Minnesota Session Laws - 1987, Regular Session

  

                         Laws of Minnesota 1987 

                        CHAPTER 299-S.F.No. 593 
           An act relating to human services; clarifying statutes 
          relating to the preadmission screening program; 
          clarifying chemical dependency consolidated fund 
          administration procedures; amending Minnesota Statutes 
          1986, sections 246.51; 246.511; 254B.01, subdivision 
          5; 254B.02, subdivisions 1, 2, 3, and 5; 254B.03, 
          subdivisions 1, 2, 3, 4, and 5; 254B.04; 254B.05; 
          254B.06, subdivision 1; 254B.08; 254B.09, subdivisions 
          3, 5, and 7; and 256B.091, subdivisions 2, 3, 4, 6, 
          and 8; repealing Minnesota Statutes 1986, section 
          256.968. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1986, section 246.51, is 
amended to read:  
    246.51 [PAYMENT FOR CARE AND TREATMENT; DETERMINATION.] 
    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 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 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.  Except for services provided under 
chapter 254B, responsibility under this section shall not apply 
to those relatives having gross earnings of less than $11,000 
per year.  
    Subd. 2.  [RULES.] The commissioner shall adopt, pursuant 
to the administrative procedure act, rules establishing uniform 
standards for determination of patient liability and relative, 
guardian or conservator responsibility for care provided at 
state hospitals.  The standards may differ for mental illness, 
chemical dependency, or mental retardation.  The standards 
established in rules adopted under chapter 254B shall determine 
the amount of patient and relative responsibility when a portion 
of the patient's cost of care has been paid under chapter 254B.  
These rules shall have the force and effect of law.  
    Sec. 2.  Minnesota Statutes 1986, section 246.511, is 
amended to read:  
    246.511 [RELATIVE RESPONSIBILITY.] 
    In no case, shall Except for chemical dependency services 
paid for with funds provided under chapter 254B, a patient's or 
resident's relatives shall not, pursuant to the commissioner's 
authority under section 246.51, be ordered to pay more than ten 
percent of the cost of care, unless they reside outside the 
state.  Parents of children in state hospitals shall have their 
responsibility to pay determined according to section 252.27, 
subdivision 2, or in rules adopted under chapter 254B if the 
cost of care is paid under chapter 254B.  The commissioner may 
accept voluntary payments in excess of ten percent.  The 
commissioner may require full payment of the full per capita 
cost of care in state hospitals for patients or residents whose 
parent, parents, spouse, guardian or conservator do not reside 
in Minnesota.  
    Sec. 3.  Minnesota Statutes 1986, section 254B.01, 
subdivision 5, is amended to read:  
    Subd. 5.  [LOCAL AGENCY.] "Local agency" means the agency 
designated by a board of county commissioners, a county welfare 
board, or a human services board to make placements and submit 
state invoices according to Laws 1986, chapter 394, sections 8 
to 20. 
    Sec. 4.  Minnesota Statutes 1986, section 254B.02, 
subdivision 1, is amended to read:  
    Subdivision 1.  [CHEMICAL DEPENDENCY TREATMENT ALLOCATION.] 
The chemical dependency funds appropriated for allocation shall 
be placed in a special revenue account.  For the fiscal year 
beginning July 1, 1987, funds shall be transferred to operate 
the vendor payment, invoice processing, and collections system 
for one year.  The commissioner shall annually transfer funds 
from the chemical dependency fund to pay for operation of the 
drug and alcohol abuse normative evaluation system and to pay 
for all costs incurred by adding two positions for licensing of 
chemical dependency treatment and rehabilitation programs 
located in hospitals for which funds are not otherwise 
appropriated.  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 remaining money must be reserved for treatment of 
American Indians by eligible vendors under section 254B.05.  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. 
    Sec. 5.  Minnesota Statutes 1986, section 254B.02, 
subdivision 2, is amended to read:  
    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 in fiscal year 1986 for chemical dependency treatment 
services eligible for payment under section 254B.05, but not 
including expenditures made for persons eligible for placement 
under section 254B.09, subdivision 6.  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 1986 state 
expenditures to determine percentage of prior expenditure, and 
counties are ranked by percentage of prior expenditure less 
expenditures for persons eligible for placement under section 
254B.09, subdivision 6. 
    (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. 
    Sec. 6.  Minnesota Statutes 1986, section 254B.02, 
subdivision 3, is amended to read:  
    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 Laws 1986, chapter 394, sections 8 
to 20, are increased.  The base level must not be decreased if 
appropriations are the fund balance from which allocations are 
made under section 254B.02, subdivision 1, is 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. 
