Minnesota Session Laws - 1993, Regular Session

  
    Laws of Minnesota 1993 

                        CHAPTER 339-S.F.No. 748 
           An act relating to human services; clarifying day 
          training and habilitation transportation exemptions; 
          clarifying that counties may contract with hospitals 
          to provide outpatient mental health services; 
          clarifying the definition of crisis assistance; 
          increasing the allowable duration of unlicensed, 
          single-family respite care; clarifying the definition 
          of related condition and application procedures for 
          family support grants; correcting references to case 
          management and hospital appeals; clarifying 
          eligibility for case management services; clarifying 
          nursing facility rate adjustments; clarifying the 
          calculation and allowing 12-month plans for special 
          needs exceptions; clarifying requirements for health 
          care provider participation; clarifying voluntary 
          spend-down procedures; amending Minnesota Statutes 
          1992, sections 174.30, subdivision 1; 245.470, 
          subdivision 1; 245.4871, subdivision 9a; 245.488, 
          subdivision 1; 245A.03, subdivision 2; 252.27, 
          subdivisions 1 and 1a; 252.32, subdivision 1a; 
          256.045, subdivision 4a; 256.9686, subdivision 6; 
          256.9695, subdivisions 1 and 3; 256B.056, subdivision 
          5; 256B.0644; 256B.092, subdivisions 1, 1b, 1g, 7, and 
          8a; 256B.431, subdivision 10; 256B.48, subdivision 3a; 
          256B.501, subdivision 8; and 609.115, subdivision 9; 
          repealing Minnesota Statutes 1992, section 256B.0629. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1992, section 174.30, 
subdivision 1, is amended to read: 
    Subdivision 1.  [APPLICABILITY LIMITATIONS; BY TYPE OF 
PROVIDER; BY SOURCE OF FUNDS.] The operating standards for 
special transportation service adopted under this section do not 
apply to special transportation provided by:  
    (a) A common carrier operating on fixed routes and 
schedules; 
    (b) A volunteer driver using a private automobile; 
    (c) A school bus as defined in section 169.01, subdivision 
6; or 
    (d) An emergency ambulance regulated under chapter 144. 
    The operating standards adopted under this section only 
apply to providers of special transportation service who receive 
grants or other financial assistance from either the state or 
the federal government, or both, to provide or assist in 
providing that service; except that the operating standards 
adopted under this section do not apply to any nursing home 
licensed under section 144A.02, to any board and care facility 
licensed under section 144.50, or to any day training and 
habilitation services, day care, or group home facility licensed 
under sections 245A.01 to 245A.16 245A.19 unless the facility or 
program provides transportation to nonresidents on a regular 
basis and the facility receives reimbursement, other than per 
diem payments, for that service under rules promulgated by the 
commissioner of human services.  
    Sec. 2.  Minnesota Statutes 1992, section 245.470, 
subdivision 1, is amended to read: 
    Subdivision 1.  [AVAILABILITY OF OUTPATIENT SERVICES.] (a) 
County boards must provide or contract for enough outpatient 
services within the county to meet the needs of adults with 
mental illness residing in the county.  Services may be provided 
directly by the county through county-operated mental health 
centers or mental health clinics approved by the commissioner 
under section 245.69, subdivision 2; by contract with privately 
operated mental health centers or mental health clinics approved 
by the commissioner under section 245.69, subdivision 2; by 
contract with hospital mental health outpatient programs 
certified by the Joint Commission on Accreditation of Hospital 
Organizations; or by contract with a licensed mental health 
professional as defined in section 245.462, subdivision 18, 
clauses (1) to (4).  Clients may be required to pay a fee 
according to section 245.481.  Outpatient services include:  
    (1) conducting diagnostic assessments; 
    (2) conducting psychological testing; 
    (3) developing or modifying individual treatment plans; 
    (4) making referrals and recommending placements as 
appropriate; 
    (5) treating an adult's mental health needs through 
therapy; 
    (6) prescribing and managing medication and evaluating the 
effectiveness of prescribed medication; and 
    (7) preventing placement in settings that are more 
intensive, costly, or restrictive than necessary and appropriate 
to meet client needs.  
     (b) County boards may request a waiver allowing outpatient 
services to be provided in a nearby trade area if it is 
determined that the client can best be served outside the county.
    Sec. 3.  Minnesota Statutes 1992, section 245.4871, 
subdivision 9a, is amended to read: 
    Subd. 9a.  [CRISIS ASSISTANCE.] "Crisis assistance" means 
assistance to the child, family, and the child's school in 
recognizing and resolving the child's family, and all providers 
of services to the child to:  recognize factors precipitating a 
mental health crisis, identify behaviors related to the crisis, 
and be informed of available resources to resolve the 
crisis.  It shall include, at a minimum, working with the child, 
family, and school to develop a crisis assistance plan Crisis 
assistance requires the development of a plan which addresses 
prevention and intervention strategies to be used in a potential 
crisis.  Other interventions include:  (1) arranging for 
admission to acute care hospital inpatient treatment; (2) crisis 
placement; (3) community resources for follow-up; and (4) 
emotional support to the family during crisis.  Crisis 
assistance does not include services designed to secure the 
safety of a child who is at risk of abuse or neglect or 
necessary emergency services. 
