and is the least restrictive intervention that would achieve
safety. Property damage, verbal aggression, or a person's refusal to receive or participate
in treatment or programming on their own, do not constitute an emergency.
 new text end

new text begin Subd. 8b. new text end

new text begin Expanded support team. new text end

new text begin "Expanded support team" means the members
of the support team defined in subdivision 46, and a licensed health or mental health
professional or other licensed, certified, or qualified professionals or consultants working
with the person and included in the team at the request of the person or the person's legal
representative.
 new text end

new text begin Subd. 8c. new text end

new text begin Family foster care. new text end

new text begin "Family foster care" means a child foster family
setting licensed according to Minnesota Rules, parts 2960.0010 to 2960.3340, or an adult
foster care home licensed according to Minnesota Rules, parts 9555.5105 to 9555.6265,
where the license holder lives in the home.
 new text end

Subd. 9.

Health services.

"Health services" means any service or treatment
consistent with the physical and mental health needs of the person, such as medication
administration and monitoring, medical, dental, nutritional, health monitoring, wellness
education, and exercise.

Subd. 10.

Home and community-based services.

"Home and community-based
services" means the services deleted text begin subject to the provisions of this chapterdeleted text end new text begin identified in section
245D.03, subdivision 1,new text end and new text begin as new text end defined innew text begin :
new text end

new text begin (1)new text end the deleted text begin federaldeleted text end new text begin federally approvednew text end waiver plans governed by United States Code,
title 42, sections 1396 et seq., deleted text begin or the state's alternative care program according to section
256B.0913,deleted text end including new text begin the waivers for persons with disabilities under section 256B.49,
subdivision 11, including new text end the brain injury (BI) waiverdeleted text begin ,deleted text end new text begin plan;new text end the community alternative
care (CAC) waiverdeleted text begin ,deleted text end new text begin plan;new text end the community alternatives for disabled individuals (CADI)
waiverdeleted text begin ,deleted text end new text begin plan;new text end the developmental disability (DD) waiverdeleted text begin ,deleted text end new text begin plan under section 256B.092,
subdivision 5;new text end the elderly waiver (EW)deleted text begin , anddeleted text end new text begin plan under section 256B.0915, subdivision 1;
or successor plans respective to each waiver;new text end new text begin or
new text end

new text begin (2) new text end the alternative care (AC) programnew text begin under section 256B.0913new text end .

Subd. 11.

Incident.

"Incident" means an occurrence deleted text begin that affects thedeleted text end new text begin which involves
a person and requires the program to make a response that is not a part of the program's
new text end ordinary provision of services to deleted text begin adeleted text end new text begin thatnew text end personnew text begin ,new text end and includes deleted text begin any of the followingdeleted text end :

(1) serious injury new text begin of a person new text end as determined by section 245.91, subdivision 6;

(2) a person's death;

(3) any medical emergency, unexpected serious illness, or significant unexpected
change in an illness or medical conditiondeleted text begin , or the mental health statusdeleted text end of a person that
requires deleted text begin callingdeleted text end new text begin the program to callnew text end 911 deleted text begin or a mental health crisis intervention teamdeleted text end ,
physician treatment, or hospitalization;

new text begin (4) any mental health crisis that requires the program to call 911 or a mental health
crisis intervention team;
 new text end

new text begin (5) an act or situation involving a person that requires the program to call 911,
law enforcement, or the fire department;
 new text end

deleted text begin (4)deleted text end new text begin (6)new text end a person's unauthorized or unexplained absence from a program;

deleted text begin (5)deleted text end new text begin (7)new text end deleted text begin physical aggressiondeleted text end new text begin conductnew text end by a person receiving services against another
person receiving services that deleted text begin causes physical pain, injury, or persistent emotional distress,
including, but not limited to, hitting, slapping, kicking, scratching, pinching, biting,
pushing, and spitting;deleted text end new text begin :
new text end

new text begin (i) is so severe, pervasive, or objectively offensive that it substantially interferes with
a person's opportunities to participate in or receive service or support;
 new text end

new text begin (ii) places the person in actual and reasonable fear of harm;
 new text end

new text begin (iii) places the person in actual and reasonable fear of damage to property of the
person; or
 new text end

new text begin (iv) substantially disrupts the orderly operation of the program;
 new text end

deleted text begin (6)deleted text end new text begin (8)new text end any sexual activity between persons receiving services involving force or
coercion as defined under section 609.341, subdivisions 3 and 14; deleted text begin or
deleted text end

new text begin (9) any emergency use of manual restraint as identified in section 245D.061; or
 new text end

deleted text begin (7)deleted text end new text begin (10)new text end a report of alleged or suspected child or vulnerable adult maltreatment
under section 626.556 or 626.557.

new text begin Subd. 11a. new text end

new text begin Intermediate care facility for persons with developmental disabilities
or ICF/DD. new text end

new text begin "Intermediate care facility for persons with developmental disabilities" or
"ICF/DD" means a residential program licensed to serve four or more persons with
developmental disabilities under section 252.28 and chapter 245A and licensed as a
supervised living facility under chapter 144, which together are certified by the Department
of Health as an intermediate care facility for persons with developmental disabilities.
 new text end

new text begin Subd. 11b. new text end

new text begin Least restrictive alternative. new text end

new text begin "Least restrictive alternative" means
the alternative method for providing supports and services that is the least intrusive and
most normalized given the level of supervision and protection required for the person.
This level of supervision and protection allows risk taking to the extent that there is no
reasonable likelihood that serious harm will happen to the person or others.
 new text end

Subd. 12.

Legal representative.

"Legal representative" means the parent of a
person who is under 18 years of age, a court-appointed guardian, or other representative
with legal authority to make decisions about services for a person. new text begin 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.
new text end

Subd. 13.

License.

"License" has the meaning given in section 245A.02,
subdivision 8.

Subd. 14.

Licensed health professional.

"Licensed health professional" means a
person licensed in Minnesota to practice those professions described in section 214.01,
subdivision 2.

Subd. 15.

License holder.

"License holder" has the meaning given in section
245A.02, subdivision 9.

Subd. 16.

Medication.

"Medication" means a prescription drug or over-the-counter
drug. For purposes of this chapter, "medication" includes dietary supplements.

deleted text begin Subd. 17. deleted text end

deleted text begin Medication administration. deleted text end

deleted text begin "Medication administration" means
performing the following set of tasks to ensure a person takes both prescription and
over-the-counter medications and treatments according to orders issued by appropriately
licensed professionals, and includes the following:
 deleted text end

deleted text begin (1) checking the person's medication record;
 deleted text end

deleted text begin (2) preparing the medication for administration;
 deleted text end

deleted text begin (3) administering the medication to the person;
 deleted text end

deleted text begin (4) documenting the administration of the medication or the reason for not
administering the medication; and
 deleted text end

deleted text begin (5) reporting to the prescriber or a nurse any concerns about the medication,
including side effects, adverse reactions, effectiveness, or the person's refusal to take the
medication or the person's self-administration of the medication.
 deleted text end

deleted text begin Subd. 18. deleted text end

deleted text begin Medication assistance. deleted text end

deleted text begin "Medication assistance" means providing verbal
or visual reminders to take regularly scheduled medication, which includes either of
the following:
 deleted text end

deleted text begin (1) bringing to the person and opening a container of previously set up medications
and emptying the container into the person's hand or opening and giving the medications
in the original container to the person, or bringing to the person liquids or food to
accompany the medication; or
 deleted text end

deleted text begin (2) providing verbal or visual reminders to perform regularly scheduled treatments
and exercises.
 deleted text end

deleted text begin Subd. 19. deleted text end

deleted text begin Medication management. deleted text end

deleted text begin "Medication management" means the
provision of any of the following:
 deleted text end

deleted text begin (1) medication-related services to a person;
 deleted text end

deleted text begin (2) medication setup;
 deleted text end

deleted text begin (3) medication administration;
 deleted text end

deleted text begin (4) medication storage and security;
 deleted text end

deleted text begin (5) medication documentation and charting;
 deleted text end

deleted text begin (6) verification and monitoring of effectiveness of systems to ensure safe medication
handling and administration;
 deleted text end

deleted text begin (7) coordination of medication refills;
 deleted text end

deleted text begin (8) handling changes to prescriptions and implementation of those changes;
 deleted text end

deleted text begin (9) communicating with the pharmacy; or
 deleted text end

deleted text begin (10) coordination and communication with prescriber.
 deleted text end

deleted text begin For the purposes of this chapter, medication management does not mean "medication
therapy management services" as identified in section 256B.0625, subdivision 13h.
 deleted text end

Subd. 20.

Mental health crisis intervention team.

"Mental health crisis
intervention team" means new text begin a new text end mental health crisis response deleted text begin providersdeleted text end new text begin providernew text end as identified
in section 256B.0624, subdivision 2, paragraph (d), for adults, and in section 256B.0944,
subdivision 1, paragraph (d), for children.

new text begin Subd. 20a. new text end

new text begin Most integrated setting. new text end

new text begin "Most integrated setting" means a setting that
enables individuals with disabilities to interact with nondisabled persons to the fullest
extent possible.
 new text end

Subd. 21.

Over-the-counter drug.

"Over-the-counter drug" means a drug that
is not required by federal law to bear the statement "Caution: Federal law prohibits
dispensing without prescription."

new text begin Subd. 21a. new text end

new text begin Outcome. new text end

new text begin "Outcome" means the behavior, action, or status attained by
the person that can be observed, measured, and determined reliable and valid.
 new text end

Subd. 22.

Person.

"Person" has the meaning given in section 245A.02, subdivision
11.

Subd. 23.

Person with a disability.

"Person with a disability" means a person
determined to have a disability by the commissioner's state medical review team as
identified in section 256B.055, subdivision 7, the Social Security Administration, or
the person is determined to have a developmental disability as defined in Minnesota
Rules, part 9525.0016, subpart 2, item B, or a related condition as defined in section
252.27, subdivision 1a.

new text begin Subd. 23a. new text end

new text begin Physician. new text end

new text begin "Physician" means a person who is licensed under chapter
147.
 new text end

Subd. 24.

Prescriber.

"Prescriber" means a deleted text begin licensed practitioner as defined in
section 151.01, subdivision 23,deleted text end new text begin personnew text end who is authorized under deleted text begin sectiondeleted text end new text begin sections 148.235;
151.01, subdivision 23; ornew text end 151.37 to prescribe drugs. deleted text begin For the purposes of this chapter, the
term "prescriber" is used interchangeably with "physician."
deleted text end

Subd. 25.

Prescription drug.

"Prescription drug" has the meaning given in section
151.01, subdivision deleted text begin 17deleted text end new text begin 16new text end .

Subd. 26.

Program.

"Program" means either the nonresidential or residential
program as defined in section 245A.02, subdivisions 10 and 14.

Subd. 27.

Psychotropic medication.

"Psychotropic medication" means any
medication prescribed to treat the symptoms of mental illness that affect thought processes,
mood, sleep, or behavior. The major classes of psychotropic medication are antipsychotic
(neuroleptic), antidepressant, antianxiety, mood stabilizers, anticonvulsants, and
stimulants and nonstimulants for the treatment of attention deficit/hyperactivity disorder.
Other miscellaneous medications are considered to be a psychotropic medication when
they are specifically prescribed to treat a mental illness or to control or alter behavior.

Subd. 28.

Restraint.

"Restraint" means physical or mechanical limiting of the free
and normal movement of body or limbs.

Subd. 29.

Seclusion.

"Seclusion" means deleted text begin separating a person from others in a way
that prevents social contact and prevents the person from leaving the situation if he or she
choosesdeleted text end new text begin the placement of a person alone in a room from which exit is prohibited by a staff
person or a mechanism such as a lock, a device, or an object positioned to hold the door
closed or otherwise prevent the person from leaving the roomnew text end .

new text begin Subd. 29a. new text end

new text begin Self-determination. new text end

new text begin "Self-determination" means the person makes
decisions independently, plans for the person's own future, determines how money is spent
for the person's supports, and takes responsibility for making these decisions. If a person
has a legal representative, the legal representative's decision-making authority is limited to
the scope of authority granted by the court or allowed in the document authorizing the
legal representative to act.
 new text end

new text begin Subd. 29b. new text end

new text begin Semi-independent living services. new text end

new text begin "Semi-independent living services"
has the meaning given in section 252.275.
 new text end

Subd. 30.

Service.

"Service" means care, training, supervision, counseling,
consultation, or medication assistance assigned to the license holder in the new text begin coordinated
new text end service new text begin and support new text end plan.

deleted text begin Subd. 31. deleted text end

deleted text begin Service plan. deleted text end

deleted text begin "Service plan" means the individual service plan or
individual care plan identified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
or successor provisions, and includes any support plans or service needs identified as
a result of long-term care consultation, or a support team meeting that includes the
participation of the person, the person's legal representative, and case manager, or assigned
to a license holder through an authorized service agreement.
 deleted text end

Subd. 32.

Service site.

"Service site" means the location where the service is
provided to the person, including, but not limited to, a facility licensed according to
chapter 245A; a location where the license holder is the owner, lessor, or tenant; a person's
own home; or a community-based location.

deleted text begin Subd. 33. deleted text end

deleted text begin Staff. deleted text end

deleted text begin "Staff" means an employee who will have direct contact with a
person served by the facility, agency, or program.
 deleted text end

new text begin Subd. 33a. new text end

new text begin Supervised living facility. new text end

new text begin "Supervised living facility" has the meaning
given in Minnesota Rules, part 4665.0100, subpart 10.
 new text end

new text begin Subd. 33b. new text end

new text begin Supervision. new text end

new text begin (a) "Supervision" means:
 new text end

new text begin (1) oversight by direct support staff as specified in the person's coordinated service
and support plan or coordinated service and support plan addendum and awareness of
the person's needs and activities;
 new text end

new text begin (2) responding to situations that present a serious risk to the health, safety, or rights
of the person while services are being provided; and
 new text end

new text begin (3) the presence of direct support staff at a service site while services are being
provided, unless a determination has been made and documented in the person's coordinated
service and support plan or coordinated service and support plan addendum that the person
does not require the presence of direct support staff while services are being provided.
 new text end

new text begin (b) For the purposes of this definition, "while services are being provided," means
any period of time during which the license holder will seek reimbursement for services.
 new text end

Subd. 34.

Support team.

"Support team" means the service planning team
identified in section 256B.49, subdivision 15, or the interdisciplinary team identified in
Minnesota Rules, part 9525.0004, subpart 14.

new text begin Subd. 34a. new text end

new text begin Time out. new text end

new text begin "Time out" means removing a person involuntarily from an
ongoing activity to a room, either locked or unlocked, or otherwise separating a person
from others in a way that prevents social contact and prevents the person from leaving
the situation if the person chooses. For the purpose of chapter 245D, "time out" does
not mean voluntary removal or self-removal for the purpose of calming, prevention of
escalation, or de-escalation of behavior for a period of up to 15 minutes. "Time out"
does not include a person voluntarily moving from an ongoing activity to an unlocked
room or otherwise separating from a situation or social contact with others if the person
chooses. For the purposes of this definition, "voluntarily" means without being forced,
compelled, or coerced.
 new text end

deleted text begin Subd. 35. deleted text end

deleted text begin Unit of government. deleted text end

deleted text begin "Unit of government" means every city, county,
town, school district, other political subdivisions of the state, and any agency of the state
or the United States, and includes any instrumentality of a unit of government.
 deleted text end

new text begin Subd. 35a. new text end

new text begin Treatment. new text end

new text begin "Treatment" means the provision of care, other than
medications, ordered or prescribed by a licensed health or mental health professional,
provided to a person to cure, rehabilitate, or ease symptoms.
 new text end

Subd. 36.

Volunteer.

"Volunteer" means an individual who, under the direction of the
license holder, provides direct services without pay to a person served by the license holder.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 18.

Minnesota Statutes 2012, section 245D.03, is amended to read:


245D.03 APPLICABILITY AND EFFECT.

Subdivision 1.

Applicability.

new text begin (a) new text end The commissioner shall regulate the provision of
home and community-based services to persons with disabilities and persons age 65 and
older pursuant to this chapter. The licensing standards in this chapter govern the provision
of deleted text begin the followingdeleted text end new text begin basic supportnew text end servicesdeleted text begin :deleted text end new text begin and intensive support services.
new text end

deleted text begin (1) housing access coordination as defined under the current BI, CADI, and DD
waiver plans or successor plans;
 deleted text end

deleted text begin (2) respite services as defined under the current CADI, BI, CAC, DD, and EW
waiver plans or successor plans when the provider is an individual who is not an employee
of a residential or nonresidential program licensed by the Department of Human Services
or the Department of Health that is otherwise providing the respite service;
 deleted text end

deleted text begin (3) behavioral programming as defined under the current BI and CADI waiver
plans or successor plans;
 deleted text end

deleted text begin (4) specialist services as defined under the current DD waiver plan or successor plans;
 deleted text end

deleted text begin (5) companion services as defined under the current BI, CADI, and EW waiver
plans or successor plans, excluding companion services provided under the Corporation
for National and Community Services Senior Companion Program established under the
Domestic Volunteer Service Act of 1973, Public Law 98-288;
 deleted text end

deleted text begin (6) personal support as defined under the current DD waiver plan or successor plans;
 deleted text end

deleted text begin (7) 24-hour emergency assistance, on-call and personal emergency response as
defined under the current CADI and DD waiver plans or successor plans;
 deleted text end

deleted text begin (8) night supervision services as defined under the current BI waiver plan or
successor plans;
 deleted text end

deleted text begin (9) homemaker services as defined under the current CADI, BI, CAC, DD, and EW
waiver plans or successor plans, excluding providers licensed by the Department of Health
under chapter 144A and those providers providing cleaning services only;
 deleted text end

deleted text begin (10) independent living skills training as defined under the current BI and CADI
waiver plans or successor plans;
 deleted text end

deleted text begin (11) prevocational services as defined under the current BI and CADI waiver plans
or successor plans;
 deleted text end

deleted text begin (12) structured day services as defined under the current BI waiver plan or successor
plans; or
 deleted text end

deleted text begin (13) supported employment as defined under the current BI and CADI waiver plans
or successor plans.
 deleted text end

new text begin (b) Basic support services provide the level of assistance, supervision, and care that
is necessary to ensure the health and safety of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of
the person. Basic support services include:
 new text end

new text begin (1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community
alternatives for disabled individuals, developmental disability, and elderly waiver plans;
 new text end

new text begin (2) companion services as defined under the brain injury, community alternatives for
disabled individuals, and elderly waiver plans, excluding companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
 new text end

new text begin (3) personal support as defined under the developmental disability waiver plan;
 new text end

new text begin (4) 24-hour emergency assistance, personal emergency response as defined under the
community alternatives for disabled individuals and developmental disability waiver plans;
 new text end

new text begin (5) night supervision services as defined under the brain injury waiver plan; and
 new text end

new text begin (6) homemaker services as defined under the community alternatives for disabled
individuals, brain injury, community alternative care, developmental disability, and elderly
waiver plans, excluding providers licensed by the Department of Health under chapter
144A and those providers providing cleaning services only.
 new text end

new text begin (c) Intensive support services provide assistance, supervision, and care that is
necessary to ensure the health and safety of the person and services specifically directed
toward the training, habilitation, or rehabilitation of the person. Intensive support services
include:
 new text end

new text begin (1) intervention services, including:
 new text end

new text begin (i) behavioral support services as defined under the brain injury and community
alternatives for disabled individuals waiver plans;
 new text end

new text begin (ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and
 new text end

new text begin (iii) specialist services as defined under the current developmental disability waiver
plan;
 new text end

new text begin (2) in-home support services, including:
 new text end

new text begin (i) in-home family support and supported living services as defined under the
developmental disability waiver plan;
 new text end

new text begin (ii) independent living services training as defined under the brain injury and
community alternatives for disabled individuals waiver plans; and
 new text end

new text begin (iii) semi-independent living services;
 new text end

new text begin (3) residential supports and services, including:
 new text end

new text begin (i) supported living services as defined under the developmental disability waiver
plan provided in a family or corporate child foster care residence, a family adult foster
care residence, a community residential setting, or a supervised living facility;
 new text end

new text begin (ii) foster care services as defined in the brain injury, community alternative care,
and community alternatives for disabled individuals waiver plans provided in a family or
corporate child foster care residence, a family adult foster care residence, or a community
residential setting; and
 new text end

new text begin (iii) residential services provided in a supervised living facility that is certified by
the Department of Health as an ICF/DD;
 new text end

new text begin (4) day services, including:
 new text end

new text begin (i) structured day services as defined under the brain injury waiver plan;
 new text end

new text begin (ii) day training and habilitation services under sections 252.40 to 252.46, and as
defined under the developmental disability waiver plan; and
 new text end

new text begin (iii) prevocational services as defined under the brain injury and community
alternatives for disabled individuals waiver plans; and
 new text end

new text begin (5) supported employment as defined under the brain injury, developmental
disability, and community alternatives for disabled individuals waiver plans.
 new text end

Subd. 2.

Relationship to other standards governing home and community-based
services.

(a) A license holder governed by this chapter is also subject to the licensure
requirements under chapter 245A.

(b) deleted text begin A license holder concurrently providing child foster care services licensed
according to Minnesota Rules, chapter 2960, to the same person receiving a service licensed
under this chapter is exempt from section 245D.04 as it applies to the person.deleted text end new text begin A corporate
or family child foster care site controlled by a license holder and providing services
governed by this chapter is exempt from compliance with section 245D.04. This exemption
applies to foster care homes where at least one resident is receiving residential supports
and services licensed according to this chapter. This chapter does not apply to corporate or
family child foster care homes that do not provide services licensed under this chapter.
new text end

new text begin (c) A family adult foster care site controlled by a license holder and providing
services governed by this chapter is exempt from compliance with Minnesota Rules, parts
9555.6185; 9555.6225, subpart 8; 9555.6235, item C; 9555.6245; 9555.6255, subpart
2; and 9555.6265. These exemptions apply to family adult foster care homes where at
least one resident is receiving residential supports and services licensed according to this
chapter. This chapter does not apply to family adult foster care homes that do not provide
services licensed under this chapter.
 new text end

new text begin (d) A license holder providing services licensed according to this chapter in a
supervised living facility is exempt from compliance with sections 245D.04; 245D.05,
subdivision 2; and 245D.06, subdivision 2, clauses (1), (4), and (5).
 new text end

new text begin (e) A license holder providing residential services to persons in an ICF/DD is exempt
from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision
2, clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09,
subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.
 new text end

deleted text begin (c)deleted text end new text begin (f)new text end A license holder deleted text begin concurrentlydeleted text end providing deleted text begin home caredeleted text end new text begin homemakernew text end services
deleted text begin registereddeleted text end new text begin licensednew text end according to deleted text begin sections 144A.43 to 144A.49 to the same person receiving
home management services licensed underdeleted text end this chapter new text begin and registered according to chapter
144A new text end is exempt from new text begin compliance with new text end section 245D.04 deleted text begin as it applies to the persondeleted text end .

deleted text begin (d) A license holder identified in subdivision 1, clauses (1), (5), and (9), is exempt
from compliance with sections 245A.65, subdivision 2, paragraph (a), and 626.557,
subdivision 14, paragraph (b).
 deleted text end

deleted text begin (e) Notwithstanding section 245D.06, subdivision 5, a license holder providing
structured day, prevocational, or supported employment services under this chapter
and day training and habilitation or supported employment services licensed under
chapter 245B within the same program is exempt from compliance with this chapter
when the license holder notifies the commissioner in writing that the requirements under
chapter 245B will be met for all persons receiving these services from the program. For
the purposes of this paragraph, if the license holder has obtained approval from the
commissioner for an alternative inspection status according to section 245B.031, that
approval will apply to all persons receiving services in the program.
 deleted text end

new text begin (g) Nothing in this chapter prohibits a license holder from concurrently serving
persons without disabilities or people who are or are not age 65 and older, provided this
chapter's standards are met as well as other relevant standards.
 new text end

new text begin (h) The documentation required under sections 245D.07 and 245D.071 must meet
the individual program plan requirements identified in section 256B.092 or successor
provisions.
 new text end

Subd. 3.

Variance.

If the conditions in section 245A.04, subdivision 9, are met,
the commissioner may grant a variance to any of the requirements in this chapter, except
sections 245D.04, deleted text begin and 245D.10, subdivision 4, paragraph (b)deleted text end new text begin 245D.06, subdivision 4,
paragraph (b), and 245D.061, subdivision 3new text end , or provisions governing data practices and
information rights of persons.

deleted text begin Subd. 4. deleted text end

deleted text begin License holders with multiple 245D licenses. deleted text end

deleted text begin (a) When a person changes
service from one license to a different license held by the same license holder, the license
holder is exempt from the requirements in section 245D.10, subdivision 4, paragraph (b).
 deleted text end

deleted text begin (b) When a staff person begins providing direct service under one or more licenses
held by the same license holder, other than the license for which staff orientation was
initially provided according to section 245D.09, subdivision 4, the license holder is
exempt from those staff orientation requirements, except the staff person must review each
person's service plan and medication administration procedures in accordance with section
245D.09, subdivision 4, paragraph (c), if not previously reviewed by the staff person.
 deleted text end

new text begin Subd. 5. new text end

new text begin Program certification. new text end

new text begin An applicant or a license holder may apply for
program certification as identified in section 245D.33.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 19.

Minnesota Statutes 2012, section 245D.04, is amended to read:


245D.04 SERVICE RECIPIENT RIGHTS.

Subdivision 1.

License holder responsibility for individual rights of persons
served by the program.

The license holder must:

(1) provide each person or each person's legal representative with a written notice
that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of
those rights within five working days of service initiation and annually thereafter;

(2) make reasonable accommodations to provide this information in other formats
or languages as needed to facilitate understanding of the rights by the person and the
person's legal representative, if any;

(3) maintain documentation of the person's or the person's legal representative's
receipt of a copy and an explanation of the rights; and

(4) ensure the exercise and protection of the person's rights in the services provided
by the license holder and as authorized in the new text begin coordinated new text end service new text begin and support new text end plan.

Subd. 2.

Service-related rights.

A person's service-related rights include the right to:

(1) participate in the development and evaluation of the services provided to the
person;

(2) have services new text begin and supports new text end identified in the new text begin coordinated new text end service new text begin and support new text end plan
new text begin and the coordinated service and support plan addendum new text end provided in a manner that respects
and takes into consideration the person's preferencesnew text begin according to the requirements in
sections 245D.07 and 245D.071new text end ;

(3) refuse or terminate services and be informed of the consequences of refusing
or terminating services;

(4) know, in advance, limits to the services available from the license holdernew text begin ,
including the license holder's knowledge, skill, and ability to meet the person's service and
support needs based on the information required in section 245D.031, subdivision 2new text end ;

(5) know conditions and terms governing the provision of services, including the
license holder's new text begin admission criteria and new text end policies and procedures related to temporary
service suspension and service termination;

(6) new text begin a coordinated transfer to ensure continuity of care when there will be a change
in the provider;
new text end

new text begin (7) new text end know what the charges are for services, regardless of who will be paying for the
services, and be notified of changes in those charges;

deleted text begin (7)deleted text end new text begin (8)new text end know, in advance, whether services are covered by insurance, government
funding, or other sources, and be told of any charges the person or other private party
may have to pay; and

deleted text begin (8)deleted text end new text begin (9)new text end receive services from an individual who is competent and trained, who has
professional certification or licensure, as required, and who meets additional qualifications
identified in the person's new text begin coordinated new text end service new text begin and support new text end plandeleted text begin .deleted text end new text begin or coordinated service and
support plan addendum.
new text end

Subd. 3.

Protection-related rights.

(a) A person's protection-related rights include
the right to:

(1) have personal, financial, service, health, and medical information kept private,
and be advised of disclosure of this information by the license holder;

(2) access records and recorded information about the person in accordance with
applicable state and federal law, regulation, or rule;

(3) be free from maltreatment;

(4) be free from restraintnew text begin , time out,new text end or seclusion deleted text begin used for a purpose other thandeleted text end new text begin except
for emergency use of manual restraintnew text end to protect the person from imminent danger to self
or othersnew text begin according to the requirements in section 245D.06new text end ;

(5) receive services in a clean and safe environment when the license holder is the
owner, lessor, or tenant of the service site;

(6) be treated with courtesy and respect and receive respectful treatment of the
person's property;

(7) reasonable observance of cultural and ethnic practice and religion;

(8) be free from bias and harassment regarding race, gender, age, disability,
spirituality, and sexual orientation;

(9) be informed of and use the license holder's grievance policy and procedures,
including knowing how to contact persons responsible for addressing problems and to
appeal under section 256.045;

(10) know the name, telephone number, and the Web site, e-mail, and street
addresses of protection and advocacy services, including the appropriate state-appointed
ombudsman, and a brief description of how to file a complaint with these offices;

(11) assert these rights personally, or have them asserted by the person's family,
authorized representative, or legal representative, without retaliation;

(12) give or withhold written informed consent to participate in any research or
experimental treatment;

(13) associate with other persons of the person's choice;

(14) personal privacy; and

(15) engage in chosen activities.

(b) For a person residing in a residential site licensed according to chapter 245A,
or where the license holder is the owner, lessor, or tenant of the residential service site,
protection-related rights also include the right to:

(1) have daily, private access to and use of a non-coin-operated telephone for local
calls and long-distance calls made collect or paid for by the person;

(2) receive and send, without interference, uncensored, unopened mail or electronic
correspondence or communication; deleted text begin and
deleted text end

(3) new text begin have use of and free access to common areas in the residence; and
new text end

new text begin (4) new text end privacy for visits with the person's spouse, next of kin, legal counsel, religious
advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
privacy in the person's bedroom.

(c) Restriction of a person's rights under new text begin subdivision 2, clause (10), or new text end paragraph (a),
clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure
the health, safety, and well-being of the person. Any restriction of those rights must be
documented in the new text begin person's coordinated new text end service new text begin and support new text end plan deleted text begin for the person anddeleted text end new text begin or
coordinated service and support plan addendum. The restriction must be implemented
in the least restrictive alternative manner necessary to protect the person and provide
support to reduce or eliminate the need for the restriction in the most integrated setting
and inclusive manner. The documentationnew text end must include the following information:

(1) the justification for the restriction based on an assessment of the person's
vulnerability related to exercising the right without restriction;

(2) the objective measures set as conditions for ending the restriction;

(3) a schedule for reviewing the need for the restriction based on the conditions for
ending the restriction to occurdeleted text begin , at a minimum, every three months for persons who do not
have a legal representative and annually for persons who do have a legal representative
deleted text end new text begin semiannually new text end from the date of initial approvalnew text begin , at a minimum, or more frequently if
requested by the person, the person's legal representative, if any, and case managernew text end ; and

(4) signed and dated approval for the restriction from the person, or the person's
legal representative, if any. A restriction may be implemented only when the required
approval has been obtained. Approval may be withdrawn at any time. If approval is
withdrawn, the right must be immediately and fully restored.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 20.

Minnesota Statutes 2012, section 245D.05, is amended to read:


245D.05 HEALTH SERVICES.

Subdivision 1.

Health needs.

(a) The license holder is responsible for deleted text begin providing
deleted text end new text begin meetingnew text end health deleted text begin servicesdeleted text end new text begin service needsnew text end assigned in the new text begin coordinated new text end service new text begin and support new text end plan
deleted text begin anddeleted text end new text begin or the coordinated service and support plan addendum, new text end consistent with the person's
health needs. The license holder is responsible for promptly notifying deleted text begin the person or
deleted text end the person's legal representativenew text begin , if any,new text end and the case manager of changes in a person's
physical and mental health needs affecting deleted text begin assigneddeleted text end health deleted text begin servicesdeleted text end new text begin service needs assigned
to the license holder in the coordinated service and support plan or the coordinated service
and support plan addendumnew text end , when discovered by the license holder, unless the license
holder has reason to know the change has already been reported. The license holder
must document when the notice is provided.

(b) deleted text begin When assigned in the service plan,deleted text end new text begin If responsibility for meeting the person's
health service needs has been assigned to the license holder in the coordinated service and
support plan or the coordinated service and support plan addendum,new text end the license holder deleted text begin is
required todeleted text end new text begin mustnew text end maintain documentation on how the person's health needs will be met,
including a description of the procedures the license holder will follow in order to:

(1) provide medication deleted text begin administration,deleted text end new text begin assistance or new text end medication deleted text begin assistance, or
medication managementdeleted text end new text begin administrationnew text end according to this chapter;

(2) monitor health conditions according to written instructions from deleted text begin the person's
physician odeleted text end r a licensed health professional;

(3) assist with or coordinate medical, dental, and other health service appointments; or

(4) use medical equipment, devices, or adaptive aides or technology safely and
correctly according to written instructions from deleted text begin the person's physician ordeleted text end a licensed
health professional.

new text begin Subd. 1a. new text end

new text begin Medication setup. new text end

new text begin For the purposes of this subdivision, "medication
setup" means the arranging of medications according to instructions from the pharmacy,
the prescriber, or a licensed nurse, for later administration when the license holder
is assigned responsibility for medication assistance or medication administration in
the coordinated service and support plan or the coordinated service and support plan
addendum. A prescription label or the prescriber's written or electronically recorded order
for the prescription is sufficient to constitute written instructions from the prescriber. The
license holder must document in the person's medication administration record: dates
of setup, name of medication, quantity of dose, times to be administered, and route of
administration at time of setup; and, when the person will be away from home, to whom
the medications were given.
 new text end

new text begin Subd. 1b. new text end

new text begin Medication assistance. new text end

new text begin If responsibility for medication assistance
is assigned to the license holder in the coordinated service and support plan or the
coordinated service and support plan addendum, the license holder must ensure that
the requirements of subdivision 2, paragraph (b), have been met when staff provides
medication assistance to enable a person to self-administer medication or treatment when
the person is capable of directing the person's own care, or when the person's legal
representative is present and able to direct care for the person. For the purposes of this
subdivision, "medication assistance" means any of the following:
 new text end

new text begin (1) bringing to the person and opening a container of previously set up medications,
emptying the container into the person's hand, or opening and giving the medications in
the original container to the person;
 new text end

new text begin (2) bringing to the person liquids or food to accompany the medication; or
 new text end

new text begin (3) providing reminders to take regularly scheduled medication or perform regularly
scheduled treatments and exercises.
 new text end

Subd. 2.

Medication administration.

(a) new text begin If responsibility for medication
administration is assigned to the license holder in the coordinated service and support plan
or the coordinated service and support plan addendum, the license holder must implement
the following medication administration procedures to ensure a person takes medications
and treatments as prescribed:
new text end

new text begin (1) checking the person's medication record;
 new text end

new text begin (2) preparing the medication as necessary;
 new text end

new text begin (3) administering the medication or treatment to the person;
 new text end

new text begin (4) documenting the administration of the medication or treatment or the reason for
not administering the medication or treatment; and
 new text end

new text begin (5) reporting to the prescriber or a nurse any concerns about the medication or
treatment, including side effects, effectiveness, or a pattern of the person refusing to
take the medication or treatment as prescribed. Adverse reactions must be immediately
reported to the prescriber or a nurse.
 new text end

new text begin (b)(1) new text end The license holder must ensure that the deleted text begin following criteriadeleted text end new text begin requirements in
clauses (2) to (4)new text end have been met before deleted text begin staff that is not a licensed health professional
administersdeleted text end new text begin administering new text end medication or treatmentdeleted text begin :deleted text end new text begin .
new text end

deleted text begin (1)deleted text end new text begin (2) The license holder must obtainnew text end written authorization deleted text begin has been obtaineddeleted text end from
the person or the person's legal representative to administer medication or treatment
deleted text begin orders;deleted text end new text begin and must obtain reauthorization annually as needed. If the person or the person's
legal representative refuses to authorize the license holder to administer medication, the
medication must not be administered. The refusal to authorize medication administration
must be reported to the prescriber as expediently as possible.
new text end

deleted text begin (2)deleted text end new text begin (3)new text end The staff person deleted text begin has completeddeleted text end new text begin responsible for administering the medication
or treatment must completenew text end medication administration training according to section
245D.09, subdivision deleted text begin 4deleted text end deleted text begin , paragraphdeleted text end new text begin 4a, paragraphs (a) andnew text end (c), deleted text begin clause (2);deleted text end andnew text begin , as applicable
to the person, paragraph (d).
new text end

deleted text begin (3) The medication or treatment will be administered under administration
procedures established for the person in consultation with a licensed health professional.
written instruction from the person's physician may constitute the medication
administration procedures. A prescription label or the prescriber's order for the
prescription is sufficient to constitute written instructions from the prescriber. A licensed
health professional may delegate medication administration procedures.
 deleted text end

new text begin (4) For a license holder providing intensive support services, the medication or
treatment must be administered according to the license holder's medication administration
policy and procedures as required under section 245D.11, subdivision 2, clause (3).
 new text end

deleted text begin (b)deleted text end new text begin (c)new text end The license holder must ensure the following information is documented in
the person's medication administration record:

(1) the information on the new text begin current new text end prescription label or the prescriber's new text begin current written
or electronically recorded new text end order new text begin or prescription new text end that includes deleted text begin directions fordeleted text end new text begin the person's
name, description of the medication or treatment to be provided, and the frequency and
other information needed tonew text end safely and correctly deleted text begin administeringdeleted text end new text begin administernew text end the medication
new text begin or treatment new text end to ensure effectiveness;

(2) information on any deleted text begin discomforts,deleted text end risksdeleted text begin ,deleted text end or other side effects that are reasonable to
expect, and any contraindications to its usenew text begin . This information must be readily available
to all staff administering the medicationnew text end ;

(3) the possible consequences if the medication or treatment is not taken or
administered as directed;

(4) instruction deleted text begin from the prescriberdeleted text end on when and to whom to report the following:

(i) if deleted text begin thedeleted text end new text begin a dose ofnew text end medication deleted text begin or treatmentdeleted text end is not administered new text begin or treatment is not
performed new text end as prescribed, whether by error by the staff or the person or by refusal by
the person; and

(ii) the occurrence of possible adverse reactions to the medication or treatment;

(5) notation of any occurrence of new text begin a dose of new text end medication not being administered new text begin or
treatment not performed new text end as prescribednew text begin , whether by error by the staff or the person or by
refusal by the person,new text end or of adverse reactions, and when and to whom the report was
made; and

(6) notation of when a medication or treatment is started, new text begin administered, new text end changed, or
discontinued.

deleted text begin (c) The license holder must ensure that the information maintained in the medication
administration record is current and is regularly reviewed with the person or the person's
legal representative and the staff administering the medication to identify medication
administration issues or errors. At a minimum, the review must be conducted every three
months or more often if requested by the person or the person's legal representative.
Based on the review, the license holder must develop and implement a plan to correct
medication administration issues or errors. If issues or concerns are identified related to
the medication itself, the license holder must report those as required under subdivision 4.
 deleted text end

deleted text begin Subd. 3. deleted text end

deleted text begin Medication assistance. deleted text end

deleted text begin The license holder must ensure that the
requirements of subdivision 2, paragraph (a), have been met when staff provides assistance
to enable a person to self-administer medication when the person is capable of directing
the person's own care, or when the person's legal representative is present and able to
direct care for the person.
 deleted text end

Subd. 4.

new text begin Reviewing and new text end reporting medication and treatment issues.

deleted text begin The
following medication administration issues must be reported to the person or the person's
legal representative and case manager as they occur or following timelines established
in the person's service plan or as requested in writing by the person or the person's legal
representative, or the case manager: deleted text end new text begin (a) When assigned responsibility for medication
administration, the license holder must ensure that the information maintained in
the medication administration record is current and is regularly reviewed to identify
medication administration errors. At a minimum, the review must be conducted every
three months, or more frequently as directed in the coordinated service and support plan
or coordinated service and support plan addendum or as requested by the person or the
person's legal representative. Based on the review, the license holder must develop and
implement a plan to correct patterns of medication administration errors when identified.
 new text end

new text begin (b) If assigned responsibility for medication assistance or medication administration,
the license holder must report the following to the person's legal representative and case
manager as they occur or as otherwise directed in the coordinated service and support plan
or the coordinated service and support plan addendum:
 new text end

(1) any reports made to the person's physician or prescriber required under
subdivision 2, paragraph deleted text begin (b)deleted text end new text begin (c)new text end , clause (4);

(2) a person's refusal or failure to take new text begin or receive new text end medication or treatment as
prescribed; or

(3) concerns about a person's self-administration of medicationnew text begin or treatmentnew text end .

Subd. 5.

Injectable medications.

Injectable medications may be administered
according to a prescriber's order and written instructions when one of the following
conditions has been met:

(1) a registered nurse or licensed practical nurse will administer the subcutaneous or
intramuscular injection;

(2) a supervising registered nurse with a physician's order has delegated the
administration of subcutaneous injectable medication to an unlicensed staff member
and has provided the necessary training; or

(3) there is an agreement signed by the license holder, the prescriber, and the
person or the person's legal representative specifying what subcutaneous injections may
be given, when, how, and that the prescriber must retain responsibility for the license
holder's giving the injections. A copy of the agreement must be placed in the person's
service recipient record.

Only licensed health professionals are allowed to administer psychotropic
medications by injection.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 21.

new text begin [245D.051] PSYCHOTROPIC MEDICATION USE AND
MONITORING.
 new text end

new text begin Subdivision 1. new text end

new text begin Conditions for psychotropic medication administration. new text end

new text begin (a)
When a person is prescribed a psychotropic medication and the license holder is assigned
responsibility for administration of the medication in the person's coordinated service
and support plan or the coordinated service and support plan addendum, the license
holder must ensure that the requirements in paragraphs (b) to (d) and section 245D.05,
subdivision 2, are met.
 new text end

new text begin (b) Use of the medication must be included in the person's coordinated service and
support plan or in the coordinated service and support plan addendum and based on a
prescriber's current written or electronically recorded prescription.
 new text end

new text begin (c) The license holder must develop, implement, and maintain the following
documentation in the person's coordinated service and support plan addendum according
to the requirements in sections 245D.07 and 245D.071:
 new text end

new text begin (1) a description of the target symptoms that the psychotropic medication is to
alleviate; and
 new text end

new text begin (2) documentation methods the license holder will use to monitor and measure
changes in the target symptoms that are to be alleviated by the psychotropic medication if
required by the prescriber. The license holder must collect and report on medication and
symptom-related data as instructed by the prescriber. The license holder must provide
the monitoring data to the expanded support team for review every three months, or as
otherwise requested by the person or the person's legal representative.
 new text end

new text begin For the purposes of this section, "target symptom" refers to any perceptible
diagnostic criteria for a person's diagnosed mental disorder as defined by the Diagnostic
and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
successive editions that has been identified for alleviation.
 new text end

new text begin (d) If a person is prescribed a psychotropic medication, monitoring the use of the
psychotropic medication must be assigned to the license holder in the coordinated service
and support plan or the coordinated service and support plan addendum. The assigned
license holder must monitor the psychotropic medication as required by this section.
 new text end

new text begin Subd. 2. new text end

new text begin Refusal to authorize psychotropic medication. new text end

new text begin If the person or the
person's legal representative refuses to authorize the administration of a psychotropic
medication as ordered by the prescriber, the license holder must follow the requirement
in section 245D.05, subdivision 2, paragraph (b), clause (2). After reporting the refusal
to the prescriber, the license holder must follow any directives or orders given by the
prescriber. A court order must be obtained to override the refusal. Refusal to authorize
administration of a specific psychotropic medication is not grounds for service termination
and does not constitute an emergency. A decision to terminate services must be reached in
compliance with section 245D.10, subdivision 3.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 22.

Minnesota Statutes 2012, section 245D.06, is amended to read:


245D.06 PROTECTION STANDARDS.

Subdivision 1.

Incident response and reporting.

(a) The license holder must
respond to deleted text begin alldeleted text end incidents under section 245D.02, subdivision 11, that occur while providing
services to protect the health and safety of and minimize risk of harm to the person.

(b) The license holder must maintain information about and report incidents to the
person's legal representative or designated emergency contact and case manager within 24
hours of an incident occurring while services are being provided, deleted text begin ordeleted text end within 24 hours of
discovery or receipt of information that an incident occurred, unless the license holder
has reason to know that the incident has already been reportednew text begin , or as otherwise directed
in a person's coordinated service and support plan or coordinated service and support
plan addendumnew text end . An incident of suspected or alleged maltreatment must be reported as
required under paragraph (d), and an incident of serious injury or death must be reported
as required under paragraph (e).

(c) When the incident involves more than one person, the license holder must not
disclose personally identifiable information about any other person when making the report
to each person and case manager unless the license holder has the consent of the person.

(d) Within 24 hours of reporting maltreatment as required under section 626.556
or 626.557, the license holder must inform the case manager of the report unless there is
reason to believe that the case manager is involved in the suspected maltreatment. The
license holder must disclose the nature of the activity or occurrence reported and the
agency that received the report.

(e) The license holder must report the death or serious injury of the person deleted text begin to the legal
representative, if any, and case manager,deleted text end new text begin as required in paragraph (b) and to new text end the Department
of Human Services Licensing Division, and the Office of Ombudsman for Mental Health
and Developmental Disabilities as required under section 245.94, subdivision 2a, within
24 hours of the death, or receipt of information that the death occurred, unless the license
holder has reason to know that the death has already been reported.

new text begin (f) When a death or serious injury occurs in a facility certified as an intermediate
care facility for persons with developmental disabilities, the death or serious injury must
be reported to the Department of Health, Office of Health Facility Complaints, and the
Office of Ombudsman for Mental Health and Developmental Disabilities, as required
under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
know that the death has already been reported.
 new text end

deleted text begin (f)deleted text end new text begin (g)new text end The license holder must conduct deleted text begin adeleted text end new text begin an internalnew text end review of incident reportsnew text begin of
deaths and serious injuries that occurred while services were being provided and that
were not reported by the program as alleged or suspected maltreatmentnew text end , for identification
of incident patterns, and implementation of corrective action as necessary to reduce
occurrences.new text begin The review must include an evaluation of whether related policies and
procedures were followed, whether the policies and procedures were adequate, whether
there is a need for additional staff training, whether the reported event is similar to past
events with the persons or the services involved, and whether there is a need for corrective
action by the license holder to protect the health and safety of persons receiving services.
Based on the results of this review, the license holder must develop, document, and
implement a corrective action plan designed to correct current lapses and prevent future
lapses in performance by staff or the license holder, if any.
new text end

new text begin (h) The license holder must verbally report the emergency use of manual restraint of
a person as required in paragraph (b), within 24 hours of the occurrence. The license holder
must ensure the written report and internal review of all incident reports of the emergency
use of manual restraints are completed according to the requirements in section 245D.061.
 new text end

Subd. 2.

Environment and safety.

The license holder must:

(1) ensure the following when the license holder is the owner, lessor, or tenant
of deleted text begin thedeleted text end new text begin an unlicensednew text end service site:

(i) the service site is a safe and hazard-free environment;

(ii) deleted text begin doors are locked ordeleted text end toxic substances or dangerous items deleted text begin normally accessibledeleted text end new text begin are
inaccessiblenew text end to persons served by the program deleted text begin are stored in locked cabinets, drawers, or
containersdeleted text end only to protect the safety of a person receiving services and not as a substitute
for staff supervision or interactions with a person who is receiving services. If deleted text begin doors are
locked ordeleted text end toxic substances or dangerous items deleted text begin normally accessible to persons served by the
program are stored in locked cabinets, drawers, or containersdeleted text end new text begin are made inaccessiblenew text end , the
license holder must deleted text begin justify and document how this determination was made in consultation
with the person or person's legal representative, and how access will otherwise be provided
to the person and all other affected persons receiving services; anddeleted text end new text begin document an assessment
of the physical plant, its environment, and its population identifying the risk factors which
require toxic substances or dangerous items to be inaccessible and a statement of specific
measures to be taken to minimize the safety risk to persons receiving services;
new text end

new text begin (iii) doors are locked from the inside to prevent a person from exiting only when
necessary to protect the safety of a person receiving services and not as a substitute for
staff supervision or interactions with the person. If doors are locked from the inside, the
license holder must document an assessment of the physical plant, the environment and
the population served, identifying the risk factors which require the use of locked doors,
and a statement of specific measures to be taken to minimize the safety risk to persons
receiving services at the service site; and
 new text end

deleted text begin (iii)deleted text end new text begin (iv)new text end a staff person is available on site who is trained in basic first aidnew text begin and, when
required in a person's coordinated service and support plan or coordinated service and
support plan addendum, cardiopulmonary resuscitation,new text end whenever persons are present and
staff are required to be at the site to provide direct servicenew text begin . The training must include
in-person instruction, hands-on practice, and an observed skills assessment under the
direct supervision of a first aid instructornew text end ;

(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
license holder in good condition when used to provide services;

(3) follow procedures to ensure safe transportation, handling, and transfers of the
person and any equipment used by the person, when the license holder is responsible for
transportation of a person or a person's equipment;

(4) be prepared for emergencies and follow emergency response procedures to
ensure the person's safety in an emergency; and

(5) follow new text begin universal precautions and new text end sanitary practicesnew text begin , including hand washing,new text end for
infection new text begin prevention and new text end controlnew text begin ,new text end and to prevent communicable diseases.

deleted text begin Subd. 3. deleted text end

deleted text begin Compliance with fire and safety codes. deleted text end

deleted text begin When services are provided at deleted text end deleted text begin a
 deleted text end deleted text begin service site deleted text end deleted text begin licensed according to chapter 245A or deleted text end deleted text begin where the license deleted text end deleted text begin holder is the owner,
lessor, or tenant of the service site, the license holder must document deleted text end deleted text begin compliance with
applicable building codes, fire and safety codes, health rules, and zoning deleted text end deleted text begin ordinances, or
document that an appropriate waiver has been granted.
 deleted text end

Subd. 4.

Funds and property.

(a) Whenever the license holder assists a person
with the safekeeping of funds or other property according to section 245A.04, subdivision
13, the license holder must deleted text begin havedeleted text end new text begin obtainnew text end written authorization to do so from the person new text begin or
the person's legal representative new text end and the case manager.new text begin Authorization must be obtained
within five working days of service initiation and renewed annually thereafter. At the time
initial authorization is obtained, the license holder must survey, document, and implement
the preferences of the person or the person's legal representative and the case manager
for frequency of receiving a statement that itemizes receipts and disbursements of funds
or other property. The license holder must document changes to these preferences when
they are requested.
new text end

(b) A license holder or staff person may not accept powers-of-attorney from a
person receiving services from the license holder for any purposedeleted text begin , and may not accept an
appointment as guardian or conservator of a person receiving services from the license
holderdeleted text end . This does not apply to license holders that are Minnesota counties or other
units of government or to staff persons employed by license holders who were acting
as deleted text begin power-of-attorney, guardian, or conservatordeleted text end new text begin attorney-in-factnew text end for specific individuals
prior to deleted text begin April 23, 2012deleted text end new text begin implementation of this chapternew text end . The license holder must maintain
documentation of the power-of-attorneydeleted text begin , guardianship, or conservatorshipdeleted text end in the service
recipient record.

new text begin (c) Upon the transfer or death of a person, any funds or other property of the person
must be surrendered to the person or the person's legal representative, or given to the
executor or administrator of the estate in exchange for an itemized receipt.
 new text end

Subd. 5.

Prohibitions.

(a) The license holder is prohibited from using deleted text begin psychotropic
medicationdeleted text end new text begin chemical restraints, mechanical restraint practices, manual restraints, time out,
or seclusionnew text end as a substitute for adequate staffingnew text begin , for a behavioral or therapeutic program
to reduce or eliminate behaviornew text end , as punishment, new text begin or new text end for staff conveniencedeleted text begin , or for any reason
other than as prescribeddeleted text end .

deleted text begin (b) The license holder is prohibited from using restraints or seclusion under any
circumstance, unless the commissioner has approved a variance request from the license
holder that allows for the emergency use of restraints and seclusion according to terms
and conditions approved in the variance. Applicants and license holders who have
reason to believe they may be serving an individual who will need emergency use of
restraints or seclusion may request a variance on the application or reapplication, and
the commissioner shall automatically review the request for a variance as part of the
application or reapplication process. License holders may also request the variance any
time after issuance of a license. In the event a license holder uses restraint or seclusion for
any reason without first obtaining a variance as required, the license holder must report
the unauthorized use of restraint or seclusion to the commissioner within 24 hours of the
occurrence and request the required variance.
 deleted text end

new text begin (b) For the purposes of this subdivision, "chemical restraint" means the
administration of a drug or medication to control the person's behavior or restrict the
person's freedom of movement and is not a standard treatment of dosage for the person's
medical or psychological condition.
 new text end

new text begin (c) For the purposes of this subdivision, "mechanical restraint practice" means the
use of any adaptive equipment or safety device to control the person's behavior or restrict
the person's freedom of movement and not as ordered by a licensed health professional.
Mechanical restraint practices include, but are not limited to, the use of bed rails or similar
devices on a bed to prevent the person from getting out of bed, chairs that prevent a person
from rising, or placing a person in a wheelchair so close to a wall that the wall prevents
the person from rising. Wrist bands or devices on clothing that trigger electronic alarms to
warn staff that a person is leaving a room or area do not, in and of themselves, restrict
freedom of movement and should not be considered restraints.
 new text end

new text begin (d) A license holder must not use manual restraints, time out, or seclusion under any
circumstance, except for emergency use of manual restraints according to the requirements
in section 245D.061 or the use of controlled procedures with a person with a developmental
disability as governed by Minnesota Rules, parts 9525.2700 to 9525.2810, or its successor
provisions. License holders implementing nonemergency use of manual restraint, or any
other programmatic use of mechanical restraint, time out, or seclusion with persons who
do not have a developmental disability that is not subject to the requirements of Minnesota
Rules, parts 9525.2700 to 9525.2810, must submit a variance request to the commissioner
for continued use of the procedure within three months of implementation of this chapter.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 23.

new text begin [245D.061] EMERGENCY USE OF MANUAL RESTRAINTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Standards for emergency use of manual restraints. new text end

new text begin Except
for the emergency use of controlled procedures with a person with a developmental
disability as governed by Minnesota Rules, part 9525.2770, or its successor provisions,
the license holder must ensure that emergency use of manual restraints complies with the
requirements of this chapter and the license holder's policy and procedures as required
under subdivision 10.
 new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) The terms used in this section have the meaning given
them in this subdivision.
 new text end

new text begin (b) "Manual restraint" means physical intervention intended to hold a person
immobile or limit a person's voluntary movement by using body contact as the only source
of physical restraint.
 new text end

new text begin (c) "Mechanical restraint" means the use of devices, materials, or equipment attached
or adjacent to the person's body, or the use of practices which restrict freedom of movement
or normal access to one's body or body parts, or limits a person's voluntary movement
or holds a person immobile as an intervention precipitated by a person's behavior. The
term does apply to mechanical restraint used to prevent injury with persons who engage in
self-injurious behaviors, such as head-banging, gouging, or other actions resulting in tissue
damage that have caused or could cause medical problems resulting from the self-injury.
 new text end

new text begin Subd. 3. new text end

new text begin Conditions for emergency use of manual restraint. new text end

new text begin Emergency use of
manual restraint must meet the following conditions:
 new text end

new text begin (1) immediate intervention must be needed to protect the person or others from
imminent risk of physical harm; and
 new text end

new text begin (2) the type of manual restraint used must be the least restrictive intervention to
eliminate the immediate risk of harm and effectively achieve safety. The manual restraint
must end when the threat of harm ends.
 new text end

new text begin Subd. 4. new text end

new text begin Permitted instructional techniques and therapeutic conduct. new text end

new text begin (a) Use of
physical contact as therapeutic conduct or as an instructional technique as identified in
paragraphs (b) and (c), is permitted and is not subject to the requirements of this section
when such use is addressed in a person's coordinated service and support plan addendum
and the required conditions have been met. For the purposes of this subdivision,
"therapeutic conduct" has the meaning given in section 626.5572, subdivision 20.
 new text end

new text begin (b) Physical contact or instructional techniques must use the least restrictive
alternative possible to meet the needs of the person and may be used:
 new text end

new text begin (1) to calm or comfort a person by holding that person with no resistance from
that person;
new text end

new text begin (2) to protect a person known to be at risk of injury due to frequent falls as a result of
a medical condition; or
 new text end

new text begin (3) to position a person with physical disabilities in a manner specified in the
person's coordinated service and support plan addendum.
 new text end

new text begin (c) Restraint may be used as therapeutic conduct:
 new text end

new text begin (1) to allow a licensed health care professional to safely conduct a medical
examination or to provide medical treatment ordered by a licensed health care professional
to a person necessary to promote healing or recovery from an acute, meaning short-term,
medical condition;
 new text end

new text begin (2) to facilitate the person's completion of a task or response when the person does
not resist or the person's resistance is minimal in intensity and duration;
 new text end

new text begin (3) to briefly block or redirect a person's limbs or body without holding the person
or limiting the person's movement to interrupt the person's behavior that may result in
injury to self or others; or
 new text end

new text begin (4) to assist in the safe evacuation of a person in the event of an emergency or to
redirect a person who is at imminent risk of harm in a dangerous situation.
 new text end

new text begin (d) A plan for using restraint as therapeutic conduct must be developed according to
the requirements in sections 245D.07 and 245D.071, and must include methods to reduce
or eliminate the use of and need for restraint.
 new text end

new text begin Subd. 5. new text end

new text begin Restrictions when implementing emergency use of manual restraint.
 new text end

new text begin (a) Emergency use of manual restraint procedures must not:
 new text end

new text begin (1) be implemented with a child in a manner that constitutes sexual abuse, neglect,
physical abuse, or mental injury, as defined in section 626.556, subdivision 2;
 new text end

new text begin (2) be implemented with an adult in a manner that constitutes abuse or neglect as
defined in section 626.5572, subdivisions 2 and 17;
 new text end

new text begin (3) be implemented in a manner that violates a person's rights and protections
identified in section 245D.04;
 new text end

new text begin (4) restrict a person's normal access to a nutritious diet, drinking water, adequate
ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping
conditions, or necessary clothing, or to any protection required by state licensing standards
and federal regulations governing the program;
 new text end

new text begin (5) deny the person visitation or ordinary contact with legal counsel, a legal
representative, or next of kin;
 new text end

new text begin (6) be used as a substitute for adequate staffing, for the convenience of staff, as
punishment, or as a consequence if the person refuses to participate in the treatment
or services provided by the program; or
 new text end

new text begin (7) use prone restraint. For the purposes of this section, "prone restraint" means use
of manual restraint that places a person in a face-down position. This does not include
brief physical holding of a person who, during an emergency use of manual restraint, rolls
into a prone position, and the person is restored to a standing, sitting, or side-lying position
as quickly as possible. Applying back or chest pressure while a person is in the prone or
supine position or face-up is prohibited.
 new text end

new text begin Subd. 6. new text end

new text begin Monitoring emergency use of manual restraint. new text end

new text begin The license holder shall
monitor a person's health and safety during an emergency use of a manual restraint. Staff
monitoring the procedure must not be the staff implementing the procedure when possible.
The license holder shall complete a monitoring form, approved by the commissioner, for
each incident involving the emergency use of a manual restraint.
 new text end

new text begin Subd. 7. new text end

new text begin Reporting emergency use of manual restraint incident. new text end

new text begin (a) Within
three calendar days after an emergency use of a manual restraint, the staff person who
implemented the emergency use must report in writing to the designated coordinator the
following information about the emergency use:
new text end

new text begin (1) the staff and persons receiving services who were involved in the incident
leading up to the emergency use of manual restraint;
 new text end

new text begin (2) a description of the physical and social environment, including who was present
before and during the incident leading up to the emergency use of manual restraint;
 new text end

new text begin (3) a description of what less restrictive alternative measures were attempted to
de-escalate the incident and maintain safety before the manual restraint was implemented
that identifies when, how, and how long the alternative measures were attempted before
manual restraint was implemented;
 new text end

new text begin (4) a description of the mental, physical, and emotional condition of the person who
was restrained, and other persons involved in the incident leading up to, during, and
following the manual restraint;
 new text end

new text begin (5) whether there was any injury to the person who was restrained or other persons
involved in the incident, including staff, before or as a result of the use of manual
restraint; and
 new text end

new text begin (6) whether there was an attempt to debrief with the staff, and, if not contraindicated,
with the person who was restrained and other persons who were involved in or who
witnessed the restraint, following the incident and the outcome of the debriefing. If the
debriefing was not conducted at the time the incident report was made, the report should
identify whether a debriefing is planned.
 new text end

new text begin (b) Each single incident of emergency use of manual restraint must be reported
separately. For the purposes of this subdivision, an incident of emergency use of manual
restraint is a single incident when the following conditions have been met:
 new text end

new text begin (1) after implementing the manual restraint, staff attempt to release the person at the
moment staff believe the person's conduct no longer poses an imminent risk of physical
harm to self or others and less restrictive strategies can be implemented to maintain safety;
 new text end

new text begin (2) upon the attempt to release the restraint, the person's behavior immediately
re-escalates; and
 new text end

new text begin (3) staff must immediately reimplement the restraint in order to maintain safety.
 new text end

new text begin Subd. 8. new text end

new text begin Internal review of emergency use of manual restraint. new text end

new text begin (a) Within five
working days of the emergency use of manual restraint, the license holder must complete
an internal review of each report of emergency use of manual restraint. The review must
include an evaluation of whether:
 new text end

new text begin (1) the person's service and support strategies developed according to sections
245D.07 and 245D.071 need to be revised;
 new text end

new text begin (2) related policies and procedures were followed;
 new text end

new text begin (3) the policies and procedures were adequate;
 new text end

new text begin (4) there is a need for additional staff training;
 new text end

new text begin (5) the reported event is similar to past events with the persons, staff, or the services
involved; and
 new text end

new text begin (6) there is a need for corrective action by the license holder to protect the health
and safety of persons.
 new text end

new text begin (b) Based on the results of the internal review, the license holder must develop,
document, and implement a corrective action plan for the program designed to correct
current lapses and prevent future lapses in performance by individuals or the license
holder, if any. The corrective action plan, if any, must be implemented within 30 days of
the internal review being completed.
 new text end

new text begin Subd. 9. new text end

new text begin Expanded support team review. new text end

new text begin (a) Within five working days after the
completion of the internal review required in subdivision 8, the license holder must consult
with the expanded support team following the emergency use of manual restraint to:
 new text end

new text begin (1) discuss the incident reported in subdivision 7, to define the antecedent or event
that gave rise to the behavior resulting in the manual restraint and identify the perceived
function the behavior served; and
 new text end

new text begin (2) determine whether the person's coordinated service and support plan addendum
needs to be revised according to sections 245D.07 and 245D.071 to positively and
effectively help the person maintain stability and to reduce or eliminate future occurrences
requiring emergency use of manual restraint.
 new text end

new text begin Subd. 10. new text end

new text begin Emergency use of manual restraints policy and procedures. new text end

new text begin The
license holder must develop, document, and implement a policy and procedures that
promote service recipient rights and protect health and safety during the emergency use of
manual restraints. The policy and procedures must comply with the requirements of this
section and must specify the following:
 new text end

new text begin (1) a description of the positive support strategies and techniques staff must use to
attempt to de-escalate a person's behavior before it poses an imminent risk of physical
harm to self or others;
 new text end

new text begin (2) a description of the types of manual restraints the license holder allows staff to
use on an emergency basis, if any. If the license holder will not allow the emergency use
of manual restraint, the policy and procedure must identify the alternative measures the
license holder will require staff to use when a person's conduct poses an imminent risk of
physical harm to self or others and less restrictive strategies would not achieve safety;
 new text end

new text begin (3) instructions for safe and correct implementation of the allowed manual restraint
procedures;
 new text end

new text begin (4) the training that staff must complete and the timelines for completion, before they
may implement an emergency use of manual restraint. In addition to the training on this
policy and procedure and the orientation and annual training required in section 245D.09,
subdivision 4, the training for emergency use of manual restraint must incorporate the
following subjects:
 new text end

new text begin (i) alternatives to manual restraint procedures, including techniques to identify
events and environmental factors that may escalate conduct that poses an imminent risk of
physical harm to self or others;
 new text end

new text begin (ii) de-escalation methods, positive support strategies, and how to avoid power
struggles;
 new text end

new text begin (iii) simulated experiences of administering and receiving manual restraint
procedures allowed by the license holder on an emergency basis;
 new text end

new text begin (iv) how to properly identify thresholds for implementing and ceasing restrictive
procedures;
 new text end

new text begin (v) how to recognize, monitor, and respond to the person's physical signs of distress,
including positional asphyxia;
new text end

new text begin (vi) the physiological and psychological impact on the person and the staff when
restrictive procedures are used;
 new text end

new text begin (vii) the communicative intent of behaviors; and
 new text end

new text begin (viii) relationship building;
 new text end

new text begin (5) the procedures and forms to be used to monitor the emergency use of manual
restraints, including what must be monitored and the frequency of monitoring per
each incident of emergency use of manual restraint, and the person or position who is
responsible for monitoring the use;
 new text end

new text begin (6) the instructions, forms, and timelines required for completing and submitting an
incident report by the person or persons who implemented the manual restraint; and
 new text end

new text begin (7) the procedures and timelines for conducting the internal review and the expanded
support team review, and the person or position responsible for completing the reviews and
who is responsible for ensuring that corrective action is taken or the person's coordinated
service and support plan addendum is revised, when determined necessary.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 24.

Minnesota Statutes 2012, section 245D.07, is amended to read:


245D.07 SERVICE deleted text begin NEEDSdeleted text end new text begin PLANNING AND DELIVERYnew text end .

Subdivision 1.

Provision of services.

The license holder must provide services as
deleted text begin specifieddeleted text end new text begin assignednew text end in thenew text begin coordinatednew text end servicenew text begin and supportnew text end plan deleted text begin and assigned to the license
holderdeleted text end . The provision of services must comply with the requirements of this chapter and
the federal waiver plans.

new text begin Subd. 1a. new text end

new text begin Person-centered planning and service delivery. new text end

new text begin (a) The license holder
must provide services in response to the person's identified needs, interests, preferences,
and desired outcomes as specified in the coordinated service and support plan, the
coordinated service and support plan addendum, and in compliance with the requirements
of this chapter. License holders providing intensive support services must also provide
outcome-based services according to the requirements in section 245D.071.
 new text end

new text begin (b) Services must be provided in a manner that supports the person's preferences,
daily needs, and activities and accomplishment of the person's personal goals and service
outcomes, consistent with the principles of:
 new text end

new text begin (1) person-centered service planning and delivery that:
 new text end

new text begin (i) identifies and supports what is important to the person as well as what is
important for the person, including preferences for when, how, and by whom direct
support service is provided;
 new text end

new text begin (ii) uses that information to identify outcomes the person desires; and
 new text end

new text begin (iii) respects each person's history, dignity, and cultural background;
 new text end

new text begin (2) self-determination that supports and provides:
 new text end

new text begin (i) opportunities for the development and exercise of functional and age-appropriate
skills, decision making and choice, personal advocacy, and communication; and
 new text end

new text begin (ii) the affirmation and protection of each person's civil and legal rights;
 new text end

new text begin (3) providing the most integrated setting and inclusive service delivery that supports,
promotes, and allows:
 new text end

new text begin (i) inclusion and participation in the person's community as desired by the person
in a manner that enables the person to interact with nondisabled persons to the fullest
extent possible and supports the person in developing and maintaining a role as a valued
community member;
 new text end

new text begin (ii) opportunities for self-sufficiency as well as developing and maintaining social
relationships and natural supports; and
 new text end

new text begin (iii) a balance between risk and opportunity, meaning the least restrictive supports or
interventions necessary are provided in the most integrated settings in the most inclusive
manner possible to support the person to engage in activities of the person's own choosing
that may otherwise present a risk to the person's health, safety, or rights.
 new text end

Subd. 2.

Service planning new text begin requirements for basic support servicesnew text end .

new text begin (a) License
holders providing basic support services must meet the requirements of this subdivision.
 new text end

new text begin (b) Within 15 days of service initiation the license holder must complete a
preliminary coordinated service and support plan addendum based on the coordinated
service and support plan.
 new text end

new text begin (c) Within 60 days of service initiation the license holder must review and revise as
needed the preliminary coordinated service and support plan addendum to document the
services that will be provided including how, when, and by whom services will be provided,
and the person responsible for overseeing the delivery and coordination of services.
 new text end

new text begin (d) new text end The license holder must participate in new text begin service planning and new text end support team
meetings deleted text begin related todeleted text end new text begin fornew text end the person following stated timelines established in the person's
new text begin coordinatednew text end servicenew text begin and supportnew text end plan or as requested by deleted text begin the support team,deleted text end the persondeleted text begin ,deleted text end or
the person's legal representativenew text begin , the support team or the expanded support teamnew text end .

Subd. 3.

Reports.