    Sec. 7.  Minnesota Statutes 1986, section 254B.02, 
subdivision 5, is amended to read:  
    Subd. 5.  [ADMINISTRATIVE ADJUSTMENT.] The commissioner may 
make payments to local agencies from money allocated under this 
section to support administrative activities under sections 
254B.03 and 254B.04.  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 quarter, based on the payments for services made in the 
most recent quarter for which data is available.  Adjustment of 
any overestimate or underestimate based on actual expenditures 
shall be made by the state agency by adjusting the 
administrative allowance for any succeeding quarter. 
    Sec. 8.  Minnesota Statutes 1986, section 254B.03, 
subdivision 1, is amended to read:  
    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 254B.05.  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.  If a county selects a vendor located in another 
state, the county shall ensure that the vendor is in compliance 
with the rules governing licensure of programs located in the 
state.  
    Sec. 9.  Minnesota Statutes 1986, section 254B.03, 
subdivision 2, is amended to read:  
    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 chemical 
dependency treatment or rehabilitation program under sections 
245.781 to 245.812, and services other than detoxification 
provided in another state that would be required to be licensed 
as a chemical dependency program if the program were in the 
state.  Out of state vendors must also provide the commissioner 
with assurances that the program complies substantially with 
state licensing requirements and possesses all licenses and 
certifications required by the host state to provide chemical 
dependency treatment.  Hospitals may apply for and receive 
licenses to be eligible vendors, notwithstanding the provisions 
of section 245.791.  Except for chemical dependency transitional 
rehabilitation programs, 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.  A 
county may elect to use the same invoice procedures and obtain 
the same state payment services as are used for chemical 
dependency services for which state payments are made under this 
section if county payments are made to the state in advance of 
state payments to vendors.  When a county uses the state system 
for payment, the commissioner shall make monthly billings to the 
county using the most recent available information to determine 
the anticipated services for which payments will be made in the 
coming month.  Adjustment of any overestimate or underestimate 
based on actual expenditures shall be made by the state agency 
by adjusting the estimate for any succeeding month. 
    (c) The commissioner shall coordinate chemical dependency 
services and determine whether there is a need for any proposed 
expansion of chemical dependency treatment services.  The 
commissioner shall deny vendor certification to any provider 
that has not received prior approval from the commissioner for 
the creation of new programs or the expansion of existing 
program capacity.  The commissioner shall consider the 
provider's capacity to obtain clients from outside the state 
based on plans, agreements, and previous utilization history, 
when determining the need for new treatment services. 
    Sec. 10.  Minnesota Statutes 1986, section 254B.03, 
subdivision 3, is amended to read:  
    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.  Payments 
shall be made at the beginning of each month for services 
provided in the previous month.  The commissioner shall bill the 
county monthly for services, based on the most recent month for 
which expenditure information is available.  Adjustment of any 
overestimate or underestimate based on actual expenditures shall 
be made by the state agency by adjusting the estimate for any 
succeeding month. 
    Sec. 11.  Minnesota Statutes 1986, section 254B.03, 
subdivision 4, is amended to read:  
    Subd. 4.  [DIVISION OF COSTS.] The county shall, out of 
local money, reimburse pay 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, less 15 percent of the cost of payment and 
collections, must be distributed to the county that paid for a 
portion of the treatment under this section.  If all funds 
allocated according to section 254B.02 are exhausted by a county 
and the county has met or exceeded the base level of 
expenditures under section 254B.02, subdivision 3, the county 
shall reimburse pay 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 254B.04, subdivision 1, if the commissioner determines 
that funds will otherwise not be available for persons who are 
entitled to chemical dependency fund services the county 
financially responsible for the persons has exhausted its 
allocation. 
    Sec. 12.  Minnesota Statutes 1986, section 254B.03, 
subdivision 5, is amended to read:  
    Subd. 5.  [RULES; APPEAL.] The commissioner shall adopt 
rules as necessary to implement Laws 1986, chapter 394, sections 
8 to 20.  The commissioner shall ensure that the rules are 
effective on July 1, 1987.  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. 
    Sec. 13.  Minnesota Statutes 1986, section 254B.04, is 
amended to read:  
    254B.04 [ELIGIBILITY FOR CHEMICAL DEPENDENCY FUND 
SERVICES.] 