    Sec. 4.  Minnesota Statutes 1992, section 245.488, 
subdivision 1, is amended to read: 
    Subdivision 1.  [AVAILABILITY OF OUTPATIENT SERVICES.] (a) 
County boards must provide or contract for enough outpatient 
services within the county to meet the needs of each child with 
emotional disturbance residing in the county and the child's 
family.  Services may be provided directly by the county through 
county-operated mental health centers or mental health clinics 
approved by the commissioner under section 245.69, subdivision 
2; by contract with privately operated mental health centers or 
mental health clinics approved by the commissioner under section 
245.69, subdivision 2; by contract with hospital mental health 
outpatient programs certified by the Joint Commission on 
Accreditation of Hospital Organizations; or by contract with a 
licensed mental health professional as defined in section 
245.4871, subdivision 27, clauses (1) to (4).  A child or a 
child's parent may be required to pay a fee based in accordance 
with section 245.481.  Outpatient services include: 
    (1) conducting diagnostic assessments; 
    (2) conducting psychological testing; 
    (3) developing or modifying individual treatment plans; 
    (4) making referrals and recommending placements as 
appropriate; 
    (5) treating the child's mental health needs through 
therapy; and 
    (6) prescribing and managing medication and evaluating the 
effectiveness of prescribed medication. 
    (b) County boards may request a waiver allowing outpatient 
services to be provided in a nearby trade area if it is 
determined that the child requires necessary and appropriate 
services that are only available outside the county. 
    (c) Outpatient services offered by the county board to 
prevent placement must be at the level of treatment appropriate 
to the child's diagnostic assessment. 
    Sec. 5.  Minnesota Statutes 1992, section 245A.03, 
subdivision 2, is amended to read: 
    Subd. 2.  [EXCLUSION FROM LICENSURE.] Sections 245A.01 to 
245A.16 do not apply to: 
     (1) residential or nonresidential programs that are 
provided to a person by an individual who is related; 
     (2) nonresidential programs that are provided by an 
unrelated individual to persons from a single related family; 
     (3) residential or nonresidential programs that are 
provided to adults who do not abuse chemicals or who do not have 
a chemical dependency, a mental illness, mental retardation or a 
related condition, a functional impairment, or a physical 
handicap; 
     (4) sheltered workshops or work activity programs that are 
certified by the commissioner of jobs and training; 
     (5) programs for children enrolled in kindergarten to the 
12th grade and prekindergarten special education in a school as 
defined in section 120.101, subdivision 4, and programs serving 
children in combined special education and regular 
prekindergarten programs that are operated or assisted by the 
commissioner of education; 
     (6) nonresidential programs for children that provide care 
or supervision for periods of less than three hours a day while 
the child's parent or legal guardian is in the same building or 
present on property that is contiguous with the physical 
facility where the nonresidential program is provided; 
     (7) nursing homes or hospitals licensed by the commissioner 
of health except as specified under section 245A.02; 
     (8) board and lodge facilities licensed by the commissioner 
of health that provide services for five or more persons whose 
primary diagnosis is mental illness who have refused an 
appropriate residential program offered by a county agency.  
This exclusion expires on July 1, 1990; 
     (9) homes providing programs for persons placed there by a 
licensed agency for legal adoption, unless the adoption is not 
completed within two years; 
     (10) programs licensed by the commissioner of corrections; 
     (11) recreation programs for children or adults that 
operate for fewer than 40 calendar days in a calendar year; 
     (12) programs whose primary purpose is to provide, for 
adults or school-age children, including children who will be 
eligible to enter kindergarten within not more than four months, 
social and recreational activities, such as scouting, boys 
clubs, girls clubs, sports, or the arts; except that a program 
operating in a school building is not excluded unless it is 
approved by the district's school board; 
        (13) head start nonresidential programs which operate for 
less than 31 days in each calendar year; 
        (14) noncertified boarding care homes unless they provide 
services for five or more persons whose primary diagnosis is 
mental illness or mental retardation; 
        (15) nonresidential programs for nonhandicapped children 
provided for a cumulative total of less than 30 days in any 
12-month period; 
    (16) residential programs for persons with mental illness, 
that are located in hospitals, until the commissioner adopts 
appropriate rules; 
    (17) the religious instruction of school-age children; 
Sabbath or Sunday schools; or the congregate care of children by 
a church, congregation, or religious society during the period 
used by the church, congregation, or religious society for its 
regular worship; 
    (18) camps licensed by the commissioner of health under 
Minnesota Rules, chapter 4630; 
    (19) mental health outpatient services for adults with 
mental illness or children with emotional disturbance; 
    (20) residential programs serving school-age children whose 
sole purpose is cultural or educational exchange, until the 
commissioner adopts appropriate rules; 
    (21) unrelated individuals who provide out-of-home respite 
care services to persons with mental retardation or related 
conditions from a single related family for no more than 30 90 
days in a 12-month period and the respite care services are for 
the temporary relief of the person's family or legal 
representative; 
    (22) respite care services provided as a home- and 
community-based service to a person with mental retardation or a 
related condition, in the person's primary residence; or 
     (23) community support services programs as defined in 
section 245.462, subdivision 6, and family community support 
services as defined in section 245.4871, subdivision 17. 