The license holder must provide written reports regarding the
person's progress or status as requested by the person, the person's legal representative, the
case manager, or the team.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 25.

new text begin [245D.071] SERVICE PLANNING AND DELIVERY; INTENSIVE
SUPPORT SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Requirements for intensive support services. new text end

new text begin A license holder
providing intensive support services identified in section 245D.03, subdivision 1,
paragraph (c), must comply with the requirements in section 245D.07, subdivisions 1
and 3, and this section.
 new text end

new text begin Subd. 2. new text end

new text begin Abuse prevention. new text end

new text begin Prior to or upon initiating services, the license holder
must develop, document, and implement an abuse prevention plan according to section
245A.65, subdivision 2.
 new text end

new text begin Subd. 3. new text end

new text begin Assessment and initial service planning. new text end

new text begin (a) Within 15 days of service
initiation the license holder must complete a preliminary coordinated service and support
plan addendum based on the coordinated service and support plan.
 new text end

new text begin (b) Within 45 days of service initiation the license holder must meet with the person,
the person's legal representative, the case manager, and other members of the support team
or expanded support team to assess and determine the following based on the person's
coordinated service and support plan and the requirements in subdivision 4 and section
245D.07, subdivision 1a:
 new text end

new text begin (1) the scope of the services to be provided to support the person's daily needs
and activities;
 new text end

new text begin (2) the person's desired outcomes and the supports necessary to accomplish the
person's desired outcomes;
 new text end

new text begin (3) the person's preferences for how services and supports are provided;
 new text end

new text begin (4) whether the current service setting is the most integrated setting available and
appropriate for the person; and
 new text end

new text begin (5) how services must be coordinated across other providers licensed under this
chapter serving the same person to ensure continuity of care for the person.
 new text end

new text begin (c) Within the scope of services, the license holder must, at a minimum, assess
the following areas:
 new text end

new text begin (1) the person's ability to self-manage health and medical needs to maintain or
improve physical, mental, and emotional well-being, including, when applicable, allergies,
seizures, choking, special dietary needs, chronic medical conditions, self-administration
of medication or treatment orders, preventative screening, and medical and dental
appointments;
 new text end

new text begin (2) the person's ability to self-manage personal safety to avoid injury or accident in
the service setting, including, when applicable, risk of falling, mobility, regulating water
temperature, community survival skills, water safety skills, and sensory disabilities; and
 new text end

new text begin (3) the person's ability to self-manage symptoms or behavior that may otherwise
result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to
(7), suspension or termination of services by the license holder, or other symptoms
or behaviors that may jeopardize the health and safety of the person or others. The
assessments must produce information about the person that is descriptive of the person's
overall strengths, functional skills and abilities, and behaviors or symptoms.
 new text end

new text begin Subd. 4. new text end

new text begin Service outcomes and supports. new text end

new text begin (a) Within ten working days of the
45-day meeting, the license holder must develop and document the service outcomes and
supports based on the assessments completed under subdivision 3 and the requirements
in section 245D.07, subdivision 1a. The outcomes and supports must be included in the
coordinated service and support plan addendum.
 new text end

new text begin (b) The license holder must document the supports and methods to be implemented
to support the accomplishment of outcomes related to acquiring, retaining, or improving
skills. The documentation must include:
 new text end

new text begin (1) the methods or actions that will be used to support the person and to accomplish
the service outcomes, including information about:
 new text end

new text begin (i) any changes or modifications to the physical and social environments necessary
when the service supports are provided;
 new text end

new text begin (ii) any equipment and materials required; and
 new text end

new text begin (iii) techniques that are consistent with the person's communication mode and
learning style;
 new text end

new text begin (2) the measurable and observable criteria for identifying when the desired outcome
has been achieved and how data will be collected;
 new text end

new text begin (3) the projected starting date for implementing the supports and methods and
the date by which progress towards accomplishing the outcomes will be reviewed and
evaluated; and
 new text end

new text begin (4) the names of the staff or position responsible for implementing the supports
and methods.
 new text end

new text begin (c) Within 20 working days of the 45-day meeting, the license holder must obtain
dated signatures from the person or the person's legal representative and case manager
to document completion and approval of the assessment and coordinated service and
support plan addendum.
 new text end

new text begin Subd. 5. new text end

new text begin Progress reviews. new text end

new text begin (a) The license holder must give the person or the
person's legal representative and case manager an opportunity to participate in the ongoing
review and development of the methods used to support the person and accomplish
outcomes identified in subdivisions 3 and 4. The license holder, in coordination with
the person's support team or expanded support team, must meet with the person, the
person's legal representative, and the case manager, and participate in progress review
meetings following stated timelines established in the person's coordinated service and
support plan or coordinated service and support plan addendum or within 30 days of a
written request by the person, the person's legal representative, or the case manager,
at a minimum of once per year.
 new text end

new text begin (b) The license holder must summarize the person's progress toward achieving the
identified outcomes and make recommendations and identify the rationale for changing,
continuing, or discontinuing implementation of supports and methods identified in
subdivision 4 in a written report sent to the person or the person's legal representative
and case manager five working days prior to the review meeting, unless the person, the
person's legal representative, or the case manager request to receive the report at the
time of the meeting.
 new text end

new text begin (c) Within ten working days of the progress review meeting, the license holder
must obtain dated signatures from the person or the person's legal representative and
the case manager to document approval of any changes to the coordinated service and
support plan addendum.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 26.

new text begin [245D.081] PROGRAM COORDINATION, EVALUATION, AND
OVERSIGHT.
 new text end

new text begin Subdivision 1. new text end

new text begin Program coordination and evaluation. new text end

new text begin (a) The license holder
is responsible for:
 new text end

new text begin (1) coordination of service delivery and evaluation for each person served by the
program as identified in subdivision 2; and
 new text end

new text begin (2) program management and oversight that includes evaluation of the program
quality and program improvement for services provided by the license holder as identified
in subdivision 3.
 new text end

new text begin (b) The same person may perform the functions in paragraph (a) if the work and
education qualifications are met in subdivisions 2 and 3.
 new text end

new text begin Subd. 2. new text end

new text begin Coordination and evaluation of individual service delivery. new text end

new text begin (a) Delivery
and evaluation of services provided by the license holder must be coordinated by a
designated staff person. The designated coordinator must provide supervision, support,
and evaluation of activities that include:
 new text end

new text begin (1) oversight of the license holder's responsibilities assigned in the person's
coordinated service and support plan and the coordinated service and support plan
addendum;
 new text end

new text begin (2) taking the action necessary to facilitate the accomplishment of the outcomes
according to the requirements in section 245D.07;
 new text end

new text begin (3) instruction and assistance to direct support staff implementing the coordinated
service and support plan and the service outcomes, including direct observation of service
delivery sufficient to assess staff competency; and
 new text end

new text begin (4) evaluation of the effectiveness of service delivery, methodologies, and progress on
the person's outcomes based on the measurable and observable criteria for identifying when
the desired outcome has been achieved according to the requirements in section 245D.07.
 new text end

new text begin (b) The license holder must ensure that the designated coordinator is competent to
perform the required duties identified in paragraph (a) through education and training in
human services and disability-related fields, and work experience in providing direct care
services and supports to persons with disabilities. The designated coordinator must have
the skills and ability necessary to develop effective plans and to design and use data
systems to measure effectiveness of services and supports. The license holder must verify
and document competence according to the requirements in section 245D.09, subdivision
3. The designated coordinator must minimally have:
 new text end

new text begin (1) a baccalaureate degree in a field related to human services, and one year of
full-time work experience providing direct care services to persons with disabilities or
persons age 65 and older;
 new text end

new text begin (2) an associate degree in a field related to human services, and two years of
full-time work experience providing direct care services to persons with disabilities or
persons age 65 and older;
 new text end

new text begin (3) a diploma in a field related to human services from an accredited postsecondary
institution and three years of full-time work experience providing direct care services to
persons with disabilities or persons age 65 and older; or
 new text end

new text begin (4) a minimum of 50 hours of education and training related to human services
and disabilities; and
 new text end

new text begin (5) four years of full-time work experience providing direct care services to persons
with disabilities or persons age 65 and older under the supervision of a staff person who
meets the qualifications identified in clauses (1) to (3).
 new text end

new text begin Subd. 3. new text end

new text begin Program management and oversight. new text end

new text begin (a) The license holder must
designate a managerial staff person or persons to provide program management and
oversight of the services provided by the license holder. The designated manager is
responsible for the following:
 new text end

new text begin (1) maintaining a current understanding of the licensing requirements sufficient to
ensure compliance throughout the program as identified in section 245A.04, subdivision
1, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21,
paragraph (b);
 new text end

new text begin (2) ensuring the duties of the designated coordinator are fulfilled according to the
requirements in subdivision 2;
 new text end

new text begin (3) ensuring the program implements corrective action identified as necessary
by the program following review of incident and emergency reports according to the
requirements in section 245D.11, subdivision 2, clause (7). An internal review of
incident reports of alleged or suspected maltreatment must be conducted according to the
requirements in section 245A.65, subdivision 1, paragraph (b);
 new text end

new text begin (4) evaluation of satisfaction of persons served by the program, the person's legal
representative, if any, and the case manager, with the service delivery and progress
towards accomplishing outcomes identified in sections 245D.07 and 245D.071, and
ensuring and protecting each person's rights as identified in section 245D.04;
 new text end

new text begin (5) ensuring staff competency requirements are met according to the requirements in
section 245D.09, subdivision 3, and ensuring staff orientation and training is provided
according to the requirements in section 245D.09, subdivisions 4, 4a, and 5;
 new text end

new text begin (6) ensuring corrective action is taken when ordered by the commissioner and that
the terms and condition of the license and any variances are met; and
 new text end

new text begin (7) evaluating the information identified in clauses (1) to (6) to develop, document,
and implement ongoing program improvements.
 new text end

new text begin (b) The designated manager must be competent to perform the duties as required and
must minimally meet the education and training requirements identified in subdivision
2, paragraph (b), and have a minimum of three years of supervisory level experience in
a program providing direct support services to persons with disabilities or persons age
65 and older.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 27.

Minnesota Statutes 2012, section 245D.09, is amended to read:


245D.09 STAFFING STANDARDS.

Subdivision 1.

Staffing requirements.

The license holder must providenew text begin the level of
new text end direct servicenew text begin supportnew text end staff deleted text begin sufficientdeleted text end new text begin supervision, assistance, and training necessary:
new text end

new text begin (1)new text end to ensure the health, safety, and protection of rights of each personnew text begin ;new text end and

new text begin (2)new text end to be able to implement the responsibilities assigned to the license holder in each
person'snew text begin coordinatednew text end servicenew text begin and supportnew text end plannew text begin or identified in the coordinated service and
support plan addendum, according to the requirements of this chapternew text end .

Subd. 2.

Supervision of staff having direct contact.

Except for a license holder
who is the sole direct deleted text begin servicedeleted text end new text begin supportnew text end staff, the license holder must provide adequate
supervision of staff providing direct deleted text begin servicedeleted text end new text begin supportnew text end to ensure the health, safety, and
protection of rights of each person and implementation of the responsibilities assigned to
the license holder in each person's deleted text begin service plandeleted text end new text begin coordinated service and support plan or
coordinated service and support plan addendumnew text end .

Subd. 3.

Staff qualifications.

(a) The license holder must ensure that staffnew text begin providing
direct support, or staff who have responsibilities related to supervising or managing the
provision of direct support service,new text end is competentnew text begin as demonstratednew text end throughnew text begin skills and
knowledgenew text end training, experience, and education to meet the person's needs and additional
requirements as written in thenew text begin coordinatednew text end servicenew text begin and supportnew text end plan new text begin or coordinated
service and support plan addendumnew text end , or when otherwise required by the case manager or
the federal waiver plan. The license holder must verify and maintain evidence of staff
competency, including documentation of:

(1) education and experience qualificationsnew text begin relevant to the job responsibilities
assigned to the staff and the needs of the general population of persons served by the
programnew text end , including a valid degree and transcript, or a current license, registration, or
certification, when a degree or licensure, registration, or certification is requirednew text begin by this
chapter or in the coordinated service and support plan or coordinated service and support
plan addendumnew text end ;

(2) deleted text begin completion of requireddeleted text end new text begin demonstrated competency in thenew text end orientation and training
new text begin areas required under this chapternew text end , deleted text begin includingdeleted text end new text begin and when applicable,new text end completion of continuing
education required to maintain professional licensure, registration, or certification
requirementsnew text begin . Competency in these areas is determined by the license holder through
knowledge testing and observed skill assessment conducted by the trainer or instructornew text end ; and

(3) except for a license holder who is the sole direct deleted text begin servicedeleted text end new text begin supportnew text end staff,new text begin periodic
new text end performance evaluations completed by the license holder of the direct deleted text begin servicedeleted text end new text begin supportnew text end staff
person's ability to perform the job functions based on direct observation.

(b) Staff under 18 years of age may not perform overnight duties or administer
medication.

Subd. 4.

Orientationnew text begin to program requirementsnew text end .

deleted text begin (a)deleted text end Except for a license holder
who does not supervise any direct deleted text begin servicedeleted text end new text begin supportnew text end staff, within deleted text begin 90 days of hiring direct
service staffdeleted text end new text begin 60 days of hire, unless stated otherwisenew text end , the license holder must provide
and ensure completion of orientationnew text begin for direct support staffnew text end that combines supervised
on-the-job training with review of and instruction deleted text begin ondeleted text end new text begin innew text end the followingnew text begin areasnew text end :

(1) the job description and how to complete specific job functions, including:

(i) responding to and reporting incidents as required under section 245D.06,
subdivision 1; and

(ii) following safety practices established by the license holder and as required in
section 245D.06, subdivision 2;

(2) the license holder's current policies and procedures required under this chapter,
including their location and access, and staff responsibilities related to implementation
of those policies and procedures;

(3) data privacy requirements according to sections 13.01 to 13.10 and 13.46, the
federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff
responsibilities related to complying with data privacy practices;

(4) the service recipient rights deleted text begin under section 245D.04deleted text end , and staff responsibilities
related to ensuring the exercise and protection of those rightsnew text begin according to the requirements
in section 245D.04new text end ;

(5) sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment
reporting and service planning for children and vulnerable adults, and staff responsibilities
related to protecting persons from maltreatment and reporting maltreatmentnew text begin . This
orientation must be provided within 72 hours of first providing direct contact services and
annually thereafter according to section 245A.65, subdivision 3new text end ;

(6) deleted text begin what constitutes use of restraints, seclusion, and psychotropic medications,
and staff responsibilities related to the prohibitions of their usedeleted text end new text begin the principles of
person-centered service planning and delivery as identified in section 245D.07, subdivision
1a, and how they apply to direct support service provided by the staff personnew text end ; and

(7) other topics as determined necessary in the person'snew text begin coordinatednew text end servicenew text begin and
supportnew text end plan by the case manager or other areas identified by the license holder.

deleted text begin (b) License holders who provide direct service themselves must complete the
orientation required in paragraph (a), clauses (3) to (7).
 deleted text end

new text begin Subd. 4a. new text end

new text begin Orientation to individual service recipient needs. new text end

deleted text begin (c)deleted text end new text begin (a)new text end Before
deleted text begin providingdeleted text end new text begin havingnew text end unsupervised direct deleted text begin service todeleted text end new text begin contact withnew text end a person served by the
program, or for whom the staff person has not previously provided direct deleted text begin servicedeleted text end new text begin supportnew text end ,
or any time the plans or procedures identified in deleted text begin clauses (1) and (2)deleted text end new text begin paragraphs (b) to
(f)new text end are revised, the staff person must review and receive instruction on the deleted text begin following
as it relatesdeleted text end new text begin requirements in paragraphs (b) to (f) as they relatenew text end to the staff person's job
functions for that persondeleted text begin :deleted text end new text begin .
new text end

new text begin (b) Orientation training and competency evaluation of direct care staff in a program
providing 24-hour care for a client with corporate supervision must be provided under
the direction of a registered nurse. Training and competency evaluations must include
the following:
 new text end

new text begin (1) documentation requirements for all services provided;
 new text end

new text begin (2) reports of changes in the client's condition to the supervisor designated by the
home care provider;
 new text end

new text begin (3) basic infection control, including blood-borne pathogens;
 new text end

new text begin (4) maintenance of a clean and safe environment;
 new text end

new text begin (5) appropriate and safe techniques in personal hygiene and grooming, including
hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities
of daily living (ADLs);
 new text end

new text begin (6) an understanding of what constitutes a healthy diet according to data from the
Centers for Disease Control and the skills necessary to prepare that diet;
 new text end

new text begin (7) skills necessary to provide appropriate support in instrumental activities of
daily living (IADLs); and
 new text end

new text begin (8) demonstrated competence in providing first aid.
 new text end

deleted text begin (1)deleted text end new text begin (c) The staff person must review and receive instruction onnew text end the person's
new text begin coordinatednew text end servicenew text begin and supportnew text end plan new text begin or coordinated service and support plan addendumnew text end as
it relates to the responsibilities assigned to the license holder, and when applicable, the
person's individual abuse prevention plan deleted text begin according to section 245A.65deleted text end , to achievenew text begin and
demonstratenew text end an understanding of the person as a unique individual, and how to implement
those plansdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (2)deleted text end new text begin (d) The staff person must review and receive instruction onnew text end medication
administration procedures established for the person whennew text begin medication administration is
new text end assigned to the license holder according to section 245D.05, subdivision 1, paragraph
(b). Unlicensed staff may administer medications only after successful completion of a
medication administration training, from a training curriculum developed by a registered
nurse, clinical nurse specialist in psychiatric and mental health nursing, certified nurse
practitioner, physician's assistant, or physician deleted text begin incorporatingdeleted text end new text begin . The training curriculum
must incorporatenew text end an observed skill assessment conducted by the trainer to ensure staff
demonstrate the ability to safely and correctly follow medication procedures.

Medication administration must be taught by a registered nurse, clinical nurse
specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
service initiation or any time thereafter, the person has or develops a health care condition
that affects the service options available to the person because the condition requires:

deleted text begin (i)deleted text end new text begin (1)new text end specialized or intensive medical or nursing supervision;new text begin and
new text end

deleted text begin (ii)deleted text end new text begin (2)new text end nonmedical service providers to adapt their services to accommodate the
health and safety needs of the persondeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (iii) necessary training in order to meet the health service needs of the person as
determined by the person's physician.
 deleted text end

new text begin (e) The staff person must review and receive instruction on the safe and correct
operation of medical equipment used by the person to sustain life, including but not
limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
by a licensed health care professional or a manufacturer's representative and incorporate
an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
operate the equipment according to the treatment orders and the manufacturer's instructions.
 new text end

new text begin (f) The staff person must review and receive instruction on what constitutes use of
restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
related to the prohibitions of their use according to the requirements in section 245D.06,
subdivision 5, why such procedures are not effective for reducing or eliminating symptoms
or undesired behavior and why they are not safe, and the safe and correct use of manual
restraint on an emergency basis according to the requirements in section 245D.061.
 new text end

new text begin (g) In the event of an emergency service initiation, the license holder must ensure
the training required in this subdivision occurs within 72 hours of the direct support staff
person first having unsupervised contact with the person receiving services. The license
holder must document the reason for the unplanned or emergency service initiation and
maintain the documentation in the person's service recipient record.
 new text end

new text begin (h) License holders who provide direct support services themselves must complete
the orientation required in subdivision 4, clauses (3) to (7).
 new text end

Subd. 5.

new text begin Annual new text end training.

deleted text begin (a)deleted text end A license holder must provide annual training to
direct deleted text begin servicedeleted text end new text begin supportnew text end staff on the topics identified in subdivision 4, deleted text begin paragraph (a),deleted text end clauses
(3) to deleted text begin (6)deleted text end new text begin (7), and subdivision 4a, paragraphs (a) to (h). A license holder providing 24-hour
care with corporate supervision must provide a minimum of 24 hours of annual training
to direct service staff in topics described in subdivisions 4, clauses (1) to (7), and 4a,
paragraphs (a) to (h). Training on relevant topics received from sources other than the
license holder may count toward training requirementsnew text end .

deleted text begin (b) A license holder providing behavioral programming, specialist services, personal
support, 24-hour emergency assistance, night supervision, independent living skills,
structured day, prevocational, or supported employment services must provide a minimum
of eight hours of annual training to direct service staff that addresses:
 deleted text end

deleted text begin (1) topics related to the general health, safety, and service needs of the population
served by the license holder; and
 deleted text end

deleted text begin (2) other areas identified by the license holder or in the person's current service plan.
 deleted text end

deleted text begin Training on relevant topics received from sources other than the license holder
may count toward training requirements.
 deleted text end

deleted text begin (c) When the license holder is the owner, lessor, or tenant of the service site and
whenever a person receiving services is present at the site, the license holder must have
a staff person available on site who is trained in basic first aid and, when required in a
person's service plan, cardiopulmonary resuscitation.
 deleted text end

new text begin Subd. 5a. new text end

new text begin Alternative sources of training. new text end

new text begin Orientation or training received by the
staff person from sources other than the license holder in the same subjects as identified
in subdivision 4 may count toward the orientation and annual training requirements if
received in the 12-month period before the staff person's date of hire. The license holder
must maintain documentation of the training received from other sources and of each staff
person's competency in the required area according to the requirements in subdivision 3.
 new text end

Subd. 6.

Subcontractorsnew text begin and temporary staffnew text end .

If the license holder uses a
subcontractornew text begin or temporary staffnew text end to perform services licensed under this chapter on the
license holder's behalf, the license holder must ensure that the subcontractornew text begin or temporary
staffnew text end meets and maintains compliance with all requirements under this chapter that apply
to the services to be providednew text begin , including training, orientation, and supervision necessary
to fulfill their responsibilities. The license holder must ensure that a background study
has been completed according to the requirements in sections 245C.03, subdivision 1,
and 245C.04. Subcontractors and temporary staff hired by the license holder must meet
the Minnesota licensing requirements applicable to the disciplines in which they are
providing services. The license holder must maintain documentation that the applicable
requirements have been metnew text end .

Subd. 7.

Volunteers.

The license holder must ensure that volunteers who provide
direct new text begin support new text end services to persons served by the program receive the training, orientation,
and supervision necessary to fulfill their responsibilities.new text begin The license holder must ensure
that a background study has been completed according to the requirements in sections
245C.03, subdivision 1, and 245C.04. The license holder must maintain documentation
that the applicable requirements have been met.
new text end

new text begin Subd. 8. new text end

new text begin Staff orientation and training plan. new text end

new text begin The license holder must develop
a staff orientation and training plan documenting when and how compliance with
subdivisions 4, 4a, and 5 will be met.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 28.

new text begin [245D.091] INTERVENTION SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Licensure requirements. new text end

new text begin An individual meeting the staff
qualification requirements of this section who is an employee of a program licensed
according to this chapter and providing behavioral support services, specialist services,
or crisis respite services is not required to hold a separate license under this chapter.
An individual meeting the staff qualifications of this section who is not providing these
services as an employee of a program licensed according to this chapter must obtain a
license according to this chapter.
 new text end

new text begin Subd. 2. new text end

new text begin Behavior professional qualifications. new text end

new text begin A behavior professional, as defined
in the brain injury and community alternatives for disabled individuals waiver plans or
successor plans, must have competencies in areas related to:
 new text end

new text begin (1) ethical considerations;
 new text end

new text begin (2) functional assessment;
 new text end

new text begin (3) functional analysis;
 new text end

new text begin (4) measurement of behavior and interpretation of data;
 new text end

new text begin (5) selecting intervention outcomes and strategies;
 new text end

new text begin (6) behavior reduction and elimination strategies that promote least restrictive
approved alternatives;
 new text end

new text begin (7) data collection;
 new text end

new text begin (8) staff and caregiver training;
 new text end

new text begin (9) support plan monitoring;
 new text end

new text begin (10) co-occurring mental disorders or neuro-cognitive disorder;
 new text end

new text begin (11) demonstrated expertise with populations being served; and
 new text end

new text begin (12) must be a:
 new text end

new text begin (i) psychologist licensed under sections 148.88 to 148.98, who has stated to the
Board of Psychology competencies in the above identified areas;
 new text end

new text begin (ii) clinical social worker licensed as an independent clinical social worker under
chapter 148D, or a person with a master's degree in social work from an accredited college
or university, with at least 4,000 hours of post-master's supervised experience in the
delivery of clinical services in the areas identified in clauses (1) to (11);
 new text end

new text begin (iii) physician licensed under chapter 147 and certified by the American Board
of Psychiatry and Neurology or eligible for board certification in psychiatry with
competencies in the areas identified in clauses (1) to (11);
 new text end

new text begin (iv) licensed professional clinical counselor licensed under sections 148B.29 to
148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery
of clinical services who has demonstrated competencies in the areas identified in clauses
(1) to (11);
 new text end

new text begin (v) person with a master's degree from an accredited college or university in one
of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services with demonstrated competencies
in the areas identified in clauses (1) to (11); or
 new text end

new text begin (vi) registered nurse who is licensed under sections 148.171 to 148.285, and who is
certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and
mental health nursing by a national nurse certification organization, or who has a master's
degree in nursing or one of the behavioral sciences or related fields from an accredited
college or university or its equivalent, with at least 4,000 hours of post-master's supervised
experience in the delivery of clinical services.
 new text end

new text begin Subd. 3. new text end

new text begin Behavior analyst qualifications. new text end

new text begin (a) A behavior analyst, as defined in
the brain injury and community alternatives for disabled individuals waiver plans or
successor plans, must:
 new text end

new text begin (1) have obtained a baccalaureate degree, master's degree, or a PhD in a social
services discipline; or
 new text end

new text begin (2) meet the qualifications of a mental health practitioner as defined in section
245.462, subdivision 17.
 new text end

new text begin (b) In addition, a behavior analyst must:
 new text end

new text begin (1) have four years of supervised experience working with individuals who exhibit
challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder;
 new text end

new text begin (2) have received ten hours of instruction in functional assessment and functional
analysis;
 new text end

new text begin (3) have received 20 hours of instruction in the understanding of the function of
behavior;
 new text end

new text begin (4) have received ten hours of instruction on design of positive practices behavior
support strategies;
 new text end

new text begin (5) have received 20 hours of instruction on the use of behavior reduction approved
strategies used only in combination with behavior positive practices strategies;
 new text end

new text begin (6) be determined by a behavior professional to have the training and prerequisite
skills required to provide positive practice strategies as well as behavior reduction
approved and permitted intervention to the person who receives behavioral support; and
 new text end

new text begin (7) be under the direct supervision of a behavior professional.
 new text end

new text begin Subd. 4. new text end

new text begin Behavior specialist qualifications. new text end

new text begin (a) A behavior specialist, as defined
in the brain injury and community alternatives for disabled individuals waiver plans or
successor plans, must meet the following qualifications:
 new text end

new text begin (1) have an associate's degree in a social services discipline; or
 new text end

new text begin (2) have two years of supervised experience working with individuals who exhibit
challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder.
 new text end

new text begin (b) In addition, a behavior specialist must:
 new text end

new text begin (1) have received a minimum of four hours of training in functional assessment;
 new text end

new text begin (2) have received 20 hours of instruction in the understanding of the function of
behavior;
 new text end

new text begin (3) have received ten hours of instruction on design of positive practices behavioral
support strategies;
 new text end

new text begin (4) be determined by a behavior professional to have the training and prerequisite
skills required to provide positive practices strategies as well as behavior reduction
approved intervention to the person who receives behavioral support; and
 new text end

new text begin (5) be under the direct supervision of a behavior professional.
 new text end

new text begin Subd. 5. new text end

new text begin Specialist services qualifications. new text end

new text begin An individual providing specialist
services, as defined in the developmental disabilities waiver plan or successor plan, must
have:
 new text end

new text begin (1) the specific experience and skills required of the specialist to meet the needs of
the person identified by the person's service planning team; and
 new text end

new text begin (2) the qualifications of the specialist identified in the person's coordinated service
and support plan.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 29.

new text begin [245D.095] RECORD REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Record-keeping systems. new text end

new text begin The license holder must ensure that the
content and format of service recipient, personnel, and program records are uniform and
legible according to the requirements of this chapter.
 new text end

new text begin Subd. 2. new text end

new text begin Admission and discharge register. new text end

new text begin The license holder must keep a written
or electronic register, listing in chronological order the dates and names of all persons
served by the program who have been admitted, discharged, or transferred, including
service terminations initiated by the license holder and deaths.
 new text end

new text begin Subd. 3. new text end

new text begin Service recipient record. new text end

new text begin (a) The license holder must maintain a record of
current services provided to each person on the premises where the services are provided
or coordinated. When the services are provided in a licensed facility, the records must
be maintained at the facility, otherwise the records must be maintained at the license
holder's program office. new text end new text begin The license holder must protect service recipient records against
loss, tampering, or unauthorized disclosure according to the requirements in sections
13.01 to 13.10 and 13.46.
 new text end

new text begin (b) The license holder must maintain the following information for each person:
 new text end

new text begin (1) an admission form signed by the person or the person's legal representative
that includes:
 new text end

new text begin (i) identifying information, including the person's name, date of birth, address,
and telephone number; and
 new text end

new text begin (ii) the name, address, and telephone number of the person's legal representative, if
any, and a primary emergency contact, the case manager, and family members or others as
identified by the person or case manager;
 new text end

new text begin (2) service information, including service initiation information, verification of the
person's eligibility for services, documentation verifying that services have been provided
as identified in the coordinated service and support plan or coordinated service and support
plan addendum according to paragraph (a), and date of admission or readmission;
 new text end

new text begin (3) health information, including medical history, special dietary needs, and
allergies, and when the license holder is assigned responsibility for meeting the person's
health service needs according to section 245D.05:
 new text end

new text begin (i) current orders for medication, treatments, or medical equipment and a signed
authorization from the person or the person's legal representative to administer or assist in
administering the medication or treatments, if applicable;
 new text end

new text begin (ii) a signed statement authorizing the license holder to act in a medical emergency
when the person's legal representative, if any, cannot be reached or is delayed in arriving;
 new text end

new text begin (iii) medication administration procedures;
 new text end

new text begin (iv) a medication administration record documenting the implementation of the
medication administration procedures, the medication administration record reviews, and
including any agreements for administration of injectable medications by the license
holder according to the requirements in section 245D.05; and
 new text end

new text begin (v) a medical appointment schedule when the license holder is assigned
responsibility for assisting with medical appointments;
 new text end

new text begin (4) the person's current coordinated service and support plan or that portion of the
plan assigned to the license holder;
 new text end

new text begin (5) copies of the individual abuse prevention plan and assessments as required under
section 245D.071, subdivisions 2 and 3;
 new text end

new text begin (6) a record of other service providers serving the person when the person's
coordinated service and support plan or coordinated service and support plan addendum
identifies the need for coordination between the service providers, that includes a contact
person and telephone numbers, services being provided, and names of staff responsible for
coordination;
 new text end

new text begin (7) documentation of orientation to service recipient rights according to section
245D.04, subdivision 1, and maltreatment reporting policies and procedures according to
section 245A.65, subdivision 1, paragraph (c);
 new text end

new text begin (8) copies of authorizations to handle a person's funds, according to section 245D.06,
subdivision 4, paragraph (a);
 new text end

new text begin (9) documentation of complaints received and grievance resolution;
 new text end

new text begin (10) incident reports involving the person, required under section 245D.06,
subdivision 1;
 new text end

new text begin (11) copies of written reports regarding the person's status when requested according
to section 245D.07, subdivision 3, progress review reports as required under section
245D.071, subdivision 5, progress or daily log notes that are recorded by the program,
and reports received from other agencies involved in providing services or care to the
person; and
 new text end

new text begin (12) discharge summary, including service termination notice and related
documentation, when applicable.
 new text end

new text begin Subd. 4. new text end

new text begin Access to service recipient records. new text end

new text begin The license holder must ensure that
the following people have access to the information in subdivision 1 in accordance with
applicable state and federal law, regulation, or rule:
 new text end

new text begin (1) the person, the person's legal representative, and anyone properly authorized
by the person;
 new text end

new text begin (2) the person's case manager;
 new text end

new text begin (3) staff providing services to the person unless the information is not relevant to
carrying out the coordinated service and support plan or coordinated service and support
plan addendum; and
 new text end

new text begin (4) the county child or adult foster care licensor, when services are also licensed as
child or adult foster care.
 new text end

new text begin Subd. 5. new text end

new text begin Personnel records. new text end

new text begin (a) The license holder must maintain a personnel
record of each employee to document and verify staff qualifications, orientation, and
training. The personnel record must include:
 new text end

new text begin (1) the employee's date of hire, completed application, an acknowledgement signed
by the employee that job duties were reviewed with the employee and the employee
understands those duties, and documentation that the employee meets the position
requirements as determined by the license holder;
 new text end

new text begin (2) documentation of staff qualifications, orientation, training, and performance
evaluations as required under section 245D.09, subdivisions 3 to 5, including the date
the training was completed, the number of hours per subject area, and the name of the
trainer or instructor; and
 new text end

new text begin (3) a completed background study as required under chapter 245C.
 new text end

new text begin (b) For employees hired after January 1, 2014, the license holder must maintain
documentation in the personnel record or elsewhere, sufficient to determine the date of the
employee's first supervised direct contact with a person served by the program, and the
date of first unsupervised direct contact with a person served by the program.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 30.

Minnesota Statutes 2012, section 245D.10, is amended to read:


245D.10 POLICIES AND PROCEDURES.

Subdivision 1.

Policy and procedure requirements.

deleted text begin Thedeleted text end new text begin Anew text end license holder
new text begin providing either basic or intensive supports and servicesnew text end must establish, enforce, and
maintain policies and procedures as required in this chapternew text begin , chapter 245A, and other
applicable state and federal laws and regulations governing the provision of home and
community-based services licensed according to this chapternew text end .

Subd. 2.

Grievances.

The license holder must establish policies and procedures
that deleted text begin providedeleted text end new text begin promote service recipient rights by providingnew text end a simple complaint process for
persons served by the program and their authorized representatives to bring a grievance that:

(1) provides staff assistance with the complaint process when requested, and the
addresses and telephone numbers of outside agencies to assist the person;

(2) allows the person to bring the complaint to the highest level of authority in the
program if the grievance cannot be resolved by other staff members, and that provides
the name, address, and telephone number of that person;

(3) requires the license holder to promptly respond to all complaints affecting a
person's health and safety. For all other complaints, the license holder must provide an
initial response within 14 calendar days of receipt of the complaint. All complaints must
be resolved within 30 calendar days of receipt or the license holder must document the
reason for the delay and a plan for resolution;

(4) requires a complaint review that includes an evaluation of whether:

(i) related policies and procedures were followed and adequate;

(ii) there is a need for additional staff training;

(iii) the complaint is similar to past complaints with the persons, staff, or services
involved; and

(iv) there is a need for corrective action by the license holder to protect the health
and safety of persons receiving services;

(5) based on the review in clause (4), requires the license holder to develop,
document, and implement a corrective action plan designed to correct current lapses and
prevent future lapses in performance by staff or the license holder, if any;

(6) provides a written summary of the complaint and a notice of the complaint
resolution to the person and case manager that:

(i) identifies the nature of the complaint and the date it was received;

(ii) includes the results of the complaint review;

(iii) identifies the complaint resolution, including any corrective action; and

(7) requires that the complaint summary and resolution notice be maintained in the
service recipient record.

Subd. 3.

Service suspension and service termination.

(a) The license holder must
establish policies and procedures for temporary service suspension and service termination
that promote continuity of care and service coordination with the person and the case
manager and with other licensed caregivers, if any, who also provide support to the person.

(b) The policy must include the following requirements:

(1) the license holder must notify the person new text begin or the person's legal representative new text end and
case manager in writing of the intended termination or temporary service suspension, and
the person's right to seek a temporary order staying the termination of service according to
the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);

(2) notice of the proposed termination of services, including those situations
that began with a temporary service suspension, must be given at least 60 days before
the proposed termination is to become effective when a license holder is providing
deleted text begin independent living skills training, structured day, prevocational or supported employment
services to the persondeleted text end new text begin intensive supports and services identified in section 245D.03,
subdivision 1, paragraph (c)new text end , and 30 days prior to termination for all other services
licensed under this chapter;

(3) the license holder must provide information requested by the person or case
manager when services are temporarily suspended or upon notice of termination;

(4) prior to giving notice of service termination or temporary service suspension,
the license holder must document actions taken to minimize or eliminate the need for
service suspension or termination;

(5) during the temporary service suspension or service termination notice period,
the license holder will work with the appropriate county agency to develop reasonable
alternatives to protect the person and others;

(6) the license holder must maintain information about the service suspension or
termination, including the written termination notice, in the service recipient record; and

(7) the license holder must restrict temporary service suspension to situations in
which the person's deleted text begin behavior causes immediate and serious danger to the health and safety
of the person or othersdeleted text end new text begin conduct poses an imminent risk of physical harm to self or others
and less restrictive or positive support strategies would not achieve safetynew text end .

Subd. 4.

Availability of current written policies and procedures.

(a) The license
holder must review and update, as needed, the written policies and procedures required
under this chapter.

(b)new text begin (1)new text end The license holder must inform the person and case manager of the policies
and procedures affecting a person's rights under section 245D.04, and provide copies of
those policies and procedures, within five working days of service initiation.

new text begin (2) If a license holder only provides basic services and supports, this includes the:
 new text end

new text begin (i) grievance policy and procedure required under subdivision 2; and
 new text end

new text begin (ii) service suspension and termination policy and procedure required under
subdivision 3.
 new text end

new text begin (3) For all other license holders this includes the:
 new text end

new text begin (i) policies and procedures in clause (2);
 new text end

new text begin (ii) emergency use of manual restraints policy and procedure required under
subdivision 3a; and
 new text end

new text begin (iii) data privacy requirements under section 245D.11, subdivision 3.
 new text end

(c) The license holder must provide a written notice at least 30 days before
implementing any deleted text begin revised policies and proceduresdeleted text end new text begin procedural revisions to policies
new text end affecting a person's new text begin service-related or protection-relatednew text end rights under section 245D.04new text begin and
maltreatment reporting policies and proceduresnew text end . The notice must explain the revision that
was made and include a copy of the revised policy and procedure. The license holder
must document the deleted text begin reasondeleted text end new text begin reasonable causenew text end for not providing the notice at least 30 days
before implementing the revisions.

(d) Before implementing revisions to required policies and procedures, the license
holder must inform all employees of the revisions and provide training on implementation
of the revised policies and procedures.

new text begin (e) The license holder must annually notify all persons, or their legal representatives,
and case managers of any procedural revisions to policies required under this chapter,
other than those in paragraph (c). Upon request, the license holder must provide the
person, or the person's legal representative, and case manager with copies of the revised
policies and procedures.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 31.

new text begin [245D.11] POLICIES AND PROCEDURES; INTENSIVE SUPPORT
SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Policy and procedure requirements. new text end

new text begin A license holder providing
intensive support services as identified in section 245D.03, subdivision 1, paragraph (c),
must establish, enforce, and maintain policies and procedures as required in this section.
 new text end

new text begin Subd. 2. new text end

new text begin Health and safety. new text end

new text begin The license holder must establish policies and
procedures that promote health and safety by ensuring:
 new text end

new text begin (1) use of universal precautions and sanitary practices in compliance with section
245D.06, subdivision 2, clause (5);
 new text end

new text begin (2) if the license holder operates a residential program, health service coordination
and care according to the requirements in section 245D.05, subdivision 1;
 new text end

new text begin (3) safe medication assistance and administration according to the requirements
in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
doctor and require completion of medication administration training according to the
requirements in section 245D.09, subdivision 4a, paragraph (c). Medication assistance
and administration includes, but is not limited to:
 new text end

new text begin (i) providing medication-related services for a person;
 new text end

new text begin (ii) medication setup;
 new text end

new text begin (iii) medication administration;
 new text end

new text begin (iv) medication storage and security;
 new text end

new text begin (v) medication documentation and charting;
 new text end

new text begin (vi) verification and monitoring of effectiveness of systems to ensure safe medication
handling and administration;
 new text end

new text begin (vii) coordination of medication refills;
 new text end

new text begin (viii) handling changes to prescriptions and implementation of those changes;
 new text end

new text begin (ix) communicating with the pharmacy; and
 new text end

new text begin (x) coordination and communication with prescriber;
 new text end

new text begin (4) safe transportation, when the license holder is responsible for transportation of
persons, with provisions for handling emergency situations according to the requirements
in section 245D.06, subdivision 2, clauses (2) to (4);
 new text end

new text begin (5) a plan for ensuring the safety of persons served by the program in emergencies as
defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
to the license holder. A license holder with a community residential setting or a day service
facility license must ensure the policy and procedures comply with the requirements in
section 245D.22, subdivision 4;
 new text end

new text begin (6) a plan for responding to all incidents as defined in section 245D.02, subdivision
11; and reporting all incidents required to be reported according to section 245D.06,
subdivision 1. The plan must:
 new text end

new text begin (i) provide the contact information of a source of emergency medical care and
transportation; and
 new text end

new text begin (ii) require staff to first call 911 when the staff believes a medical emergency may be
life threatening, or to call the mental health crisis intervention team when the person is
experiencing a mental health crisis; and
 new text end

new text begin (7) a procedure for the review of incidents and emergencies to identify trends or
patterns, and corrective action if needed. The license holder must establish and maintain
a record-keeping system for the incident and emergency reports. Each incident and
emergency report file must contain a written summary of the incident. The license holder
must conduct a review of incident reports for identification of incident patterns, and
implementation of corrective action as necessary to reduce occurrences. Each incident
report must include:
 new text end

new text begin (i) the name of the person or persons involved in the incident. It is not necessary
to identify all persons affected by or involved in an emergency unless the emergency
resulted in an incident;
 new text end

new text begin (ii) the date, time, and location of the incident or emergency;
 new text end

new text begin (iii) a description of the incident or emergency;
 new text end

new text begin (iv) a description of the response to the incident or emergency and whether a person's
coordinated service and support plan addendum or program policies and procedures were
implemented as applicable;
 new text end

new text begin (v) the name of the staff person or persons who responded to the incident or
emergency; and
 new text end

new text begin (vi) the determination of whether corrective action is necessary based on the results
of the review.
 new text end

new text begin Subd. 3. new text end

new text begin Data privacy. new text end

new text begin The license holder must establish policies and procedures that
promote service recipient rights by ensuring data privacy according to the requirements in:
 new text end

new text begin (1) the Minnesota Government Data Practices Act, section 13.46, and all other
applicable Minnesota laws and rules in handling all data related to the services provided;
and
 new text end

new text begin (2) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the
extent that the license holder performs a function or activity involving the use of protected
health information as defined under Code of Federal Regulations, title 45, section 164.501,
including, but not limited to, providing health care services; health care claims processing
or administration; data analysis, processing, or administration; utilization review; quality
assurance; billing; benefit management; practice management; repricing; or as otherwise
provided by Code of Federal Regulations, title 45, section 160.103. The license holder
must comply with the Health Insurance Portability and Accountability Act of 1996 and
its implementing regulations, Code of Federal Regulations, title 45, parts 160 to 164,
and all applicable requirements.
 new text end

new text begin Subd. 4. new text end

new text begin Admission criteria. new text end

new text begin The license holder must establish policies and
procedures that promote continuity of care by ensuring that admission or service initiation
criteria:
 new text end

new text begin (1) is consistent with the license holder's registration information identified in the
requirements in section 245D.031, subdivision 2, and with the service-related rights
identified in section 245D.04, subdivisions 2, clauses (4) to (7), and 3, clause (8);
 new text end

new text begin (2) identifies the criteria to be applied in determining whether the license holder
can develop services to meet the needs specified in the person's coordinated service and
support plan;
 new text end

new text begin (3) requires a license holder providing services in a health care facility to comply
with the requirements in section 243.166, subdivision 4b, to provide notification to
residents when a registered predatory offender is admitted into the program or to a
potential admission when the facility was already serving a registered predatory offender.
For purposes of this clause, "health care facility" means a facility licensed by the
commissioner as a residential facility under chapter 245A to provide adult foster care or
residential services to persons with disabilities; and
 new text end

new text begin (4) requires that when a person or the person's legal representative requests services
from the license holder, a refusal to admit the person must be based on an evaluation of
the person's assessed needs and the license holder's lack of capacity to meet the needs of
the person. The license holder must not refuse to admit a person based solely on the
type of residential services the person is receiving, or solely on the person's severity of
disability, orthopedic or neurological handicaps, sight or hearing impairments, lack of
communication skills, physical disabilities, toilet habits, behavioral disorders, or past
failure to make progress. Documentation of the basis for refusal must be provided to the
person or the person's legal representative and case manager upon request.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 32.

new text begin [245D.21] FACILITY LICENSURE REQUIREMENTS AND
APPLICATION PROCESS.
 new text end

new text begin Subdivision 1. new text end

new text begin Community residential settings and day service facilities. new text end

new text begin For
purposes of this section, "facility" means both a community residential setting and day
service facility and the physical plant.
 new text end

new text begin Subd. 2. new text end

new text begin Inspections and code compliance. new text end

new text begin (a) Physical plants must comply with
applicable state and local fire, health, building, and zoning codes.
 new text end

new text begin (b)(1) The facility must be inspected by a fire marshal or their delegate within
12 months before initial licensure to verify that it meets the applicable occupancy
requirements as defined in the State Fire Code and that the facility complies with the fire
safety standards for that occupancy code contained in the State Fire Code.
 new text end

new text begin (2) The fire marshal inspection of a community residential setting must verify the
residence is a dwelling unit within a residential occupancy as defined in section 9.117 of
the State Fire Code. A home safety checklist, approved by the commissioner, must be
completed for a community residential setting by the license holder and the commissioner
before the satellite license is reissued.
 new text end

new text begin (3) The facility shall be inspected according to the facility capacity specified on the
initial application form.
 new text end

new text begin (4) If the commissioner has reasonable cause to believe that a potentially hazardous
condition may be present or the licensed capacity is increased, the commissioner shall
request a subsequent inspection and written report by a fire marshal to verify the absence
of hazard.
 new text end

new text begin (5) Any condition cited by a fire marshal, building official, or health authority as
hazardous or creating an immediate danger of fire or threat to health and safety must be
corrected before a license is issued by the department, and for community residential
settings, before a license is reissued.
 new text end

new text begin (c) The facility must maintain in a permanent file the reports of health, fire, and
other safety inspections.
 new text end

new text begin (d) The facility's plumbing, ventilation, heating, cooling, lighting, and other
fixtures and equipment, including elevators or food service, if provided, must conform to
applicable health, sanitation, and safety codes and regulations.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 33.

new text begin [245D.22] FACILITY SANITATION AND HEALTH.
 new text end

new text begin Subdivision 1. new text end

new text begin General maintenance. new text end

new text begin The license holder must maintain the interior
and exterior of buildings, structures, or enclosures used by the facility, including walls,
floors, ceilings, registers, fixtures, equipment, and furnishings in good repair and in a
sanitary and safe condition. The facility must be clean and free from accumulations of
dirt, grease, garbage, peeling paint, mold, vermin, and insects. The license holder must
correct building and equipment deterioration, safety hazards, and unsanitary conditions.
 new text end

new text begin Subd. 2. new text end

new text begin Hazards and toxic substances. new text end

new text begin (a) The license holder must ensure that
service sites owned or leased by the license holder are free from hazards that would
threaten the health or safety of a person receiving services by ensuring the requirements
in paragraphs (b) to (h) are met.
 new text end

new text begin (b) Chemicals, detergents, and other hazardous or toxic substances must not be
stored with food products or in any way that poses a hazard to persons receiving services.
 new text end

new text begin (c) The license holder must install handrails and nonslip surfaces on interior and
exterior runways, stairways, and ramps according to the applicable building code.
 new text end

new text begin (d) If there are elevators in the facility, the license holder must have elevators
inspected each year. The date of the inspection, any repairs needed, and the date the
necessary repairs were made must be documented.
 new text end

new text begin (e) The license holder must keep stairways, ramps, and corridors free of obstructions.
 new text end

new text begin (f) Outside property must be free from debris and safety hazards. Exterior stairs and
walkways must be kept free of ice and snow.
 new text end

new text begin (g) Heating, ventilation, air conditioning units, and other hot surfaces and moving
parts of machinery must be shielded or enclosed.
 new text end

new text begin (h) Use of dangerous items or equipment by persons served by the program must be
allowed in accordance with the person's coordinated service and support plan addendum
or the program abuse prevention plan, if not addressed in the coordinated service and
support plan addendum.
 new text end

new text begin Subd. 3. new text end

new text begin Storage and disposal of medication. new text end

new text begin Schedule II controlled substances in
the facility that are named in section 152.02, subdivision 3, must be stored in a locked
storage area permitting access only by persons and staff authorized to administer the
medication. This must be incorporated into the license holder's medication administration
policy and procedures required under section 245D.11, subdivision 2, clause (3).
Medications must be disposed of according to the Environmental Protection Agency
recommendations.
 new text end

new text begin Subd. 4. new text end

new text begin First aid must be available on site. new text end

new text begin (a) A staff person trained in first aid
must be available on site and, when required in a person's coordinated service and support
plan or coordinated service and support plan addendum, cardiopulmonary resuscitation,
whenever persons are present and staff are required to be at the site to provide direct
service. The training must include in-person instruction, hands-on practice, and an
observed skills assessment under the direct supervision of a first aid instructor.
 new text end

new text begin (b) A facility must have first aid kits readily available for use by, and that meets
the needs of, persons receiving services and staff. At a minimum, the first aid kit must
be equipped with accessible first aid supplies including bandages, sterile compresses,
scissors, an ice bag or cold pack, an oral or surface thermometer, mild liquid soap,
adhesive tape, and first aid manual.
 new text end

new text begin Subd. 5. new text end

new text begin Emergencies. new text end

new text begin (a) The license holder must have a written plan for
responding to emergencies as defined in section 245D.02, subdivision 8, to ensure the
safety of persons served in the facility. The plan must include:
 new text end

new text begin (1) procedures for emergency evacuation and emergency sheltering, including:
 new text end

new text begin (i) how to report a fire or other emergency;
 new text end

new text begin (ii) procedures to notify, relocate, and evacuate occupants, including use of adaptive
procedures or equipment to assist with the safe evacuation of persons with physical or
sensory disabilities; and
 new text end

new text begin (iii) instructions on closing off the fire area, using fire extinguishers, and activating
and responding to alarm systems;
 new text end

new text begin (2) a floor plan that identifies:
 new text end

new text begin (i) the location of fire extinguishers;
 new text end

new text begin (ii) the location of audible or visual alarm systems, including but not limited to
manual fire alarm boxes, smoke detectors, fire alarm enunciators and controls, and
sprinkler systems;
 new text end

new text begin (iii) the location of exits, primary and secondary evacuation routes, and accessible
egress routes, if any; and
 new text end

new text begin (iv) the location of emergency shelter within the facility;
 new text end

new text begin (3) a site plan that identifies:
 new text end

new text begin (i) designated assembly points outside the facility;
 new text end

new text begin (ii) the locations of fire hydrants; and
 new text end

new text begin (iii) the routes of fire department access;
 new text end

new text begin (4) the responsibilities each staff person must assume in case of emergency;
 new text end

new text begin (5) procedures for conducting quarterly drills each year and recording the date of
each drill in the file of emergency plans;
 new text end

new text begin (6) procedures for relocation or service suspension when services are interrupted
for more than 24 hours;
 new text end

new text begin (7) for a community residential setting with three or more dwelling units, a floor
plan that identifies the location of enclosed exit stairs; and
 new text end

new text begin (8) an emergency escape plan for each resident.
 new text end

new text begin (b) The license holder must:
 new text end

new text begin (1) maintain a log of quarterly fire drills on file in the facility;
 new text end

new text begin (2) provide an emergency response plan that is readily available to staff and persons
receiving services;
 new text end

new text begin (3) inform each person of a designated area within the facility where the person
should go to for emergency shelter during severe weather and the designated assembly
points outside the facility; and
 new text end

new text begin (4) maintain emergency contact information for persons served at the facility that
can be readily accessed in an emergency.
 new text end

new text begin Subd. 6. new text end

new text begin Emergency equipment. new text end

new text begin The facility must have a flashlight and a portable
radio or television set that do not require electricity and can be used if a power failure
occurs.
 new text end

new text begin Subd. 7. new text end

new text begin Telephone and posted numbers. new text end

new text begin A facility must have a non-coin operated
telephone that is readily accessible. A list of emergency numbers must be posted in a
prominent location. When an area has a 911 number or a mental health crisis intervention
team number, both numbers must be posted and the emergency number listed must be
911. In areas of the state without a 911 number, the numbers listed must be those of the
local fire department, police department, emergency transportation, and poison control
center. The names and telephone numbers of each person's representative, physician, and
dentist must be readily available.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 34.

new text begin [245D.23] COMMUNITY RESIDENTIAL SETTINGS; SATELLITE
LICENSURE REQUIREMENTS AND APPLICATION PROCESS.
 new text end

new text begin Subdivision 1. new text end

new text begin Separate satellite license required for separate sites. new text end

new text begin (a) A license
holder providing residential support services must obtain a separate satellite license for
each community residential setting located at separate addresses when the community
residential settings are to be operated by the same license holder. For purposes of this
chapter, a community residential setting is a satellite of the home and community-based
services license.
 new text end

new text begin (b) Community residential settings are permitted single-family use homes. After a
license has been issued, the commissioner shall notify the local municipality where the
residence is located of the approved license.
 new text end

new text begin Subd. 2. new text end

new text begin Notification to local agency. new text end

new text begin The license holder must notify the local
agency within 24 hours of the onset of changes in a residence resulting from construction,
remodeling, or damages requiring repairs that require a building permit or may affect a
licensing requirement in this chapter.
 new text end

new text begin Subd. 3. new text end

new text begin Alternate overnight supervision. new text end

new text begin A license holder granted an alternate
overnight supervision technology adult foster care license according to section 245A.11,
subdivision 7a, that converts to a community residential setting satellite license according
to this chapter must retain that designation.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 35.

new text begin [245D.24] COMMUNITY RESIDENTIAL SETTINGS; PHYSICAL
PLANT AND ENVIRONMENT.
 new text end

new text begin Subdivision 1. new text end

new text begin Occupancy. new text end

new text begin The residence must meet the definition of a dwelling
unit in a residential occupancy.
 new text end

new text begin Subd. 2. new text end

new text begin Common area requirements. new text end

new text begin The living area must be provided with an
adequate number of furnishings for the usual functions of daily living and social activities.
The dining area must be furnished to accommodate meals shared by all persons living in
the residence. These furnishings must be in good repair and functional to meet the daily
needs of the persons living in the residence.
 new text end

new text begin Subd. 3. new text end

new text begin Bedrooms. new text end

new text begin (a) People receiving services must mutually consent, in
writing, to sharing a bedroom with one another. No more than two people receiving
services may share one bedroom.
 new text end

new text begin (b) A single occupancy bedroom must have at least 80 square feet of floor space with
a 7-1/2 foot ceiling. A double occupancy room must have at least 120 square feet of floor
space with a 7-1/2 foot ceiling. Bedrooms must be separated from halls, corridors, and
other habitable rooms by floor to ceiling walls containing no openings except doorways
and must not serve as a corridor to another room used in daily living.
 new text end

new text begin (c) A person's personal possessions and items for the person's own use are the only
items permitted to be stored in a person's bedroom.
 new text end

new text begin (d) Unless otherwise documented through assessment as a safety concern for the
person, each person must be provided with the following furnishings:
 new text end

new text begin (1) a separate bed of proper size and height for the convenience and comfort of the
person, with a clean mattress in good repair;
 new text end

new text begin (2) clean bedding appropriate for the season for each person;
 new text end

new text begin (3) an individual cabinet, or dresser, shelves, and a closet, for storage of personal
possessions and clothing; and
 new text end

new text begin (4) a mirror for grooming.
 new text end

new text begin (e) When possible, a person must be allowed to have items of furniture that the
person personally owns in the bedroom, unless doing so would interfere with safety
precautions, violate a building or fire code, or interfere with another person's use of the
bedroom. A person may choose to not have a cabinet, dresser, shelves, or a mirror in the
bedroom, as otherwise required under paragraph (d), clause (3) or (4). A person may
choose to use a mattress other than an innerspring mattress and may choose to not have
the mattress on a mattress frame or support. If a person chooses not to have a piece of
required furniture, the license holder must document this choice and is not required to
provide the item. If a person chooses to use a mattress other than an innerspring mattress
or chooses to not have a mattress frame or support, the license holder must document this
choice and allow the alternative desired by the person.
 new text end

new text begin (f) A person must be allowed to bring personal possessions into the bedroom
and other designated storage space, if such space is available, in the residence. The
person must be allowed to accumulate possessions to the extent the residence is able to
accommodate them, unless doing so is contraindicated for the person's physical or mental
health, would interfere with safety precautions or another person's use of the bedroom, or
would violate a building or fire code. The license holder must allow for locked storage
of personal items. Any restriction on the possession or locked storage of personal items,
including requiring a person to use a lock provided by the license holder, must comply
with section 245D.04, subdivision 3, paragraph (c), and allow the person to be present if
and when the license holder opens the lock.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 36.

new text begin [245D.25] COMMUNITY RESIDENTIAL SETTINGS; FOOD AND
WATER.
 new text end

new text begin Subdivision 1. new text end

new text begin Water. new text end

new text begin Potable water from privately owned wells must be tested
annually by a Department of Health-certified laboratory for coliform bacteria and nitrate
nitrogens to verify safety. The health authority may require retesting and corrective
measures if results exceed state water standards in Minnesota Rules, chapter 4720, or in
the event of a flooding or incident which may put the well at risk of contamination. To
prevent scalding, the water temperature of faucets must not exceed 120 degrees Fahrenheit.
 new text end

new text begin Subd. 2. new text end

new text begin Food. new text end

new text begin Food served must meet any special dietary needs of a person as
prescribed by the person's physician or dietitian. Three nutritionally balanced meals a day
must be served or made available to persons, and nutritious snacks must be available
between meals.
 new text end

new text begin Subd. 3. new text end

new text begin Food safety. new text end

new text begin Food must be obtained, handled, and properly stored to
prevent contamination, spoilage, or a threat to the health of a person.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 37.

new text begin [245D.26] COMMUNITY RESIDENTIAL SETTINGS; SANITATION
AND HEALTH.
 new text end

new text begin Subdivision 1. new text end

new text begin Goods provided by the license holder. new text end

new text begin Individual clean bed linens
appropriate for the season and the person's comfort, including towels and wash cloths,
must be available for each person. Usual or customary goods for the operation of a
residence which are communally used by all persons receiving services living in the
residence must be provided by the license holder, including household items for meal
preparation, cleaning supplies to maintain the cleanliness of the residence, window
coverings on windows for privacy, toilet paper, and hand soap.
 new text end

new text begin Subd. 2. new text end

new text begin Personal items. new text end

new text begin Personal health and hygiene items must be stored in a
safe and sanitary manner.
 new text end

new text begin Subd. 3. new text end

new text begin Pets and service animals. new text end

new text begin Pets and service animals housed within
the residence must be immunized and maintained in good health as required by local
ordinances and state law. The license holder must ensure that the person and the person's
representative is notified before admission of the presence of pets in the residence.
 new text end

new text begin Subd. 4. new text end

new text begin Smoking in the residence. new text end

new text begin License holders must comply with the
requirements of the Minnesota Clean Indoor Air Act, sections 144.411 to 144.417, when
smoking is permitted in the residence.
 new text end

new text begin Subd. 5. new text end

new text begin Weapons. new text end

new text begin Weapons and ammunition must be stored separately in locked
areas that are inaccessible to a person receiving services. For purposes of this subdivision,
"weapons" means firearms and other instruments or devices designed for and capable of
producing bodily harm.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 38.

new text begin [245D.27] DAY SERVICES FACILITIES; SATELLITE LICENSURE
REQUIREMENTS AND APPLICATION PROCESS.
 new text end

new text begin Except for day service facilities on the same or adjoining lot, the license holder
providing day services must apply for a separate license for each facility-based service
site when the license holder is the owner, lessor, or tenant of the service site at which
persons receive day services and the license holder's employees who provide day services
are present for a cumulative total of more than 30 days within any 12-month period. For
purposes of this chapter, a day services facility license is a satellite license of the day
services program. A day services program may operate multiple licensed day service
facilities in one or more counties in the state. For the purposes of this section, "adjoining
lot" means day services facilities that are next door to or across the street from one another.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 39.

new text begin [245D.28] DAY SERVICES FACILITIES; PHYSICAL PLANT AND
SPACE REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Facility capacity and useable space requirements. new text end

new text begin (a) The facility
capacity of each day service facility must be determined by the amount of primary space
available, the scheduling of activities at other service sites, and the space requirements of
all persons receiving services at the facility, not just the licensed services. The facility
capacity must specify the maximum number of persons that may receive services on
site at any one time.
 new text end

new text begin (b) When a facility is located in a multifunctional organization, the facility may
share common space with the multifunctional organization if the required available
primary space for use by persons receiving day services is maintained while the facility is
operating. The license holder must comply at all times with all applicable fire and safety
codes under section 245A.04, subdivision 2a, and adequate supervision requirements
under section 245D.31 for all persons receiving day services.
 new text end

new text begin (c) A day services facility must have a minimum of 40 square feet of primary
space available for each consumer who is present at the site at any one time. Primary
space does not include:
 new text end

new text begin (1) common areas, such as hallways, stairways, closets, utility areas, bathrooms,
and kitchens;
 new text end

new text begin (2) floor areas beneath stationary equipment; or
 new text end

new text begin (3) any space occupied by persons associated with the multifunctional organization
while persons receiving day services are using common space.
 new text end

new text begin Subd. 2. new text end

new text begin Individual personal articles. new text end

new text begin Each person must be provided space in a
closet, cabinet, on a shelf, or a coat hook for storage of personal items for the person's own
use while receiving services at the facility, unless doing so would interfere with safety
precautions, another person's work space, or violate a building or fire code.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 40.

new text begin [245D.29] DAY SERVICES FACILITIES; HEALTH AND SAFETY
REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Refrigeration. new text end

new text begin If the license holder provides refrigeration at service
sites owned or leased by the license holder for storing perishable foods and perishable
portions of bag lunches, whether the foods are supplied by the license holder or the
persons receiving services, the refrigeration must have a temperature of 40 degrees
Fahrenheit or less.
 new text end

new text begin Subd. 2. new text end

new text begin Drinking water. new text end

new text begin Drinking water must be available to all persons
receiving services. If a person is unable to request or obtain drinking water, it must be
provided according to that person's individual needs. Drinking water must be provided in
single-service containers or from drinking fountains accessible to all persons.
 new text end

new text begin Subd. 3. new text end

new text begin Individuals who become ill during the day. new text end

new text begin There must be an area in
which a person receiving services can rest if:
 new text end

new text begin (1) the person becomes ill during the day;
new text end

new text begin (2) the person does not live in a licensed residential site;
 new text end

new text begin (3) the person requires supervision; and
 new text end

new text begin (4) there is not a caretaker immediately available. Supervision must be provided
until the caretaker arrives to bring the person home.
 new text end

new text begin Subd. 4. new text end

new text begin Safety procedures. new text end

new text begin The license holder must establish general written
safety procedures that include criteria for selecting, training, and supervising persons who
work with hazardous machinery, tools, or substances. Safety procedures specific to each
person's activities must be explained and be available in writing to all staff members
and persons receiving services.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 41.

new text begin [245D.31] DAY SERVICES FACILITIES; STAFF RATIO AND
FACILITY COVERAGE.
 new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin This section applies only to facility-based day services.
 new text end

new text begin Subd. 2. new text end

new text begin Factors. new text end

new text begin (a) The number of direct support service staff members that a
license holder must have on duty at the facility at a given time to meet the minimum
staffing requirements established in this section varies according to:
 new text end

new text begin (1) the number of persons who are enrolled and receiving direct support services
at that given time;
 new text end

new text begin (2) the staff ratio requirement established under subdivision 3 for each person who
is present; and
 new text end

new text begin (3) whether the conditions described in subdivision 8 exist and warrant additional
staffing beyond the number determined to be needed under subdivision 7.
 new text end

new text begin (b) The commissioner must consider the factors in paragraph (a) in determining a
license holder's compliance with the staffing requirements and must further consider
whether the staff ratio requirement established under subdivision 3 for each person
receiving services accurately reflects the person's need for staff time.
 new text end

new text begin Subd. 3. new text end

new text begin Staff ratio requirement for each person receiving services. new text end

new text begin The case
manager, in consultation with the interdisciplinary team, must determine at least once each
year which of the ratios in subdivisions 4, 5, and 6 is appropriate for each person receiving
services on the basis of the characteristics described in subdivisions 4, 5, and 6. The ratio
assigned each person and the documentation of how the ratio was arrived at must be kept
in each person's individual service plan. Documentation must include an assessment of the
person with respect to the characteristics in subdivisions 4, 5, and 6 recorded on a standard
assessment form required by the commissioner.
 new text end

new text begin Subd. 4. new text end

new text begin Person requiring staff ratio of one to four. new text end

new text begin A person must be assigned a
staff ratio requirement of one to four if:
 new text end

new text begin (1) on a daily basis the person requires total care and monitoring or constant
hand-over-hand physical guidance to successfully complete at least three of the following
activities: toileting, communicating basic needs, eating, ambulating; or is not capable of
taking appropriate action for self-preservation under emergency conditions; or
 new text end

new text begin (2) the person engages in conduct that poses an imminent risk of physical harm to
self or others at a documented level of frequency, intensity, or duration requiring frequent
daily ongoing intervention and monitoring as established in the person's coordinated
service and support plan or coordinated service and support plan addendum.
 new text end

new text begin Subd. 5. new text end

new text begin Person requiring staff ratio of one to eight. new text end

new text begin A person must be assigned a
staff ratio requirement of one to eight if:
 new text end

new text begin (1) the person does not meet the requirements in subdivision 4; and
 new text end

new text begin (2) on a daily basis the person requires verbal prompts or spot checks and minimal
or no physical assistance to successfully complete at least four of the following activities:
toileting, communicating basic needs, eating, ambulating, or taking appropriate action for
self-preservation under emergency conditions.
 new text end

new text begin Subd. 6. new text end

new text begin Person requiring staff ratio of one to six. new text end

new text begin A person who does not have
any of the characteristics described in subdivision 4 or 5 must be assigned a staff ratio
requirement of one to six.
 new text end

new text begin Subd. 7. new text end

new text begin Determining number of direct support service staff required. new text end

new text begin The
minimum number of direct support service staff members required at any one time to
meet the combined staff ratio requirements of the persons present at that time can be
determined by the following steps:
 new text end

new text begin (1) assign each person in attendance the three-digit decimal below that corresponds
to the staff ratio requirement assigned to that person. A staff ratio requirement of one to
four equals 0.250. A staff ratio requirement of one to eight equals 0.125. A staff ratio
requirement of one to six equals 0.166. A staff ratio requirement of one to ten equals 0.100;
 new text end

new text begin (2) add all of the three-digit decimals (one three-digit decimal for every person in
attendance) assigned in clause (1);
 new text end

new text begin (3) when the sum in clause (2) falls between two whole numbers, round off the sum
to the larger of the two whole numbers; and
 new text end

new text begin (4) the larger of the two whole numbers in clause (3) equals the number of direct
support service staff members needed to meet the staff ratio requirements of the persons
in attendance.
 new text end

new text begin Subd. 8. new text end

new text begin Staff to be included in calculating minimum staffing requirement.
 new text end

new text begin Only staff providing direct support must be counted as staff members in calculating the
staff-to-participant ratio. A volunteer may be counted as a staff providing direct support
in calculating the staff-to-participant ratio if the volunteer meets the same standards
and requirements as paid staff. No person receiving services must be counted as or be
substituted for a staff member in calculating the staff-to-participant ratio.
 new text end

new text begin Subd. 9. new text end

new text begin Conditions requiring additional direct support staff. new text end

new text begin The license holder
must increase the number of direct support staff members present at any one time beyond
the number arrived at in subdivision 4 if necessary when any one or combination of the
following circumstances can be documented by the commissioner as existing:
 new text end

new text begin (1) the health and safety needs of the persons receiving services cannot be met by
the number of staff members available under the staffing pattern in effect even though the
number has been accurately calculated under subdivision 7; or
 new text end

new text begin (2) the person's conduct frequently presents an imminent risk of physical harm to
self or others.
 new text end

new text begin Subd. 10. new text end

new text begin Supervision requirements. new text end

new text begin (a) At no time must one direct support
staff member be assigned responsibility for supervision and training of more than ten
persons receiving supervision and training, except as otherwise stated in each person's risk
management plan.
 new text end

new text begin (b) In the temporary absence of the director or a supervisor, a direct support staff
member must be designated to supervise the center.
 new text end

new text begin Subd. 11. new text end

new text begin Multifunctional programs. new text end

new text begin A multifunctional program may count other
employees of the organization besides direct support staff of the day service facility in
calculating the staff to participant ratio if the employee is assigned to the day services
facility for a specified amount of time, during which the employee is not assigned to
another organization or program.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 42.

new text begin [245D.32] ALTERNATIVE LICENSING INSPECTIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Eligibility for an alternative licensing inspection. new text end

new text begin (a) A license
holder providing services licensed under this chapter, with a qualifying accreditation and
meeting the eligibility criteria in paragraphs (b) and (c) may request approval for an
alternative licensing inspection when all services provided under the license holder's
license are accredited. A license holder with a qualifying accreditation and meeting
the eligibility criteria in paragraphs (b) and (c) may request approval for an alternative
licensing inspection for individual community residential settings or day services facilities
licensed under this chapter.
 new text end

new text begin (b) In order to be eligible for an alternative licensing inspection, the program must
have had at least one inspection by the commissioner following issuance of the initial
license. For programs operating a day services facility, each facility must have had at least
one on-site inspection by the commissioner following issuance of the initial license.
 new text end

new text begin (c) In order to be eligible for an alternative licensing inspection, the program must
have been in "substantial and consistent compliance" at the time of the last licensing
inspection and during the current licensing period. For purposes of this section, substantial
and consistent compliance means:
 new text end

new text begin (1) the license holder's license was not made conditional, suspended, or revoked;
 new text end

new text begin (2) there have been no substantiated allegations of maltreatment against the license
holder;
 new text end

new text begin (3) there were no program deficiencies identified that would jeopardize the health,
safety, or rights of persons being served; and
 new text end

new text begin (4) the license holder maintained substantial compliance with the other requirements
of chapters 245A and 245C and other applicable laws and rules.
 new text end

new text begin (d) For the purposes of this section, the license holder's license includes services
licensed under this chapter that were previously licensed under chapter 245B until
December 31, 2013.
 new text end

new text begin Subd. 2. new text end

new text begin Qualifying accreditation. new text end

new text begin The commissioner must accept a three-year
accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF)
as a qualifying accreditation.
 new text end

new text begin Subd. 3. new text end

new text begin Request for approval of an alternative inspection status. new text end

new text begin (a) A request
for an alternative inspection must be made on the forms and in the manner prescribed
by the commissioner. When submitting the request, the license holder must submit all
documentation issued by the accrediting body verifying that the license holder has obtained
and maintained the qualifying accreditation and has complied with recommendations
or requirements from the accrediting body during the period of accreditation. Based
on the request and the additional required materials, the commissioner may approve
an alternative inspection status.
 new text end

new text begin (b) The commissioner must notify the license holder in writing that the request for
an alternative inspection status has been approved. Approval must be granted until the
end of the qualifying accreditation period.
 new text end

new text begin (c) The license holder must submit a written request for approval to be renewed
one month before the end of the current approval period according to the requirements
in paragraph (a). If the license holder does not submit a request to renew approval as
required, the commissioner must conduct a licensing inspection.
 new text end

new text begin Subd. 4. new text end

new text begin Programs approved for alternative licensing inspection; deemed
compliance licensing requirements. new text end

new text begin (a) A license holder approved for alternative
licensing inspection under this section is required to maintain compliance with all
licensing standards according to this chapter.
 new text end

new text begin (b) A license holder approved for alternative licensing inspection under this section
must be deemed to be in compliance with all the requirements of this chapter, and the
commissioner must not perform routine licensing inspections.
 new text end

new text begin (c) Upon receipt of a complaint regarding the services of a license holder approved
for alternative licensing inspection under this section, the commissioner must investigate
the complaint and may take any action as provided under section 245A.06 or 245A.07.
 new text end

new text begin Subd. 5. new text end

new text begin Investigations of alleged or suspected maltreatment. new text end

new text begin Nothing in this
section changes the commissioner's responsibilities to investigate alleged or suspected
maltreatment of a minor under section 626.556 or a vulnerable adult under section 626.557.
 new text end

new text begin Subd. 6. new text end

new text begin Termination or denial of subsequent approval. new text end

new text begin Following approval of
an alternative licensing inspection, the commissioner may terminate or deny subsequent
approval of an alternative licensing inspection if the commissioner determines that:
 new text end

new text begin (1) the license holder has not maintained the qualifying accreditation;
 new text end

new text begin (2) the commissioner has substantiated maltreatment for which the license holder or
facility is determined to be responsible during the qualifying accreditation period; or
 new text end

new text begin (3) during the qualifying accreditation period, the license holder has been issued
an order for conditional license, fine, suspension, or license revocation that has not been
reversed upon appeal.
 new text end

new text begin Subd. 7. new text end

new text begin Appeals. new text end

new text begin The commissioner's decision that the conditions for approval for
an alternative licensing inspection have not been met is final and not subject to appeal
under the provisions of chapter 14.
 new text end

new text begin Subd. 8. new text end

new text begin Commissioner's programs. new text end

new text begin Home and community-based services licensed
under this chapter for which the commissioner is the license holder with a qualifying
accreditation are excluded from being approved for an alternative licensing inspection.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 43.

new text begin [245D.33] ADULT MENTAL HEALTH CERTIFICATION STANDARDS.
 new text end

new text begin (a) The commissioner of human services shall issue a mental health certification
for services licensed under this chapter, when a license holder is determined to have met
the requirements under paragraph (b). This certification is voluntary for license holders.
The certification shall be printed on the license and identified on the commissioner's
public Web site.
 new text end

new text begin (b) The requirements for certification are:
 new text end

new text begin (1) all staff have received at least seven hours of annual training covering all of
the following topics:
 new text end

new text begin (i) mental health diagnoses;
 new text end

new text begin (ii) mental health crisis response and de-escalation techniques;
 new text end

new text begin (iii) recovery from mental illness;
 new text end

new text begin (iv) treatment options, including evidence-based practices;
 new text end

new text begin (v) medications and their side effects;
 new text end

new text begin (vi) co-occurring substance abuse and health conditions; and
 new text end

new text begin (vii) community resources;
 new text end

new text begin (2) a mental health professional, as defined in section 245.462, subdivision 18, or a
mental health practitioner as defined in section 245.462, subdivision 17, is available
for consultation and assistance;
 new text end

new text begin (3) there is a plan and protocol in place to address a mental health crisis; and
 new text end

new text begin (4) each person's individual service and support plan identifies who is providing
clinical services and their contact information, and includes an individual crisis prevention
and management plan developed with the person.
 new text end

new text begin (c) License holders seeking certification under this section must request this
certification on forms and in the manner prescribed by the commissioner.
 new text end

new text begin (d) If the commissioner finds that the license holder has failed to comply with the
certification requirements under paragraph (b), the commissioner may issue a correction
order and an order of conditional license in accordance with section 245A.06 or may
issue a sanction in accordance with section 245A.07, including and up to removal of
the certification.
 new text end

new text begin (e) A denial of the certification or the removal of the certification based on a
determination that the requirements under paragraph (b) have not been met is not subject to
appeal. A license holder that has been denied a certification or that has had a certification
removed may again request certification when the license holder is in compliance with the
requirements of paragraph (b).
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 44.

Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:


Subd. 11.

Residential support services.

(a) Upon federal approval, there is
established a new service called residential support that is available on the community
alternative care, community alternatives for disabled individuals, developmental
disabilities, and brain injury waivers. Existing waiver service descriptions must be
modified to the extent necessary to ensure there is no duplication between other services.
Residential support services must be provided by vendors licensed as a community
residential setting as defined in section 245A.11, subdivision 8new text begin , a foster care setting
licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or an adult foster care
setting licensed under Minnesota Rules, parts 9555.5105 to 9555.6265new text end .

(b) Residential support services must meet the following criteria:

deleted text begin (1) providers of residential support services must own or control the residential site;
 deleted text end

deleted text begin (2) the residential site must not be the primary residence of the license holder;
 deleted text end

deleted text begin (3)deleted text end new text begin (1)new text end the residential site must have a designated deleted text begin program supervisordeleted text end new text begin person
new text end responsible for programnew text begin management,new text end oversight, development, and implementation of
policies and procedures;

deleted text begin (4)deleted text end new text begin (2)new text end the provider of residential support services must provide supervision, training,
and assistance as described in the person's coordinated service and support plan; and

deleted text begin (5)deleted text end new text begin (3)new text end the provider of residential support services must meet the requirements of
licensure and additional requirements of the person's coordinated service and support plan.

(c) Providers of residential support services that meet the definition in paragraph (a)
deleted text begin must be registered using a process determined by the commissioner beginning July 1, 2009
deleted text end new text begin must be licensed according to chapter 245Dnew text end . Providers licensed to provide child foster care
under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult foster care licensed under
Minnesota Rules, parts 9555.5105 to 9555.6265, and that meet the requirements in section
245A.03, subdivision 7, paragraph (g), are considered registered under this section.

Sec. 45.

Minnesota Statutes 2012, section 256B.4912, subdivision 1, is amended to read:


Subdivision 1.

Provider qualifications.

new text begin (a) new text end For the home and community-based
waivers providing services to seniors and individuals with disabilitiesnew text begin under sections
256B.0913, 256B.0915, 256B.092, and 256B.49new text end , the commissioner shall establish:

(1) agreements with enrolled waiver service providers to ensure providers meet
Minnesota health care program requirements;

(2) regular reviews of provider qualifications, and including requests of proof of
documentation; and

(3) processes to gather the necessary information to determine provider qualifications.

new text begin (b) new text end Beginning July 1, 2012, staff that provide direct contact, as defined in section
245C.02, subdivision 11, for services specified in the federally approved waiver plans
must meet the requirements of chapter 245C prior to providing waiver services and as
part of ongoing enrollment. Upon federal approval, this requirement must also apply to
consumer-directed community supports.

new text begin (c) Beginning January 1, 2014, service owners and managerial officials overseeing
the management or policies of services that provide direct contact as specified in the
federally approved waiver plans must meet the requirements of chapter 245C prior to
reenrollment or, for new providers, prior to initial enrollment if they have not already done
so as a part of service licensure requirements.
 new text end

Sec. 46.

Minnesota Statutes 2012, section 256B.4912, subdivision 7, is amended to read:


Subd. 7.

Applicant and license holder training.

An applicant or license holder
new text begin for the home and community-based waivers providing services to seniors and individuals
with disabilities under sections 256B.0913, 256B.0915, 256B.092, and 256B.49 new text end that is
not enrolled as a Minnesota health care program home and community-based services
waiver provider at the time of application must ensure that at least one controlling
individual completes a onetime training on the requirements for providing home and
community-based services deleted text begin from a qualified sourcedeleted text end as determined by the commissioner,
before a provider is enrolled or license is issued.new text begin Within six months of enrollment, a newly
enrolled home and community-based waiver service provider must ensure that at least one
controlling individual has completed training on waiver and related program billing.
new text end

Sec. 47.

Minnesota Statutes 2012, section 256B.4912, is amended by adding a
subdivision to read:


new text begin Subd. 8. new text end

new text begin Data on use of emergency use of manual restraint. new text end

new text begin Beginning July 1,
2013, facilities and services to be licensed under chapter 245D shall submit data regarding
the use of emergency use of manual restraint as identified in section 245D.061 in a format
and at a frequency identified by the commissioner.
 new text end

Sec. 48.

Minnesota Statutes 2012, section 256B.4912, is amended by adding a
subdivision to read:


new text begin Subd. 9. new text end

new text begin Definitions. new text end

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

new text begin (b) "Controlling individual" means a public body, governmental agency, business
entity, officer, owner, or managerial official whose responsibilities include the direction of
the management or policies of a program.
 new text end

new text begin (c) "Managerial official" means an individual who has decision-making authority
related to the operation of the program and responsibility for the ongoing management of
or direction of the policies, services, or employees of the program.
 new text end

new text begin (d) "Owner" means an individual who has direct or indirect ownership interest in
a corporation or partnership, or business association enrolling with the Department of
Human Services as a provider of waiver services.
 new text end

Sec. 49.

Minnesota Statutes 2012, section 256B.4912, is amended by adding a
subdivision to read:


new text begin Subd. 10. new text end

new text begin Enrollment requirements. new text end

new text begin All home and community-based waiver
providers must provide, at the time of enrollment and within 30 days of a request, in a
format determined by the commissioner, information and documentation that includes, but
is not limited to, the following:
 new text end

new text begin (1) proof of surety bond coverage in the amount of $50,000 or ten percent of the
provider's payments from Medicaid in the previous calendar year, whichever is greater;
 new text end

new text begin (2) proof of fidelity bond coverage in the amount of $20,000; and
 new text end

new text begin (3) proof of liability insurance.
 new text end

Sec. 50.

Minnesota Statutes 2012, section 626.557, subdivision 9a, is amended to read:


Subd. 9a.

Evaluation and referral of reports made to common entry point unit.

The common entry point must screen the reports of alleged or suspected maltreatment for
immediate risk and make all necessary referrals as follows:

(1) if the common entry point determines that there is an immediate need for
adult protective services, the common entry point agency shall immediately notify the
appropriate county agency;

(2) if the report contains suspected criminal activity against a vulnerable adult, the
common entry point shall immediately notify the appropriate law enforcement agency;

(3) the common entry point shall refer all reports of alleged or suspected
maltreatment to the appropriate lead investigative agency as soon as possible, but in any
event no longer than two working days;new text begin and
new text end

deleted text begin (4) if the report involves services licensed by the Department of Human Services
and subject to chapter 245D, the common entry point shall refer the report to the county as
the lead agency according to clause (3), but shall also notify the Department of Human
Services of the report; and
 deleted text end

deleted text begin (5)deleted text end new text begin (4)new text end if the report contains information about a suspicious death, the common
entry point shall immediately notify the appropriate law enforcement agencies, the local
medical examiner, and the ombudsman for mental health and developmental disabilities
established under section 245.92. Law enforcement agencies shall coordinate with the
local medical examiner and the ombudsman as provided by law.

Sec. 51.

Minnesota Statutes 2012, section 626.5572, subdivision 13, is amended to read:


Subd. 13.

Lead investigative agency.

"Lead investigative agency" is the primary
administrative agency responsible for investigating reports made under section 626.557.

(a) The Department of Health is the lead investigative agency for facilities or
services licensed or required to be licensed as hospitals, home care providers, nursing
homes, boarding care homes, hospice providers, residential facilities that are also federally
certified as intermediate care facilities that serve people with developmental disabilities,
or any other facility or service not listed in this subdivision that is licensed or required to
be licensed by the Department of Health for the care of vulnerable adults. "Home care
provider" has the meaning provided in section 144A.43, subdivision 4, and applies when
care or services are delivered in the vulnerable adult's home, whether a private home or a
housing with services establishment registered under chapter 144D, including those that
offer assisted living services under chapter 144G.

(b) deleted text begin Except as provided under paragraph (c), for services licensed according to
chapter 245D,deleted text end The Department of Human Services is the lead investigative agency for
facilities or services licensed or required to be licensed as adult day care, adult foster care,
programs for people with developmental disabilities, family adult day services, mental
health programs, mental health clinics, chemical dependency programs, the Minnesota
sex offender program, or any other facility or service not listed in this subdivision that is
licensed or required to be licensed by the Department of Human Services.

(c) The county social service agency or its designee is the lead investigative agency
for all other reports, including, but not limited to, reports involving vulnerable adults
receiving services from a personal care provider organization under section 256B.0659deleted text begin ,
or receiving home and community-based services licensed by the Department of Human
Services and subject to chapter 245Ddeleted text end .

Sec. 52. new text begin INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
AND COMMUNITY-BASED SERVICES.
new text end

new text begin (a) The Department of Health Compliance Monitoring Division and the Department
of Human Services Licensing Division shall jointly develop an integrated licensing system
for providers of both home care services subject to licensure under Minnesota Statutes,
chapter 144A, and for home and community-based services subject to licensure under
Minnesota Statutes, chapter 245D. The integrated licensing system shall:
 new text end

new text begin (1) require only one license of any provider of services under Minnesota Statutes,
sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
 new text end

new text begin (2) promote quality services that recognize a person's individual needs and protect
the person's health, safety, rights, and well-being;
 new text end

new text begin (3) promote provider accountability through application requirements, compliance
inspections, investigations, and enforcement actions;
 new text end

new text begin (4) reference other applicable requirements in existing state and federal laws,
including the federal Affordable Care Act;
 new text end

new text begin (5) establish internal procedures to facilitate ongoing communications between the
agencies, and with providers and services recipients about the regulatory activities;
 new text end

new text begin (6) create a link between the agency Web sites so that providers and the public can
access the same information regardless of which Web site is accessed initially; and
 new text end

new text begin (7) collect data on identified outcome measures as necessary for the agencies to
report to the Centers for Medicare and Medicaid Services.
 new text end

new text begin (b) The joint recommendations for legislative changes to implement the integrated
licensing system are due to the legislature by February 15, 2014.
 new text end

new text begin (c) Before implementation of the integrated licensing system, providers licensed as
home care providers under Minnesota Statutes, chapter 144A, may also provide home
and community-based services subject to licensure under Minnesota Statutes, chapter
245D, without obtaining a home and community-based services license under Minnesota
Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
apply to these providers:
 new text end

new text begin (1) the provider must comply with all requirements under Minnesota Statutes, chapter
245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
 new text end

new text begin (2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
enforced by the Department of Health under the enforcement authority set forth in
Minnesota Statutes, section 144A.475; and
 new text end

new text begin (3) the Department of Health will provide information to the Department of Human
Services about each provider licensed under this section, including the provider's license
application, licensing documents, inspections, information about complaints received, and
investigations conducted for possible violations of Minnesota Statutes, chapter 245D.
 new text end

Sec. 53. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, sections 245B.01; 245B.02; 245B.03; 245B.031;
245B.04; 245B.05, subdivisions 1, 2, 3, 5, 6, and 7; 245B.055; 245B.06; 245B.07; and
245B.08, new text end new text begin are repealed effective January 1, 2014.
new text end

new text begin (b) new text end new text begin Minnesota Statutes 2012, section 245D.08, new text end new text begin is repealed.
 new text end

ARTICLE 9

WAIVER PROVIDER STANDARDS TECHNICAL CHANGES

Section 1.

Minnesota Statutes 2012, section 16C.10, subdivision 5, is amended to read:


Subd. 5.

Specific purchases.

The solicitation process described in this chapter is
not required for acquisition of the following:

(1) merchandise for resale purchased under policies determined by the commissioner;

(2) farm and garden products which, as determined by the commissioner, may be
purchased at the prevailing market price on the date of sale;

(3) goods and services from the Minnesota correctional facilities;

(4) goods and services from rehabilitation facilities and extended employment
providers that are certified by the commissioner of employment and economic
development, and day deleted text begin training and habilitationdeleted text end services licensed under deleted text begin sections 245B.01
to 245B.08deleted text end new text begin chapter 245Dnew text end ;

(5) goods and services for use by a community-based facility operated by the
commissioner of human services;

(6) goods purchased at auction or when submitting a sealed bid at auction provided
that before authorizing such an action, the commissioner consult with the requesting
agency to determine a fair and reasonable value for the goods considering factors
including, but not limited to, costs associated with submitting a bid, travel, transportation,
and storage. This fair and reasonable value must represent the limit of the state's bid;

(7) utility services where no competition exists or where rates are fixed by law or
ordinance; and

(8) goods and services from Minnesota sex offender program facilities.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 2.

Minnesota Statutes 2012, section 16C.155, subdivision 1, is amended to read:


Subdivision 1.

Service contracts.

The commissioner of administration shall
ensure that a portion of all contracts for janitorial services; document imaging;
document shredding; and mailing, collating, and sorting services be awarded by the
state to rehabilitation programs and extended employment providers that are certified
by the commissioner of employment and economic development, and day deleted text begin training and
habilitationdeleted text end services licensed under deleted text begin sections 245B.01 to 245B.08deleted text end new text begin chapter 245Dnew text end . The
amount of each contract awarded under this section may exceed the estimated fair market
price as determined by the commissioner for the same goods and services by up to six
percent. The aggregate value of the contracts awarded to eligible providers under this
section in any given year must exceed 19 percent of the total value of all contracts for
janitorial services; document imaging; document shredding; and mailing, collating, and
sorting services entered into in the same year. For the 19 percent requirement to be
applicable in any given year, the contract amounts proposed by eligible providers must be
within six percent of the estimated fair market price for at least 19 percent of the contracts
awarded for the corresponding service area.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 3.

Minnesota Statutes 2012, section 144D.01, subdivision 4, is amended to read:


Subd. 4.

Housing with services establishment or establishment.

(a) "Housing
with services establishment" or "establishment" means:

(1) an establishment providing sleeping accommodations to one or more adult
residents, at least 80 percent of which are 55 years of age or older, and offering or
providing, for a fee, one or more regularly scheduled health-related services or two or
more regularly scheduled supportive services, whether offered or provided directly by the
establishment or by another entity arranged for by the establishment; or

(2) an establishment that registers under section 144D.025.

(b) Housing with services establishment does not include:

(1) a nursing home licensed under chapter 144A;

(2) a hospital, certified boarding care home, or supervised living facility licensed
under sections 144.50 to 144.56;

(3) a board and lodging establishment licensed under chapter 157 and Minnesota
Rules, parts 9520.0500 to 9520.0670, 9525.0215 to 9525.0355, 9525.0500 to 9525.0660,
or 9530.4100 to 9530.4450, or under chapter deleted text begin 245Bdeleted text end new text begin 245Dnew text end ;

(4) a board and lodging establishment which serves as a shelter for battered women
or other similar purpose;

(5) a family adult foster care home licensed by the Department of Human Services;

(6) private homes in which the residents are related by kinship, law, or affinity with
the providers of services;

(7) residential settings for persons with developmental disabilities in which the
services are licensed under Minnesota Rules, parts 9525.2100 to 9525.2140, or applicable
successor rules or laws;

(8) a home-sharing arrangement such as when an elderly or disabled person or
single-parent family makes lodging in a private residence available to another person
in exchange for services or rent, or both;

(9) a duly organized condominium, cooperative, common interest community, or
owners' association of the foregoing where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are occupied by individuals
who are the owners, members, or shareholders of the units; or

(10) services for persons with developmental disabilities that are provided under
a license according to Minnesota Rules, parts 9525.2000 to 9525.2140 in effect until
January 1, 1998, or under chapter deleted text begin 245Bdeleted text end new text begin 245Dnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 4.

Minnesota Statutes 2012, section 174.30, subdivision 1, is amended to read:


Subdivision 1.

Applicability.

(a) The operating standards for special transportation
service adopted under this section do not apply to special transportation provided by:

(1) a common carrier operating on fixed routes and schedules;

(2) a volunteer driver using a private automobile;

(3) a school bus as defined in section 169.011, subdivision 71; or

(4) an emergency ambulance regulated under chapter 144.

(b) The operating standards adopted under this section only apply to providers
of special transportation service who receive grants or other financial assistance from
either the state or the federal government, or both, to provide or assist in providing that
service; except that the operating standards adopted under this section do not apply
to any nursing home licensed under section 144A.02, to any board and care facility
licensed under section 144.50, or to any day training and habilitation services, day care,
or group home facility licensed under sections 245A.01 to 245A.19 unless the facility or
program provides transportation to nonresidents on a regular basis and the facility receives
reimbursement, other than per diem payments, for that service under rules promulgated
by the commissioner of human services.

(c) Notwithstanding paragraph (b), the operating standards adopted under this
section do not apply to any vendor of services licensed under chapter deleted text begin 245Bdeleted text end new text begin 245Dnew text end that
provides transportation services to consumers or residents of other vendors licensed under
chapter deleted text begin 245Bdeleted text end new text begin 245Dnew text end and transports 15 or fewer persons, including consumers or residents
and the driver.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 5.

Minnesota Statutes 2012, section 245A.02, subdivision 1, is amended to read:


Subdivision 1.

Scope.

The terms used in this chapter deleted text begin and chapter 245Bdeleted text end have the
meanings given them in this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 6.

Minnesota Statutes 2012, section 245A.02, subdivision 9, is amended to read:


Subd. 9.

License holder.

"License holder" means an individual, corporation,
partnership, voluntary association, or other organization that is legally responsible for the
operation of the program, has been granted a license by the commissioner under this chapter
or chapter deleted text begin 245Bdeleted text end new text begin 245D new text end and the rules of the commissioner, and is a controlling individual.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 7.

Minnesota Statutes 2012, section 245A.03, subdivision 9, is amended to read:


Subd. 9.

Permitted services by an individual who is related.

Notwithstanding
subdivision 2, paragraph (a), clause (1), and subdivision 7, an individual who is related to a
person receiving supported living services may provide licensed services to that person if:

(1) the person who receives supported living services received these services in a
residential site on July 1, 2005;

(2) the services under clause (1) were provided in a corporate foster care setting for
adults and were funded by the developmental disabilities home and community-based
services waiver defined in section 256B.092;

(3) the individual who is related obtains and maintains both a license under chapter
deleted text begin 245Bdeleted text end new text begin 245Dnew text end and an adult foster care license under Minnesota Rules, parts 9555.5105
to 9555.6265; and

(4) the individual who is related is not the guardian of the person receiving supported
living services.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 8.

Minnesota Statutes 2012, section 245A.04, subdivision 13, is amended to read:


Subd. 13.

Funds and property; other requirements.

(a) A license holder must
ensure that persons served by the program retain the use and availability of personal funds
or property unless restrictions are justified in the person's individual plan. deleted text begin This subdivision
does not apply to programs governed by the provisions in section 245B.07, subdivision 10.
deleted text end

(b) The license holder must ensure separation of funds of persons served by the
program from funds of the license holder, the program, or program staff.

(c) Whenever the license holder assists a person served by the program with the
safekeeping of funds or other property, the license holder must:

(1) immediately document receipt and disbursement of the person's funds or other
property at the time of receipt or disbursement, including the person's signature, or the
signature of the conservator or payee; and

(2) return to the person upon the person's request, funds and property in the license
holder's possession subject to restrictions in the person's treatment plan, as soon as
possible, but no later than three working days after the date of request.

(d) License holders and program staff must not:

(1) borrow money from a person served by the program;

(2) purchase personal items from a person served by the program;

(3) sell merchandise or personal services to a person served by the program;

(4) require a person served by the program to purchase items for which the license
holder is eligible for reimbursement; or

(5) use funds of persons served by the program to purchase items for which the
facility is already receiving public or private payments.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 9.

Minnesota Statutes 2012, section 245A.07, subdivision 3, is amended to read:


Subd. 3.

License suspension, revocation, or fine.

(a) The commissioner may
suspend or revoke a license, or impose a fine if:

(1) a license holder fails to comply fully with applicable laws or rules;

(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
a disqualification which has not been set aside under section 245C.22;

(3) a license holder knowingly withholds relevant information from or gives false
or misleading information to the commissioner in connection with an application for
a license, in connection with the background study status of an individual, during an
investigation, or regarding compliance with applicable laws or rules; or

(4) after July 1, 2012, and upon request by the commissioner, a license holder fails
to submit the information required of an applicant under section 245A.04, subdivision 1,
paragraph (f) or (g).

A license holder who has had a license suspended, revoked, or has been ordered
to pay a fine must be given notice of the action by certified mail or personal service. If
mailed, the notice must be mailed to the address shown on the application or the last
known address of the license holder. The notice must state the reasons the license was
suspended, revoked, or a fine was ordered.

(b) If the license was suspended or revoked, the notice must inform the license
holder of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
the commissioner within ten calendar days after the license holder receives notice that the
license has been suspended or revoked. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received
the order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits
a timely appeal of an order suspending or revoking a license, the license holder may
continue to operate the program as provided in section 245A.04, subdivision 7, paragraphs
(g) and (h), until the commissioner issues a final order on the suspension or revocation.

(c)(1) If the license holder was ordered to pay a fine, the notice must inform the
license holder of the responsibility for payment of fines and the right to a contested case
hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal
of an order to pay a fine must be made in writing by certified mail or personal service. If
mailed, the appeal must be postmarked and sent to the commissioner within ten calendar
days after the license holder receives notice that the fine has been ordered. If a request is
made by personal service, it must be received by the commissioner within ten calendar
days after the license holder received the order.

(2) The license holder shall pay the fines assessed on or before the payment date
specified. If the license holder fails to fully comply with the order, the commissioner
may issue a second fine or suspend the license until the license holder complies. If the
license holder receives state funds, the state, county, or municipal agencies or departments
responsible for administering the funds shall withhold payments and recover any payments
made while the license is suspended for failure to pay a fine. A timely appeal shall stay
payment of the fine until the commissioner issues a final order.

(3) A license holder shall promptly notify the commissioner of human services,
in writing, when a violation specified in the order to forfeit a fine is corrected. If upon
reinspection the commissioner determines that a violation has not been corrected as
indicated by the order to forfeit a fine, the commissioner may issue a second fine. The
commissioner shall notify the license holder by certified mail or personal service that a
second fine has been assessed. The license holder may appeal the second fine as provided
under this subdivision.

(4) Fines shall be assessed as follows: the license holder shall forfeit $1,000 for
each determination of maltreatment of a child under section 626.556 or the maltreatment
of a vulnerable adult under section 626.557 for which the license holder is determined
responsible for the maltreatment under section 626.556, subdivision 10e, paragraph (i),
or 626.557, subdivision 9c, paragraph (c); the license holder shall forfeit $200 for each
occurrence of a violation of law or rule governing matters of health, safety, or supervision,
including but not limited to the provision of adequate staff-to-child or adult ratios, and
failure to comply with background study requirements under chapter 245C; and the license
holder shall forfeit $100 for each occurrence of a violation of law or rule other than
those subject to a $1,000 or $200 fine above. For purposes of this section, "occurrence"
means each violation identified in the commissioner's fine order. Fines assessed against a
license holder that holds a license to provide deleted text begin the residential-based habilitationdeleted text end new text begin home and
community-based new text end services, as deleted text begin defined underdeleted text end new text begin identified innew text end section deleted text begin 245B.02, subdivision
20deleted text end new text begin 245D.03, subdivision 1new text end , and a new text begin community residential setting or day services facility
new text end license deleted text begin to provide foster caredeleted text end new text begin under chapter 245D where the services are providednew text end , may be
assessed against both licenses for the same occurrence, but the combined amount of the
fines shall not exceed the amount specified in this clause for that occurrence.

(5) When a fine has been assessed, the license holder may not avoid payment by
closing, selling, or otherwise transferring the licensed program to a third party. In such an
event, the license holder will be personally liable for payment. In the case of a corporation,
each controlling individual is personally and jointly liable for payment.

(d) Except for background study violations involving the failure to comply with an
order to immediately remove an individual or an order to provide continuous, direct
supervision, the commissioner shall not issue a fine under paragraph (c) relating to a
background study violation to a license holder who self-corrects a background study
violation before the commissioner discovers the violation. A license holder who has
previously exercised the provisions of this paragraph to avoid a fine for a background
study violation may not avoid a fine for a subsequent background study violation unless at
least 365 days have passed since the license holder self-corrected the earlier background
study violation.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 10.

Minnesota Statutes 2012, section 256B.0625, subdivision 19c, is amended to
read:


Subd. 19c.

Personal care.

Medical assistance covers personal care assistance
services provided by an individual who is qualified to provide the services according to
subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
plan, and supervised by a qualified professional.

"Qualified professional" means a mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6);
deleted text begin ordeleted text end a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker
as defined in sections 148E.010 and 148E.055, or a qualified deleted text begin developmental disabilities
deleted text end deleted text begin specialist under section 245B.07, subdivision 4deleted text end new text begin designated coordinator under section
245D.081, subdivision 2new text end . The qualified professional shall perform the duties required in
section 256B.0659.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 11.

Minnesota Statutes 2012, section 256B.5011, subdivision 2, is amended to read:


Subd. 2.

Contract provisions.

(a) The service contract with each intermediate
care facility must include provisions for:

(1) modifying payments when significant changes occur in the needs of the
consumers;

(2) appropriate and necessary statistical information required by the commissioner;

(3) annual aggregate facility financial information; and

(4) additional requirements for intermediate care facilities not meeting the standards
set forth in the service contract.

(b) The commissioner of human services and the commissioner of health, in
consultation with representatives from counties, advocacy organizations, and the provider
community, shall review deleted text begin the consolidated standards under chapter 245B anddeleted text end new text begin the home and
community-based services standards under chapter 245D and new text end the supervised living facility
rule under Minnesota Rules, chapter 4665, to determine what provisions in Minnesota
Rules, chapter 4665, may be waived by the commissioner of health for intermediate care
facilities in order to enable facilities to implement the performance measures in their
contract and provide quality services to residents without a duplication of or increase in
regulatory requirements.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 12.

Minnesota Statutes 2012, section 471.59, subdivision 1, is amended to read:


Subdivision 1.

Agreement.

Two or more governmental units, by agreement entered
into through action of their governing bodies, may jointly or cooperatively exercise
any power common to the contracting parties or any similar powers, including those
which are the same except for the territorial limits within which they may be exercised.
The agreement may provide for the exercise of such powers by one or more of the
participating governmental units on behalf of the other participating units. The term
"governmental unit" as used in this section includes every city, county, town, school
district, independent nonprofit firefighting corporation, other political subdivision of
this or another state, another state, federally recognized Indian tribe, the University
of Minnesota, the Minnesota Historical Society, nonprofit hospitals licensed under
sections 144.50 to 144.56, rehabilitation facilities and extended employment providers
that are certified by the commissioner of employment and economic development, deleted text begin day
training and habilitation services licensed under sections 245B.01 to 245B.08,deleted text end new text begin day and
supported employment services licensed under chapter 245D, new text end and any agency of the state
of Minnesota or the United States, and includes any instrumentality of a governmental
unit. For the purpose of this section, an instrumentality of a governmental unit means an
instrumentality having independent policy-making and appropriating authority.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 13.

Minnesota Statutes 2012, section 626.556, subdivision 2, is amended to read:


Subd. 2.

Definitions.

As used in this section, the following terms have the meanings
given them unless the specific content indicates otherwise:

(a) "Family assessment" means a comprehensive assessment of child safety, risk
of subsequent child maltreatment, and family strengths and needs that is applied to a
child maltreatment report that does not allege substantial child endangerment. Family
assessment does not include a determination as to whether child maltreatment occurred
but does determine the need for services to address the safety of family members and the
risk of subsequent maltreatment.

(b) "Investigation" means fact gathering related to the current safety of a child
and the risk of subsequent maltreatment that determines whether child maltreatment
occurred and whether child protective services are needed. An investigation must be used
when reports involve substantial child endangerment, and for reports of maltreatment in
facilities required to be licensed under chapter 245A or 245B; under sections 144.50 to
144.58 and 241.021; in a school as defined in sections 120A.05, subdivisions 9, 11, and
13, and 124D.10; or in a nonlicensed personal care provider association as defined in
sections 256B.04, subdivision 16, and 256B.0625, subdivision 19a.

(c) "Substantial child endangerment" means a person responsible for a child's care,
and in the case of sexual abuse includes a person who has a significant relationship to the
child as defined in section 609.341, or a person in a position of authority as defined in
section 609.341, who by act or omission commits or attempts to commit an act against a
child under their care that constitutes any of the following:

(1) egregious harm as defined in section 260C.007, subdivision 14;

(2) sexual abuse as defined in paragraph (d);

(3) abandonment under section 260C.301, subdivision 2;

(4) neglect as defined in paragraph (f), clause (2), that substantially endangers the
child's physical or mental health, including a growth delay, which may be referred to as
failure to thrive, that has been diagnosed by a physician and is due to parental neglect;

(5) murder in the first, second, or third degree under section 609.185, 609.19, or
609.195;

(6) manslaughter in the first or second degree under section 609.20 or 609.205;

(7) assault in the first, second, or third degree under section 609.221, 609.222, or
609.223;

(8) solicitation, inducement, and promotion of prostitution under section 609.322;

(9) criminal sexual conduct under sections 609.342 to 609.3451;

(10) solicitation of children to engage in sexual conduct under section 609.352;

(11) malicious punishment or neglect or endangerment of a child under section
609.377 or 609.378;

(12) use of a minor in sexual performance under section 617.246; or

(13) parental behavior, status, or condition which mandates that the county attorney
file a termination of parental rights petition under section 260C.301, subdivision 3,
paragraph (a).

(d) "Sexual abuse" means the subjection of a child by a person responsible for the
child's care, by a person who has a significant relationship to the child, as defined in
section 609.341, or by a person in a position of authority, as defined in section 609.341,
subdivision 10, to any act which constitutes a violation of section 609.342 (criminal sexual
conduct in the first degree), 609.343 (criminal sexual conduct in the second degree),
609.344 (criminal sexual conduct in the third degree), 609.345 (criminal sexual conduct
in the fourth degree), or 609.3451 (criminal sexual conduct in the fifth degree). Sexual
abuse also includes any act which involves a minor which constitutes a violation of
prostitution offenses under sections 609.321 to 609.324 or 617.246. Sexual abuse includes
threatened sexual abuse which includes the status of a parent or household member
who has committed a violation which requires registration as an offender under section
243.166, subdivision 1b, paragraph (a) or (b), or required registration under section
243.166, subdivision 1b, paragraph (a) or (b).

(e) "Person responsible for the child's care" means (1) an individual functioning
within the family unit and having responsibilities for the care of the child such as a
parent, guardian, or other person having similar care responsibilities, or (2) an individual
functioning outside the family unit and having responsibilities for the care of the child
such as a teacher, school administrator, other school employees or agents, or other lawful
custodian of a child having either full-time or short-term care responsibilities including,
but not limited to, day care, babysitting whether paid or unpaid, counseling, teaching,
and coaching.

(f) "Neglect" means the commission or omission of any of the acts specified under
clauses (1) to (9), other than by accidental means:

(1) failure by a person responsible for a child's care to supply a child with necessary
food, clothing, shelter, health, medical, or other care required for the child's physical or
mental health when reasonably able to do so;

(2) failure to protect a child from conditions or actions that seriously endanger the
child's physical or mental health when reasonably able to do so, including a growth delay,
which may be referred to as a failure to thrive, that has been diagnosed by a physician and
is due to parental neglect;

(3) failure to provide for necessary supervision or child care arrangements
appropriate for a child after considering factors as the child's age, mental ability, physical
condition, length of absence, or environment, when the child is unable to care for the
child's own basic needs or safety, or the basic needs or safety of another child in their care;

(4) failure to ensure that the child is educated as defined in sections 120A.22 and
260C.163, subdivision 11, which does not include a parent's refusal to provide the parent's
child with sympathomimetic medications, consistent with section 125A.091, subdivision 5;

(5) nothing in this section shall be construed to mean that a child is neglected solely
because the child's parent, guardian, or other person responsible for the child's care in
good faith selects and depends upon spiritual means or prayer for treatment or care of
disease or remedial care of the child in lieu of medical care; except that a parent, guardian,
or caretaker, or a person mandated to report pursuant to subdivision 3, has a duty to report
if a lack of medical care may cause serious danger to the child's health. This section does
not impose upon persons, not otherwise legally responsible for providing a child with
necessary food, clothing, shelter, education, or medical care, a duty to provide that care;

(6) prenatal exposure to a controlled substance, as defined in section 253B.02,
subdivision 2, used by the mother for a nonmedical purpose, as evidenced by withdrawal
symptoms in the child at birth, results of a toxicology test performed on the mother at
delivery or the child at birth, medical effects or developmental delays during the child's
first year of life that medically indicate prenatal exposure to a controlled substance, or the
presence of a fetal alcohol spectrum disorder;

(7) "medical neglect" as defined in section 260C.007, subdivision 6, clause (5);

(8) chronic and severe use of alcohol or a controlled substance by a parent or
person responsible for the care of the child that adversely affects the child's basic needs
and safety; or

(9) emotional harm from a pattern of behavior which contributes to impaired
emotional functioning of the child which may be demonstrated by a substantial and
observable effect in the child's behavior, emotional response, or cognition that is not
within the normal range for the child's age and stage of development, with due regard to
the child's culture.

(g) "Physical abuse" means any physical injury, mental injury, or threatened injury,
inflicted by a person responsible for the child's care on a child other than by accidental
means, or any physical or mental injury that cannot reasonably be explained by the child's
history of injuries, or any aversive or deprivation procedures, or regulated interventions,
that have not been authorized under section 121A.67 or 245.825.

Abuse does not include reasonable and moderate physical discipline of a child
administered by a parent or legal guardian which does not result in an injury. Abuse does
not include the use of reasonable force by a teacher, principal, or school employee as
allowed by section 121A.582. Actions which are not reasonable and moderate include,
but are not limited to, any of the following that are done in anger or without regard to the
safety of the child:

(1) throwing, kicking, burning, biting, or cutting a child;

(2) striking a child with a closed fist;

(3) shaking a child under age three;

(4) striking or other actions which result in any nonaccidental injury to a child
under 18 months of age;

(5) unreasonable interference with a child's breathing;

(6) threatening a child with a weapon, as defined in section 609.02, subdivision 6;

(7) striking a child under age one on the face or head;

(8) purposely giving a child poison, alcohol, or dangerous, harmful, or controlled
substances which were not prescribed for the child by a practitioner, in order to control or
punish the child; or other substances that substantially affect the child's behavior, motor
coordination, or judgment or that results in sickness or internal injury, or subjects the
child to medical procedures that would be unnecessary if the child were not exposed
to the substances;

(9) unreasonable physical confinement or restraint not permitted under section
609.379, including but not limited to tying, caging, or chaining; or

(10) in a school facility or school zone, an act by a person responsible for the child's
care that is a violation under section 121A.58.

(h) "Report" means any report received by the local welfare agency, police
department, county sheriff, or agency responsible for assessing or investigating
maltreatment pursuant to this section.

(i) "Facility" means:

(1) a licensed or unlicensed day care facility, residential facility, agency, hospital,
sanitarium, or other facility or institution required to be licensed under sections 144.50 to
144.58, 241.021, or 245A.01 to 245A.16, or chapter deleted text begin 245Bdeleted text end new text begin 245Dnew text end ;

(2) a school as defined in sections 120A.05, subdivisions 9, 11, and 13; and
124D.10; or

(3) a nonlicensed personal care provider organization as defined in sections 256B.04,
subdivision 16, and 256B.0625, subdivision 19a.

(j) "Operator" means an operator or agency as defined in section 245A.02.

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

(l) "Practice of social services," for the purposes of subdivision 3, includes but is
not limited to employee assistance counseling and the provision of guardian ad litem and
parenting time expeditor services.

(m) "Mental injury" means an injury to the psychological capacity or emotional
stability of a child as evidenced by an observable or substantial impairment in the child's
ability to function within a normal range of performance and behavior with due regard to
the child's culture.

(n) "Threatened injury" means a statement, overt act, condition, or status that
represents a substantial risk of physical or sexual abuse or mental injury. Threatened
injury includes, but is not limited to, exposing a child to a person responsible for the
child's care, as defined in paragraph (e), clause (1), who has:

(1) subjected a child to, or failed to protect a child from, an overt act or condition
that constitutes egregious harm, as defined in section 260C.007, subdivision 14, or a
similar law of another jurisdiction;

(2) been found to be palpably unfit under section 260C.301, paragraph (b), clause
(4), or a similar law of another jurisdiction;

(3) committed an act that has resulted in an involuntary termination of parental rights
under section 260C.301, or a similar law of another jurisdiction; or

(4) committed an act that has resulted in the involuntary transfer of permanent
legal and physical custody of a child to a relative under Minnesota Statutes 2010, section
260C.201, subdivision 11, paragraph (d), clause (1), section 260C.515, subdivision 4, or a
similar law of another jurisdiction.

A child is the subject of a report of threatened injury when the responsible social
services agency receives birth match data under paragraph (o) from the Department of
Human Services.

(o) Upon receiving data under section 144.225, subdivision 2b, contained in a
birth record or recognition of parentage identifying a child who is subject to threatened
injury under paragraph (n), the Department of Human Services shall send the data to the
responsible social services agency. The data is known as "birth match" data. Unless the
responsible social services agency has already begun an investigation or assessment of the
report due to the birth of the child or execution of the recognition of parentage and the
parent's previous history with child protection, the agency shall accept the birth match
data as a report under this section. The agency may use either a family assessment or
investigation to determine whether the child is safe. All of the provisions of this section
apply. If the child is determined to be safe, the agency shall consult with the county
attorney to determine the appropriateness of filing a petition alleging the child is in need
of protection or services under section 260C.007, subdivision 6, clause (16), in order to
deliver needed services. If the child is determined not to be safe, the agency and the county
attorney shall take appropriate action as required under section 260C.301, subdivision 3.

(p) Persons who conduct assessments or investigations under this section shall take
into account accepted child-rearing practices of the culture in which a child participates
and accepted teacher discipline practices, which are not injurious to the child's health,
welfare, and safety.

(q) "Accidental" means a sudden, not reasonably foreseeable, and unexpected
occurrence or event which:

(1) is not likely to occur and could not have been prevented by exercise of due
care; and

(2) if occurring while a child is receiving services from a facility, happens when the
facility and the employee or person providing services in the facility are in compliance
with the laws and rules relevant to the occurrence or event.

(r) "Nonmaltreatment mistake" means:

(1) at the time of the incident, the individual was performing duties identified in the
center's child care program plan required under Minnesota Rules, part 9503.0045;

(2) the individual has not been determined responsible for a similar incident that
resulted in a finding of maltreatment for at least seven years;

(3) the individual has not been determined to have committed a similar
nonmaltreatment mistake under this paragraph for at least four years;

(4) any injury to a child resulting from the incident, if treated, is treated only with
remedies that are available over the counter, whether ordered by a medical professional or
not; and

(5) except for the period when the incident occurred, the facility and the individual
providing services were both in compliance with all licensing requirements relevant to the
incident.

This definition only applies to child care centers licensed under Minnesota
Rules, chapter 9503. If clauses (1) to (5) apply, rather than making a determination of
substantiated maltreatment by the individual, the commissioner of human services shall
determine that a nonmaltreatment mistake was made by the individual.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 14.

Minnesota Statutes 2012, section 626.556, subdivision 3, is amended to read:


Subd. 3.

Persons mandated to report.

(a) A person who knows or has reason
to believe a child is being neglected or physically or sexually abused, as defined in
subdivision 2, or has been neglected or physically or sexually abused within the preceding
three years, shall immediately report the information to the local welfare agency, agency
responsible for assessing or investigating the report, police department, or the county
sheriff if the person is:

(1) a professional or professional's delegate who is engaged in the practice of
the healing arts, social services, hospital administration, psychological or psychiatric
treatment, child care, education, correctional supervision, probation and correctional
services, or law enforcement; or

(2) employed as a member of the clergy and received the information while
engaged in ministerial duties, provided that a member of the clergy is not required by
this subdivision to report information that is otherwise privileged under section 595.02,
subdivision 1, paragraph (c).

The police department or the county sheriff, upon receiving a report, shall
immediately notify the local welfare agency or agency responsible for assessing or
investigating the report, orally and in writing. The local welfare agency, or agency
responsible for assessing or investigating the report, upon receiving a report, shall
immediately notify the local police department or the county sheriff orally and in writing.
The county sheriff and the head of every local welfare agency, agency responsible
for assessing or investigating reports, and police department shall each designate a
person within their agency, department, or office who is responsible for ensuring that
the notification duties of this paragraph and paragraph (b) are carried out. Nothing in
this subdivision shall be construed to require more than one report from any institution,
facility, school, or agency.

(b) Any person may voluntarily report to the local welfare agency, agency responsible
for assessing or investigating the report, police department, or the county sheriff if the
person knows, has reason to believe, or suspects a child is being or has been neglected or
subjected to physical or sexual abuse. The police department or the county sheriff, upon
receiving a report, shall immediately notify the local welfare agency or agency responsible
for assessing or investigating the report, orally and in writing. The local welfare agency or
agency responsible for assessing or investigating the report, upon receiving a report, shall
immediately notify the local police department or the county sheriff orally and in writing.

(c) A person mandated to report physical or sexual child abuse or neglect occurring
within a licensed facility shall report the information to the agency responsible for
licensing the facility under sections 144.50 to 144.58; 241.021; 245A.01 to 245A.16; or
chapter deleted text begin 245Bdeleted text end new text begin 245Dnew text end ; or a nonlicensed personal care provider organization as defined in
sections 256B.04, subdivision 16; and 256B.0625, subdivision 19. A health or corrections
agency receiving a report may request the local welfare agency to provide assistance
pursuant to subdivisions 10, 10a, and 10b. A board or other entity whose licensees
perform work within a school facility, upon receiving a complaint of alleged maltreatment,
shall provide information about the circumstances of the alleged maltreatment to the
commissioner of education. Section 13.03, subdivision 4, applies to data received by the
commissioner of education from a licensing entity.

(d) Any person mandated to report shall receive a summary of the disposition of
any report made by that reporter, including whether the case has been opened for child
protection or other services, or if a referral has been made to a community organization,
unless release would be detrimental to the best interests of the child. Any person who is
not mandated to report shall, upon request to the local welfare agency, receive a concise
summary of the disposition of any report made by that reporter, unless release would be
detrimental to the best interests of the child.

(e) For purposes of this section, "immediately" means as soon as possible but in
no event longer than 24 hours.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 15.

Minnesota Statutes 2012, section 626.556, subdivision 10d, is amended to read:


Subd. 10d.

Notification of neglect or abuse in facility.

(a) When a report is
received that alleges neglect, physical abuse, sexual abuse, or maltreatment of a child while
in the care of a licensed or unlicensed day care facility, residential facility, agency, hospital,
sanitarium, or other facility or institution required to be licensed according to sections
144.50 to 144.58; 241.021; or 245A.01 to 245A.16; or chapter deleted text begin 245Bdeleted text end new text begin 245Dnew text end , or a school as
defined in sections 120A.05, subdivisions 9, 11, and 13; and 124D.10; or a nonlicensed
personal care provider organization as defined in section 256B.04, subdivision 16, and
256B.0625, subdivision 19a, the commissioner of the agency responsible for assessing
or investigating the report or local welfare agency investigating the report shall provide
the following information to the parent, guardian, or legal custodian of a child alleged to
have been neglected, physically abused, sexually abused, or the victim of maltreatment
of a child in the facility: the name of the facility; the fact that a report alleging neglect,
physical abuse, sexual abuse, or maltreatment of a child in the facility has been received;
the nature of the alleged neglect, physical abuse, sexual abuse, or maltreatment of a child
in the facility; that the agency is conducting an assessment or investigation; any protective
or corrective measures being taken pending the outcome of the investigation; and that a
written memorandum will be provided when the investigation is completed.

(b) The commissioner of the agency responsible for assessing or investigating the
report or local welfare agency may also provide the information in paragraph (a) to the
parent, guardian, or legal custodian of any other child in the facility if the investigative
agency knows or has reason to believe the alleged neglect, physical abuse, sexual
abuse, or maltreatment of a child in the facility has occurred. In determining whether
to exercise this authority, the commissioner of the agency responsible for assessing
or investigating the report or local welfare agency shall consider the seriousness of the
alleged neglect, physical abuse, sexual abuse, or maltreatment of a child in the facility; the
number of children allegedly neglected, physically abused, sexually abused, or victims of
maltreatment of a child in the facility; the number of alleged perpetrators; and the length
of the investigation. The facility shall be notified whenever this discretion is exercised.

(c) When the commissioner of the agency responsible for assessing or investigating
the report or local welfare agency has completed its investigation, every parent, guardian,
or legal custodian previously notified of the investigation by the commissioner or
local welfare agency shall be provided with the following information in a written
memorandum: the name of the facility investigated; the nature of the alleged neglect,
physical abuse, sexual abuse, or maltreatment of a child in the facility; the investigator's
name; a summary of the investigation findings; a statement whether maltreatment was
found; and the protective or corrective measures that are being or will be taken. The
memorandum shall be written in a manner that protects the identity of the reporter and
the child and shall not contain the name, or to the extent possible, reveal the identity of
the alleged perpetrator or of those interviewed during the investigation. If maltreatment
is determined to exist, the commissioner or local welfare agency shall also provide the
written memorandum to the parent, guardian, or legal custodian of each child in the facility
who had contact with the individual responsible for the maltreatment. When the facility is
the responsible party for maltreatment, the commissioner or local welfare agency shall also
provide the written memorandum to the parent, guardian, or legal custodian of each child
who received services in the population of the facility where the maltreatment occurred.
This notification must be provided to the parent, guardian, or legal custodian of each child
receiving services from the time the maltreatment occurred until either the individual
responsible for maltreatment is no longer in contact with a child or children in the facility
or the conclusion of the investigation. In the case of maltreatment within a school facility,
as defined in sections 120A.05, subdivisions 9, 11, and 13, and 124D.10, the commissioner
of education need not provide notification to parents, guardians, or legal custodians of
each child in the facility, but shall, within ten days after the investigation is completed,
provide written notification to the parent, guardian, or legal custodian of any student
alleged to have been maltreated. The commissioner of education may notify the parent,
guardian, or legal custodian of any student involved as a witness to alleged maltreatment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014.
 new text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2012, section 256B.49, subdivision 16a, new text end new text begin is repealed effective
January 1, 2014.
 new text end

ARTICLE 10

MISCELLANEOUS

Section 1.

Minnesota Statutes 2012, section 62A.65, subdivision 2, is amended to read:


Subd. 2.

Guaranteed renewal.

new text begin (a) new text end No individual health plan may be offered, sold,
issued, or renewed to a Minnesota resident unless the health plan provides that the plan
is guaranteed renewable at a premium rate that does not take into account the claims
experience or any change in the health status of any covered person that occurred after
the initial issuance of the health plan to the person. The premium rate upon renewal
must also otherwise comply with this section. A health carrier must not refuse to renew
an individual health plan, except for nonpayment of premiums, fraud, ornew text begin intentional
new text end misrepresentationnew text begin of a material factnew text end .

new text begin (b) A health carrier may elect to discontinue health plan coverage of an individual in
the individual market only, excluding a grandfathered plan as defined in section 62A.011,
subdivision 1c, in one or more of the following situations:
 new text end

new text begin (1) the health carrier is ceasing to offer individual health plan coverage in the
individual market in accordance with sections 62A.65, subdivision 8, 62E.11, subdivision
9, and federal law;
 new text end

new text begin (2) for network plans, the individual no longer resides, lives, or works in the
service area of the health carrier, or the area for which the health carrier is authorized to
do business, but only if coverage is terminated uniformly without regard to any health
status-related factor of covered individuals; or
 new text end

new text begin (3) a decision by the health carrier to discontinue offering a particular type of
individual health plan if it meets the following requirements:
 new text end

new text begin (i) provides notice in writing to each individual provided coverage of that type of
health plan at least 90 days before the date coverage will be discontinued;
 new text end

new text begin (ii) provides notice to the commissioner of commerce at least 30 business days
before the issuer or health carrier gives notice to the individuals;
 new text end

new text begin (iii) offers to each covered individual information about products currently offered
that are closest in actuarial equivalence;
 new text end

new text begin (iv) offers to each covered individual, on a guaranteed issue basis, the option to
purchase any other individual health plan currently being offered by the health carrier or
related health carrier for individuals in the market; and
 new text end

new text begin (v) acts uniformly without regard to any health status-related factor of covered
individuals or dependents of covered individuals who may become eligible for coverage.
 new text end

Sec. 2.

Minnesota Statutes 2012, section 62A.65, is amended by adding a subdivision
to read:


new text begin Subd. 2a. new text end

new text begin Modification of plan. new text end

new text begin At the time of coverage renewal, an issuer or
health carrier may modify the health plan, excluding a grandfathered plan as defined under
section 62A.011, subdivision 1c, providing individual health plan coverage offered to
individuals in the individual market, so long as the modification is consistent with state
law and is effective on a uniform basis for individuals with that coverage.
 new text end

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 deleted text begin tendeleted text end new text begin 25new text end full-day absent days per child, excluding
holidays, in a fiscal yearnew text begin , or for more than ten consecutive full-day absent daysnew text end . 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 deleted text begin tendeleted text end absent deleted text begin daydeleted text end new text begin daysnew text end 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.

new text begin (b) Notwithstanding paragraph (a), children with documented medical conditions
that cause more frequent absences may exceed the 25 absent days limit, or ten consecutive
full-day absent days limit. Absences due to a documented medical condition of a parent
or sibling who lives in the same residence as the child receiving child care assistance
do not count against the absent days limit in a fiscal year. Documentation of medical
conditions must be on the forms and submitted according to the timelines established by
the commissioner. A public health nurse or school nurse may verify the illness in lieu of
a medical practitioner. If a provider sends a child home early due to a medical reason,
including, but not limited to, fever or contagious illness, the child care center director or
lead teacher may verify the illness in lieu of a medical practitioner.
 new text end

deleted text begin (b)deleted text end new text begin (c)new text end Notwithstanding paragraph (a), children in families may exceed the deleted text begin tendeleted text end 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.

deleted text begin (c)deleted text end new text begin (d)new text end 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 deleted text begin tendeleted text end absent deleted text begin daydeleted text end new text begin daysnew text end limit.

deleted text begin (d)deleted text end new text begin (e)new text end 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.

deleted text begin (e)deleted text end new text begin (f)new text end 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.

new text begin (g) For purposes of this subdivision, "absent days limit" means 25 full-day absent
days per child, excluding holidays, in a fiscal year; and ten consecutive full-day absent days.
 new text end

Sec. 4.

new text begin [214.075] HEALTH-RELATED LICENSING BOARDS; CRIMINAL
BACKGROUND CHECKS.
 new text end

new text begin Subdivision 1. new text end

new text begin Applications. new text end

new text begin (a) By January 1, 2018, each health-related licensing
board, as defined in section 214.01, subdivision 2, shall require applicants for initial
licensure, licensure by endorsement, or reinstatement or other relicensure after a lapse
in licensure, as defined by the individual health-related licensing boards to submit to
a criminal history records check of state data completed by the Bureau of Criminal
Apprehension (BCA) and a national criminal history records check, including a search of
the records of the Federal Bureau of Investigation (FBI).
 new text end

new text begin (b) An applicant must complete a criminal background check if more than one year
has elapsed since the applicant last submitted a background check to the board.
 new text end

new text begin Subd. 2. new text end

new text begin Investigations. new text end

new text begin If a health-related licensing board has reasonable cause
to believe a licensee has been charged with or convicted of a crime in this or any other
jurisdiction, the health-related licensing board may require the licensee to submit to a
criminal history records check of state data completed by the BCA and a national criminal
history records check, including a search of the records of the FBI.
 new text end

new text begin Subd. 3. new text end

new text begin Consent form; fees; fingerprints. new text end

new text begin In order to effectuate the federal
and state level, fingerprint-based criminal background check, the applicant or licensee
must submit a completed criminal history records check consent form and a full set of
fingerprints to the respective health-related licensing board or a designee in the manner
and form specified by the board. The applicant or licensee is responsible for all fees
associated with preparation of the fingerprints, the criminal records check consent form,
and the criminal background check. The fees for the criminal records background check
shall be set by the BCA and the FBI and are not refundable.
 new text end

new text begin Subd. 4. new text end

new text begin Refusal to consent. new text end

new text begin (a) The health-related licensing boards shall not issue
a license to any applicant who refuses to consent to a criminal background check or fails
to submit fingerprints within 90 days after submission of an application for licensure. Any
fees paid by the applicant to the board shall be forfeited if the applicant refuses to consent
to the criminal background check or fails to submit the required fingerprints.
 new text end

new text begin (b) The failure of a licensee to submit to a criminal background check as provided in
subdivision 3 is grounds for disciplinary action by the respective health licensing board.
 new text end

new text begin Subd. 5. new text end

new text begin Submission of fingerprints to BCA. new text end

new text begin The health-related licensing board
or designee shall submit applicant or licensee fingerprints to the BCA. The BCA shall
perform a check for state criminal justice information and shall forward the applicant's
or licensee's fingerprints to the FBI to perform a check for national criminal justice
information regarding the applicant or licensee. The BCA shall report to the board the
results of the state and national criminal justice information checks.
 new text end

new text begin Subd. 6. new text end

new text begin Alternatives to fingerprint-based criminal background checks. new text end

new text begin The
health-related licensing board may require an alternative method of criminal history
checks for an applicant or licensee who has submitted at least three sets of fingerprints in
accordance with this section that have been unreadable by the BCA or FBI.
 new text end

new text begin Subd. 7. new text end

new text begin Opportunity to challenge accuracy of report. new text end

new text begin Prior to taking disciplinary
action against an applicant or a licensee based on a criminal conviction, the health-related
licensing board shall provide the applicant or licensee an opportunity to complete or
challenge the accuracy of the criminal history information reported to the board. The
applicant or licensee shall have 30 calendar days following notice from the board of the
intent to deny licensure or take disciplinary action to request an opportunity to correct or
complete the record prior to the board taking disciplinary action based on the information
reported to the board. The board shall provide the applicant up to 180 days to challenge
the accuracy or completeness of the report with the agency responsible for the record. This
subdivision does not affect the right of the subject of the data to contest the accuracy or
completeness under section 13.04, subdivision 4.
 new text end

new text begin Subd. 8. new text end

new text begin Instructions to the board; plans. new text end

new text begin The health-related licensing boards, in
collaboration with the commissioner of human services and the BCA, shall establish a
plan for completing criminal background checks of all licensees who were licensed before
the effective date requirement under subdivision 1. The plan must seek to minimize
duplication of requirements for background checks of licensed health professionals. The
plan for background checks of current licensees shall be developed no later than January
1, 2017, and may be contingent upon the implementation of a system by the BCA or FBI
in which any new crimes that an applicant or licensee commits after an initial background
check are flagged in the BCA's or FBI's database and reported back to the board. The plan
shall include recommendations for any necessary statutory changes.
 new text end

Sec. 5.

Minnesota Statutes 2012, section 214.40, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this
section.

(b) "Administrative services unit" means the administrative services unit for the
health-related licensing boards.

(c) "Charitable organization" means a charitable organization within the meaning of
section 501(c)(3) of the Internal Revenue Code that has as a purpose the sponsorship or
support of programs designed to improve the quality, awareness, and availability of health
care services and that serves as a funding mechanism for providing those services.

(d) "Health care facility or organization" means a health care facility licensed under
chapter 144 or 144A, or a charitable organization.

(e) "Health care provider" means a physician licensed under chapter 147, physician
assistant registered and practicing under chapter 147A, nurse licensed and registered to
practice under chapter 148, or dentist deleted text begin ordeleted text end new text begin ,new text end dental hygienistnew text begin , dental therapist, or advanced
dental therapist new text end licensed under chapter 150A.

(f) "Health care services" means health promotion, health monitoring, health
education, diagnosis, treatment, minor surgical procedures, the administration of local
anesthesia for the stitching of wounds, and primary dental services, including preventive,
diagnostic, restorative, and emergency treatment. Health care services do not include the
administration of general anesthesia or surgical procedures other than minor surgical
procedures.

(g) "Medical professional liability insurance" means medical malpractice insurance
as defined in section 62F.03.

new text begin EFFECTIVE DATE. new text end

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

Sec. 6.

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.new text begin 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.
new text end

(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. 7.

Minnesota Statutes 2012, section 245A.1435, is amended to read:


245A.1435 REDUCTION OF RISK OF SUDDENnew text begin UNEXPECTEDnew text end INFANT
DEATH deleted text begin SYNDROMEdeleted text end 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 deleted text begin parentdeleted text end new text begin physiciannew text end directing an alternative sleeping position for the infant. The
deleted text begin parentdeleted text end new text begin physiciannew text end directive must be on a form approved by the commissioner and must
deleted text begin 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.deleted text end new text begin 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.
new text end

(b) deleted text begin 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 infantdeleted text end new text begin 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 that 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. For the purposes of this section, a
pacifier is defined as a synthetic nipple designed for infant sucking with nothing attached
to itnew text end . The requirements of this section apply to license holders serving infants deleted text begin up to and
including 12 monthsdeleted text end new text begin younger than one yearnew text end of age. Licensed child care providers must
meet the crib requirements under section 245A.146.

new text begin (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.
 new text end

new text begin (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.
 new text end

Sec. 8.

Minnesota Statutes 2012, section 245A.144, is amended to read:


245A.144 new text begin TRAINING ON RISK OF new text end SUDDEN new text begin UNEXPECTED new text end INFANT
DEATH AND deleted text begin SHAKEN BABY SYNDROMEdeleted text end new text begin ABUSIVE HEAD TRAUMAnew text end 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 suddennew text begin unexpectednew text end infant
death deleted text begin syndromedeleted text end and deleted text begin shaken baby syndrome fordeleted text end new text begin abusive head trauma from shakingnew text end 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 new text begin unexpected new text end infant death
deleted text begin syndromedeleted text end and deleted text begin shaken baby syndromedeleted text end new text begin abusive head traumanew text end 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 new text begin unexpected new text end infant death deleted text begin syndromedeleted text end and deleted text begin shaken baby
syndromedeleted text end new text begin abusive head traumanew text end , means of reducing the risk of sudden new text begin unexpected new text end infant
death deleted text begin syndromedeleted text end and deleted text begin shaken baby syndromedeleted text end new text begin abusive head traumanew text end , and license holder
communication with parents regarding reducing the risk of sudden new text begin unexpected new text end infant
death deleted text begin syndromedeleted text end and deleted text begin shaken baby syndromedeleted text end new text begin abusive head traumanew text end .

(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. 9.

Minnesota Statutes 2012, section 245A.1444, is amended to read:


245A.1444 TRAINING ON RISK OF SUDDEN new text begin UNEXPECTED new text end INFANT
DEATH deleted text begin SYNDROMEdeleted text end AND deleted text begin SHAKEN BABY SYNDROMEdeleted text end new text begin ABUSIVE HEAD
TRAUMAnew text end 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 suddennew text begin unexpectednew text end infant death deleted text begin syndromedeleted text end and
deleted text begin shaken baby syndromedeleted text end new text begin abusive head trauma from shaking infants and young childrennew text end . 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. 10.

new text begin [245A.1446] FAMILY CHILD CARE DIAPERING AREA
DISINFECTION.
 new text end

new text begin 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:
 new text end

new text begin (1) the manufacturer's label or instructions state that the product is registered with
the United States Environmental Protection Agency;
 new text end

new text begin (2) the manufacturer's label or instructions state that the disinfectant is effective
against Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa;
 new text end

new text begin (3) the manufacturer's label or instructions state that the disinfectant is effective with
a ten minute or less contact time;
 new text end

new text begin (4) the disinfectant is clearly labeled by the manufacturer with directions for mixing
and use;
 new text end

new text begin (5) the disinfectant is used only in accordance with the manufacturer's directions; and
 new text end

new text begin (6) the product does not include triclosan or derivatives of triclosan.
 new text end

Sec. 11.

new text begin [245A.147] FAMILY CHILD CARE INFANT SLEEP SUPERVISION
REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin In-person checks on infants. new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin Subd. 2. new text end

new text begin Use of audio or visual monitoring devices. new text end

new text begin 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.
 new text end

Sec. 12.

new text begin [245A.152] CHILD CARE LICENSE HOLDER INSURANCE.
 new text end

new text begin (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.
 new text end

new text begin (b) If the license holder has liability insurance:
 new text end

new text begin (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;
 new text end

new text begin (2) the notice must provide the parent or guardian with the date of expiration or
next renewal of the policy; and
 new text end

new text begin (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.
 new text end

new text begin If the policy was renewed, the license holder must provide the new expiration date of the
policy in writing to the parents or guardians.
 new text end

new text begin (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.
 new text end

new text begin (d) The license holder must notify all parents and guardians in writing immediately
of any change in insurance status.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

Sec. 13.

Minnesota Statutes 2012, section 245A.40, subdivision 5, is amended to read:


Subd. 5.

Sudden new text begin unexpected new text end infant death deleted text begin syndromedeleted text end and deleted text begin shaken baby syndrome
deleted text end new text begin abusive head trauma new text end training.

(a) License holders must document that before staff
persons new text begin and volunteers new text end care for infants, they are instructed on the standards in section
245A.1435 and receive training on reducing the risk of sudden new text begin unexpected new text end infant death
deleted text begin syndromedeleted text end . 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 deleted text begin shaken baby
syndromedeleted text end new text begin abusive head trauma from shaking infants and young childrennew text end . The training
in this subdivision may be provided as orientation training under subdivision 1 and
in-service training under subdivision 7.

(b) Suddennew text begin unexpectednew text end infant death deleted text begin syndromedeleted text end reduction training required under
this subdivision must be at least one-half hour in length and must be completed at least
once every deleted text begin five yearsdeleted text end new text begin yearnew text end . At a minimum, the training must address the risk factors
related to sudden new text begin unexpected new text end infant death deleted text begin syndromedeleted text end , means of reducing the risk of sudden
new text begin unexpected new text end infant death deleted text begin syndromedeleted text end in child care, and license holder communication with
parents regarding reducing the risk of sudden new text begin unexpected new text end infant death deleted text begin syndromedeleted text end .

(c) deleted text begin Shaken baby syndromedeleted text end new text begin Abusive head traumanew text end training under this subdivision
must be at least one-half hour in length and must be completed at least once every deleted text begin five
yearsdeleted text end new text begin yearnew text end . At a minimum, the training must address the risk factors related to deleted text begin shaken
baby syndrome fordeleted text end new text begin shakingnew text end infants and young children, means to reduce the risk of deleted text begin shaken
baby syndromedeleted text end new text begin abusive head traumanew text end in child care, and license holder communication with
parents regarding reducing the risk of deleted text begin shaken baby syndromedeleted text end new text begin abusive head traumanew text end .

(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. 14.

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 new text begin and behavior guidance new text end 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 deleted text begin twodeleted text end new text begin fournew text end hours of child growth and development
new text begin and behavior guidance new text end training deleted text begin within the first year ofdeleted text end new text begin prior to initialnew text end licensurenew text begin , and before
caring for childrennew text end . 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.new text begin "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.
new text end

(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.new text begin First aid training must be repeated
every two years.
new text end

(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 airwaysnew text begin that includes CPR
techniques for infants and childrennew text end . The CPR training must have been provided by an
individual approved to provide CPR instruction, must be repeated at least once every deleted text begin three
deleted text end new text begin twonew text end 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) deleted text begin Video training reviewed and approved by the county licensing agency satisfies
the training requirement of this subdivision.deleted text end new text begin Persons providing CPR training must use
CPR training that has been developed:
new text end

new text begin (1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or
 new text end

new text begin (2) using nationally recognized, evidence-based guidelines for CPR training and
incorporates psychomotor skills to support the instruction.
 new text end

Subd. 5.

Suddennew text begin unexpectednew text end infant death deleted text begin syndromedeleted text end and deleted text begin shaken baby syndrome
deleted text end new text begin abusive head traumanew text end 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
new text begin unexpected new text end infant death deleted text begin syndromedeleted text end . 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 deleted text begin shaken baby syndromedeleted text end new text begin abusive
head trauma from shaking infants and young childrennew text end . The training in this subdivision
may be provided as initial training under subdivision 1 or ongoing annual training under
subdivision 7.