    Subdivision 1.  [ELIGIBILITY.] Persons eligible for 
benefits under sections 256D.01 to 256D.21, or for federal 
benefits under Code of Federal Regulations, title 25, part 20, 
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 is 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 commissioner shall establish a 
separate fee scale for recipients of chemical dependency 
transitional rehabilitation services that provides for the 
collection of fees for board and lodging expenses.  The fee 
schedule shall ensure that employed persons are allowed the 
income disregards and savings accounts that are allowed 
residents of community mental illness facilities under section 
256D.06, subdivisions 1 and 1b.  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. 14.  Minnesota Statutes 1986, section 254B.05, is 
amended to read: 
    254B.05 [VENDOR ELIGIBILITY.] 
    Subdivision 1.  [LICENSURE REQUIRED.] 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.  
    Subd. 2.  [REGULATORY METHODS.] (a) Where appropriate and 
feasible, the commissioner shall identify and implement 
alternative methods of regulation and enforcement to the extent 
authorized in this subdivision.  These methods shall include: 
     (1) expansion of the types and categories of licenses that 
may be granted; 
    (2) when the standards of an independent accreditation body 
have been shown to predict compliance with the rules, the 
commissioner shall consider compliance with the accreditation 
standards to be equivalent to partial compliance with the rules; 
and 
    (3) use of an abbreviated inspection that employs key 
standards that have been shown to predict full compliance with 
the rules. 
    If the commissioner determines that the methods in clause 
(2) or (3) can be used in licensing a program, the commissioner 
may reduce any fee set under section 10 by up to 50 percent. 
    (b) The commissioner shall work with the commissioners of 
health, public safety, administration, and education in 
consolidating duplicative licensing and certification rules and 
standards if the commissioner determines that consolidation is 
administratively feasible, would significantly reduce the cost 
of licensing, and would not reduce the protection given to 
persons receiving services in licensed programs.  Where 
administratively feasible and appropriate, the commissioner 
shall work with the commissioners of health, public safety, 
administration, and education in conducting joint agency 
inspections of programs. 
    (c) The commissioner shall work with the commissioners of 
health, public safety, administration, and education in 
establishing a single point of application for applicants who 
are required to obtain concurrent licensure from more than one 
of the commissioners listed in this clause. 
    Subd. 3.  [FEE REDUCTIONS.] If the commissioner determines 
that the methods in subdivision 2, clause (2) or (3), can be 
used in licensing a program, the commissioner shall reduce 
licensure fees by up to 50 percent.  The commissioner may adopt 
rules to provide for the reduction of fees when a license holder 
substantially exceeds the basic standards for licensure. 
    Sec. 15.  Minnesota Statutes 1986, section 254B.06, 
subdivision 1, is amended to read:  
    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 Laws 1986, chapter 394, sections 8 to 
20.  The commissioner may collect all third-party payments for 
chemical dependency services provided under Laws 1986, chapter 
394, sections 8 to 20, including private insurance and federal 
medicaid and medicare financial participation.  The commissioner 
shall deposit in the general fund a dedicated account a 
percentage of collections to pay for the cost of operating the 
chemical dependency consolidated treatment fund invoice 
processing and vendor payment system, billing, and collections.  
The remaining receipts must be deposited in the chemical 
dependency fund. 
    Sec. 16.  Minnesota Statutes 1986, section 254B.08, is 
amended to read: 
    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.  
    Notwithstanding sections 254B.04 and 256B.02, subdivision 
8, clause (18), and rules adopted under section 254B.03, 
subdivision 5, persons eligible under section 256B.06 for 
medical assistance benefits shall not be eligible for services 
reimbursed through the consolidated chemical dependency fund, 
except for transitional rehabilitation, extended care programs, 
and culturally specific programs as defined by Minnesota Rules, 
part 9530.6605, subpart 13, until the federal Social Security 
Act, section 2108 (1915B), program waivers are secured.  Until 
the necessary federal program waivers are secured, persons 
eligible for medical assistance benefits under section 256B.06 
shall be eligible for chemical dependency treatment services 
under section 256B.02, subdivision 8. 
    Sec. 17.  Minnesota Statutes 1986, section 254B.09, 
subdivision 3, is amended to read:  
    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 
4. 
    Sec. 18.  Minnesota Statutes 1986, section 254B.09, 
subdivision 5, is amended to read:  
    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.  Reserve payments shall be made 
only for persons entitled to services under section 254B.04, 
subdivision 1.  Money must be allocated as invoices are received.