    Sec. 6.  Minnesota Statutes 1992, section 252.27, 
subdivision 1, is amended to read: 
    Subdivision 1.  [COUNTY RESPONSIBILITY.] Whenever any child 
who has mental retardation or a related condition, or a physical 
disability or emotional handicap disturbance is in 24-hour care 
outside the home including respite care, in a facility licensed 
by the commissioner of human services, the cost of services 
shall be paid by the county of financial responsibility 
determined pursuant to chapter 256G.  If the child's parents or 
guardians do not reside in this state, the cost shall be paid by 
the responsible governmental agency in the state from which the 
child came, by the parents or guardians of the child if they are 
financially able, or, if no other payment source is available, 
by the commissioner of human services.  
    Sec. 7.  Minnesota Statutes 1992, section 252.27, 
subdivision 1a, is amended to read: 
    Subd. 1a.  [DEFINITIONS.] A person has a "related 
condition" if that person has a severe, chronic disability that 
meets all of the following conditions:  (a) is attributable to 
cerebral palsy, epilepsy, autism, Prader-Willi syndrome, or any 
other condition, other than mental illness as defined under 
section 245.462, subdivision 20, or an emotional disturbance, as 
defined under section 245.4871, subdivision 15, found to be 
closely related to mental retardation because the condition 
results in impairment of general intellectual functioning or 
adaptive behavior similar to that of persons with mental 
retardation and requires treatment or services similar to those 
required for persons with mental retardation; (b) is manifested 
before the person reaches 22 years of age; (c) is likely to 
continue indefinitely; and (d) results in substantial functional 
limitations in three or more of the following areas of major 
life activity:  (1) self-care, (2) understanding and use of 
language, (3) learning, (4) mobility, (5) self-direction, (6) 
capacity for independent living.  For the purposes of this 
section, a child has an "emotional handicap" if the child has a 
psychiatric or other emotional disorder which substantially 
impairs the child's mental health and requires 24-hour treatment 
or supervision. 
    Sec. 8.  Minnesota Statutes 1992, section 252.32, 
subdivision 1a, is amended to read: 
    Subd. 1a.  [SUPPORT GRANTS.] (a) Provision of support 
grants must be limited to families who require support and whose 
dependents are under the age of 22 and who have mental 
retardation or who have a related condition and who have been 
determined by a screening team established under section 
256B.092 to require the level of care provided by an 
intermediate care facility for persons with mental retardation 
or related conditions be at risk of institutionalization.  
Families who are receiving home- and community-based waivered 
services for persons with mental retardation or related 
conditions are not eligible for support grants.  Families whose 
annual adjusted gross income is $60,000 or more are not eligible 
for support grants except in cases where extreme hardship is 
demonstrated.  Beginning in state fiscal year 1994, the 
commissioner shall adjust the income ceiling annually to reflect 
the projected change in the average value in the United States 
Department of Labor Bureau of Labor Statistics consumer price 
index (all urban) for that year. 
    (b) Support grants may be made available as monthly subsidy 
grants and lump sum grants. 
    (c) Support grants may be issued in the form of cash, 
voucher, and direct county payment to a vendor.  
    (d) Applications for the support grant shall be made by the 
county social service agency to the department of human 
services.  The application shall specify the needs of the family 
families, the form of the grant requested by the family 
families, and how the family intends to use the support 
grant that the families have agreed to use the support grant for 
items and services within the designated reimbursable expense 
categories and recommendations of the county.  
     (e) Families who were receiving subsidies on the date of 
implementation of the $60,000 income limit in paragraph (a) 
continue to be eligible for a family support grant until 
December 31, 1991, if all other eligibility criteria are met.  
After December 31, 1991, these families are eligible for a grant 
in the amount of one-half the grant they would otherwise 
receive, for as long as they remain eligible under other 
eligibility criteria. 
    Sec. 9.  Minnesota Statutes 1992, section 256.045, 
subdivision 4a, is amended to read: 
    Subd. 4a.  [CASE MANAGEMENT APPEALS.] Any recipient of case 
management services pursuant to section 256B.092, subdivisions 1 
to 1b who contests the county agency's action or failure to act 
in the provision of those services, other than a failure to act 
with reasonable promptness or a suspension, reduction, denial, 
or termination of services, must submit a written request 
for review a conciliation conference to the county agency.  The 
county agency shall inform the commissioner of the receipt of a 
request for review when it is submitted and shall schedule a 
conciliation conference.  The county agency shall notify the 
recipient, the commissioner, and all interested persons of the 
time, date, and location of the conciliation conference.  The 
commissioner shall designate a representative to be present at 
the conciliation conference to assist in the resolution of the 
dispute without the need for a hearing.  Within 30 days, the 
county agency shall conduct the conciliation conference and 
inform the recipient in writing of the action the county agency 
is going to take and when that action will be taken and notify 
the recipient of the right to a hearing under this subdivision.  