(b) Suddennew text begin unexpectednew text end infant death deleted text begin syndromedeleted text end reduction training required under this
subdivision must be at least one-half hour in length and must be completed new text begin in person
new text end at least once every deleted text begin five yearsdeleted text end new text begin two yearsnew text end . new text begin 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.new text end At a
minimum, the training must address the risk factors related to sudden new text begin unexpected new text end infant
death deleted text begin syndromedeleted text end , means of reducing the risk of sudden new text begin unexpected new text end infant death deleted text begin syndrome
deleted text end in child care, and license holder communication with parents regarding reducing the risk
of sudden new text begin unexpected new text end infant death deleted text begin syndromedeleted text end .

(c) deleted text begin Shaken baby syndromedeleted text end new text begin Abusive head traumanew text end training required under this
subdivision must be at least one-half hour in length and must be completed at least once
every deleted text begin five yearsdeleted text end new text begin yearnew text end . At a minimum, the training must address the risk factors related
to deleted text begin shaken baby syndromedeleted text end new text begin shaking infants and young childrennew text end , means of reducing the
risk of deleted text begin shaken baby syndromedeleted text end new text begin abusive head traumanew text end in child care, and license holder
communication with parents regarding reducing the risk of deleted text begin shaken baby syndromedeleted text end new text begin abusive
head traumanew text end .

(d) Training for family and group family child care providers must be new text begin developed
by the commissioner in conjunction with the Minnesota Sudden Infant Death Center
andnew text end approved deleted text begin by the county licensing agencydeleted text end new text begin by the Minnesota Center for Professional
Developmentnew text end .

deleted text begin (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.
 deleted text end

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 deleted text begin eightdeleted text end new text begin 16new text end hours of new text begin ongoing new text end 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. new text begin Repeat of topical
training requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
requirement. Additional new text end ongoing training subjects new text begin to meet the annual 16-hour training
requirement new text end must be selected from the following areas:

(1) deleted text begin "deleted text end child growth and development trainingdeleted text begin " has the meaning given indeleted text end new text begin under
new text end subdivision 2, paragraph (a);

(2) deleted text begin "deleted text end learning environment and curriculumdeleted text begin " includesdeleted text end new text begin , includingnew text end training in
establishing an environment and providing activities that provide learning experiences to
meet each child's needs, capabilities, and interests;

(3) deleted text begin "deleted text end assessment and planning for individual needsdeleted text begin " includesdeleted text end new text begin , includingnew text end 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) deleted text begin "deleted text end interactions with childrendeleted text begin " includesdeleted text end new text begin , includingnew text end training in establishing
supportive relationships with children, guiding them as individuals and as part of a group;

(5) deleted text begin "deleted text end families and communitiesdeleted text begin " includesdeleted text end new text begin , includingnew text end training in working
collaboratively with families and agencies or organizations to meet children's needs and to
encourage the community's involvement;

(6) deleted text begin "deleted text end health, safety, and nutritiondeleted text begin " includesdeleted text end new text begin , includingnew text end 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; deleted text begin and
deleted text end

(7) deleted text begin "deleted text end program planning and evaluationdeleted text begin " includesdeleted text end new text begin , includingnew text end training in establishing,
implementing, evaluating, and enhancing program operationsdeleted text begin .deleted text end new text begin ; andnew text end

new text begin (8) behavior guidance, including training in the understanding of the functions of
child behavior and strategies for managing behavior.
 new text end

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.

new text begin Subd. 9. new text end

new text begin Supervising for safety; training requirement. new text end

new text begin 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 of 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.
 new text end

new text begin Subd. 10. new text end

new text begin Approved training. new text end

new text begin County licensing staff must accept training approved
by the Minnesota Center for Professional Development, including:
 new text end

new text begin (1) face-to-face or classroom training;
 new text end

new text begin (2) online training; and
 new text end

new text begin (3) relationship-based professional development, such as mentoring, coaching,
and consulting.
 new text end

Sec. 15.

Minnesota Statutes 2012, section 246.54, is amended to read:


246.54 LIABILITY OF COUNTY; REIMBURSEMENT.

Subdivision 1.

County portion for cost of care.

(a) Except for chemical
dependency services provided under sections 254B.01 to 254B.09, the client's county
shall pay to the state of Minnesota a portion of the cost of care provided in a regional
treatment center or a state nursing facility to a client legally settled in that county. A
county's payment shall be made from the county's own sources of revenue and payments
shall equal a percentage of the cost of care, as determined by the commissioner, for each
day, or the portion thereof, that the client spends at a regional treatment center or a state
nursing facility according to the following schedule:

(1) zero percent for the first 30 days;

(2) 20 percent for days 31 to 60; and

(3) deleted text begin 50deleted text end new text begin 75new text end percent for any days over 60.

(b) The increase in the county portion for cost of care under paragraph (a), clause
(3), shall be imposed when the treatment facility has determined that it is clinically
appropriate for the client to be discharged.

(c) If payments received by the state under sections 246.50 to 246.53 exceed 80
percent of the cost of care for days 31 to 60, or deleted text begin 50deleted text end new text begin 25new text end percent for days over 60, the county
shall be responsible for paying the state only the remaining amount. The county shall
not be entitled to reimbursement from the client, the client's estate, or from the client's
relatives, except as provided in section 246.53.

Subd. 2.

Exceptions.

(a) Subdivision 1 does not apply to services provided at the
Minnesota Security Hospital deleted text begin or the Minnesota extended treatment options programdeleted text end . For
services at deleted text begin these facilitiesdeleted text end new text begin the Minnesota Security Hospitalnew text end , a county's payment shall be
made from the county's own sources of revenue and payments deleted text begin shall be paid as follows:deleted text end new text begin .
Excluding the state-operated forensic transition service,new text end payments to the state from the
county shall equal ten percent of the cost of care, as determined by the commissioner, for
each day, or the portion thereof, that the client spends at the facility. new text begin For the state-operated
forensic transition service, payments to the state from the county shall equal 50 percent of
the cost of care, as determined by the commissioner, for each day, or the portion thereof,
that the client spends in the program. new text end If payments received by the state under sections
246.50 to 246.53 new text begin for services provided at the Minnesota Security Hospital, excluding the
state-operated forensic transition service, new text end exceed 90 percent of the cost of care, the county
shall be responsible for paying the state only the remaining amount. new text begin If payments received
by the state under sections 246.50 to 246.53 for the state-operated forensic transition service
exceed 50 percent of the cost of care, the county shall be responsible for paying the state
only the remaining amount. new text end The county shall not be entitled to reimbursement from the
client, the client's estate, or from the client's relatives, except as provided in section 246.53.

(b) Regardless of the facility to which the client is committed, subdivision 1 does
not apply to the following individuals:

deleted text begin (1) clients who are committed as mentally ill and dangerous under section 253B.02,
subdivision 17;
 deleted text end

deleted text begin (2)deleted text end new text begin (1)new text end clients who are committed as sexual psychopathic personalities under section
253B.02, subdivision 18b; and

deleted text begin (3)deleted text end new text begin (2)new text end clients who are committed as sexually dangerous persons under section
253B.02, subdivision 18c.

deleted text begin For each of the individuals in clauses (1) to (3), the payment by the county to the state
shall equal ten percent of the cost of care for each day as determined by the commissioner.
 deleted text end

Sec. 16.

new text begin [256.999] CULTURAL AND ETHNIC COMMUNITIES LEADERSHIP
COUNCIL.
 new text end

new text begin Subdivision 1. new text end

new text begin Establishment; purpose. new text end

new text begin There is hereby established the Cultural
and Ethnic Communities Leadership Council for the Department of Human Services. The
purpose of the council is to advise the commissioner of human services on reducing
disparities that affect racial and ethnic groups.
 new text end

new text begin Subd. 2. new text end

new text begin Members. new text end

new text begin (a) The council must consist of no fewer than 15 and no more
than 25 members appointed by the commissioner of human services, in consultation with
county, tribal, cultural, and ethnic communities; diverse program participants; and parent
representatives from these communities. The commissioner shall direct the development
of guidelines defining the membership of the council; setting out definitions; and
developing duties of the commissioner, the council, and council members regarding racial
and ethnic disparities reduction. The guidelines must be developed in consultation with:
 new text end

new text begin (1) the chairs of relevant committees; and
 new text end

new text begin (2) county, tribal, and cultural communities and program participants from these
communities.
 new text end

new text begin (b) Members must be appointed to allow for representation of the following groups:
 new text end

new text begin (1) racial and ethnic minority groups;
 new text end

new text begin (2) tribal service providers;
 new text end

new text begin (3) culturally and linguistically specific advocacy groups and service providers;
 new text end

new text begin (4) human services program participants;
 new text end

new text begin (5) public and private institutions;
 new text end

new text begin (6) parents of human services program participants;
 new text end

new text begin (7) members of the faith community;
 new text end

new text begin (8) Department of Human Services employees;
 new text end

new text begin (9) chairs of relevant legislative committees; and
 new text end

new text begin (10) any other group the commissioner deems appropriate to facilitate the goals
and duties of the council.
 new text end

new text begin (c) Each member of the council must be appointed to either a one-year or two-year
term. The commissioner shall appoint one member as chair.
 new text end

new text begin (d) Notwithstanding section 15.059, members of the council shall receive no
compensation for their services.
 new text end

new text begin Subd. 3. new text end

new text begin Duties of commissioner. new text end

new text begin (a) The commissioner of human services or the
commissioner's designee shall:
 new text end

new text begin (1) maintain the council established in this section;
 new text end

new text begin (2) supervise and coordinate policies for persons from racial, ethnic, cultural,
linguistic, and tribal communities who experience disparities in access and outcomes;
 new text end

new text begin (3) identify human services rules or statutes affecting persons from racial, ethnic,
cultural, linguistic, and tribal communities that may need to be revised;
 new text end

new text begin (4) investigate and implement cost-effective models of service delivery such as
careful adaptation of clinically proven services that constitute one strategy for increasing
the number of culturally relevant services available to currently underserved populations;
new text end

new text begin (5) based on recommendations of the council, review identified department
policies that maintain racial, ethnic, cultural, linguistic, and tribal disparities, and make
adjustments to ensure those disparities are not perpetuated; and
 new text end

new text begin (6) based on recommendations of the council, submit legislation to reduce disparities
affecting racial and ethnic groups, increase access to programs, and promote better
outcomes.
 new text end

new text begin (b) The commissioner of human services or the commissioner's designee shall
consult with the council and receive recommendations from the council when meeting
the requirements of this section.
 new text end

new text begin Subd. 4. new text end

new text begin Duties of council. new text end

new text begin The Cultural and Ethnic Communities Leadership
Council shall:
 new text end

new text begin (1) recommend to the commissioner for review identified policies in the Department
of Human Services that maintain racial, ethnic, cultural, linguistic, and tribal disparities;
 new text end

new text begin (2) identify issues regarding disparities by engaging diverse populations in human
services programs;
 new text end

new text begin (3) engage in mutual learning essential for achieving human services parity and
optimal wellness for service recipients;
 new text end

new text begin (4) raise awareness about human services disparities to the legislature and media;
 new text end

new text begin (5) provide technical assistance and consultation support to counties, private
nonprofit agencies, and other service providers to build their capacity to provide equitable
human services for persons from racial, ethnic, cultural, linguistic, and tribal communities
who experience disparities in access and outcomes;
 new text end

new text begin (6) provide technical assistance to promote statewide development of culturally
and linguistically appropriate, accessible, and cost-effective human services and related
policies;
 new text end

new text begin (7) provide training and outreach to facilitate access to culturally and linguistically
appropriate, accessible, and cost-effective human services to prevent disparities;
 new text end

new text begin (8) facilitate culturally appropriate and culturally sensitive admissions, continued
services, discharges, and utilization review for human services agencies and institutions;
 new text end

new text begin (9) form work groups to help carry out the duties of the council that include, but are
not limited to, persons who provide and receive services and representatives of advocacy
groups, and provide the work groups with clear guidelines, standardized parameters, and
tasks for the work groups to accomplish; and
 new text end

new text begin (10) promote information-sharing in the human services community and statewide.
 new text end

new text begin Subd. 5. new text end

new text begin Duties of council members. new text end

new text begin The members of the council shall:
 new text end

new text begin (1) attend and participate in scheduled meetings and be prepared by reviewing
meeting notes;
 new text end

new text begin (2) maintain open communication channels with respective constituencies;
 new text end

new text begin (3) identify and communicate issues and risks that could impact the timely
completion of tasks;
 new text end

new text begin (4) collaborate on disparity reduction efforts;
 new text end

new text begin (5) communicate updates of the council's work progress and status on the
Department of Human Services Web site; and
 new text end

new text begin (6) participate in any activities the council or chair deem appropriate and necessary
to facilitate the goals and duties of the council.
new text end

new text begin Subd. 6. new text end

new text begin Expiration. new text end

new text begin Notwithstanding section 15.059, the council does not expire
unless directed by the commissioner.
 new text end

Sec. 17.

Minnesota Statutes 2012, section 256I.04, subdivision 3, is amended to read:


Subd. 3.

Moratorium on development of group residential housing beds.

(a)
County agencies shall not enter into agreements for new group residential housing beds
with total rates in excess of the MSA equivalent rate except:

(1) for group residential housing establishments licensed under Minnesota Rules,
parts 9525.0215 to 9525.0355, provided the facility is needed to meet the census reduction
targets for persons with developmental disabilities at regional treatment centers;

(2) to ensure compliance with the federal Omnibus Budget Reconciliation Act
alternative disposition plan requirements for inappropriately placed persons with
developmental disabilities or mental illness;

(3) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers
and are refused placement in emergency shelters because of their state of intoxication,
and planning for the specialized facility must have been initiated before July 1, 1991,
in anticipation of receiving a grant from the Housing Finance Agency under section
462A.05, subdivision 20a, paragraph (b);

(4) notwithstanding the provisions of subdivision 2a, for up to 190 supportive
housing units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a
mental illness, a history of substance abuse, or human immunodeficiency virus or acquired
immunodeficiency syndrome. For purposes of this section, "homeless adult" means a
person who is living on the street or in a shelter or discharged from a regional treatment
center, community hospital, or residential treatment program and has no appropriate
housing available and lacks the resources and support necessary to access appropriate
housing. At least 70 percent of the supportive housing units must serve homeless adults
with mental illness, substance abuse problems, or human immunodeficiency virus or
acquired immunodeficiency syndrome who are about to be or, within the previous six
months, has been discharged from a regional treatment center, or a state-contracted
psychiatric bed in a community hospital, or a residential mental health or chemical
dependency treatment program. If a person meets the requirements of subdivision 1,
paragraph (a), and receives a federal or state housing subsidy, the group residential housing
rate for that person is limited to the supplementary rate under section 256I.05, subdivision
1a, and is determined by subtracting the amount of the person's countable income that
exceeds the MSA equivalent rate from the group residential housing supplementary rate.
A resident in a demonstration project site who no longer participates in the demonstration
program shall retain eligibility for a group residential housing payment in an amount
determined under section 256I.06, subdivision 8, using the MSA equivalent rate. Service
funding under section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching
funds are available and the services can be provided through a managed care entity. If
federal matching funds are not available, then service funding will continue under section
256I.05, subdivision 1a;

(5) for group residential housing beds in settings meeting the requirements of
subdivision 2a, clauses (1) and (3), which are used exclusively for recipients receiving
home and community-based waiver services under sections 256B.0915, 256B.092,
subdivision 5, 256B.093, and 256B.49, and who resided in a nursing facility for the six
months immediately prior to the month of entry into the group residential housing setting.
The group residential housing rate for these beds must be set so that the monthly group
residential housing payment for an individual occupying the bed when combined with the
nonfederal share of services delivered under the waiver for that person does not exceed the
nonfederal share of the monthly medical assistance payment made for the person to the
nursing facility in which the person resided prior to entry into the group residential housing
establishment. The rate may not exceed the MSA equivalent rate plus $426.37 for any case;

(6) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that
has had a group residential housing contract with the county and has been licensed as a
board and lodge facility with special services since 1980;

(7) for a group residential housing provider located in the city of St. Cloud, or a county
contiguous to the city of St. Cloud, that operates a 40-bed facility, that received financing
through the Minnesota Housing Finance Agency Ending Long-Term Homelessness
Initiative and serves chemically dependent clientele, providing 24-hour-a-day supervision;

(8) for a new 65-bed facility in Crow Wing County that will serve chemically
dependent persons, operated by a group residential housing provider that currently
operates a 304-bed facility in Minneapolis, and a 44-bed facility in Duluth;

(9) for a group residential housing provider that operates two ten-bed facilities, one
located in Hennepin County and one located in Ramsey County, that provide community
support and 24-hour-a-day supervision to serve the mental health needs of individuals
who have chronically lived unsheltered; and

(10) for a group residential facility in Hennepin County with a capacity of up to 48
beds that has been licensed since 1978 as a board and lodging facility and that until August
1, 2007, operated as a licensed chemical dependency treatment program.

(b) A county agency may enter into a group residential housing agreement for beds
with rates in excess of the MSA equivalent rate in addition to those currently covered
under a group residential housing agreement if the additional beds are only a replacement
of beds with rates in excess of the MSA equivalent rate which have been made available
due to closure of a setting, a change of licensure or certification which removes the beds
from group residential housing payment, or as a result of the downsizing of a group
residential housing setting. The transfer of available beds from one county to another can
only occur by the agreement of both counties.

new text begin (c) Effective July 1, 2013, 35 beds with rates in excess of the MSA-equivalent rate
must be designated for youth victims of sex trafficking.
 new text end

Sec. 18.

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


Subd. 1e.

Supplementary rate for certain facilities.

deleted text begin (a)deleted text end Notwithstanding the
provisions of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall
negotiate a supplementary rate in addition to the rate specified in subdivision 1, not to
exceed $700 per month, including any legislatively authorized inflationary adjustments,
for a group residential housing provider that:

(1) is located in Hennepin County and has had a group residential housing contract
with the county since June 1996;

(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a
26-bed facility; and

(3) serves a chemically dependent clientele, providing 24 hours per day supervision
and limiting a resident's maximum length of stay to 13 months out of a consecutive
24-month period.

deleted text begin (b) Notwithstanding subdivisions 1a and 1c, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700
per month, including any legislatively authorized inflationary adjustments, of a group
residential provider that:
 deleted text end

deleted text begin (1) is located in St. Louis County and has had a group residential housing contract
with the county since 2006;
 deleted text end

deleted text begin (2) operates a 62-bed facility; and
 deleted text end

deleted text begin (3) serves a chemically dependent adult male clientele, providing 24 hours per
day supervision and limiting a resident's maximum length of stay to 13 months out of
a consecutive 24-month period.
 deleted text end

deleted text begin (c) Notwithstanding subdivisions 1a and 1c, beginning July 1, 2013, a county agency
shall negotiate a supplementary rate in addition to the rate specified in subdivision 1, not
to exceed $700 per month, including any legislatively authorized inflationary adjustments,
for the group residential provider described under paragraphs (a) and (b), not to exceed
an additional 115 beds.
 deleted text end

Sec. 19.

Minnesota Statutes 2012, section 256J.35, is amended to read:


256J.35 AMOUNT OF ASSISTANCE PAYMENT.

Except as provided in paragraphs (a) to deleted text begin (c)deleted text end new text begin (d)new text end , the amount of an assistance payment
is equal to the difference between the MFIP standard of need or the Minnesota family
wage level in section 256J.24 and countable income.

(a) When MFIP eligibility exists for the month of application, the amount of the
assistance payment for the month of application must be prorated from the date of
application or the date all other eligibility factors are met for that applicant, whichever is
later. This provision applies when an applicant loses at least one day of MFIP eligibility.

(b) MFIP overpayments to an assistance unit must be recouped according to section
256J.38, subdivision 4.

(c) An initial assistance payment must not be made to an applicant who is not
eligible on the date payment is made.

new text begin (d) MFIP assistance units whose housing costs exceed 50 percent of their monthly
cash grant are eligible for an additional cash amount in the form of a housing assistance
grant. The housing assistance grant must be equal to 50 percent of the difference between
the assistance unit's cash grant and its housing costs, with a maximum housing assistance
grant of $250 per month. MFIP assistance units must report their housing costs to the lead
agency on the forms and according to the timelines established by the commissioner.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective December 1, 2013.
 new text end

Sec. 20.

Minnesota Statutes 2012, section 256K.45, is amended to read:


256K.45 deleted text begin RUNAWAY ANDdeleted text end HOMELESS YOUTH ACT.

Subdivision 1.

new text begin Mission. new text end

new text begin The mission of the Homeless Youth Act is to reduce
the incidence of homelessness among youth by providing integrated and supportive
services and housing to homeless youth, youth at risk of homelessness, and runaways.
The commissioner shall establish a Homeless Youth Act fund and award grants to
providers who are committed to serving homeless youth, to provide street and community
outreach and drop-in programs, emergency shelter programs, and supportive housing and
transitional living programs, consistent with the program descriptions in this act.
 new text end

new text begin Subd. 1a. new text end

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.

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, deleted text begin prostitutiondeleted text end new text begin sexual exploitationnew text end , 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 new text begin and homeless youth new text end 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, deleted text begin prostitutiondeleted text end new text begin sexual exploitationnew text end , 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.

deleted text begin Anydeleted text end Funds appropriated for this section may be expended on
programs described under subdivisions 3 to 5, technical assistance, and capacity buildingdeleted text begin .
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 Minnesotadeleted text end new text begin to meet the greatest need on
a statewide basisnew text end . new text begin Programs funded under this section must submit demographic and
outcome information to the commissioner. The commissioner must submit a report
regarding program demographic and outcome information to the legislature upon request.
new text end

Sec. 21.

Minnesota Statutes 2012, section 257.0755, subdivision 1, is amended to read:


Subdivision 1.

Creation.

deleted text begin Onedeleted text end new text begin Eachnew text end ombudsperson shall operate independently from
but in collaboration with deleted text begin each of the following groupsdeleted text end new text begin the community-specific board that
appointed the ombudsperson under section 257.0768new text end : the Indian Affairs Council, the
Council on Affairs of Chicano/Latino people, the Council on Black Minnesotans, and
the Council on Asian-Pacific Minnesotans.

Sec. 22.

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 deleted text begin under the age of 16 years
deleted text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2014, and applies to
offenses committed on or after that date.
 new text end

Sec. 23.

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,new text begin subdivision 2 or 3,new text end 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 deleted text begin under the age of 16 yearsdeleted text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2014, and applies to
offenses committed on or after that date.
 new text end

Sec. 24.

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) deleted text begin has engaged in prostitution as defined in section 609.321, subdivision 9deleted text end new text begin is a
sexually exploited youthnew text end ;

(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;new text begin or
new text end

(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 childdeleted text begin ; ordeleted text end new text begin .
new text end

deleted text begin (17) is a sexually exploited youth.
 deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2014.
 new text end

Sec. 25.

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,new text begin 609.344,new text end 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.

new text begin EFFECTIVE DATE. new text end

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

Sec. 26.

Laws 1998, chapter 407, article 6, section 116, is amended to read:


Sec. 116. EBT TRANSACTION COSTSdeleted text begin ; APPROVAL FROM LEGISLATUREdeleted text end .

The commissioner of human services shall deleted text begin request and receive approval from the
legislature before adjusting the payment todeleted text end new text begin not subsidizenew text end retailers for electronic benefit
transfer deleted text begin transaction costsdeleted text end new text begin Supplemental Nutrition Assistance Program transactionsnew text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective 30 days after the commissioner
notifies retailers of the termination of their agreement with the state. The commissioner of
human services must notify the revisor of statutes of that date.
 new text end

Sec. 27.

Laws 2011, First Special Session chapter 9, article 1, section 3, the effective
date, is amended to read:


EFFECTIVE DATE.

This section is effective deleted text begin January 1, 2013deleted text end new text begin July 1, 2014new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 1, 2013.
 new text end

Sec. 28. new text begin INCLUSION OF OTHER HEALTH-RELATED OCCUPATIONS TO
CRIMINAL BACKGROUND CHECKS.
new text end

new text begin (a) If the Department of Health is not reviewed by the Sunset Advisory Commission
according to the schedule in Minnesota Statutes, section 3D.21, the commissioner
of health, as the regulator for occupational therapy practitioners, speech-language
pathologists, audiologists, and hearing instrument dispensers, shall require applicants
for licensure or renewal to submit to a criminal history records check as required under
Minnesota Statutes, section 214.075, for other health-related licensed occupations
regulated by the health-related licensing boards.
 new text end

new text begin (b) Any statutory changes necessary to include the commissioner of health to
Minnesota Statutes, section 214.075, shall be included in the plan required in Minnesota
Statutes, section 214.075, subdivision 8.
 new text end

Sec. 29. new text begin DIRECTION TO COMMISSIONERS; INCOME AND ASSET
EXCLUSION.
new text end

new text begin (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; or the MinnesotaCare program under
Minnesota Statutes, chapter 256L, during the duration of the demonstration.
 new text end

new text begin (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.
 new text end

new text begin (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.
 new text end

new text begin (d) For the purposes of this section:
 new text end

new text begin (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
 new text end

new text begin (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.
 new text end

Sec. 30. new text begin REDUCTION OF YOUTH HOMELESSNESS.
new text end

new text begin (a) The Minnesota Interagency Council on Homelessness established under the
authority of Minnesota Statutes, section 462A.29, as it updates its statewide plan to
prevent and end homelessness, shall make recommendations on strategies to reduce the
number of youth experiencing homelessness and to prevent homelessness for youth who
are at risk of becoming homeless.
 new text end

new text begin (b) Recommended strategies must take into consideration, to the extent feasible,
issues that contribute to or reduce youth homelessness including, but not limited to, mental
health, chemical dependency, trafficking of youth for sex or other purposes, exiting foster
care, and involvement in gangs. The recommended strategies must include supportive
services as outlined in Minnesota Statutes, section 256K.45, subdivision 5.
 new text end

new text begin (c) The council shall provide an update on the status of its work by December 1,
2014, to the legislative committees with jurisdiction over housing, homelessness, and
matters pertaining to youth. If the council determines legislative action is required to
implement recommended strategies, the council shall submit proposals to the legislature at
the earliest possible opportunity.
 new text end

Sec. 31. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, sections 256J.24, subdivision 6; and 256K.45,
subdivision 2, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2012, section 609.093, new text end new text begin is repealed.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (b) is effective the day following final enactment.
 new text end

ARTICLE 11

HOME CARE PROVIDERS

Section 1.

Minnesota Statutes 2012, section 144.051, is amended by adding a
subdivision to read:


new text begin Subd. 3. new text end

new text begin Data classification; private data. new text end

new text begin For providers regulated pursuant to
sections 144A.43 to 144A.482, the following data collected, created, or maintained by the
commissioner are classified as "private data" as defined in section 13.02, subdivision 12:
 new text end

new text begin (1) data submitted by or on behalf of applicants for licenses prior to issuance of
the license;
 new text end

new text begin (2) the identity of complainants who have made reports concerning licensees or
applicants unless the complainant consents to the disclosure;
 new text end

new text begin (3) the identity of individuals who provide information as part of surveys and
investigations;
 new text end

new text begin (4) Social Security numbers; and
 new text end

new text begin (5) health record data.
 new text end

Sec. 2.

Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
to read:


new text begin Subd. 4. new text end

new text begin Data classification; public data. new text end

new text begin For providers regulated pursuant to
sections 144A.43 to 144A.482, the following data collected, created, or maintained by the
commissioner are classified as "public data" as defined in section 13.02, subdivision 15:
 new text end

new text begin (1) all application data on licensees, license numbers, license status;
 new text end

new text begin (2) licensing information about licenses previously held under this chapter;
 new text end

new text begin (3) correction orders, including information about compliance with the order and
whether the fine was paid;
 new text end

new text begin (4) final enforcement actions pursuant to chapter 14;
 new text end

new text begin (5) orders for hearing, findings of fact and conclusions of law; and
 new text end

new text begin (6) when the licensee and department agree to resolve the matter without a hearing,
the agreement and specific reasons for the agreement are public data.
 new text end

Sec. 3.

Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin Data classification; confidential data. new text end

new text begin For providers regulated pursuant to
sections 144A.43 to 144A.482, the following data collected, created, or maintained by
the Department of Health are classified as "confidential data" as defined in section 13.02,
subdivision 3: active investigative data relating to the investigation of potential violations
of law by licensee including data from the survey process before the correction order is
issued by the department.
 new text end

Sec. 4.

Minnesota Statutes 2012, section 144.051, is amended by adding a subdivision
to read:


new text begin Subd. 6. new text end

new text begin Release of private or confidential data. new text end

new text begin For providers regulated pursuant
to sections 144A.43 to 144A.482, the department may release private or confidential
data, except Social Security numbers, to the appropriate state, federal, or local agency
and law enforcement office to enhance investigative or enforcement efforts or further
public health protective process. Types of offices include, but are not limited to, Adult
Protective Services, Office of the Ombudsmen for Long-Term Care and Office of the
Ombudsmen for Mental Health and Developmental Disabilities, the health licensing
boards, Department of Human Services, county or city attorney's offices, police, and local
or county public health offices.
 new text end

Sec. 5.

Minnesota Statutes 2012, section 144A.43, is amended to read:


144A.43 DEFINITIONS.

Subdivision 1.

Applicability.

The definitions in this section apply to sections
144.699, subdivision 2, and 144A.43 to deleted text begin 144A.47deleted text end new text begin 144A.482new text end .

new text begin Subd. 1a. new text end

new text begin Agent. new text end

new text begin "Agent" means the person upon whom all notices and orders shall
be served and who is authorized to accept service of notices and orders on behalf of
the home care provider.
 new text end

new text begin Subd. 1b. new text end

new text begin Applicant. new text end

new text begin "Applicant" means an individual, organization, association,
corporation, unit of government, or other entity that applies for a temporary license,
license, or renewal of their home care provider license under section 144A.472.
 new text end

new text begin Subd. 1c. new text end

new text begin Client. new text end

new text begin "Client" means a person to whom home care services are provided.
 new text end

new text begin Subd. 1d. new text end

new text begin Client record. new text end

new text begin "Client record" means all records that document
information about the home care services provided to the client by the home care provider.
 new text end

new text begin Subd. 1e. new text end

new text begin Client representative. new text end

new text begin "Client representative" means a person who,
because of the client's needs, makes decisions about the client's care on behalf of the
client. A client representative may be a guardian, health care agent, family member, or
other agent of the client. Nothing in this section expands or diminishes the rights of
persons to act on behalf of clients under other law.
 new text end

Subd. 2.

Commissioner.

"Commissioner" means the commissioner of health.

new text begin Subd. 2a. new text end

new text begin Controlled substance. new text end

new text begin "Controlled substance" has the meaning given
in section 152.01, subdivision 4.
 new text end

new text begin Subd. 2b. new text end

new text begin Department. new text end

new text begin "Department" means the Minnesota Department of Health.
 new text end

new text begin Subd. 2c. new text end

new text begin Dietary supplement. new text end

new text begin "Dietary supplement" means a product taken by
mouth that contains a "dietary ingredient" intended to supplement the diet. Dietary
ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and
substances such as enzymes, organ tissue, glandulars, or metabolites.
 new text end

new text begin Subd. 2d. new text end

new text begin Dietitian. new text end

new text begin "Dietitian" is a person licensed under sections 148.621 to
148.633.
 new text end

new text begin Subd. 2e. new text end

new text begin Dietetics or nutrition practice. new text end

new text begin "Dietetics or nutrition practice" is
performed by a licensed dietician or licensed nutritionist and includes the activities of
assessment, setting priorities and objectives, providing nutrition counseling, developing
and implementing nutrition care services, and evaluating and maintaining appropriate
standards of quality of nutrition care under sections 148.621 to 148.633.
 new text end

Subd. 3.

Home care service.

"Home care service" means any of the following
services deleted text begin whendeleted text end delivered in deleted text begin a place of residence todeleted text end new text begin the home of new text end a person whose illness,
disability, or physical condition creates a need for the service:

deleted text begin (1) nursing services, including the services of a home health aide;
 deleted text end

deleted text begin (2) personal care services not included under sections 148.171 to 148.285;
deleted text end

deleted text begin (3) physical therapy;
 deleted text end

deleted text begin (4) speech therapy;
 deleted text end

deleted text begin (5) respiratory therapy;
 deleted text end

deleted text begin (6) occupational therapy;
 deleted text end

deleted text begin (7) nutritional services;
 deleted text end

deleted text begin (8) home management services when provided to a person who is unable to perform
these activities due to illness, disability, or physical condition. Home management
services include at least two of the following services: housekeeping, meal preparation,
and shopping;
 deleted text end

deleted text begin (9) medical social services;
 deleted text end

deleted text begin (10) the provision of medical supplies and equipment when accompanied by the
provision of a home care service; and
 deleted text end

deleted text begin (11) other similar medical services and health-related support services identified by
the commissioner in rule.
 deleted text end

deleted text begin "Home care service" does not include the following activities conducted by the
commissioner of health or a board of health as defined in section 145A.02, subdivision 2:
communicable disease investigations or testing; administering or monitoring a prescribed
therapy necessary to control or prevent a communicable disease; or the monitoring
of an individual's compliance with a health directive as defined in section 144.4172,
subdivision 6.
deleted text end

new text begin (1) assistive tasks provided by unlicensed personnel;
 new text end

new text begin (2) services provided by a registered nurse or licensed practical nurse, physical
therapist, respiratory therapist, occupational therapist, speech-language pathologist,
dietitian or nutritionist, or social worker;
 new text end

new text begin (3) medication and treatment management services; or
 new text end

new text begin (4) the provision of durable medical equipment services when provided with any of
the home care services listed in clauses (1) to (3).
 new text end

new text begin Subd. 3a. new text end

new text begin Hands-on-assistance. new text end

new text begin "Hands-on-assistance" means physical help by
another person without which the client is not able to perform the activity.
 new text end

new text begin Subd. 3b. new text end

new text begin Home. new text end

new text begin "Home" means the client's temporary or permanent place of
residence.
 new text end

Subd. 4.

Home care provider.

"Home care provider" means an individual,
organization, association, corporation, unit of government, or other entity that is regularly
engaged in the deliverynew text begin of at least one home care servicenew text end , directly deleted text begin or by contractual
arrangement, of home care servicesdeleted text end new text begin in a client's homenew text end for a feenew text begin and who has a valid current
temporary license or license issued under sections 144A.43 to 144A.482new text end . deleted text begin At least one
home care service must be provided directly, although additional home care services may
be provided by contractual arrangements. "Home care provider" does not include:
deleted text end

deleted text begin (1) any home care or nursing services conducted by and for the adherents of any
recognized church or religious denomination for the purpose of providing care and
services for those who depend upon spiritual means, through prayer alone, for healing;
 deleted text end

deleted text begin (2) an individual who only provides services to a relative;
 deleted text end

deleted text begin (3) an individual not connected with a home care provider who provides assistance
with home management services or personal care needs if the assistance is provided
primarily as a contribution and not as a business;
 deleted text end

deleted text begin (4) an individual not connected with a home care provider who shares housing with
and provides primarily housekeeping or homemaking services to an elderly or disabled
person in return for free or reduced-cost housing;
 deleted text end

deleted text begin (5) an individual or agency providing home-delivered meal services;
 deleted text end

deleted text begin (6) an agency providing senior companion services and other older American
volunteer programs established under the Domestic Volunteer Service Act of 1973,
Public Law 98-288;
 deleted text end

deleted text begin (7) an employee of a nursing home licensed under this chapter or an employee of a
boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
emergency calls from individuals residing in a residential setting that is attached to or
located on property contiguous to the nursing home or boarding care home;
deleted text end

deleted text begin (8) a member of a professional corporation organized under chapter 319B that does
not regularly offer or provide home care services as defined in subdivision 3;
 deleted text end

deleted text begin (9) the following organizations established to provide medical or surgical services
that do not regularly offer or provide home care services as defined in subdivision 3:
a business trust organized under sections 318.01 to 318.04, a nonprofit corporation
organized under chapter 317A, a partnership organized under chapter 323, or any other
entity determined by the commissioner;
deleted text end

deleted text begin (10) an individual or agency that provides medical supplies or durable medical
equipment, except when the provision of supplies or equipment is accompanied by a
home care service;
 deleted text end

deleted text begin (11) an individual licensed under chapter 147; or
 deleted text end

deleted text begin (12) an individual who provides home care services to a person with a developmental
disability who lives in a place of residence with a family, foster family, or primary caregiver.
 deleted text end

deleted text begin Subd. 5. deleted text end

deleted text begin Medication reminder. deleted text end

deleted text begin "Medication reminder" means providing a verbal
or visual reminder to a client to take medication. This includes bringing the medication
to the client and providing liquids or nutrition to accompany medication that a client is
self-administering.
 deleted text end

new text begin Subd. 6. new text end

new text begin License. new text end

new text begin "License" means a basic or comprehensive home care license
issued by the commissioner to a home care provider.
 new text end

new text begin Subd. 7. new text end

new text begin Licensed health professional. new text end

new text begin "Licensed health professional" means a
person, other than a registered nurse or licensed practical nurse, who provides home care
services within the scope of practice of the person's health occupation license, registration,
or certification as regulated and who is licensed by the appropriate Minnesota state board
or agency.
 new text end

new text begin Subd. 8. new text end

new text begin Licensee. new text end

new text begin "Licensee" means a home care provider that is licensed under
this chapter.
 new text end

new text begin Subd. 9. new text end

new text begin Managerial official. new text end

new text begin "Managerial official" means an administrator,
director, officer, trustee, or employee of a home care provider, however designated, who
has the authority to establish or control business policy.
 new text end

new text begin Subd. 10. new text end

new text begin Medication. new text end

new text begin "Medication" means a prescription or over-the-counter drug.
For purposes of this chapter only, medication includes dietary supplements.
 new text end

new text begin Subd. 11. new text end

new text begin Medication administration. new text end

new text begin "Medication administration" means
performing a set of tasks to ensure a client takes medications, and includes the following:
 new text end

new text begin (1) checking the client's medication record;
 new text end

new text begin (2) preparing the medication as necessary;
 new text end

new text begin (3) administering the medication to the client;
 new text end

new text begin (4) documenting the administration or reason for not administering the medication;
and
 new text end

new text begin (5) reporting to a nurse any concerns about the medication, the client, or the client's
refusal to take the medication.
 new text end

new text begin Subd. 12. new text end

new text begin Medication management. new text end

new text begin "Medication management" means the
provision of any of the following medication-related services to a client:
 new text end

new text begin (1) performing medication setup;
 new text end

new text begin (2) administering medication;
 new text end

new text begin (3) storing and securing medications;
 new text end

new text begin (4) documenting medication activities;
 new text end

new text begin (5) verifying and monitoring effectiveness of systems to ensure safe handling and
administration;
 new text end

new text begin (6) coordinating refills;
 new text end

new text begin (7) handling and implementing changes to prescriptions;
 new text end

new text begin (8) communicating with the pharmacy about the client's medications; and
 new text end

new text begin (9) coordinating and communicating with the prescriber.
 new text end

new text begin Subd. 13. new text end

new text begin Medication setup. new text end

new text begin "Medication setup" means arranging medications by a
nurse, pharmacy, or authorized prescriber for later administration by the client or by
comprehensive home care staff.
 new text end

new text begin Subd. 14. new text end

new text begin Nurse. new text end

new text begin "Nurse" means a person who is licensed under sections 148.171 to
148.285.
 new text end

new text begin Subd. 15. new text end

new text begin Occupational therapist. new text end

new text begin "Occupational therapist" means a person who is
licensed under sections 148.6401 to 148.6450.
 new text end

new text begin Subd. 16. new text end

new text begin Over-the-counter drug. new text end

new text begin "Over-the-counter drug" means a drug that is
not required by federal law to bear the symbol "Rx only."
 new text end

new text begin Subd. 17. new text end

new text begin Owner. new text end

new text begin "Owner" means a proprietor, general partner, limited partner who
has five percent or more of equity interest in a limited partnership, a person who owns or
controls voting stock in a corporation in an amount equal to or greater than five percent of
the shares issued and outstanding, or a corporation that owns equity interest in a licensee
or applicant for a license.
 new text end

new text begin Subd. 18. new text end

new text begin Pharmacist. new text end

new text begin "Pharmacist" has the meaning given in section 151.01,
subdivision 3.
 new text end

new text begin Subd. 19. new text end

new text begin Physical therapist. new text end

new text begin "Physical therapist" means a person who is licensed
under sections 148.65 to 148.78.
 new text end

new text begin Subd. 20. new text end

new text begin Physician. new text end

new text begin "Physician" means a person who is licensed under chapter 147.
 new text end

new text begin Subd. 21. new text end

new text begin Prescriber. new text end

new text begin "Prescriber" means a person who is authorized by sections
148.235; 151.01, subdivision 23; and 151.37, to prescribe prescription drugs.
 new text end

new text begin Subd. 22. new text end

new text begin Prescription. new text end

new text begin "Prescription" has the meaning given in section 151.01,
subdivision 16.
 new text end

new text begin Subd. 23. new text end

new text begin Regularly scheduled. new text end

new text begin "Regularly scheduled" means ordered or planned
to be completed at predetermined times or according to a predetermined routine.
 new text end

new text begin Subd. 24. new text end

new text begin Reminder. new text end

new text begin "Reminder" means providing a verbal or visual reminder
to a client.
 new text end

new text begin Subd. 25. new text end

new text begin Respiratory therapist. new text end

new text begin "Respiratory therapist" means a person who
is licensed under chapter 147C.
 new text end

new text begin Subd. 26. new text end

new text begin Revenues. new text end

new text begin "Revenues" means all money received by a licensee derived
from the provision of home care services, including fees for services and appropriations
of public money for home care services.
 new text end

new text begin Subd. 27. new text end

new text begin Service plan. new text end

new text begin "Service plan" means the written plan between the client or
client's representative and the temporary licensee or licensee about the services that will
be provided to the client.
 new text end

new text begin Subd. 28. new text end

new text begin Social worker. new text end

new text begin "Social worker" means a person who is licensed under
chapter 148D or 148E.
 new text end

new text begin Subd. 29. new text end

new text begin Speech language pathologist. new text end

new text begin "Speech language pathologist" has the
meaning given in section 148.512.
 new text end

new text begin Subd. 30. new text end

new text begin Standby assistance. new text end

new text begin "Standby assistance" means the presence of another
person within arm's reach to minimize the risk of injury while performing daily activities
through physical intervention or cuing.
 new text end

new text begin Subd. 31. new text end

new text begin Substantial compliance. new text end

new text begin "Substantial compliance" means complying
with the requirements in this chapter sufficiently to prevent unacceptable health or safety
risks to the home care client.
 new text end

new text begin Subd. 32. new text end

new text begin Survey. new text end

new text begin "Survey" means an inspection of a licensee or applicant for
licensure for compliance with this chapter.
 new text end

new text begin Subd. 33. new text end

new text begin Surveyor. new text end

new text begin "Surveyor" means a staff person of the department authorized
to conduct surveys of home care providers and applicants.
 new text end

new text begin Subd. 34. new text end

new text begin Temporary license. new text end

new text begin "Temporary license" means the initial basic or
comprehensive home care license the department issues after approval of a complete
written application and before the department completes the temporary license survey and
determines that the temporary licensee is in substantial compliance.
 new text end

new text begin Subd. 35. new text end

new text begin Treatment or therapy. new text end

new text begin "Treatment" or "therapy" means the provision
of care, other than medications, ordered or prescribed by a licensed health professional
provided to a client to cure, rehabilitate, or ease symptoms.
 new text end

new text begin Subd. 36. new text end

new text begin Unit of government. new text end

new text begin "Unit of government" means every city, county,
town, school district, other political subdivisions of the state, and any agency of the state
or federal government, which includes any instrumentality of a unit of government.
 new text end

new text begin Subd. 37. new text end

new text begin Unlicensed personnel. new text end

new text begin "Unlicensed personnel" are individuals not
otherwise licensed or certified by a governmental health board or agency who provide
home care services in the client's home.
 new text end

new text begin Subd. 38. new text end

new text begin Verbal. new text end

new text begin "Verbal" means oral and not in writing.
 new text end

Sec. 6.

Minnesota Statutes 2012, section 144A.44, is amended to read:


144A.44 HOME CARE BILL OF RIGHTS.

Subdivision 1.

Statement of rights.

A person who receives home care services
has these rights:

(1) the right to receive written information about rights deleted text begin in advance ofdeleted text end new text begin before
new text end receiving deleted text begin care or during the initial evaluation visit before the initiation of treatment
deleted text end new text begin servicesnew text end , including what to do if rights are violated;

(2) the right to receive care and services according to a suitable and up-to-date plan,
and subject to accepted new text begin health care, new text end medical or nursing standards, to take an active part
in deleted text begin creating and changing the plandeleted text end new text begin developing, modifying,new text end and evaluating deleted text begin caredeleted text end new text begin the plan
new text end and services;

(3) the right to be told deleted text begin in advance ofdeleted text end new text begin beforenew text end receiving deleted text begin care about thedeleted text end services deleted text begin that will
be provided, the disciplines that will furnish caredeleted text end new text begin the type and disciplines of staff who will
be providing the servicesnew text end , the frequency of visits proposed to be furnished, other choices
that are availablenew text begin for addressing home care needsnew text end , and deleted text begin the consequences of these choices
includingdeleted text end the new text begin potential new text end consequences of refusing these services;

(4) the right to be told in advance of any deleted text begin changedeleted text end new text begin recommended changes by the
providernew text end in the new text begin service new text end plan deleted text begin of caredeleted text end and to take an active part in any deleted text begin changedeleted text end new text begin decisions
about changes to the service plannew text end ;

(5) the right to refuse services or treatment;

(6) the right to know, deleted text begin in advancedeleted text end new text begin before receiving services or during the initial
visitnew text end , any limits to the services available from a new text begin home care new text end providerdeleted text begin , and the provider's
grounds for a termination of servicesdeleted text end ;

deleted text begin (7) the right to know in advance of receiving care whether the services are covered
by health insurance, medical assistance, or other health programs, the charges for services
that will not be covered by Medicare, and the charges that the individual may have to pay;
 deleted text end

deleted text begin (8)deleted text end new text begin (7)new text end the right to deleted text begin knowdeleted text end new text begin be told before services are initiatednew text end what the new text begin provider
new text end charges are for new text begin the new text end services, deleted text begin no matter who will be paying the billdeleted text end new text begin and if known to what
extent payment may be expected from health insurance, public programs or other sources,
and what charges the client may be responsible for payingnew text end ;

deleted text begin (9)deleted text end new text begin (8) new text end the right to know that there may be other services available in the community,
including other home care services and providers, and to know where to deleted text begin go fordeleted text end new text begin find
new text end information about these services;

deleted text begin (10)deleted text end new text begin (9)new text end the right to choose freely among available providers and to change providers
after services have begun, within the limits of health insurance, new text begin long-term care insurance,
new text end medical assistance, or other health programs;

deleted text begin (11)deleted text end new text begin (10)new text end the right to have personal, financial, and medical information kept private,
and to be advised of the provider's policies and procedures regarding disclosure of such
information;

deleted text begin (12)deleted text end new text begin (11)new text end the right to deleted text begin be alloweddeleted text end access deleted text begin todeleted text end new text begin the client's own new text end records and written
information from new text begin those new text end records in accordance with sections 144.291 to 144.298;

deleted text begin (13)deleted text end new text begin (12)new text end the right to be served by people who are properly trained and competent
to perform their duties;

deleted text begin (14)deleted text end new text begin (13)new text end the right to be treated with courtesy and respect, and to have the deleted text begin patient's
deleted text end new text begin client'snew text end property treated with respect;

deleted text begin (15)deleted text end new text begin (14)new text end the right to be free from physical and verbal abusenew text begin , neglect, financial
exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and
the Maltreatment of Minors Actnew text end ;

deleted text begin (16)deleted text end new text begin (15)new text end the right to reasonable, advance notice of changes in services or chargesdeleted text begin ,
includingdeleted text end new text begin ;
new text end

new text begin (16) the right to know the provider's reason for termination of services;
 new text end

new text begin (17) the right tonew text end at least ten days' advance notice of the termination of a service by a
provider, except in cases where:

(i) the deleted text begin recipient of servicesdeleted text end new text begin clientnew text end engages in conduct that new text begin significantly new text end alters the
deleted text begin conditions of employment as specified in the employment contract betweendeleted text end new text begin terms of
the service plan withnew text end the home care provider deleted text begin and the individual providing home care
services, or createsdeleted text end new text begin ;
new text end

new text begin (ii) the client, person who lives with the client, or others createnew text end an abusive or unsafe
work environment for the deleted text begin individualdeleted text end new text begin personnew text end providing home care services; or

deleted text begin (ii)deleted text end new text begin (iii)new text end an emergency deleted text begin for the informal caregiverdeleted text end or a significant change in the
deleted text begin recipient'sdeleted text end new text begin client'snew text end condition has resulted in service needs that exceed the current service
deleted text begin provider agreementdeleted text end new text begin plannew text end and that cannot be safely met by the home care provider;

deleted text begin (17)deleted text end new text begin (18)new text end the right to a coordinated transfer when there will be a change in the
provider of services;

deleted text begin (18)deleted text end new text begin (19)new text end the right to deleted text begin voice grievances regarding treatment or care that isdeleted text end new text begin complain
about services that are providednew text end , or deleted text begin fails to be, furnished, or regardingdeleted text end new text begin fail to be provided,
and new text end the lack of courtesy or respect to the deleted text begin patientdeleted text end new text begin client new text end or the deleted text begin patient'sdeleted text end new text begin client's new text end property;

deleted text begin (19)deleted text end new text begin (20)new text end the right to know how to contact an individual associated with the new text begin home
care new text end provider who is responsible for handling problems and to have the new text begin home care new text end provider
investigate and attempt to resolve the grievance or complaint;

deleted text begin (20)deleted text end new text begin (21)new text end the right to know the name and address of the state or county agency to
contact for additional information or assistance; and

deleted text begin (21)deleted text end new text begin (22)new text end the right to assert these rights personally, or have them asserted by
the deleted text begin patient's family or guardian when the patient has been judged incompetent,deleted text end new text begin client's
representative or by anyone on behalf of the client,new text end without retaliation.

Subd. 2.

Interpretation and enforcement of rights.

These rights are established
for the benefit of deleted text begin personsdeleted text end new text begin clientsnew text end who receive home care services. deleted text begin "Home care services"
means home care services as defined in section 144A.43, subdivision 3, and unlicensed
personal care assistance services, including services covered by medical assistance under
section 256B.0625, subdivision 19a.deleted text end new text begin All home care providers, including those exempted
under section 144A.471, must comply with this section. The commissioner shall enforce
this section and the home care bill of rights requirement against home care providers
exempt from licensure in the same manner as for licensees. new text end A home care provider may
not new text begin request or new text end require a deleted text begin persondeleted text end new text begin clientnew text end to surrender new text begin any of new text end these rights as a condition of
receiving services. deleted text begin A guardian or conservator or, when there is no guardian or conservator,
a designated person, may seek to enforce these rights.deleted text end This statement of rights does not
replace or diminish other rights and liberties that may exist relative to deleted text begin personsdeleted text end new text begin clients
new text end receiving home care services, persons providing home care services, or providers licensed
under deleted text begin Laws 1987, chapter 378. A copy of these rights must be provided to an individual
at the time home care services, including personal care assistance services, are initiated.
The copy shall also contain the address and phone number of the Office of Health Facility
Complaints and the Office of Ombudsman for Long-Term Care and a brief statement
describing how to file a complaint with these offices. Information about how to contact
the Office of Ombudsman for Long-Term Care shall be included in notices of change in
client fees and in notices where home care providers initiate transfer or discontinuation of
servicesdeleted text end new text begin sections 144A.43 to 144A.482new text end .

Sec. 7.

Minnesota Statutes 2012, section 144A.45, is amended to read:


144A.45 REGULATION OF HOME CARE SERVICES.

Subdivision 1.

deleted text begin Rulesdeleted text end new text begin Regulationsnew text end .

The commissioner shall deleted text begin adopt rules for the
regulation ofdeleted text end new text begin regulatenew text end home care providers pursuant to sections 144A.43 to deleted text begin 144A.47
deleted text end new text begin 144A.482new text end . The deleted text begin rulesdeleted text end new text begin regulationsnew text end shall include the following:

(1) provisions to assure, to the extent possible, the health, safety and well-being,
and appropriate treatment of persons who receive home care servicesnew text begin while respecting
clients' autonomy and choicenew text end ;

(2) requirements that home care providers furnish the commissioner with specified
information necessary to implement sections 144A.43 to deleted text begin 144A.47deleted text end new text begin 144A.482new text end ;

(3) standards of training of home care provider personneldeleted text begin , which may vary according
to the nature of the services provided or the health status of the consumerdeleted text end ;

new text begin (4) standards for provision of home care services;
 new text end

deleted text begin (4)deleted text end new text begin (5)new text end standards for medication management deleted text begin which may vary according to the
nature of the services provided, the setting in which the services are provided, or the
status of the consumer. Medication management includes the central storage, handling,
distribution, and administration of medicationsdeleted text end ;

deleted text begin (5)deleted text end new text begin (6)new text end standards for supervision of home care services deleted text begin requiring supervision by a
registered nurse or other appropriate health care professional which must occur on site
at least every 62 days, or more frequently if indicated by a clinical assessment, and in
accordance with sections 148.171 to 148.285 and rules adopted thereunder, except that a
person performing home care aide tasks for a class B licensee providing paraprofessional
services does not require nursing supervisiondeleted text end ;

deleted text begin (6)deleted text end new text begin (7)new text end standards for client evaluation or assessment deleted text begin which may vary according to
the nature of the services provided or the status of the consumerdeleted text end ;

deleted text begin (7)deleted text end new text begin (8)new text end requirements for the involvement of a deleted text begin consumer's physiciandeleted text end new text begin client's health
care providernew text end , the documentation of deleted text begin physicians'deleted text end new text begin health care providers'new text end orders, if required,
and the deleted text begin consumer's treatmentdeleted text end new text begin client's servicenew text end plandeleted text begin , anddeleted text end new text begin ;
new text end

new text begin (9)new text end the maintenance of accurate, current deleted text begin clinicaldeleted text end new text begin clientnew text end records;

deleted text begin (8)deleted text end new text begin (10)new text end the establishment of deleted text begin different classesdeleted text end new text begin basic and comprehensive levelsnew text end of
licenses deleted text begin for different types of providers and different standards and requirements for
different kinds of home caredeleted text end new text begin based on new text end servicesnew text begin providednew text end ; and

deleted text begin (9) operating procedures required to implementdeleted text end new text begin (11) provisions to enforce these
regulations andnew text end the home care bill of rights.

deleted text begin Subd. 1a. deleted text end

deleted text begin Home care aide tasks. deleted text end

deleted text begin Notwithstanding the provisions of Minnesota
Rules, part 4668.0110, subpart 1, item E, home care aide tasks also include assisting
toileting, transfers, and ambulation if the client is ambulatory and if the client has no
serious acute illness or infectious disease.
 deleted text end

deleted text begin Subd. 1b. deleted text end

deleted text begin Home health aide qualifications. deleted text end

deleted text begin Notwithstanding the provisions of
Minnesota Rules, part 4668.0100, subpart 5, a person may perform home health aide tasks
if the person maintains current registration as a nursing assistant on the Minnesota nursing
assistant registry. Maintaining current registration on the Minnesota nursing assistant
registry satisfies the documentation requirements of Minnesota Rules, part 4668.0110,
subpart 3.
 deleted text end

Subd. 2.

Regulatory functions.

deleted text begin (a)deleted text end The commissioner shall:

(1) deleted text begin evaluate, monitor, anddeleted text end licensenew text begin , survey, and monitor without advance notice, new text end home
care providers in accordance with sections deleted text begin 144A.45 to 144A.47deleted text end new text begin 144A.43 to 144A.482new text end ;

deleted text begin (2) inspect the office and records of a provider during regular business hours without
advance notice to the home care provider;
 deleted text end

new text begin (2) survey every temporary licensee within one year of the temporary license issuance
date subject to the temporary licensee providing home care services to a client or clients;
 new text end

new text begin (3) survey all licensed home care providers on an interval that will promote the
health and safety of clients;
 new text end

deleted text begin (3)deleted text end new text begin (4)new text end with the consent of the deleted text begin consumerdeleted text end new text begin clientnew text end , visit the home where services are
being provided;

deleted text begin (4)deleted text end new text begin (5)new text end issue correction orders and assess civil penalties in accordance with section
144.653, subdivisions 5 to 8, for violations of sections 144A.43 to deleted text begin 144A.47 or the rules
adopted under those sectionsdeleted text end new text begin 144A.482new text end ;

deleted text begin (5)deleted text end new text begin (6)new text end take action as authorized in section deleted text begin 144A.46, subdivision 3deleted text end new text begin 144A.475new text end ; and

deleted text begin (6)deleted text end new text begin (7)new text end take other action reasonably required to accomplish the purposes of sections
144A.43 to deleted text begin 144A.47deleted text end new text begin 144A.482new text end .

deleted text begin (b) In the exercise of the authority granted in sections 144A.43 to 144A.47, the
commissioner shall comply with the applicable requirements of section 144.122, the
Government Data Practices Act, and the Administrative Procedure Act.
 deleted text end

deleted text begin Subd. 4. deleted text end

deleted text begin Medicaid reimbursement. deleted text end

deleted text begin Notwithstanding the provisions of section
256B.37 or state plan requirements to the contrary, certification by the federal Medicare
program must not be a requirement of Medicaid payment for services delivered under
section 144A.4605.
 deleted text end

deleted text begin Subd. 5. deleted text end

deleted text begin Home care providers; services for Alzheimer's disease or related
disorder. deleted text end

deleted text begin (a) If a home care provider licensed under section 144A.46 or 144A.4605 markets
or otherwise promotes services for persons with Alzheimer's disease or related disorders,
the facility's direct care staff and their supervisors must be trained in dementia care.
 deleted text end

deleted text begin (b) Areas of required training include:
 deleted text end

deleted text begin (1) an explanation of Alzheimer's disease and related disorders;
 deleted text end

deleted text begin (2) assistance with activities of daily living;
 deleted text end

deleted text begin (3) problem solving with challenging behaviors; and
 deleted text end

deleted text begin (4) communication skills.
 deleted text end

deleted text begin (c) The licensee shall provide to consumers in written or electronic form a
description of the training program, the categories of employees trained, the frequency
of training, and the basic topics covered.
 deleted text end

Sec. 8.

new text begin [144A.471] HOME CARE PROVIDER AND HOME CARE SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin License required. new text end

new text begin A home care provider may not open, operate,
manage, conduct, maintain, or advertise itself as a home care provider or provide home
care services in Minnesota without a temporary or current home care provider license
issued by the commissioner of health.
 new text end

new text begin Subd. 2. new text end

new text begin Determination of direct home care service. new text end

new text begin "Direct home care service"
means a home care service provided to a client by the home care provider or its employees,
and not by contract. Factors that must be considered in determining whether an individual
or a business entity provides at least one home care service directly include, but are not
limited to, whether the individual or business entity:
 new text end

new text begin (1) has the right to control, and does control, the types of services provided;
 new text end

new text begin (2) has the right to control, and does control, when and how the services are provided;
 new text end

new text begin (3) establishes the charges;
 new text end

new text begin (4) collects fees from the clients or receives payment from third-party payers on
the clients' behalf;
 new text end

new text begin (5) pays individuals providing services compensation on an hourly, weekly, or
similar basis;
 new text end

new text begin (6) treats the individuals providing services as employees for the purposes of payroll
taxes and workers' compensation insurance; and
 new text end

new text begin (7) holds itself out as a provider of home care services or acts in a manner that
leads clients or potential clients to believe that it is a home care provider providing home
care services.
 new text end

new text begin None of the factors listed in this subdivision is solely determinative.
 new text end

new text begin Subd. 3. new text end

new text begin Determination of regularly engaged. new text end

new text begin "Regularly engaged" means
providing, or offering to provide, home care services as a regular part of a business. The
following factors must be considered by the commissioner in determining whether an
individual or a business entity is regularly engaged in providing home care services:
 new text end

new text begin (1) whether the individual or business entity states or otherwise promotes that the
individual or business entity provides home care services;
 new text end

new text begin (2) whether persons receiving home care services constitute a substantial part of the
individual's or the business entity's clientele; and
 new text end

new text begin (3) whether the home care services provided are other than occasional or incidental
to the provision of services other than home care services.
 new text end

new text begin None of the factors listed in this subdivision is solely determinative.
 new text end

new text begin Subd. 4. new text end

new text begin Penalties for operating without license. new text end

new text begin A person involved in the
management, operation, or control of a home care provider that operates without an
appropriate license is guilty of a misdemeanor. This section does not apply to a person
who has no legal authority to affect or change decisions related to the management,
operation, or control of a home care provider.
 new text end

new text begin Subd. 5. new text end

new text begin Basic and comprehensive levels of licensure. new text end

new text begin An applicant seeking
to become a home care provider must apply for either a basic or comprehensive home
care license.
 new text end

new text begin Subd. 6. new text end

new text begin Basic home care license provider. new text end

new text begin Home care services that can be
provided with a basic home care license are assistive tasks provided by licensed or
unlicensed personnel that include:
 new text end

new text begin (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting,
and bathing;
 new text end

new text begin (2) providing standby assistance;
 new text end

new text begin (3) providing verbal or visual reminders to the client to take regularly scheduled
medication which includes bringing the client previously set-up medication, medication in
original containers, or liquid or food to accompany the medication;
 new text end

new text begin (4) providing verbal or visual reminders to the client to perform regularly scheduled
treatments and exercises;
 new text end

new text begin (5) preparing modified diets ordered by a licensed health professional; and
 new text end

new text begin (6) assisting with laundry, housekeeping, meal preparation, shopping, or other
household chores and services if the provider is also providing at least one of the activities
in clauses (1) to (5)
 new text end

new text begin Subd. 7. new text end

new text begin Comprehensive home care license provider. new text end

new text begin Home care services that
may be provided with a comprehensive home care license include any of the basic home
care services listed in subdivision 6, and one or more of the following:
 new text end

new text begin (1) services of an advanced practice nurse, registered nurse, licensed practical
nurse, physical therapist, respiratory therapist, occupational therapist, speech-language
pathologist, dietician or nutritionist, or social worker;
 new text end

new text begin (2) tasks delegated to unlicensed personnel by a registered nurse or assigned by a
licensed health professional within the person's scope of practice;
 new text end

new text begin (3) medication management services;
 new text end

new text begin (4) hands-on assistance with transfers and mobility;
 new text end

new text begin (5) assisting clients with eating when the clients have complicating eating problems
as identified in the client record or through an assessment such as difficulty swallowing,
recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous
instruments to be fed; or
 new text end

new text begin (6) providing other complex or specialty health care services.
 new text end

new text begin Subd. 8. new text end

new text begin Exemptions from home care services licensure. new text end

new text begin (a) Except as otherwise
provided in this chapter, home care services that are provided by the state, counties, or
other units of government must be licensed under this chapter.
 new text end

new text begin (b) An exemption under this subdivision does not excuse the exempted individual or
organization from complying with applicable provisions of the home care bill of rights
in section 144A.44. The following individuals or organizations are exempt from the
requirement to obtain a home care provider license:
 new text end

new text begin (1) an individual or organization that offers, provides, or arranges for personal care
assistance services under the medical assistance program as authorized under sections
256B.04, subdivision 16; 256B.0625, subdivision 19a; and 256B.0659;
 new text end

new text begin (2) a provider that is licensed by the commissioner of human services to provide
semi-independent living services for persons with developmental disabilities under section
252.275 and Minnesota Rules, parts 9525.0900 to 9525.1020;
 new text end

new text begin (3) a provider that is licensed by the commissioner of human services to provide
home and community-based services for persons with developmental disabilities under
section 256B.092 and Minnesota Rules, parts 9525.1800 to 9525.1930;
 new text end

new text begin (4) an individual or organization that provides only home management services, if
the individual or organization is registered under section 144A.482; or
new text end

new text begin (5) an individual who is licensed in this state as a nurse, dietitian, social worker,
occupational therapist, physical therapist, or speech-language pathologist who provides
health care services in the home independently and not through any contractual or
employment relationship with a home care provider or other organization.
 new text end

new text begin Subd. 9. new text end

new text begin Exclusions from home care licensure. new text end

new text begin The following are excluded from
home care licensure and are not required to provide the home care bill of rights:
 new text end

new text begin (1) an individual or business entity providing only coordination of home care that
includes one or more of the following:
 new text end

new text begin (i) determination of whether a client needs home care services, or assisting a client
in determining what services are needed;
 new text end

new text begin (ii) referral of clients to a home care provider;
 new text end

new text begin (iii) administration of payments for home care services; or
 new text end

new text begin (iv) administration of a health care home established under section 256B.0751;
 new text end

new text begin (2) an individual who is not an employee of a licensed home care provider if the
individual:
 new text end

new text begin (i) only provides services as an independent contractor to one or more licensed
home care providers;
 new text end

new text begin (ii) provides no services under direct agreements or contracts with clients; and
 new text end

new text begin (iii) is contractually bound to perform services in compliance with the contracting
home care provider's policies and service plans;
 new text end

new text begin (3) a business that provides staff to home care providers, such as a temporary
employment agency, if the business:
 new text end

new text begin (i) only provides staff under contract to licensed or exempt providers;
 new text end

new text begin (ii) provides no services under direct agreements with clients; and
 new text end

new text begin (iii) is contractually bound to perform services under the contracting home care
provider's direction and supervision;
 new text end

new text begin (4) any home care services conducted by and for the adherents of any recognized
church or religious denomination for its members through spiritual means, or by prayer
for healing;
 new text end

new text begin (5) an individual who only provides home care services to a relative;
 new text end

new text begin (6) an individual not connected with a home care provider that provides assistance
with basic home care needs if the assistance is provided primarily as a contribution and
not as a business;
 new text end

new text begin (7) an individual not connected with a home care provider that shares housing with
and provides primarily housekeeping or homemaking services to an elderly or disabled
person in return for free or reduced-cost housing;
 new text end

new text begin (8) an individual or provider providing home-delivered meal services;
 new text end

new text begin (9) an individual providing senior companion services and other Older American
Volunteer Programs (OAVP) established under the Domestic Volunteer Service Act of
1973, United States Code, title 42, chapter 66;
 new text end

new text begin (10) an employee of a nursing home licensed under this chapter or an employee of a
boarding care home licensed under sections 144.50 to 144.56 who responds to occasional
emergency calls from individuals residing in a residential setting that is attached to or
located on property contiguous to the nursing home or boarding care home;
 new text end

new text begin (11) a member of a professional corporation organized under chapter 319B that
does not regularly offer or provide home care services as defined in section 144A.43,
subdivision 3;
 new text end

new text begin (12) the following organizations established to provide medical or surgical services
that do not regularly offer or provide home care services as defined in section 144A.43,
subdivision 3: a business trust organized under sections 318.01 to 318.04, a nonprofit
corporation organized under chapter 317A, a partnership organized under chapter 323, or
any other entity determined by the commissioner;
 new text end

new text begin (13) an individual or agency that provides medical supplies or durable medical
equipment, except when the provision of supplies or equipment is accompanied by a
home care service;
 new text end

new text begin (14) a physician licensed under chapter 147;
 new text end

new text begin (15) an individual who provides home care services to a person with a developmental
disability who lives in a place of residence with a family, foster family, or primary caregiver;
 new text end

new text begin (16) a business that only provides services that are primarily instructional and not
medical services or health-related support services;
 new text end

new text begin (17) an individual who performs basic home care services for no more than 14 hours
each calendar week to no more than one client;
 new text end

new text begin (18) an individual or business licensed as hospice as defined in sections 144A.75 to
144A.755 who is not providing home care services independent of hospice service;
 new text end

new text begin (19) activities conducted by the commissioner of health or a board of health as
defined in section 145A.02, subdivision 2, including communicable disease investigations
or testing; or
 new text end

new text begin (20) administering or monitoring a prescribed therapy necessary to control or
prevent a communicable disease, or the monitoring of an individual's compliance with a
health directive as defined in section 144.4172, subdivision 6.
 new text end

Sec. 9.

