Minnesota Session Laws - 1986, Regular Session

  

                         Laws of Minnesota 1986 

                        CHAPTER 394-S.F.No. 0912 
           An act relating to human services; providing regional 
          treatment center revolving fund for chemical 
          dependency; creating a consolidated fund for payment 
          of chemical dependency treatment; appropriating money 
          to counties for treatment; providing for client 
          eligibility, vendor eligibility, and state 
          collections; providing for American Indian special 
          funding; removing chemical dependency treatment from 
          medical assistance, general assistance medical care, 
          and general assistance funding; amending Minnesota 
          Statutes 1984, sections 246.04; 246.18; 246.50, by 
          adding a subdivision; 246.51, subdivision 1; 256B.70; 
          and 256E.08, subdivision 7; amending Minnesota 
          Statutes 1985 Supplement, sections 246.23; 246.54; 
          256B.02, subdivision 8; and 256D.03, subdivision 4; 
          proposing coding for new law in Minnesota Statutes, 
          chapter 246; and proposing coding for new law as 
          Minnesota Statutes, chapter 254B. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1984, section 246.04, is 
amended to read: 
    246.04 [BOOKS AND ACCOUNTS.] 
    The commissioner of human services shall keep at his office 
a proper and complete system of books and accounts with each 
institution, showing every expenditure authorized and made 
therefor.  Such books shall contain a separate account of each 
extraordinary or special appropriation made by the legislature, 
with every item of expenditure therefrom.  The commissioner 
shall maintain a separate fund for all chemical dependency 
appropriations that will provide for an ascertainable review of 
receipts and expenditures under section 246.18, subdivision 2. 
    Sec. 2.  Minnesota Statutes 1984, section 246.18, is 
amended to read: 
    246.18 [DISPOSAL OF FUNDS.] 
    Subdivision 1.  [GENERALLY.] Except as provided in 
subdivision 2, every officer and employee of the several 
institutions under the jurisdiction of the commissioner of human 
services shall pay to the accounting officer thereof any funds 
in his hands belonging to the institution.  Every accounting 
officer, at the close of each month or oftener, shall forward to 
the commissioner of human services a statement of the amount and 
sources of all moneys received.  On receipt of such statement, 
the commissioner shall transmit the same to the commissioner of 
finance, who shall deliver to the state treasurer a draft upon 
the accounting officer for the same specifying the funds to 
which it is to be credited.  Upon payment of such draft, the 
amount shall be so credited.  
    Subd. 2.  [CHEMICAL DEPENDENCY FUND.] Money received by a 
chemical dependency treatment facility operated by a regional 
treatment center or nursing home under the jurisdiction of the 
commissioner of human services must be deposited in the state 
treasury and credited to a chemical dependency fund.  Money in 
the chemical dependency fund is appropriated to the commissioner 
to operate chemical dependency programs. 
    Subd. 3.  [CHEMICAL DEPENDENCY ACCOUNTS.] The commissioner 
of finance shall provide technical assistance and accounting 
procedures for separate interest bearing chemical dependency 
accounts within the chemical dependency fund for each state 
facility providing chemical dependency services that will allow 
money to be readily available to finance chemical dependency 
programs.  After June 30, 1992, the commissioner must not 
allocate money to a state facility for chemical dependency 
programs in excess of the amount of deposits of money received 
by the facility and deposited in the facility's chemical 
dependency account without the approval of the governor after 
consultation with the legislative advisory commission, except 
that before June 30, 1992, the commissioner may transfer or 
supplement funds in chemical dependency accounts to cover any 
revenue shortfall in a particular regional treatment center 
chemical dependency program.  Twenty percent of the money in the 
chemical dependency fund that was reappropriated from the 
regional treatment center account must be transferred to the 
regional treatment centers' chemical dependency accounts on a 
pro rata basis as an advance payment for chemical dependency 
services to be delivered under sections 8 to 16.  
    Sec. 3.  Minnesota Statutes 1985 Supplement, section 
246.23, is amended to read: 
    246.23 [PERSONS ADMISSIBLE TO STATE HOSPITALS REGIONAL 
TREATMENT CENTERS.] 
    No person who has not a settlement in a county, as defined 
in section 256D.18, shall be admitted to a state hospital 
regional treatment center for persons with mental illness, 
mental retardation, or chemical dependency, except that the 
commissioner of human services may authorize admission thereto 
when the residence cannot be ascertained, or when the 
circumstances in his judgment make it advisable.  Except for 
emergency admissions under sections 253B.05 and 253B.11, or when 
authorized by the commissioner, a chemical dependency program 
must not admit a chemically dependent person unless the cost of 
services will be paid for by private money or nongovernmental 
third-party payments, the person has been placed by a county or 
a federally recognized tribal unit that is responsible for 
payment, or the regional treatment center obtains approval of 
the admission from the county financially responsible for the 
person.  The commissioner shall maintain and enhance cooperative 
and effective relationships between counties and regional 
treatment centers and between the various regional treatment 
center chemical dependency programs.  In carrying out this 
responsibility the commissioner shall maintain a regionally 
based, state administered system of chemical dependency programs.
When application is made to a judge of probate for admission to 
any of the state hospitals regional treatment centers above 
named for admission thereto, if he finds that the person for 
whom application is made has not such residence, or that his 
residence cannot be ascertained, he shall so report to the 
commissioner; and he may recommend that such person be admitted 
notwithstanding, giving his reasons therefor.  The commissioner 
of human services shall thereupon investigate the question of 
residence and, if he finds that such person has not such 
residence and has a legal residence in another state or country, 
he may cause him to be returned thereto at the expense of this 
state.  
    Sec. 4.  Minnesota Statutes 1984, section 246.50, is 
amended by adding a subdivision to read:  
    Subd. 9.  "Chemical dependency programs" means all planned 
services for chemically dependent persons provided by the 
commissioner in a specific regional treatment center, the 
chemical dependency unit operated by the Ah-Gwah-Ching nursing 
home, and diagnostic evaluation, prevention, referral, 
outpatient, or aftercare services developed as part of licensed 
residential or nonresidential chemical dependency treatment 
programs. 