The conciliation conference shall be conducted in a manner 
consistent with the procedures for reconsideration of an 
individual service plan pursuant to Minnesota Rules, parts 
9525.0075, subpart 5, and 9525.0105, subpart 6 the 
commissioner's instructions.  If the county fails to conduct the 
conciliation conference and issue its report within 30 days, or, 
at any time up to 90 days after the conciliation conference is 
held, a recipient may submit to the commissioner a written 
request for a hearing before a state human services referee to 
determine whether case management services have been provided in 
accordance with applicable laws and rules or whether the county 
agency has assured that the services identified in the 
recipient's individual service plan have been delivered in 
accordance with the laws and rules governing the provision of 
those services.  The state human services referee shall 
recommend an order to the commissioner, who shall, in accordance 
with the procedure in subdivision 5, issue a final order within 
60 days of the receipt of the request for a hearing, unless the 
commissioner refuses to accept the recommended order, in which 
event a final order shall issue within 90 days of the receipt of 
that request.  The order may direct the county agency to take 
those actions necessary to comply with applicable laws or 
rules.  The commissioner may issue a temporary order prohibiting 
the demission of a recipient of case management services from a 
residential or day habilitation program licensed under chapter 
245A, while a county agency review process or an appeal brought 
by a recipient under this subdivision is pending, or for the 
period of time necessary for the county agency to implement the 
commissioner's order.  The commissioner shall not issue a final 
order staying the demission of a recipient of case management 
services from a residential or day habilitation program licensed 
under chapter 245A.  
    Sec. 10.  Minnesota Statutes 1992, section 256.9686, 
subdivision 6, is amended to read: 
    Subd. 6.  [HOSPITAL.] "Hospital" means a facility defined 
in section 144.696, subdivision 3, and licensed under sections 
144.50 to 144.58, an out-of-state facility licensed to provide 
acute care under the requirements of that state in which it is 
located, or an Indian health service facility designated to 
provide acute care by the federal government. 
    Sec. 11.  Minnesota Statutes 1992, section 256.9695, 
subdivision 1, is amended to read: 
    Subdivision 1.  [APPEALS.] A hospital may appeal a decision 
arising from the application of standards or methods under 
section 256.9685, 256.9686, or 256.969, if an appeal would 
result in a change to the hospital's payment rate or payments.  
Both overpayments and underpayments that result from the 
submission of appeals shall be implemented.  Regardless of any 
appeal outcome, relative values shall not be recalculated.  The 
appeal shall be heard by an administrative law judge according 
to sections 14.57 to 14.62, or upon agreement by both parties, 
according to a modified appeals procedure established by the 
commissioner and the office of administrative hearings.  In any 
proceeding under this section, the appealing party must 
demonstrate by a preponderance of the evidence that the 
commissioner's determination is incorrect or not according to 
law. 
    (a) To appeal a payment rate or payment determination or a 
determination made from base year information, the hospital 
shall file a written appeal request to the commissioner within 
60 days of the date the payment rate determination was mailed.  
The appeal request shall specify:  (i) the disputed items; (ii) 
the authority in federal or state statute or rule upon which the 
hospital relies for each disputed item; and (iii) the name and 
address of the person to contact regarding the appeal.  After 
December 31, 1990, payment rates shall not be adjusted for 
appeals of base year information that affect years prior to the 
rate year beginning January 1, 1991.  Facts to be considered in 
any appeal of base year information are limited to those in 
existence at the time the payment rates of the first rate year 
were established from the base year information.  In the case of 
Medicare settled appeals, the 60-day appeal period shall begin 
on the mailing date of the notice by the Medicare program or the 
date the medical assistance payment rate determination notice is 
mailed, whichever is later. 
    (b) To appeal a payment rate or payment change that results 
from a difference in case mix between the base year and a rate 
year, the procedures and requirements of paragraph (a) apply.  
However, the appeal must be filed with the commissioner within 
120 days after the end of a rate year.  A case mix appeal must 
apply to the cost of services to all medical assistance patients 
that received inpatient services from the hospital during the 
rate year appealed.  
    Sec. 12.  Minnesota Statutes 1992, section 256.9695, 
subdivision 3, is amended to read: 
    Subd. 3.  [TRANSITION.] Except as provided in section 
256.969, subdivision 8, the commissioner shall establish a 
transition period for the calculation of payment rates from July 
1, 1989, to the implementation date of the upgrade to the 
Medicaid management information system or July 1, 1992, 
whichever is earlier. 
    During the transition period: 
    (a) Changes resulting from section 256.969, subdivisions 7, 
9, 10, 11, and 13, shall not be implemented, except as provided 
in section 256.969, subdivisions 12 and 20. 
    (b) The beginning of the 1991 rate year shall be delayed 
and the rates notification requirement shall not be applicable. 
    (c) Operating payment rates shall be indexed from the 
hospital's most recent fiscal year ending prior to January 1, 
1991, by prorating the hospital cost index methodology in effect 
on January 1, 1989.  For payments made for admissions occurring 
on or after June 1, 1990, until the implementation date of the 
upgrade to the Medicaid management information system the 
hospital cost index excluding the technology factor shall not 
exceed five percent.  This hospital cost index limitation shall 
not apply to hospitals that meet the requirements of section 
256.969, subdivision 20, paragraphs (a) and (b). 
     (d) Property and pass-through payment rates shall be 
maintained at the most recent payment rate effective for June 1, 
1990.  However, all hospitals are subject to the hospital cost 
index limitation of subdivision 2c, for two complete fiscal 
years.  Property and pass-through costs shall be retroactively 
settled through the transition period.  The laws in effect on 
the day before July 1, 1989, apply to the retroactive settlement.