    Sec. 19.  Minnesota Statutes 1986, section 254B.09, 
subdivision 7, is amended to read:  
    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.  Any 
funds for treatment of nonreservation Indians remaining at the 
end of a fiscal year shall be reallocated under section 254B.02. 
    Sec. 20.  Minnesota Statutes 1986, section 256B.091, 
subdivision 2, is amended to read:  
    Subd. 2.  [SCREENING TEAMS; ESTABLISHMENT.] Each county 
agency designated by the commissioner of human services to 
participate in the program shall contract with the local board 
of health organized under sections 145.911 to 145.922 or other 
public or nonprofit agency to establish a screening team to 
assess the health and social needs of all applicants prior to 
admission to a nursing home or a boarding care home licensed 
under section 144A.02 or sections 144.50 to 144.56, that is 
certified for medical assistance as a skilled nursing facility, 
intermediate care facility level I, or intermediate care 
facility level II.  Each local screening team shall be composed 
of a public health nurse from the local public health nursing 
service and a social worker from the local community welfare 
agency.  Each screening team shall have a physician available 
for consultation and shall utilize individuals' attending 
physicians' physical assessment forms, if any, in assessing 
needs.  The individual's physician shall be included on the 
screening team if the physician chooses to participate.  If a 
person who has been screened must be reassessed for purposes of 
assigning a case mix classification because admission to a 
nursing home occurs later than the time allowed by rule 
following the initial screening and assessment, the reassessment 
may be completed by the public health nurse member of the 
screening team.  If the individual is being discharged from an 
acute care facility, a discharge planner from that facility may 
be present, at the facility's request, during the screening 
team's assessment of the individual and may participate in 
discussions but not in making the screening team's 
recommendations under subdivision 3, clause (e).  If the 
assessment procedure or screening team recommendation results in 
a delay of the individual's discharge from the acute care 
facility, the facility shall not be denied medical assistance 
reimbursement or incur any other financial or regulatory penalty 
of the medical assistance program that would otherwise be caused 
by the individual's extended length of stay; 50 percent of the 
cost of this reimbursement or financial or regulatory penalty 
shall be paid by the state and 50 percent shall be paid by the 
county.  Other personnel as deemed appropriate by the county 
agency may be included on the team.  The county agency may 
contract with an acute care facility to have the facility's 
discharge planners perform the functions of a screening team 
with regard to individuals discharged from the facility and in 
those cases the discharge planners may participate in making 
recommendations under subdivision 3, clause (e).  No member of a 
screening team shall have a direct or indirect financial or 
self-serving interest in a nursing home or noninstitutional 
referral such that it would not be possible for the member to 
consider each case objectively. 
    Individuals not eligible for medical assistance who are 
being transferred from a hospital to a nursing home or boarding 
care home may be screened by only one member of the screening 
team in consultation with the other member.  The interagency 
board for quality assurance, with the participation of members 
of screening teams, shall identify other circumstances when it 
would be appropriate for only one member of a screening team to 
conduct the nursing home preadmission screenings.  The committee 
shall report its recommendations to the legislature in January, 
1987. 
    Sec. 21.  Minnesota Statutes 1986, section 256B.091, 
subdivision 3, is amended to read:  
    Subd. 3.  [SCREENING TEAM; DUTIES.] Local screening teams 
shall seek cooperation from other public and private agencies in 
the community which offer services to the disabled and elderly.  
The responsibilities of the agency responsible for screening 
shall include:  
    (a) Provision of information and education to the general 
public regarding availability of the screening program;  
    (b) Acceptance of referrals from individuals, families, 
human service professionals and nursing home personnel of the 
community agencies;  
    (c) Assessment of health and social needs of referred 
individuals and identification of services needed to maintain 
these persons in the least restrictive environments;  
    (d) Identification of available noninstitutional services 
to meet the needs of individuals referred;  
    (e) Recommendations for individuals screened regarding: 
    (1) Nursing home or boarding care home admission; and 
    (2) Maintenance in the community with specific service 
plans and referrals and designation of a lead agency to 
implement each individual's plan of care;  
    (f) Provision of follow up services as needed; and 
    (g) Preparation of reports which may be required by the 
commissioner of human services.  