    Sec. 5.  Minnesota Statutes 1984, section 246.51, 
subdivision 1, is amended to read:  
    Subdivision 1.  [PROCEDURES.] The commissioner shall make 
investigation as necessary to determine, and as circumstances 
require redetermine, what part of the cost of care, if any, the 
patient is able to pay.  If the patient is unable to pay the 
full cost of care the commissioner shall make a determination as 
to the ability of the relatives to pay.  The patient or 
relatives or both shall provide the commissioner documents and 
proofs necessary to determine their ability to pay.  Failure to 
provide the commissioner with sufficient information to 
determine ability to pay may make the patient or relatives, 
both, liable for the full per capita cost of care until the time 
when sufficient information is provided.  No parent shall be 
liable for the cost of care given a patient at a state hospital 
regional treatment center after the patient has reached the age 
of 18 years.  The commissioner's determination shall be 
conclusive in any action to enforce payment of the cost of care 
unless appealed from as provided in section 246.55.  All money 
received, except for chemical dependency receipts, shall be paid 
to the state treasurer and placed in the general fund of the 
state and a separate account kept of it.  Responsibility under 
this section shall not apply to those relatives having gross 
earnings of less than $11,000 per year.  
    Sec. 6.  Minnesota Statutes 1985 Supplement, section 
246.54, is amended to read: 
    246.54 [LIABILITY OF COUNTY; REIMBURSEMENT.] 
    Except for chemical dependency services provided under 
sections 8 to 16, the patient's or resident's county shall pay 
to the state of Minnesota a portion of the cost of care provided 
in a state hospital regional treatment center to a patient or 
resident legally settled in that county.  A county's payment 
shall be made from the county's own sources of revenue and 
payments shall be paid as follows:  payments to the state from 
the county shall equal ten percent of the per capita rate, as 
determined by the commissioner, for each day, or the portion 
thereof, that the patient or resident spends at a state hospital 
regional treatment center.  If payments received by the state 
under sections 246.50 to 246.53 exceed 90 percent of the per 
capita rate, the county shall be responsible for paying the 
state only the remaining amount.  The county shall not be 
entitled to reimbursement from the patient or resident, the 
patient's or resident's estate, or from the patient's or 
resident's relatives, except as provided in section 246.53.  No 
such payments shall be made for any patient or resident who was 
last committed prior to July 1, 1947.  
    Sec. 7.  [246.64] [CHEMICAL DEPENDENCY SERVICE AGREEMENTS.] 
    Subdivision 1.  [CHEMICAL DEPENDENCY RATES.] 
Notwithstanding sections 246.50, subdivision 5; 246.511; and 
251.011, the commissioner shall establish separate rates for 
each chemical dependency service operated by the commissioner 
and may establish separate rates for each service component 
within the program by establishing fees for services or 
different per diem rates for each separate chemical dependency 
unit within the program based on actual costs attributable to 
the service or unit.  The rate must allocate the cost of all 
anticipated maintenance, treatment, and expenses including 
depreciation of buildings and equipment, interest paid on bonds 
issued for capital improvements for chemical dependency 
programs, reimbursement and other indirect costs related to the 
operation of chemical dependency programs other than that paid 
from the Minnesota state building fund, and losses due to bad 
debt.  The rate must not include allocations of chaplaincy, 
patient advocacy, or quality assurance costs that are not 
required for chemical dependency licensure by the commissioner 
or certification for chemical dependency by the Joint Commission 
on Accreditation of Hospitals.  Notwithstanding any other law, 
the commissioner shall treat these costs as nonhospital 
department expenses. 
    Subd. 2.  [DEPRECIATION COLLECTIONS.] Beginning July 1, 
1987, depreciation collected under subdivision 1 must be 
credited to the general fund and principal and interest on the 
bonded debt collected under subdivision 1 must be deposited in 
the state bond fund. 
    Subd. 3.  [RESPONSIBILITIES OF COMMISSIONER.] The 
commissioner shall credit all receipts from billings for rates 
set in subdivision 1, except those credited according to 
subdivision 2, to the chemical dependency fund.  This money must 
not be used for a regional treatment center activity that is not 
a chemical dependency service or an allocation of expenditures 
that are included in the base for computation of the rates under 
subdivision 1.  The commissioner may expand chemical dependency 
services so long as expenditures are recovered by patient fees, 
transfer of funds, or supplementary appropriations.  The 
commissioner may expand or reduce chemical dependency staff 
complement as long as expenditures are recovered by patient 
fees, transfer of funds, or supplementary appropriations.  An 
increase or decrease in chemical dependency staff shall not 
result in an increase or decrease in staff in any facility or 
unit not providing chemical dependency services.  
Notwithstanding chapters 176 and 268, the commissioner shall 
provide for the self-insurance of regional treatment center 
chemical dependency programs for the costs of unemployment 
compensation and workers' compensation claims.  The commissioner 
shall provide a biennial report to the chairs of the senate 
finance subcommittee on health and human services, the house of 
representatives human services division of appropriations, and 
the senate and house of representatives health and human 
services committees.  
     Subd. 4.  [TRADE SECRET INFORMATION.] Notwithstanding any 
law to the contrary, data concerning matters affecting the 
competitive position of the chemical dependency programs is 
"trade secret information" for purposes of classification under 
section 13.37, subdivision 2.  
    Sec. 8.  [254B.01] [DEFINITIONS.] 
    Subdivision 1.  [APPLICABILITY.] The definitions in this 
section apply to sections 8 to 20. 
    Subd. 2.  [AMERICAN INDIAN.] For purposes of services 
provided under section 16, subdivision 7, "American Indian" 
means a person who is a member of an Indian tribe, and the 
commissioner shall use the definitions of "Indian" and "Indian 
tribe" and "Indian organization" provided in Public Law Number 
93-638.  For purposes of services provided under section 16, 
subdivision 4, "American Indian" means a resident of federally 
recognized tribal lands who is recognized as an Indian person by 
the federally recognized tribal governing body. 