    (e) If the upgrade to the Medicaid management information 
system has not been completed by July 1, 1992, the commissioner 
shall make adjustments for admissions occurring on or after that 
date as follows: 
    (1) provide a ten percent increase to hospitals that meet 
the requirements of section 256.969, subdivision 20, or, upon 
written request from the hospital to the commissioner, 50 
percent of the rate change that the commissioner estimates will 
occur after the upgrade to the Medicaid management information 
system; and 
    (2) adjust the rebased payment rates that are established 
after the upgrade to the Medicaid management information system 
to compensate for a rebasing effective date of July 1, 1992.  
The adjustment shall be based on the change in rates from July 
1, 1992, to the rebased rates in effect under the systems 
upgrade.  The adjustment shall reflect payments under clause 
(1), differences in the hospital cost index and dissimilar rate 
establishment procedures such as the variable outlier and the 
treatment of transfers, births, and rehabilitation units of 
hospitals.  The adjustment shall be in effect for a period not 
to exceed the amount of time until the amount due or owed on a 
per admission basis from July 1, 1992, to the systems upgrade is 
fully paid. 
    Sec. 13.  Minnesota Statutes 1992, section 256B.056, 
subdivision 5, is amended to read: 
    Subd. 5.  [EXCESS INCOME.] A person who has excess income 
is eligible for medical assistance if the person has expenses 
for medical care that are more than the amount of the person's 
excess income, computed by deducting incurred medical expenses 
from the excess income to reduce the excess to the income 
standard specified in subdivision 4.  The person shall elect to 
have the medical expenses deducted at the beginning of a 
one-month budget period or at the beginning of a six-month 
budget period.  Until June 30, 1993, or the date the Medicaid 
Management Information System (MMIS) upgrade is implemented, 
whichever occurs last, the commissioner shall allow persons 
eligible for assistance on a one-month spend-down basis under 
this subdivision to elect to pay the monthly spend-down amount 
in advance of the month of eligibility to the local agency in 
order to maintain eligibility on a continuous basis.  If the 
recipient does not pay the spend-down amount on or before the 
20th 10th of the month, the recipient is ineligible for this 
option for the following month.  The local agency must deposit 
spend-down payments into its treasury and issue a monthly 
payment to the state agency with the necessary individual 
account information.  The local agency shall code the client 
eligibility system to indicate that the spend-down obligation 
has been satisfied for the month paid.  The state agency shall 
convey this information to providers through eligibility cards 
which list no remaining spend-down obligation.  After the 
implementation of the MMIS upgrade, the a recipient may elect to 
electing advance payment must pay the state agency the monthly 
spend-down amount.  The recipient must make the payment on or 
before the 20th 10th of the month in order to be eligible for 
this option in the following month. 
    Sec. 14.  Minnesota Statutes 1992, section 256B.0644, is 
amended to read: 
    256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
OTHER STATE HEALTH CARE PROGRAMS.] 
    A vendor of medical care, as defined in section 256B.02, 
subdivision 7, and a health maintenance organization, as defined 
in chapter 62D, must participate as a provider or contractor in 
the medical assistance program, general assistance medical care 
program, and the health right plan MinnesotaCare as a condition 
of participating as a provider in health insurance plans or 
contractor for state employees established under section 43A.18, 
the public employees insurance plan under section 43A.316, the 
workers' compensation system under section 176.135, and 
insurance plans provided through the Minnesota comprehensive 
health association under sections 62E.01 to 62E.17.  For 
providers other than health maintenance organizations, 
participation in the medical assistance program means that (1) 
the provider accepts new medical assistance, general assistance 
medical care, and MinnesotaCare patients or (2) at least 20 
percent of the provider's patients are covered by medical 
assistance, general assistance medical care, or the health right 
plan and MinnesotaCare as their primary source of coverage.  The 
commissioner shall establish participation requirements for 
health maintenance organizations.  The commissioner shall 
provide lists of participating medical assistance providers on a 
quarterly basis to the commissioner of employee relations, the 
commissioner of labor and industry, and the commissioner of 
commerce.  Each of the commissioners shall develop and implement 
procedures to exclude as participating providers in the program 
or programs under their jurisdiction those providers who do not 
participate in the medical assistance program. 
    Sec. 15.  Minnesota Statutes 1992, section 256B.092, 
subdivision 1, is amended to read: 
    Subdivision 1.  [COUNTY OF FINANCIAL RESPONSIBILITY; 
DUTIES.] Before any services shall be rendered to persons with 
mental retardation or related conditions who are in need of 
social service and medical assistance, the county of financial 
responsibility shall conduct or arrange for a diagnostic 
evaluation in order to determine whether the person has or may 
have mental retardation or has or may have a related condition.  