new text begin [144A.472] HOME CARE PROVIDER LICENSE; APPLICATION AND
RENEWAL.
 new text end

new text begin Subdivision 1. new text end

new text begin License applications. new text end

new text begin Each application for a home care provider
license must include information sufficient to show that the applicant meets the
requirements of licensure, including:
 new text end

new text begin (1) the applicant's name, e-mail address, physical address, and mailing address,
including the name of the county in which the applicant resides and has a principal
place of business;
 new text end

new text begin (2) the initial license fee in the amount specified in subdivision 7;
 new text end

new text begin (3) e-mail address, physical address, mailing address, and telephone number of the
principal administrative office;
 new text end

new text begin (4) e-mail address, physical address, mailing address, and telephone number of
each branch office, if any;
 new text end

new text begin (5) names, e-mail and mailing addresses, and telephone numbers of all owners
and managerial officials;
 new text end

new text begin (6) documentation of compliance with the background study requirements of section
144A.476 for all persons involved in the management, operation, or control of the home
care provider;
 new text end

new text begin (7) documentation of a background study as required by section 144.057 for any
individual seeking employment, paid or volunteer, with the home care provider;
 new text end

new text begin (8) evidence of workers' compensation coverage as required by sections 176.181
and 176.182;
 new text end

new text begin (9) documentation of liability coverage, if the provider has it;
 new text end

new text begin (10) identification of the license level the provider is seeking;
 new text end

new text begin (11) documentation that identifies the managerial official who is in charge of
day-to-day operations and attestation that the person has reviewed and understands the
home care provider regulations;
 new text end

new text begin (12) documentation that the applicant has designated one or more owners,
managerial officials, or employees as an agent or agents, which shall not affect the legal
responsibility of any other owner or managerial official under this chapter;
 new text end

new text begin (13) the signature of the officer or managing agent on behalf of an entity, corporation,
association, or unit of government;
 new text end

new text begin (14) verification that the applicant has the following policies and procedures in place
so that if a license is issued, the applicant will implement the policies and procedures
and keep them current:
 new text end

new text begin (i) requirements in sections 626.556, reporting of maltreatment of minors, and
626.557, reporting of maltreatment of vulnerable adults;
 new text end

new text begin (ii) conducting and handling background studies on employees;
 new text end

new text begin (iii) orientation, training, and competency evaluations of home care staff, and a
process for evaluating staff performance;
 new text end

new text begin (iv) handling complaints from clients, family members, or client representatives
regarding staff or services provided by staff;
 new text end

new text begin (v) conducting initial evaluation of clients' needs and the providers' ability to provide
those services;
 new text end

new text begin (vi) conducting initial and ongoing client evaluations and assessments and how
changes in a client's condition are identified, managed, and communicated to staff and
other health care providers as appropriate;
 new text end

new text begin (vii) orientation to and implementation of the home care client bill of rights;
 new text end

new text begin (viii) infection control practices;
 new text end

new text begin (ix) reminders for medications, treatments, or exercises, if provided; and
 new text end

new text begin (x) conducting appropriate screenings, or documentation of prior screenings, to
show that staff are free of tuberculosis, consistent with current United States Centers for
Disease Control standards; and
 new text end

new text begin (15) other information required by the department.
 new text end

new text begin Subd. 2. new text end

new text begin Comprehensive home care license applications. new text end

new text begin In addition to the
information and fee required in subdivision 1, applicants applying for a comprehensive
home care license must also provide verification that the applicant has the following
policies and procedures in place so that if a license is issued, the applicant will implement
the policies and procedures in this subdivision and keep them current:
 new text end

new text begin (1) conducting initial and ongoing assessments of the client's needs by a registered
nurse or appropriate licensed health professional, including how changes in the client's
conditions are identified, managed, and communicated to staff and other health care
providers, as appropriate;
 new text end

new text begin (2) ensuring that nurses and licensed health professionals have current and valid
licenses to practice;
 new text end

new text begin (3) medication and treatment management;
 new text end

new text begin (4) delegation of home care tasks by registered nurses or licensed health professionals;
 new text end

new text begin (5) supervision of registered nurses and licensed health professionals; and
 new text end

new text begin (6) supervision of unlicensed personnel performing delegated home care tasks.
 new text end

new text begin Subd. 3. new text end

new text begin License renewal. new text end

new text begin (a) Except as provided in section 144A.475, a license
may be renewed for a period of one year if the licensee satisfies the following:
 new text end

new text begin (1) submits an application for renewal in the format provided by the commissioner
at least 30 days before expiration of the license;
 new text end

new text begin (2) submits the renewal fee in the amount specified in subdivision 7;
 new text end

new text begin (3) has provided home care services within the past 12 months;
 new text end

new text begin (4) complies with sections 144A.43 to 144A.4799;
 new text end

new text begin (5) provides information sufficient to show that the applicant meets the requirements
of licensure, including items required under subdivision 1;
 new text end

new text begin (6) provides verification that all policies under subdivision 1, are current; and
new text end

new text begin (7) provides any other information deemed necessary by the commissioner.
 new text end

new text begin (b) A renewal applicant who holds a comprehensive home care license must also
provide verification that policies listed under subdivision 2 are current.
 new text end

new text begin Subd. 4. new text end

new text begin Multiple units. new text end

new text begin Multiple units or branches of a licensee must be separately
licensed if the commissioner determines that the units cannot adequately share supervision
and administration of services from the main office.
 new text end

new text begin Subd. 5. new text end

new text begin Transfers prohibited; changes in ownership. new text end

new text begin Any home care license
issued by the commissioner may not be transferred to another party. Before acquiring
ownership of a home care provider business, a prospective applicant must apply for a
new temporary license. A change of ownership is a transfer of operational control to
a different business entity, and includes:
 new text end

new text begin (1) transfer of the business to a different or new corporation;
 new text end

new text begin (2) in the case of a partnership, the dissolution or termination of the partnership under
chapter 323A, with the business continuing by a successor partnership or other entity;
new text end

new text begin (3) relinquishment of control of the provider to another party, including to a contract
management firm that is not under the control of the owner of the business' assets;
 new text end

new text begin (4) transfer of the business by a sole proprietor to another party or entity; or
 new text end

new text begin (5) in the case of a privately held corporation, the change in ownership or control of
50 percent or more of the outstanding voting stock.
 new text end

new text begin Subd. 6. new text end

new text begin Notification of changes of information. new text end

new text begin The temporary licensee or
licensee shall notify the commissioner in writing within ten working days after any
change in the information required in subdivision 1, except the information required in
subdivision 1, clause (5), is required at the time of license renewal.
 new text end

new text begin Subd. 7. new text end

new text begin Fees; application, change of ownership, and renewal. new text end

new text begin (a) An initial
applicant seeking a temporary home care licensure must submit the following application
fee to the commissioner along with a completed application:
 new text end

new text begin (1) basic home care provider, $2,100; or
 new text end

new text begin (2) comprehensive home care provider, $4,200.
 new text end

new text begin (b) A home care provider who is filing a change of ownership as required under
subdivision 5 must submit the following application fee to the commissioner, along with
the documentation required for the change of ownership:
 new text end

new text begin (1) basic home care provider, $2,100; or
 new text end

new text begin (2) comprehensive home care provider, $4,200.
 new text end

new text begin (c) A home care provider who is seeking to renew the provider's license shall pay a
fee to the commissioner based on revenues derived from the provision of home care
services during the calendar year prior to the year in which the application is submitted,
according to the following schedule:
 new text end

new text begin License Renewal Fee
 new text end

new text begin Provider Annual Revenue
 new text end 		new text begin Fee
 new text end
new text begin greater than $1,500,000
 new text end 		new text begin $6,625
 new text end
new text begin greater than $1,275,000 and no more than
$1,500,000
 new text end 		new text begin $5,797
 new text end
new text begin greater than $1,100,000 and no more than
$1,275,000
 new text end 		new text begin $4,969
 new text end
new text begin greater than $950,000 and no more than
$1,100,000
 new text end 		new text begin $4,141
 new text end
new text begin greater than $850,000 and no more than
$950,000
 new text end 		new text begin $3,727
 new text end
new text begin greater than $750,000 and no more than
$850,000
 new text end 		new text begin $3,313
 new text end
new text begin greater than $650,000 and no more than
$750,000
 new text end 		new text begin $2,898
 new text end
new text begin greater than $550,000 and no more than
$650,000
 new text end 		new text begin $2,485
 new text end
new text begin greater than $450,000 and no more than
$550,000
 new text end 		new text begin $2,070
 new text end
new text begin greater than $350,000 and no more than
$450,000
 new text end 		new text begin $1,656
 new text end
new text begin greater than $250,000 and no more than
$350,000
 new text end 		new text begin $1,242
 new text end
new text begin greater than $100,000 and no more than
$250,000
 new text end 		new text begin $828
 new text end
new text begin greater than $50,000 and no more than $100,000
 new text end 		new text begin $500
 new text end
new text begin greater than $25,000 and no more than $50,000
 new text end 		new text begin $400
 new text end
new text begin no more than $25,000
 new text end 		new text begin $200
 new text end

new text begin (d) If requested, the home care provider shall provide the commissioner information
to verify the provider's annual revenues or other information as needed, including copies
of documents submitted to the Department of Revenue.
 new text end

new text begin (e) At each annual renewal, a home care provider may elect to pay the highest
renewal fee for its license category, and not provide annual revenue information to the
commissioner.
 new text end

new text begin (f) A temporary license or license applicant, or temporary licensee or licensee that
knowingly provides the commissioner incorrect revenue amounts for the purpose of
paying a lower license fee, shall be subject to a civil penalty in the amount of double the
fee the provider should have paid.
 new text end

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

new text begin (h) The license renewal fee schedule in this subdivision is effective July 1, 2016.
 new text end

Sec. 10.

new text begin [144A.473] ISSUANCE OF TEMPORARY LICENSE AND LICENSE
RENEWAL.
 new text end

new text begin Subdivision 1. new text end

new text begin Temporary license and renewal of license. new text end

new text begin (a) The department
shall review each application to determine the applicant's knowledge of and compliance
with Minnesota home care regulations. Before granting a temporary license or renewing a
license, the commissioner may further evaluate the applicant or licensee by requesting
additional information or documentation or by conducting an on-site survey of the
applicant to determine compliance with sections 144A.43 to 144A.482.
 new text end

new text begin (b) Within 14 calendar days after receiving an application for a license,
the commissioner shall acknowledge receipt of the application in writing. The
acknowledgment must indicate whether the application appears to be complete or whether
additional information is required before the application will be considered complete.
 new text end

new text begin (c) Within 90 days after receiving a complete application, the commissioner shall
issue a temporary license, renew the license, or deny the license.
 new text end

new text begin (d) The commissioner shall issue a license that contains the home care provider's
name, address, license level, expiration date of the license, and unique license number. All
licenses are valid for one year from the date of issuance.
 new text end

new text begin Subd. 2. new text end

new text begin Temporary license. new text end

new text begin (a) For new license applicants, the commissioner
shall issue a temporary license for either the basic or comprehensive home care level. A
temporary license is effective for one year from the date of issuance. Temporary licensees
must comply with sections 144A.43 to 144A.482.
 new text end

new text begin (b) During the temporary license year, the commissioner shall survey the temporary
licensee after the commissioner is notified or has evidence that the temporary licensee
is providing home care services.
 new text end

new text begin (c) Within five days of beginning the provision of services, the temporary
licensee must notify the commissioner that it is serving clients. The notification to the
commissioner may be mailed or e-mailed to the commissioner at the address provided by
the commissioner. If the temporary licensee does not provide home care services during
the temporary license year, then the temporary license expires at the end of the year and
the applicant must reapply for a temporary home care license.
 new text end

new text begin (d) A temporary licensee may request a change in the level of licensure prior to
being surveyed and granted a license by notifying the commissioner in writing and
providing additional documentation or materials required to update or complete the
changed temporary license application. The applicant must pay the difference between the
application fees when changing from the basic to the comprehensive level of licensure.
No refund will be made if the provider chooses to change the license application to the
basic level.
 new text end

new text begin (e) If the temporary licensee notifies the commissioner that the licensee has clients
within 45 days prior to the temporary license expiration, the commissioner may extend the
temporary license for up to 60 days in order to allow the commissioner to complete the
on-site survey required under this section and follow-up survey visits.
 new text end

new text begin Subd. 3. new text end

new text begin Temporary licensee survey. new text end

new text begin (a) If the temporary licensee is in substantial
compliance with the survey, the commissioner shall issue either a basic or comprehensive
home care license. If the temporary licensee is not in substantial compliance with the
survey, the commissioner shall not issue a basic or comprehensive license and there will
be no contested hearing right under chapter 14.
 new text end

new text begin (b) If the temporary licensee whose basic or comprehensive license has been denied
disagrees with the conclusions of the commissioner, then the licensee may request a
reconsideration by the commissioner or commissioner's designee. The reconsideration
request process will be conducted internally by the commissioner or commissioner's
designee, and chapter 14 does not apply.
 new text end

new text begin (c) The temporary licensee requesting reconsideration must make the request in
writing and must list and describe the reasons why the licensee disagrees with the decision
to deny the basic or comprehensive home care license.
 new text end

new text begin (d) A temporary licensee whose license is denied must comply with the requirements
for notification and transfer of clients in section 144A.475, subdivision 5.
 new text end

Sec. 11.

new text begin [144A.474] SURVEYS AND INVESTIGATIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Surveys. new text end

new text begin The commissioner shall conduct surveys of each home
care provider. By June 30, 2016, the commissioner shall conduct a survey of home care
providers on a frequency of at least once every three years. Survey frequency may be
based on the license level, the provider's compliance history, number of clients served,
or other factors as determined by the department deemed necessary to ensure the health,
safety, and welfare of clients and compliance with the law.
 new text end

new text begin Subd. 2. new text end

new text begin Types of home care surveys. new text end

new text begin (a) "Initial full survey" is the survey
conducted of a new temporary licensee after the department is notified or has evidence that
the licensee is providing home care services to determine if the provider is in compliance
with home care requirements. Initial surveys must be completed within 14 months after
the department's issuance of a temporary basic or comprehensive license.
 new text end

new text begin (b) "Core survey" means periodic inspection of home care providers to determine
ongoing compliance with the home care requirements, focusing on the essential health and
safety requirements. Core surveys are available to licensed home care providers who have
been licensed for three years and surveyed at least once in the past three years with the
latest survey having no widespread violations beyond Level 1 as provided in subdivision
11. Providers must also not have had any substantiated licensing complaints, substantiated
complaints against the agency under the Vulnerable Adults Act or Maltreatment of Minors
Act, or an enforcement action as authorized in section 144A.475 in the past three years.
new text end

new text begin (1) The core survey for basic license-level providers reviews compliance in the
following areas:
 new text end

new text begin (i) reporting of maltreatment;
 new text end

new text begin (ii) orientation to and implementation of Home Care Client Bill of Rights;
 new text end

new text begin (iii) statement of home care services;
 new text end

new text begin (iv) initial evaluation of clients and initiation of services;
 new text end

new text begin (v) basic-license level client review and monitoring;
 new text end

new text begin (vi) service plan implementation and changes to the service plan;
 new text end

new text begin (vii) client complaint and investigative process;
 new text end

new text begin (viii) competency of unlicensed personnel; and
 new text end

new text begin (ix) infection control.
 new text end

new text begin (2) For comprehensive license-level providers, the core survey will include
everything in the basic license-level core survey plus these areas:
 new text end

new text begin (i) delegation to unlicensed personnel;
 new text end

new text begin (ii) assessment, monitoring, and reassessment of clients; and
 new text end

new text begin (iii) medication, treatment, and therapy management.
 new text end

new text begin (c) "Full survey" means the periodic inspection of home care providers to determine
ongoing compliance with the home care requirements that cover the core survey areas
and all the legal requirements for home care providers. A full survey is conducted for all
temporary licensees and for providers who do not meet the requirements needed for a core
survey, and when a surveyor identifies unacceptable client health or safety risks during a
core survey. A full survey will include all the tasks identified as part of the core survey
and any additional review deemed necessary by the department, including additional
observation, interviewing, or records review of additional clients and staff.
new text end

new text begin (d) "Follow-up surveys" are conducted to determine if a home care provider has
corrected deficient issues and systems identified during a core survey, full survey, or
complaint investigation. Follow-up surveys may be conducted via phone, e-mail, fax,
mail, or on-site reviews. Follow-up surveys, other than complaint surveys, shall be
concluded with an exit conference and written information provided on the process for
requesting a reconsideration of the survey results.
 new text end

new text begin (e) Upon receiving information that a home care provider has violated or is currently
violating a requirement of sections 144A.43 to 144A.482, the commissioner shall
investigate the complaint according to sections 144A.51 to 144A.54.
 new text end

new text begin Subd. 3. new text end

new text begin Survey process. new text end

new text begin (a) The survey process for core surveys shall include the
following as applicable to the particular licensee and setting surveyed:
 new text end

new text begin (1) presurvey review of pertinent documents and notification to the ombudsman
for long-term care;
 new text end

new text begin (2) an entrance conference with available staff;
 new text end

new text begin (3) communication with managerial officials or the registered nurse in charge, if
available, and ongoing communication with key staff throughout the survey regarding
information needed by the surveyor, clarifications regarding home care requirements, and
applicable standards of practice;
 new text end

new text begin (4) presentation of written contact information to the provider about the survey staff
conducting the survey, the supervisor, and the process for requesting a reconsideration of
the survey results;
 new text end

new text begin (5) a brief tour of a sample of the housing with services establishments in which the
provider is providing home care services;
 new text end

new text begin (6) a sample selection of home care clients;
 new text end

new text begin (7) information-gathering through client and staff observations, client and staff
interviews, and reviews of records, policies, procedures, practices, and other agency
information;
 new text end

new text begin (8) interviews of clients' family members, if available, with clients' consent when the
client can legally give consent;
 new text end

new text begin (9) except for complaint surveys conducted by the Office of Health Facilities
Complaints, exit conference, with preliminary findings shared and discussed with the
provider and written information provided on the process for requesting a reconsideration
of the survey results; and
 new text end

new text begin (10) postsurvey analysis of findings and formulation of survey results, including
correction orders when applicable.
 new text end

new text begin Subd. 4. new text end

new text begin Scheduling surveys. new text end

new text begin Surveys and investigations shall be conducted
without advance notice to home care providers. Surveyors may contact the home care
provider on the day of a survey to arrange for someone to be available at the survey site.
The contact does not constitute advance notice.
 new text end

new text begin Subd. 5. new text end

new text begin Information provided by home care provider. new text end

new text begin The home care provider
shall provide accurate and truthful information to the department during a survey,
investigation, or other licensing activities.
 new text end

new text begin Subd. 6. new text end

new text begin Providing client records. new text end

new text begin Upon request of a surveyor, home care providers
shall provide a list of current and past clients or client representatives that includes
addresses and telephone numbers and any other information requested about the services
to clients within a reasonable period of time.
 new text end

new text begin Subd. 7. new text end

new text begin Contacting and visiting clients. new text end

new text begin Surveyors may contact or visit a home
care provider's clients to gather information without notice to the home care provider.
Before visiting a client, a surveyor shall obtain the client's or client's representative's
permission by telephone, mail, or in person. Surveyors shall inform all clients or client's
representatives of their right to decline permission for a visit.
 new text end

new text begin Subd. 8. new text end

new text begin Correction orders. new text end

new text begin (a) A correction order may be issued whenever the
commissioner finds upon survey or during a complaint investigation that a home care
provider, a managerial official, or an employee of the provider is not in compliance with
sections 144A.43 to 144A.482. The correction order shall cite the specific statute and
document areas of noncompliance and the time allowed for correction.
 new text end

new text begin (b) The commissioner shall mail copies of any correction order within 30 calendar
days after exit survey to the last known address of the home care provider. A copy of each
correction order and copies of any documentation supplied to the commissioner shall be
kept on file by the home care provider, and public documents shall be made available for
viewing by any person upon request. Copies may be kept electronically.
 new text end

new text begin (c) By the correction order date, the home care provider must document in the
provider's records any action taken to comply with the correction order. The commissioner
may request a copy of this documentation and the home care provider's action to respond
to the correction order in future surveys, upon a complaint investigation, and as otherwise
needed.
 new text end

new text begin Subd. 9. new text end

new text begin Follow-up surveys. new text end

new text begin For providers that have Level 3 or Level 4 violations
or any violations determined to be widespread, the department shall conduct a follow-up
survey within 90 calendar days of the survey. When conducting a follow-up survey, the
surveyor will focus on whether the previous violations have been corrected and may also
address any new violations that are observed while evaluating the corrections that have
been made. If a new violation is identified on a follow-up survey, no fine will be imposed
unless it is not corrected on the next follow-up survey.
 new text end

new text begin Subd. 10. new text end

new text begin Performance incentive. new text end

new text begin A licensee is eligible for a performance
incentive if there are no violations identified in a core or full survey. The performance
incentive is a ten percent discount on the licensee's next home care renewal license fee.
 new text end

new text begin Subd. 11. new text end

new text begin Fines. new text end

new text begin (a) Fines and enforcement actions under this subdivision may be
assessed based on the level and scope of the violations described in paragraph (c) as follows:
 new text end

new text begin (1) Level 1, no fines or enforcement;
 new text end

new text begin (2) Level 2, fines ranging from $0 to $500, in addition to any of the enforcement
mechanisms authorized in section 144A.475 for widespread violations;
 new text end

new text begin (3) Level 3, fines ranging from $500 to $1,000, in addition to any of the enforcement
mechanisms authorized in section 144A.475; and
 new text end

new text begin (4) Level 4, fines ranging from $1,000 to $5,000, in addition to any of the
enforcement mechanisms authorized in section 144A.475.
 new text end

new text begin (b) Correction orders for violations are categorized by both level and scope as
follows and fines will be assessed accordingly:
 new text end

new text begin (1) Level of violation:
 new text end

new text begin (i) Level 1. A violation that has no potential to cause more than a minimal impact on
the client and does not affect health or safety.
 new text end

new text begin (ii) Level 2. A violation that did not harm the client's health or safety, but had the
potential to have harmed a client's health or safety, but was not likely to cause serious
injury, impairment, or death.
 new text end

new text begin (iii) Level 3. A violation that harmed a client's health or safety, not including serious
injury, impairment, or death, or a violation that has the potential to lead to serious injury,
impairment, or death.
 new text end

new text begin (iv) Level 4. A violation that results in serious injury, impairment, or death.
 new text end

new text begin (2) Scope of violation:
 new text end

new text begin (i) Isolated. When one or a limited number of clients are affected, or one or a limited
number of staff are involved, or the situation has occurred only occasionally.
 new text end

new text begin (ii) Pattern. When more than a limited number of clients are affected, more than
a limited number of staff are involved, or the situation has occurred repeatedly but is
not found to be pervasive.
 new text end

new text begin (iii) Widespread. When problems are pervasive or represent a systemic failure that
has affected or has the potential to affect a large portion or all of the clients.
 new text end

new text begin (c) If the commissioner finds that the applicant or a home care provider required
to be licensed under sections 144A.43 to 144A.482 has not corrected violations by the
date specified in the correction order or conditional license resulting from a survey or
complaint investigation, the commissioner may impose a fine. A notice of noncompliance
with a correction order must be mailed to the applicant's or provider's last known address.
The noncompliance notice must list the violations not corrected.
 new text end

new text begin (d) The license holder must pay the fines assessed on or before the payment date
specified. If the license holder fails to fully comply with the order, the commissioner
may issue a second fine or suspend the license until the license holder complies by
paying the fine. A timely appeal shall stay payment of the fine until the commissioner
issues a final order.
 new text end

new text begin (e) A license holder shall promptly notify the commissioner in writing when a
violation specified in the order is corrected. If upon reinspection the commissioner
determines that a violation has not been corrected as indicated by the order, the
commissioner may issue a second fine. The commissioner shall notify the license holder by
mail to the last known address in the licensing record that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.
 new text end

new text begin (f) A home care provider that has been assessed a fine under this subdivision has a
right to a reconsideration or a hearing under this section and chapter 14.
 new text end

new text begin (g) When a fine has been assessed, the license holder may not avoid payment by
closing, selling, or otherwise transferring the licensed program to a third party. In such an
event, the license holder shall be liable for payment of the fine.
new text end

new text begin (h) In addition to any fine imposed under this section, the commissioner may assess
costs related to an investigation that results in a final order assessing a fine or other
enforcement action authorized by this chapter.
 new text end

new text begin (i) Fines collected under this subdivision shall be deposited in the state government
special revenue fund and credited to an account separate from the revenue collected under
section 144A.472. Subject to an appropriation by the legislature, the revenue from the
fines collected may be used by the commissioner for special projects to improve home care
in Minnesota as recommended by the advisory council established in section 144A.4799.
 new text end

new text begin Subd. 12. new text end

new text begin Reconsideration. new text end

new text begin The commissioner shall make available to home
care providers a correction order reconsideration process. This process may be used
to challenge the correction order issued, including the level and scope described in
subdivision 9, and any fine assessed. During the correction order reconsideration request,
the issuance for the correction orders under reconsideration are not stayed, but the
department will post in formation on the Web site with the correction order that the
licensee has requested a reconsideration required and that the review is pending.
 new text end

new text begin (a) A licensed home care provider may request from the commissioner, in writing,
a correction order reconsideration regarding any correction order issued to the provider.
The correction order reconsideration shall not be reviewed by any surveyor, investigator,
or supervisor that participated in the writing or reviewing of the correction order being
disputed. The correction order reconsiderations may be conducted in person by telephone,
by another electronic form, or in writing, as determined by the commissioner. The
commissioner shall respond in writing to the request from a home care provider for
a correction order reconsideration within 60 days of the date the provider requests a
reconsideration. The commissioner's response shall identify the commissioner's decision
regarding each citation challenged by the home care provider.
 new text end

new text begin The findings of a correction order reconsideration process shall be one or more of
the following:
 new text end

new text begin (1) Supported in full. The correction order is supported in full, with no deletion of
findings to the citation.
 new text end

new text begin (2) Supported in substance. The correction order is supported, but one or more
findings are deleted or modified without any change in the citation.
 new text end

new text begin (3) Correction order cited an incorrect home care licensing requirement. The
correction order is amended by changing the correction order to the appropriate statutory
reference.
 new text end

new text begin (4) Correction order was issued under an incorrect citation. The correction order is
amended to be issued under the more appropriate correction order citation.
 new text end

new text begin (5) The correction order is rescinded.
 new text end

new text begin (6) Fine is amended. It is determined the fine assigned to the correction order was
applied incorrectly.
 new text end

new text begin (7) The level or scope of the citation is modified based on the reconsideration.
 new text end

new text begin (b) If the correction order findings are changed by the commissioner, the
commissioner shall update the correction order Web site accordingly.
 new text end

new text begin Subd. 13. new text end

new text begin Home care surveyor training. new text end

new text begin Before conducting a home care survey,
each home care surveyor must receive training on the following topics:
 new text end

new text begin (1) Minnesota home care licensure requirements;
 new text end

new text begin (2) Minnesota Home Care Client Bill of Rights;
 new text end

new text begin (3) Minnesota Vulnerable Adults Act and reporting of maltreatment of minors;
 new text end

new text begin (4) principles of documentation;
 new text end

new text begin (5) survey protocol and processes;
 new text end

new text begin (6) Offices of the Ombudsman roles;
 new text end

new text begin (7) Office of Health Facility Complaints;
 new text end

new text begin (8) Minnesota landlord-tenant and housing with services laws;
 new text end

new text begin (9) types of payors for home care services; and
 new text end

new text begin (10) Minnesota Nurse Practice Act for nurse surveyors.
 new text end

new text begin Materials used for this training will be posted on the department Web site. Requisite
understanding of these topics will be reviewed as part of the quality improvement plan
in section 28.
 new text end

Sec. 12.

new text begin [144A.475] ENFORCEMENT.
 new text end

new text begin Subdivision 1. new text end

new text begin Conditions. new text end

new text begin (a) The commissioner may refuse to grant a temporary
license, renew a license, suspend or revoke a license, or impose a conditional license if the
home care provider or owner or managerial official of the home care provider:
 new text end

new text begin (1) is in violation of, or during the term of the license has violated, any of the
requirements in sections 144A.471 to 144A.482;
 new text end

new text begin (2) permits, aids, or abets the commission of any illegal act in the provision of
home care;
 new text end

new text begin (3) performs any act detrimental to the health, safety, and welfare of a client;
 new text end

new text begin (4) obtains the license by fraud or misrepresentation;
 new text end

new text begin (5) knowingly made or makes a false statement of a material fact in the application
for a license or in any other record or report required by this chapter;
 new text end

new text begin (6) denies representatives of the department access to any part of the home care
provider's books, records, files, or employees;
 new text end

new text begin (7) interferes with or impedes a representative of the department in contacting the
home care provider's clients;
 new text end

new text begin (8) interferes with or impedes a representative of the department in the enforcement
of this chapter or has failed to fully cooperate with an inspection, survey, or investigation
by the department;
 new text end

new text begin (9) destroys or makes unavailable any records or other evidence relating to the home
care provider's compliance with this chapter;
 new text end

new text begin (10) refuses to initiate a background study under section 144.057 or 245A.04;
 new text end

new text begin (11) fails to timely pay any fines assessed by the department;
 new text end

new text begin (12) violates any local, city, or township ordinance relating to home care services;
 new text end

new text begin (13) has repeated incidents of personnel performing services beyond their
competency level; or
 new text end

new text begin (14) has operated beyond the scope of the home care provider's license level.
 new text end

new text begin (b) A violation by a contractor providing the home care services of the home care
provider is a violation by the home care provider.
 new text end

new text begin Subd. 2. new text end

new text begin Terms to suspension or conditional license. new text end

new text begin A suspension or conditional
license designation may include terms that must be completed or met before a suspension
or conditional license designation is lifted. A conditional license designation may include
restrictions or conditions that are imposed on the provider. Terms for a suspension or
conditional license may include one or more of the following and the scope of each will be
determined by the commissioner:
 new text end

new text begin (1) requiring a consultant to review, evaluate, and make recommended changes to
the home care provider's practices and submit reports to the commissioner at the cost of
the home care provider;
 new text end

new text begin (2) requiring supervision of the home care provider or staff practices at the cost
of the home care provider by an unrelated person who has sufficient knowledge and
qualifications to oversee the practices and who will submit reports to the commissioner;
 new text end

new text begin (3) requiring the home care provider or employees to obtain training at the cost of
the home care provider;
 new text end

new text begin (4) requiring the home care provider to submit reports to the commissioner;
 new text end

new text begin (5) prohibiting the home care provider from taking any new clients for a period
of time; or
 new text end

new text begin (6) any other action reasonably required to accomplish the purpose of this
subdivision and section 144A.45, subdivision 2.
 new text end

new text begin Subd. 3. new text end

new text begin Notice. new text end

new text begin Prior to any suspension, revocation, or refusal to renew a license,
the home care provider shall be entitled to notice and a hearing as provided by sections
14.57 to 14.69. In addition to any other remedy provided by law, the commissioner may,
without a prior contested case hearing, temporarily suspend a license or prohibit delivery
of services by a provider for not more than 90 days if the commissioner determines that
the health or safety of a consumer is in imminent danger, provided:
 new text end

new text begin (1) advance notice is given to the home care provider;
 new text end

new text begin (2) after notice, the home care provider fails to correct the problem;
 new text end

new text begin (3) the commissioner has reason to believe that other administrative remedies are not
likely to be effective; and
 new text end

new text begin (4) there is an opportunity for a contested case hearing within the 90 days.
 new text end

new text begin Subd. 4. new text end

new text begin Time limits for appeals. new text end

new text begin To appeal the assessment of civil penalties
under section 144A.45, subdivision 2, clause (5), and an action against a license under
this section, a provider must request a hearing no later than 15 days after the provider
receives notice of the action.
 new text end

new text begin Subd. 5. new text end

new text begin Plan required. new text end

new text begin (a) The process of suspending or revoking a license
must include a plan for transferring affected clients to other providers by the home care
provider, which will be monitored by the commissioner. Within three business days of
being notified of the final revocation or suspension action, the home care provider shall
provide the commissioner, the lead agencies as defined in section 256B.0911, and the
ombudsman for long-term care with the following information:
 new text end

new text begin (1) a list of all clients, including full names and all contact information on file;
 new text end

new text begin (2) a list of each client's representative or emergency contact person, including full
names and all contact information on file;
 new text end

new text begin (3) the location or current residence of each client;
 new text end

new text begin (4) the payor sources for each client, including payor source identification numbers;
and
 new text end

new text begin (5) for each client, a copy of the client's service plan, and a list of the types of
services being provided.
 new text end

new text begin (b) The revocation or suspension notification requirement is satisfied by mailing the
notice to the address in the license record. The home care provider shall cooperate with
the commissioner and the lead agencies during the process of transferring care of clients to
qualified providers. Within three business days of being notified of the final revocation or
suspension action, the home care provider must notify and disclose to each of the home
care provider's clients, or the client's representative or emergency contact persons, that
the commissioner is taking action against the home care provider's license by providing a
copy of the revocation or suspension notice issued by the commissioner.
 new text end

new text begin Subd. 6. new text end

new text begin Owners and managerial officials; refusal to grant license. new text end

new text begin (a) The
owner and managerial officials of a home care provider whose Minnesota license has not
been renewed or that has been revoked because of noncompliance with applicable laws or
rules shall not be eligible to apply for nor will be granted a home care license, including
other licenses under this chapter, or be given status as an enrolled personal care assistance
provider agency or personal care assistant by the Department of Human Services under
section 256B.0659 for five years following the effective date of the nonrenewal or
revocation. If the owner and managerial officials already have enrollment status, their
enrollment will be terminated by the Department of Human Services.
 new text end

new text begin (b) The commissioner shall not issue a license to a home care provider for five
years following the effective date of license nonrenewal or revocation if the owner or
managerial official, including any individual who was an owner or managerial official
of another home care provider, had a Minnesota license that was not renewed or was
revoked as described in paragraph (a).
 new text end

new text begin (c) Notwithstanding subdivision 1, the commissioner shall not renew, or shall
suspend or revoke, the license of any home care provider that includes any individual
as an owner or managerial official who was an owner or managerial official of a home
care provider whose Minnesota license was not renewed or was revoked as described in
paragraph (a) for five years following the effective date of the nonrenewal or revocation.
 new text end

new text begin (d) The commissioner shall notify the home care provider 30 days in advance of
the date of nonrenewal, suspension, or revocation of the license. Within ten days after
the receipt of the notification, the home care provider may request, in writing, that the
commissioner stay the nonrenewal, revocation, or suspension of the license. The home
care provider shall specify the reasons for requesting the stay; the steps that will be taken
to attain or maintain compliance with the licensure laws and regulations; any limits on the
authority or responsibility of the owners or managerial officials whose actions resulted in
the notice of nonrenewal, revocation, or suspension; and any other information to establish
that the continuing affiliation with these individuals will not jeopardize client health, safety,
or well-being. The commissioner shall determine whether the stay will be granted within
30 days of receiving the provider's request. The commissioner may propose additional
restrictions or limitations on the provider's license and require that the granting of the stay
be contingent upon compliance with those provisions. The commissioner shall take into
consideration the following factors when determining whether the stay should be granted:
 new text end

new text begin (1) the threat that continued involvement of the owners and managerial officials with
the home care provider poses to client health, safety, and well-being;
 new text end

new text begin (2) the compliance history of the home care provider; and
 new text end

new text begin (3) the appropriateness of any limits suggested by the home care provider.
 new text end

new text begin If the commissioner grants the stay, the order shall include any restrictions or
limitation on the provider's license. The failure of the provider to comply with any
restrictions or limitations shall result in the immediate removal of the stay and the
commissioner shall take immediate action to suspend, revoke, or not renew the license.
 new text end

new text begin Subd. 7. new text end

new text begin Request for hearing. new text end

new text begin A request for a hearing must be in writing and must:
 new text end

new text begin (1) be mailed or delivered to the department or the commissioner's designee;
 new text end

new text begin (2) contain a brief and plain statement describing every matter or issue contested; and
 new text end

new text begin (3) contain a brief and plain statement of any new matter that the applicant or home
care provider believes constitutes a defense or mitigating factor.
 new text end

new text begin Subd. 8. new text end

new text begin Informal conference. new text end

new text begin At any time, the applicant or home care provider
and the commissioner may hold an informal conference to exchange information, clarify
issues, or resolve issues.
 new text end

new text begin Subd. 9. new text end

new text begin Injunctive relief. new text end

new text begin In addition to any other remedy provided by law, the
commissioner may bring an action in district court to enjoin a person who is involved in
the management, operation, or control of a home care provider or an employee of the
home care provider from illegally engaging in activities regulated by sections 144A.43 to
144A.482. The commissioner may bring an action under this subdivision in the district
court in Ramsey County or in the district in which a home care provider is providing
services. The court may grant a temporary restraining order in the proceeding if continued
activity by the person who is involved in the management, operation, or control of a home
care provider, or by an employee of the home care provider, would create an imminent
risk of harm to a recipient of home care services.
 new text end

new text begin Subd. 10. new text end

new text begin Subpoena. new text end

new text begin In matters pending before the commissioner under sections
144A.43 to 144A.482, the commissioner may issue subpoenas and compel the attendance
of witnesses and the production of all necessary papers, books, records, documents, and
other evidentiary material. If a person fails or refuses to comply with a subpoena or
order of the commissioner to appear or testify regarding any matter about which the
person may be lawfully questioned or to produce any papers, books, records, documents,
or evidentiary materials in the matter to be heard, the commissioner may apply to the
district court in any district, and the court shall order the person to comply with the
commissioner's order or subpoena. The commissioner of health may administer oaths to
witnesses or take their affirmation. Depositions may be taken in or outside the state in the
manner provided by law for the taking of depositions in civil actions. A subpoena or other
process or paper may be served on a named person anywhere in the state by an officer
authorized to serve subpoenas in civil actions, with the same fees and mileage and in the
same manner as prescribed by law for a process issued out of a district court. A person
subpoenaed under this subdivision shall receive the same fees, mileage, and other costs
that are paid in proceedings in district court.
 new text end

Sec. 13.

new text begin [144A.476] BACKGROUND STUDIES.
 new text end

new text begin Subdivision 1. new text end

new text begin Prior criminal convictions; owner and managerial officials. new text end

new text begin (a)
Before the commissioner issues a temporary license or renews a license, an owner or
managerial official is required to complete a background study under section 144.057. No
person may be involved in the management, operation, or control of a home care provider
if the person has been disqualified under chapter 245C. If an individual is disqualified
under section 144.057 or chapter 245C, the individual may request reconsideration of
the disqualification. If the individual requests reconsideration and the commissioner
sets aside or rescinds the disqualification, the individual is eligible to be involved in the
management, operation, or control of the provider. If an individual has a disqualification
under section 245C.15, subdivision 1, and the disqualification is affirmed, the individual's
disqualification is barred from a set aside, and the individual must not be involved in the
management, operation, or control of the provider.
 new text end

new text begin (b) For purposes of this section, owners of a home care provider subject to the
background check requirement are those individuals whose ownership interest provides
sufficient authority or control to affect or change decisions related to the operation of the
home care provider. An owner includes a sole proprietor, a general partner, or any other
individual whose individual ownership interest can affect the management and direction
of the policies of the home care provider.
 new text end

new text begin (c) For the purposes of this section, managerial officials subject to the background
check requirement are individuals who provide direct contact as defined in section 245C.02,
subdivision 11, or individuals who have the responsibility for the ongoing management or
direction of the policies, services, or employees of the home care provider. Data collected
under this subdivision shall be classified as private data under section 13.02, subdivision 12.
 new text end

new text begin (d) The department shall not issue any license if the applicant or owner or managerial
official has been unsuccessful in having a background study disqualification set aside
under section 144.057 and chapter 245C; if the owner or managerial official, as an owner
or managerial official of another home care provider, was substantially responsible for
the other home care provider's failure to substantially comply with sections 144A.43 to
144A.482; or if an owner that has ceased doing business, either individually or as an
owner of a home care provider, was issued a correction order for failing to assist clients in
violation of this chapter.
 new text end

new text begin Subd. 2. new text end

new text begin Employees, contractors, and volunteers. new text end

new text begin (a) Employees, contractors,
and volunteers of a home care provider are subject to the background study required by
section 144.057, and may be disqualified under chapter 245C. Nothing in this section shall
be construed to prohibit a home care provider from requiring self-disclosure of criminal
conviction information.
 new text end

new text begin (b) Termination of an employee in good faith reliance on information or records
obtained under paragraph (a) or subdivision 1, regarding a confirmed conviction does not
subject the home care provider to civil liability or liability for unemployment benefits.
 new text end

Sec. 14.

new text begin [144A.477] COMPLIANCE.
 new text end

new text begin Subdivision 1. new text end

new text begin Medicare-certified providers; coordination of surveys. new text end

new text begin If feasible,
the commissioner shall survey licensees to determine compliance with this chapter at the
same time as surveys for certification for Medicare if Medicare certification is based on
compliance with the federal conditions of participation and on survey and enforcement
by the Department of Health as agent for the United States Department of Health and
Human Services.
 new text end

new text begin Subd. 2. new text end

new text begin Medicare-certified providers; equivalent requirements. new text end

new text begin For home care
providers licensed to provide comprehensive home care services that are also certified for
participation in Medicare as a home health agency under Code of Federal Regulations,
title 42, part 484, the following state licensure regulations are considered equivalent to
the federal requirements:
 new text end

new text begin (1) quality management, section 144A.479, subdivision 3;
 new text end

new text begin (2) personnel records, section 144A.479, subdivision 7;
 new text end

new text begin (3) acceptance of clients, section 144A.4791, subdivision 4;
 new text end

new text begin (4) referrals, section 144A.4791, subdivision 5;
 new text end

new text begin (5) client assessment, sections 144A.4791, subdivision 8, and 144A.4792,
subdivisions 2 and 3;
 new text end

new text begin (6) individualized monitoring and reassessment, sections 144A.4791, subdivision
8, and 144A.4792, subdivisions 2 and 3;
 new text end

new text begin (7) individualized service plan, sections 144A.4791, subdivision 9, 144A.4792,
subdivision 5, and 144A.4793, subdivision 3;
 new text end

new text begin (8) client complaint and investigation process, section 144A.4791, subdivision 11;
 new text end

new text begin (9) prescription orders, section 144A.4792, subdivisions 13 to 16;
 new text end

new text begin (10) client records, section 144A.4794, subdivisions 1 to 3;
 new text end

new text begin (11) qualifications for unlicensed personnel performing delegated tasks, section
144A.4795;
 new text end

new text begin (12) training and competency staff, section 144A.4795;
 new text end

new text begin (13) training and competency for unlicensed personnel, section 144A.4795,
subdivision 7;
 new text end

new text begin (14) delegation of home care services, section 144A.4795, subdivision 4;
 new text end

new text begin (15) availability of contact person, section 144A.4797, subdivision 1; and
 new text end

new text begin (16) supervision of staff, section 144A.4797, subdivisions 2 and 3.
 new text end

new text begin Violations of requirements in clauses (1) to (16) may lead to enforcement actions
under section 144A.474.
 new text end

Sec. 15.

new text begin [144A.478] INNOVATION VARIANCE.
 new text end

new text begin Subdivision 1. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "innovation variance"
means a specified alternative to a requirement of this chapter. An innovation variance
may be granted to allow a home care provider to offer home care services of a type or
in a manner that is innovative, will not impair the services provided, will not adversely
affect the health, safety, or welfare of the clients, and is likely to improve the services
provided. The innovative variance cannot change any of the client's rights under section
144A.44, home care bill of rights.
 new text end

new text begin Subd. 2. new text end

new text begin Conditions. new text end

new text begin The commissioner may impose conditions on the granting of
an innovation variance that the commissioner considers necessary.
 new text end

new text begin Subd. 3. new text end

new text begin Duration and renewal. new text end

new text begin The commissioner may limit the duration of any
innovation variance and may renew a limited innovation variance.
 new text end

new text begin Subd. 4. new text end

new text begin Applications; innovation variance. new text end

new text begin An application for innovation
variance from the requirements of this chapter may be made at any time, must be made in
writing to the commissioner, and must specify the following:
 new text end

new text begin (1) the statute or law from which the innovation variance is requested;
 new text end

new text begin (2) the time period for which the innovation variance is requested;
 new text end

new text begin (3) the specific alternative action that the licensee proposes;
 new text end

new text begin (4) the reasons for the request; and
 new text end

new text begin (5) justification that an innovation variance will not impair the services provided,
will not adversely affect the health, safety, or welfare of clients, and is likely to improve
the services provided.
 new text end

new text begin The commissioner may require additional information from the home care provider before
acting on the request.
 new text end

new text begin Subd. 5. new text end

new text begin Grants and denials. new text end

new text begin The commissioner shall grant or deny each request
for an innovation variance in writing within 45 days of receipt of a complete request.
Notice of a denial shall contain the reasons for the denial. The terms of a requested
innovation variance may be modified upon agreement between the commissioner and
the home care provider.
 new text end

new text begin Subd. 6. new text end

new text begin Violation of innovation variances. new text end

new text begin A failure to comply with the terms of
an innovation variance shall be deemed to be a violation of this chapter.
 new text end

new text begin Subd. 7. new text end

new text begin Revocation or denial of renewal. new text end

new text begin The commissioner shall revoke or
deny renewal of an innovation variance if:
 new text end

new text begin (1) it is determined that the innovation variance is adversely affecting the health,
safety, or welfare of the licensee's clients;
 new text end

new text begin (2) the home care provider has failed to comply with the terms of the innovation
variance;
 new text end

new text begin (3) the home care provider notifies the commissioner in writing that it wishes to
relinquish the innovation variance and be subject to the statute previously varied; or
 new text end

new text begin (4) the revocation or denial is required by a change in law.
 new text end

Sec. 16.

new text begin [144A.479] HOME CARE PROVIDER RESPONSIBILITIES;
BUSINESS OPERATION.
 new text end

new text begin Subdivision 1. new text end

new text begin Display of license. new text end

new text begin The original current license must be displayed
in the home care providers' principal business office and copies must be displayed in
any branch office. The home care provider must provide a copy of the license to any
person who requests it.
 new text end

new text begin Subd. 2. new text end

new text begin Advertising. new text end

new text begin Home care providers shall not use false, fraudulent,
or misleading advertising in the marketing of services. For purposes of this section,
advertising includes any verbal, written, or electronic means of communicating to
potential clients about the availability, nature, or terms of home care services.
 new text end

new text begin Subd. 3. new text end

new text begin Quality management. new text end

new text begin The home care provider shall engage in quality
management appropriate to the size of the home care provider and relevant to the type
of services the home care provider provides. The quality management activity means
evaluating the quality of care by periodically reviewing client services, complaints made,
and other issues that have occurred and determining whether changes in services, staffing,
or other procedures need to be made in order to ensure safe and competent services to
clients. Documentation about quality management activity must be available for two
years. Information about quality management must be available to the commissioner at
the time of the survey, investigation, or renewal.
 new text end

new text begin Subd. 4. new text end

new text begin Provider restrictions. new text end

new text begin (a) This subdivision does not apply to licensees
that are Minnesota counties or other units of government.
 new text end

new text begin (b) A home care provider or staff cannot accept powers-of-attorney from clients for
any purpose, and may not accept appointments as guardians or conservators of clients.
 new text end

new text begin (c) A home care provider cannot serve as a client's representative.
new text end

new text begin Subd. 5. new text end

new text begin Handling of client's finances and property. new text end

new text begin (a) A home care provider
may assist clients with household budgeting, including paying bills and purchasing
household goods, but may not otherwise manage a client's property. A home care provider
must provide a client with receipts for all transactions and purchases paid with the clients'
funds. When receipts are not available, the transaction or purchase must be documented.
A home care provider must maintain records of all such transactions.
 new text end

new text begin (b) A home care provider or staff may not borrow a client's funds or personal or
real property, nor in any way convert a client's property to the home care provider's or
staff's possession.
 new text end

new text begin (c) Nothing in this section precludes a home care provider or staff from accepting
gifts of minimal value, or precludes the acceptance of donations or bequests made to a
home care provider that are exempt from income tax under section 501(c) of the Internal
Revenue Code of 1986.
 new text end

new text begin Subd. 6. new text end

new text begin Reporting maltreatment of vulnerable adults and minors. new text end

new text begin (a) All
home care providers must comply with requirements for the reporting of maltreatment
of minors in section 626.556 and the requirements for the reporting of maltreatment
of vulnerable adults in section 626.557. Home care providers must report suspected
maltreatment of minors and vulnerable adults to the common entry point. Each home
care provider must establish and implement a written procedure to ensure that all cases
of suspected maltreatment are reported.
 new text end

new text begin (b) Each home care provider must develop and implement an individual abuse
prevention plan for each vulnerable minor or adult for whom home care services are
provided by a home care provider. The plan shall contain an individualized review or
assessment of the person's susceptibility to abuse by another individual, including other
vulnerable adults or minors; the person's risk of abusing other vulnerable adults or minors;
and statements of the specific measures to be taken to minimize the risk of abuse to that
person and other vulnerable adults or minors. For purposes of the abuse prevention plan,
the term abuse includes self-abuse.
 new text end

new text begin Subd. 7. new text end

new text begin Employee records. new text end

new text begin The home care provider must maintain current records
of each paid employee, regularly scheduled volunteers providing home care services, and
of each individual contractor providing home care services. The records must include
the following information:
 new text end

new text begin (1) evidence of current professional licensure, registration, or certification, if
licensure, registration, or certification is required by this statute, or other rules;
 new text end

new text begin (2) records of orientation, required annual training and infection control training,
and competency evaluations;
 new text end

new text begin (3) current job description, including qualifications, responsibilities, and
identification of staff providing supervision;
 new text end

new text begin (4) documentation of annual performance reviews which identify areas of
improvement needed and training needs;
 new text end

new text begin (5) for individuals providing home care services, verification that required health
screenings under section 144A.4798 have taken place and the dates of those screenings; and
 new text end

new text begin (6) documentation of the background study as required under section 144.057.
 new text end

new text begin Each employee record must be retained for at least three years after a paid employee,
home care volunteer, or contractor ceases to be employed by or under contract with the
home care provider. If a home care provider ceases operation, employee records must be
maintained for three years.
 new text end

Sec. 17.

new text begin [144A.4791] HOME CARE PROVIDER RESPONSIBILITIES WITH
RESPECT TO CLIENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Home care bill of rights; notification to client. new text end

new text begin (a) The home
care provider shall provide the client or the client's representative a written notice of the
rights under section 144A.44 in a language that the client or the client's representative
can understand before the initiation of services to that client. If a written version is not
available, the home care bill of rights must be communicated to the client or client's
representative in a language they can understand.
 new text end

new text begin (b) In addition to the text of the home care bill of rights in section 144A.44,
subdivision 1, the notice shall also contain the following statement describing how to file
a complaint with these offices.
 new text end

new text begin "If you have a complaint about the provider or the person providing your
home care services, you may call, write, or visit the Office of Health Facility
Complaints, Minnesota Department of Health. You may also contact the Office of
Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health
and Developmental Disabilities."
 new text end

new text begin The statement should include the telephone number, Web site address, e-mail
address, mailing address, and street address of the Office of Health Facility Complaints at
the Minnesota Department of Health, the Office of the Ombudsman for Long-Term Care,
and the Office of the Ombudsman for Mental Health and Developmental Disabilities. The
statement should also include the home care provider's name, address, e-mail, telephone
number, and name or title of the person at the provider to whom problems or complaints
may be directed. It must also include a statement that the home care provider will not
retaliate because of a complaint.
 new text end

new text begin (c) The home care provider shall obtain written acknowledgment of the client's
receipt of the home care bill of rights or shall document why an acknowledgment cannot
be obtained. The acknowledgment may be obtained from the client or the client's
representative. Acknowledgment of receipt shall be retained in the client's record.
 new text end

new text begin Subd. 2. new text end

new text begin Notice of services for dementia, Alzheimer's disease, or related
disorders. new text end

new text begin The home care provider that provides services to clients with dementia shall
provide in written or electronic form, to clients and families or other persons who request
it, a description of the training program and related training it provides, including the
categories of employees trained, the frequency of training, and the basic topics covered.
This information satisfies the disclosure requirements in section 325F.72, subdivision
2, clause (4).
 new text end

new text begin Subd. 3. new text end

new text begin Statement of home care services. new text end

new text begin Prior to the initiation of services,
a home care provider must provide to the client or the client's representative a written
statement which identifies if they have a basic or comprehensive home care license, the
services they are authorized to provide, and which services they cannot provide under the
scope of their license. The home care provider shall obtain written acknowledgment
from the clients that they have provided the statement or must document why they could
not obtain the acknowledgment.
 new text end

new text begin Subd. 4. new text end

new text begin Acceptance of clients. new text end

new text begin No home care provider may accept a person as a
client unless the home care provider has staff, sufficient in qualifications, competency,
and numbers, to adequately provide the services agreed to in the service plan and that
are within the provider's scope of practice.
 new text end

new text begin Subd. 5. new text end

new text begin Referrals. new text end

new text begin If a home care provider reasonably believes that a client is in
need of another medical or health service, including a licensed health professional, or
social service provider, the home care provider shall:
 new text end

new text begin (1) determine the client's preferences with respect to obtaining the service; and
 new text end

new text begin (2) inform the client of resources available, if known, to assist the client in obtaining
services.
 new text end

new text begin Subd. 6. new text end

new text begin Initiation of services. new text end

new text begin When a provider initiates services and the
individualized review or assessment required in subdivisions 7 and 8 has not been
completed, the provider must complete a temporary plan and agreement with the client for
services.
 new text end

new text begin Subd. 7. new text end

new text begin Basic individualized client review and monitoring. new text end

new text begin (a) When services
being provided are basic home care services, an individualized initial review of the client's
needs and preferences must be conducted at the client's residence with the client or client's
representative. This initial review must be completed within 30 days after the initiation of
the home care services.
 new text end

new text begin (b) Client monitoring and review must be conducted as needed based on changes
in the needs of the client and cannot exceed 90 days from the date of the last review.
The monitoring and review may be conducted at the client's residence or through the
utilization of telecommunication methods based on practice standards that meet the
individual client's needs.
 new text end

new text begin Subd. 8. new text end

new text begin Comprehensive assessment, monitoring, and reassessment. new text end

new text begin (a) When
the services being provided are comprehensive home care services, an individualized
initial assessment must be conducted in-person by a registered nurse. When the services
are provided by other licensed health professionals, the assessment must be conducted by
the appropriate health professional. This initial assessment must be completed within five
days after initiation of home care services.
 new text end

new text begin (b) Client monitoring and reassessment must be conducted in the client's home no
more than 14 days after initiation of services.
 new text end

new text begin (c) Ongoing client monitoring and reassessment must be conducted as needed based
on changes in the needs of the client and cannot exceed 90 days from the last date of the
assessment. The monitoring and reassessment may be conducted at the client's residence
or through the utilization of telecommunication methods based on practice standards that
meet the individual client's needs.
 new text end

new text begin Subd. 9. new text end

new text begin Service plan, implementation, and revisions to service plan. new text end

new text begin (a) No later
than 14 days after the initiation of services, a home care provider shall finalize a current
written service plan.
 new text end

new text begin (b) The service plan and any revisions must include a signature or other
authentication by the home care provider and by the client or the client's representative
documenting agreement on the services to be provided. The service plan must be revised,
if needed, based on client review or reassessment under subdivisions 7 and 8. The provider
must provide information to the client about changes to the provider's fee for services and
how to contact the Office of the Ombudsman for Long-Term Care.
 new text end

new text begin (c) The home care provider must implement and provide all services required by
the current service plan.
 new text end

new text begin (d) The service plan and revised service plan must be entered into the client's record,
including notice of a change in a client's fees when applicable.
 new text end

new text begin (e) Staff providing home care services must be informed of the current written
service plan.
 new text end

new text begin (f) The service plan must include:
 new text end

new text begin (1) a description of the home care services to be provided, the fees for services, and
the frequency of each service, according to the client's current review or assessment and
client preferences;
 new text end

new text begin (2) the identification of the staff or categories of staff who will provide the services;
 new text end

new text begin (3) the schedule and methods of monitoring reviews or assessments of the client;
 new text end

new text begin (4) the frequency of sessions of supervision of staff and type of personnel who
will supervise staff; and
 new text end

new text begin (5) a contingency plan that includes:
 new text end

new text begin (i) the action to be taken by the home care provider and by the client or client's
representative if the scheduled service cannot be provided;
 new text end

new text begin (ii) information and method for a client or client's representative to contact the
home care provider;
 new text end

new text begin (iii) names and contact information of persons the client wishes to have notified
in an emergency or if there is a significant adverse change in the client's condition,
including identification of and information as to who has authority to sign for the client in
an emergency; and
 new text end

new text begin (iv) the circumstances in which emergency medical services are not to be summoned
consistent with chapters 145B and 145C, and declarations made by the client under those
chapters.
 new text end

new text begin Subd. 10. new text end

new text begin Termination of service plan. new text end

new text begin (a) If a home care provider terminates a
service plan with a client, and the client continues to need home care services, the home
care provider shall provide the client and the client's representative, if any, with a written
notice of termination which includes the following information:
 new text end

new text begin (1) the effective date of termination;
 new text end

new text begin (2) the reason for termination;
 new text end

new text begin (3) a list of known licensed home care providers in the client's immediate geographic
area;
 new text end

new text begin (4) a statement that the home care provider will participate in a coordinated transfer
of care of the client to another home care provider, health care provider, or caregiver, as
required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
 new text end

new text begin (5) the name and contact information of a person employed by the home care
provider with whom the client may discuss the notice of termination; and
 new text end

new text begin (6) if applicable, a statement that the notice of termination of home care services
does not constitute notice of termination of the housing with services contract with a
housing with services establishment.
 new text end

new text begin (b) When the home care provider voluntarily discontinues services to all clients, the
home care provider must notify the commissioner, lead agencies, and the ombudsman for
long-term care about its clients and comply with the requirements in this subdivision.
 new text end

new text begin Subd. 11. new text end

new text begin Client complaint and investigative process. new text end

new text begin (a) The home care
provider must have a written policy and system for receiving, investigating, reporting,
and attempting to resolve complaints from its clients or clients' representatives. The
policy should clearly identify the process by which clients may file a complaint or concern
about home care services and an explicit statement that the home care provider will not
discriminate or retaliate against a client for expressing concerns or complaints. A home
care provider must have a process in place to conduct investigations of complaints made
by the client or the client's representative about the services in the client's plan that are or
are not being provided or other items covered in the client's home care bill of rights. This
complaint system must provide reasonable accommodations for any special needs of the
client or client's representative if requested.
 new text end

new text begin (b) The home care provider must document the complaint, name of the client,
investigation, and resolution of each complaint filed. The home care provider must
maintain a record of all activities regarding complaints received, including the date the
complaint was received, and the home care provider's investigation and resolution of the
complaint. This complaint record must be kept for each event for at least two years after
the date of entry and must be available to the commissioner for review.
 new text end

new text begin (c) The required complaint system must provide for written notice to each client or
client's representative that includes:
 new text end

new text begin (1) the client's right to complain to the home care provider about the services received;
 new text end

new text begin (2) the name or title of the person or persons with the home care provider to contact
with complaints;
 new text end

new text begin (3) the method of submitting a complaint to the home care provider; and
 new text end

new text begin (4) a statement that the provider is prohibited against retaliation according to
paragraph (d).
 new text end

new text begin (d) A home care provider must not take any action that negatively affects a client
in retaliation for a complaint made or a concern expressed by the client or the client's
representative.
 new text end

new text begin Subd. 12. new text end

new text begin Disaster planning and emergency preparedness plan. new text end

new text begin The home care
provider must have a written plan of action to facilitate the management of the client's care
and services in response to a natural disaster, such as flood and storms, or other emergencies
that may disrupt the home care provider's ability to provide care or services. The licensee
must provide adequate orientation and training of staff on emergency preparedness.
 new text end

new text begin Subd. 13. new text end

new text begin Request for discontinuation of life-sustaining treatment. new text end

new text begin (a) If a
client, family member, or other caregiver of the client requests that an employee or other
agent of the home care provider discontinue a life-sustaining treatment, the employee or
agent receiving the request:
 new text end

new text begin (1) shall take no action to discontinue the treatment; and
 new text end

new text begin (2) shall promptly inform their supervisor or other agent of the home care provider
of the client's request.
 new text end

new text begin (b) Upon being informed of a request for termination of treatment, the home care
provider shall promptly:
 new text end

new text begin (1) inform the client that the request will be made known to the physician who
ordered the client's treatment;
 new text end

new text begin (2) inform the physician of the client's request; and
 new text end

new text begin (3) work with the client and the client's physician to comply with the provisions of
the Health Care Directive Act in chapter 145C.
 new text end

new text begin (c) This section does not require the home care provider to discontinue treatment,
except as may be required by law or court order.
 new text end

new text begin (d) This section does not diminish the rights of clients to control their treatments,
refuse services, or terminate their relationships with the home care provider.
 new text end

new text begin (e) This section shall be construed in a manner consistent with chapter 145B or
145C, whichever applies, and declarations made by clients under those chapters.
 new text end

Sec. 18.

new text begin [144A.4792] MEDICATION MANAGEMENT.
 new text end

new text begin Subdivision 1. new text end

new text begin Medication management services; comprehensive home care
license. new text end

new text begin (a) This subdivision applies only to home care providers with a comprehensive
home care license that provides medication management services to clients. Medication
management services may not be provided by a home care provider that has a basic
home care license.
 new text end

new text begin (b) A comprehensive home care provider who provides medication management
services must develop, implement, and maintain current written medication management
policies and procedures. The policies and procedures must be developed under the
supervision and direction of a registered nurse, licensed health professional, or pharmacist
consistent with current practice standards and guidelines.
 new text end

new text begin (c) The written policies and procedures must address requesting and receiving
prescriptions for medications; preparing and giving medications; verifying that
prescription drugs are administered as prescribed; documenting medication management
activities; controlling and storing medications; monitoring and evaluating medication use;
resolving medication errors; communicating with the prescriber, pharmacist, and client
and client representative, if any; disposing of unused medications; and educating clients
and client representatives about medications. When controlled substances are being
managed, the policies and procedures must also identify how the provider will ensure
security and accountability for the overall management, control, and disposition of those
substances in compliance with state and federal regulations and with subdivision 22.
 new text end

new text begin Subd. 2. new text end

new text begin Provision of medication management services. new text end

new text begin (a) For each client who
requests medication management services, the comprehensive home care provider shall,
prior to providing medication management services, have a registered nurse, licensed
health professional, or authorized prescriber under section 151.37 conduct an assessment
to determine what mediation management services will be provided and how the services
will be provided. This assessment must be conducted face-to-face with the client. The
assessment must include an identification and review of all medications the client is known
to be taking. The review and identification must include indications for medications, side
effects, contraindications, allergic or adverse reactions, and actions to address these issues.
 new text end

new text begin (b) The assessment must identify interventions needed in management of
medications to prevent diversion of medication by the client or others who may have
access to the medications. Diversion of medications means the misuse, theft, or illegal
or improper disposition of medications.
 new text end

new text begin Subd. 3. new text end

new text begin Individualized medication monitoring and reassessment. new text end

new text begin The
comprehensive home care provider must monitor and reassess the client's medication
management services as needed under subdivision 14 when the client presents with
symptoms or other issues that may be medication-related and, at a minimum, annually.
 new text end

new text begin Subd. 4. new text end

new text begin Client refusal. new text end

new text begin The home care provider must document in the client's
record any refusal for an assessment for medication management by the client. The
provider must discuss with the client the possible consequences of the client's refusal and
document the discussion in the client's record.
 new text end

new text begin Subd. 5. new text end

new text begin Individualized medication management plan. new text end

new text begin (a) For each client
receiving medication management services, the comprehensive home care provider must
prepare and include in the service plan a written statement of the medication management
services that will be provided to the client. The provider must develop and maintain a
current individualized medication management record for each client based on the client's
assessment that must contain the following:
new text end

new text begin (1) a statement describing the medication management services that will be provided;
 new text end

new text begin (2) a description of storage of medications based on the client's needs and
preferences, risk of diversion, and consistent with the manufacturer's directions;
 new text end

new text begin (3) documentation of specific client instructions relating to the administration
of medications;
 new text end

new text begin (4) identification of persons responsible for monitoring medication supplies and
ensuring that medication refills are ordered on a timely basis;
 new text end

new text begin (5) identification of medication management tasks that may be delegated to
unlicensed personnel;
new text end

new text begin (6) procedures for staff notifying a registered nurse or appropriate licensed health
professional when a problem arises with medication management services; and
 new text end

new text begin (7) any client-specific requirements relating to documenting medication
administration, verifications that all medications are administered as prescribed, and
monitoring of medication use to prevent possible complications or adverse reactions.
 new text end

new text begin (b) The medication management record must be current and updated when there are
any changes.
 new text end

new text begin Subd. 6. new text end

new text begin Administration of medication. new text end

new text begin Medications may be administered by a
nurse, physician, or other licensed health practitioner authorized to administer medications
or by unlicensed personnel who have been delegated medication administration tasks by
a registered nurse.
 new text end

new text begin Subd. 7. new text end

new text begin Delegation of medication administration. new text end

new text begin When administration of
medications is delegated to unlicensed personnel, the comprehensive home care provider
must ensure that the registered nurse has:
 new text end

new text begin (1) instructed the unlicensed personnel in the proper methods to administer the
medications, and the unlicensed personnel has demonstrated ability to competently follow
the procedures;
 new text end

new text begin (2) specified, in writing, specific instructions for each client and documented those
instructions in the client's records; and
 new text end

new text begin (3) communicated with the unlicensed personnel about the individual needs of
the client.
 new text end

new text begin Subd. 8. new text end

new text begin Documentation of administration of medications. new text end

new text begin Each medication
administered by comprehensive home care provider staff must be documented in the
client's record. The documentation must include the signature and title of the person
who administered the medication. The documentation must include the medication
name, dosage, date and time administered, and method and route of administration. The
staff must document the reason why medication administration was not completed as
prescribed and document any follow-up procedures that were provided to meet the client's
needs when medication was not administered as prescribed and in compliance with the
client's medication management plan.
 new text end

new text begin Subd. 9. new text end

new text begin Documentation of medication set up. new text end

new text begin Documentation of dates of
medication set up, name of medication, quantity of dose, times to be administered, route
of administration, and name of person completing medication set up must be done at
time of set up.
 new text end

new text begin Subd. 10. new text end

new text begin Medications management for clients who will be away from home. new text end

new text begin (a)
A home care provider that is providing medication management services to the client and
controls the client's access to the medications must develop and implement policies and
procedures for giving accurate and current medications to clients for planned or unplanned
times away from home according to the client's individualized medication management
plan. The policy and procedures must state that:
 new text end

new text begin (1) for planned time away, the medications must be obtained from the pharmacy or
set up by the registered nurse according to appropriate state and federal laws and nursing
standards of practice;
 new text end

new text begin (2) for unplanned time away, when the pharmacy is not able to provide the
medications, a licensed nurse or unlicensed personnel shall give the client or client's
representative medications in amounts and dosages needed for the length of the anticipated
absence, not to exceed 120 hours;
 new text end

new text begin (3) the client, or the client's representative, must be provided written information
on medications, including any special instructions for administering or handling the
medications, including controlled substances;
 new text end

new text begin (4) the medications must be placed in a medication container or containers
appropriate to the provider's medication system and must be labeled with the client's name
and the dates and times that the medications are scheduled; and
 new text end

new text begin (5) the client or client's representative must be provided in writing the home care
provider's name and information on how to contact the home care provider.
 new text end

new text begin (b) For unplanned time away when the licensed nurse is not available, the registered
nurse may delegate this task to unlicensed personnel if:
 new text end

new text begin (1) the registered nurse has trained the unlicensed staff and determined the
unlicensed staff is competent to follow the procedures for giving medications to clients;
 new text end

new text begin (2) the registered nurse has developed written procedures for the unlicensed
personnel, including any special instructions or procedures regarding controlled substances
that are prescribed for the client. The procedures must address:
 new text end

new text begin (i) the type of container or containers to be used for the medications appropriate to
the provider's medication system;
 new text end

new text begin (ii) how the container or containers must be labeled;
 new text end

new text begin (iii) the written information about the medications to be given to the client or client's
representative;
 new text end

new text begin (iv) how the unlicensed staff will document in the client's record that medications
have been given to the client or the client's representative, including documenting the date
the medications were given to the client or the client's representative and who received the
medications, the person who gave the medications to the client, the number of medications
that were given to the client, and other required information;
 new text end

new text begin (v) how the registered nurse will be notified that medications have been given to
the client or client's representative and whether the registered nurse needs to be contacted
before the medications are given to the client or the client's representative; and
 new text end

new text begin (vi) a review by the registered nurse of the completion of this task to verify that this
task was completed accurately by the unlicensed personnel.
 new text end

new text begin Subd. 11. new text end

new text begin Prescribed and nonprescribed medication. new text end

new text begin The comprehensive home
care provider must determine whether it will require a prescription for all medications it
manages. The comprehensive home care provider must inform the client or the client's
representative whether the comprehensive home care provider requires a prescription
for all over-the-counter and dietary supplements before the comprehensive home care
provider will agree to manage those medications.
 new text end

new text begin Subd. 12. new text end

new text begin Medications; over-the-counter; dietary supplements not prescribed.
 new text end

new text begin A comprehensive home care provider providing medication management services for
over-the-counter drugs or dietary supplements must retain those items in the original labeled
container with directions for use prior to setting up for immediate or later administration.
The provider must verify that the medications are up-to-date and stored as appropriate.
 new text end

new text begin Subd. 13. new text end

new text begin Prescriptions. new text end

new text begin There must be a current written or electronically recorded
prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed
medications that the comprehensive home care provider is managing for the client.
 new text end

new text begin Subd. 14. new text end

new text begin Renewal of prescriptions. new text end

new text begin Prescriptions must be renewed at least
every 12 months or more frequently as indicated by the assessment in subdivision 2.
Prescriptions for controlled substances must comply with chapter 152.
 new text end

new text begin Subd. 15. new text end

new text begin Verbal prescription orders. new text end

new text begin Verbal prescription orders from an
authorized prescriber must be received by a nurse or pharmacist. The order must be
handled according to Minnesota Rules, part 6800.6200.
new text end

new text begin Subd. 16. new text end

new text begin Written or electronic prescription. new text end

new text begin When a written or electronic
prescription is received, it must be communicated to the registered nurse in charge and
recorded or placed in the client's record.
 new text end

new text begin Subd. 17. new text end

new text begin Records confidential. new text end

new text begin A prescription or order received verbally, in
writing, or electronically must be kept confidential according to sections 144.291 to
144.298 and 144A.44.
 new text end

new text begin Subd. 18. new text end

new text begin Medications provided by client or family members. new text end

new text begin When the
comprehensive home care provider is aware of any medications or dietary supplements
that are being used by the client and are not included in the assessment for medication
management services, the staff must advise the registered nurse and document that in
the client's record.
 new text end

new text begin Subd. 19. new text end

new text begin Storage of drugs. new text end

new text begin A comprehensive home care provider providing
storage of medications outside of the client's private living space must store all prescription
drugs in securely locked and substantially constructed compartments according to the
manufacturer's directions and permit only authorized personnel to have access.
 new text end

new text begin Subd. 20. new text end

new text begin Prescription drugs. new text end

new text begin A prescription drug, prior to being set up for
immediate or later administration, must be kept in the original container in which it was
dispensed by the pharmacy bearing the original prescription label with legible information
including the expiration or beyond-use date of a time-dated drug.
 new text end

new text begin Subd. 21. new text end

new text begin Prohibitions. new text end

new text begin No prescription drug supply for one client may be used or
saved for use by anyone other than the client.
 new text end

new text begin Subd. 22. new text end

new text begin Disposition of drugs. new text end

new text begin (a) Any current medications being managed by the
comprehensive home care provider must be given to the client or the client's representative
when the client's service plan ends or medication management services are no longer part
of the service plan. Medications that have been stored in the client's private living space
for a client that is deceased or that have been discontinued or that have expired may be
given to the client or the client's representative for disposal.
 new text end

new text begin (b) The comprehensive home care provider will dispose of any medications
remaining with the comprehensive home care provider that are discontinued or expired or
upon the termination of the service contract or the client's death according to state and
federal regulations for disposition of drugs and controlled substances.
 new text end

new text begin (c) Upon disposition, the comprehensive home care provider must document in the
client's record the disposition of the medications including the medication's name, strength,
prescription number as applicable, quantity, to whom the medications were given, date of
disposition, and names of staff and other individuals involved in the disposition.
 new text end

new text begin Subd. 23. new text end

new text begin Loss or spillage. new text end

new text begin (a) Comprehensive home care providers providing
medication management must develop and implement procedures for loss or spillage of all
controlled substances defined in Minnesota Rules, part 6800.4220. These procedures must
require that when a spillage of a controlled substance occurs, a notation must be made
in the client's record explaining the spillage and the actions taken. The notation must
be signed by the person responsible for the spillage and include verification that any
contaminated substance was disposed of according to state or federal regulations.
 new text end

new text begin (b) The procedures must require the comprehensive home care provider of
medication management to investigate any known loss or unaccounted for prescription
drugs and take appropriate action required under state or federal regulations and document
the investigation in required records.
 new text end