    Subd. 3.  [CHEMICAL DEPENDENCY SERVICES.] "Chemical 
dependency services" means a planned program of care for the 
treatment of chemical dependency or chemical abuse to minimize 
or prevent further chemical abuse by the person.  Diagnostic, 
evaluation, prevention, referral, detoxification, and aftercare 
services that are not part of a program of care licensable as a 
residential or nonresidential chemical dependency treatment 
program are not chemical dependency services for purposes of 
this section. 
    Subd. 4.  [COMMISSIONER.] Unless otherwise indicated, 
"commissioner" means the commissioner of human services. 
    Subd. 5.  [LOCAL AGENCY.] "Local agency" means the agency 
designated by a board of county commissioners or a human 
services board to make placements and submit state invoices 
according to sections 8 to 20. 
    Subd. 6.  [LOCAL MONEY.] "Local money" means county levies, 
community social services block grants, federal social services 
money, or other money that may be spent at county discretion to 
provide chemical dependency services eligible for payment 
according to sections 8 to 20. 
    Sec. 9.  [254B.02] [CHEMICAL DEPENDENCY ALLOCATION 
PROCESS.] 
    Subdivision 1.  [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.] 
The commissioner shall annually divide the money available in 
the chemical dependency fund that is not held in reserve by 
counties from a previous allocation.  Twelve percent of the 
money must be reserved for treatment of American Indians by 
eligible vendors under section 12.  The remainder of the money 
must be allocated among the counties according to the following 
formula, using state demographer data and other data sources 
determined by the commissioner: 
    (a) The county non-Indian and over age 14 per capita-months 
of eligibility for aid to families with dependent children, 
general assistance, and medical assistance is divided by the 
total state non-Indian and over age 14 per capita-months of 
eligibility to determine the caseload factor for each county. 
    (b) The average median family income for the previous three 
years for the state is divided by the average median family 
income for the previous three years for each county to determine 
the income factor.  
    (c) The non-Indian and over age 14 population of the county 
is multiplied by the sum of the income factor and the caseload 
factor to determine the adjusted population.  
    (d) $15,000 shall be allocated to each county.  
    (e) The remaining funds shall be allocated proportional to 
the county adjusted population. 
    Subd. 2.  [COUNTY ADJUSTMENT; MAXIMUM ALLOCATION.] The 
commissioner shall determine the state money used by each county 
in fiscal year 1986, using all state data sources.  If available 
records do not provide specific chemical dependency expenditures 
for every county, the commissioner shall determine the amount of 
state money using estimates based on available data.  In state 
fiscal year 1988, a county must not be allocated more than 150 
percent of the state money spent by or on behalf of the county 
for chemical dependency treatment services eligible for payment 
under section 12.  The allocation maximums must be increased by 
25 percent each year.  After fiscal year 1992, there must be no 
allocation maximum.  The commissioner shall reallocate the 
excess over the maximum to counties allocated less than the 
fiscal year 1986 state money, using the following process: 
    (a) The allocation is divided by 1985 state expenditures to 
determine percentage of prior expenditure, and counties are 
ranked by percentage of prior expenditure. 
    (b) The allocation of the lowest ranked county is raised to 
the same percentage of prior expenditure as the second lowest 
ranked county.  The allocation of these two counties is then 
raised to the percentage of prior expenditures of the third 
lowest ranked county. 
    (c) The operations under paragraph (b) are repeated with 
each county by ranking until the money in excess of the 
allocation maximum has been allocated. 
     Subd. 3.  [RESERVE ACCOUNT.] The commissioner shall 
allocate money from the reserve account to counties that, during 
the current fiscal year, have met or exceeded the base level of 
expenditures for eligible chemical dependency services from 
local money.  The commissioner shall establish the base level 
for fiscal year 1988 as the amount of local money used for 
eligible services in calendar year 1986.  In later years, the 
base level must be increased in the same proportion as state 
appropriations to implement sections 8 to 20 are increased.  The 
base level must not be decreased if appropriations are decreased 
in later years.  The local match rate for the reserve account is 
the same rate as applied to the initial allocation.  Reserve 
account payments must not be included when calculating the 
county adjustments made according to subdivision 2. 
    Subd. 4.  [ALLOCATION SPENDING LIMITS.] Money allocated 
according to subdivision 1 and section 16, subdivision 4, is 
available for payments for up to two years.  The commissioner 
shall deduct payments from the most recent year allocation in 
which money is available.  Allocations under this section that 
are not used within two years must be reallocated to the reserve 
account for payments under subdivision 3.  Allocations under 
section 16, subdivision 4, that are not used within two years 
must be reallocated for payments under section 16, subdivision 5.
    Subd. 5.  [ADMINISTRATIVE ADJUSTMENT.] The commissioner may 
make payments to local agencies from money allocated under this 
section to support administrative activities under sections 10 
and 11.  The administrative payment must not exceed five percent 
of the first $50,000, four percent of the next $50,000, and 
three percent of the remaining county allocation and must not be 
paid if the level of expenditures indicates that the allocation 
for the year will be exhausted by payments for services from the 
allocation.  Twenty-five percent of the administrative allowance 
shall be advanced at the beginning of each year and remaining 
payments must be made under this section at the end of each 
quarter from any unspent allocation for that year. 
    Sec. 10.  [254B.03] [RESPONSIBILITY TO PROVIDE CHEMICAL 
DEPENDENCY TREATMENT.] 
    Subdivision 1.  [LOCAL AGENCY DUTIES.] (a) Every local 
agency shall provide chemical dependency services to persons 
residing within its jurisdiction who meet criteria established 
by the commissioner for placement in a chemical dependency 
residential or nonresidential treatment service.  Chemical 
dependency money must be administered by the local agencies 
according to law and rules adopted by the commissioner under 
sections 14.01 to 14.69. 