If the county of financial responsibility determines that the 
person has mental retardation or a related condition, the county 
shall inform the person of case management services available 
under this section.  Except as provided in subdivision 1g or 4b, 
if a person is diagnosed as having mental retardation or a 
related condition, the county of financial responsibility shall 
conduct or arrange for a needs assessment, develop or arrange 
for an individual service plan, provide or arrange for ongoing 
case management services at the level identified in the 
individual service plan, provide or arrange for case management 
administration, and authorize services identified in the 
person's individual service plan developed according to 
subdivision 1b.  Diagnostic information, obtained by other 
providers or agencies, may be used to meet the diagnosis 
requirements of this section by the county agency in determining 
eligibility for case management.  Nothing in this section shall 
be construed as requiring:  (1) assessment in areas agreed to as 
unnecessary by the case manager and the person, or the person's 
legal guardian or conservator, or the parent if the person is a 
minor, or (2) assessments in areas where there has been a 
functional assessment completed in the previous 12 months for 
which the case manager and the person or person's guardian or 
conservator, or the parent if the person is a minor, agree that 
further assessment is not necessary.  For persons under state 
guardianship, the case manager shall seek authorization from the 
public guardianship office for waiving any assessment 
requirements.  Assessments related to health, safety, and 
protection of the person for the purpose of identifying service 
type, amount, and frequency or assessments required to authorize 
services may not be waived.  To the extent possible, for wards 
of the commissioner the county shall consider the opinions of 
the parent of the person with mental retardation or a related 
condition when developing the person's individual service plan.  
If the county of financial responsibility places a person in 
another county for services, the placement shall be made in 
cooperation with the county where services are provided, 
according to subdivision 8a, and arrangements shall be made 
between the two counties for ongoing social service, including 
annual reviews of the person's individual service plan.  The 
county where services are provided may not make changes in the 
person's service plan without approval by the county of 
financial responsibility. 
    Sec. 16.  Minnesota Statutes 1992, section 256B.092, 
subdivision 1b, is amended to read: 
    Subd. 1b.  [INDIVIDUAL SERVICE PLAN.] The individual 
service plan must: 
     (1) include the results of the assessment information on 
the person's need for service, including identification of 
service needs that will be or that are met by the person's 
relatives, friends, and others, as well as community services 
used by the general public; 
     (2) identify the person's preferences for services as 
stated by the person, the person's legal guardian or 
conservator, or the parent if the person is a minor; 
     (3) identify long- and short-range goals for the person; 
     (4) identify specific services and the amount and frequency 
of the services to be provided to the person based on assessed 
needs, preferences, and available resources.  The individual 
service plan shall also specify other services the person needs 
that are not available; 
     (5) identify the need for an individual program plan to be 
developed by the provider according to the respective state and 
federal licensing and certification standards, and additional 
assessments to be completed or arranged by the provider after 
service initiation; 
    (6) identify provider responsibilities to implement and 
make recommendations for modification to the individual service 
plan; 
    (7) include notice of the right to request a conciliation 
conference or a hearing under section 256.045; 
    (8) be agreed upon and signed by the person, the person's 
legal guardian or conservator, or the parent if the person is a 
minor, and the authorized county representative; and 
    (9) be reviewed by a health professional if the person has 
overriding medical needs that impact the delivery of services; 
and. 
    (10) be completed on forms approved by the commissioner, 
including forms developed for interagency planning such as 
transition and individual family service plans.  
    Service planning formats developed for interagency planning 
such as transition, vocational, and individual family service 
plans may be substituted for service planning formats developed 
by county agencies. 
    Sec. 17.  Minnesota Statutes 1992, section 256B.092, 
subdivision 1g, is amended to read: 
    Subd. 1g.  [CONDITIONS NOT REQUIRING DEVELOPMENT OF 
INDIVIDUAL SERVICE PLAN.] Unless otherwise required by federal 
law, the county agency is not required to complete an individual 
service plan as defined in subdivision 1b for:  
    (1) persons whose families are requesting respite care as a 
single service for their family member who resides with them, or 
whose families are requesting only a family subsidy support 
grant and are not requesting purchase or arrangement of other 
habilitative or social services; and 
    (2) persons with mental retardation or related conditions, 
living independently without authorized services or receiving 
funding for services at a rehabilitation facility as defined in 
section 268A.01, subdivision 6, and not in need of or requesting 
additional services.  
    Sec. 18.  Minnesota Statutes 1992, section 256B.092, 
subdivision 7, is amended to read: 
    Subd. 7.  [SCREENING TEAMS.] For persons with mental 
retardation or a related condition, screening teams shall be 
established which shall evaluate the need for the level of care 
provided by residential-based habilitation services, residential 
services, training and habilitation services, and nursing 
facility services.  The evaluation shall address whether home- 
and community-based services are appropriate for persons who are 
at risk of placement in an intermediate care facility for 
persons with mental retardation or related conditions, or for 
whom there is reasonable indication that they might require this 
level of care.  The screening team shall make an evaluation of 
need within 15 working days of the date that the assessment is 
completed or within 60 working days of a request for service by 
a person with mental retardation or related conditions, 
whichever is the earlier, and within five working days of an 
emergency admission of a person to an intermediate care facility 
for persons with mental retardation or related conditions.  The 
screening team shall consist of the case manager for persons 
with mental retardation or related conditions, the person, the 
person's legal guardian or conservator, or the parent if the 
person is a minor, and a qualified mental retardation 
professional, as defined in the Code of Federal Regulations, 
title 42, section 483.430, as amended through June 3, 1988.  The 
case manager may also act as the qualified mental retardation 
professional if the case manager meets the federal definition.  