    Sec. 22.  Minnesota Statutes 1986, section 256B.091, 
subdivision 4, is amended to read:  
    Subd. 4.  [SCREENING OF PERSONS.] Prior to nursing home or 
boarding care home admission, screening teams shall assess the 
needs of all applicants, except (1) patients transferred from 
other certified nursing homes or boarding care homes; (2) 
patients who, having entered acute care facilities from nursing 
homes or boarding care homes, are returning to a nursing home or 
boarding care home; (3) persons entering a facility described in 
section 256B.431, subdivision 4, paragraph (c); (4) individuals 
not eligible for medical assistance whose length of stay is 
expected to be 30 days or less based on a physician's 
certification, if the facility notifies the screening team upon 
admission and provides an update to the screening team on the 
30th day after admission; (5) individuals who have a contractual 
right to have their nursing home care paid for indefinitely by 
the veteran's administration; or (6) persons entering a facility 
conducted by and for the adherents of a 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.  The cost for screening applicants 
who are receiving medical assistance must be paid by the medical 
assistance program.  The total screening cost for each county 
for applicants who are not eligible for medical assistance must 
be paid monthly by nursing homes and boarding care homes 
participating in the medical assistance program in the county.  
The monthly amount to be paid by each nursing home and boarding 
care home must be determined by dividing the county's estimate 
of the total annual cost of screenings allowed by the 
commissioner in the county for the following rate year by 12 to 
determine the monthly cost estimate and allocating the monthly 
cost estimate to each nursing home and boarding care home based 
on the number of licensed beds in the nursing home or boarding 
care home.  The monthly cost estimate for each nursing home or 
boarding care home must be submitted to the nursing home or 
boarding care home and the state by the county no later than 
February 15 of each year for inclusion in the nursing home's or 
boarding care home's payment rate on the following rate year.  
The commissioner shall include the reported annual estimated 
cost of screenings for each nursing home or boarding care home 
as an operating cost of that nursing home in accordance with 
section 256B.431, subdivision 2b, clause (g).  For all 
individuals regardless of payment source, if delay-of-screening 
timelines are not met because a county is late in screening an 
individual who meets the delay-of-screening criteria, the county 
is solely responsible for paying the nursing home rate for the 
resident days that exceed the delay-of-screening timelines until 
the screening is completed cost of the preadmission screening.  
Notwithstanding section 256B.0641, overpayments attributable to 
payment of the screening costs under the medical assistance 
program may not be recovered from a facility. 
    Sec. 23.  Minnesota Statutes 1986, section 256B.091, 
subdivision 6, is amended to read:  
    Subd. 6.  [REIMBURSEMENT.] The commissioner of human 
services shall amend the Minnesota medical assistance plan to 
include reimbursement for the local screening teams.  
Reimbursement shall not be provided for any recipient placed in 
a nursing home in opposition to the screening team's 
recommendation after January 1, 1981; provided, however, the 
commissioner shall not deny reimbursement for (1) an individual 
admitted to a nursing home or boarding care home who is assessed 
to need long-term supportive services if long-term supportive 
services other than nursing home care are not available in that 
community; (2) any eligible individual placed in the nursing 
home or boarding care home pending an appeal of the preadmission 
screening team's decision; (3) any eligible individual placed in 
the nursing home or boarding care home by a physician in an 
emergency situation and where the screening team has not made a 
decision within five working days of its initial contact; or (4) 
any medical assistance recipient when, after full discussion of 
all appropriate alternatives including those that are expected 
to be less costly than nursing home care in a nursing home or 
boarding care home, the individual or the individual's legal 
representative insists on nursing home or boarding care home 
placement.  The screening team shall provide documentation that 
the most cost effective alternatives available were offered to 
this individual or the individual's legal representative.  
    Sec. 24.  Minnesota Statutes 1986, section 256B.091, 
subdivision 8, is amended to read:  
    Subd. 8.  [ALTERNATIVE CARE GRANTS.] The commissioner shall 
provide grants to counties participating in the program to pay 
costs of providing alternative care to individuals screened 
under subdivision 4 and nursing home or boarding care home 
residents who request a screening.  Prior to July of each year, 
the commissioner shall allocate state funds available for 
alternative care grants to each local agency.  This allocation 
must be made as follows:  half of the state funds available for 
alternative care grants must be allocated to each county 
according to the total number of adults in that county who are 
recipients age 65 or older who are reported to the department by 
March 1 of each state fiscal year and half of the state funds 
available for alternative care grants must be allocated to a 
county according to that county's number of medicare enrollments 
age 65 or older for the most recent statistical report.  Payment 
is available under this subdivision only for individuals (1) for 
whom the screening team would recommend nursing home or boarding 
care home admission, or continued stay if alternative care were 
not available; (2) who are receiving medical assistance or who 
would be eligible for medical assistance within 180 days of 
admission to a nursing home; (3) who need services that are not 
available at that time in the county through other public 
assistance; and (4) who are age 65 or older. 