    (b) In order to contain costs, the county board shall, with 
the approval of the commissioner of human services, select 
eligible vendors of chemical dependency services who can provide 
economical and appropriate treatment.  Unless the local agency 
is a social services department directly administered by a 
county or human services board, the local agency shall not be an 
eligible vendor under section 12.  The commissioner may approve 
proposals from county boards to provide services in an 
economical manner or to control utilization, with safeguards to 
ensure that necessary services are provided.  If a county 
implements a demonstration or experimental medical services 
funding plan, the commissioner shall transfer the money as 
appropriate. 
    Subd. 2.  [CHEMICAL DEPENDENCY SERVICES.] (a) Payment from 
the chemical dependency fund is limited to payments for services 
other than detoxification that, if located outside of federally 
recognized tribal lands, would be required to be licensed by the 
commissioner as a residential or nonresidential treatment 
program under sections 245.781 to 245.812.  Hospitals may apply 
for and receive licenses to be eligible vendors, notwithstanding 
the provisions of section 245.791.  Vendors receiving payments 
from the chemical dependency fund must not require copayment 
from a recipient of benefits for services provided under this 
subdivision. 
    (b) A county may, from its own resources, provide chemical 
dependency services for which state payments are not made. 
    (c) The commissioner shall coordinate chemical dependency 
services and determine whether there is a need for any proposed 
expansion of chemical dependency treatment services.  The 
commissioner shall deny vendor certification to any provider 
that has not received prior approval from the commissioner for 
the creation of new programs or the expansion of existing 
program capacity.  The commissioner shall consider the 
provider's capacity to obtain clients from outside the state 
based on plans, agreements, and previous utilization history, 
when determining the need for new treatment services. 
    Subd. 3.  [LOCAL AGENCIES TO PAY STATE FOR COUNTY 
SHARE.] Local agencies shall submit invoices to the state on 
forms supplied by the commissioner and according to procedures 
established by the commissioner.  Local agencies shall pay the 
state for the county share of the invoiced services. 
    Subd. 4.  [DIVISION OF COSTS.] The county shall, out of 
local money, reimburse the state for 15 percent of the cost of 
chemical dependency services costs paid by the state under this 
section.  Counties may use the indigent hospitalization levy for 
treatment and hospital payments made under this section.  
Fifteen percent of any state collections from private or 
third-party pay must be distributed to the county that paid for 
the treatment under this section.  If all funds allocated 
according to section 9 are exhausted by a county and the county 
has met or exceeded the base level of expenditures under section 
9, subdivision 3, the county shall reimburse the state for 15 
percent of the costs paid by the state under this section.  The 
commissioner may refuse to pay state funds for services to 
persons not eligible under section 11, subdivision 1, if the 
commissioner determines that funds will otherwise not be 
available for persons who are entitled to chemical dependency 
fund services. 
    Subd. 5.  [RULES; APPEAL.] The commissioner shall adopt 
rules as necessary to implement sections 8 to 20.  The 
commissioner shall establish an appeals process for use by 
vendors or recipients when services certified by the county are 
disputed.  The commissioner shall adopt rules and standards for 
the appeal process to assure adequate redress for persons 
referred to inappropriate services. 
    Subd. 6.  [PILOT PROJECTS.] The commissioner may transfer 
funds for chemical dependency services from the general fund 
appropriations for the general assistance, general assistance 
medical care, and medical assistance programs for pilot projects 
to design and test procedures legislation.  The commissioner 
shall exempt funds from these sources that are used in pilot 
projects from relevant provisions of state laws and rules 
governing the use of these funds.  The commissioner may make 
grants and contracts for this purpose, and the provisions of 
chapter 14 shall not apply to the procedures and criteria used 
to implement pilot projects.  The commissioner shall submit a 
detailed plan of the proposed pilot project to the chair of the 
health and human services subcommittees of the senate finance 
committee and the chair of the human services division of the 
house appropriations committee for review prior to the 
implementation of the pilot project. 
    Subd. 7.  [COMMISSIONER REVIEW; COMPLAINTS.] The 
commissioner shall:  
    (1) provide training and assistance to counties on 
procedures for processing placements and making payments; 
    (2) visit facilities and review records as necessary to 
determine compliance with procedures established by law and rule;
    (3) take complaints from vendors and recipients and 
investigate county placement activities as needed to determine 
compliance with law and rule. 
     Counties and vendors shall make regular reports as required 
by the commissioner to facilitate commissioner review.  
    Subd. 8.  [REPORT TO LEGISLATURE.] The commissioner shall 
report to the legislature each biennium beginning in 1989 on 
chemical dependency services provided and expenditures made, and 
shall make recommendations regarding funding levels and new 
legislation. 
    Sec. 11.  [254B.04] [ELIGIBILITY FOR CHEMICAL DEPENDENCY 
FUND SERVICES.] 
    Subdivision 1.  [ELIGIBILITY.] Persons eligible for 
benefits under sections 256D.01 to 256D.21 and persons eligible 
for federal health care benefits under section 256B.06 are 
entitled to chemical dependency fund services. 
    Subd. 2.  [AMOUNT OF CONTRIBUTION.] The commissioner shall 
adopt a sliding fee scale to determine the amount of 
contribution to be required from persons whose income and 
nonexempt property are greater than the standard of assistance 
under sections 256B.06 and 256D.01 to 256D.21.  The commissioner 
may adopt an existing fee scale from another assistance program 
or from the state facilities by publication in the state 
register.  The fee scale must not provide assistance to persons 
whose income is more than 115 percent of the state median 
income.  Payments of liabilities under this section are medical 
expenses for purposes of determining spend-down under sections 
256B.06 and 256D.01 to 256D.21. 
    Sec. 12.  [254B.05] [VENDOR ELIGIBILITY.] 
    Programs licensed by the commissioner are eligible vendors. 
Hospitals may apply for and receive licenses to be eligible 
vendors, notwithstanding the provisions of section 245.791.  