Sec. 19.

new text begin [144A.4793] TREATMENT AND THERAPY MANAGEMENT
SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Providers with a comprehensive home care license. new text end

new text begin This section
applies only to home care providers with a comprehensive home care license that provide
treatment or therapy management services to clients. Treatment or therapy management
services cannot be provided by a home care provider that has a basic home care license.
 new text end

new text begin Subd. 2. new text end

new text begin Policies and procedures. new text end

new text begin (a) A comprehensive home care provider who
provides treatment and therapy management services must develop, implement, and
maintain up-to-date written treatment or therapy management policies and procedures.
The policies and procedures must be developed under the supervision and direction of
a registered nurse or appropriate licensed health professional consistent with current
practice standards and guidelines.
 new text end

new text begin (b) The written policies and procedures must address requesting and receiving
orders or prescriptions for treatments or therapies, providing the treatment or therapy,
documenting of treatment or therapy activities, educating and communicating with clients
about treatments or therapy they are receiving, monitoring and evaluating the treatment
and therapy, and communicating with the prescriber.
 new text end

new text begin Subd. 3. new text end

new text begin Individualized treatment or therapy management plan. new text end

new text begin For each
client receiving management of ordered or prescribed treatments or therapy services, the
comprehensive home care provider must prepare and include in the service plan a written
statement of the treatment or therapy services that will be provided to the client. The
provider must also develop and maintain a current individualized treatment and therapy
management record for each client which must contain at least the following:
new text end

new text begin (1) a statement of the type of services that will be provided;
 new text end

new text begin (2) documentation of specific client instructions relating to the treatments or therapy
administration;
 new text end

new text begin (3) identification of treatment or therapy tasks that will be delegated to unlicensed
personnel;
new text end

new text begin (4) procedures for notifying a registered nurse or appropriate licensed health
professional when a problem arises with treatments or therapy services; and
 new text end

new text begin (5) any client-specific requirements relating to documentation of treatment
and therapy received, verification that all treatment and therapy was administered as
prescribed, and monitoring of treatment or therapy to prevent possible complications or
adverse reactions. The treatment or therapy management record must be current and
updated when there are any changes.
 new text end

new text begin Subd. 4. new text end

new text begin Administration of treatments and therapy. new text end

new text begin Ordered or prescribed
treatments or therapies must be administered by a nurse, physician, or other licensed health
professional authorized to perform the treatment or therapy, or may be delegated or assigned
to unlicensed personnel by the licensed health professional according to the appropriate
practice standards for delegation or assignment. When administration of a treatment or
therapy is delegated or assigned to unlicensed personnel, the home care provider must
ensure that the registered nurse or authorized licensed health professional has:
 new text end

new text begin (1) instructed the unlicensed personnel in the proper methods with respect to each
client and has demonstrated their ability to competently follow the procedures;
 new text end

new text begin (2) specified, in writing, specific instructions for each client and documented those
instructions in the client's record; and
 new text end

new text begin (3) communicated with the unlicensed personnel about the individual needs of
the client.
 new text end

new text begin Subd. 5. new text end

new text begin Documentation of administration of treatments and therapies. new text end

new text begin Each
treatment or therapy administered by a comprehensive home care provider must be
documented in the client's record. The documentation must include the signature and title
of the person who administered the treatment or therapy and must include the date and
time of administration. When treatment or therapies are not administered as ordered or
prescribed, the provider must document the reason why it was not administered and any
follow-up procedures that were provided to meet the client's needs.
 new text end

new text begin Subd. 6. new text end

new text begin Orders or prescriptions. new text end

new text begin There must be an up-to-date written or
electronically recorded order or prescription for all treatments and therapies. The order
must contain the name of the client, description of the treatment or therapy to be provided,
and the frequency and other information needed to administer the treatment or therapy.
 new text end

Sec. 20.

new text begin [144A.4794] CLIENT RECORD REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Client record. new text end

new text begin (a) The home care provider must maintain records
for each client for whom it is providing services. Entries in the client records must be
current, legible, permanently recorded, dated, and authenticated with the name and title
of the person making the entry.
 new text end

new text begin (b) Client records, whether written or electronic, must be protected against loss,
tampering, or unauthorized disclosure in compliance with chapter 13 and other applicable
relevant federal and state laws. The home care provider shall establish and implement
written procedures to control use, storage, and security of client's records and establish
criteria for release of client information.
 new text end

new text begin (c) The home care provider may not disclose to any other person any personal,
financial, medical, or other information about the client, except:
 new text end

new text begin (1) as may be required by law;
 new text end

new text begin (2) to employees or contractors of the home care provider, another home care
provider, other health care practitioner or provider, or inpatient facility needing
information in order to provide services to the client, but only such information that
is necessary for the provision of services;
 new text end

new text begin (3) to persons authorized in writing by the client or the client's representative to
receive the information, including third-party payers; and
 new text end

new text begin (4) to representatives of the commissioner authorized to survey or investigate home
care providers under this chapter or federal laws.
 new text end

new text begin Subd. 2. new text end

new text begin Access to records. new text end

new text begin The home care provider must ensure that the
appropriate records are readily available to employees or contractors authorized to access
the records. Client records must be maintained in a manner that allows for timely access,
printing, or transmission of the records.
 new text end

new text begin Subd. 3. new text end

new text begin Contents of client record. new text end

new text begin Contents of a client record include the
following for each client:
 new text end

new text begin (1) identifying information, including the client's name, date of birth, address, and
telephone number;
 new text end

new text begin (2) the name, address, and telephone number of an emergency contact, family
members, client's representative, if any, or others as identified;
 new text end

new text begin (3) names, addresses, and telephone numbers of the client's health and medical
service providers and other home care providers, if known;
 new text end

new text begin (4) health information, including medical history, allergies, and when the provider
is managing medications, treatments or therapies that require documentation, and other
relevant health records;
 new text end

new text begin (5) client's advance directives, if any;
 new text end

new text begin (6) the home care provider's current and previous assessments and service plans;
 new text end

new text begin (7) all records of communications pertinent to the client's home care services;
 new text end

new text begin (8) documentation of significant changes in the client's status and actions taken in
response to the needs of the client including reporting to the appropriate supervisor or
health care professional;
 new text end

new text begin (9) documentation of incidents involving the client and actions taken in response
to the needs of the client including reporting to the appropriate supervisor or health
care professional;
 new text end

new text begin (10) documentation that services have been provided as identified in the service plan;
 new text end

new text begin (11) documentation that the client has received and reviewed the home care bill
of rights;
 new text end

new text begin (12) documentation that the client has been provided the statement of disclosure on
limitations of services under section 144A.4791, subdivision 3;
 new text end

new text begin (13) documentation of complaints received and resolution;
 new text end

new text begin (14) discharge summary, including service termination notice and related
documentation, when applicable; and
 new text end

new text begin (15) other documentation required under this chapter and relevant to the client's
services or status.
 new text end

new text begin Subd. 4. new text end

new text begin Transfer of client records. new text end

new text begin If a client transfers to another home care
provider or other health care practitioner or provider, or is admitted to an inpatient facility,
the home care provider, upon request of the client or the client's representative, shall take
steps to ensure a coordinated transfer including sending a copy or summary of the client's
record to the new home care provider, facility, or the client, as appropriate.
 new text end

new text begin Subd. 5. new text end

new text begin Record retention. new text end

new text begin Following the client's discharge or termination of
services, a home care provider must retain a client's record for at least five years, or as
otherwise required by state or federal regulations. Arrangements must be made for secure
storage and retrieval of client records if the home care provider ceases business.
 new text end

Sec. 21.

new text begin [144A.4795] HOME CARE PROVIDER RESPONSIBILITIES; STAFF.
 new text end

new text begin Subdivision 1. new text end

new text begin Qualifications, training, and competency. new text end

new text begin All staff providing
home care services must be trained and competent in the provision of home care services
consistent with current practice standards appropriate to the client's needs.
 new text end

new text begin Subd. 2. new text end

new text begin Licensed health professionals and nurses. new text end

new text begin (a) Licensed health
professionals and nurses providing home care services as an employee of a licensed home
care provider must possess current Minnesota license or registration to practice.
 new text end

new text begin (b) Licensed health professionals and registered nurses must be competent in
assessing client needs, planning appropriate home care services to meet client needs,
implementing services, and supervising staff if assigned.
 new text end

new text begin (c) Nothing in this section limits or expands the rights of nurses or licensed health
professionals to provide services within the scope of their licenses or registrations, as
provided by law.
 new text end

new text begin Subd. 3. new text end

new text begin Unlicensed personnel. new text end

new text begin (a) Unlicensed personnel providing basic home
care services must have:
 new text end

new text begin (1) successfully completed a training and competency evaluation appropriate to
the services provided by the home care provider and the topics listed in subdivision 7,
paragraph (b); or
 new text end

new text begin (2) demonstrated competency by satisfactorily completing a written or oral test on
the tasks the unlicensed personnel will perform and in the topics listed in subdivision
7, paragraph (b); and successfully demonstrate competency of topics in subdivision 7,
paragraph (b), clauses (5), (7), and (8), by a practical skills test.
 new text end

new text begin Unlicensed personnel providing home care services for a basic home care provider may
not perform delegated nursing or therapy tasks.
 new text end

new text begin (b) Unlicensed personnel performing delegated nursing tasks for a comprehensive
home care provider must:
 new text end

new text begin (1) have successfully completed training and demonstrated competency by
successfully completing a written or oral test of the topics in subdivision 7, paragraphs (b)
and (c), and a practical skills test on tasks listed in subdivision 7, paragraphs (b), clauses (5)
and (7), and (c), clauses (3), (5), (6), and (7), and all the delegated tasks they will perform;
 new text end

new text begin (2) satisfy the current requirements of Medicare for training or competency of home
health aides or nursing assistants, as provided by Code of Federal Regulations, title 42,
section 483 or section 484.36; or
 new text end

new text begin (3) have, before April 19, 1993, completed a training course for nursing assistants
that was approved by the commissioner.
 new text end

new text begin (c) Unlicensed personnel performing therapy or treatment tasks delegated or
assigned by a licensed health professional must meet the requirements for delegated
tasks in subdivision 4 and any other training or competency requirements within the
licensed health professional scope of practice relating to delegation or assignment of tasks
to unlicensed personnel.
 new text end

new text begin Subd. 4. new text end

new text begin Delegation of home care tasks. new text end

new text begin A registered nurse or licensed health
professional may delegate tasks only to staff that are competent and possess the knowledge
and skills consistent with the complexity of the tasks and according to the appropriate
Minnesota Practice Act. The comprehensive home care provider must establish and
implement a system to communicate up-to-date information to the registered nurse or
licensed health professional regarding the current available staff and their competency so
the registered nurse or licensed health professional has sufficient information to determine
the appropriateness of delegating tasks to meet individual client needs and preferences.
 new text end

new text begin Subd. 5. new text end

new text begin Individual contractors. new text end

new text begin When a home care provider contracts with an
individual contractor excluded from licensure under section 144A.471 to provide home
care services, the contractor must meet the same requirements required by this section for
personnel employed by the home care provider.
 new text end

new text begin Subd. 6. new text end

new text begin Temporary staff. new text end

new text begin When a home care provider contracts with a temporary
staffing agency excluded from licensure under section 144A.471, those individuals must
meet the same requirements required by this section for personnel employed by the home
care provider and shall be treated as if they are staff of the home care provider.
 new text end

new text begin Subd. 7. new text end

new text begin Requirements for instructors, training content, and competency
evaluations for unlicensed personnel. new text end

new text begin (a) Instructors and competency evaluators must
meet the following requirements:
 new text end

new text begin (1) training and competency evaluations of unlicensed personnel providing basic
home care services must be conducted by individuals with work experience and training in
providing home care services listed in section 144A.471, subdivisions 6 and 7; and
 new text end

new text begin (2) training and competency evaluations of unlicensed personnel providing
comprehensive home care services must be conducted by a registered nurse, or another
instructor may provide training in conjunction with the registered nurse. If the home care
provider is providing services by licensed health professionals only, then that specific
training and competency evaluation may be conducted by the licensed health professionals
as appropriate.
 new text end

new text begin (b) Training and competency evaluations for all unlicensed personnel must include
the following:
 new text end

new text begin (1) documentation requirements for all services provided;
 new text end

new text begin (2) reports of changes in the client's condition to the supervisor designated by the
home care provider;
 new text end

new text begin (3) basic infection control, including blood-borne pathogens;
 new text end

new text begin (4) maintenance of a clean and safe environment;
 new text end

new text begin (5) appropriate and safe techniques in personal hygiene and grooming, including:
 new text end

new text begin (i) hair care and bathing;
 new text end

new text begin (ii) care of teeth, gums, and oral prosthetic devices;
 new text end

new text begin (iii) care and use of hearing aids; and
 new text end

new text begin (iv) dressing and assisting with toileting;
 new text end

new text begin (6) training on the prevention of falls for providers working with the elderly or
individuals at risk of falls;
 new text end

new text begin (7) standby assistance techniques and how to perform them;
 new text end

new text begin (8) medication, exercise, and treatment reminders;
 new text end

new text begin (9) basic nutrition, meal preparation, food safety, and assistance with eating;
 new text end

new text begin (10) preparation of modified diets as ordered by a licensed health professional;
 new text end

new text begin (11) communication skills that include preserving the dignity of the client and
showing respect for the client and the client's preferences, cultural background, and family;
 new text end

new text begin (12) awareness of confidentiality and privacy;
 new text end

new text begin (13) understanding appropriate boundaries between staff and clients and the client's
family;
 new text end

new text begin (14) procedures to utilize in handling various emergency situations; and
 new text end

new text begin (15) awareness of commonly used health technology equipment and assistive devices.
 new text end

new text begin (c) In addition to paragraph (b), training and competency evaluation for unlicensed
personnel providing comprehensive home care services must include:
 new text end

new text begin (1) observation, reporting, and documenting of client status;
 new text end

new text begin (2) basic knowledge of body functioning and changes in body functioning, injuries,
or other observed changes that must be reported to appropriate personnel;
 new text end

new text begin (3) reading and recording temperature, pulse, and respirations of the client;
 new text end

new text begin (4) recognizing physical, emotional, cognitive, and developmental needs of the client;
 new text end

new text begin (5) safe transfer techniques and ambulation;
 new text end

new text begin (6) range of motioning and positioning; and
 new text end

new text begin (7) administering medications or treatments as required.
 new text end

new text begin (d) When the registered nurse or licensed health professional delegates tasks, they
must ensure that prior to the delegation the unlicensed personnel is trained in the proper
methods to perform the tasks or procedures for each client and are able to demonstrate
the ability to competently follow the procedures and perform the tasks. If an unlicensed
personnel has not regularly performed the delegated home care task for a period of 24
consecutive months, the unlicensed personnel must demonstrate competency in the task
to the registered nurse or appropriate licensed health professional. The registered nurse
or licensed health professional must document instructions for the delegated tasks in
the client's record.
 new text end

Sec. 22.

new text begin [144A.4796] ORIENTATION AND ANNUAL TRAINING
REQUIREMENTS.
 new text end

new text begin Subdivision 1. new text end

new text begin Orientation of staff and supervisors to home care. new text end

new text begin All staff
providing and supervising direct home care services must complete an orientation to home
care licensing requirements and regulations before providing home care services to clients.
The orientation may be incorporated into the training required under subdivision 6. The
orientation need only be completed once for each staff person and is not transferable
to another home care provider.
 new text end

new text begin Subd. 2. new text end

new text begin Content. new text end

new text begin The orientation must contain the following topics:
 new text end

new text begin (1) an overview of sections 144A.43 to 144A.4798;
 new text end

new text begin (2) introduction and review of all the provider's policies and procedures related to
the provision of home care services;
 new text end

new text begin (3) handling of emergencies and use of emergency services;
 new text end

new text begin (4) compliance with and reporting the maltreatment of minors or vulnerable adults
under sections 626.556 and 626.557;
 new text end

new text begin (5) home care bill of rights, under section 144A.44;
 new text end

new text begin (6) handling of clients' complaints; reporting of complaints and where to report
complaints including information on the Office of Health Facility Complaints and the
Common Entry Point;
 new text end

new text begin (7) consumer advocacy services of the Office of Ombudsman for Long-Term Care,
Office of Ombudsman for Mental Health and Developmental Disabilities, Managed Care
Ombudsman at the Department of Human Services, county managed care advocates,
or other relevant advocacy services; and
 new text end

new text begin (8) review of the types of home care services the employee will be providing and
the provider's scope of licensure.
 new text end

new text begin Subd. 3. new text end

new text begin Verification and documentation of orientation. new text end

new text begin Each home care provider
shall retain evidence in the employee record of each staff person having completed the
orientation required by this section.
 new text end

new text begin Subd. 4. new text end

new text begin Orientation to client. new text end

new text begin Staff providing home care services must be oriented
specifically to each individual client and the services to be provided. This orientation may
be provided in person, orally, in writing, or electronically.
 new text end

new text begin Subd. 5. new text end

new text begin Training required relating to Alzheimer's disease and related disorders.
 new text end

new text begin For home care providers that provide services for persons with Alzheimer's or related
disorders, all direct care staff and supervisors working with those clients must receive
training that includes a current explanation of Alzheimer's disease and related disorders
effective approaches to use to problem solve when working with a client's challenging
behaviors, and how to communicate with clients who have Alzheimer's or related disorders.
 new text end

new text begin Subd. 6. new text end

new text begin Required annual training. new text end

new text begin All staff that perform direct home care
services must complete at least eight hours of annual training for each 12 months of
employment. The training may be obtained from the home care provider or another source
and must include topics relevant to the provision of home care services. The annual
training must include:
 new text end

new text begin (1) training on reporting of maltreatment of minors under section 626.556 and
maltreatment of vulnerable adults under section 626.557, whichever is applicable to the
services provided;
 new text end

new text begin (2) review of the home care bill of rights in section 144A.44;
 new text end

new text begin (3) review of infection control techniques used in the home and implementation of
infection control standards including a review of hand washing techniques; the need for
and use of protective gloves, gowns, and masks; appropriate disposal of contaminated
materials and equipment, such as dressings, needles, syringes, and razor blades;
disinfecting reusable equipment; disinfecting environmental surfaces; and reporting of
communicable diseases; and
 new text end

new text begin (4) review of the provider's policies and procedures relating to the provision of home
care services and how to implement those policies and procedures.
 new text end

new text begin Subd. 7. new text end

new text begin Documentation. new text end

new text begin A home care provider must retain documentation in the
employee records of the staff that have satisfied the orientation and training requirements
of this section.
 new text end

Sec. 23.

new text begin [144A.4797] PROVISION OF SERVICES.
 new text end

new text begin Subdivision 1. new text end

new text begin Availability of contact person to staff. new text end

new text begin (a) A home care provider
with a basic home care license must have a person available to staff for consultation on
items relating to the provision of services or about the client.
 new text end

new text begin (b) A home care provider with a comprehensive home care license must have a
registered nurse available for consultation to staff performing delegated nursing tasks
and must have an appropriate licensed health professional available if performing other
delegated services such as therapies.
 new text end

new text begin (c) The appropriate contact person must be readily available either in person, by
telephone, or by other means to the staff at times when the staff is providing services.
 new text end

new text begin Subd. 2. new text end

new text begin Supervision of staff; basic home care services. new text end

new text begin (a) Staff who perform
basic home care services must be supervised periodically where the services are being
provided to verify that the work is being performed competently and to identify problems
and solutions to address issues relating to the staff's ability to provide the services. The
supervision of the unlicensed personnel must be done by staff of the home care provider
having the authority, skills, and ability to provide the supervision of unlicensed personnel
and who can implement changes as needed, and train staff.
 new text end

new text begin (b) Supervision includes direct observation of unlicensed personnel while they
are providing the services and may also include indirect methods of gaining input such
as gathering feedback from the client. Supervisory review of staff must be provided at a
frequency based on the staff person's competency and performance.
 new text end

new text begin (c) For an individual who is licensed as a home care provider, this section does
not apply.
 new text end

new text begin Subd. 3. new text end

new text begin Supervision of staff providing delegated nursing or therapy home
care tasks. new text end

new text begin (a) Staff who perform delegated nursing or therapy home care tasks must be
supervised by an appropriate licensed health professional or a registered nurse periodically
where the services are being provided to verify that the work is being performed
competently and to identify problems and solutions related to the staff person's ability to
perform the tasks. Supervision of staff performing medication or treatment administration
shall be provided by a registered nurse or appropriate licensed health professional and
must include observation of the staff administering the medication or treatment and the
interaction with the client.
 new text end

new text begin (b) The direct supervision of staff performing delegated tasks must be provided
within 30 days after the individual begins working for the home care provider and
thereafter as needed based on performance. This requirement also applies to staff who
have not performed delegated tasks for one year or longer.
 new text end

new text begin Subd. 4. new text end

new text begin Documentation. new text end

new text begin A home care provider must retain documentation of
supervision activities in the personnel records.
 new text end

new text begin Subd. 5. new text end

new text begin Exemption. new text end

new text begin This section does not apply to an individual licensed under
sections 144A.43 to 144A.4799.
 new text end

Sec. 24.

new text begin [144A.4798] EMPLOYEE HEALTH STATUS.
 new text end

new text begin Subdivision 1. new text end

new text begin Tuberculosis (TB) prevention and control. new text end

new text begin A home care provider
must establish and maintain a TB prevention and control program based on the most
current guidelines issued by the Centers for Disease Control and Prevention (CDC).
Components of a TB prevention and control program include screening all staff providing
home care services, both paid and unpaid, at the time of hire for active TB disease and
latent TB infection, and developing and implementing a written TB infection control plan.
The commissioner shall make the most recent CDC standards available to home care
providers on the department's Web site.
 new text end

new text begin Subd. 2. new text end

new text begin Communicable diseases. new text end

new text begin A home care provider must follow
current federal or state guidelines for prevention, control, and reporting of human
immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, or other
communicable diseases as defined in Minnesota Rules, part 4605.7040.
 new text end

Sec. 25.

new text begin [144A.4799] DEPARTMENT OF HEALTH LICENSED HOME CARE
PROVIDER ADVISORY COUNCIL.
 new text end

new text begin Subdivision 1. new text end

new text begin Membership. new text end

new text begin The commissioner of health shall appoint eight
persons to a home care provider advisory council consisting of the following:
 new text end

new text begin (1) three public members as defined in section 214.02 who shall be either persons
who are currently receiving home care services or have family members receiving home
care services, or persons who have family members who have received home care services
within five years of the application date;
 new text end

new text begin (2) three Minnesota home care licensees representing basic and comprehensive
levels of licensure who may be a managerial official, an administrator, a supervising
registered nurse, or an unlicensed personnel performing home care tasks;
 new text end

new text begin (3) one member representing the Minnesota Board of Nursing; and
 new text end

new text begin (4) one member representing the ombudsman for long-term care.
 new text end

new text begin Subd. 2. new text end

new text begin Organizations and meetings. new text end

new text begin The advisory council shall be organized
and administered under section 15.059 with per diems and costs paid within the limits of
available appropriations. Meetings will be held quarterly and hosted by the department.
Subcommittees may be developed as necessary by the commissioner. Advisory council
meetings are subject to the Open Meeting Law under chapter 13D.
 new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin At the commissioner's request, the advisory council shall provide
advice regarding regulations of Department of Health licensed home care providers in
this chapter such as:
 new text end

new text begin (1) advice to the commissioner regarding community standards for home care
practices;
 new text end

new text begin (2) advice to the commissioner on enforcement of licensing standards and whether
certain disciplinary actions are appropriate;
 new text end

new text begin (3) advice to the commissioner about ways of distributing information to licensees
and consumers of home care;
 new text end

new text begin (4) advice to the commissioner about training standards;
 new text end

new text begin (5) identify emerging issues and opportunities in the home care field, including the
use of technology in home and telehealth capabilities; and
 new text end

new text begin (6) perform other duties as directed by the commissioner.
 new text end

Sec. 26.

new text begin [144A.481] HOME CARE LICENSING IMPLEMENTATION FOR
NEW LICENSEES AND TRANSITION PERIOD FOR CURRENT LICENSEES.
 new text end

new text begin Subdivision 1. new text end

new text begin Temporary home care licenses and changes of ownership. new text end

new text begin (a)
Beginning January 1, 2014, all temporary license applicants must apply for either a
temporary basic or comprehensive home care license.
 new text end

new text begin (b) Temporary home care temporary licenses issued beginning January 1, 2014,
will be issued according to the provisions in sections 144A.43 to 144A.4799 and fees in
section 144A.472 and will be required to comply with this chapter.
 new text end

new text begin (c) No temporary licenses or licenses will be accepted or issued between October 1,
2013, and December 31, 2013.
 new text end

new text begin (d) Beginning October 1, 2013, changes in ownership applications will require
payment of the new fees listed in section 144A.472.
 new text end

new text begin Subd. 2. new text end

new text begin Current home care licensees with licenses prior to July 1, 2013. new text end

new text begin (a)
Beginning July 1, 2014, department licensed home care providers must apply for either
the basic or comprehensive home care license on their regularly scheduled renewal date.
 new text end

new text begin (b) By June 30, 2015, all home care providers must either have a basic or
comprehensive home care license or temporary license.
 new text end

new text begin Subd. 3. new text end

new text begin Renewal application of home care licensure during transition period.
 new text end

new text begin Renewal of home care licenses issued beginning July 1, 2014, will be issued according to
sections 144A.43 to 144A.4799 and, upon license renewal, providers must comply with
sections 144A.43 to 144A.4799. Prior to renewal, providers must comply with the home
care licensure law in effect on June 30, 2013.
 new text end

new text begin The fees charged for licenses renewed between July 1, 2014, and June 30, 2016,
shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000
increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625.
 new text end

new text begin For fiscal year 2014 only, the fees for providers with revenues greater than $25,000
and no more than $100,000 will be $313 and for providers with revenues no more than
$25,000 the fee will be $125.
 new text end

Sec. 27.

new text begin [144A.482] REGISTRATION OF HOME MANAGEMENT
PROVIDERS.
 new text end

new text begin (a) For purposes of this section, a home management provider is an individual or
organization that provides at least two of the following services: housekeeping, meal
preparation, and shopping, to a person who is unable to perform these activities due to
illness, disability, or physical condition.
 new text end

new text begin (b) A person or organization that provides only home management services may not
operate in the state without a current certificate of registration issued by the commissioner
of health. To obtain a certificate of registration, the person or organization must annually
submit to the commissioner the name, mailing and physical address, e-mail address, and
telephone number of the individual or organization and a signed statement declaring that
the individual or organization is aware that the home care bill of rights applies to their
clients and that the person or organization will comply with the home care bill of rights
provisions contained in section 144A.44. An individual or organization applying for a
certificate must also provide the name, business address, and telephone number of each of
the individuals responsible for the management or direction of the organization.
new text end

new text begin (c) The commissioner shall charge an annual registration fee of $20 for individuals
and $50 for organizations. The registration fee shall be deposited in the state treasury and
credited to the state government special revenue fund.
 new text end

new text begin (d) A home care provider that provides home management services and other home
care services must be licensed, but licensure requirements other than the home care bill of
rights do not apply to those employees or volunteers who provide only home management
services to clients who do not receive any other home care services from the provider.
A licensed home care provider need not be registered as a home management service
provider, but must provide an orientation on the home care bill of rights to its employees
or volunteers who provide home management services.
 new text end

new text begin (e) An individual who provides home management services under this section must,
within 120 days after beginning to provide services, attend an orientation session approved
by the commissioner that provides training on the home care bill of rights and an orientation
on the aging process and the needs and concerns of elderly and disabled persons.
 new text end

new text begin (f) The commissioner may suspend or revoke a provider's certificate of registration
or assess fines for violation of the home care bill of rights. Any fine assessed for a
violation of the home care bill of rights by a provider registered under this section shall be
in the amount established in the licensure rules for home care providers. As a condition
of registration, a provider must cooperate fully with any investigation conducted by the
commissioner, including providing specific information requested by the commissioner on
clients served and the employees and volunteers who provide services. Fines collected
under this paragraph shall be deposited in the state treasury and credited to the fund
specified in the statute or rule in which the penalty was established.
 new text end

new text begin (g) The commissioner may use any of the powers granted in sections 144A.43 to
144A.4799 to administer the registration system and enforce the home care bill of rights
under this section.
 new text end

Sec. 28. new text begin AGENCY QUALITY IMPROVEMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Annual legislative report on home care licensing. new text end

new text begin The
commissioner shall establish a quality improvement program for the home care survey
and home care complaint investigation processes. The commissioner shall submit to the
legislature an annual report, beginning October 1, 2015, and each October 1 thereafter.
Each report will review the previous state fiscal year of home care licensing and regulatory
activities. The report must include, but is not limited to, an analysis of:
 new text end

new text begin (1) the number of FTE's in the Division of Compliance Monitoring, including the
Office of Health Facility Complaints units assigned to home care licensing, survey,
investigation and enforcement process;
 new text end

new text begin (2) numbers of and descriptive information about licenses issued, complaints
received and investigated, including allegations made and correction orders issued,
surveys completed and timelines, and correction order reconsiderations and results;
 new text end

new text begin (3) descriptions of emerging trends in home care provision and areas of concern
identified by the department in its regulation of home care providers;
 new text end

new text begin (4) information and data regarding performance improvement projects underway
and planned by the commissioner in the area of home care surveys; and
 new text end

new text begin (5) work of the Department of Health Home Care Advisory Council.
 new text end

new text begin Subd. 2. new text end

new text begin Study of correction order appeal process. new text end

new text begin Starting July 1, 2015, the
commissioner shall study whether to add a correction order appeal process conducted by
an independent reviewer such as an administrative law judge or other office and submit a
report to the legislature by February 1, 2016. The commissioner shall review home care
regulatory systems in other states as part of that study. The commissioner shall consult
with the home care providers and representatives.
 new text end

Sec. 29. new text begin INTEGRATED LICENSING SYSTEM FOR HOME CARE AND HOME
AND COMMUNITY-BASED SERVICES.
new text end

new text begin (a) The Department of Health Compliance Monitoring Division and the Department
of Human Services Licensing Division shall jointly develop an integrated licensing system
for providers of both home care services subject to licensure under Minnesota Statutes,
chapter 144A, and for home and community-based services subject to licensure under
Minnesota Statutes, chapter 245D. The integrated licensing system shall:
 new text end

new text begin (1) require only one license of any provider of services under Minnesota Statutes,
sections 144A.43 to 144A.482, and 245D.03, subdivision 1;
 new text end

new text begin (2) promote quality services that recognize a person's individual needs and protect
the person's health, safety, rights, and well-being;
 new text end

new text begin (3) promote provider accountability through application requirements, compliance
inspections, investigations, and enforcement actions;
 new text end

new text begin (4) reference other applicable requirements in existing state and federal laws,
including the federal Affordable Care Act;
 new text end

new text begin (5) establish internal procedures to facilitate ongoing communications between the
agencies, and with providers and services recipients about the regulatory activities;
 new text end

new text begin (6) create a link between the agency Web sites so that providers and the public can
access the same information regardless of which Web site is accessed initially; and
 new text end

new text begin (7) collect data on identified outcome measures as necessary for the agencies to
report to the Centers for Medicare and Medicaid Services.
 new text end

new text begin (b) The joint recommendations for legislative changes to implement the integrated
licensing system are due to the legislature by February 15, 2014.
 new text end

new text begin (c) Before implementation of the integrated licensing system, providers licensed as
home care providers under Minnesota Statutes, chapter 144A, may also provide home
and community-based services subject to licensure under Minnesota Statutes, chapter
245D, without obtaining a home and community-based services license under Minnesota
Statutes, chapter 245D. During this time, the conditions under clauses (1) to (3) shall
apply to these providers:
 new text end

new text begin (1) the provider must comply with all requirements under Minnesota Statutes, chapter
245D, for services otherwise subject to licensure under Minnesota Statutes, chapter 245D;
 new text end

new text begin (2) a violation of requirements under Minnesota Statutes, chapter 245D, may be
enforced by the Department of Health under the enforcement authority set forth in
Minnesota Statutes, section 144A.475; and
 new text end

new text begin (3) the Department of Health will provide information to the Department of Human
Services about each provider licensed under this section, including the provider's license
application, licensing documents, inspections, information about complaints received, and
investigations conducted for possible violations of Minnesota Statutes, chapter 245D.
 new text end

Sec. 30. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, sections 144A.46; and 144A.461, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin 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; and 4669.0050, new text end new text begin are repealed.
 new text end

Sec. 31. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 30 are effective the day following final enactment.
 new text end

ARTICLE 12

HEALTH DEPARTMENT

Section 1.

Minnesota Statutes 2012, section 16A.724, subdivision 2, is amended to read:


Subd. 2.

Transfers.

(a) Notwithstanding section 295.581, to the extent available
resources in the health care access fund exceed expenditures in that fund, effective for
the biennium beginning July 1, 2007, the commissioner of management and budget shall
transfer the excess funds from the health care access fund to the general fund on June 30
of each year, provided that the amount transferred in any fiscal biennium shall not exceed
$96,000,000. The purpose of this transfer is to meet the rate increase required under Laws
2003, First Special Session chapter 14, article 13C, section 2, subdivision 6.

(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and,
if necessary, the commissioner shall reduce these transfers from the health care access
fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary,
transfer sufficient funds from the general fund to the health care access fund to meet
annual MinnesotaCare expenditures.

new text begin (c) Notwithstanding section 295.581, to the extent available resources in the health
care access fund exceed expenditures in that fund, effective for the biennium beginning
July 1, 2013, the commissioner of management and budget shall transfer $1,000,000 each
fiscal year from the health access fund to the medical education and research costs fund
established under section 62J.692, for distribution under section 62J.692, subdivision 4,
paragraph (b).
new text end

Sec. 2.

new text begin [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS.
 new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms defined in
paragraphs (b) to (e) have the meanings given.
 new text end

new text begin (b) "Autism spectrum disorders" means the conditions as determined by criteria
set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental
Disorders of the American Psychiatric Association.
 new text end

new text begin (c) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
 new text end

new text begin (d) "Medically necessary care" means health care services appropriate, in terms of
type, frequency, level, setting, and duration, to the enrollee's condition, and diagnostic
testing and preventative services. Medically necessary care must be consistent with
generally accepted practice parameters as determined by physicians and licensed
psychologists who typically manage patients who have autism spectrum disorders.
new text end

new text begin (e) "Mental health professional" has the meaning given in section 245.4871,
subdivision 27.
 new text end

new text begin Subd. 2. new text end

new text begin Optional coverage required. new text end

new text begin (a) A health plan must provide:
 new text end

new text begin (1) all health benefits related to the treatment of autism spectrum disorders required
by the essential health benefits required under section 1302 of the Affordable Care Act;
 new text end

new text begin (2) all health benefits required by this section or any other section of Minnesota
Statutes as of December 31, 2012; and
 new text end

new text begin (3) an offer of one or more options for the purchase of supplemental autism coverage
for young children for children under age 18 for the diagnosis, evaluation, assessment,
and medically necessary care of autism spectrum disorders, including but not limited to
the following:
 new text end

new text begin (i) early intensive behavioral and developmental therapy based in behavioral and
developmental science, including but not limited to applied behavior analysis, intensive
early intervention behavior therapy, intensive behavior intervention, and Lovaas therapy
and developmental approaches;
 new text end

new text begin (ii) neurodevelopmental and behavioral health treatments and management;
 new text end

new text begin (iii) speech therapy;
 new text end

new text begin (iv) occupational therapy;
 new text end

new text begin (v) physical therapy; and
 new text end

new text begin (vi) medications.
 new text end

new text begin (b) The diagnosis, evaluation, and assessment must include an assessment of the
child's developmental skills, functional behavior, needs, and capacities.
 new text end

new text begin (c) The coverage option required under this section shall include treatment that is
in accordance with an individualized treatment plan prescribed by the insured's treating
physician or mental health professional.
 new text end

new text begin (d) A health plan may not refuse to renew or reissue, or otherwise terminate or
restrict, coverage of an individual solely because the individual is diagnosed with an
autism spectrum disorder.
 new text end

new text begin (e) A health plan may request an updated treatment plan only once every six months,
unless the health plan and the treating physician or mental health professional agree that a
more frequent review is necessary due to emerging circumstances.
 new text end

new text begin (f) An independent progress evaluation conducted by a mental health professional
with expertise and training in autism spectrum disorder and child development must
be completed to determine if progress toward functional and generalizable gains, as
determined in the treatment plan, is being made.
 new text end

new text begin (g) A health plan may cap the dollar value of the supplemental coverage offered
under this subdivision, but may not cap the value at less than $50,000 per calendar year
per individual receiving a diagnosis of autism spectrum disorder.
 new text end

new text begin Subd. 3. new text end

new text begin No effect on other law. new text end

new text begin Nothing in this section limits in any way the
coverage required under section 62Q.47.
 new text end

new text begin Subd. 4. new text end

new text begin State health care programs. new text end

new text begin This section does not affect benefits available
under the medical assistance and MinnesotaCare programs and does not limit, restrict, or
otherwise reduce coverage under these programs.
 new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2014, and sunsets effective
December 31, 2015, and applies to coverage offered, issued, sold, renewed, or continued
as defined in Minnesota Statutes, section 60A.02, subdivision 2a, on or after that date.
 new text end

Sec. 3.

new text begin [62D.0425] NET WORTH LIMIT.
 new text end

new text begin (a) Between July 1, 2013, and June 30, 2018, no health maintenance organization
shall have a net worth of more than 25 percent of the sum of all expenses incurred during
the most recent calendar year, except as provided in paragraph (b).
 new text end

new text begin (b) A health maintenance organization may have a net worth of more than 25 percent
of the sum of all expenses incurred during the most recent calendar year if necessary to
maintain capital reserves at the level of the product of 2.0 and its authorized control
level risk-based capital, as required pursuant to sections 60A.50 to 60A.592 and 62D.04.
Paragraphs (c) and (d) do not apply to health maintenance organizations permitted, under
this paragraph, to have a net worth greater than 25 percent of the sum of all expenses
incurred during the most recent calendar year.
 new text end

new text begin (c) By June 15, 2013, and annually thereafter until June 15, 2017, for a health
maintenance organization that has a net worth of more than 25 percent of the sum of all
expenses incurred during the most recent calendar year, the commissioner of health, in
consultation with the commissioners of commerce and human services, shall determine:
 new text end

new text begin (1) capital reserves using the National Association of Insurance Commissioners
definitions of admitted assets, which shall be used in clauses (2) to (5);
 new text end

new text begin (2) the proportion of capital reserves that are reasonably attributable to net
underwriting gains in Minnesota public health care programs based on annual financial
filings for calendar years 2003 through 2012;
 new text end

new text begin (3) the proportion of capital reserves that are reasonably attributable to investment
gains associated with net underwriting gains in Minnesota public health care programs
based on annual financial filings for calendar years 2003 through 2012;
 new text end

new text begin (4) any adjustments needed to clause (1) or (2) based on corporate reorganizations,
since 2003; and
 new text end

new text begin (5) any adjustments needed to account for the impact of annual financial filings for
calendar years 2013 through 2016.
 new text end

new text begin (d) A health maintenance organization that has a net worth of more than 25 percent
of the sum of all expenses incurred during the most recent calendar year shall reduce its
capital reserves as follows:
 new text end

new text begin (1) as determined by paragraph (c), the proportion of capital reserves that are greater
than 25 percent of the sum of all expenses incurred during the most recent calendar
year and that are reasonably attributable to net underwriting gains and investment gains
associated with net underwriting gains in Minnesota public health care programs shall be
spent down. The health maintenance organization shall place excess capital reserves in a
special restricted account under the control of the health maintenance organization. The
special restricted account may only be used to pay for a portion of the health maintenance
organization's current public program enrollee premiums. The health maintenance
organization shall spend no less than 50 percent of this special restricted account in any
state fiscal year beginning on or after July 1, 2013; and
 new text end

new text begin (2) the proportion of capital reserves that are greater than 25 percent of the
sum of all expenses incurred during the most recent calendar year and that are not
reasonably attributable to net underwriting gains and investment gains associated with net
underwriting gains in Minnesota public health care programs shall be spent down. The
health maintenance organization shall place these excess capital reserves in a second
special restricted account under the control of the health maintenance organization. The
health maintenance organization may use this special restricted account to benefit current
enrollees by moderating variation in premium increases, assisting enrollees in accessing
new benefits, reducing health disparities, promoting health, wellness and preventive
services, and improving care coordination. Prior to spending down excess reserves from
this special revenue account, the health maintenance organization's spenddown plan must
be approved by the commissioner of health. The health maintenance organization shall
spend no less than 33 percent of this special restricted account in any state fiscal year
beginning July 1, 2013.
 new text end

new text begin (e) The health maintenance organization must spend down all of the reserves placed
in its special restricted accounts by July 1, 2018. All reserves placed in a special account
must be spent according to paragraph (d), unless the reserves are necessary for the health
maintenance organization to maintain capital reserves at the level of the product of 2.0 and
its authorized control level risk-based capital, as required pursuant to sections 60A.50 to
60A.592 and 62D.04, in which case the health maintenance organization may transfer funds
out of its special restricted accounts in a manner approved by the commissioner of health.
 new text end

new text begin (f) The commissioner of health must approve all health maintenance organization
expenditures for the acquisition of any asset that is not an admitted asset under National
Association of Insurance Commissioners definitions. The commissioner shall disapprove
any acquisition unless the health maintenance organization demonstrates that the
acquisition is: (1) consistent with its long-standing business practices; or (2) more
beneficial to enrollees than benefits to enrollees under paragraph (d).
 new text end

Sec. 4.

Minnesota Statutes 2012, section 62J.692, subdivision 4, is amended to read:


Subd. 4.

Distribution of funds.

(a) The commissioner shall annually distribute the
available medical education funds to all qualifying applicants based on a distribution
formula that reflects a summation of two factors:

(1) a public program volume factor, which is determined by the total volume of
public program revenue received by each training site as a percentage of all public
program revenue received by all training sites in the fund pool; and

(2) a supplemental public program volume factor, which is determined by providing
a supplemental payment of 20 percent of each training site's grant to training sites whose
public program revenue accounted for at least 0.98 percent of the total public program
revenue received by all eligible training sites. Grants to training sites whose public
program revenue accounted for less than 0.98 percent of the total public program revenue
received by all eligible training sites shall be reduced by an amount equal to the total
value of the supplemental payment.

Public program revenue for the distribution formula includes revenue from medical
assistance, prepaid medical assistance, general assistance medical care, and prepaid
general assistance medical care. Training sites that receive no public program revenue
are ineligible for funds available under this subdivision. For purposes of determining
training-site level grants to be distributed under paragraph (a), total statewide average
costs per trainee for medical residents is based on audited clinical training costs per trainee
in primary care clinical medical education programs for medical residents. Total statewide
average costs per trainee for dental residents is based on audited clinical training costs
per trainee in clinical medical education programs for dental students. Total statewide
average costs per trainee for pharmacy residents is based on audited clinical training costs
per trainee in clinical medical education programs for pharmacy students. Training sites
whose training site level grant is less than $1,000, based on the formula described in this
paragraph, are ineligible for funds available under this subdivision.

(b) new text begin Of available medical education funds, $1,000,000 shall be distributed each year
for grants to family medicine residency programs located outside of the seven-county
metropolitan area, as defined in section 473.121, subdivision 4, focused on eduction and
training of family medicine physicians to serve communities outside the metropolitan area.
To be eligible for a grant under this paragraph, a family medicine residency program must
demonstrate that over the most recent three calendar years, at least 25 percent of its residents
practice in Minnesota communities outside of the metropolitan area. Grant funds must be
allocated proportionally based on the number of residents per eligible residency program.
new text end

new text begin (c) new text end Funds distributed shall not be used to displace current funding appropriations
from federal or state sources.

deleted text begin (c)deleted text end new text begin (d)new text end Funds shall be distributed to the sponsoring institutions indicating the amount
to be distributed to each of the sponsor's clinical medical education programs based on
the criteria in this subdivision and in accordance with the commissioner's approval letter.
Each clinical medical education program must distribute funds allocated under paragraph
(a) to the training sites as specified in the commissioner's approval letter. Sponsoring
institutions, which are accredited through an organization recognized by the Department
of Education or the Centers for Medicare and Medicaid Services, may contract directly
with training sites to provide clinical training. To ensure the quality of clinical training,
those accredited sponsoring institutions must:

(1) develop contracts specifying the terms, expectations, and outcomes of the clinical
training conducted at sites; and

(2) take necessary action if the contract requirements are not met. Action may include
the withholding of payments under this section or the removal of students from the site.

deleted text begin (d)deleted text end new text begin (e)new text end Any funds not distributed in accordance with the commissioner's approval
letter must be returned to the medical education and research fund within 30 days of
receiving notice from the commissioner. The commissioner shall distribute returned funds
to the appropriate training sites in accordance with the commissioner's approval letter.

deleted text begin (e)deleted text end new text begin (f)new text end A maximum of $150,000 of the funds dedicated to the commissioner
under section 297F.10, subdivision 1, clause (2), may be used by the commissioner for
administrative expenses associated with implementing this section.

Sec. 5.

Minnesota Statutes 2012, section 62Q.19, subdivision 1, is amended to read:


Subdivision 1.

Designation.

(a) The commissioner shall designate essential
community providers. The criteria for essential community provider designation shall be
the following:

(1) a demonstrated ability to integrate applicable supportive and stabilizing services
with medical care for uninsured persons and high-risk and special needs populations,
underserved, and other special needs populations; and

(2) a commitment to serve low-income and underserved populations by meeting the
following requirements:

(i) has nonprofit status in accordance with chapter 317A;

(ii) has tax-exempt status in accordance with the Internal Revenue Service Code,
section 501(c)(3);

(iii) charges for services on a sliding fee schedule based on current poverty income
guidelines; and

(iv) does not restrict access or services because of a client's financial limitation;

(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
government, an Indian health service unit, or a community health board as defined in
chapter 145A;

(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
conditions;

(5) a sole community hospital. For these rural hospitals, the essential community
provider designation applies to all health services provided, including both inpatient and
outpatient services. For purposes of this section, "sole community hospital" means a
rural hospital that:

(i) is eligible to be classified as a sole community hospital according to Code
of Federal Regulations, title 42, section 412.92, or is located in a community with a
population of less than 5,000 and located more than 25 miles from a like hospital currently
providing acute short-term services;

(ii) has experienced net operating income losses in two of the previous three
most recent consecutive hospital fiscal years for which audited financial information is
available; and

(iii) consists of 40 or fewer licensed beds; deleted text begin or
deleted text end

(6) a birth center licensed under section 144.615deleted text begin .deleted text end new text begin ; or
new text end

new text begin (7) a hospital, and its affiliated specialty clinics, whose inpatients are predominantly
under 21 years of age and that meets the following criteria:
 new text end

new text begin (i) provides intensive specialty pediatric services that are routinely provided in
only four or fewer hospitals in the state; and
 new text end

new text begin (ii) serves children from at least one-half of the counties in the state.
 new text end

(b) Prior to designation, the commissioner shall publish the names of all applicants
in the State Register. The public shall have 30 days from the date of publication to submit
written comments to the commissioner on the application. No designation shall be made
by the commissioner until the 30-day period has expired.

(c) The commissioner may designate an eligible provider as an essential community
provider for all the services offered by that provider or for specific services designated by
the commissioner.

(d) For the purpose of this subdivision, supportive and stabilizing services include at
a minimum, transportation, child care, cultural, and linguistic services where appropriate.

Sec. 6.

Minnesota Statutes 2012, section 103I.005, is amended by adding a subdivision
to read:


new text begin Subd. 1a. new text end

new text begin Bored geothermal heat exchanger. new text end

new text begin "Bored geothermal heat exchanger"
means an earth-coupled heating or cooling device consisting of a sealed closed-loop
piping system installed in a boring in the ground to transfer heat to or from the surrounding
earth with no discharge.
 new text end

Sec. 7.

Minnesota Statutes 2012, section 103I.521, is amended to read:


103I.521 FEES deleted text begin DEPOSITED WITH COMMISSIONER OF MANAGEMENT
AND BUDGETdeleted text end .

new text begin Unless otherwise specified, new text end fees collected deleted text begin for licenses or registrationdeleted text end new text begin by the
commissionernew text end under this chapter shall be deposited in the state treasurynew text begin and credited to
the state government special revenue fundnew text end .

Sec. 8.

Minnesota Statutes 2012, section 144.0724, subdivision 6, is amended to read:


Subd. 6.

Penalties for late or nonsubmission.

A facility that fails to complete or
submit an assessment for a RUG-III or RUG-IV classification within seven days of the
time requirements in subdivisions 4 and 5 is subject to a reduced rate for that resident.
The reduced rate shall be the lowest rate for that facility. The reduced rate is effective on
the day of admission for new admission assessments or on the day that the assessment
was due for all other assessments and continues in effect until the first day of the month
following the date of submission of the resident's assessment.new text begin If loss of revenue due to
penalties incurred by a facility for any period of 92 days are equal to or greater than 1.0
percent of the total operating costs on the facility's most recent annual statistical and cost
report, a facility may apply to the commissioner of human services for a reduction in
the total penalty amount. The commissioner of human services in consultation with the
commissioner of health may, at the sole discretion of the commissioner of human services,
limit the penalty for residents covered by medical assistance to 15 days.
new text end

Sec. 9.

Minnesota Statutes 2012, section 144.123, subdivision 1, is amended to read:


deleted text begin Subdivision 1. deleted text end

deleted text begin Who must pay. deleted text end

Except for the limitation contained in this section,
the commissioner of health deleted text begin shall charge a handling feedeleted text end new text begin may enter into a contractual
agreement to recover costs incurred for analysis for diagnostic purposesnew text end for each specimen
submitted to the Department of Health deleted text begin for analysis for diagnostic purposesdeleted text end by any hospital,
deleted text begin privatedeleted text end laboratory, deleted text begin privatedeleted text end clinic, or physician. deleted text begin No fee shall be charged to any entity which
receives direct or indirect financial assistance from state or federal funds administered by
the Department of Health, including any public health department, nonprofit community
clinic, sexually transmitted disease clinic, or similar entity. No fee will be chargeddeleted text end new text begin The
commissioner shall not chargenew text end for any biological materials submitted to the Department
of Health as a requirement of Minnesota Rules, part 4605.7040, or for those biological
materials requested by the department to gather information for disease prevention or
control purposes. The commissioner of health may establish other exceptions to the
handling fee as may be necessary to protect the public's health. deleted text begin All fees collected pursuant
to this section shall be deposited in the state treasury and credited to the state government
special revenue fund.deleted text end new text begin Funds generated in a contractual agreement made pursuant to this
section shall be deposited in a special account and are appropriated to the commissioner
for purposes of providing the services specified in the contracts. All such contractual
agreements shall be processed in accordance with the provisions of chapter 16C.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2014.
 new text end

Sec. 10.

Minnesota Statutes 2012, section 144.125, subdivision 1, is amended to read:


Subdivision 1.

Duty to perform testing.

new text begin (a) new text end It is the duty of (1) the administrative
officer or other person in charge of each institution caring for infants 28 days or less
of age, (2) the person required in pursuance of the provisions of section 144.215, to
register the birth of a child, or (3) the nurse midwife or midwife in attendance at the
birth, to arrange to have administered to every infant or child in its care tests for heritable
and congenital disorders according to subdivision 2 and rules prescribed by the state
commissioner of health.

new text begin (b)new text end Testing deleted text begin and thedeleted text end new text begin ,new text end recording deleted text begin anddeleted text end new text begin of test results,new text end reporting of test resultsnew text begin , and
follow-up of infants with heritable congenital disorders, including hearing loss detected
through the early hearing detection and intervention program in section 144.966,new text end shall be
performed at the times and in the manner prescribed by the commissioner of health. deleted text begin The
commissioner shall charge a fee so that the total of fees collected will approximate the
costs of conducting the tests and implementing and maintaining a system to follow-up
infants with heritable or congenital disorders, including hearing loss detected through the
early hearing detection and intervention program under section 144.966.
deleted text end

new text begin (c)new text end The fee deleted text begin is $101 per specimen. Effective July 1, 2010, the fee shall be increased
to $106deleted text end new text begin to support the newborn screening program, including tests administered under
this section and section 144.966, shall be $145new text end per specimen. deleted text begin The increased fee amount
shall be deposited in the general fund. Costs associated with capital expenditures and
the development of new procedures may be prorated over a three-year period when
calculating the amount of the fees.deleted text end new text begin This fee amount shall be deposited in the state treasury
and credited to the state government special revenue fund.
new text end

new text begin (d) The fee to offset the cost of the support services provided under section 144.966,
subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury
and credited to the general fund.
 new text end

Sec. 11.

new text begin [144.1251] NEWBORN SCREENING FOR CRITICAL CONGENITAL
HEART DISEASE (CCHD).
 new text end

new text begin Subdivision 1. new text end

new text begin Required testing and reporting. new text end

new text begin Each licensed hospital or
state-licensed birthing center or facility that provides maternity and newborn care services
shall provide screening for congenital heart disease to all newborns prior to discharge
using pulse oximetry screening. This screening should occur before discharge from the
nursery, after the infant turns 24 hours of age. If discharge prior to 24 hours after birth
occurs, screening should occur as close as possible to the time of discharge. Results of this
screening must be reported to the Department of Health.
 new text end

new text begin For premature infants (less than 36 weeks of gestation) and infants admitted to a
higher-level nursery (special care or intensive care), pulse oximetry should be performed
when medically appropriate, but always prior to discharge.
 new text end

new text begin Subd. 2. new text end

new text begin Implementation. new text end

new text begin The Department of Health shall:
 new text end

new text begin (1) communicate the screening protocol requirements;
 new text end

new text begin (2) make information and forms available to the persons with a duty to perform
testing and reporting, health care providers, parents of newborns, and the public on
screening and parental options;
new text end

new text begin (3) provide training to ensure compliance with and appropriate implementation of
the screening;
new text end

new text begin (4) establish the mechanism for the required data collection and reporting of
screening and follow-up diagnostic results to the Department of Health according to the
Department of Health's recommendations;
new text end

new text begin (5) coordinate the implementation of universal standardized screening;
new text end

new text begin (6) act as a resource for providers as the screening program is implemented, and in
consultation with the Advisory Committee on Heritable and Congenital Disorders, develop
and implement policies for early medical and developmental intervention services and
long-term follow-up services for children and their families identified with a CCHD; and
 new text end

new text begin (7) comply with sections 144.125 to 144.128.
 new text end

Sec. 12.

new text begin [144.492] DEFINITIONS.
 new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For the purposes of sections 144.492 to 144.494, the
terms defined in this section have the meanings given them.
 new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of health.
 new text end

new text begin Subd. 3. new text end

new text begin Stroke. new text end

new text begin "Stroke" means the sudden death of brain cells in a localized
area due to inadequate blood flow.
 new text end

Sec. 13.

new text begin [144.493] CRITERIA.
 new text end

new text begin Subdivision 1. new text end

new text begin Comprehensive stroke center. new text end

new text begin A hospital meets the criteria for a
comprehensive stroke center if the hospital has been certified as a comprehensive stroke
center by the joint commission or another nationally recognized accreditation entity.
 new text end

new text begin Subd. 2. new text end

new text begin Primary stroke center. new text end

new text begin A hospital meets the criteria for a primary stroke
center if the hospital has been certified as a primary stroke center by the joint commission
or another nationally recognized accreditation entity.
 new text end

new text begin Subd. 3. new text end

new text begin Acute stroke ready hospital. new text end

new text begin A hospital meets the criteria for an acute
stroke ready hospital if the hospital has the following elements of an acute stroke ready
hospital:
 new text end

new text begin (1) an acute stroke team available and/or on-call 24 hours a days, seven days a week;
 new text end

new text begin (2) written stroke protocols, including triage, stabilization of vital functions, initial
diagnostic tests, and use of medications;
 new text end

new text begin (3) a written plan and letter of cooperation with emergency medical services regarding
triage and communication that are consistent with regional patient care procedures;
 new text end

new text begin (4) emergency department personnel who are trained in diagnosing and treating
acute stroke;
 new text end

new text begin (5) the capacity to complete basic laboratory tests, electrocardiograms, and chest
x-rays 24 hours a day, seven days a week;
 new text end

new text begin (6) the capacity to perform and interpret brain injury imaging studies 24 hours a
days, seven days a week;
 new text end

new text begin (7) written protocols that detail available emergent therapies and reflect current
treatment guidelines, which include performance measures and are revised at least annually;
 new text end

new text begin (8) a neurosurgery coverage plan, call schedule, and a triage and transportation plan;
 new text end

new text begin (9) transfer protocols and agreements for stroke patients; and
 new text end

new text begin (10) a designated medical director with experience and expertise in acute stroke care.
 new text end

Sec. 14.

new text begin [144.494] DESIGNATING STROKE CENTERS AND STROKE
HOSPITALS.
 new text end

new text begin Subdivision 1. new text end

new text begin Naming privileges. new text end

new text begin Unless it has been designated as a stroke center
or stroke hospital pursuant to section 144.493, no hospital shall use the term "stroke
center" or "stroke hospital" in its name or its advertising or shall otherwise indicate it
has stroke treatment capabilities.
 new text end

new text begin Subd. 2. new text end

new text begin Designation. new text end

new text begin A hospital that voluntarily meets the criteria for a
comprehensive stroke center, primary stroke center, or acute stroke ready hospital may
apply to the commissioner for designation, and upon the commissioner's review and
approval of the application, shall be designated as a comprehensive stroke center, a
primary stroke center, or an acute stroke ready hospital for a three-year period. If a hospital
loses its certification as a comprehensive stroke center or primary stroke center from
the joint commission or other nationally recognized accreditation entity, its Minnesota
designation will be immediately withdrawn. Prior to the expiration of the three-year
designation, a hospital seeking to remain part of the voluntary acute stroke system may
reapply to the commissioner for designation.
 new text end

Sec. 15.

new text begin [144.554] HEALTH FACILITIES CONSTRUCTION PLAN
SUBMITTAL AND FEES.
 new text end

new text begin For hospitals, nursing homes, boarding care homes, residential hospices, supervised
living facilities, freestanding outpatient surgical centers, and end-stage renal disease
facilities, the commissioner shall collect a fee for the review and approval of architectural,
mechanical, and electrical plans and specifications submitted before construction begins
for each project relative to construction of new buildings, additions to existing buildings,
or for remodeling or alterations of existing buildings. All fees collected in this section
shall be deposited in the state treasury and credited to the state government special revenue
fund. Fees must be paid at the time of submission of final plans for review and are not
refundable. The fee is calculated as follows:
 new text end

new text begin Construction project total estimated cost
 new text end 		new text begin Fee
 new text end
new text begin $0 - $10,000
 new text end 		new text begin $30
 new text end
new text begin $10,001 - $50,000
 new text end 		new text begin $150
 new text end
new text begin $50,001 - $100,000
 new text end 		new text begin $300
 new text end
new text begin $100,001 - $150,000
 new text end 		new text begin $450
 new text end
new text begin $150,001 - $200,000
 new text end 		new text begin $600
 new text end
new text begin $200,001 - $250,000
 new text end 		new text begin $750
 new text end
new text begin $250,001 - $300,000
 new text end 		new text begin $900
 new text end
new text begin $300,001 - $350,000
 new text end 		new text begin $1,050
 new text end
new text begin $350,001 - $400,000
 new text end 		new text begin $1,200
 new text end
new text begin $400,001 - $450,000
 new text end 		new text begin $1,350
 new text end
new text begin $450,001 - $500,000
 new text end 		new text begin $1,500
 new text end
new text begin $500,001 - $550,000
 new text end 		new text begin $1,650
 new text end
new text begin $550,001 - $600,000
 new text end 		new text begin $1,800
 new text end
new text begin $600,001 - $650,000
 new text end 		new text begin $1,950
 new text end
new text begin $650,001 - $700,000
 new text end 		new text begin $2,100
 new text end
new text begin $700,001 - $750,000
 new text end 		new text begin $2,250
 new text end
new text begin $750,001 - $800,000
 new text end 		new text begin $2,400
 new text end
new text begin $800,001 - $850,000
 new text end 		new text begin $2,550
 new text end
new text begin $850,001 - $900,000
 new text end 		new text begin $2,700
 new text end
new text begin $900,001 - $950,000
 new text end 		new text begin $2,850
 new text end
new text begin $950,001 - $1,000,000
 new text end 		new text begin $3,000
 new text end
new text begin $1,000,001 - $1,050,000
 new text end 		new text begin $3,150
 new text end
new text begin $1,050,001 - $1,100,000
 new text end 		new text begin $3,300
 new text end
new text begin $1,100,001 - $1,150,000
 new text end 		new text begin $3,450
 new text end
new text begin $1,150,001 - $1,200,000
 new text end 		new text begin $3,600
 new text end
new text begin $1,200,001 - $1,250,000
 new text end 		new text begin $3,750
 new text end
new text begin $1,250,001 - $1,300,000
 new text end 		new text begin $3,900
 new text end
new text begin $1,300,001 - $1,350,000
 new text end 		new text begin $4,050
 new text end
new text begin $1,350,001 - $1,400,000
 new text end 		new text begin $4,200
 new text end
new text begin $1,400,001 - $1,450,000
 new text end 		new text begin $4,350
 new text end
new text begin $1,450,001 - $1,500,000
 new text end 		new text begin $4,500
 new text end
new text begin $1,500,001 and over
 new text end 		new text begin $4,800
 new text end

Sec. 16.

Minnesota Statutes 2012, section 144.966, subdivision 2, is amended to read:


Subd. 2.

Newborn Hearing Screening Advisory Committee.

(a) The
commissioner of health shall establish a Newborn Hearing Screening Advisory Committee
to advise and assist the Department of Health and the Department of Education in:

(1) developing protocols and timelines for screening, rescreening, and diagnostic
audiological assessment and early medical, audiological, and educational intervention
services for children who are deaf or hard-of-hearing;

(2) designing protocols for tracking children from birth through age three that may
have passed newborn screening but are at risk for delayed or late onset of permanent
hearing loss;

(3) designing a technical assistance program to support facilities implementing the
screening program and facilities conducting rescreening and diagnostic audiological
assessment;

(4) designing implementation and evaluation of a system of follow-up and tracking;
and

(5) evaluating program outcomes to increase effectiveness and efficiency and ensure
culturally appropriate services for children with a confirmed hearing loss and their families.

(b) The commissioner of health shall appoint at least one member from each of the
following groups with no less than two of the members being deaf or hard-of-hearing:

(1) a representative from a consumer organization representing culturally deaf
persons;

(2) a parent with a child with hearing loss representing a parent organization;

(3) a consumer from an organization representing oral communication options;

(4) a consumer from an organization representing cued speech communication
options;

(5) an audiologist who has experience in evaluation and intervention of infants
and young children;

(6) a speech-language pathologist who has experience in evaluation and intervention
of infants and young children;

(7) two primary care providers who have experience in the care of infants and young
children, one of which shall be a pediatrician;

(8) a representative from the early hearing detection intervention teams;

(9) a representative from the Department of Education resource center for the deaf
and hard-of-hearing or the representative's designee;

(10) a representative of the Commission of Deaf, DeafBlind and Hard-of-Hearing
Minnesotans;

(11) a representative from the Department of Human Services Deaf and
Hard-of-Hearing Services Division;

(12) one or more of the Part C coordinators from the Department of Education, the
Department of Health, or the Department of Human Services or the department's designees;

(13) the Department of Health early hearing detection and intervention coordinators;

(14) two birth hospital representatives from one rural and one urban hospital;

(15) a pediatric geneticist;

(16) an otolaryngologist;

(17) a representative from the Newborn Screening Advisory Committee under
this subdivision; and

(18) a representative of the Department of Education regional low-incidence
facilitators.

The commissioner must complete the appointments required under this subdivision by
September 1, 2007.

(c) The Department of Health member shall chair the first meeting of the committee.
At the first meeting, the committee shall elect a chair from its membership. The committee
shall meet at the call of the chair, at least four times a year. The committee shall adopt
written bylaws to govern its activities. The Department of Health shall provide technical
and administrative support services as required by the committee. These services shall
include technical support from individuals qualified to administer infant hearing screening,
rescreening, and diagnostic audiological assessments.

Members of the committee shall receive no compensation for their service, but
shall be reimbursed as provided in section 15.059 for expenses incurred as a result of
their duties as members of the committee.

(d) This subdivision expires June 30, deleted text begin 2013deleted text end new text begin 2019new text end .

Sec. 17.

Minnesota Statutes 2012, section 144.966, subdivision 3a, is amended to read:


Subd. 3a.

Support services to families.

The commissioner shall contract with a
nonprofit organization to provide support and assistance to families with children who are
deaf or have a hearing loss. The family support provided must includenew text begin :
new text end

new text begin (1)new text end direct new text begin hearing loss specific new text end parent-to-parent assistance and new text begin unbiased new text end information
on communication, educational, and medical optionsnew text begin , preferably provided by a program
that is part of a national organization; and
new text end

new text begin (2) individualized deaf or hard of hearing mentors who provide education, including
instruction in American Sign Languagenew text end .

The commissioner shall give preference to a nonprofit organization that has the ability to
provide these services throughout the state.

Sec. 18.

Minnesota Statutes 2012, section 144.98, subdivision 3, is amended to read:


Subd. 3.

Annual fees.

(a) An application for accreditation under subdivision 6 must
be accompanied by the annual fees specified in this subdivision. The annual fees include:

(1) base accreditation fee, deleted text begin $1,500deleted text end new text begin $600new text end ;

(2) sample preparation techniques fee, $200 per technique;

(3) an administrative fee for laboratories located outside this state, deleted text begin $3,750deleted text end new text begin $2,000new text end ; and

(4) test category fees.

(b) For the programs in subdivision 3a, the commissioner may accredit laboratories
for fields of testing under the categories listed in clauses (1) to (10) upon completion of
the application requirements provided by subdivision 6 and receipt of the fees for each
category under each program that accreditation is requested. The categories offered and
related fees include:

(1) microbiology, deleted text begin $450deleted text end new text begin $200new text end ;

(2) inorganics, deleted text begin $450deleted text end new text begin $200new text end ;

(3) metals, deleted text begin $1,000deleted text end new text begin $500new text end ;

(4) volatile organics, deleted text begin $1,300deleted text end new text begin $1,000new text end ;

(5) other organics, deleted text begin $1,300deleted text end new text begin $1,000new text end ;

(6) radiochemistry, deleted text begin $1,500deleted text end new text begin $750new text end ;

(7) emerging contaminants, deleted text begin $1,500deleted text end new text begin $1,000new text end ;

(8) agricultural contaminants, deleted text begin $1,250deleted text end new text begin $1,000new text end ;

(9) toxicity (bioassay), deleted text begin $1,000deleted text end new text begin $500new text end ; and

(10) physical characterization, $250.

(c) The total annual fee includes the base fee, the sample preparation techniques
fees, the test category fees per program, and, when applicable, an administrative fee for
out-of-state laboratories.

new text begin EFFECTIVE DATE. new text end

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

Sec. 19.

Minnesota Statutes 2012, section 144.98, subdivision 5, is amended to read:


Subd. 5.

State government special revenue fund.

Fees collected new text begin by the
commissioner new text end under this section must be deposited in the state new text begin treasury and credited to
the state new text end government special revenue fund.

new text begin EFFECTIVE DATE. new text end

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

Sec. 20.

Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
to read:


new text begin Subd. 10. new text end

new text begin Establishing a selection committee. new text end

new text begin (a) The commissioner shall
establish a selection committee for the purpose of recommending approval of qualified
laboratory assessors and assessment bodies. Committee members shall demonstrate
competence in assessment practices. The committee shall initially consist of seven
members appointed by the commissioner as follows:
 new text end

new text begin (1) one member from a municipal laboratory accredited by the commissioner;
 new text end

new text begin (2) one member from an industrial treatment laboratory accredited by the
commissioner;
 new text end

new text begin (3) one member from a commercial laboratory located in this state and accredited by
the commissioner;
 new text end

new text begin (4) one member from a commercial laboratory located outside the state and
accredited by the commissioner;
 new text end

new text begin (5) one member from a nongovernmental client of environmental laboratories;
 new text end

new text begin (6) one member from a professional organization with a demonstrated interest in
environmental laboratory data and accreditation; and
 new text end

new text begin (7) one employee of the laboratory accreditation program administered by the
department.
 new text end

new text begin (b) Committee appointments begin on January 1 and end on December 31 of the
same year.
 new text end

new text begin (c) The commissioner shall appoint persons to fill vacant committee positions,
expand the total number of appointed positions, or change the designated positions upon
the advice of the committee.
 new text end

new text begin (d) The commissioner shall rescind the appointment of a selection committee
member for sufficient cause as the commissioner determines, such as:
 new text end

new text begin (1) neglect of duty;
 new text end

new text begin (2) failure to notify the commissioner of a real or perceived conflict of interest;
 new text end

new text begin (3) nonconformance with committee procedures;
 new text end

new text begin (4) failure to demonstrate competence in assessment practices; or
 new text end

new text begin (5) official misconduct.
 new text end

new text begin (e) Members of the selection committee shall be compensated according to the
provisions in section 15.059, subdivision 3.
 new text end

Sec. 21.

Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
to read:


new text begin Subd. 11. new text end

new text begin Activities of the selection committee. new text end

new text begin (a) The selection committee
will determine assessor and assessment body application requirements, the frequency
of application submittal, and the application review schedule. The commissioner shall
publish the application requirements and procedures on the accreditation program Web site.
 new text end

new text begin (b) In its selection process, the committee shall ensure its application requirements
and review process:
 new text end

new text begin (1) meet the standards implemented in subdivision 2a;
 new text end

new text begin (2) ensure assessors have demonstrated competence in technical disciplines offered
for accreditation by the commissioner; and
 new text end

new text begin (3) consider any history of repeated nonconformance or complaints regarding
assessors or assessment bodies.
 new text end

new text begin (c) The selection committee shall consider an application received from qualified
applicants and shall supply a list of recommended assessors and assessment bodies to
the commissioner of health no later than 90 days after the commissioner notifies the
committee of the need for review of applications.
 new text end

Sec. 22.

Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
to read:


new text begin Subd. 12. new text end

new text begin Commissioner approval of assessors and scheduling of assessments.
 new text end

new text begin (a) The commissioner shall approve assessors who:
 new text end

new text begin (1) are employed by the commissioner for the purpose of accrediting laboratories
and demonstrate competence in assessment practices for environmental laboratories; or
 new text end

new text begin (2) are employed by a state or federal agency with established agreements for
mutual assistance or recognition with the commissioner and demonstrate competence in
assessment practices for environmental laboratories.
 new text end

new text begin (b) The commissioner may approve other assessors or assessment bodies who are
recommended by the selection committee according to subdivision 11, paragraph (c). The
commissioner shall publish the list of assessors and assessment bodies approved from the
recommendations.
 new text end

new text begin (c) The commissioner shall rescind approval for an assessor or assessment body for
sufficient cause as the commissioner determines, such as:
 new text end

new text begin (1) failure to meet the minimum qualifications for performing assessments;
 new text end

new text begin (2) lack of availability;
 new text end

new text begin (3) nonconformance with the applicable laws, rules, standards, policies, and
procedures;
 new text end

new text begin (4) misrepresentation of application information regarding qualifications and
training; or
 new text end

new text begin (5) excessive cost to perform the assessment activities.
 new text end

Sec. 23.

Minnesota Statutes 2012, section 144.98, is amended by adding a subdivision
to read:


new text begin Subd. 13. new text end

new text begin Laboratory requirements for assessor selection and scheduling
assessments. new text end

new text begin (a) A laboratory accredited or seeking accreditation that requires an
assessment by the commissioner must select an assessor, group of assessors, or an
assessment body from the published list specified in subdivision 12, paragraph (b). An
accredited laboratory must complete an assessment and make all corrective actions at least
once every 24 months. Unless the commissioner grants interim accreditation, a laboratory
seeking accreditation must complete an assessment and make all corrective actions
prior to, but no earlier than, 18 months prior to the date the application is submitted to
the commissioner.
 new text end

new text begin (b) A laboratory shall not select the same assessor more than twice in succession
for assessments of the same facility unless the laboratory receives written approval
from the commissioner for the selection. The laboratory must supply a written request
to the commissioner for approval and must justify the reason for the request and provide
the alternate options considered.
 new text end

new text begin (c) A laboratory must select assessors appropriate to the size and scope of the
laboratory's application or existing accreditation.
 new text end

new text begin (d) A laboratory must enter into its own contract for direct payment of the assessors
or assessment body. The contract must authorize the assessor, assessment body, or
subcontractors to release all records to the commissioner regarding the assessment activity,
when the assessment is performed in compliance with this statute.
 new text end

new text begin (e) A laboratory must agree to permit other assessors as selected by the commissioner
to participate in the assessment activities.
 new text end

new text begin (f) If the laboratory determines no approved assessor is available to perform
the assessment, the laboratory must notify the commissioner in writing and provide a
justification for the determination. If the commissioner confirms no approved assessor
is available, the commissioner may designate an alternate assessor from those approved
in subdivision 12, paragraph (a), or the commissioner may delay the assessment until
an assessor is available. If an approved alternate assessor performs the assessment, the
commissioner may collect fees equivalent to the cost of performing the assessment
activities.
 new text end

new text begin (g) Fees collected under this section are deposited in a special account and are
annually appropriated to the commissioner for the purpose of performing assessment
activities.
 new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 24.

Minnesota Statutes 2012, section 144.99, subdivision 4, is amended to read:


Subd. 4.

Administrative penalty orders.

(a) The commissioner may issue an
order requiring violations to be corrected and administratively assessing monetary
penalties for violations of the statutes, rules, and other actions listed in subdivision 1. The
procedures in section 144.991 must be followed when issuing administrative penalty
orders. Except in the case of repeated or serious violations, the penalty assessed in the
order must be forgiven if the person who is subject to the order demonstrates in writing
to the commissioner before the 31st day after receiving the order that the person has
corrected the violation or has developed a corrective plan acceptable to the commissioner.
The maximum amount of an administrative penalty order is $10,000 for each violator for
all violations by that violator identified in an inspection or review of compliance.

(b) Notwithstanding paragraph (a), the commissioner may issue to a large public
water supply, serving a population of more than 10,000 persons, an administrative penalty
order imposing a penalty of at least $1,000 per day per violation, not to exceed $10,000
for each violation of sections 144.381 to 144.385 and rules adopted thereunder.

new text begin (c) Notwithstanding paragraph (a), the commissioner may issue to a certified lead
firm or person performing regulated lead work, an administrative penalty order imposing a
penalty of at least $5,000 per violation per day, not to exceed $10,000 for each violation of
sections 144.9501 to 144.9512 and rules adopted thereunder. All revenue collected from
monetary penalties in this section shall be deposited in the state treasury and credited to
the state government special revenue fund.
 new text end

Sec. 25.

Minnesota Statutes 2012, section 144A.53, subdivision 2, is amended to read:


Subd. 2.

Complaints.

The director may receive a complaint from any source
concerning an action of an administrative agency, a health care provider, a home care
provider, a residential care home, or a health facility. The director may require a
complainant to pursue other remedies or channels of complaint open to the complainant
before accepting or investigating the complaint.new text begin Investigators are required to interview
at least one family member of the vulnerable adult identified in the complaint. If the
vulnerable adult is directing the vulnerable adult's own care and does not want the
investigator to contact the family, this information shall be documented in the investigative
file.
new text end

The director shall keep written records of all complaints and any action upon
them. After completing an investigation of a complaint, the director shall inform the
complainant, the administrative agency having jurisdiction over the subject matter, the
health care provider, the home care provider, the residential care home, and the health
facility of the action taken.new text begin Complainants must be provided a copy of the public report
upon completion of the investigation.
new text end

Sec. 26.

new text begin [145.4716] SAFE HARBOR FOR SEXUALLY EXPLOITED YOUTH.
 new text end

new text begin Subdivision 1. new text end

new text begin Director. new text end

new text begin The commissioner of health shall establish a position for a
director of child sex trafficking prevention.
 new text end

new text begin Subd. 2. new text end

new text begin Duties of director. new text end

new text begin The director of child sex trafficking prevention is
responsible for the following:
 new text end

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

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

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

new text begin (4) managing grant programs established under this act;
 new text end

new text begin (5) identifying best practices in serving sexually exploited youth, as defined in
section 260C.007, subdivision 31;
 new text end

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

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

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

Sec. 27.

new text begin [145.4717] REGIONAL NAVIGATOR GRANTS.
 new text end

new text begin The commissioner of health, through its director of child sex trafficking prevention,
established in section 145.4716, shall provide grants to regional navigators serving six
regions of the state to be determined by the commissioner. Each regional navigator must
develop and annually submit a work plan to the director of child sex trafficking prevention.
The work plans must include, but are not limited to, the following information:
 new text end

new text begin (1) a needs statement specific to the region, including an examination of the
population at risk;
 new text end

new text begin (2) regional resources available to sexually exploited youth, as defined in section
260C.007, subdivision 31;
 new text end

new text begin (3) grant goals and measurable outcomes; and
 new text end

new text begin (4) grant activities including timelines.
 new text end

Sec. 28.

new text begin [145.4718] PROGRAM EVALUATION.
 new text end

new text begin (a) The director of child sex trafficking prevention, established under section
145.4716, must conduct, or contract for, comprehensive evaluation of the statewide
program for safe harbor for sexually exploited youth. The first evaluation must be
completed by June 30, 2015, and must be submitted to the commissioner of health by
September 1, 2015, and every two years thereafter. The evaluation must consider whether
the program is reaching intended victims and whether support services are available,
accessible, and adequate for sexually exploited youth, as defined in section 260C.007,
subdivision 31.
 new text end

new text begin (b) In conducting the evaluation, the director of child sex trafficking prevention must
consider evaluation of outcomes, including whether the program increases identification
of sexually exploited youth, coordination of investigations, access to services and housing
available for sexually exploited youth, and improved effectiveness of services. The
evaluation must also include examination of the ways in which penalties under section
609.3241 are assessed, collected, and distributed to ensure funding for investigation,
prosecution, and victim services to combat sexual exploitation of youth.
 new text end

Sec. 29.

Minnesota Statutes 2012, section 145.986, is amended to read:


145.986 STATEWIDE HEALTH IMPROVEMENT PROGRAM.

Subdivision 1.

deleted text begin Grants to local communitiesdeleted text end new text begin Purposenew text end .

new text begin The purpose of the statewide
health improvement program is to:
 new text end

new text begin (1) address the top three leading preventable causes of illness, preventable health
costs, and death: tobacco use and exposure, poor diet, and lack of regular physical activity;
 new text end

new text begin (2) promote the development, availability, and use of evidence-based, community
level, comprehensive strategies to create healthy communities; and
 new text end

new text begin (3) measure the impact of the evidence-based, community health improvement
practices which over time work to contain health care costs and reduce chronic diseases.
 new text end

new text begin Subd. 1a. new text end

new text begin Grants to local communities. new text end

(a) Beginning July 1, deleted text begin 2009deleted text end new text begin 2013new text end ,
the commissioner of health shall award deleted text begin competitivedeleted text end grants to new text begin allnew text end community health
boards established pursuant to section 145A.09 and tribal governments to convene,
coordinate, and implement evidence-based strategies targeted at reducing the percentage
of Minnesotans who are obese or overweight and to reduce the use of tobacco.

(b) Grantee activities shall:

(1) be based on scientific evidence;

(2) be based on community input;

(3) address behavior change at the individual, community, and systems levels;

(4) occur in community, school, worksite, and health care settings; deleted text begin and
deleted text end

(5) be focused on policy, systems, and environmental changes that support healthy
behaviorsdeleted text begin .deleted text end new text begin ; and
new text end

new text begin (6) address the health disparities and inequities that exist in the grantee's community.
 new text end

(c) To receive a grant under this section, community health boards and tribal
governments must submit proposals to the commissioner. A local match of ten percent
of the total funding allocation is required. This local match may include funds donated
by community partners.

(d) In order to receive a grant, community health boards and tribal governments
must submit a health improvement plan to the commissioner of health for approval. The
commissioner may require the plan to identify a community leadership team, community
partners, and a community action plan that includes an assessment of area strengths and
needs, proposed action strategies, technical assistance needs, and a staffing plan.

(e) The grant recipient must implement the health improvement plan, evaluate the
effectiveness of the deleted text begin interventionsdeleted text end new text begin strategiesnew text end , and modify or discontinue deleted text begin interventions
deleted text end new text begin strategies new text end found to be ineffective.

deleted text begin (f) By January 15, 2011, the commissioner of health shall recommend whether any
funding should be distributed to community health boards and tribal governments based
on health disparities demonstrated in the populations served.
 deleted text end

deleted text begin (g)deleted text end new text begin (f)new text end Grant recipients shall report their activities and their progress toward the
outcomes established under subdivision 2 to the commissioner in a format and at a time
specified by the commissioner.

deleted text begin (h)deleted text end new text begin (g)new text end All grant recipients shall be held accountable for making progress toward
the measurable outcomes established in subdivision 2. The commissioner shall require a
corrective action plan and may reduce the funding level of grant recipients that do not
make adequate progress toward the measurable outcomes.

Subd. 2.

Outcomes.

(a) The commissioner shall set measurable outcomes to meet
the goals specified in subdivision 1, and annually review the progress of grant recipients
in meeting the outcomes.

(b) The commissioner shall measure current public health status, using existing
measures and data collection systems when available, to determine baseline data against
which progress shall be monitored.

Subd. 3.

Technical assistance and oversight.

new text begin (a) new text end The commissioner shall provide
content expertise, technical expertise, deleted text begin anddeleted text end training to grant recipients and advice on
evidence-based strategies, including those based on populations and types of communities
served. The commissioner shall ensure that the statewide health improvement program
meets the outcomes established under subdivision 2 by conducting a comprehensive
statewide evaluation and assisting grant recipients to modify or discontinue interventions
found to be ineffective.

new text begin (b) In carrying out its responsibilities for administration, technical assistance, and
oversight, the commissioner may contract out its responsibilities within the limits of the
administrative budget given for those purposes.
 new text end

Subd. 4.

Evaluation.

new text begin (a) new text end Using the outcome measures established in subdivision
3, the commissioner shall conduct deleted text begin a biennialdeleted text end new text begin an new text end evaluation of the statewide health
improvement program funded under this section. Grant recipients shall cooperate with
the commissioner in the evaluation and provide the commissioner with the information
necessary to conduct the evaluation.

new text begin (b) Grant recipients will collect, monitor, and submit to the Department of Health
baseline and annual data, and provide information to improve the quality and impact of
community health improvement strategies.
 new text end

Subd. 5.

Report.

The commissioner shall submit a biennial report to the legislature
on the statewide health improvement program funded under this section. These reports
must include information on grant recipients, activities that were conducted using grant
funds, evaluation data, and outcome measures, if available. In addition, the commissioner
shall provide recommendations on future areas of focus for health improvement. These
reports are due by January 15 of every other year, beginning in 2010. deleted text begin In the report due
on January 15, 2010, the commissioner shall include recommendations on a sustainable
funding source for the statewide health improvement program other than the health care
access fund.
deleted text end

Subd. 6.

Supplantation of existing funds.

Community health boards and tribal
governments must use funds received under this section to develop new programs, expand
current programs that work to reduce the percentage of Minnesotans who are obese or
overweight or who use tobacco, or replace discontinued state or federal funds previously
used to reduce the percentage of Minnesotans who are obese or overweight or who use
tobacco. Funds must not be used to supplant current state or local funding to community
health boards or tribal governments used to reduce the percentage of Minnesotans who are
obese or overweight or to reduce tobacco use.

Sec. 30.

Minnesota Statutes 2012, section 149A.02, subdivision 1a, is amended to read:


Subd. 1a.

Alkaline hydrolysis.

"Alkaline hydrolysis" means the reduction of a dead
human body to essential elements through deleted text begin exposure to a combination of heat and alkaline
hydrolysis and the repositioning or movement of the body during the process to facilitate
reduction,deleted text end new text begin a water-based dissolution process using alkaline chemicals, heat, agitation, and
pressure to accelerate natural decomposition;new text end the processing of the new text begin hydrolyzed new text end remains
after removal from the alkaline hydrolysis deleted text begin chamber,deleted text end new text begin vessel;new text end placement of the processed
remains in a new text begin hydrolyzed new text end remains containerdeleted text begin ,deleted text end new text begin ;new text end and release of the new text begin hydrolyzed new text end remains to an
appropriate party. Alkaline hydrolysis is a form of final disposition.

Sec. 31.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 1b. new text end

new text begin Alkaline hydrolysis container. new text end

new text begin "Alkaline hydrolysis container" means a
hydrolyzable or biodegradable closed container or pouch resistant to leakage of bodily
fluids that encases the body and into which a dead human body is placed prior to insertion
into an alkaline hydrolysis vessel. Alkaline hydrolysis containers may be hydrolyzable or
biodegradable alternative containers or caskets.
 new text end

Sec. 32.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 1c. new text end

new text begin Alkaline hydrolysis facility. new text end

new text begin "Alkaline hydrolysis facility" means a
building or structure containing one or more alkaline hydrolysis vessels for the alkaline
hydrolysis of dead human bodies.
 new text end

Sec. 33.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 1d. new text end

new text begin Alkaline hydrolysis vessel. new text end

new text begin "Alkaline hydrolysis vessel" means the
container in which the alkaline hydrolysis of a dead human body is performed.
 new text end

Sec. 34.

Minnesota Statutes 2012, section 149A.02, subdivision 2, is amended to read:


Subd. 2.

Alternative container.

"Alternative container" means a nonmetal
receptacle or enclosure, without ornamentation or a fixed interior lining, which is designed
for the encasement of dead human bodies and is made of new text begin hydrolyzable or biodegradable
materials, new text end corrugated cardboard, fiberboard, pressed-wood, or other like materials.

Sec. 35.

Minnesota Statutes 2012, section 149A.02, subdivision 3, is amended to read:


Subd. 3.

Arrangements for disposition.

"Arrangements for disposition" means
any action normally taken by a funeral provider in anticipation of or preparation for the
entombment, burial in a cemetery, new text begin alkaline hydrolysis, new text end or cremation of a dead human body.

Sec. 36.

Minnesota Statutes 2012, section 149A.02, subdivision 4, is amended to read:


Subd. 4.

Cash advance item.

"Cash advance item" means any item of service
or merchandise described to a purchaser as a "cash advance," "accommodation," "cash
disbursement," or similar term. A cash advance item is also any item obtained from a
third party and paid for by the funeral provider on the purchaser's behalf. Cash advance
items include, but are not limited to, cemeterynew text begin , alkaline hydrolysis, new text end or crematory services,
pallbearers, public transportation, clergy honoraria, flowers, musicians or singers, obituary
notices, gratuities, and death records.

Sec. 37.

Minnesota Statutes 2012, section 149A.02, subdivision 5, is amended to read:


Subd. 5.

Casket.

"Casket" means a rigid container which is designed for the
encasement of a dead human body and is usually constructed of new text begin hydrolyzable or
biodegradable materials, new text end wood, metal, fiberglass, plastic, or like material, and ornamented
and lined with fabric.

Sec. 38.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 12a. new text end

new text begin Crypt. new text end

new text begin "Crypt" means a space in a mausoleum of sufficient size, used or
intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.
 new text end

Sec. 39.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 12b. new text end

new text begin Direct alkaline hydrolysis. new text end

new text begin "Direct alkaline hydrolysis" means a
final disposition of a dead human body by alkaline hydrolysis, without formal viewing,
visitation, or ceremony with the body present.
 new text end

Sec. 40.

Minnesota Statutes 2012, section 149A.02, subdivision 16, is amended to read:


Subd. 16.

Final disposition.

"Final disposition" means the acts leading to and the
entombment, burial in a cemetery, new text begin alkaline hydrolysis, new text end or cremation of a dead human body.

Sec. 41.

Minnesota Statutes 2012, section 149A.02, subdivision 23, is amended to read:


Subd. 23.

Funeral services.

"Funeral services" means any services which may
be used to: (1) care for and prepare dead human bodies for burial, new text begin alkaline hydrolysis,
new text end cremation, or other final disposition; and (2) arrange, supervise, or conduct the funeral
ceremony or the final disposition of dead human bodies.

Sec. 42.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 24b. new text end

new text begin Hydrolyzed remains. new text end

new text begin "Hydrolyzed remains" means the remains of a
dead human body following the alkaline hydrolysis process. Hydrolyzed remains does not
include pacemakers, prostheses, or similar foreign materials.
 new text end

Sec. 43.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 24c. new text end

new text begin Hydrolyzed remains container. new text end

new text begin "Hydrolyzed remains container" means
a receptacle in which hydrolyzed remains are placed. For purposes of this chapter, a
hydrolyzed remains container is interchangeable with "urn" or similar keepsake storage
jewelry.
 new text end

Sec. 44.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 26a. new text end

new text begin Inurnment. new text end

new text begin "Inurnment" means placing hydrolyzed or cremated remains
in a hydrolyzed or cremated remains container suitable for placement, burial, or shipment.
 new text end

Sec. 45.

Minnesota Statutes 2012, section 149A.02, subdivision 27, is amended to read:


Subd. 27.

Licensee.

"Licensee" means any person new text begin or entity new text end that has been issued
a license to practice mortuary science, to operate a funeral establishment, new text begin to operate an
alkaline hydrolysis facility, new text end or to operate a crematory by the Minnesota commissioner
of health.

Sec. 46.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 30a. new text end

new text begin Niche. new text end

new text begin "Niche" means a space in a columbarium used, or intended to be
used, for the placement of hydrolyzed or cremated remains.
 new text end

Sec. 47.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 32a. new text end

new text begin Placement. new text end

new text begin "Placement" means the placing of a container holding
hydrolyzed or cremated remains in a crypt, vault, or niche.
 new text end

Sec. 48.

Minnesota Statutes 2012, section 149A.02, subdivision 34, is amended to read:


Subd. 34.

Preparation of the body.

"Preparation of the body" means new text begin placement of
the body into an appropriate cremation or alkaline hydrolysis container, new text end embalming of
the body or such items of care as washing, disinfecting, shaving, positioning of features,
restorative procedures, application of cosmetics, dressing, and casketing.

Sec. 49.

Minnesota Statutes 2012, section 149A.02, subdivision 35, is amended to read:


Subd. 35.

Processing.

"Processing" means the removal of foreign objectsnew text begin , drying or
cooling,new text end and the reduction of the new text begin hydrolyzed or new text end cremated remains by mechanical means
including, but not limited to, grinding, crushing, or pulverizing, to a granulated appearance
appropriate for final disposition.

Sec. 50.

Minnesota Statutes 2012, section 149A.02, subdivision 37, is amended to read:


Subd. 37.

Public transportation.

"Public transportation" means all manner of
transportation via common carrier available to the general public including airlines, buses,
railroads, and ships. For purposes of this chapter, a livery service providing transportation
to private funeral establishmentsnew text begin , alkaline hydrolysis facilities, new text end or crematories is not public
transportation.

Sec. 51.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 37c. new text end

new text begin Scattering. new text end

new text begin "Scattering" means the authorized dispersal of hydrolyzed
or cremated remains in a defined area of a dedicated cemetery or in areas where no local
prohibition exists provided that the hydrolyzed or cremated remains are not distinguishable
to the public, are not in a container, and that the person who has control over disposition
of the hydrolyzed or cremated remains has obtained written permission of the property
owner or governing agency to scatter on the property.
 new text end

Sec. 52.

Minnesota Statutes 2012, section 149A.02, is amended by adding a
subdivision to read:


new text begin Subd. 41. new text end

new text begin Vault. new text end

new text begin "Vault" means a space in a mausoleum of sufficient size, used or
intended to be used, to entomb human remains, cremated remains, or hydrolyzed remains.
Vault may also mean a sealed and lined casket enclosure.
 new text end

Sec. 53.

Minnesota Statutes 2012, section 149A.03, is amended to read:


149A.03 DUTIES OF COMMISSIONER.

The commissioner shall:

(1) enforce all laws and adopt and enforce rules relating to the:

(i) removal, preparation, transportation, arrangements for disposition, and final
disposition of dead human bodies;

(ii) licensure and professional conduct of funeral directors, morticians, interns,
practicum students, and clinical students;

(iii) licensing and operation of a funeral establishment; deleted text begin and
deleted text end

new text begin (iv) licensing and operation of an alkaline hydrolysis facility; and
 new text end

deleted text begin (iv)deleted text end new text begin (v) new text end licensing and operation of a crematory;

(2) provide copies of the requirements for licensure and permits to all applicants;

(3) administer examinations and issue licenses and permits to qualified persons
and other legal entities;

(4) maintain a record of the name and location of all current licensees and interns;

(5) perform periodic compliance reviews and premise inspections of licensees;

(6) accept and investigate complaints relating to conduct governed by this chapter;

(7) maintain a record of all current preneed arrangement trust accounts;

(8) maintain a schedule of application, examination, permit, and licensure fees,
initial and renewal, sufficient to cover all necessary operating expenses;

(9) educate the public about the existence and content of the laws and rules for
mortuary science licensing and the removal, preparation, transportation, arrangements
for disposition, and final disposition of dead human bodies to enable consumers to file
complaints against licensees and others who may have violated those laws or rules;

(10) evaluate the laws, rules, and procedures regulating the practice of mortuary
science in order to refine the standards for licensing and to improve the regulatory and
enforcement methods used; and

(11) initiate proceedings to address and remedy deficiencies and inconsistencies in
the laws, rules, or procedures governing the practice of mortuary science and the removal,
preparation, transportation, arrangements for disposition, and final disposition of dead
human bodies.

Sec. 54.

new text begin [149A.54] LICENSE TO OPERATE AN ALKALINE HYDROLYSIS
FACILITY.
 new text end

new text begin Subdivision 1. new text end

new text begin License requirement. new text end

new text begin Except as provided in section 149A.01,
subdivision 3, a place or premise shall not be maintained, managed, or operated which
is devoted to or used in the holding and alkaline hydrolysis of a dead human body
without possessing a valid license to operate an alkaline hydrolysis facility issued by the
commissioner of health.
 new text end

new text begin Subd. 2. new text end

new text begin Requirements for an alkaline hydrolysis facility. new text end

new text begin (a) An alkaline
hydrolysis facility licensed under this section must consist of:
 new text end

new text begin (1) a building or structure that complies with applicable local and state building
codes, zoning laws and ordinances, wastewater management and environmental standards,
containing one or more alkaline hydrolysis vessels for the alkaline hydrolysis of dead
human bodies;
 new text end

new text begin (2) a method approved by the commissioner of health to dry the hydrolyzed remains
and which is located within the licensed facility;
 new text end

new text begin (3) a means approved by the commissioner of health for refrigeration of dead human
bodies awaiting alkaline hydrolysis;
 new text end

new text begin (4) an appropriate means of processing hydrolyzed remains to a granulated
appearance appropriate for final disposition; and
 new text end

new text begin (5) an appropriate holding facility for dead human bodies awaiting alkaline
hydrolysis.
 new text end

new text begin (b) An alkaline hydrolysis facility licensed under this section may also contain a
display room for funeral goods.
 new text end

new text begin Subd. 3. new text end

new text begin Application procedure; documentation; initial inspection. new text end

new text begin An
application to license and operate an alkaline hydrolysis facility shall be submitted to the
commissioner of health. A completed application includes:
 new text end

new text begin (1) a completed application form, as provided by the commissioner;
 new text end

new text begin (2) proof of business form and ownership;
 new text end

new text begin (3) proof of liability insurance coverage or other financial documentation, as
determined by the commissioner, that demonstrates the applicant's ability to respond in
damages for liability arising from the ownership, maintenance management, or operation
of an alkaline hydrolysis facility; and
 new text end

new text begin (4) copies of wastewater and other environmental regulatory permits and
environmental regulatory licenses necessary to conduct operations.
 new text end

new text begin Upon receipt of the application and appropriate fee, the commissioner shall review and
verify all information. Upon completion of the verification process and resolution of any
deficiencies in the application information, the commissioner shall conduct an initial
inspection of the premises to be licensed. After the inspection and resolution of any
deficiencies found and any reinspections as may be necessary, the commissioner shall
make a determination, based on all the information available, to grant or deny licensure. If
the commissioner's determination is to grant the license, the applicant shall be notified and
the license shall issue and remain valid for a period prescribed on the license, but not to
exceed one calendar year from the date of issuance of the license. If the commissioner's
determination is to deny the license, the commissioner must notify the applicant in writing
of the denial and provide the specific reason for denial.
 new text end

new text begin Subd. 4. new text end

new text begin Nontransferability of license. new text end

new text begin A license to operate an alkaline hydrolysis
facility is not assignable or transferable and shall not be valid for any entity other than the
one named. Each license issued to operate an alkaline hydrolysis facility is valid only for the
location identified on the license. A 50 percent or more change in ownership or location of
the alkaline hydrolysis facility automatically terminates the license. Separate licenses shall
be required of two or more persons or other legal entities operating from the same location.
 new text end

new text begin Subd. 5. new text end

new text begin Display of license. new text end

new text begin Each license to operate an alkaline hydrolysis
facility must be conspicuously displayed in the alkaline hydrolysis facility at all times.
Conspicuous display means in a location where a member of the general public within the
alkaline hydrolysis facility will be able to observe and read the license.
 new text end

new text begin Subd. 6. new text end

new text begin Period of licensure. new text end

new text begin All licenses to operate an alkaline hydrolysis facility
issued by the commissioner are valid for a period of one calendar year beginning on July 1
and ending on June 30, regardless of the date of issuance.
 new text end

new text begin Subd. 7. new text end

new text begin Reporting changes in license information. new text end

new text begin Any change of license
information must be reported to the commissioner, on forms provided by the
commissioner, no later than 30 calendar days after the change occurs. Failure to report
changes is grounds for disciplinary action.
 new text end

new text begin Subd. 8. new text end

new text begin Notification to the commissioner. new text end

new text begin If the licensee is operating under a
wastewater or an environmental permit or license that is subsequently revoked, denied,
or terminated, the licensee shall notify the commissioner.
 new text end

new text begin Subd. 9. new text end

new text begin Application information. new text end

new text begin All information submitted to the commissioner
for a license to operate an alkaline hydrolysis facility is classified as licensing data under
section 13.41, subdivision 5.
 new text end

Sec. 55.

new text begin [149A.55] RENEWAL OF LICENSE TO OPERATE AN ALKALINE
HYDROLYSIS FACILITY.
 new text end

new text begin Subdivision 1. new text end

new text begin Renewal required. new text end

new text begin All licenses to operate an alkaline hydrolysis
facility issued by the commissioner expire on June 30 following the date of issuance of the
license and must be renewed to remain valid.
 new text end

new text begin Subd. 2. new text end

new text begin Renewal procedure and documentation. new text end

new text begin Licensees who wish to renew
their licenses must submit to the commissioner a completed renewal application no later
than June 30 following the date the license was issued. A completed renewal application
includes:
 new text end

new text begin (1) a completed renewal application form, as provided by the commissioner; and
 new text end

new text begin (2) proof of liability insurance coverage or other financial documentation, as
determined by the commissioner, that demonstrates the applicant's ability to respond in
damages for liability arising from the ownership, maintenance, management, or operation
of an alkaline hydrolysis facility.
 new text end

new text begin Upon receipt of the completed renewal application, the commissioner shall review and
verify the information. Upon completion of the verification process and resolution of
any deficiencies in the renewal application information, the commissioner shall make a
determination, based on all the information available, to reissue or refuse to reissue the
license. If the commissioner's determination is to reissue the license, the applicant shall
be notified and the license shall issue and remain valid for a period prescribed on the
license, but not to exceed one calendar year from the date of issuance of the license. If
the commissioner's determination is to refuse to reissue the license, section 149A.09,
subdivision 2, applies.
 new text end

new text begin Subd. 3. new text end

new text begin Penalty for late filing. new text end

new text begin Renewal applications received after the expiration
date of a license will result in the assessment of a late filing penalty. The late filing penalty
must be paid before the reissuance of the license and received by the commissioner no
later than 31 calendar days after the expiration date of the license.
 new text end

new text begin Subd. 4. new text end

new text begin Lapse of license. new text end

new text begin Licenses to operate alkaline hydrolysis facilities
shall automatically lapse when a completed renewal application is not received by the
commissioner within 31 calendar days after the expiration date of a license, or a late
filing penalty assessed under subdivision 3 is not received by the commissioner within 31
calendar days after the expiration of a license.
 new text end

new text begin Subd. 5. new text end

new text begin Effect of lapse of license. new text end

new text begin Upon the lapse of a license, the person to whom
the license was issued is no longer licensed to operate an alkaline hydrolysis facility in
Minnesota. The commissioner shall issue a cease and desist order to prevent the lapsed
license holder from operating an alkaline hydrolysis facility in Minnesota and may pursue
any additional lawful remedies as justified by the case.
 new text end

new text begin Subd. 6. new text end

new text begin Restoration of lapsed license. new text end

new text begin The commissioner may restore a lapsed
license upon receipt and review of a completed renewal application, receipt of the late
filing penalty, and reinspection of the premises, provided that the receipt is made within
one calendar year from the expiration date of the lapsed license and the cease and desist
order issued by the commissioner has not been violated. If a lapsed license is not restored
within one calendar year from the expiration date of the lapsed license, the holder of the
lapsed license cannot be relicensed until the requirements in section 149A.54 are met.
 new text end

new text begin Subd. 7. new text end

new text begin Reporting changes in license information. new text end

new text begin Any change of license
information must be reported to the commissioner, on forms provided by the
commissioner, no later than 30 calendar days after the change occurs. Failure to report
changes is grounds for disciplinary action.
 new text end

new text begin Subd. 8. new text end

new text begin Application information. new text end

new text begin All information submitted to the commissioner
by an applicant for renewal of licensure to operate an alkaline hydrolysis facility is
classified as licensing data under section 13.41, subdivision 5.
 new text end

Sec. 56.

Minnesota Statutes 2012, section 149A.65, is amended by adding a
subdivision to read:


new text begin Subd. 6. new text end

new text begin Alkaline hydrolysis facilities. new text end

new text begin The initial and renewal fee for an alkaline
hydrolysis facility is $300. The late fee charge for a license renewal is $25.
 new text end

Sec. 57.

Minnesota Statutes 2012, section 149A.65, is amended by adding a
subdivision to read:


new text begin Subd. 7. new text end

new text begin State government special revenue fund. new text end

new text begin Fees collected by the
commissioner under this section must be deposited in the state treasury and credited to
the state government special revenue fund.
 new text end

Sec. 58.

Minnesota Statutes 2012, section 149A.70, subdivision 1, is amended to read:


Subdivision 1.

Use of titles.

Only a person holding a valid license to practice
mortuary science issued by the commissioner may use the title of mortician, funeral
director, or any other title implying that the licensee is engaged in the business or practice
of mortuary science. new text begin Only the holder of a valid license to operate an alkaline hydrolysis
facility issued by the commissioner may use the title of alkaline hydrolysis facility, water
cremation, water-reduction, biocremation, green-cremation, resomation, dissolution, or
any other title, word, or term implying that the licensee operates an alkaline hydrolysis
facility. new text end Only the holder of a valid license to operate a funeral establishment issued by the
commissioner may use the title of funeral home, funeral chapel, funeral service, or any
other title, word, or term implying that the licensee is engaged in the business or practice
of mortuary science. Only the holder of a valid license to operate a crematory issued by
the commissioner may use the title of crematory, crematorium, new text begin green-cremation, new text end or any
other title, word, or term implying that the licensee operates a crematory or crematorium.

Sec. 59.

Minnesota Statutes 2012, section 149A.70, subdivision 2, is amended to read:


Subd. 2.

Business location.

A funeral establishmentnew text begin , alkaline hydrolysis facility, new text end or
crematory shall not do business in a location that is not licensed as a funeral establishmentnew text begin ,
alkaline hydrolysis facility, new text end or crematory and shall not advertise a service that is available
from an unlicensed location.

Sec. 60.

Minnesota Statutes 2012, section 149A.70, subdivision 3, is amended to read:


Subd. 3.

Advertising.

No licensee, clinical student, practicum student, or intern
shall publish or disseminate false, misleading, or deceptive advertising. False, misleading,
or deceptive advertising includes, but is not limited to:

(1) identifying, by using the names or pictures of, persons who are not licensed to
practice mortuary science in a way that leads the public to believe that those persons will
provide mortuary science services;

(2) using any name other than the names under which the funeral establishmentnew text begin ,
alkaline hydrolysis facility, new text end or crematory is known to or licensed by the commissioner;

(3) using a surname not directly, actively, or presently associated with a licensed
funeral establishmentnew text begin , alkaline hydrolysis facility, new text end or crematory, unless the surname had
been previously and continuously used by the licensed funeral establishmentnew text begin , alkaline
hydrolysis facility, new text end or crematory; and

(4) using a founding or establishing date or total years of service not directly or
continuously related to a name under which the funeral establishmentnew text begin , alkaline hydrolysis
facility, new text end or crematory is currently or was previously licensed.

Any advertising or other printed material that contains the names or pictures of
persons affiliated with a funeral establishmentnew text begin , alkaline hydrolysis facility, new text end or crematory
shall state the position held by the persons and shall identify each person who is licensed
or unlicensed under this chapter.

Sec. 61.

Minnesota Statutes 2012, section 149A.70, subdivision 5, is amended to read:


Subd. 5.

Reimbursement prohibited.

No licensee, clinical student, practicum
student, or intern shall offer, solicit, or accept a commission, fee, bonus, rebate, or other
reimbursement in consideration for recommending or causing a dead human body to
be disposed of by a specific body donation program, funeral establishment, new text begin alkaline
hydrolysis facility, new text end crematory, mausoleum, or cemetery.

Sec. 62.

Minnesota Statutes 2012, section 149A.71, subdivision 2, is amended to read:


Subd. 2.

Preventive requirements.

(a) To prevent unfair or deceptive acts or
practices, the requirements of this subdivision must be met.

(b) Funeral providers must tell persons who ask by telephone about the funeral
provider's offerings or prices any accurate information from the price lists described in
paragraphs (c) to (e) and any other readily available information that reasonably answers
the questions asked.

(c) Funeral providers must make available for viewing to people who inquire in
person about the offerings or prices of funeral goods or burial site goods, separate printed
or typewritten price lists using a ten-point font or larger. Each funeral provider must have a
separate price list for each of the following types of goods that are sold or offered for sale:

(1) caskets;

(2) alternative containers;

(3) outer burial containers;

new text begin (4) alkaline hydrolysis containers;
 new text end

deleted text begin (4)deleted text end new text begin (5)new text end cremation containers;

new text begin (6) hydrolyzed remains containers;
 new text end

deleted text begin (5)deleted text end new text begin (7) new text end cremated remains containers;

deleted text begin (6)deleted text end new text begin (8) new text end markers; and

deleted text begin (7)deleted text end new text begin (9) new text end headstones.

(d) Each separate price list must contain the name of the funeral provider's place
of business, address, and telephone number and a caption describing the list as a price
list for one of the types of funeral goods or burial site goods described in paragraph (c),
clauses (1) to deleted text begin (7)deleted text end new text begin (9)new text end . The funeral provider must offer the list upon beginning discussion
of, but in any event before showing, the specific funeral goods or burial site goods and
must provide a photocopy of the price list, for retention, if so asked by the consumer. The
list must contain, at least, the retail prices of all the specific funeral goods and burial site
goods offered which do not require special ordering, enough information to identify each,
and the effective date for the price list. However, funeral providers are not required to
make a specific price list available if the funeral providers place the information required
by this paragraph on the general price list described in paragraph (e).

(e) Funeral providers must give a printed price list, for retention, to persons who
inquire in person about the funeral goods, funeral services, burial site goods, or burial site
services or prices offered by the funeral provider. The funeral provider must give the list
upon beginning discussion of either the prices of or the overall type of funeral service or
disposition or specific funeral goods, funeral services, burial site goods, or burial site
services offered by the provider. This requirement applies whether the discussion takes
place in the funeral establishment or elsewhere. However, when the deceased is removed
for transportation to the funeral establishment, an in-person request for authorization to
embalm does not, by itself, trigger the requirement to offer the general price list. If the
provider, in making an in-person request for authorization to embalm, discloses that
embalming is not required by law except in certain special cases, the provider is not
required to offer the general price list. Any other discussion during that time about prices
or the selection of funeral goods, funeral services, burial site goods, or burial site services
triggers the requirement to give the consumer a general price list. The general price list
must contain the following information:

(1) the name, address, and telephone number of the funeral provider's place of
business;

(2) a caption describing the list as a "general price list";

(3) the effective date for the price list;

(4) the retail prices, in any order, expressed either as a flat fee or as the prices per
hour, mile, or other unit of computation, and other information described as follows:

(i) forwarding of remains to another funeral establishment, together with a list of
the services provided for any quoted price;

(ii) receiving remains from another funeral establishment, together with a list of
the services provided for any quoted price;

(iii) separate prices for each new text begin alkaline hydrolysis or new text end cremation offered by the funeral
provider, with the price including an alternative new text begin container new text end or new text begin alkaline hydrolysis or
new text end cremation container, any new text begin alkaline hydrolysis or new text end crematory charges, and a description of the
services and container included in the price, where applicable, and the price of new text begin alkaline
hydrolysis or new text end cremation where the purchaser provides the container;

(iv) separate prices for each immediate burial offered by the funeral provider,
including a casket or alternative container, and a description of the services and container
included in that price, and the price of immediate burial where the purchaser provides the
casket or alternative container;

(v) transfer of remains to the funeral establishment or other location;

(vi) embalming;

(vii) other preparation of the body;

(viii) use of facilities, equipment, or staff for viewing;

(ix) use of facilities, equipment, or staff for funeral ceremony;

(x) use of facilities, equipment, or staff for memorial service;

(xi) use of equipment or staff for graveside service;

(xii) hearse or funeral coach;

(xiii) limousine; and

(xiv) separate prices for all cemetery-specific goods and services, including all goods
and services associated with interment and burial site goods and services and excluding
markers and headstones;

(5) the price range for the caskets offered by the funeral provider, together with the
statement "A complete price list will be provided at the funeral establishment or casket
sale location." or the prices of individual caskets, as disclosed in the manner described
in paragraphs (c) and (d);

(6) the price range for the alternative containers offered by the funeral provider,
together with the statement "A complete price list will be provided at the funeral
establishment or alternative container sale location." or the prices of individual alternative
containers, as disclosed in the manner described in paragraphs (c) and (d);

(7) the price range for the outer burial containers offered by the funeral provider,
together with the statement "A complete price list will be provided at the funeral
establishment or outer burial container sale location." or the prices of individual outer
burial containers, as disclosed in the manner described in paragraphs (c) and (d);

new text begin (8) the price range for the alkaline hydrolysis container offered by the funeral
provider, together with the statement: "A complete price list will be provided at the funeral
establishment or alkaline hydrolysis container sale location.", or the prices of individual
alkaline hydrolysis containers, as disclosed in the manner described in paragraphs (c)
and (d);
 new text end

new text begin (9) the price range for the hydrolyzed remains container offered by the funeral
provider, together with the statement: "A complete price list will be provided at the
funeral establishment or hydrolyzed remains container sale location.", or the prices
of individual hydrolyzed remains container, as disclosed in the manner described in
paragraphs (c) and (d);
 new text end

deleted text begin (8)deleted text end new text begin (10) new text end the price range for the cremation containers offered by the funeral provider,
together with the statement "A complete price list will be provided at the funeral
establishment or cremation container sale location." or the prices of individual cremation
containersdeleted text begin and cremated remains containersdeleted text end , as disclosed in the manner described in
paragraphs (c) and (d);

deleted text begin (9)deleted text end new text begin (11) new text end the price range for the cremated remains containers offered by the funeral
provider, together with the statement, "A complete price list will be provided at the funeral
establishment or deleted text begin cremationdeleted text end new text begin cremated remainsnew text end container sale location," or the prices of
individual cremation containers as disclosed in the manner described in paragraphs (c)
and (d);

deleted text begin (10)deleted text end new text begin (12) new text end the price for the basic services of funeral provider and staff, together with a
list of the principal basic services provided for any quoted price and, if the charge cannot
be declined by the purchaser, the statement "This fee for our basic services will be added
to the total cost of the funeral arrangements you select. (This fee is already included in
our charges for new text begin alkaline hydrolysis, new text end direct cremations, immediate burials, and forwarding
or receiving remains.)" If the charge cannot be declined by the purchaser, the quoted
price shall include all charges for the recovery of unallocated funeral provider overhead,
and funeral providers may include in the required disclosure the phrase "and overhead"
after the word "services." This services fee is the only funeral provider fee for services,
facilities, or unallocated overhead permitted by this subdivision to be nondeclinable,
unless otherwise required by law;

deleted text begin (11)deleted text end new text begin (13) new text end the price range for the markers and headstones offered by the funeral
provider, together with the statement "A complete price list will be provided at the funeral
establishment or marker or headstone sale location." or the prices of individual markers
and headstones, as disclosed in the manner described in paragraphs (c) and (d); and

deleted text begin (12)deleted text end new text begin (14) new text end any package priced funerals offered must be listed in addition to and
following the information required in paragraph (e) and must clearly state the funeral
goods and services being offered, the price being charged for those goods and services,
and the discounted savings.

(f) Funeral providers must give an itemized written statement, for retention, to each
consumer who arranges an at-need funeral or other disposition of human remains at the
conclusion of the discussion of the arrangements. The itemized written statement must be
signed by the consumer selecting the goods and services as required in section 149A.80.
If the statement is provided by a funeral establishment, the statement must be signed by
the licensed funeral director or mortician planning the arrangements. If the statement is
provided by any other funeral provider, the statement must be signed by an authorized
agent of the funeral provider. The statement must list the funeral goods, funeral services,
burial site goods, or burial site services selected by that consumer and the prices to be paid
for each item, specifically itemized cash advance items (these prices must be given to the
extent then known or reasonably ascertainable if the prices are not known or reasonably
ascertainable, a good faith estimate shall be given and a written statement of the actual
charges shall be provided before the final bill is paid), and the total cost of goods and
services selected. At the conclusion of an at-need arrangement, the funeral provider is
required to give the consumer a copy of the signed itemized written contract that must
contain the information required in this paragraph.

(g) Upon receiving actual notice of the death of an individual with whom a funeral
provider has entered a preneed funeral agreement, the funeral provider must provide
a copy of all preneed funeral agreement documents to the person who controls final
disposition of the human remains or to the designee of the person controlling disposition.
The person controlling final disposition shall be provided with these documents at the time
of the person's first in-person contact with the funeral provider, if the first contact occurs
in person at a funeral establishment, new text begin alkaline hydrolysis facility, new text end crematory, or other place
of business of the funeral provider. If the contact occurs by other means or at another
location, the documents must be provided within 24 hours of the first contact.

Sec. 63.

Minnesota Statutes 2012, section 149A.71, subdivision 4, is amended to read:


Subd. 4.

Casket, alternate container, new text begin alkaline hydrolysis containers, new text end and
cremation container sales; records; required disclosures.

Any funeral provider who
sells or offers to sell a casket, alternate container, new text begin alkaline hydrolysis container, hydrolyzed
remains container, new text end or cremation container, or cremated remains container to the public
must maintain a record of each sale that includes the name of the purchaser, the purchaser's
mailing address, the name of the decedent, the date of the decedent's death, and the place
of death. These records shall be open to inspection by the regulatory agency. Any funeral
provider selling a casket, alternate container, or cremation container to the public, and not
having charge of the final disposition of the dead human body, shall provide a copy of the
statutes and rules controlling the removal, preparation, transportation, arrangements for
disposition, and final disposition of a dead human body. This subdivision does not apply to
morticians, funeral directors, funeral establishments, crematories, or wholesale distributors
of caskets, alternate containers, new text begin alkaline hydrolysis containers, new text end or cremation containers.

Sec. 64.

Minnesota Statutes 2012, section 149A.72, subdivision 3, is amended to read:


Subd. 3.

Casket for new text begin alkaline hydrolysis or new text end cremation provisions; deceptive acts
or practices.

In selling or offering to sell funeral goods or funeral services to the public, it
is a deceptive act or practice for a funeral provider to represent that a casket is required for
new text begin alkaline hydrolysis or new text end cremations by state or local law or otherwise.

Sec. 65.

Minnesota Statutes 2012, section 149A.72, is amended by adding a
subdivision to read:


new text begin Subd. 3a. new text end

new text begin Casket for alkaline hydrolysis provision; preventive measures. new text end

new text begin To
prevent deceptive acts or practices, funeral providers must place the following disclosure
in immediate conjunction with the prices shown for alkaline hydrolysis: "Minnesota
law does not require you to purchase a casket for alkaline hydrolysis. If you want to
arrange for alkaline hydrolysis, you can use an alkaline hydrolysis container. An alkaline
hydrolysis container is a hydrolyzable or biodegradable closed container or pouch resistant
to leakage of bodily fluids that encases the body and into which a dead human body is
placed prior to insertion into an alkaline hydrolysis vessel. The containers we provide
are (specify containers provided)." This disclosure is required only if the funeral provider
arranges alkaline hydrolysis.
 new text end

Sec. 66.

Minnesota Statutes 2012, section 149A.72, subdivision 9, is amended to read:


Subd. 9.

Deceptive acts or practices.

In selling or offering to sell funeral goods,
funeral services, burial site goods, or burial site services to the public, it is a deceptive act
or practice for a funeral provider to represent that federal, state, or local laws, or particular
cemeteriesnew text begin , alkaline hydrolysis facilities,new text end or crematories, require the purchase of any funeral
goods, funeral services, burial site goods, or burial site services when that is not the case.

Sec. 67.

Minnesota Statutes 2012, section 149A.73, subdivision 1, is amended to read:


Subdivision 1.

Casket for new text begin alkaline hydrolysis or new text end cremation provisions; deceptive
acts or practices.

In selling or offering to sell funeral goods, funeral services, burial site
goods, or burial site services to the public, it is a deceptive act or practice for a funeral
provider to require that a casket be purchased for new text begin alkaline hydrolysis or new text end cremation.

Sec. 68.

Minnesota Statutes 2012, section 149A.73, subdivision 2, is amended to read:


Subd. 2.

Casket for new text begin alkaline hydrolysis or new text end cremation; preventive requirements.

To prevent unfair or deceptive acts or practices, if funeral providers arrange new text begin for alkaline
hydrolysis or new text end cremations, they must make deleted text begin adeleted text end new text begin an alkaline hydrolysis container ornew text end cremation
container available for new text begin alkaline hydrolysis or new text end cremations.

Sec. 69.

Minnesota Statutes 2012, section 149A.73, subdivision 4, is amended to read:


Subd. 4.

Required purchases of funeral goods or services; preventive
requirements.

To prevent unfair or deceptive acts or practices, funeral providers must
place the following disclosure in the general price list, immediately above the prices
required by section 149A.71, subdivision 2, paragraph (e), clauses (4) to (10): "The goods
and services shown below are those we can provide to our customers. You may choose
only the items you desire. If legal or other requirements mean that you must buy any items
you did not specifically ask for, we will explain the reason in writing on the statement we
provide describing the funeral goods, funeral services, burial site goods, and burial site
services you selected." However, if the charge for "services of funeral director and staff"
cannot be declined by the purchaser, the statement shall include the sentence "However,
any funeral arrangements you select will include a charge for our basic services." between
the second and third sentences of the sentences specified in this subdivision. The statement
may include the phrase "and overhead" after the word "services" if the fee includes a
charge for the recovery of unallocated funeral overhead. If the funeral provider does
not include this disclosure statement, then the following disclosure statement must be
placed in the statement of funeral goods, funeral services, burial site goods, and burial site
services selected, as described in section 149A.71, subdivision 2, paragraph (f): "Charges
are only for those items that you selected or that are required. If we are required by law or
by a cemeterynew text begin , alkaline hydrolysis facility,new text end or crematory to use any items, we will explain
the reasons in writing below." A funeral provider is not in violation of this subdivision by
failing to comply with a request for a combination of goods or services which would be
impossible, impractical, or excessively burdensome to provide.

Sec. 70.

Minnesota Statutes 2012, section 149A.74, is amended to read:


149A.74 FUNERAL SERVICES PROVIDED WITHOUT PRIOR APPROVAL.

Subdivision 1.

Services provided without prior approval; deceptive acts or
practices.

In selling or offering to sell funeral goods or funeral services to the public, it
is a deceptive act or practice for any funeral provider to embalm a dead human body
unless state or local law or regulation requires embalming in the particular circumstances
regardless of any funeral choice which might be made, or prior approval for embalming
has been obtained from an individual legally authorized to make such a decision. In
seeking approval to embalm, the funeral provider must disclose that embalming is not
required by law except in certain circumstances; that a fee will be charged if a funeral
is selected which requires embalming, such as a funeral with viewing; and that no
embalming fee will be charged if the family selects a service which does not require
embalming, such as new text begin direct alkaline hydrolysis, new text end direct cremationnew text begin ,new text end or immediate burial.

Subd. 2.

Services provided without prior approval; preventive requirement.

To prevent unfair or deceptive acts or practices, funeral providers must include on
the itemized statement of funeral goods or services, as described in section 149A.71,
subdivision 2, paragraph (f), the statement "If you selected a funeral that may require
embalming, such as a funeral with viewing, you may have to pay for embalming. You do
not have to pay for embalming you did not approve if you selected arrangements such
as new text begin direct alkaline hydrolysis, new text end direct cremationnew text begin ,new text end or immediate burial. If we charged for
embalming, we will explain why below."

Sec. 71.

Minnesota Statutes 2012, section 149A.91, subdivision 9, is amended to read:


Subd. 9.

deleted text begin Embalmeddeleted text end Bodies awaiting new text begin final new text end disposition.

All deleted text begin embalmeddeleted text end bodies
awaiting final disposition shall be kept in an appropriate holding facility or preparation
and embalming room. The holding facility must be secure from access by anyone except
the authorized personnel of the funeral establishment, preserve the dignity and integrity of
the body, and protect the health and safety of the personnel of the funeral establishment.

Sec. 72.

Minnesota Statutes 2012, section 149A.93, subdivision 3, is amended to read:


Subd. 3.

Disposition permit.

A disposition permit is required before a body can
be buried, entombed, new text begin alkaline hydrolyzed, new text end or cremated. No disposition permit shall be
issued until a fact of death record has been completed and filed with the local or state
registrar of vital statistics.

Sec. 73.

Minnesota Statutes 2012, section 149A.93, subdivision 6, is amended to read:


Subd. 6.

Conveyances permitted for transportation.

A dead human body may be
transported by means of private vehicle or private aircraft, provided that the body must be
encased in an appropriate container, that meets the following standards:

(1) promotes respect for and preserves the dignity of the dead human body;

(2) shields the body from being viewed from outside of the conveyance;

(3) has ample enclosed area to accommodate a cot, stretcher, rigid tray, casket,
alternative container, new text begin alkaline hydrolysis container, new text end or cremation container in a horizontal
position;

(4) is designed to permit loading and unloading of the body without excessive tilting
of the cot, stretcher, rigid tray, casket, alternative container,new text begin alkaline hydrolysis container,
new text end or cremation container; and

(5) if used for the transportation of more than one dead human body at one time,
the vehicle must be designed so that a body or container does not rest directly on top of
another body or container and that each body or container is secured to prevent the body
or container from excessive movement within the conveyance.

A vehicle that is a dignified conveyance and was specified for use by the deceased
or by the family of the deceased may be used to transport the body to the place of final
disposition.

Sec. 74.

Minnesota Statutes 2012, section 149A.94, is amended to read:


149A.94 FINAL DISPOSITION.

Subdivision 1.

Generally.

Every dead human body lying within the state, except
unclaimed bodies delivered for dissection by the medical examiner, those delivered for
anatomical study pursuant to section 149A.81, subdivision 2, or lawfully carried through
the state for the purpose of disposition elsewhere; and the remains of any dead human
body after dissection or anatomical study, shall be decently burieddeleted text begin ,deleted text end new text begin ornew text end entombed in a
public or private cemetery, new text begin alkaline hydrolyzed new text end or cremateddeleted text begin ,deleted text end within a reasonable time
after death. Where final disposition of a body will not be accomplished within 72 hours
following death or release of the body by a competent authority with jurisdiction over the
body, the body must be properly embalmed, refrigerated, or packed with dry ice. A body
may not be kept in refrigeration for a period exceeding six calendar days, or packed in dry
ice for a period that exceeds four calendar days, from the time of death or release of the
body from the coroner or medical examiner.

Subd. 3.

Permit required.

No dead human body shall be buried, entombed, or
cremated without a disposition permit. The disposition permit must be filed with the person
in charge of the place of final disposition. Where a dead human body will be transported out
of this state for final disposition, the body must be accompanied by a certificate of removal.

Subd. 4.

new text begin Alkaline hydrolysis or new text end cremation.

Inurnment of new text begin alkaline hydrolyzed or
new text end cremated remains and release to an appropriate party is considered final disposition and no
further permits or authorizations are required for transportation, interment, entombment, or
placement of the cremated remains, except as provided in section 149A.95, subdivision 16.

Sec. 75.

new text begin [149A.941] ALKALINE HYDROLYSIS FACILITIES AND ALKALINE
HYDROLYSIS.
 new text end

new text begin Subdivision 1. new text end

new text begin License required. new text end

new text begin A dead human body may only be hydrolyzed in
this state at an alkaline hydrolysis facility licensed by the commissioner of health.
 new text end

new text begin Subd. 2. new text end

new text begin General requirements. new text end

new text begin Any building to be used as an alkaline hydrolysis
facility must comply with all applicable local and state building codes, zoning laws and
ordinances, wastewater management regulations, and environmental statutes, rules, and
standards. An alkaline hydrolysis facility must have, on site, a purpose built human
alkaline hydrolysis system approved by the commissioner of health, a system approved by
the commissioner of health for drying the hydrolyzed remains, a motorized mechanical
device approved by the commissioner of health for processing hydrolyzed remains and
must have in the building a holding facility approved by the commissioner of health for
the retention of dead human bodies awaiting alkaline hydrolysis. The holding facility
must be secure from access by anyone except the authorized personnel of the alkaline
hydrolysis facility, preserve the dignity of the remains, and protect the health and safety of
the alkaline hydrolysis facility personnel.
 new text end

new text begin Subd. 3. new text end

new text begin Lighting and ventilation. new text end

new text begin The room where the alkaline hydrolysis vessel
is located and the room where the chemical storage takes place shall be properly lit and
ventilated with an exhaust fan that provides at least 12 air changes per hour.
 new text end

new text begin Subd. 4. new text end

new text begin Plumbing connections. new text end

new text begin All plumbing fixtures, water supply lines,
plumbing vents, and waste drains shall be properly vented and connected pursuant to the
Minnesota Plumbing Code. The alkaline hydrolysis facility shall be equipped with a
functional sink with hot and cold running water.
 new text end

new text begin Subd. 5. new text end

new text begin Flooring, walls, ceiling, doors, and windows. new text end

new text begin The room where the
alkaline hydrolysis vessel is located and the room where the chemical storage takes place
shall have nonporous flooring, so that a sanitary condition is provided. The walls and
ceiling of the room where the alkaline hydrolysis vessel is located and the room where
the chemical storage takes place shall run from floor to ceiling and be covered with tile,
or by plaster or sheetrock painted with washable paint or other appropriate material so
that a sanitary condition is provided. The doors, walls, ceiling, and windows shall be
constructed to prevent odors from entering any other part of the building. All windows
or other openings to the outside must be screened and all windows must be treated in a
manner that prevents viewing into the room where the alkaline hydrolysis vessel is located
and the room where the chemical storage takes place. A viewing window for authorized
family members or their designees is not a violation of this subdivision.
 new text end

new text begin Subd. 6. new text end

new text begin Equipment and supplies. new text end

new text begin The alkaline hydrolysis facility must have a
functional emergency eye wash and quick drench shower.
 new text end

new text begin Subd. 7. new text end

new text begin Access and privacy. new text end

new text begin (a) The room where the alkaline hydrolysis vessel is
located and the room where the chemical storage takes place must be private and have no
general passageway through it. The room shall, at all times, be secure from the entrance of
unauthorized persons. Authorized persons are:
 new text end

new text begin (1) licensed morticians;
 new text end

new text begin (2) registered interns or students as described in section 149A.91, subdivision 6;
 new text end

new text begin (3) public officials or representatives in the discharge of their official duties;
new text end

new text begin (4) trained alkaline hydrolysis facility operators; and
 new text end

new text begin (5) the person(s) with the right to control the dead human body as defined in section
149A.80, subdivision 2, and their designees.
 new text end

new text begin (b) Each door allowing ingress or egress shall carry a sign that indicates that the
room is private and access is limited. All authorized persons who are present in or enter
the room where the alkaline hydrolysis vessel is located while a body is being prepared for
final disposition must be attired according to all applicable state and federal regulations
regarding the control of infectious disease and occupational and workplace health and
safety.
 new text end

new text begin Subd. 8. new text end

new text begin Sanitary conditions and permitted use. new text end

new text begin The room where the alkaline
hydrolysis vessel is located and the room where the chemical storage takes place and all
fixtures, equipment, instruments, receptacles, clothing, and other appliances or supplies
stored or used in the room must be maintained in a clean and sanitary condition at all times.
 new text end

new text begin Subd. 9. new text end

new text begin Boiler use. new text end

new text begin When a boiler is required by the manufacturer of the alkaline
hydrolysis vessel for its operation, all state and local regulations for that boiler must be
followed.
 new text end

new text begin Subd. 10. new text end

new text begin Occupational and workplace safety. new text end

new text begin All applicable provisions of state
and federal regulations regarding exposure to workplace hazards and accidents shall be
followed in order to protect the health and safety of all authorized persons at the alkaline
hydrolysis facility.
 new text end

new text begin Subd. 11. new text end

new text begin Licensed personnel. new text end

new text begin A licensed alkaline hydrolysis facility must employ
a licensed mortician to carry out the process of alkaline hydrolysis of a dead human body.
It is the duty of the licensed alkaline hydrolysis facility to provide proper procedures for
all personnel, and the licensed alkaline hydrolysis facility shall be strictly accountable for
compliance with this chapter and other applicable state and federal regulations regarding
occupational and workplace health and safety.
 new text end

new text begin Subd. 12. new text end

new text begin Authorization to hydrolyze required. new text end

new text begin No alkaline hydrolysis facility
shall hydrolyze or cause to be hydrolyzed any dead human body or identifiable body part
without receiving written authorization to do so from the person or persons who have the
legal right to control disposition as described in section 149A.80 or the person's legal
designee. The written authorization must include:
 new text end

new text begin (1) the name of the deceased and the date of death of the deceased;
 new text end

new text begin (2) a statement authorizing the alkaline hydrolysis facility to hydrolyze the body;
 new text end

new text begin (3) the name, address, telephone number, relationship to the deceased, and signature
of the person or persons with legal right to control final disposition or a legal designee;
 new text end

new text begin (4) directions for the disposition of any nonhydrolyzed materials or items recovered
from the alkaline hydrolysis vessel;
 new text end

new text begin (5) acknowledgment that the hydrolyzed remains will be dried and mechanically
reduced to a granulated appearance and placed in an appropriate container and
authorization to place any hydrolyzed remains that a selected urn or container will not
accommodate into a temporary container;
 new text end

new text begin (6) new text end new text begin acknowledgment that, even with the exercise of reasonable care, it is not possible
to recover all particles of the hydrolyzed remains and that some particles may inadvertently
become commingled with particles of other hydrolyzed remains that remain in the alkaline
hydrolysis vessel or other mechanical devices used to process the hydrolyzed remains;
 new text end

new text begin (7) directions for the ultimate disposition of the hydrolyzed remains; and
 new text end

new text begin (8) a statement that includes, but is not limited to, the following information:
"During the alkaline hydrolysis process, chemical dissolution using heat, water, and an
alkaline solution is used to chemically break down the human tissue and the hydrolyzable
alkaline hydrolysis container. After the process is complete, the liquid effluent solution
contains the chemical by-products of the alkaline hydrolysis process except for the
deceased's bone fragments. The solution is cooled and released according to local
environmental regulations. A water rinse is applied to the hydrolyzed remains which are
then dried and processed to facilitate inurnment or scattering."
 new text end

new text begin Subd. 13. new text end

new text begin Limitation of liability. new text end

new text begin A licensed alkaline hydrolysis facility acting in
good faith, with reasonable reliance upon an authorization to hydrolyze, pursuant to an
authorization to hydrolyze and in an otherwise lawful manner, shall be held harmless from
civil liability and criminal prosecution for any actions taken by the alkaline hydrolysis
facility.
 new text end

new text begin Subd. 14. new text end

new text begin Acceptance of delivery of body. new text end

new text begin (a) No dead human body shall be
accepted for final disposition by alkaline hydrolysis unless:
 new text end

new text begin (1) encased in an appropriate alkaline hydrolysis container;
 new text end

new text begin (2) accompanied by a disposition permit issued pursuant to section 149A.93,
subdivision 3, including a photocopy of the completed death record or a signed release
authorizing alkaline hydrolysis of the body received from the coroner or medical
examiner; and
 new text end

new text begin (3) accompanied by an alkaline hydrolysis authorization that complies with
subdivision 12.
 new text end

new text begin (b) An alkaline hydrolysis facility shall refuse to accept delivery of an alkaline
hydrolysis container where there is:
 new text end

new text begin (1) evidence of leakage of fluids from the alkaline hydrolysis container;
 new text end

new text begin (2) a known dispute concerning hydrolysis of the body delivered;
 new text end

new text begin (3) a reasonable basis for questioning any of the representations made on the written
authorization to hydrolyze; or
 new text end

new text begin (4) any other lawful reason.
 new text end

new text begin Subd. 15. new text end

new text begin Bodies awaiting hydrolysis. new text end

new text begin A dead human body must be hydrolyzed
within 24 hours of the alkaline hydrolysis facility accepting legal and physical custody of
the body.
 new text end

new text begin Subd. 16. new text end

new text begin Handling of alkaline hydrolysis containers for dead human bodies.
 new text end

new text begin All alkaline hydrolysis facility employees handling alkaline hydrolysis containers for
dead human bodies shall use universal precautions and otherwise exercise all reasonable
precautions to minimize the risk of transmitting any communicable disease from the body.
No dead human body shall be removed from the container in which it is delivered.
 new text end

new text begin Subd. 17. new text end

new text begin Identification of body. new text end

new text begin All licensed alkaline hydrolysis facilities shall
develop, implement, and maintain an identification procedure whereby dead human
bodies can be identified from the time the alkaline hydrolysis facility accepts delivery
of the remains until the hydrolyzed remains are released to an authorized party. After
hydrolyzation, an identifying disk, tab, or other permanent label shall be placed within the
hydrolyzed remains container before the hydrolyzed remains are released from the alkaline
hydrolysis facility. Each identification disk, tab, or label shall have a number that shall
be recorded on all paperwork regarding the decedent. This procedure shall be designed
to reasonably ensure that the proper body is hydrolyzed and that the hydrolyzed remains
are returned to the appropriate party. Loss of all or part of the hydrolyzed remains or the
inability to individually identify the hydrolyzed remains is a violation of this subdivision.
 new text end

new text begin Subd. 18. new text end

new text begin Alkaline hydrolysis vessel for human remains. new text end

new text begin A licensed alkaline
hydrolysis facility shall knowingly hydrolyze only dead human bodies or human remains
in an alkaline hydrolysis vessel, along with the alkaline hydrolysis container used for
infectious disease control.
 new text end

new text begin Subd. 19. new text end

new text begin Alkaline hydrolysis procedures; privacy. new text end

new text begin The final disposition of
dead human bodies by alkaline hydrolysis shall be done in privacy. Unless there is
written authorization from the person with the legal right to control the disposition,
only authorized alkaline hydrolysis facility personnel shall be permitted in the alkaline
hydrolysis area while any dead human body is in the alkaline hydrolysis area awaiting
alkaline hydrolysis, in the alkaline hydrolysis vessel, being removed from the alkaline
hydrolysis vessel, or being processed and placed in a hydrolyzed remains container.
 new text end

new text begin Subd. 20. new text end

new text begin Alkaline hydrolysis procedures; commingling of hydrolyzed remains
prohibited. new text end

new text begin Except with the express written permission of the person with the legal right
to control the disposition, no alkaline hydrolysis facility shall hydrolyze more than one
dead human body at the same time and in the same alkaline hydrolysis vessel, or introduce
a second dead human body into an alkaline hydrolysis vessel until reasonable efforts have
been employed to remove all fragments of the preceding hydrolyzed remains, or hydrolyze
a dead human body and other human remains at the same time and in the same alkaline
hydrolysis vessel. This section does not apply where commingling of human remains
during alkaline hydrolysis is otherwise provided by law. The fact that there is incidental
and unavoidable residue in the alkaline hydrolysis vessel used in a prior hydrolyzation is
not a violation of this subdivision.
 new text end

new text begin Subd. 21. new text end

new text begin Alkaline hydrolysis procedures; removal from alkaline hydrolysis
vessel. new text end

new text begin Upon completion of the alkaline hydrolysis process, reasonable efforts shall be
made to remove from the alkaline hydrolysis vessel all of the recoverable hydrolyzed
remains and nonhydrolyzed materials or items. Further, all reasonable efforts shall be
made to separate and recover the nonhydrolyzed materials or items from the hydrolyzed
human remains and dispose of these materials in a lawful manner, by the alkaline
hydrolysis facility. The hydrolyzed human remains shall be placed in an appropriate
container to be transported to the processing area.
 new text end

new text begin Subd. 22. new text end

new text begin Drying device or mechanical processor procedures; commingling of
hydrolyzed remains prohibited. new text end

new text begin Except with the express written permission of the
person with the legal right to control the final disposition or otherwise provided by
law, no alkaline hydrolysis facility shall dry or mechanically process the hydrolyzed
human remains of more than one body at a time in the same drying device or mechanical
processor, or introduce the hydrolyzed human remains of a second body into a drying
device or mechanical processor until processing of any preceding hydrolyzed human
remains has been terminated and reasonable efforts have been employed to remove all
fragments of the preceding hydrolyzed remains. The fact that there is incidental and
unavoidable residue in the drying device, the mechanical processor, or any container used
in a prior alkaline hydrolysis process, is not a violation of this provision.
 new text end

new text begin Subd. 23. new text end

new text begin Alkaline hydrolysis procedures; processing hydrolyzed remains. new text end

new text begin The
hydrolyzed human remains shall be dried and then reduced by a motorized mechanical
device to a granulated appearance appropriate for final disposition and placed in an
alkaline hydrolysis remains container along with the appropriate identifying disk, tab,
or permanent label. Processing must take place within the licensed alkaline hydrolysis
facility. Dental gold, silver or amalgam, jewelry, or mementos, to the extent that they
can be identified, may be removed prior to processing the hydrolyzed remains, only by
staff licensed or registered by the commissioner of health; however, any dental gold and
silver, jewelry, or mementos that are removed shall be returned to the hydrolyzed remains
container unless otherwise directed by the person or persons having the right to control the
final disposition. Every person who removes or possesses dental gold or silver, jewelry,
or mementos from any hydrolyzed remains without specific written permission of the
person or persons having the right to control those remains is guilty of a misdemeanor.
The fact that residue and any unavoidable dental gold or dental silver, or other precious
metals remain in the alkaline hydrolysis vessel or other equipment or any container used
in a prior hydrolysis is not a violation of this section.
 new text end

new text begin Subd. 24. new text end

new text begin Alkaline hydrolysis procedures; container of insufficient capacity.
 new text end

new text begin If a hydrolyzed remains container is of insufficient capacity to accommodate all
hydrolyzed remains of a given dead human body, subject to directives provided in the
written authorization to hydrolyze, the alkaline hydrolysis facility shall place the excess
hydrolyzed remains in a secondary alkaline hydrolysis remains container and attach the
second container, in a manner so as not to be easily detached through incidental contact, to
the primary alkaline hydrolysis remains container. The secondary container shall contain a
duplicate of the identification disk, tab, or permanent label that was placed in the primary
container and all paperwork regarding the given body shall include a notation that the
hydrolyzed remains were placed in two containers. Keepsake jewelry or similar miniature
hydrolyzed remains containers are not subject to the requirements of this subdivision.
 new text end

new text begin Subd. 25. new text end

new text begin Disposition procedures; commingling of hydrolyzed remains
prohibited. new text end

new text begin No hydrolyzed remains shall be disposed of or scattered in a manner or in
a location where the hydrolyzed remains are commingled with those of another person
without the express written permission of the person with the legal right to control
disposition or as otherwise provided by law. This subdivision does not apply to the
scattering or burial of hydrolyzed remains at sea or in a body of water from individual
containers, to the scattering or burial of hydrolyzed remains in a dedicated cemetery, to
the disposal in a dedicated cemetery of accumulated residue removed from an alkaline
hydrolysis vessel or other alkaline hydrolysis equipment, to the inurnment of members
of the same family in a common container designed for the hydrolyzed remains of more
than one body, or to the inurnment in a container or interment in a space that has been
previously designated, at the time of sale or purchase, as being intended for the inurnment
or interment of the hydrolyzed remains of more than one person.
 new text end

new text begin Subd. 26. new text end

new text begin Alkaline hydrolysis procedures; disposition of accumulated residue.
 new text end

new text begin Every alkaline hydrolysis facility shall provide for the removal and disposition in a
dedicated cemetery of any accumulated residue from any alkaline hydrolysis vessel,
drying device, mechanical processor, container, or other equipment used in alkaline
hydrolysis. Disposition of accumulated residue shall be according to the regulations of the
dedicated cemetery and any applicable local ordinances.
 new text end

new text begin Subd. 27. new text end

new text begin Alkaline hydrolysis procedures; release of hydrolyzed remains.
 new text end

new text begin Following completion of the hydrolyzation, the inurned hydrolyzed remains shall be
released according to the instructions given on the written authorization to hydrolyze. If
the hydrolyzed remains are to be shipped, they must be securely packaged and transported
by a method which has an internal tracing system available and which provides for a
receipt signed by the person accepting delivery. Where there is a dispute over release
or disposition of the hydrolyzed remains, an alkaline hydrolysis facility may deposit
the hydrolyzed remains with a court of competent jurisdiction pending resolution of the
dispute or retain the hydrolyzed remains until the person with the legal right to control
disposition presents satisfactory indication that the dispute is resolved.
 new text end

new text begin Subd. 28. new text end

new text begin Unclaimed hydrolyzed remains. new text end

new text begin If, after 30 calendar days following
the inurnment, the hydrolyzed remains are not claimed or disposed of according to the
written authorization to hydrolyze, the alkaline hydrolysis facility or funeral establishment
may give written notice, by certified mail, to the person with the legal right to control
the final disposition or a legal designee, that the hydrolyzed remains are unclaimed and
requesting further release directions. Should the hydrolyzed remains be unclaimed 120
calendar days following the mailing of the written notification, the alkaline hydrolysis
facility or funeral establishment may dispose of the hydrolyzed remains in any lawful
manner deemed appropriate.
 new text end

new text begin Subd. 29. new text end

new text begin Required records. new text end

new text begin Every alkaline hydrolysis facility shall create and
maintain on its premises or other business location in Minnesota an accurate record of
every hydrolyzation provided. The record shall include all of the following information
for each hydrolyzation:
 new text end

new text begin (1) the name of the person or funeral establishment delivering the body for alkaline
hydrolysis;
 new text end

new text begin (2) the name of the deceased and the identification number assigned to the body;
 new text end

new text begin (3) the date of acceptance of delivery;
 new text end

new text begin (4) the names of the alkaline hydrolysis vessel, drying device, and mechanical
processor operator;
 new text end

new text begin (5) the time and date that the body was placed in and removed from the alkaline
hydrolysis vessel;
 new text end

new text begin (6) the time and date that processing and inurnment of the hydrolyzed remains
was completed;
 new text end

new text begin (7) the time, date, and manner of release of the hydrolyzed remains;
 new text end

new text begin (8) the name and address of the person who signed the authorization to hydrolyze;
 new text end

new text begin (9) all supporting documentation, including any transit or disposition permits, a
photocopy of the death record, and the authorization to hydrolyze; and
 new text end

new text begin (10) the type of alkaline hydrolysis container.
 new text end

new text begin Subd. 30. new text end

new text begin Retention of records. new text end

new text begin Records required under subdivision 29 shall be
maintained for a period of three calendar years after the release of the hydrolyzed remains.
Following this period and subject to any other laws requiring retention of records, the
alkaline hydrolysis facility may then place the records in storage or reduce them to
microfilm, microfiche, laser disc, or any other method that can produce an accurate
reproduction of the original record, for retention for a period of ten calendar years from
the date of release of the hydrolyzed remains. At the end of this period and subject to any
other laws requiring retention of records, the alkaline hydrolysis facility may destroy
the records by shredding, incineration, or any other manner that protects the privacy of
the individuals identified.
 new text end

Sec. 76.