County social service agencies may contract with a public or 
private agency or individual who is not a service provider for 
the person for the public guardianship representation required 
by the screening or individual service planning process.  The 
contract shall be limited to public guardianship representation 
for the screening and individual service planning activities.  
The contract shall require compliance with the commissioner's 
instructions and may be for paid or voluntary services.  For 
persons determined to have overriding health care needs and are 
seeking admission to a nursing facility or an ICF/MR, or seeking 
access to home- and community-based waivered services, a 
registered nurse must be designated as either the case manager 
or the qualified mental retardation professional.  The case 
manager shall consult with the person's physician, other health 
professionals or other individuals as necessary to make this 
evaluation.  For persons under the jurisdiction of a 
correctional agency, the case manager must consult with the 
corrections administrator regarding additional health, safety, 
and supervision needs.  The case manager, with the concurrence 
of the person, the person's legal guardian or conservator, or 
the parent if the person is a minor, may invite other 
individuals to attend meetings of the screening team.  No member 
of the screening team shall have any direct or indirect service 
provider interest in the case.  Nothing in this section shall be 
construed as requiring the screening team meeting to be separate 
from the service planning meeting. 
    Sec. 19.  Minnesota Statutes 1992, section 256B.092, 
subdivision 8a, is amended to read: 
    Subd. 8a.  [COUNTY CONCURRENCE.] (a) If the county of 
financial responsibility wishes to place a person in another 
county for services, the county of financial responsibility 
shall seek concurrence from the proposed county of service and 
the placement shall be made cooperatively between the two 
counties.  Arrangements shall be made between the two counties 
for ongoing social service, including annual reviews of the 
person's individual service plan.  The county where services are 
provided may not make changes in the person's service plan 
without approval by the county of financial responsibility. 
    (b) When a person has been screened and authorized for 
services in an intermediate care facility for persons with 
mental retardation or related conditions or for home- and 
community-based services for persons with mental retardation or 
related conditions, the case manager shall assist that person in 
identifying a service provider who is able to meet the needs of 
the person according to the person's individual service plan.  
If the identified service is to be provided in a county other 
than the county of financial responsibility, the county of 
financial responsibility shall request concurrence of the county 
where the person is requesting to receive the identified 
services.  The county of service may refuse to concur if:  
    (1) it can demonstrate that the provider is unable to 
provide the services identified in the person's individual 
service plan as services that are needed and are to be provided; 
    (2) in the case of an intermediate care facility for 
persons with mental retardation or related conditions, there has 
been no authorization for admission by the admission review team 
as required in section 256B.0926; or 
    (3) in the case of home- and community-based services for 
persons with mental retardation or related conditions, the 
county of service can demonstrate that the prospective provider 
has failed to substantially comply with the terms of a past 
contract or has had a prior contract terminated within the last 
12 months for failure to provide adequate services, or has 
received a notice of intent to terminate the contract.  
    (b) (c) The county of service shall notify the county of 
financial responsibility of concurrence or refusal to concur no 
later than 20 working days following receipt of the written 
request.  Unless other mutually acceptable arrangements are made 
by the involved county agencies, the county of financial 
responsibility is responsible for costs of social services and 
the costs associated with the development and maintenance of the 
placement.  The county of service may request that the county of 
financial responsibility purchase case management services from 
the county of service or from a contracted provider of case 
management when the county of financial responsibility is not 
providing case management as defined in this section and rules 
adopted under this section, unless other mutually acceptable 
arrangements are made by the involved county agencies.  
Standards for payment limits under this section may be 
established by the commissioner.  Financial disputes between 
counties shall be resolved as provided in section 256G.09.  
    Sec. 20.  Minnesota Statutes 1992, section 256B.431, 
subdivision 10, is amended to read: 
    Subd. 10.  [APPRAISAL SAMPLE STABILIZATION PROPERTY RATE 
ADJUSTMENTS AND SPECIAL REAPPRAISALS CONSTRUCTION PROJECTS.] (a) 
The percentage change in appraised values for nursing facilities 
in the sample used for routine updating of appraised values 
under Minnesota Rules, part 9549.0060, subpart 2, shall be 
stabilized by eliminating from the sample of nursing facility 
those appraisals that represent the five highest and the five 
lowest deviations from those nursing facilities' previously 
established appraised values. 
    (b) A special reappraisal nursing facility's request for a 
property-related payment rate adjustment and the related 
supporting documentation of project construction cost 
information must be submitted to the commissioner within 60 days 
after the construction project's completion date to be 
considered eligible for a special reappraisal property-related 
payment rate adjustment.  If a project has multiple completion 
dates or involves multiple projects, only projects or parts of 
projects with completion dates within one year of the completion 
date associated with a special reappraisal request can be 
included for the purpose of establishing the nursing facility's 
eligibility for a special reappraisal.  A facility which is 
eligible to request, has requested, or has received a special 
reappraisal during the calendar year must not be included in the 
random sample process used to determine the average percentage 
change in appraised value of nursing facilities in the sample. 
Construction projects with completion dates within one year of 
the completion date associated with the property rate adjustment 
request and phased projects with project completion dates within 
three years of the last phase of the phased project must be 
aggregated for purposes of the minimum thresholds in 
subdivisions 16 and 17, and the maximum threshold in section 
144A.071, subdivision 2.  "Construction project," "project 
construction costs," and "phased project" have the meanings 
given them in Minnesota Rules, part 4655.1110 (Emergency). 