American Indian programs that, if located outside of federally 
recognized tribal lands, would be required to be licensed to 
provide chemical dependency primary treatment, extended care, 
transitional residence, or outpatient treatment services, are 
eligible vendors.  Detoxification programs are not eligible 
vendors.  Programs that, if located outside of federally 
recognized tribal lands, would not be licensed as a chemical 
dependency residential or nonresidential treatment program under 
sections 245.781 to 245.812 are not eligible vendors.  To be 
eligible for payment under the Consolidated Chemical Dependency 
Treatment Fund, a vendor must participate in the Drug and 
Alcohol Abuse Normative Evaluation System or a comparable system 
approved by the commissioner.  
    Sec. 13.  [254B.06] [REIMBURSEMENT; PAYMENT; DENIAL.] 
    Subdivision 1.  [STATE COLLECTIONS.] The commissioner is 
responsible for all collections from persons determined to be 
partially responsible for the cost of care of an eligible person 
receiving services under sections 8 to 20.  The commissioner may 
collect all third-party payments for chemical dependency 
services provided under sections 8 to 20, including private 
insurance and federal medicaid and medicare financial 
participation.  The commissioner shall deposit in the general 
fund a percentage of collections to pay for the cost of billing 
and collections.  The remaining receipts must be deposited in 
the chemical dependency fund. 
    Subd. 2.  [ALLOCATION OF COLLECTIONS.] The commissioner 
shall allocate all federal financial participation collections 
to the reserve fund under section 9, subdivision 3.  The 
commissioner shall retain 85 percent of patient payments and 
third-party payments and allocate the collections to the 
treatment allocation for the county that is financially 
responsible for the person.  Fifteen percent of patient and 
third-party payments must be paid to the county financially 
responsible for the patient.  Collections for patient payment 
and third-party payment for services provided under section 16 
shall be allocated to the allocation of the tribal unit which 
placed the person.  Collections of federal financial 
participation for services provided under section 16 shall be 
allocated to the tribal reserve account under section 16, 
subdivision 5. 
    Subd. 3.  [PAYMENT; DENIAL.] The commissioner shall pay 
eligible vendors for placements made by local agencies under 
section 10, subdivision 1, and placements by tribal designated 
agencies according to section 16.  The commissioner may reduce 
or deny payment of the state share when services are not 
provided according to the placement criteria established by the 
commissioner.  The commissioner may pay for all or a portion of 
improper county chemical dependency placements and bill the 
county for the entire payment made when the placement did not 
comply with criteria established by the commissioner. 
    Sec. 14.  [254B.07] [THIRD-PARTY LIABILITY.] 
    The state agency provision and payment of, or liability 
for, chemical dependency medical care is the same as in section 
256B.042. 
    Sec. 15.  [254B.08] [FEDERAL WAIVERS.] 
    The commissioner shall apply for any federal waivers 
necessary to secure, to the extent allowed by law, federal 
financial participation for the provision of services to persons 
who need chemical dependency services.  The commissioner may 
seek amendments to the waivers or apply for additional waivers 
to contain costs.  The commissioner shall ensure that payment 
for the cost of providing chemical dependency services under the 
federal waiver plan does not exceed the cost of chemical 
dependency services that would have been provided without the 
waivered services.  
    Sec. 16.  [254B.09] [INDIAN RESERVATION ALLOCATION OF 
CHEMICAL DEPENDENCY FUND.] 
    Subdivision 1.  [AMERICAN INDIAN CHEMICAL DEPENDENCY 
ACCOUNT.] The commissioner shall pay eligible vendors for 
chemical dependency services to American Indians on the same 
basis as other payments, except that no local match is required 
when an invoice is submitted by the governing authority of a 
federally recognized American Indian tribal body on behalf of a 
current resident of the reservation under this section. 
    Subd. 2.  [AMERICAN INDIAN AGREEMENTS.] The commissioner 
may enter into agreements with federally recognized tribal units 
to pay for chemical dependency treatment services provided under 
sections 8 to 20.  The agreements must require the governing 
body of the tribal unit to fulfill all county responsibilities 
regarding the form and manner of invoicing, and provide that 
only invoices for eligible vendors according to section 12 will 
be included in invoices sent to the commissioner for payment, to 
the extent that money allocated under subdivisions 3, 4, and 5 
is used. 
    Subd. 3.  [TRIBAL NONPARTICIPATION.] If a federally 
recognized tribal governing body has not entered into an 
agreement under subdivision 2 or cancels the agreement, money 
must be reallocated to the account established by subdivision 5. 
    Subd. 4.  [TRIBAL ALLOCATION.] Forty-two and one-half 
percent of the American Indian chemical dependency account must 
be allocated to the federally recognized American Indian tribal 
governing bodies that have entered into an agreement under 
subdivision 2 as follows:  $10,000 must be allocated to each 
governing body and the remainder must be allocated in direct 
proportion to the population of the reservation according to the 
most recently available estimates from the federal Bureau of 
Indian Affairs. 
    Subd. 5.  [TRIBAL RESERVE ACCOUNT.] The commissioner shall 
reserve 7.5 percent of the American Indian chemical dependency 
account.  The reserve must be allocated to those tribal units 
that have used all money allocated under subdivision 4 according 
to agreements made under subdivision 2.  An American Indian 
tribal governing body may receive not more than 30 percent of 
the reserve account in a year.  Money must be allocated as 
invoices are received. 
    Subd. 6.  [AMERICAN INDIAN TRIBAL PLACEMENTS.] After 
entering into an agreement under subdivision 2, the governing 
authority of each reservation may submit invoices to the state 
for the cost of providing chemical dependency services to 
residents of the reservation according to the placement 
regulations governing county placements, except that local match 
requirements are waived.  The governing body may designate an 
agency to act on its behalf to provide placement services and 
manage invoices by written notice to the commissioner and 
evidence of agreement by the agency designated. 