    The commissioner shall establish by rule, in accordance 
with chapter 14, procedures for determining grant reallocations, 
limits on the rates for payment of approved services, including 
screenings, and submittal and approval of a biennial county plan 
for the administration of the preadmission screening and 
alternative care grants program.  Grants may be used for payment 
of costs of providing care-related supplies, equipment, and 
services such as, but not limited to, foster care for elderly 
persons, day care whether or not offered through a nursing home, 
nutritional counseling, or medical social services, which 
services are provided by a licensed health care provider, a home 
health service eligible for reimbursement under Titles XVIII and 
XIX of the federal Social Security Act, or by persons employed 
by or contracted with by the county board or the local welfare 
agency.  The county agency shall ensure that a plan of care is 
established for each individual in accordance with subdivision 
3, clause (e)(2), and that a client's service needs and 
eligibility is reassessed at least every six months.  The plan 
shall include any services prescribed by the individual's 
attending physician as necessary and follow up services as 
necessary.  The county agency shall provide documentation to the 
commissioner verifying that the individual's alternative care is 
not available at that time through any other public assistance 
or service program and shall provide documentation in each 
individual's plan of care and to the commissioner that the most 
cost-effective alternatives available have been offered to the 
individual and that the individual was free to choose among 
available qualified providers, both public and private.  The 
county agency shall document to the commissioner that the agency 
made reasonable efforts to inform potential providers of the 
anticipated need for services under the alternative care grants 
program, including a minimum of 14 days written advance notice 
of the opportunity to be selected as a service provider and an 
annual public meeting with providers to explain and review the 
criteria for selection, and that the agency allowed potential 
providers an opportunity to be selected to contract with the 
county board.  Grants to counties under this subdivision are 
subject to audit by the commissioner for fiscal and utilization 
control. 
     The county must select providers for contracts or 
agreements using the following criteria and other criteria 
established by the county: 
    (1) the need for the particular services offered by the 
provider; 
    (2) the population to be served, including the number of 
clients, the length of time services will be provided, and the 
medical condition of clients; 
    (3) the geographic area to be served; 
    (4) quality assurance methods, including appropriate 
licensure, certification, or standards, and supervision of 
employees when needed; 
    (5) rates for each service and unit of service exclusive of 
county administrative costs; 
    (6) evaluation of services previously delivered by the 
provider; and 
    (7) contract or agreement conditions, including billing 
requirements, cancellation, and indemnification. 
    The county must evaluate its own agency services under the 
criteria established for other providers.  The county shall 
provide a written statement of the reasons for not selecting 
providers. 
    The commissioner shall establish a sliding fee schedule for 
requiring payment for the cost of providing services under this 
subdivision to persons who are eligible for the services but who 
are not yet eligible for medical assistance.  The sliding fee 
schedule is not subject to chapter 14 but the commissioner shall 
publish the schedule and any later changes in the State Register 
and allow a period of 20 working days from the publication date 
for interested persons to comment before adopting the sliding 
fee schedule in final forms.  
    The commissioner shall apply for a waiver for federal 
financial participation to expand the availability of services 
under this subdivision.  The commissioner shall provide grants 
to counties from the nonfederal share, unless the commissioner 
obtains a federal waiver for medical assistance payments, of 
medical assistance appropriations.  A county agency may use 
grant money to supplement but not supplant services available 
through other public assistance or service programs and shall 
not use grant money to establish new programs for which public 
money is available through sources other than grants provided 
under this subdivision.  A county agency shall not use grant 
money to provide care under this subdivision to an individual if 
the anticipated cost of providing this care would exceed the 
average payment, as determined by the commissioner, for the 
level of nursing home care that the recipient would receive if 
placed in a nursing home or boarding care home.  The nonfederal 
share may be used to pay up to 90 percent of the start-up and 
service delivery costs of providing care under this 
subdivision.  Each county agency that receives a grant shall pay 
ten percent of the costs for persons who are eligible for the 
services but who are not yet eligible for medical assistance. 
    The commissioner shall promulgate emergency rules in 
accordance with sections 14.29 to 14.36, to establish required 
documentation and reporting of care delivered. 
    Sec. 25.  [REPEALER.] 
    Minnesota Statutes 1986, section 256.968, is repealed. 
    Sec. 26.  [EFFECTIVE DATE.] 
     Section 14 is effective the day 
following enactment.  Sections 20 to 24 are effective July 1, 
1987. 
    Approved May 28, 1987