    Sec. 21.  Minnesota Statutes 1992, section 256B.48, 
subdivision 3a, is amended to read: 
    Subd. 3a.  [AUDIT ADJUSTMENTS.] If the commissioner 
requests supporting documentation during a field an audit for an 
item of cost reported by a long-term care facility, and the 
long-term care facility's response does not adequately document 
the item of cost, the commissioner may make reasoned assumptions 
considered appropriate in the absence of the requested 
documentation to reasonably establish a payment rate rather than 
disallow the entire item of cost.  This provision shall not 
diminish the long-term care facility's appeal rights. 
    Sec. 22.  Minnesota Statutes 1992, section 256B.501, 
subdivision 8, is amended to read: 
    Subd. 8.  [PAYMENT FOR PERSONS WITH SPECIAL NEEDS.] The 
commissioner shall establish by December 31, 1983, procedures to 
be followed by the counties to seek authorization from the 
commissioner for medical assistance reimbursement for very 
dependent persons with special needs in an amount in excess of 
the rates allowed pursuant to subdivisions subdivision 2 and 4, 
including rates established under section 252.46 when they apply 
to services provided to residents of intermediate care 
facilities for persons with mental retardation or related 
conditions, and procedures to be followed for rate limitation 
exemptions for intermediate care facilities for persons with 
mental retardation or related conditions.  No excess payment 
approved by the commissioner after June 30, 1991, shall be 
authorized unless: 
    (1) the need for specific level of service is documented in 
the individual service plan of the person to be served; 
    (2) the level of service needed can be provided within the 
rates established under section 252.46 and Minnesota Rules, 
parts 9553.0010 to 9553.0080, without a rate exception within 12 
months; 
    (3) staff hours beyond those available under the rates 
established under section 252.46 and Minnesota Rules, parts 
9553.0010 to 9553.0080, necessary to deliver services do not 
exceed 720 hours within six months 1,440 hours within 12 months; 
    (4) there is a basis for the estimated cost of services; 
    (5) the provider requesting the exception documents that 
current per diem rates are insufficient to support needed 
services; 
    (6) estimated costs, when added to the costs of current 
medical assistance-funded residential and day training and 
habilitation services and calculated as a per diem, do not 
exceed the per diem established for the regional treatment 
centers for persons with mental retardation and related 
conditions on July 1, 1990, indexed annually by the urban 
consumer price index, all items, published by the United States 
Department of Labor as forecasted by Data Resources Inc., for 
the next fiscal year over the current fiscal year; 
    (7) any contingencies for an approval as outlined in 
writing by the commissioner are met; and 
    (8) any commissioner orders for use of preferred providers 
are met. 
    The commissioner shall evaluate the services provided 
pursuant to this subdivision through program and fiscal audits.  
    The commissioner may terminate the rate exception at any 
time under any of the conditions outlined in Minnesota Rules, 
part 9510.1120, subpart 3, for county termination, or by reason 
of information obtained through program and fiscal audits which 
indicate the criteria outlined in this subdivision have not 
been, or are no longer being, met. 
    The commissioner may approve no more than two consecutive 
six-month rate exceptions for an eligible client whose first 
application for funding occurs after June 30, 1991 one rate 
exception, up to 12 months duration, for an eligible client. 
    Sec. 23.  Minnesota Statutes 1992, section 609.115, 
subdivision 9, is amended to read: 
    Subd. 9.  [COMPULSIVE GAMBLING ASSESSMENT REQUIRED.] (a) If 
a person is convicted of a felony for theft under section 
609.52, embezzlement of public funds under section 609.54, or 
forgery under section 609.625, 609.63, or 609.631, the probation 
officer shall determine in the report prepared under subdivision 
1 whether or not compulsive gambling contributed to the 
commission of the offense.  If so, the report shall contain the 
results of a compulsive gambling assessment conducted in 
accordance with this subdivision.  The probation officer shall 
make an appointment for the defendant offender to undergo the 
assessment if so indicated. 
    (b) The compulsive gambling assessment report must include 
a recommended level of care treatment for the defendant offender 
if the assessor concludes that the defendant offender is in need 
of compulsive gambling treatment.  The assessment must be 
conducted by an assessor qualified under section 245.98, 
subdivision 2a, to perform these assessments or to provide 
compulsive gambling treatment.  An assessor providing a 
compulsive gambling assessment may not have any direct or shared 
financial interest or referral relationship resulting in shared 
financial gain with a treatment provider.  If an independent 
assessor is not available, the probation officer may use the 
services of an assessor with a financial interest or referral 
relationship as authorized under rules adopted by the 
commissioner of human services under section 245.98, subdivision 
2a. 
    (c) The commissioner of human services shall reimburse the 
county assessor for the costs associated with a compulsive 
gambling assessment at a rate established by the commissioner up 
to a maximum of $100 for each assessment.  The commissioner 
shall reimburse these costs after receiving written verification 
from the probation officer that the assessment was performed and 
found acceptable. 
    Sec. 24.  [REPEALER.] 
    Minnesota Statutes 1992, section 256B.0629, is repealed. 
    Presented to the governor May 20, 1993 
    Signed by the governor May 24, 1993, 12:09 p.m.