    Subd. 7.  [NONRESERVATION INDIAN ACCOUNT.] Fifty percent of 
the American Indian chemical dependency allocation must be held 
in reserve by the commissioner in an account for treatment of 
Indians not residing on lands of a reservation receiving money 
under subdivision 4.  This money must be used to pay for 
services certified by county invoice to have been provided to an 
American Indian eligible recipient.  Money allocated under this 
subdivision may be used for payments on behalf of American 
Indian county residents only if, in addition to other placement 
standards, the county certifies that the placement was 
appropriate to the cultural orientation of the client.  
    Sec. 17.  Minnesota Statutes 1985 Supplement, section 
256B.02, subdivision 8, is amended to read: 
    Subd. 8.  [MEDICAL ASSISTANCE; MEDICAL CARE.] "Medical 
assistance" or "medical care" means payment of part or all of 
the cost of the following care and services for eligible 
individuals whose income and resources are insufficient to meet 
all of this cost: 
     (1) Inpatient hospital services.  A second medical opinion 
is required prior to reimbursement for elective surgeries.  The 
commissioner shall publish in the State Register a proposed list 
of elective surgeries that require a second medical opinion 
prior to reimbursement.  The list is not subject to the 
requirements of sections 14.01 to 14.70.  The commissioner's 
decision whether a second medical opinion is required, made in 
accordance with rules governing that decision, is not subject to 
administrative appeal;  
     (2) Skilled nursing home services and services of 
intermediate care facilities, including training and 
habilitation services, as defined in section 256B.50, 
subdivision 1, for persons with mental retardation or related 
conditions who are residing in intermediate care facilities for 
persons with mental retardation or related conditions.  Medical 
assistance must not be used to pay the costs of nursing care 
provided to a patient in a swing bed as defined in section 
144.562; 
     (3) Physicians' services; 
     (4) Outpatient hospital or nonprofit community health 
clinic services or physician-directed clinic services.  The 
physician-directed clinic staff shall include at least two 
physicians, one of whom is on the premises whenever the clinic 
is open, and all services shall be provided under the direct 
supervision of the physician who is on the premises.  Hospital 
outpatient departments are subject to the same limitations and 
reimbursements as other enrolled vendors for all services, 
except initial triage, emergency services, and services not 
provided or immediately available in clinics, physicians' 
offices, or by other enrolled providers.  "Emergency services" 
means those medical services required for the immediate 
diagnosis and treatment of medical conditions that, if not 
immediately diagnosed and treated, could lead to serious 
physical or mental disability or death or are necessary to 
alleviate severe pain.  Neither the hospital, its employees, nor 
any physician or dentist, shall be liable in any action arising 
out of a determination not to render emergency services or care 
if reasonable care is exercised in determining the condition of 
the person, or in determining the appropriateness of the 
facilities, or the qualifications and availability of personnel 
to render these services consistent with this section;  
      (5) Community mental health center services, as defined in 
rules adopted by the commissioner pursuant to section 256B.04, 
subdivision 2, and provided by a community mental health center 
as defined in section 245.62, subdivision 2;  
      (6) Home health care services; 
      (7) Private duty nursing services; 
      (8) Physical therapy and related services; 
      (9) Dental services, excluding cast metal restorations; 
     (10) Laboratory and X-ray services; 
          (11) The following if prescribed by a licensed 
practitioner:  drugs, eyeglasses, dentures, and prosthetic 
devices.  The commissioner shall designate a formulary committee 
which shall advise the commissioner on the names of drugs for 
which payment shall be made, recommend a system for reimbursing 
providers on a set fee or charge basis rather than the present 
system, and develop methods encouraging use of generic drugs 
when they are less expensive and equally effective as trademark 
drugs.  The commissioner shall appoint the formulary committee 
members no later than 30 days following July 1, 1981.  The 
formulary committee shall consist of nine members, four of whom 
shall be physicians who are not employed by the department of 
human services, and a majority of whose practice is for persons 
paying privately or through health insurance, three of whom 
shall be pharmacists who are not employed by the department of 
human services, and a majority of whose practice is for persons 
paying privately or through health insurance, a consumer 
representative, and a nursing home representative.  Committee 
members shall serve two year terms and shall serve without 
compensation.  The commissioner may establish a drug formulary.  
Its establishment and publication shall not be subject to the 
requirements of the administrative procedure act, but the 
formulary committee shall review and comment on the formulary 
contents.  Prior authorization may be required by the 
commissioner, with the consent of the drug formulary committee, 
before certain formulary drugs are eligible for payment.  The 
formulary shall not include:  drugs or products for which there 
is no federal funding; over the counter drugs, except for 
antacids, acetaminophen, family planning products, aspirin, 
insulin, prenatal vitamins, and vitamins for children under the 
age of seven; or any other over the counter drug identified by 
the commissioner, in consultation with the appropriate 
professional consultants under contract with or employed by the 
state agency, as necessary, appropriate and cost effective for 
the treatment of certain specified chronic diseases, conditions 
or disorders, and this determination shall not be subject to the 
requirements of chapter 14, the administrative procedure act; 
nutritional products, except for those products needed for 
treatment of phenylketonuria, hyperlysinemia, maple syrup urine 
disease, a combined allergy to human milk, cow milk, and soy 
formula, or any other childhood or adult diseases, conditions, 
or disorders identified by the commissioner as requiring a 
similarly necessary nutritional product; anorectics; and drugs 
for which medical value has not been established.  Separate 
payment shall not be made for nutritional products for residents 
of long-term care facilities; payment for dietary requirements 
is a component of the per diem rate paid to these facilities.  
Payment to drug vendors shall not be modified before the 
formulary is established except that the commissioner shall not 
permit payment for any drugs which may not by law be included in 
the formulary, and his determination shall not be subject to 
chapter 14, the administrative procedure act.  The commissioner 
shall publish conditions for prohibiting payment for specific 
drugs after considering the formulary committee's 
recommendations.  