Minnesota Statutes 2012, section 149A.96, subdivision 9, is amended to read:


Subd. 9.

new text begin Hydrolyzed and new text end cremated remains.

Subject to section 149A.95,
subdivision 16, inurnment of the new text begin hydrolyzed or new text end cremated remains and release to an
appropriate party is considered final disposition and no further permits or authorizations
are required for disinterment, transportation, or placement of the new text begin hydrolyzed or new text end cremated
remains.

Sec. 77.

Laws 2011, First Special Session chapter 9, article 2, section 27, is amended to
read:


Sec. 27. MINNESOTA TASK FORCE ON PREMATURITY.

Subdivision 1.

Establishment.

The Minnesota Task Force on Prematurity is
established to evaluate and make recommendations on methods for reducing prematurity
and improving premature infant health care in the state.

Subd. 2.

Membership; meetings; staff.

(a) The task force shall be composed of at
least the following members, who serve at the pleasure of their appointing authority:

(1) 15 representatives of the Minnesota Prematurity Coalition including, but not
limited to, health care providers who treat pregnant women or neonates, organizations
focused on preterm births, early childhood education and development professionals, and
families affected by prematurity;

(2) one representative appointed by the commissioner of human services;

(3) two representatives appointed by the commissioner of health;

(4) one representative appointed by the commissioner of education;

(5) two members of the house of representatives, one appointed by the speaker of
the house and one appointed by the minority leader; and

(6) two members of the senate, appointed according to the rules of the senate.

(b) Members of the task force serve without compensation or payment of expenses.

(c) The commissioner of health must convene the first meeting of the Minnesota
Task Force on Prematurity by July 31, 2011. The task force must continue to meet at
least quarterly. Staffing and technical assistance shall be provided by the Minnesota
Perinatal Coalition.

Subd. 3.

Duties.

The task force must report the current state of prematurity in
Minnesota and develop recommendations on strategies for reducing prematurity and
improving premature infant health care in the state by deleted text begin considering the followingdeleted text end :

(1) new text begin promoting adherence to new text end standards of care for premature infants born less than 37
weeks gestational age, including deleted text begin recommendations to improvedeleted text end new text begin utilization of appropriate
new text end hospital discharge and follow-up care procedures;

(2) coordination of information among appropriate professional and advocacy
organizations on measures to improve health care for infants born prematurely;

(3) identification and centralization of available resources to improve access and
awareness for caregivers of premature infants; new text begin and
new text end

deleted text begin (4) development and dissemination of evidence-based practices through networking
and educational opportunities;
deleted text end

deleted text begin (5) a review of relevant evidence-based research regarding the causes and effects of
premature births in Minnesota;
 deleted text end

deleted text begin (6) a review of relevant evidence-based research regarding premature infant health
care, including methods for improving quality of and access to care for premature infants;
 deleted text end

deleted text begin (7)deleted text end new text begin (4) new text end a review of the potential improvements in health status related to the use of
health care homes to provide and coordinate pregnancy-related servicesdeleted text begin ; anddeleted text end new text begin .
new text end

deleted text begin (8) identification of gaps in public reporting measures and possible effects of these
measures on prematurity rates.
 deleted text end

Subd. 4.

Report; expiration.

(a) By deleted text begin November 30, 2011deleted text end new text begin January 15, 2015new text end , the
task force must submit a new text begin final new text end report new text begin to the chairs and ranking minority members of
the legislative policy committees on health and human services new text end on the deleted text begin currentdeleted text end state of
prematurity in Minnesota deleted text begin to the chairs of the legislative policy committees on health and
human servicesdeleted text end new text begin , including any recommendations to reduce premature births and improve
premature infant health in the statenew text end .

deleted text begin (b) By January 15, 2013, the task force must report its final recommendations,
including any draft legislation necessary for implementation, to the chairs of the legislative
policy committees on health and human services.
 deleted text end

deleted text begin (c)deleted text end new text begin (b)new text end This task force expires on January 31, deleted text begin 2013deleted text end new text begin 2015new text end , or upon submission of the
final report required in paragraph deleted text begin (b)deleted text end new text begin (a)new text end , whichever is earlier.

Sec. 78. new text begin FUNERAL ESTABLISHMENTS; BRANCH LOCATIONS.
new text end

new text begin The commissioner of health shall review the statutory requirements for preparation
and embalming rooms and develop legislation with input from stakeholders that provides
appropriate health and safety protection for funeral home locations where deceased bodies
are present but are branch locations associated through a majority ownership of a licensed
funeral establishment that meets the requirements of Minnesota Statutes, sections 149A.50
and 149A.92, subdivisions 2 to 10. The review shall include consideration of distance
between the main location and branch and other health and safety issues.
 new text end

Sec. 79. new text begin STAFFING PLAN DISCLOSURE ACT.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Core staffing plan" means the projected number of full-time equivalent
nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit.
 new text end

new text begin (c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses,
and other health care workers, which may include but is not limited to nursing assistants,
nursing aides, patient care technicians, and patient care assistants, who perform
nonmanagerial direct patient care functions for more than 50 percent of their scheduled
hours on a given patient care unit.
 new text end

new text begin (d) "Inpatient care unit" means a designated inpatient area for assigning patients and
staff for which a distinct staffing plan exists and that operates 24 hours per day, seven days
per week in a hospital setting. Inpatient care unit does not include any hospital-based
clinic, long-term care facility, or outpatient hospital department.
 new text end

new text begin (e) "Staffing hours per patient day" means the number of full-time equivalent
nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
divided by the expected average number of patients upon which such assignments are based.
 new text end

new text begin (f) "Patient acuity tool" means a system for measuring an individual patient's need
for nursing care. This includes utilizing a professional registered nursing assessment of
patient condition to assess staffing need.
 new text end

new text begin Subd. 2. new text end

new text begin Hospital staffing report. new text end

new text begin (a) The chief nursing executive or nursing
designee of every reporting hospital in Minnesota under section 144.50 will develop a
core staffing plan for each patient care unit.
 new text end

new text begin (b) Core staffing plans shall specify the full-time equivalent for each patient care
unit for each 24-hour period.
 new text end

new text begin (c) Prior to submitting the core staffing plan, as required in subdivision 3,
hospitals shall consult with representatives of the hospital medical staff, managerial and
nonmanagerial care staff, and other relevant hospital personnel about the core staffing plan
and the expected average number of patients upon which the staffing plan is based.
 new text end

new text begin Subd. 3. new text end

new text begin Standard electronic reporting developed. new text end

new text begin (a) Hospitals must submit
the core staffing plans to the Minnesota Hospital Association by January 1, 2014. The
Minnesota Hospital Association shall include each reporting hospital's core staffing plan on
the Minnesota Hospital Association's Minnesota Hospital Quality Report Web site by April
1, 2014. Any substantial changes to the core staffing plan shall be updated within 30 days.
 new text end

new text begin (b) The Minnesota Hospital Association shall include on its Web site for each
reporting hospital on a quarterly basis the actual direct patient care hours per patient and
per unit. Hospitals must submit the direct patient care report to the Minnesota Hospital
Association by July 1, 2014, and quarterly thereafter.
 new text end

Sec. 80. new text begin STUDY; NURSE STAFFING LEVELS AND PATIENT OUTCOMES.
new text end

new text begin The Department of Health shall convene a work group to study the correlation
between nurse staffing levels and patient outcomes. This report shall be presented to the
chairs and ranking minority members of the health and human services committees in the
house of representatives and the senate by January 15, 2015.
 new text end

Sec. 81. new text begin TRAUMA CENTERS.
new text end

new text begin The commissioner of health, through the Office of Rural Health and Primary Care,
and in consultation with the commissioner of human services, shall study the 24-hour
costs of maintaining a level of readiness in hospitals designated as trauma centers under
Minnesota Statutes, section 144.605, and shall present recommendations to the legislature,
by December 15, 2013, on a state public programs level of readiness payment modifier
for hospitals designated as trauma centers.
 new text end

Sec. 82. new text begin HEALTH EQUITY REPORT.
new text end

new text begin By February 1, 2014, the commissioner of health, in consultation with local public
health, health care, and community partners, must submit a report to the chairs and ranking
minority members of the committees with jurisdiction over health policy and finance, on a
plan for advancing health equity in Minnesota. The report must include the following:
 new text end

new text begin (1) assessment of health disparities that exist in the state and how these disparities
relate to health equity;
 new text end

new text begin (2) identification of policies, processes, and systems that contribute to health
inequity in the state;
 new text end

new text begin (3) recommendations for changes to policies, processes and systems within the
Department of Health that would increase the department's leadership in addressing health
inequities;
 new text end

new text begin (4) identification of best practices for local public health, health care, and community
partners to provide culturally responsive services and advance health equity; and
 new text end

new text begin (5) recommendations for strategies for the use of data to document and monitor
existing health inequities and to evaluate effectiveness of policies, processes, systems,
and environmental changes that will advance health equity.
 new text end

Sec. 83. new text begin ELIMINATING HEALTH DISPARITIES GRANTS; ORGANIZATIONS
WITH LIMITED FISCAL CAPACITY.
new text end

new text begin For grants awarded from the general fund under Minnesota Statutes, section 145.928,
during the fiscal years ending June 30, 2013, and June 30, 2014, the commissioner
of health may provide working capital advanced to grantees determined during the
application process to have limited financial capacity, in accordance with Office of Grant
Management Policies.
 new text end

Sec. 84. new text begin ASSESSMENT OF QUALITY METRICS FOR MEASURING THE
SCREENING, DIAGNOSIS, AND TREATMENT OF YOUNG CHILDREN WITH
AUTISM SPECTRUM DISORDER.
new text end

new text begin As part of the annual review and ongoing development of quality measures under
Minnesota Statutes, section 62U.02, the commissioner of health shall assess the medical
evidence and feasibility of adding a set of quality metrics for measuring the screening,
diagnosis, and treatment of young children with autism spectrum disorder.
 new text end

Sec. 85. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor shall substitute the term "vertical heat exchangers" or "vertical
heat exchanger" with "bored geothermal heat exchangers" or "bored geothermal heat
exchanger" wherever it appears in Minnesota Statutes, sections 103I.005, subdivisions
2 and 12; 103I.101, subdivisions 2 and 5; 103I.105; 103I.205, subdivision 4; 103I.208,
subdivision 2; 103I.501; 103I.531, subdivision 5; and 103I.641, subdivisions 1, 2, and 3.
 new text end

Sec. 86. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2012, sections 103I.005, subdivision 20; 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; and 485.14, new text end new text begin are repealed.
 new text end

new text begin (b) new text end new text begin Minnesota Statutes 2012, section 144.123, subdivision 2, new text end new text begin is repealed effective
July 1, 2014.
 new text end

ARTICLE 13

HUMAN SERVICES FORECAST ADJUSTMENTS

Section 1. new text begin COMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin (161,031,000)
 new text end 		new text begin new text end
new text begin Appropriations by Fund
 new text end
new text begin 2013
 new text end
new text begin General Fund
 new text end 		new text begin (158,668,000)
 new text end 		new text begin new text end
new text begin Health Care Access
 new text end 		new text begin (7,179,000)
 new text end 		new text begin new text end
new text begin TANF
 new text end 		new text begin 4,816,000
 new text end 		new text begin new text end

new text begin Subd. 2. new text end

new text begin Forecasted Programs
 new text end

new text begin (a) MFIP/DWP Grants
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General Fund
 new text end 		new text begin (8,211,000)
 new text end 		new text begin new text end
new text begin TANF
 new text end 		new text begin 4,399,000
 new text end 		new text begin new text end
new text begin (b) MFIP Child Care Assistance Grants
 new text end 		new text begin 10,113,000
 new text end 		new text begin new text end
new text begin (c) General Assistance Grants
 new text end 		new text begin 3,230,000
 new text end 		new text begin new text end
new text begin (d) Minnesota Supplemental Aid Grants
 new text end 		new text begin (1,008,000)
 new text end 		new text begin new text end
new text begin (e) Group Residential Housing Grants
 new text end 		new text begin (5,423,000)
 new text end 		new text begin new text end
new text begin (f) MinnesotaCare Grants
 new text end 		new text begin (7,179,000)
 new text end 		new text begin new text end

new text begin This appropriation is from the health care
access fund.
 new text end

new text begin (g) Medical Assistance Grants
 new text end 		new text begin (159,733,000)
 new text end 		new text begin new text end
new text begin (h) Alternative Care Grants
 new text end 		new text begin -0-
 new text end 		new text begin new text end
new text begin (i) CD Entitlement Grants
 new text end 		new text begin 2,364,000
 new text end 		new text begin new text end

new text begin Subd. 3. new text end

new text begin Technical Activities
 new text end

new text begin 417,000
 new text end 		new text begin new text end

new text begin This appropriation is from the TANF fund.
 new text end

Sec. 2. new text begin EFFECTIVE DATE.
new text end

new text begin Section 1 is effective the day following final enactment.
 new text end

ARTICLE 14

HEALTH AND HUMAN SERVICES APPROPRIATIONS

Section 1. new text begin SUMMARY OF APPROPRIATIONS.
new text end

new text begin The amounts shown in this section summarize direct appropriations, by fund, made
in this article.
 new text end

new text begin 2014
 new text end 		new text begin 2015
 new text end 		new text begin Total
 new text end
new text begin General
 new text end 		new text begin $
 new text end 		new text begin 5,643,757,000
 new text end 		new text begin $
 new text end 		new text begin 5,877,152,000
 new text end 		new text begin $
 new text end 		new text begin 11,520,909,000
 new text end
new text begin State Government Special
Revenue
 new text end 		new text begin 69,619,000
 new text end 		new text begin 74,135,000
 new text end 		new text begin 143,754,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 664,087,000
 new text end 		new text begin 432,345,000
 new text end 		new text begin 1,096,433,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 269,628,000
 new text end 		new text begin 266,526,000
 new text end 		new text begin 536,154,000
 new text end
new text begin Lottery Prize Fund
 new text end 		new text begin 1,667,000
 new text end 		new text begin 1,668,000
 new text end 		new text begin 3,335,000
 new text end
new text begin Total
 new text end 		new text begin $
 new text end 		new text begin 6,648,757,000
 new text end 		new text begin $
 new text end 		new text begin 6,651,827,000
 new text end 		new text begin $
 new text end 		new text begin 13,300,584,000
 new text end

Sec. 2. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.new text end

new text begin The sums shown in the columns marked "Appropriations" are appropriated to the
agencies and for the purposes specified in this article. The appropriations are from the
general fund, or another named fund, and are available for the fiscal years indicated
for each purpose. The figures "2014" and "2015" used in this article mean that the
appropriations listed under them are available for the fiscal year ending June 30, 2014, or
June 30, 2015, respectively. "The first year" is fiscal year 2014. "The second year" is fiscal
year 2015. "The biennium" is fiscal years 2014 and 2015.
 new text end

new text begin APPROPRIATIONS
 new text end
new text begin Available for the Year
 new text end
new text begin Ending June 30
 new text end
new text begin 2014
 new text end 		new text begin 2015
 new text end

Sec. 3. new text begin COMMISSIONER OF HUMAN
SERVICES
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 6,454,078,000
 new text end 		new text begin $
 new text end 		new text begin 6,455,116,000
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2014
 new text end 		new text begin 2015
 new text end
new text begin General
 new text end 		new text begin 5,558,235,000
 new text end 		new text begin 5,796,754,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 4,099,000
 new text end 		new text begin 6,332,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 631,807,000
 new text end 		new text begin 395,628,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 257,915,000
 new text end 		new text begin 254,813,000
 new text end
new text begin Lottery Prize Fund
 new text end 		new text begin 1,667,000
 new text end 		new text begin 1,668,000
 new text end

new text begin Receipts for Systems Projects.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, and SSIS must be deposited
in the state system account authorized
in Minnesota Statutes, section 256.014.
Money appropriated for computer projects
approved by the commissioner of Minnesota
information technology services, funded
by the legislature, and approved by the
commissioner of management and budget,
may be transferred from one project to
another and from development to operations
as the commissioner of human services
considers necessary. Any unexpended
balance in the appropriation for these
projects does not cancel but is available for
ongoing development and operations.
 new text end

new text begin Nonfederal Share Transfers. The
nonfederal share of activities for which
federal administrative reimbursement is
appropriated to the commissioner may be
transferred to the special revenue fund.
 new text end

new text begin ARRA Supplemental Nutrition Assistance
Benefit Increases. The funds provided for
food support benefit increases under the
Supplemental Nutrition Assistance Program
provisions of the American Recovery and
Reinvestment Act (ARRA) of 2009 must be
used for benefit increases beginning July 1,
2009.
 new text end

new text begin Supplemental Nutrition Assistance
Program Employment and Training.
(1) Notwithstanding Minnesota Statutes,
sections 256D.051, subdivisions 1a, 6b,
and 6c, and 256J.626, federal Supplemental
Nutrition Assistance employment and
training funds received as reimbursement of
MFIP consolidated fund grant expenditures
for diversionary work program participants
and child care assistance program
expenditures must be deposited in the general
fund. The amount of funds must be limited to
$4,900,000 per year in fiscal years 2014 and
2015, and to $4,400,000 per year in fiscal
years 2016 and 2017, contingent on approval
by the federal Food and Nutrition Service.
 new text end

new text begin (2) Consistent with the receipt of the federal
funds, the commissioner may adjust the
level of working family credit expenditures
claimed as TANF maintenance of effort.
Notwithstanding any contrary provision in
this article, this rider expires June 30, 2017.
 new text end

new text begin TANF Maintenance of Effort. (a) In order
to meet the basic maintenance of effort
(MOE) requirements of the TANF block grant
specified under Code of Federal Regulations,
title 45, section 263.1, the commissioner may
only report nonfederal money expended for
allowable activities listed in the following
clauses as TANF/MOE expenditures:
 new text end

new text begin (1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
 new text end

new text begin (2) the child care assistance programs
under Minnesota Statutes, sections 119B.03
and 119B.05, and county child care
administrative costs under Minnesota
Statutes, section 119B.15;
 new text end

new text begin (3) state and county MFIP administrative
costs under Minnesota Statutes, chapters
256J and 256K;
 new text end

new text begin (4) state, county, and tribal MFIP
employment services under Minnesota
Statutes, chapters 256J and 256K;
 new text end

new text begin (5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
 new text end

new text begin (6) qualifying working family credit
expenditures under Minnesota Statutes,
section 290.0671;
 new text end

new text begin (7) qualifying Minnesota education credit
expenditures under Minnesota Statutes,
section 290.0674; and
 new text end

new text begin (8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
 new text end

new text begin (b) The commissioner shall ensure that
sufficient qualified nonfederal expenditures
are made each year to meet the state's
TANF/MOE requirements. For the activities
listed in paragraph (a), clauses (2) to
(8), the commissioner may only report
expenditures that are excluded from the
definition of assistance under Code of
Federal Regulations, title 45, section 260.31.
 new text end

new text begin (c) For fiscal years beginning with state fiscal
year 2003, the commissioner shall ensure
that the maintenance of effort used by the
commissioner of management and budget
for the February and November forecasts
required under Minnesota Statutes, section
16A.103, contains expenditures under
paragraph (a), clause (1), equal to at least 16
percent of the total required under Code of
Federal Regulations, title 45, section 263.1.
 new text end

new text begin (d) The requirement in Minnesota Statutes,
section 256.011, subdivision 3, that federal
grants or aids secured or obtained under that
subdivision be used to reduce any direct
appropriations provided by law, do not apply
if the grants or aids are federal TANF funds.
 new text end

new text begin (e) For the federal fiscal years beginning on
or after October 1, 2007, the commissioner
may not claim an amount of TANF/MOE in
excess of the 75 percent standard in Code
of Federal Regulations, title 45, section
263.1(a)(2), except:
 new text end

new text begin (1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1),
if it is determined by the commissioner
that the state will not meet the TANF work
participation target rate for the current year;
 new text end

new text begin (2) to provide any additional amounts
under Code of Federal Regulations, title 45,
section 264.5, that relate to replacement of
TANF funds due to the operation of TANF
penalties; and
 new text end

new text begin (3) to provide any additional amounts that
may contribute to avoiding or reducing
TANF work participation penalties through
the operation of the excess MOE provisions
of Code of Federal Regulations, title 45,
section 261.43(a)(2).
 new text end

new text begin For the purposes of clauses (1) to (3),
the commissioner may supplement the
MOE claim with working family credit
expenditures or other qualified expenditures
to the extent such expenditures are otherwise
available after considering the expenditures
allowed in this subdivision and subdivisions
2 and 3.
 new text end

new text begin (f) Notwithstanding any contrary provision
in this article, paragraphs (a) to (e) expire
June 30, 2017.
 new text end

new text begin Working Family Credit Expenditures
as TANF/MOE. The commissioner may
claim as TANF maintenance of effort up to
$6,707,000 per year of working family credit
expenditures in each fiscal year.
 new text end

new text begin Subd. 2. new text end

new text begin Working Family Credit to be Claimed
for TANF/MOE
 new text end

new text begin The commissioner may count the following
amounts of working family credit
expenditures as TANF/MOE:
 new text end

new text begin (1) fiscal year 2014, $43,576,000; and
 new text end

new text begin (2) fiscal year 2015, $43,548,000.
 new text end

new text begin Subd. 3. new text end

new text begin TANF Transfer to Federal Child Care
and Development Fund
 new text end

new text begin (a) The following TANF fund amounts
are appropriated to the commissioner for
purposes of MFIP/transition year child care
assistance under Minnesota Statutes, section
119B.05:
 new text end

new text begin (1) fiscal year 2014; $14,020,000; and
 new text end

new text begin (2) fiscal year 2015, $14,020,000.
 new text end

new text begin (b) The commissioner shall authorize the
transfer of sufficient TANF funds to the
federal child care and development fund to
meet this appropriation and shall ensure that
all transferred funds are expended according
to federal child care and development fund
regulations.
 new text end

new text begin Subd. 4. new text end

new text begin Central Office
 new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
 new text end

new text begin (a) Operations
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 88,410,000
 new text end 		new text begin 89,985,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 3,974,000
 new text end 		new text begin 6,207,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 13,252,000
 new text end 		new text begin 13,154,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 117,000
 new text end 		new text begin 100,000
 new text end

new text begin Return on Taxpayer Investment
Implementation Study. $100,000 is
appropriated in fiscal year 2014 from the
general fund to the commissioner of human
services for transfer to the commissioner
of management and budget to develop
recommendations for implementing a return
on taxpayer investment (ROTI) methodology
and practice related to human services and
corrections programs administered and
funded by state and county government.
The scope of the study shall include
assessments of ROTI initiatives in other
states, design implications for Minnesota,
and identification of one or more Minnesota
institutions of higher education capable of
providing rigorous and consistent nonpartisan
institutional support for ROTI. The scope of
the study shall also include recommendations
on methods to evaluate the value of prepaid
medical assistance services (PMAP)
versus other ways of delivering public
health care programs. The commissioner
shall consult with representatives of other
state agencies, counties, legislative staff,
Minnesota institutions of higher education,
and other stakeholders in developing
recommendations. The commissioner shall
report findings and recommendations to the
governor and legislature by November 30,
2013.
 new text end

new text begin DHS Receipt Center Accounting. The
commissioner is authorized to transfer
appropriations to, and account for DHS
receipt center operations in, the special
revenue fund.
 new text end

new text begin Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost
of administering the following provisions:
 new text end

new text begin (1) Minnesota Statutes, section 125A.744,
subdivision 3;
 new text end

new text begin (2) Minnesota Statutes, section 245.495,
paragraph (b);
 new text end

new text begin (3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
 new text end

new text begin (4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
 new text end

new text begin (5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and
 new text end

new text begin (6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
 new text end

new text begin Systems Modernization. The following
amounts are appropriated for transfer to
the state systems account authorized in
Minnesota Statutes, section 256.014:
 new text end

new text begin (1) $1,825,000 in fiscal year 2014 and
$2,502,000 in fiscal year 2015 is for the
state share of Medicaid-allocated costs of
the health insurance exchange information
technology and operational structure. The
funding base is $3,222,000 in fiscal year 2016
and $3,037,000 in fiscal year 2017 but shall
not be included in the base thereafter; and
 new text end

new text begin (2) Any unexpended balance from
the contingent system modernization
appropriation in article 15 must be
transferred from the Department of Human
Services state systems account to the Office
of Enterprise Technology when the Office
of Enterprise Technology has negotiated a
federally approved internal service fund rates
and billing process with sufficient internal
accounting controls to properly maximize
federal reimbursement to Minnesota for
human services system modernization
projects, but not later than June 30, 2015.
 new text end

new text begin Base Adjustment. The general fund base
is increased by $6,099,000 in fiscal year
2016 and $1,185,000 in fiscal year 2017.
The health access fund base is decreased by
$551,000 in fiscal years 2016 and 2017.
 new text end

new text begin (b) Children and Families
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 7,626,000
 new text end 		new text begin 7,634,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 2,282,000
 new text end 		new text begin 2,282,000
 new text end

new text begin Financial Institution Data Match and
Payment of Fees. The commissioner is
authorized to allocate up to $310,000 each
year in fiscal years 2014 and 2015 from the
PRISM special revenue account to make
payments to financial institutions in exchange
for performing data matches between account
information held by financial institutions
and the public authority's database of child
support obligors as authorized by Minnesota
Statutes, section 13B.06, subdivision 7.
 new text end

new text begin Base Adjustment. The general fund base is
decreased by $300,000 in fiscal years 2016
and 2017, and the federal TANF fund base is
increased by $300,000 in fiscal years 2016
and 2017.
 new text end

new text begin (c) Health Care
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 13,924,000
 new text end 		new text begin 13,795,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 26,599,000
 new text end 		new text begin 30,306,000
 new text end

new text begin Base Adjustment. The health care access
fund base is increased by $8,177,000 in fiscal
year 2016 and by $6,712,000 in fiscal year
2017.
 new text end

new text begin Medical assistance costs for inmates. The
commissioner of corrections, for fiscal years
2014 through 2017, shall transfer to the
commissioner of human services an amount
equal to the state share of medical assistance
costs related to implementation of Minnesota
Statutes, section 256B.055, subdivision 14,
paragraph (c).
 new text end

new text begin (d) Continuing Care
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 18,734,000
 new text end 		new text begin 19,272,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 125,000
 new text end 		new text begin 125,000
 new text end

new text begin Base Adjustment. The general fund base is
increased by $3,324,000 in fiscal year 2016
and by $3,324,000 in fiscal year 2017.
 new text end

new text begin (e) Chemical and Mental Health
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 4,480,000
 new text end 		new text begin 4,300,000
 new text end
new text begin Lottery Prize Fund
 new text end 		new text begin 159,000
 new text end 		new text begin 160,000
 new text end

new text begin Subd. 5. new text end

new text begin Forecasted Programs
 new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
 new text end

new text begin (a) MFIP/DWP
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 72,583,000
 new text end 		new text begin 74,634,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 83,104,000
 new text end 		new text begin 80,510,000
 new text end
new text begin (b) MFIP Child Care Assistance
 new text end 		new text begin 59,662,000
 new text end 		new text begin 59,393,000
 new text end

new text begin Notwithstanding Minnesota Statutes, section
256J.021, TANF funds may be used to pay for
any additional costs related to repeal of the
MFIP family cap for individuals identified
under Minnesota Statutes, section 256J.021.
 new text end

new text begin (c) General Assistance
 new text end 		new text begin 54,787,000
 new text end 		new text begin 56,068,000
 new text end

new text begin General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart
from parents or a legal guardian at $203.
The commissioner may reduce this amount
according to Laws 1997, chapter 85, article
3, section 54.
 new text end

new text begin Emergency General Assistance. The
amount appropriated for emergency general
assistance funds is limited to no more
than $6,729,812 in fiscal year 2014 and
$6,729,812 in fiscal year 2015. Funds
to counties shall be allocated by the
commissioner using the allocation method in
Minnesota Statutes, section 256D.06.
 new text end

new text begin (d) MN Supplemental Assistance
 new text end 		new text begin 38,646,000
 new text end 		new text begin 39,821,000
 new text end
new text begin (e) Group Residential Housing
 new text end 		new text begin 140,447,000
 new text end 		new text begin 149,984,000
 new text end
new text begin (f) MinnesotaCare
 new text end
new text begin Health Care Access
 new text end 		new text begin 296,282,000
 new text end 		new text begin 226,619,000
 new text end
new text begin (g) Medical Assistance
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 4,371,808,000
 new text end 		new text begin 4,595,789,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 292,697,000
 new text end 		new text begin 123,386,000
 new text end

new text begin The Departments of Human Services and
Management and Budget shall identify
general fund medical assistance populations
costing $240,426,000 for fiscal year 2016
and $218,557,000 for fiscal year 2017 and
transfer those costs to the HCAF. The base for
these costs shall be counted in the health care
access fund for fiscal years 2016 and 2017.
 new text end

new text begin Newborn Screening. $121,000 in fiscal
year 2014 and $141,000 in fiscal year 2015
are appropriated from the general fund, and
$10,000 in fiscal year 2014 and $13,000 in
fiscal year 2015 are appropriated from the
health care access fund to the commissioner
of human services for the hospital
reimbursement increase in Minnesota
Statutes, section 256.969, subdivision 29.
The base for this appropriation in fiscal year
2016 is $14,000.
 new text end

new text begin new text begin Transfer.new text end $704,000 in fiscal year 2014 and
$2,090,000 in fiscal year 2015 is transferred
from the health care access fund to the
general fund to provide increases in dental
payment rates under Minnesota Statutes,
section 256B.76, subdivision 2, paragraph (j).
 new text end

new text begin (h) Alternative Care
 new text end 		new text begin 47,197,000
 new text end 		new text begin 45,084,000
 new text end

new text begin Alternative Care Transfer. Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but shall be transferred to the
medical assistance account.
 new text end

new text begin (i) CD Treatment Fund
 new text end 		new text begin 81,440,000
 new text end 		new text begin 74,875,000
 new text end

new text begin Balance Transfer. The commissioner must
transfer $18,188,000 from the consolidated
chemical dependency treatment fund to the
general fund by September 30, 2013.
 new text end

new text begin Subd. 6. new text end

new text begin Grant Programs
 new text end

new text begin The amounts that may be spent from this
appropriation for each purpose are as follows:
 new text end

new text begin (a) Support Services Grants
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 8,715,000
 new text end 		new text begin 8,715,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 91,832,000
 new text end 		new text begin 90,952,000
 new text end

new text begin MFIP Housing Assistance Grants. MFIP
housing assistance grants under Minnesota
Statutes, section 256J.35, paragraph (d),
must be paid out of support services grants
under this paragraph.
 new text end

new text begin Base Adjustment. The general fund base is
decreased by $4,618,000 in fiscal years 2016
and 2017. The TANF fund base is increased
by $1,700,000 in fiscal years 2016 and 2017.
 new text end

new text begin (b) Basic Sliding Fee Child Care Assistance
Grants
 new text end 		new text begin 38,356,000
 new text end 		new text begin 38,681,000
 new text end

new text begin Base Adjustment. The general fund base is
increased by $1,278,000 in fiscal year 2016
and by $1,349,000 in fiscal year 2017.
 new text end

new text begin (c) Child Care Development Grants
 new text end 		new text begin 1,487,000
 new text end 		new text begin 1,487,000
 new text end
new text begin (d) Child Support Enforcement Grants
 new text end 		new text begin 50,000
 new text end 		new text begin 50,000
 new text end

new text begin Federal Child Support Demonstration
Grants. Federal administrative
reimbursement resulting from the federal
child support grant expenditures authorized
under United States Code, title 42, section
1315, is appropriated to the commissioner
for this activity.
 new text end

new text begin (e) Children's Services Grants
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 47,438,000
 new text end 		new text begin 47,801,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 140,000
 new text end 		new text begin 140,000
 new text end

new text begin Adoption Assistance and Relative Custody
Assistance. The commissioner may transfer
unencumbered appropriation balances for
adoption assistance and relative custody
assistance between fiscal years and between
programs.
 new text end

new text begin Privatized Adoption Grants. Federal
reimbursement for privatized adoption grant
and foster care recruitment grant expenditures
is appropriated to the commissioner for
adoption grants and foster care and adoption
administrative purposes.
 new text end

new text begin Adoption Assistance Incentive Grants.
Federal funds available during fiscal years
2014 and 2015 for adoption incentive grants
are appropriated to the commissioner for
these purposes.
 new text end

new text begin Base Adjustment. The general fund base is
increased by $5,139,000 in fiscal year 2016
and by $9,155,000 in fiscal year 2017.
 new text end

new text begin (f) Child and Community Service Grants
 new text end 		new text begin 53,301,000
 new text end 		new text begin 53,301,000
 new text end
new text begin (g) Child and Economic Support Grants
 new text end 		new text begin 16,597,000
 new text end 		new text begin 16,598,000
 new text end

new text begin new text begin Minnesota Food Assistance Program.
new text end Unexpended funds for the Minnesota food
assistance program for fiscal year 2014 do
not cancel but are available for this purpose
in fiscal year 2015.
 new text end

new text begin Family Assets for Independence. $250,000
each year is for the Family Assets for
Independence Minnesota program. This
appropriation is available in either year of the
biennium and may be transferred between
fiscal years. This appropriation is added to
the base.
 new text end

new text begin Food Shelf Programs. $25,000 each year
from the general fund is for food shelf
programs under Minnesota Statutes, section
256E.34. This appropriation is onetime.
Notwithstanding Minnesota Statutes, section
256E.34, subdivision 4, no portion of this
appropriation may be used by Hunger
Solutions for its administrative expenses,
including but not limited to rent and salaries.
 new text end

new text begin (h) Health Care Grants
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 90,000
 new text end 		new text begin 90,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 2,228,000
 new text end 		new text begin 1,413,000
 new text end

new text begin Premium Subsidy. $....... is appropriated
from the general fund in fiscal years 2014
and 2015 to the commissioner of human
services for the purpose of providing a
premium subsidy to families purchasing
supplemental autism coverage for young
children on the private market if a family has
an income below 400 percent of the federal
poverty level. The commissioner may utilize
the existing eligibility and enrollment system
described in Minnesota Statutes, section
252.27, to determine a family's eligibility
for subsidies under this section. This
appropriation is available until expended and
does not become part of the base.
 new text end

new text begin Base Adjustment. The health care access
fund is decreased by $1,223,000 in fiscal
years 2016 and 2017.
 new text end

new text begin (i) Aging and Adult Services Grants
 new text end 		new text begin 18,556,000
 new text end 		new text begin 19,422,000
 new text end

new text begin Community Service Development Grants
and Community Services Grants. Of
this appropriation, $1,025,000 each year is
for community service development grants
and $1,165,000 each year is for community
services grants.
 new text end

new text begin (j) Deaf and Hard-of-Hearing Grants
 new text end 		new text begin 1,767,000
 new text end 		new text begin 1,767,000
 new text end
new text begin (k) Disabilities Grants
 new text end 		new text begin 17,984,000
 new text end 		new text begin 17,861,000
 new text end

new text begin $180,000 each year from the general fund is
for a grant to the Minnesota Organization
on Fetal Alcohol Syndrome (MOFAS) to
support nonprofit Fetal Alcohol Spectrum
Disorders (FASD) outreach prevention
programs in Olmsted County. This is a
onetime appropriation.
 new text end

new text begin Base Adjustment. The general fund base
is increased by $502,000 in fiscal year 2016
and by $676,000 in fiscal year 2017.
 new text end

new text begin (l) Adult Mental Health Grants
 new text end
new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 71,257,000
 new text end 		new text begin 69,588,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 750,000
 new text end 		new text begin 750,000
 new text end
new text begin Lottery Prize
 new text end 		new text begin 1,508,000
 new text end 		new text begin 1,508,000
 new text end

new text begin Funding Usage. Up to 75 percent of a fiscal
year's appropriations for adult mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
 new text end

new text begin Base Adjustment. The general fund base is
decreased by $4,461,000 in fiscal years 2016
and 2017.
 new text end

new text begin Mental Health Pilot Project. $230,000
each year is for a grant to the Zumbro
Valley Mental Health Center. The grant
shall be used to implement a pilot project
to test an integrated behavioral health care
coordination model. The grant recipient must
report measurable outcomes and savings
to the commissioner of human services
by January 15, 2016. This is a onetime
appropriation.
 new text end

new text begin High-risk adults. $100,000 in fiscal year
2014 and $100,000 in fiscal year 2015 are
appropriated from the general fund to the
commissioner of human services for a grant
to the nonprofit organization selected to
administer the demonstration project for
high-risk adults under Laws 2007, chapter
54, article 1, section 19, in order to complete
the project. This is a onetime appropriation.
 new text end

new text begin (m) Child Mental Health Grants
 new text end 		new text begin 17,599,000
 new text end 		new text begin 19,988,000
 new text end

new text begin Funding Usage. Up to 75 percent of a fiscal
year's appropriation for child mental health
grants may be used to fund allocations in that
portion of the fiscal year ending December
31.
 new text end

new text begin (n) CD Treatment Support Grants
 new text end 		new text begin 1,516,000
 new text end 		new text begin 1,516,000
 new text end

new text begin Base Adjustment. The general fund base is
decreased by $300,000 in fiscal years 2016
and 2017.
 new text end

new text begin Subd. 7. new text end

new text begin State-Operated Services
 new text end

new text begin 186,744,000
 new text end 		new text begin 188,183,000
 new text end

new text begin Transfer Authority Related to
State-Operated Services. Money
appropriated for state-operated services
may be transferred between fiscal years
of the biennium with the approval of the
commissioner of management and budget.
 new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
 new text end

new text begin (a) SOS Mental Health
 new text end 		new text begin 116,598,000
 new text end 		new text begin 117,467,000
 new text end

new text begin Dedicated Receipts Available. Of the
revenue received under Minnesota Statutes,
section 246.18, subdivision 8, paragraph
(a), $1,000,000 each year is available for
the purposes of paragraph (b), clause (1),
of that subdivision, $1,000,000 each year
is available to transfer to the adult mental
health budget activity for the purposes of
paragraph (b), clause (2), of that subdivision,
and up to $2,713,000 each year is available
for the purposes of paragraph (b), clause (3),
of that subdivision.
 new text end

new text begin (b) SOS MN Security Hospital
 new text end 		new text begin 70,146,000
 new text end 		new text begin 70,715,000
 new text end

new text begin Subd. 8. new text end

new text begin Sex Offender Program
 new text end

new text begin 77,341,000
 new text end 		new text begin 80,895,000
 new text end

new text begin Transfer Authority Related to Minnesota
Sex Offender Program. Money
appropriated for the Minnesota sex offender
program may be transferred between fiscal
years of the biennium with the approval of the
commissioner of management and budget.
 new text end

new text begin Subd. 9. new text end

new text begin Technical Activities
 new text end

new text begin 80,440,000
 new text end 		new text begin 80,829,000
 new text end

new text begin This appropriation is from the federal TANF
fund.
 new text end

new text begin Base Adjustment. The federal TANF fund
base is decreased by $22,000 in fiscal year
2016 and by $49,000 in fiscal year 2017.
 new text end

new text begin Subd. 10. new text end

new text begin Transfer.
 new text end

new text begin The commissioner of management and
budget must transfer $65,000,000 in fiscal
year 2014 from the general fund to the health
care access fund. This is a onetime transfer.
 new text end

Sec. 4. new text begin COMMISSIONER OF HEALTH
new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 172,440,000
 new text end 		new text begin $
 new text end 		new text begin 173,946,000
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2014
 new text end 		new text begin 2015
 new text end
new text begin General
 new text end 		new text begin 80,151,000
 new text end 		new text begin 75,001,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 48,296,000
 new text end 		new text begin 50,515,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 32,280,000
 new text end 		new text begin 36,717,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 11,713,000
 new text end 		new text begin 11,713,000
 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
 new text end

new text begin Subd. 2. new text end

new text begin Health Improvement
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 53,475,000
 new text end 		new text begin 48,260,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 1,040,000
 new text end 		new text begin 1,047,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 21,725,000
 new text end 		new text begin 26,731,000
 new text end
new text begin Federal TANF
 new text end 		new text begin 11,713,000
 new text end 		new text begin 11,713,000
 new text end

new text begin Notwithstanding the cancellation requirement
in Minnesota Statutes, section 256J.02,
subdivision 6, TANF funds awarded under
Minnesota Statutes, section 145.928, during
fiscal year 2013 to grantees determined
during the application process to have limited
financial capacity, are available until June
30, 2014.
 new text end

new text begin Statewide Health Improvement Program.
 new text end

new text begin (a) $20,000,000 in fiscal year 2014 and
$25,000,000 in fiscal year 2015 is from the
Health Care Access fund for the Statewide
Health Improvement Program (SHIP) for
grants to all local community health boards
and tribal governments. Funds appropriated
under this paragraph are available until
expended. Public health agencies in their
third cycle of SHIP funding shall incorporate
activities targeted to addressing populations
with health disparities or persons with
disabilities.
 new text end

new text begin (b) Of the appropriated amount, $500,000
in fiscal year 2015 shall be distributed as
two-year pilot grants focused on improving
health and reducing health care costs in
populations over age 60. Grants shall be
awarded by February 1, 2014, to five county
public health agencies, multicounty public
health agency partnerships, or county/city
public health agency partnerships to initiate
evidence-based strategies for improving
the physical activity levels of citizens over
age 60 with a goal of improving health and
reducing health care costs. Partnerships with
community education, health providers, or
other local institutions shall be encouraged
to establish ongoing outreach and sustainable
programming.
 new text end

new text begin (c) Pilot project funds shall be distributed
based on a $30,000 base with a per senior
add-on based on the population to be served
and shall include urban, suburban, regional
center, and rural counties. Each grant shall
serve an area with a minimum population
base of persons over age 60 and shall target
those seniors most at risk of high health costs
due to a sedentary lifestyle, chronic disease,
or other risk factors. Up to 8 percent of the
above appropriation is available for creating
a library of evidence-based programs that
improve health and reduce health care costs,
outcome-based reporting, and administration.
The planning for the pilots shall engage
local public health officials, other health
promotion organizations and Board of Aging
staff, and explore the potential future use of
Title III Older American Act funds and other
nonstate funding.
 new text end

new text begin (d) No more than 16 percent of the SHIP
budget may be used for administration,
technical assistance, and state-level
evaluation costs.
 new text end

new text begin Statewide Cancer Surveillance System.
 new text end new text begin Of the general fund appropriation, $350,000
in fiscal year 2014 and $350,000 in fiscal
year 2015 are appropriated to develop and
implement a new cancer reporting system
under Minnesota Statutes, sections 144.671
to 144.69. Any information technology
development or support costs necessary
for the cancer surveillance system must
be incorporated into the agency's service
level agreement and paid to the Office of
Enterprise Technology.
 new text end

new text begin Eliminating Reproductive Health
Disparities. To the extent funds are
available for fiscal years 2014 and 2015
for grants provided pursuant to Minnesota
Statutes, section 145.928, the commissioner
may provide a grant to a Somali-based
organization located in Minnesota to
develop a reproductive health strategic
plan to eliminate reproductive health
disparities for Somali women. The plan shall
develop initiatives to provide educational
and information resources to health care
providers, community organizations, and
Somali women to ensure effective interaction
with Somali culture and western medicine
and the delivery of appropriate health care
services, and the achievement of better health
outcomes for Somali women. The plan must
engage health care providers, the Somali
community, and Somali health-centered
organizations. The commissioner shall
submit a report to the chairs and ranking
minority members of the senate and house
committees with jurisdiction over health
policy on the strategic plan developed under
this grant for eliminating reproductive health
disparities for Somali women. The report
must be submitted by February 15, 2014.
 new text end

new text begin TANF Appropriations. new text end new text begin (1) $1,156,000 of
the TANF funds is appropriated each year of
the biennium to the commissioner for family
planning grants under Minnesota Statutes,
section 145.925.
 new text end

new text begin (2) $3,579,000 of the TANF funds is
appropriated each year of the biennium to
the commissioner for home visiting and
nutritional services listed under Minnesota
Statutes, section 145.882, subdivision 7,
clauses (6) and (7). Funds must be distributed
to community health boards according to
Minnesota Statutes, section 145A.131,
subdivision 1.
 new text end

new text begin (3) $2,000,000 of the TANF funds is
appropriated each year of the biennium to
the commissioner for decreasing racial and
ethnic disparities in infant mortality rates
under Minnesota Statutes, section 145.928,
subdivision 7.
 new text end

new text begin (4) $4,978,000 of the TANF funds is
appropriated each year of the biennium to the
commissioner for the family home visiting
grant program according to Minnesota
Statutes, section 145A.17. $4,000,000 of the
funding must be distributed to community
health boards according to Minnesota
Statutes, section 145A.131, subdivision 1.
$978,000 of the funding must be distributed
to tribal governments based on Minnesota
Statutes, section 145A.14, subdivision 2a.
 new text end

new text begin (5) The commissioner may use up to 6.23
percent of the funds appropriated each fiscal
year to conduct the ongoing evaluations
required under Minnesota Statutes, section
145A.17, subdivision 7, and training and
technical assistance as required under
Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
 new text end

new text begin TANF Carryforward. new text end new text begin Any unexpended
balance of the TANF appropriation in the
first year of the biennium does not cancel but
is available for the second year.
 new text end

new text begin Subd. 3. new text end

new text begin Policy Quality and Compliance
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 9,400,000
 new text end 		new text begin 9,409,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 14,481,000
 new text end 		new text begin 16,548,000
 new text end
new text begin Health Care Access
 new text end 		new text begin 10,555,000
 new text end 		new text begin 9,986,000
 new text end

new text begin Base Level Adjustment. new text end new text begin The state
government special revenue fund base shall
be reduced by $2,000 in fiscal year 2017. The
health care access base shall be increased by
$600,000 in fiscal year 2015.
 new text end

new text begin Subd. 4. new text end

new text begin Health Protection
 new text end

new text begin Appropriations by Fund
 new text end
new text begin General
 new text end 		new text begin 9,503,000
 new text end 		new text begin 9,558,000
 new text end
new text begin State Government
Special Revenue
 new text end 		new text begin 32,775,000
 new text end 		new text begin 32,920,000
 new text end

new text begin Infectious Disease Laboratory. new text end new text begin Of the
general fund appropriation, $200,000 in
fiscal year 2014 and $200,000 in fiscal year
2015 are appropriated to the commissioner
to monitor infectious disease trends and
investigate infectious disease outbreaks.
 new text end

new text begin Surveillance for Elevated Blood Lead
Levels. Of the general fund appropriation,
$100,000 in fiscal year 2014 and $100,000
in fiscal year 2015 are appropriated to the
commissioner for the blood lead surveillance
system under Minnesota Statutes, section
144.9502.
 new text end

new text begin Newborn Screening. (a) $365,000 in fiscal
year 2014 and $349,000 in fiscal year 2015
are appropriated for the purpose of providing
support services to families as required
under Minnesota Statutes, section 144.966,
subdivision 3a.
new text end

new text begin (b) $164,000 in fiscal year 2014 and
$156,000 in fiscal year 2015 are appropriated
for home-based education in American Sign
Language for families with children who
are deaf or have hearing loss, as required
under Minnesota Statutes, section 144.966,
subdivision 3a.
 new text end

new text begin Sexual Violence Prevention. Within
available appropriations, by January 15,
2015, the commissioner must report to the
legislature on its activities to prevent sexual
violence, including activities to promote
coordination of existing state programs and
services to achieve maximum impact on
addressing the root causes of sexual violence.
 new text end

new text begin Safe Harbor for Sexually Exploited
Youth. (a) $1,000,000 in fiscal year 2014
and $1,000,000 in fiscal year 2015 are
for supportive service grants for the safe
harbor for sexually exploited youth program,
under Minnesota Statutes, section 145.4716,
including advocacy services, civil legal
services, health care services, mental and
chemical health services, education and
employment services, aftercare and relapse
prevention, and family reunification services.
This appropriation shall be added to the base.
 new text end

new text begin (b) $381,000 in fiscal year 2014 and
$381,000 in fiscal year 2015 are for
grants to six regional navigators under
Minnesota Statutes, section 145.4717. This
appropriation shall be added to the base.
 new text end

new text begin (c) $82,500 in fiscal year 2014 and $82,500
in fiscal year 2015 are for the director of
child sex trafficking prevention position.
This appropriation shall be added to the base.
 new text end

new text begin (d) $72,900 in fiscal year 2015 is for
program evaluation required under
Minnesota Statutes, section 145.4718. This
appropriation shall be added to the base.
 new text end

new text begin Base Level Adjustment. The state
government special revenue base is increased
by $6,000 in fiscal year 2016 and by $27,000
in fiscal year 2017.
 new text end

new text begin Subd. 5. new text end

new text begin Administrative Support Services
 new text end

new text begin 7,773,000
 new text end 		new text begin 7,774,000
 new text end

new text begin Regional Support for Local Public Health
Departments. new text end new text begin $350,000 in fiscal year
2014 and $350,000 in fiscal year 2015
are appropriated to the commissioner for
regional staff who provide specialized
expertise to local public health departments.
 new text end

Sec. 5.

new text begin HEALTH-RELATED BOARDS
 new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 17,224,000
 new text end 		new text begin $
 new text end 		new text begin 17,288,000
 new text end

new text begin This appropriation is from the state
government special revenue fund. The
amounts that may be spent for each purpose
are specified in the following subdivisions.
 new text end

new text begin Subd. 2. new text end

new text begin Board of Chiropractic Examiners
 new text end

new text begin 473,000
 new text end 		new text begin 477,000
 new text end

new text begin Subd. 3. new text end

new text begin Board of Dentistry
 new text end

new text begin 1,835,000
 new text end 		new text begin 1,850,000
 new text end

new text begin Health Professional Services Program. Of
this appropriation, $704,000 in fiscal year
2014 and $704,000 in fiscal year 2015 from
the state government special revenue fund are
for the health professional services program.
 new text end

new text begin Subd. 4. new text end

new text begin Board of Dietetic and Nutrition
Practice
 new text end

new text begin 112,000
 new text end 		new text begin 112,000
 new text end

new text begin Subd. 5. new text end

new text begin Board of Marriage and Family
Therapy
 new text end

new text begin 169,000
 new text end 		new text begin 170,000
 new text end

new text begin Subd. 6. new text end

new text begin Board of Medical Practice
 new text end

new text begin 3,883,000
 new text end 		new text begin 3,900,000
 new text end

new text begin Subd. 7. new text end

new text begin Board of Nursing
 new text end

new text begin 3,664,000
 new text end 		new text begin 3,692,000
 new text end

new text begin Subd. 8. new text end

new text begin Board of Nursing Home
Administrators
 new text end

new text begin 1,630,000
 new text end 		new text begin 1,586,000
 new text end

new text begin Administrative Services Unit - Operating
Costs. Of this appropriation, $676,000
in fiscal year 2014 and $626,000 in
fiscal year 2015 are for operating costs
of the administrative services unit. The
administrative services unit may receive
and expend reimbursements for services
performed by other agencies.
 new text end

new text begin Administrative Services Unit - Volunteer
Health Care Provider Program. Of this
appropriation, $150,000 in fiscal year 2014
and $150,000 in fiscal year 2015 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
 new text end

new text begin Administrative Services Unit - Contested
Cases and Other Legal Proceedings. Of
this appropriation, $200,000 in fiscal year
2014 and $200,000 in fiscal year 2015 are
for costs of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded
under this section. Upon certification of a
health-related board to the administrative
services unit that the costs will be incurred
and that there is insufficient money available
to pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval
of the commissioner of management and
budget. This appropriation does not cancel.
Any unencumbered and unspent balances
remain available for these expenditures in
subsequent fiscal years.
 new text end

new text begin new text begin Criminal Background Checks. new text end $390,000
each year from the state government special
revenue fund is for the Administrative
Support Services Unit for the implementation
of a criminal background check program.
 new text end

new text begin Subd. 9. new text end

new text begin Board of Optometry
 new text end

new text begin 108,000
 new text end 		new text begin 108,000
 new text end

new text begin Subd. 10. new text end

new text begin Board of Pharmacy
 new text end

new text begin 2,362,000
 new text end 		new text begin 2,380,000
 new text end

new text begin Prescription Electronic Reporting. Of
this appropriation, $356,000 in fiscal year
2014 and $356,000 in fiscal year 2015 from
the state government special revenue fund
are to the board to operate the prescription
electronic reporting system in Minnesota
Statutes, section 152.126.
 new text end

new text begin Subd. 11. new text end

new text begin Board of Physical Therapy
 new text end

new text begin 348,000
 new text end 		new text begin 351,000
 new text end

new text begin Subd. 12. new text end

new text begin Board of Podiatry
 new text end

new text begin 76,000
 new text end 		new text begin 77,000
 new text end

new text begin Subd. 13. new text end

new text begin Board of Psychology
 new text end

new text begin 853,000
 new text end 		new text begin 861,000
 new text end

new text begin Subd. 14. new text end

new text begin Board of Social Work
 new text end

new text begin 1,061,000
 new text end 		new text begin 1,069,000
 new text end

new text begin Subd. 15. new text end

new text begin Board of Veterinary Medicine
 new text end

new text begin 232,000
 new text end 		new text begin 234,000
 new text end

new text begin Subd. 16. new text end

new text begin Board of Behavioral Health and
Therapy
 new text end

new text begin 418,000
 new text end 		new text begin 421,000
 new text end

Sec. 6. new text begin EMERGENCY MEDICAL SERVICES
REGULATORY BOARD
new text end

new text begin $
 new text end 		new text begin 2,749,000
 new text end 		new text begin $
 new text end 		new text begin 2,756,000
 new text end

new text begin Regional Grants. $585,000 in fiscal year
2014 and $585,000 in fiscal year 2015 are
for regional emergency medical services
programs, to be distributed equally to the
eight emergency medical service regions.
 new text end

new text begin Cooper/Sams Volunteer Ambulance
Program. new text end new text begin $700,000 in fiscal year 2014 and
$700,000 in fiscal year 2015 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
 new text end

new text begin (a) Of this amount, $611,000 in fiscal year
2014 and $611,000 in fiscal year 2015
are for the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.
 new text end

new text begin (b) Of this amount, $89,000 in fiscal year
2014 and $89,000 in fiscal year 2015 are
for the operations of the ambulance service
personnel longevity award and incentive
program under Minnesota Statutes, section
144E.40.
 new text end

new text begin Ambulance Training Grant. $361,000 in
fiscal year 2014 and $361,000 in fiscal year
2015 are for training grants.
 new text end

new text begin EMSRB Board Operations. $1,095,000 in
fiscal year 2014 and $1,095,000 in fiscal year
2015 are for operations.
 new text end

Sec. 7. new text begin COUNCIL ON DISABILITY
new text end

new text begin $
 new text end 		new text begin 618,000
 new text end 		new text begin $
 new text end 		new text begin 622,000
 new text end

Sec. 8. new text begin OMBUDSMAN FOR MENTAL
HEALTH AND DEVELOPMENTAL
DISABILITIES
new text end

new text begin $
 new text end 		new text begin 1,668,000
 new text end 		new text begin $
 new text end 		new text begin 1,680,000
 new text end

Sec. 9. new text begin OMBUDSPERSON FOR FAMILIES
new text end

new text begin $
 new text end 		new text begin 336,000
 new text end 		new text begin $
 new text end 		new text begin 339,000
 new text end

Sec. 10.

Minnesota Statutes 2012, section 256.01, subdivision 34, is amended to read:


Subd. 34.

Federal administrative reimbursement dedicated.

Federal
administrative reimbursement resulting from the following activities is appropriated to the
commissioner for the designated purposes:

(1) reimbursement for the Minnesota senior health options project; deleted text begin and
deleted text end

(2) reimbursement related to prior authorization and inpatient admission certification
by a professional review organization. A portion of these funds must be used for activities
to decrease unnecessary pharmaceutical costs in medical assistancedeleted text begin .deleted text end new text begin ; and
new text end

new text begin (3) reimbursement resulting from the federal child support grant expenditures
authorized under United States Code, title 42, section 1315.
 new text end

Sec. 11.

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


new text begin Subd. 35. new text end

new text begin Federal reimbursement for privatized adoption grants. new text end

new text begin Federal
reimbursement for privatized adoption grant and foster care recruitment grant expenditures
is appropriated to the commissioner for adoption grants and foster care and adoption
administrative purposes.
 new text end

Sec. 12.

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


new text begin Subd. 36. new text end

new text begin DHS receipt center accounting. new text end

new text begin The commissioner may transfer
appropriations to, and account for DHS receipt center operations in, the special revenue
fund.
 new text end

Sec. 13. new text begin TRANSFERS.
new text end

new text begin Subdivision 1. new text end

new text begin Grants. new text end

new text begin The commissioner of human services, with the approval of
the commissioner of management and budget, may transfer unencumbered appropriation
balances for the biennium ending June 30, 2015, within fiscal years among the MFIP,
general assistance, general assistance medical care under Minnesota Statutes 2009
Supplement, section 256D.03, subdivision 3, medical assistance, MinnesotaCare, MFIP
child care assistance under Minnesota Statutes, section 119B.05, Minnesota supplemental
aid, group residential housing programs, the entitlement portion of the chemical
dependency consolidated treatment fund, and between fiscal years of the biennium. The
commissioner shall inform the chairs and ranking minority members of the senate Health
and Human Services Finance Division and the house of representatives Health and Human
Services Finance Committee quarterly about transfers made under this provision.
 new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin Positions, salary money, and nonsalary administrative
money may be transferred within the Departments of Human Services and Health as the
commissioners consider necessary, with the advance approval of the commissioner of
management and budget. The commissioner shall inform the chairs and ranking minority
members of the senate Health and Human Services Finance Division and the house of
representatives Health and Human Services Finance Committee quarterly about transfers
made under this provision.
 new text end

Sec. 14. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end

new text begin The commissioners of health and human services shall not use indirect cost
allocations to pay for the operational costs of any program for which they are responsible.
 new text end

Sec. 15. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2015, unless a
different expiration date is explicit.
 new text end

Sec. 16. new text begin EFFECTIVE DATE.
new text end

new text begin This article is effective July 1, 2013, unless a different effective date is specified.
 new text end

ARTICLE 15

HUMAN SERVICES CONTINGENT APPROPRIATIONS

Section 1. new text begin HUMAN SERVICES APPROPRIATIONS.new text end

new text begin The sums shown in the columns marked "Appropriations" are added to or, if shown
in parentheses, subtracted from the appropriations in article 14 to the agencies and for the
purposes specified in this article. The appropriations are from the general fund or other
named fund and are available for the fiscal years indicated for each purpose. The figures
"2014" and "2015" used in this article mean that the addition to or subtraction from the
appropriation listed under them is available for the fiscal year ending June 30, 2014, or
June 30, 2015, respectively. Supplemental appropriations and reductions to appropriations
for the fiscal year ending June 30, 2014, are effective the day following final enactment
unless a different effective date is explicit.
 new text end

new text begin APPROPRIATIONS
 new text end
new text begin Available for the Year
 new text end
new text begin Ending June 30
 new text end
new text begin 2014
 new text end 		new text begin 2015
 new text end

Sec. 2.

new text begin COMMISSIONER OF HUMAN
SERVICES
 new text end

new text begin Subdivision 1. new text end

new text begin Total Appropriation
 new text end

new text begin $
 new text end 		new text begin 1,906,000
 new text end 		new text begin $
 new text end 		new text begin 2,047,000
 new text end
new text begin Appropriations by Fund
 new text end
new text begin 2014
 new text end 		new text begin 2015
 new text end
new text begin General
 new text end 		new text begin 1,906,000
 new text end 		new text begin 2,047,000
 new text end

new text begin Reform 2020 Contingency. The
appropriation from the general fund may
be adjusted as provided in article 2, section
49, in order to implement Reform 2020 and
systems modernization.
 new text end

new text begin Subd. 2. new text end

new text begin Central Office Operations
 new text end

new text begin (a) Operations
 new text end 		new text begin 3,384,000
 new text end 		new text begin 14,506,000
 new text end

new text begin Systems Modernization Transfer. If
contingent funding is fully or partially
disbursed as provided in article 2, section 49,
and transferred to the state systems account,
the unexpended balance of that appropriation
must be transferred to the Office of Enterprise
Technology in accordance with clause (2)
of the systems modernization provision in
article 14. Contingent funding under this
provision must not exceed $16,992,000 for
the biennium.
 new text end

new text begin (b) Children and Families
 new text end 		new text begin 109,000
 new text end 		new text begin 206,000
 new text end
new text begin (c) Health Care
 new text end 		new text begin 100,000
 new text end 		new text begin 100,000
 new text end
new text begin (d) Continuing Care
 new text end 		new text begin 5,236,000
 new text end 		new text begin 5,541,000
 new text end

new text begin Subd. 3. new text end

new text begin Forecasted Programs
 new text end

new text begin (a) Group Residential Housing
 new text end 		new text begin (1,166,000)
 new text end 		new text begin (8,602,000)
 new text end
new text begin (b) Medical Assistance
 new text end 		new text begin (3,770,000)
 new text end 		new text begin (10,086,000)
 new text end
new text begin (c) Alternative Care
 new text end 		new text begin (6,981,000)
 new text end 		new text begin (4,394,000)
 new text end

new text begin Subd. 4. new text end

new text begin Grant Programs
 new text end

new text begin (a) Child and Community Services Grants
 new text end 		new text begin 3,000,000
 new text end 		new text begin 3,000,000
 new text end
new text begin (b) Aging and Adult Services Grants
 new text end 		new text begin 1,430,000
 new text end 		new text begin 1,237,000
 new text end
new text begin (c) Disability Grants
 new text end 		new text begin 564,000
 new text end 		new text begin 539,000
 new text end