     The basis for determining the amount of payment shall be 
the actual acquisition costs of the drugs plus a fixed 
dispensing fee established by the commissioner.  Actual 
acquisition cost includes quantity and other special discounts 
except time and cash discounts.  Establishment of this fee shall 
not be subject to the requirements of the administrative 
procedure act.  Whenever a generically equivalent product is 
available, payment shall be on the basis of the actual 
acquisition cost of the generic drug, unless the prescriber 
specifically indicates "dispense as written" on the prescription 
as required by section 151.21, subdivision 2.  
     Notwithstanding the above provisions, implementation of any 
change in the fixed dispensing fee which has not been subject to 
the administrative procedure act shall be limited to not more 
than 180 days, unless, during that time, the commissioner shall 
have initiated rulemaking through the administrative procedure 
act;  
     (12) Diagnostic, screening, and preventive services; 
     (13) Health care prepayment plan premiums and insurance 
premiums if paid directly to a vendor and supplementary medical 
insurance benefits under Title XVIII of the Social Security Act; 
     (14) Abortion services, but only if one of the following 
conditions is met: 
     (a) The abortion is a medical necessity.  "Medical 
necessity" means (1) the signed written statement of two 
physicians indicating the abortion is medically necessary to 
prevent the death of the mother, and (2) the patient has given 
her consent to the abortion in writing unless the patient is 
physically or legally incapable of providing informed consent to 
the procedure, in which case consent will be given as otherwise 
provided by law; 
     (b) The pregnancy is the result of criminal sexual conduct 
as defined in section 609.342, clauses (c), (d), (e)(i), and 
(f), and the incident is reported within 48 hours after the 
incident occurs to a valid law enforcement agency for 
investigation, unless the victim is physically unable to report 
the criminal sexual conduct, in which case the report shall be 
made within 48 hours after the victim becomes physically able to 
report the criminal sexual conduct; or 
       (c) The pregnancy is the result of incest, but only if the 
incident and relative are reported to a valid law enforcement 
agency for investigation prior to the abortion; 
      (15) Transportation costs incurred solely for obtaining 
emergency medical care or transportation costs incurred by 
nonambulatory persons in obtaining emergency or nonemergency 
medical care when paid directly to an ambulance company, common 
carrier, or other recognized providers of transportation 
services.  For the purpose of this clause, a person who is 
incapable of transport by taxicab or bus shall be considered to 
be nonambulatory; 
    (16) To the extent authorized by rule of the state agency, 
costs of bus or taxicab transportation incurred by any 
ambulatory eligible person for obtaining nonemergency medical 
care; 
    (17) Personal care attendant services provided by an 
individual, not a relative, who is qualified to provide the 
services, where the services are prescribed by a physician in 
accordance with a plan of treatment and are supervised by a 
registered nurse.  Payments to personal care attendants shall be 
adjusted annually to reflect changes in the cost of living or of 
providing services by the average annual adjustment granted to 
vendors such as nursing homes and home health agencies; and 
    (18) Any other medical or remedial care licensed and 
recognized under state law unless otherwise prohibited by law, 
except licensed chemical dependency treatment programs or 
primary treatment or extended care treatment units in hospitals 
that are covered under sections 8 to 20.  The commissioner shall 
include chemical dependency services in the state medical 
assistance plan for federal reporting purposes, but payment must 
be made under sections 8 to 20.  
    Sec. 18.  Minnesota Statutes 1984, section 256B.70, is 
amended to read: 
    256B.70 [DEMONSTRATION PROJECT WAIVER.] 
    Each hospital that participates as a provider in a 
demonstration project, established by the commissioner of human 
services to deliver medical assistance, or chemical dependency 
services on a prepaid, capitation basis, is exempt from the 
prospective payment system for inpatient hospital service during 
the period of its participation in that project.  
    Sec. 19.  Minnesota Statutes 1985 Supplement, section 
256D.03, subdivision 4, is amended to read: 
    Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] (a) 
Reimbursement under the general assistance medical care program 
shall be limited to the following categories of service: 
inpatient hospital care, outpatient hospital care, services 
provided by medicare certified rehabilitation agencies, 
prescription drugs, equipment necessary to administer insulin 
and diagnostic supplies and equipment for diabetics to monitor 
blood sugar level, eyeglasses and eye examinations provided by a 
physician or optometrist, hearing aids, prosthetic devices, 
laboratory and X-ray services, physician's services, medical 
transportation, chiropractic services as covered under the 
medical assistance program, podiatric services, and dental 
care.  In addition, payments of state aid shall be made for day 
treatment services provided by a mental health center 
established under sections 245.61 to 245.69, subdivision 1, and 
funded through chapter 256E and for prescribed medications for 
persons who have been diagnosed as mentally ill as necessary to 
prevent more restrictive institutionalization. 
     (b) In order to contain costs, the commissioner of human 
services shall select vendors of medical care who can provide 
the most economical care consistent with high medical standards 
and shall where possible contract with organizations on a 
prepaid capitation basis to provide these services.  The 
commissioner shall consider proposals by counties and vendors 
for prepaid health plans, competitive bidding programs, block 
grants, or other vendor payment mechanisms designed to provide 
services in an economical manner or to control utilization, with 
safeguards to ensure that necessary services are provided.  
Before implementing prepaid programs in counties with a county 
operated or affiliated public teaching hospital or a hospital or 
clinic operated by the University of Minnesota, the commissioner 
shall consider the risks the prepaid program creates for the 
hospital and allow the county or hospital the opportunity to 
participate in the program in a manner that reflects the risk of 
adverse selection and the nature of the patients served by the 
hospital, provided the terms of participation in the program are 
competitive with the terms of other participants considering the 
nature of the population served.  Payment for services provided 
pursuant to this subdivision shall be as provided to medical 
assistance vendors of these services under section 256B.02, 
subdivision 8.  The rates payable under this section must be 
calculated according to section 256.966, subdivision 2. 
     (c) The commissioner of human services may reduce payments 
provided under sections 256D.01 to 256D.21 and 261.23 in order 
to remain within the amount appropriated for general assistance 
medical care, within the following restrictions. 
      For the period July 1, 1985, to December 31, 1985, 
reductions below the cost per service unit allowable under 
section 256.966, are permitted only as follows:  payments for 
inpatient and outpatient hospital care provided in response to a 
primary diagnosis of chemical dependency or mental illness may 
be reduced no more than 30 percent; payments for all other 
inpatient hospital care may be reduced no more than 20 percent.  
Reductions below the payments allowable under general assistance 
medical care for the remaining general assistance medical care 
services allowable under this subdivision may be reduced no more 
than ten percent. 
      For the period January 1, 1986 to December 31, 1986, 
reductions below the cost per service unit allowable under 
section 256.966 are permitted only as follows:  payments for 
inpatient and outpatient hospital care provided in response to a 
primary diagnosis of chemical dependency or mental illness may 
be reduced no more than 20 percent; payments for all other 
inpatient hospital care may be reduced no more than 15 percent.  
Reductions below the payments allowable under general assistance 
medical care for the remaining general assistance medical care 
services allowable under this subdivision may be reduced no more 
than five percent. 
     For the period January 1, 1987 to June 30, 1987, reductions 
below the cost per service unit allowable under section 256.966 
are permitted only as follows:  payments for inpatient and 
outpatient hospital care provided in response to a primary 
diagnosis of chemical dependency or mental illness may be 
reduced no more than 15 percent; payments for all other 
inpatient hospital care may be reduced no more than ten 
percent.  Reductions below the payments allowable under medical 
assistance for the remaining general assistance medical care 
services allowable under this subdivision may be reduced no more 
than five percent.  
    There shall be no copayment required of any recipient of 
benefits for any services provided under this subdivision.  A 
hospital receiving a reduced payment as a result of this section 
may apply the unpaid balance toward satisfaction of the 
hospital's bad debts. 
    (d) Any county may, from its own resources, provide medical 
5 payments for which state payments are not made. 
    (e) Chemical dependency services that are reimbursed under 
sections 8 to 20 must not be reimbursed under general assistance 
medical care.  
    Sec. 20.  Minnesota Statutes 1984, section 256E.08, 
subdivision 7, is amended to read: 
    Subd. 7.  [COUNTY OF FINANCIAL RESPONSIBILITY.] (a) Except 
as described in paragraphs (b) and (c), the county responsible 
for payment for community social services is the county in which 
the recipient of services resides at the time of application if 
the applicant is not in a facility described in section 256B.02, 
subdivision 2, or has never resided in this state other than in 
such a facility.  If the applicant is in a facility described in 
section 256B.02 and has previously resided in this state without 
being in such a facility, then the county of financial 
responsibility is the county in which he or she resided 
immediately before entering the facility.  The county of 
financial responsibility does not change as a result of referral 
or approval of referral for services to another county by the 
county of financial responsibility.  Minors are considered as 
residing in the county in which their parents or guardians 
reside.  When a minor reaches the age of 18, the county of 
financial responsibility is the county in which the minor 
resides.  If a person continues in residential care or treatment 
after reaching the age of 18, the county which initiated the 
treatment is the county of financial responsibility.  When there 
is a dispute as to the county of financial responsibility, the 
county providing or arranging for services shall pay for them 
pending final determination of the county of residence.  
Disputes concerning the county of financial responsibility shall 
be settled in the manner prescribed in section 256D.18, 
subdivision 4.  When the county board providing the care or 
service is not the county of the minor's legal residence, it has 
a claim for recovery of costs upon the county where the minor 
has residence.  
    (b) The county of financial responsibility for 
detoxification services and chemical dependency emergency 
admissions is the county where the client is when the need for 
services is identified.  If the client is a resident of a 
chemical dependency facility, paragraph (a) applies.  
    (c) The county of financial responsibility for social 
services for a person receiving aid to families with dependent 
children, general assistance, or medical assistance is the 
county from which that person is receiving the aid or assistance.
    Sec. 21.  [APPROPRIATIONS.] 
    Subdivision 1.  [CHEMICAL DEPENDENCY FUND.] The general 
fund appropriations for the general assistance, general 
assistance medical care, and medical assistance programs are 
reduced by the amount attributable to chemical dependency 
services covered under sections 8 to 16 and this amount is 
reappropriated to the commissioner of human services for 
transfer to the chemical dependency fund.  
    The general fund appropriation for the regional treatment 
center account is reduced by the amount attributable to chemical 
dependency programs and this amount is reappropriated to the 
commissioner of human services for transfer to the chemical 
dependency fund.  This amount must be increased by the amount of 
salary supplement funds allocated for chemical dependency 
services for each biennium.  
    Notwithstanding any other law, $1,050,000 of the federal 
alcohol and drug block grant is appropriated to the commissioner 
of human services for the chemical dependency fund. 
    Subd. 2.  [AMERICAN INDIAN GRANTS.] The general fund 
appropriation for chemical dependency services grants for 
American Indians is reduced by $640,000 and reappropriated to 
the commissioner of human services for transfer to the chemical 
dependency services fund. 
    Sec. 22.  [254B.10] [EXEMPTION.] 
    Medical assistance funding for all intermediate care 
facilities providing chemical dependency services on or before 
January 1, 1986, shall be exempted from the provisions of 
sections 8 to 20.  The commissioner shall include in the 
biennial report required under section 10, subdivision 8, 
recommendations regarding the necessity for continuing this 
exception beyond July 1, 1989. 
    Sec. 23.  [SUNSET.] 
    The new sections and subdivisions and amendments enacted by 
sections 1 to 22 are repealed July 1, 1987, unless adequate 
funding is made available to meet the cash-flow and capital 
needs of the regional treatment center chemical dependency units 
as determined by the commissioner in consultation with the chief 
executive officers of those units. 
    Sec. 24.  [EFFECTIVE DATE.] 
    Section 10, subdivision 6, and section 15 are effective the 
day following final enactment.  Sections 1 to 9; 10, 
subdivisions 1 to 5, 7, and 8; 11 to 14; and 16 to 23 are 
effective July 1, 1987. 
    Approved March 21, 1986